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Telephone nursing constitutes a significant part of total healthcare and is increasing in society. Often it entails the care-seeking person’s first contact with healthcare and can be crucial for the whole episode of healthcare for the individual person. In every telephone healthcare context, there are persons who call repeatedly, commonly referred to as frequent callers. The definition of the term frequent caller however varies across studies. The frequent calling can affect the telephone nurses working environment and thereby the healthcare for frequent callers and other callers as well. It is a challenge for the healthcare system and telephone nurses to help these callers in an already stressful call-center environment with high time-pressure and limited time for each call. There is limited research on frequent callers, and the existing research has been conducted in different healthcare contexts. Frequent callers seem to be a vulnerable group with a larger need to call healthcare services. Therefore, the overall aim of this thesis is to describe telephone nurses work with frequent callers to telephone nursing services and how frequent callers can be helped. 

To gather and integrate the existing research an integrative review was conducted on frequent callers in different healthcare contexts, Study I. The results showed that frequent callers are a heterogeneous group with complex healthcare needs and mental ill-health. The suggestions for helping frequent callers were individual strategies and cooperation among health services.

To investigate how telephone nurses perceive to handle frequent caller calls, in Study II a survey was conducted at Sweden’s national telephone nursing service, 1177. The survey was answered by 199 telephone nurses at 11 sites. The answers were analyzed with content analysis and summative analysis. The results showed that telephone nurses sometimes feel hopelessness in helping frequent callers. They were also afraid of missing something urgent in the calls with frequent callers. Suggestions for handling frequent caller calls was a common strategy at the workplace and to truly listen to frequent callers when they call. 

Further, to find out about parameters considered relevant for telephone nurses working environment in the task of answering frequent caller calls, three parameters were added to the survey:  stress, self-efficacy, and empathy. The answers were analyzed statistically with correlation analysis, analysis of variance, and multiple regression analysis. The results revealed that telephone nurses who were already stressed perceived higher levels of stress in relation to frequent caller calls. Self-efficacy worked as a significant mediator for the other parameters and was correlated with lower stress and higher empathy. Telephone nurses who had worked for more than 30 years had lower empathy that those who had worked shorter than 30 years. 

There have been few interventions conducted of frequent callers and therefore in Study IV a case study was performed where an intervention project with frequent callers at an emergency medical dispatch center was followed and analyzed. The project nurse gathered data from the frequent callers’ medical records. To describe the intervention that aimed to optimize healthcare for frequent callers from a person-centered perspective, an interview was carried out with the project nurse and one caller from the project.

 The results showed that the most common cause for calling was anxiety. The frequent callers had overall tough life-situations. When individual nurse strategies were realized in the project, most of the callers stopped calling or the calls decreased.

Conclusions are that to help frequent callers it is suggested to work person-centered and individualize the healthcare nurse strategies. Cooperation within the current healthcare service as well as with other healthcare services is crucial.