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:6/24/2016)... (PRWEB) , ... June 24, 2016 , ... Comfort Keepers® ... American Cancer Society and the Road To Recovery® program to drive cancer patients to ... and other adults to ensure the highest quality of life and ongoing independence. ...
(Date:6/24/2016)... ... June 24, 2016 , ... The Haute Beauty Network, ... M. Weintraub as a prominent plastic surgeon and the network’s newest partner. ... the most handsome men, look naturally attractive. Plastic surgery should be invisible.” He ...
(Date:6/24/2016)... ... June 24, 2016 , ... Venture Construction Group (VCG) ... held on June 20th at the Woodmont Country Club at 1201 Rockville Pike, Rockville, ... dedicated to helping service members that have been wounded in battle and their families. ...
(Date:6/24/2016)... ... June 24, 2016 , ... ... and infrastructure. Most providers, however, are unsure how to move forward, given the ... to define a path forward tailored to an organization’s specific needs. , PYA ...
(Date:6/24/2016)... (PRWEB) , ... June 24, 2016 , ... Dr. Seema ... joins Evans Dermatology in the South Lamar location as of July 13, 2016. , ... Medical School. As a medical student, she regularly volunteered at the Agape Clinic serving ...
Breaking Medicine News(10 mins):
(Date:6/23/2016)... HILLS, Calif. , June 23, 2016 Any ... the many challenges of the current process. Many of them ... because of the technical difficulties and high laboratory costs involved. ... have to offer it at such a high cost that ... afford it. Dr. Parsa Zadeh , founder ...
(Date:6/23/2016)... Research and Markets has announced the ... 2016 - Forecast to 2022" report to their offering. ... up to date financial data derived from varied research sources ... with potential impact on the market during the next five ... comprises of sub markets, regional and country level analysis. The ...
(Date:6/23/2016)... MOUNTAIN VIEW, Calif. , June 23, 2016 ... 9:00 a.m. CST on Thursday, July 7, 2016 , , ... kayla.belcher@frost.com ) , , , , EXPERT PANELISTS:  ... Sciences, Nitin Naik; Senior Industry Analyst, Christi Bird; Senior Industry Analyst, ... The global pharmaceutical industry is witnessing ...
Breaking Medicine Technology: