Navigation Links
Telenurses face conflict between what is best for patients and what services are available
Date:2/17/2010

Nurses who provide telephone advice services have to balance the conflicting demands of providing appropriate medical advice and acting as a gatekeeper to limited healthcare services, according to a review in the March issue of the Journal of Advanced Nursing.

Canadian researchers reviewed 16 studies carried out over the last two decades, covering more than 700 nurses in the UK, Canada, the USA and Sweden. The studies included interviews, videotaped consultations, simulated calls and stimulated recall.

"Telenurses who took part in half of the studies expressed a conflict between what they thought was best for the caller and what healthcare services could provide" says lead author Dr Rebecca J Purc-Stephenson from the University of Alberta, Canada.

"They believed patients had a right to accurate handling of their problems, but were also conscious of the fact that doctors had a limited number of appointments available and that these needed to be kept free for urgent patients.

"Sometime telenurses advised callers who needed primary care to go to the emergency department because there was nowhere else to refer them to."

Dr Purc-Stephenson and co-author Dr Christine Thrasher, from the Faculty of Nursing at the University of Windsor in Ontario, maintain that telephone triage and advice services have substantially changed nursing practice.

"The first is that the nurses work in call-centre environments, rather than clinical settings, and the second is that they no longer have the opportunity to physically examine patients" explains Dr Purc-Stephenson.

Other key findings of the study include:

  • The degree to which the telenurses used protocols varied across the studies, with some being restrained by decision-making software and others having more flexibility to use their clinical judgement.

  • Telenurses often felt they had developed new communication skills including listening to verbal and non-verbal clues, like tone of voice, breathing, words and expressions used and general conversational tone.

  • While some nurses felt that their clinical knowledge had been enhanced by working with colleagues, some raised concerns about retaining clinical skills. Although training was encouraged, heavy workloads and retention issues created barriers to ongoing training.

  • Other nurses said that workloads left little time to interact with other telenurses and that the lack of feedback from the advice they gave was frustrating and had a negative impact on their job satisfaction.

  • Some nurses felt stressed and exhausted by their heavy workloads and others were concerned that rushing calls could compromise quality of care. They also said that callers could become aggressive if they were kept waiting.

  • In some cases telenurses felt uncomfortable making decisions over the telephone and considered worst-case scenarios in an attempt to reduce legal or professional consequences.

  • One of the greatest challenges was to work out whether patients were exaggerating or playing down symptoms.

"Our review has revealed that telenurses face complex decision-making processes when they are dealing with calls, as they need to consider a range of factors" says Dr Purc-Stephenson. "Addressing some of these can help to remove barriers, but others can actually create barriers that prevent telenurses from adequately addressing their callers' needs.

"For example, the conflict between doing what is best for the patient and not overwhelming limited healthcare resources poses a real dilemma and in many cases there is no easy solution.

"There are a number of other implications for clinical practice and policy that need to be addressed.

"It is clear that the assessment skills used in face-to-face consultation are not directly transferable to the telephone and telenurses need specific training in telephone consultation, assessment and decision-making skills.

"Managers also need to address job demands, such as heavy workload, autonomy in decision-making, isolation and stress as these can have an impact on job satisfaction."


'/>"/>

Contact: Annette Whibley
wizard.media@virgin.net
Wiley-Blackwell
Source:Eurekalert

Related medicine news :

1. Couples who say we do better at resolving conflicts
2. From Conflict to Consensus: Interaction Associates Outlines How Leaders Can Achieve Successful Alignment and Implementation
3. Veterans From Iraq, Afghanistan & Other Conflicts Partner With Service Dogs in Americas VetDogs Graduation Ceremony
4. Conflict-affected countries receive less aid dedicated to reproductive health
5. Conflicts of Interest Still Exist in Cancer Research
6. Review finds conflicts of interest in many cancer studies
7. How to turn conflict into collaboration when patients and physicians disagree
8. Statement by Christine K. Cassel, MD, President and CEO of the ABIM Foundation on the Institute of Medicine Report: Conflict of Interest in Medical Research, Education, and Practice
9. Lutheran World Relief Responds to Escalating Conflict in Sri Lanka
10. Argus Honored by Flaspohler Research Group as Highest-Rated PBM for No Conflicts of Interest
11. Conflicts of interest in clinical research
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/25/2016)... ... 2016 , ... Experts from the American Institutes for Research ... June 26-28, 2016, at the Hynes Convention Center in Boston. , AIR experts ... planning, healthcare costs and patient and family engagement. , AIR researchers will be ...
(Date:6/25/2016)... ... ... of Bruton Memorial Library on June 21 due to a possible lice infestation, as reported ... head lice: the parasite’s ability to live away from a human host, and to infest ... in the event that lice have simply gotten out of control. , As lice are ...
(Date:6/25/2016)... ... June 25, 2016 , ... First Choice Emergency Room , the largest ... as the Medical Director of its new Mesquite-Samuell Farm facility. , “We are ... Mesquite location,” said Dr. James M. Muzzarelli, Executive Medical Director of First Choice Emergency ...
(Date:6/25/2016)... ... June 25, 2016 , ... Dr. Calvin ... injury. Recently, he has implemented orthobiologic procedures as a method for treating his ... of the first doctors to perform the treatment. Orthobiologics are substances that orthopaedic ...
(Date:6/25/2016)... ... June 25, 2016 , ... Conventional wisdom preaches the benefits ... terms of the latter, setting the bar too high can result in disappointment, perhaps ... slow progress toward their goal. , Research from PsychTests.com reveals that ...
Breaking Medicine News(10 mins):
(Date:6/26/2016)... , June 26, 2016 One of Australia,s ... announced the formation of a new biotechnology company, Noxopharm Limited [ABN ... in an IPO and to list on the ASX. ... NOX66, ready to enter a Phase 1 clinical study later this ... to address one of the biggest problems facing cancer patients - ...
(Date:6/26/2016)... -- Jazz Pharmaceuticals plc (Nasdaq: JAZZ ) ... Improvements Act of 1976, as amended ("HSR"), with respect ... Nasdaq: CPXX ) expired effective June 24, ... As previously announced on May 31, 2016, Jazz Pharmaceuticals ... which Jazz Pharmaceuticals has commenced a tender offer for ...
(Date:6/26/2016)... , June 27, 2016  VMS Rehab Systems, Inc. ... will take whatever measures required to build a strong ... which is currently listed on the OTC Markets-pink current ... Chairman and CEO, "We are seeing an anomaly in ... understand, not only by the Company, but shareholders and ...
Breaking Medicine Technology: