Managing the Absence of Patient Visibility in Telephone Triage -A Qualitative Descriptive Study
Table of Contents
History and Background of Telephone Triage. 3
Telenursing Self-care advice. 4
The Context of Telephone Nursing Advice. 5
The Process of giving a Telephone Nursing Advice. 6
Consequences / Effect on triage outcomes. 9
The Viewpoint of a Care Seeker 9
Parents call concerning their children’s health problems. 9
Literature Review
Introduction
The basis of this literature is managing the absence of a patient via telephone through a descriptive study triage. Mainly, this involves calling a patient back after a patient had made a call to monitor the progress of the patient concerning his/her prognosis. An example of this scenario would be a nurse making a call to find out the course of gastroenteritis in a child, once or severally, after the initial phone call. According to Pettinari and Jessopp (2001), managing the absence of patient visibility in telephone is different from making a follow-up call because follow-up calls are concerned with knowing the progress of a patient after their stay in the hospital. However, the former is concerned with giving appropriate support to the individual seeking care by enabling the reexamination of the disease status and providing useful self-care advice (Lähdet et al. 2009).
The researcher becomes more interested in this area as a result of long-time engagement with a local hospital as a clinical officer. So far, his involvement in giving self-care advice to care seekers has gone deep because he has immense experience in the area, working partly in development and care, research, and as a clinical officer in the same local health facility. The primary responsibilities and tasks in telenursing are to examine the most severe care needs, give self-care advice to care seekers, and, most importantly, to coordinate resources for providing appropriate care (Kaminsky, Rosenqvist and Holmström, 2009). Managing the absence of patient visibility in telephone is, in itself, an intensive and complicated task in the field of nursing since nurses hardly work without telenursing. According to Yang, Rhee, and Aacharya, Gastmans, and Denier (2011), approximately 1000 Tele nurses work by responding to case seekers’ calls via the care line. Don't use plagiarised sources.Get your custom essay just from $11/page
Examining and advising care seekers about their health-related problems through a telephone is not limited to speaking to the care-seeker himself/herself, but also involves giving advice indirectly through others (Giesen et al. 2007). In this regard, this paper places its primary focus on parents/guardians of little children suffering from gastroenteritis. This dissertation aims to increase the knowledge of telenursing through ‘Managing the Absence of Patient Visibility in Telephone’ as a research phenomenon. In the previous studies, managing the absence of patient visibility in telephone has only been revealed in a few reviews where the principal objective has been the monitoring of calls; otherwise, few to no researchers have shown interest in the central phenomenon (Lähdet et al. 2009; Lee et al. 2008 and Asada 2018). For this literature review part, this dissertation will look into several contexts, perspectives, and processes.
First and foremost, the paper will review works touching on the telephone triage in the nursing context, and the telephone advice nursing process. Secondly, the paper will review materials concerning the care seeker perspective, where it will delve into Parents’ calls about their children. Thirdly, the paper will review materials concerning telenursing perspective and, lastly, the rationale for the studies in this thesis.
History and Background of Telephone Triage
Monitoring calls: according to Takayanagi et al. (2018), almost 2 million calls out of the 4 million calls made through the care line in 2018 were as a result of telenursing. Amongst these calls, care seekers were allowed to receive a patient visibility management call (see figure 1 below). On the other hand, Lee et al. (2008) posit that managing the absence of patient visibility in telephone is a situation where a Telenurse supervises or monitors the course of disease through phone calls. For instance, a Tele nurse may regularly make calls to a care seeker to find out the course of the illness that the care seeker is suffering from, and thus, give an appropriate self-care advice depending on the needs presented by the care seeker at the time of the call. In some instances, the Tele nurse may consider it necessary to refer the care seeker to the nearest health facility after monitoring before (Sandelius, 2017).
Figure 1: Monitoring call illustration (Sandelius, 2017)
In typical situations, Tele nurses, who make the initial call, do make a monitoring call, although some other nurses may as well do the same. According to the nursing dictionary sixth edition, monitoring is an intervallic observation of the condition of a patient, which is either visually, manually, or electronically (Pettinari and Jessopp, 2001). According to the Swedish healthcare for children, monitoring is a technique of working in which there is a constant follow-up of a child’s health to detect any possible anomaly as early as possible (Massoudi, Wickberg, and Hwang, 2011).
