Cancerlink: helping people help themselves.
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Cancer Information Services: a pre-/post-evaluation of training to promote nationwide consistency of information.
The object of this study was to evaluate whether an integrated training package improved the consistency and accuracy of advice about breast cancer to callers of Cancer Information Services (CIS) in Australia. The study followed a pre-/post-evaluation design and the participants were all CIS officers from the state-based CIS. A computerized database was used which contained the current best advice about breast cancer combined with a 1-day interactive training workshop for all officers of participating CIS. The proportion of responses that accorded with predetermined model answers for each of five scenarios employed by simulated callers during normal working hours at pre-and post-evaluation were then calculated. There were 95 simulated calls during pre-evaluation, and 104 calls post-evaluation. In some cases, such as breast reconstruction, accordance with model answers was high at both pre- and post-test. The proportion of responses on an item that related to a description of lymphoedaema differed from pre-to post-test with P = 0.007; while an item on the appropriateness of discussing genetic testing with general practitioners differed from pre-to post-test with P = 0.003. There was less concordance, both pre- and post-test, for issues related to surgery, hospitalization, familial aspects and Tamoxifen. We concluded that the intervention presents a method of disseminating consistent information across a number of independent CIS. Some areas were identified that require more targeted intervention.
Adult↗
Parenting issues that may be addressed through a confidential helpline.
This study identifies what parents might expect from a confidential helpline and highlights areas of parental concern in the task of child-rearing. A community sample of 424 families from four schools was collected. Although many issues raised concerned parents, those particularly cited were behaviour management, school bullying and drug and alcohol problems. It is clear that there is a perceived need by parents for input into the parenting process; parents were seeking information and advice rather than support. The question of which aspects of parenting can be developed, either through a helpline or other services, is discussed.
Adolescent↗
"Your ears become your eyes": managing the absence of visibility in NHS Direct.
AIMS: To identify and describe nurses' perceptions of interactional practices they use to manage the absence of visual cues in telephone consultations with callers at an NHS Direct site. BACKGROUND: A routine activity in telephone consultations is visualizing the patient and the situation from which the call is made, that is, "building a picture of the patient". Little is known about interactional practices between nurse and caller that contribute to shaping a conception of the caller, or other activities that nurses do to manage the absence of visibility in the consultation. METHODS: Qualitative analysis of semi-structured interviews conducted with nurses new to NHS Direct telephone consultations, the first immediately prior to the NHS Direct site's opening, and the second 6 months later. FINDINGS: The activity of visualizing patients and their environment is closely linked to interactional practices carried out between nurse and caller. Nurses described a range of interactional activities that they perceive help callers to describe with more precision what the nurse cannot see. Nurses also tailor interaction to a nonvisual environment in order to manage the more emotional aspects of telephone consultations, such as delivering information, advice, reassurance, and building trust and rapport. CONCLUSION: Nurses developed skills to manage interaction with callers in order to compensate for the absence of visibility. Skills were based on their professional backgrounds and experience and developed in an ad hoc way. Further research could examine the efficacy of these strategies, and be a prerequisite to adding them to training programmes.
Attitude of Health Personnel↗
Knowledge, confidence and attitudes towards mental health of nurses working in NHS Direct and the effects of training.
BACKGROUND: NHS Direct, the United Kingdom's 24-hour nurse-led telephone advice service, was announced in December 1997. By November 2000 the service was available throughout England and Wales. Initial research had shown that people with mental health problems used the service and that, prior to its going live, this was one area about which nurses felt least confident. AIMS: The aim of the study was to measure confidence in dealing with mental health calls, knowledge of mental health issues, and attitudes to mental health before and after training. METHODS: A postal questionnaire was sent to all nurse advisers working in 17 NHS Direct sites in England before and after mental health training had been received. The questionnaire was designed to measure confidence, knowledge and attitudes. This was done through scenarios of real calls to NHS Direct, questions from the World Health Organization guide to Mental Health in Primary Care and the Depression Attitude Questionnaire. RESULTS: Confidence increased in nurses who received mental health training. Although there was no statistically significant increase in knowledge scores after training, those who had received training increased by on average one point. After training, attitudes towards depression had shifted in that nurses now felt more positive towards their role in treating depressed patients. CONCLUSIONS: Training in mental health can lead to increases in confidence and a change in attitudes and would be beneficial for all nurses working in NHS Direct and in other primary care fields. It would also be beneficial to repeat the study with a larger number of nurses and after a longer period of time to assess the long-term effects of training.
Adult↗
Seeking advice from NHS direct on common childhood complaints: does it matter who answers the phone?
