'We feel abandoned out here': teamwork dilemmas among rural health professionals in distributed emergency settings

In rural northern Sweden, community hospitals serve as essential first-response centres. During emergencies, general practitioners remotely collaborate on-call with on-site nurses via videoconferencing. This setup of geographically distributed teams enables healthcare delivery across long distances. However, little is known about how healthcare professionals make sense of and negotiate roles and responsibilities in such distributed emergency settings. Hence, the aim of this study was to analyse how healthcare professionals position themselves and others in interprofessional teams when collaborating in distributed emergency settings in rural areas.

Interprofessional focus group interviews (n = 17) were conducted with staff (one nursing assistant, one registered nurse and one physician per focus group) at community hospitals in rural northern Sweden, following full-scale, simulated, in-situ team training. The analysis was inspired by Billig's concept of ideological dilemmas and Wetherell's concept of interpretative repertoires.

Participants drew on three interpretative repertoires-Involvement, Responsibility and competence, and Control and dependency-to account for teamwork in distributed emergency settings. Across these repertoires, participants accounted for involvement as both enabled and difficult to sustain, responsibility as not readily transferred, and control as limited and dependent on others' accounts. These ways of accounting reflected ongoing dilemmas, as professionals positioned themselves in relation to competing demands when acting under conditions of distance, uncertainty and mediated access to the clinical situation.

Distributed teamwork reshapes the conditions for collaboration in emergency care, as roles and responsibilities become continuously negotiated in relation to tensions concerning involvement, responsibility and control. As a result, collaboration is unevenly achieved and cannot be taken for granted.

Not applicable.