Registered Nurses’ Work Environment Associated with Auto-Anamnesis, Auto-Triage, and Online Chat
DOI:
https://doi.org/10.18291/njwls.161779Keywords:
Health, Working Environment & Wellbeing, Innovation & Productivity, Work/Life Balance, Identity, Meaning & Culture, Organization & ManagementAbstract
Background: The aim of this study was to explore experiences of how 1177 Direct, a medical system incorporating auto-anamnesis, auto-triage, and online chat, affected the work environment of registered nurses in Swedish primary health care.
Methods: A qualitative study using content analysis of 29 semi-structured interviews was conducted with nurses from the central 1177 service (n = 10), official primary health care (n = 10), and private primary health care centers (n = 9).
Results: Three main categories were found with regard to the study aim: ‘professional competence and patient interaction’, ‘job demands’ (cognitive and psychological job demands), and ‘resources’ (job control, support, and desired resources).
Conclusion: Registered nurses reported altered patient interactions, increased job demands, and partial reduction in job control associated with 1177 Direct. To mitigate these challenges, they emphasized the need for streamlined contact channels, increased autonomy, reduced accessibility for minor conditions, and a strengthened recognition of their professional role in the digital context.
References
Albulescu, P., Macsinga, I., Rusu, A., Sulea, C., Bodnaru, A., & Tulbure, B. T. (2022). ‘Give me a break!’ A systematic review and meta-analysis on the efficacy of micro-breaks for increasing well-being and performance. PLoS ONE, 17(8 August). https://doi.org/10. 1371/journal.pone.0272460
Althubaiti, A. (2016). Information bias in health research: Definition, pitfalls, and adjustment methods. Journal of Multidisciplinary Healthcare, 9(1), 211–217. https://doi.org/10.2147/JMDH.S104807
Bakker, A. B., & Demerouti, E. (2007). The Job Demands-Resources model: State of the art. Journal of Managerial Psychology, 22(3), 309–328. https://doi.org/10.1108/02683940710733115
Bakker, A. B., Demerouti, E. & Sanz-Vergel, A. (2023). Job Demands-Resources Theory: Ten Years Later. Annual Review of Organizational Psychology and Organizational Behavior, 10(1), 25–53. https://doi.org/10.1146/annurev-orgpsych-120920-053933
Birk, H. O., Vrangbæk, K., Rudkjøbing, A., Krasnik, A., Eriksen, A., Richardson, E., & Jervelund, S. S. (2024). Denmark: Health System Review. Health Systems in Transition, 26(1), 1–186.
Borges do Nascimento, I. J., Abdulazeem, H., Vasanthan, L. T., Martinez, E. Z., Zucoloto, M. L., Østengaard, L., Azzopardi-Muscat, N., Zapata, T. & Novillo-Ortiz, D. (2023). Barriers and facilitators to utilizing digital health technologies by healthcare professionals. NPJ Digital Medicine, 6(1), 161. https://doi.org/10.1038/s41746-023-00899-4 Cajander, Å., Hedström, G., Leijon, S. & Larusdottir, M. (2021). Professional decision mak-
ing with digitalisation of patient contacts in a medical advice setting: A qualitative study of a pilot project with a chat programme in Sweden. BMJ Open, 11(12), e054103. https://doi.org/10.1136/bmjopen-2021-054103
22 Registered Nurses’ Magdalena Ramstedt Stadin & Åsa Cajander, Å., Larusdottir, M. & Hedström, G. (2020). The effects of automation of a
patient-centric service in primary care on the work engagement and exhaustion of nurses. Quality and User Experience, 5(1), 1-13. https://doi.org/10.1007/s41233-020-00038-x
Demerouti, E., Bakker, A. B., Geurts, S. A. E. & Taris, T. W. (2009). Daily recovery from work-related effort during non-work time. Research in Occupational Stress and WellBeing, 7, 85–123. https://doi.org/10.1108/S1479-3555(2009)7
Ekman, B., Thulesius, H., Wilkens, J., Lindgren, A., Cronberg, O. & Arvidsson, E. (2019). Utilization of digital primary care in Sweden: Descriptive analysis of claims data on demographics, socioeconomics, and diagnoses. International Journal of Medical Informatics, 127, 134–140. https://doi.org/10.1016/j.ijmedinf.2019.04.016
Eldh, A. C., Sverker, A., Bendtsen, P. & Nilsson, E. (2020). Health care professionals’ experience of a digital tool for patient exchange, namnesis, and triage in primary care: Qualitative study. JMIR Hum Factors, 7(4), e21698. https://doi.org/10.2196/21698
Entezarjou, A., Bolmsjö, B. B., Calling, S., Midlöv, P. & Milos Nymberg, V. (2020). Experiences of digital communication with automated patient interviews and asynchronous chat in Swedish primary care: A qualitative study. BMJ Open, 10(7), e036585. https://doi.org/10.1136/bmjopen-2019-036585
Eriksson, P., Hammar, T., Lagrosen, S. & Nilsson, E. (2022). Digital consultation in primary healthcare: The effects on access, efficiency and patient safety based on provider experience; a qualitative study. Scandinavian Journal of Primary Health Care, 40(4), 498–506. https://doi.org/10.1080/02813432.2022.2159200
Frennert, S., Petersson, L. & Erlingsdottir, G. (2023). “More” work for nurses: The ironies of eHealth. BMC Health Services Research, 23(1), 411. https://doi.org/10.1186/s12913-023-09418-3
Gottliebsen, K. & Petersson, G. (2020). Limited evidence of benefits of patient operated intelligent primary care triage tools: Findings of a literature review. BMJ Health & Care Informatics, 27(1), e100114. https://doi.org/10.1136/bmjhci-2019-100114
Graneheim, U. H. & Lundman, B. (2004). Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24(2), 105–112. https://doi.org/10.1016/j.nedt.2003.10.001
Hägglund, M., Kharko, A., Hagström, J., Bärkås, A., Blease, C., Cajander, Å., DesRoches, C., Fagerlund, A. J., Haage, B., Huvila, I., Hörhammer, I., Kane, B., Klein, G. O., Kristiansen, E., Luks, K., Moll, J., Muli, I., Raphaug, E. H., Rexhepi, H. & Johansen, M. A. (2023). The NORDeHEALTH 2022 Patient Survey: Cross-sectional study of national patient portal users in Norway, Sweden, Finland, and Estonia. J Med Internet Res, 25, e47573.
Haig, B. D. (2005). An abductive theory of scientific method. Psychological Methods, 10(4), 371–388. https://doi.org/10.1037/1082-989X.10.4.371
Håkansta, C., Asp, A. & Palm, K. (2025). Effects of work-related digital technology on occupational health in the public sector: A scoping review. Work, 81(2), 2477–2490. https://doi.org/10.1177/10519815251320274
Hall, L. H., Johnson, J., Watt, I., Tsipa, A. & O’Connor, D. B. (2016). Healthcare staff wellbeing, burnout, and patient safety: A systematic review. PLoS One, 11(7), e0159015. https://doi.org/10.1371/journal.pone.0159015
Halmambetova, E., Nilsson, E., Fagerström, C., Thulesius, H., Axelsson, C., Aidemark, J. & Werkander Harstäde, C. (2025). Digital chat-based care assessments in primary healthcare: Nurses’ work experiences and training needs. Scandinavian Journal of Primary Health Care, 1–13. https://doi.org/10.1080/02813432.2025.2511067
Judi, A., Parizad, N., Mohammadpour, Y. & Alinejad, V. (2025). The relationship between professional autonomy and job performance among Iranian ICU nurses: The mediating Nordic journal of working life studies 23 effect of job satisfaction and organizational commitment. BMC Nursing, 24(1), 20. https://doi.org/10.1186/s12912-024-02551-2
Kainiemi , E., Kaihlanen, A., Virtanen, L., Vehko, T. & Heponiemi, T. (2024). Registered nurses’ digital client work and associating factors: A cross-sectional study. Journal of Advanced Nursing, 81 (7), 3703–3714. https://doi.org/10.1111/jan.16485
Kallio, H., Pietilä, A.-M., Johnson, M. & Kangasniemi, M. (2016). Systematic methodological review: Developing a framework for a qualitative semi-structured interview guide. Journal of Advanced Nursing, 72(12), 2954–2965. https://doi.org/10.1111/jan.13031
Karasek, R. & Theorell, T. (1990). Healthy work: Stress productivity and the reconstruction of working life. Basic Books.