BACKGROUND: National Health Services (NHS) Direct is a national nurse-led, call-centre based, telephone triage, health information and advice service in the United Kingdom (UK). Forty percent of calls to NHS Direct are about children. There is a need to identify whether there is a difference in the time taken for nurses to triage calls about children. AIM: The aim of the study was to determine if the call length and outcomes of Registered Sick Children's Nurses and Registered Nurses were different when triaging children who presented with 'rash' or 'fever' by telephone. SAMPLE: This study was carried out at NHS Direct, West Midlands, and involved analysis of 1281 calls taken by 22 nurses. METHODS: This study examined the frequency of referral by the two nurse groups to five triage outcome groups. Information about the calls was extracted from routinely collected data generated by the computerized clinical decision support software. The data were used for secondary analysis. DATA ANALYSIS: The data were analysed using Statistics Package for Social Sciences version 10 and nonparametric Mann-Whitney U -tests were performed to compare call lengths of the two groups. The chi-square test was used to analyse differences in frequency of triage to outcome groups. RESULTS: The mean call length of the Registered Sick Children's Nurses was statistically significantly shorter than that of the Registered Nurses (P < 0.001). With the exception of referral for a routine appointment with a general medical practitioner, both Registered Sick Children's Nurses and Registered Nurses referred to other triage outcomes groups with equal frequency. LIMITATIONS: Inaccuracy of call length measurement of less than 1 minute and more than 20 minutes was because of the limitations of the data extraction software. This system-led definition and measured length of a call limits both the analysis and conclusions that could be drawn about the content of NHS Direct nurse consultation. CONCLUSIONS: Registered Sick Children's Nurses take less time than Registered Nurses to triage calls about children presenting with 'rash' or 'fever'. Further investigation is required into the content and consultation process of the nurses, and also the safety and appropriateness of referral.
Adolescent↗
Nurses' views of using computerized decision support software in NHS Direct.
BACKGROUND: Nurses working in NHS Direct, the 24-hour telephone advice line in England, use computerized decision support software to recommend to callers the most appropriate service to contact, or to advise on self-care. AIMS: To explore nurses' views of their roles and the computerized decision support software in NHS Direct. METHODS: Qualitative analysis of semi-structured interviews with 24 NHS Direct nurses in 12 sites. FINDINGS: Nurses described both the software and themselves as essential to the clinical decision-making process. The software acted as safety net, provider of consistency, and provider of script, and was relied upon more when nurses did not have clinical knowledge relevant to the call. The nurse handled problems not covered by the software, probed patients for the appropriate information to enter into the software, and interpreted software recommendations in the light of contextual information which the software was unable to use. Nurses described a dual process of decision-making, with the nurse as active decision maker looking for consensus with the software recommendation and ready to override recommendations made by the software if necessary. However, nurses' accounts of the software as a guide, prompt or support did not fully acknowledge the power of the software, which they are required to use, and the recommendation of which they are required to follow under some management policies. Over time, the influence of nurse and software merges as nurses internalize the software script as their own knowledge, and navigate the software to produce recommendations that they feel are most appropriate. CONCLUSIONS: The nurse and the software have distinct roles in NHS Direct, although the effect of each on the clinical decision-making process may be difficult to determine in practice.
Attitude of Health Personnel↗
A randomized trial of a Telephone Reassurance Programme for patients recently discharged from an ophthalmic unit.
Patients often experience problems after discharge, for instance with housekeeping or a general lack of information. The effect of a nurse-initiated Telephone Reassurance Programme (TRP) on ophthalmic patient outcomes was investigated. Patients in the intervention group were phoned by a nurse 3-6 days after being randomized and discharged home. Patients in both intervention and control groups received a questionnaire 1 week and 1 month after discharge to assess the patient outcomes 'Informational needs', 'Uncertainty', 'Emotional complaints' and 'Functional limitations'. In an attempt to explain the lack of statistically significant results, the limitations related to the participants, intervention and outcomes are discussed.
Aftercare↗
Telephone nurses' experience of problems with telephone advice in Sweden.
By telephoning a healthcare call centre, individuals in Sweden can consult a nurse to discuss medical problems and health care accessibility, and to receive professional information on how to find their way about the health care system. The aim of the study was to identify problems, difficulties and disadvantages that telephone nurses with varying degrees of experience had met during their professional careers. The Delphi technique was used with three sets of questionnaires. Twenty-five nurses with varying experience of working with telephone advice from six 24-hours call centres participated in the study. The response rate was 100%. An open-ended question generated 154 statements. Comments were categorized into 24 different problem categories. Ten problem categories were mainly related to the nurse perspective, i.e. the problems experienced were associated with the qualities of the nurse, eight principally to the patient perspective, i.e. problems associated with caller characteristics and six mostly to the organizational perspective, i.e. problems linked to the organization of the national health service. 'Lack of health care resources' was rated as the biggest problem, 'second-hand consultations' as the second and 'always making a decision' as the third biggest problem. Decision-making seems to be the core of telephone advice nursing and problems related to the nurses, patients and organization seem to influence the telephone nurses' working situation. Training should focus on active listening and handling social conflicts.
Adult↗
Provision of out-of-hours support to a forensic population: strategies and research potential.
Community Mental Health Nurses (CMHNs) working within regional forensic services are increasingly expected to provide out-of-hours cover for community forensic patients. This is often in the absence of appropriate resources or indeed informed knowledge as to what are appropriate resources. In areas such as forensic services it would be assumed that out-of-hours cover is essential. Yet most forensic services find it difficult to provide this cover, because of the low number of CMHNs and the regional nature of the service. One option which has not been explored is the use of telephone support in conjunction with individual contingency plans for each patient. This paper explores this area and makes suggestions for researching outcomes for this service change.