Observation and monitoring in the nursing field are part of the profession; thus, professional nurses are those that are associated with ‘watchful care,’ such as examining signs of improvement or deterioration in patients’ health conditions and ensuring their safety. Ernesäter et al. (2009) demonstrated in their study that Tele nurses apply the 22 criteria as a means of examining healthcare needs. The rules comprise of care seeker monitoring by doing a follow-up to the course of a health problem, either through a single call or more calls.
Telenursing Self-care advice: according to Lake et al. (2017), self-care is an individual’s life functioning as their health experience and wellbeing as they take care of themselves. A theoretical view of self-care, therefore posits that human beings must take care of themselves. In response, Huibers et al. (2012) argued that such a theoretical view is in itself complicated in the sense that the self or an individual becomes an agent of action, and at the same time, he/she is the object of the real work. According to Santos, Ramos, and Fonseca (2017), self-care is a series of activities that an individual starts and performs for himself/herself to maintain their wellbeing, health, and life. Sandelius, 2017), on her side, defined self-care as “a healthcare measure that licensed healthcare professionals have assessed that a patient can perform for him/herself.” Generally, self-care cannot be considered as healthcare when viewed following the healthcare law. However, it is the examination of healthcare planning, needs, as well as follow-up of self-care (Chen, Gong, and Pan, 2015). Based on the rule of healthcare, self-care
is not considered as healthcare but rather a valuation of the requirements of healthcare, supervision of the self-care, and arrangements of healthcare. According to the guidance given on telephone caring, an individual can compare the advice provided in self-care with the Orem’s supportive and enlighten care method (Chen, Gong, and Pan, 2015). It implies that, in the Process of guiding an individual who needs care, so that he/she can conduct some activities which facilitate the satisfaction of their wants, and this through the development of an environment that assists in the way of a supervising call (Aacharya, Gastmans, and Denier, 2011).o
The main objective is to enable the care seeker to be independent through self-care (Purc‐Stephenson, and Thrasher, 2010). In a situation where a care-seeker has appropriate skills, it can inhibit an individual from obtaining all of his/her self-care requirements. The duty of the telenurse is after that confined to giving assistance to a care seeker in decision making, and sharing with them the knowledge, and techniques, together with educating them (Purc‐Stephenson, and Thrasher, 2010). In 2017, the number that received the self-care guidance was about 2.2 million (45.9%) out of the 1177 line of leadership at the call centres of the Swedish healthcare, and this hin more than half of the calls about the patients whose ages were ranging from 0-10 years (Kondo et al. 2015). The guidance is on the 89.5% calls that ended up in the self-care guidance (Sandelius, 2017). The nurses had to inquire from individuals who needed care if they are interested in being offered the care. The inquiry has to be accompanied by the interrogations on their ability to individually conduct self-care, or if they can need assistance from their siblings (Aacharya, Gastmans, and Denier, 2011). a
Relationship between the supervision calls and inquiry calls: the two calls are varied based on their definitions. The purpose and application of the inquiry calls are in numerous researches (Smits et al. 2010; Kondo et al. 2015 and Greatbatch et al. 2005). According to Kondo et al. (2015 ), the inquiry calls are calls by nurses to their patients who have been released from the hospital to go home. Such a request may be, for instance, to check on patients having colostomy or perhaps the women delivering on their first time (Kondo et al. 2015). Supervision calls, on the other hand, is an example of an inquiry call that entails regular supervision to determine the base of the disease that the patient is suffering in its critical stage immediately the appearance of the signs, and symptoms (Greatbatch et al. 2005).
The Context of Telephone Nursing Advice
The immense societal influences, such as the increased healthcare complexity has led to a transformation in the field of nursing. According to Bryant‐Lukosius et al. (2016), the role of nurses to include giving support to ambulatory care in managing the absence of patient visibility and self-care management. As a result, new opportunities for care seeker teaching, coaching, coordination, and support has emerged. Essentially, telenursing has become a vital part of ambulatory nursing care (Mastal, Matlock, and Start, 2016). According to Mastal, Matlock, and Start (2016), ambulatory nursing is a multifaceted and complex speciality that includes a collaborative and independent practice. The authors argue that ambulatory care is founded on broad health and nursing knowledge and applies clinical speciality based on the nursing process. Nurses, therefore, use evidence-based information across many outpatient care settings to ensure the safety of the patients along with the quality of care.