Kivimäki, M., Nyberg, S. T., Batty, G. D., Fransson, E. I., Heikkilä, K., Alfredsson, L., Bjorner, J. B., Borritz, M., Burr, H., Casini, A., Clays, E., De Bacquer, D., Dragano, N., Ferrie, J. E., Geuskens, G. A., Goldberg, M., Hamer, M., Hooftman, W. E., Houtman, I. L. & Theorell, T. (2012). Job strain as a risk factor for coronary heart disease: A collaborative meta-analysis of individual participant data. The Lancet, 380(9852), 1491–1497. https://doi.org/10.1016/S0140-6736(12)60994-5
Murthi, S., Martini, N., Falconer, N. & Scahill, S. (2024). Evaluating EHR-integrated digital technologies for medication-related outcomes and health equity in hospitalised adults: A scoping review. Journal of Medical Systems, 48(1), 79. https://doi.org/10.1007/s10916-024-02097-5
Palm, K., Asp, A. & Hakansta, C. (2024). Implementing digital technologies in the school setting—How does it relate to work environment? Educational Review. https://doi.org/10.1080/00131911.2024.2368183
Pursio, K., Kankkunen, P., Mikkonen, S. & Kvist, T. (2024). Organizational characteristics of nursing practice environments related to registered nurses’ professional autonomy and job satisfaction in two Finnish Magnet-aspiring hospitals: Structural equation modeling study. BMC Nursing, 23(1), 100. https://doi.org/10.1186/s12912-024-01772-9
Rydell, E., Jakobsson, U. & Stjernswärd, S. (2025). Nurses’ experiences of text-based digital triage at primary healthcare centres in Sweden: A qualitative interview study. BMC Nursing, 24(1), 48. https://doi.org/10.1186/s12912-025-02683-z
Siira, E., Tyskbo, D. & Nygren, J. (2024). Healthcare leaders’ experiences of implementing artificial intelligence for medical history-taking and triage in Swedish primary care: An interview study. BMC Primary Care, 25(1), 268. https://doi.org/10.1186/s12875-024-02516-z
Srivastava, D., Van Kessel, R., Delgrange, M., Cherla, A., Sood, H. & Mossialos, E. (2023). A framework for digital health policy: Insights from virtual primary care systems across five nations A framework for digital health policy: Insights from virtual primary care systems across five nations. PLOS Digital Health, 2(11). https://doi.org/10.1371/journal. pdig.0000382
Sveriges Kommuner och Regioner. (2024). Primärvård i Sverige: Uppdrag, organisation, kontinuitet och prioriteringar (In Swedish). https://palliativregistret.se/media/stcdkqoq/skr-prim%C3%A4rvardsrapporten.pdf
Tarafdar, M., Tu, Q., Ragu-Nathan, B. S. & Ragu-Nathan, T. S. (2007). The impact of technostress on role stress and productivity. Journal of Management Information Systems, 24(1), 301–328. https://doi.org/10.2753/MIS0742-1222240109
The National Board of Health and Welfare. (2019). Digitala vårdtjänster och artificiell intelligens i hälsooch sjukvården (In Swedish). https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/ovrigt/2019-10-6431.pdf
Theorell, T., Hammarström, A., Aronsson, G., Träskman Bendz, L., Grape, T., Hogstedt, C., Marteinsdottir, I., Skoog, I. & Hall, C. (2015). A systematic review including meta-analysis of work environment and depressive symptoms. BMC Puclic Health, 15(1), 738. https://doi.org/10.1186/s12889-015-1954-4
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