Telenursing is an integral part of professional outpatient care that uses several telecommunication technologies at the times of care needs to examine, triage, offer a nursing consultation, and lastly, do surveillance and follow-up to the status of a patient (Eastwood et al. 2017). Nursing through telephone consultation has become one of the most prevalent healthcare settings in Europe and America. Most of the nations in these continents have specific care line which their citizens can call whenever they need healthcare advice. For instance, the Swedish use the number 1177 when seeking a telenursing service. In the United States, telenursing services have rapidly developed in the last few decades, just like in European countries like Sweden (Culligan et al. 2017). In the United Kingdom, there is healthcare service known as NHS 111, previously referred to as NHS Direct, and operates the same way as Sweden’s 1177. According to Burger et al. (2017), NHS 111 receives at least 8 million calls from care seeker in every year. The nursing societies describe the level of competency required for a nurse to be considered a telenurse. The reason for such descriptions is to give telenurses competence and professional skills. Huibers et al. (2016) defined a telenurse as a nurse who spends most of his/her work-time working in telenursing, notwithstanding the practice setting. The description of nurses competencies highlight the unique skills and knowledge required by telenursing in various fields like education and communication; nursing care and medicine, health promotion and nursing; nursing and community development, training and leadership (Huibers et al. 2016).
The Process of giving a Telephone Nursing Advice
The telenursing procedure varies based on the facial interaction between nurses and patients because it lacks visual communication (Campbell et al. 2015). Campbell et al. (2015) outlined how telenurses came up with the technology of handling communications with care seekers so that they can count for the absence of visual communication. These are purposeful developments. For instance, hearing physical symbols like heavy panting, and having the caller conducting tests on themselves, such as recording the degree of hotness or coldness of their body. The design of these calls is such that if both telenurse and care seeker have visible plans for the dialogue. The conversation is to an individual based care meeting (Pettinari and Jessopp, 2001). Pettinari and Jessopp came up with a clear structure of the procedure that outlines a distinguished portrait of the doings of telenurse as they conduct an inquiry with a care seeker. The construction commences with analysis, and digestion of words the care seeker says, after which the structure describes the three varied phases during the call as demonstrated in the figure below.
Figure 2: The telenursing process
The first phase is the collection of data; this is a section of nursing duties whereby the contents that are related to the care seeker are acquired. The second phase is cognitive production, whereby the opinions of the care seeker are applied to come up with appropriate decisions. The third phase, output, entails numerous nursing roles, and directives to some nursing decisions (Purc‐Stephenson, and Thrasher, 2010). Amongst the choices might be call monitoring. A telephone self-supervision equipment that resembles this telenursing procedure is under the improvement, and its purpose is to facilitate the development of interaction, and individual competence in telephone guidance caring (Massoudi, Wickberg, and Hwang, 2011).
Rinus of Sweden processed, and outlined the steps to be followed when performing the telephone guidance caring. It describes the interaction procedure through the five varied phases. These begin when; a telenurse begins to call with an open interrogation. In such a situation, the nurse then attentively gives all ears to the care seeker, find out the familiar point that both the telenurse and care seeker develops one portrait of health challenge together. The telenurse makes a summary of the need for interaction, and lastly exit (Massoudi, Wickberg, and Hwang, 2011). The Swedis apply the procedure in 1177 healthcare call centres, and the vibrant telenurses could be trained internally on this skill, which entails analysis of health challenges by using both the open and closed interrogations. Besides, it involves the acquisition of the portrait of what the care seeker awaits, and consider, and a picture of a patient’s past medical information. In the last section, a summary of the health challenge is concurred with the care seeker to acquire a collective portrait. The disadvantages of the interactions are also outlined, for instance, when the nurse harshly decides on what the communication is all about, or fails to digest the information shared by the care seeker quickly, and rushes to the decision-making section (Massoudi, Wickberg, and Hwang, 2011).
Decision making in telephone triage: researchers such as Edwards (2015) demonstrated that the results of telephone triage in the context of benefit to the nursing department of to the care seeker. Perhaps the realization of the complications inherent in telenursing (Edwards 2015) has illustrated the processes involved in decision making in telephone triage. Gallagher, Huddart, and Henderson (2018) conducted a study in Sweden’s primary care and found that telenursing was more of informing the care seekers rather than cancelling them. In their research, nurses highlighted some of the complications they experience in their attempt to conclude the collected data, but not in the Process of receiving it. Also, there were diagnostic problems and communication difficulties associated with the inability to see the care seeker or the patient. In this scenario, an unfussy decision-making strategy was apparent, as Gallagher, Huddart, and Henderson (2018) put it that it may be owing to the caregiver or nurse concerning the health issue at a level that is relatively uncomplicated than doctors.
Gamst-Jensen et al. (2018) conducted a study to find out the components that make up the telephone triage decision-making process made only by experienced triage telenurses. They felt that judgments made by the experienced telenurses during crisis times, where speed and accuracy were necessary. However, the information gathered was minimal. Therefore they resorted to a simulation exercise. From the use, the researchers found that, even though the situation deprives nurses of the opportunity to deliberate methodologically, they considered a consistent and broad range of triage decision-making components, and that they did so in an identifiable and scientific framework. Gamst-Jensen et al. (2018) also found that the telenurses generated their suppositions on a single symptom and the information basis. The figure below summarizes Gamst-Jensen et al. (2018) ‘s Decision-making process in telephone triage.
Figure 3: Decision-making process in telephone triage (Gamst-Jensen et al. 2018)
Consequences / Effect on triage outcomes: a fast and precise triage of care seekers is fundamental to patient healthcare. According to findings made by Massoudi, Wickberg, and Hwang, (2011) about the consequences of triage outcomes, they argue that a precise and rapid triage of an injured patient reduces deaths and has considerably enhanced resource usage. Triage is a term that comes from the Dutch word ‘trier’ which means to categorize and prioritize. The concept is currently applied times of disasters, wars and mass destructions. However, people now use the term in all sectors where there is a sense of emergency, particularly in hospitals to refer patients in a critical condition without plan and timing. According to Yang, Rhee, and Asada, (2008), a workable triage system is one that is capable of identifying care seekers or patients who need emergency care to enable a rapid nurse response.
Most of the emergency sections have put in place the application of a five-level emergency severity index. In emergency medicine, this is considered an essential standard and accepted in various states (Aacharya, Gastmans, and Denier, 2011). This system categorizes sick people into five sections according to the extent of the injuries — the importance of medical amenities to them. The most significant area of the damage is covered in the first section, while the lowest degree of the injury in the fifth section. The ESI framed for the emergency sections to which the sick individuals need to handle their problems. Different researches exist on the extent of application of this equipment by nurses to ascertain their validity (O’Cathain et al. 2004). Even though the pre-hospital triage system tries to build its trust in the views, and clinical history of the sick people. The previous studies show that the critical factor that impacts the period of transfer between the emergency and care departments are finding out the extent of early triage. The period of providing medical services is directly affected by the opinions of nurses triage, and lack of giving out triage services may result in serious outcomes (Sandelius, 2017 and Culligan et al. 2017).
The Viewpoint of a Care Seeker
A care seeker is an individual who calls a telenurse at an individual level, or on behalf of some a sick person (Sandelius, 2017). Sandelius (2017) had it that, approximately half of the calls are from people who call on behalf of the patients, and not the patients themselves. In many scenarios, care seekers are perceived as well off with the telephone guidance, and to some point outlined as being friendly to the sick people (Aacharya, Gastmans, and Denier, 2011).
Aacharya, Gastmans, and Denier, (2011) has it that the care seekers guided to acquire medical care are significantly better off with health care call centres as compared to those are advised on how to perform self-care. However, the researchers also had it that young age, together with along queueing time, is always dissatisfied. It is clear, therefore, that there are factors that impact satisfaction, for instance, the technical knowhow of the telenurse which appears to influence the level of pleasure of the care seeker. According to Sandelius (2017), are seekers on their realization that the guidance provided was not enough; they also become dissatisfied. The author also posits that emotional factors also affected the level of satisfaction, for instance, in a situation whereby the care seeker has a sense of insecurity, and if the call has a cooling down impact.
Parents call concerning their children’s health problems: concerning the care-seeker viewpoint, the focus is on observing calls to parents of the kids with diseases such as gastroenteritis. It, therefore, means that telenurses seem to conduct supervisory calls to parents who call. Otherwise, they report on the symptoms of gastroenteritis they observe in their young ones. They appeal most probably when they are in sympathy with their young ones, or the step they should follow as the elderly of the young ones (Eastwood et al. 2017). Their ability to highlight their challenges has narrowed down their concerns such that they major on the obstacles (Eastwood et al. 2017). In many situations, mothers make calls on behalf of their ill children. The main reason for communicating with parents as outlined by the healthcare call centres are diseases like sore throat, gastroenteritis, rashes, and fever. According to Santos, Ramos, and Fonseca (2017), approximately 35% of the calls to telenurses are about pediatric challenges. The researchers also found that about 6% of the calls to healthcare call centres are about the children having gastroenteritis. Approximately 47% of the calls develops into self-care guidance from the telenurses (Santos, Ramos, and Fonseca, 2017). Gastroenteritis in infants can be as a result of too much loss of water (Eastwood et al. 2017).
The Telenursing Viewpoint
Many studies have telenurse perspectives outlined in numerous researches. Amongst the reviews is one research clearly articulating the varied views of the believed telenursing challenges when operating with telephone guidance. First, the opinions of the sick person, it entails diverse phases of problems, for instance, the trust of the caller or for them to be satisfied that they agree not to visit the healthcare service. The opinion of nursing highlights the challenges that result in telenurse like inability to physically observe the sick individuals. Also, inquiries done via third parties, and lastly the views of the organization, highlighting the challenges within the organization, for instance, inadequate healthcare facilities, and no response, that is lack of information on the occurrence immediately after the call (Purc‐Stephenson, and Thrasher, 2010).
Concerning the research conducted by Eastwood et al. (2017), telenurses explained the ethical challenges they face when interacting with care seekers. Besides, the authors also found that there is a challenge of sharing confidential difficulties over the phone. The triage needs of the caller for the data with skilled duty was an ethical dilemma. Telenurses face many challenges, such as inadequate facilities, together with the healthcare of the organization. The telenurses apply approximately 15 varied bases for their inquiries (Lake et al. 2017). These studies have highlighted three significant views. (1) The care seekers, for example, the telenurses might believe that the care seeker does not clearly articulate everything as required in words. (2) The telenurses might fail to have the assurance of the inquiry, and might later call the care seeker to inquire on the root of the disease. (3) The firm, for instance, the telenurses have to confine their inquiry on how to quickly reach out to the existing healthcare services (Huibers et al. 2012).
At times being a telenurse can be challenging if you cannot physically talk to the care seeker but instead have to listen and internalize the non-verbal interaction. The non-verbal communication is the listening to the sounds that surround the care seeker, for example when operating with children; this can be looking to whether they are running, or the music they produce as they cough (Lake et al. 2017). The decision support tool that assists the telenurses at 1177 is known as Decision Support (Purc‐Stephenson, and Thrasher, 2010). The main objective of this is to ensure that there are a continuation and inquiries safely conducted (Kaminsky, Rosenqvist, and Holmström, 2009). In the situation of gastroenteritis in the infants, it provides the data of symptoms and interventions.
In their study to determine the relationship between nurses and callers, Kemp et al. (2018) found that telenurses assess a variety of calls: (1) A gatekeeping call made when the aim is to connect a care seeker with a different facility. (2) The gendered request is when the telenurse responded as a mother when they received a call from a child. The researchers, therefore, argued that these two calls exist in three groups according to their themes; that is, medicine focused calls, gendered calls, and gatekeeping calls (Kemp et al. (2018). Telenurses believe that having better clinical skills is the backbone of telephone nursing guidance, and at the same time, they feel that they have developed a new communication technology (Jonasson et al. 2017).
Chapter Summary
In Europe, the most applied form of healthcare is telephone advice nursing. For example, about 4.6 million Swedes utilize the opportunity of the provided care line (1177) every year to acquire guidance from the telenurses, and about 1 million of them generate a self-care guidance to parents/siblings as well as their infants. By having personal contacts, Gallagher, Huddart, and Henderson (2018) found that supervision and consultation call at some healthcare centres that are related to the management of the absence of patient visibility in telephone triage calls. Telenursing, therefore, depends on self-care guidance based on the supportive, and learning system of Orem; which means that people are seeking care ough be to carry out activities to enable them to meet what their life requires (Chen, Gong, and Pan, 2015).
In a nutshell, the underlying telephone-nursing literature posits that the basis for telenursing should be on developing a facilitating environment which favours supervision call, monitoring call as well as follow-up calls. Previous researches have outlined that the people seeking care were generally better off with telephone guidance and that telenursing brings out the supervision of people seeking care need for consideration as a problem (O’Cathain et al. 2004; Sandelius, 2017 and Culligan et al. 2017). However, telephone advice is a new area of study where, even though some factors have, there are still spaces of skills. Culligan et al. (2017) posit that is conducting supervision calls has been identified as a way that the telenurses apply to supervise the need for care. There is, therefore, the importance of an enlarged body of skills based on the aspect of managing, managing, follow-up, and monitoring calls.
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