Community Health Nursing↗
Telephone nursing: calls and caller satisfaction.
To understand the function of telephone nursing, every call to the Medical Call Centre in Stockholm was recorded during one week (n = 2866). Every tenth caller (n = 203) was asked to answer a mailed questionnaire about consultation and satisfaction. The most common reason for calling was symptoms of infection. The predominant outcome was self-care advice (49%). In the mailed questionnaire 85% of respondents stated that they had followed the advice and 95% were satisfied with their consultation. Compared to earlier studies of calls to health-care centres and accident and emergency departments, a larger proportion of the callers were advised to see a physician. The Call Centre we examined proved to be more inclined to give self-care advice than other health-care settings.
Adolescent↗
School crisis intervention in the Ikeda incident: organization and activity of the mental support team.
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Adult↗
Impact of a telephone call centre on emergency department workload.
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Australia↗
Evaluation of an on-call diabetes service in a large teaching hospital.
AIMS: To assess prospectively the activity and effectiveness of a diabetes specialist on-call service. METHODS: All requests for specialist advice received by the doctor on-call for diabetes in a large teaching hospital were recorded and analysed over a period of 3 weeks. RESULTS: The total number of calls was 135 (mean 45 per week) of which 48.1% were outside normal working hours. Requests for advice from surgical and medical ward staff accounted for 43% of calls, the remainder were from staff in the maternity ward (12.6%), staff in other hospitals in the city (3.7%), general practitioners (13.3%) and patients (27.4%). The time spent by the on-call doctor for diabetes responding to calls was a mean of 8.6 h per week. The number of acute admissions prevented by this service was estimated to be 11 (3.6 per week). CONCLUSIONS: Open access to specialist advice provided by a doctor with expertise in diabetes is an effective adjunct to the delivery of diabetes care in the setting of a large teaching hospital.
Adult↗
'Carer and gatekeeper' - conflicting demands in nurses' experiences of telephone advisory services.
'Carer and gatekeeper' - conflicting demands in nurses' experiences of telephone advisory services Millions of calls are made to the telephone advisory services in primary health care in Sweden. The patients seem happy with the advice and counselling they receive, but little has been written about nurses' experiences of performing telephone advisory services. Yet, the nurses are expected to be patient, sensitive and have a broad knowledge of medicine, nursing and pedagogy. The aim of this study was to describe how nurses experience the patient encounter when performing telephone advisory services. A strategic sample of five nurses were interviewed and asked to describe how they experienced the central aspects of the patient encounter by telephone. The transcribed interviews were analysed by the Empirical Phenomenological Psychological method. The nurses' experience of the patient encounter when performing telephone advisory services can be characterized in terms of the conflicting demands of being both carer and gatekeeper. The constituents of these conflicting demands were: reading between the lines while pressed for time; educating patients for self-care while fearful of misinterpreting the situation; encountering patients' satisfaction and dissatisfaction. The conflicting demands of being both professional carer and gatekeeper caused stress among the nurses. The organization of the telephone advisory services seems to hinder high-quality care.
Attitude of Health Personnel↗
Computerized health information and the demand for medical care.
OBJECTIVE: Consumer health information, once the domain of books and booklets, has become increasingly digitized and available on the Internet. This study assessed the effect of using computerized health information on consumers' demand for medical care. METHODS: The dependent variable was self-reported number of visits to the doctor in the past year. The key independent variable was the use of computerized health information, which was treated as endogenous. We tested the effect of using computerized health information on physician visits using ordinary least squares, instrumental variables, fixed effects, and fixed-effects instrumental variables models. The instrumental variables included exposure to the Healthwise Communities Project, a community-wide health information intervention; computer ownership; and Internet access. Random households in three cities were mailed questionnaires before and after the Healthwise Communities Project. In total, 5909 surveys were collected for a response rate of 54%. RESULTS: In both the bivariate and the multivariate analyses, the use of computerized health information was not associated with self-reported entry into care or number of visits. The instrumental variables models also found no differences, with the exception that the probability of entering care was significantly greater with the two-stage conditional logit model (P <.05). CONCLUSIONS: Although providing people with health information is intuitively appealing, we found little evidence of an association between using a computer for health information and self-reported medical visits in the past year. This study used overall self-reported utilizations as the dependent variable, and more research is needed to determine whether health information affects the health production function in other important ways, such as the location of care, the timing of getting care, or the intensity of treatment.
Adolescent↗
Evaluation of telenursing outcomes: satisfaction, self-care practices, and cost savings.
Info-Santé CLSC, the Québec telenursing service, is a telephone health line nursing service that was implemented in 1995 in every local community service center (CLSC; n = 141) of 15 regional health authorities in the Province of Québec, Canada. It is, at present, one of the most important first-line health services and it operates in continuity with the other resources in the health and social service system. Info-Santé CLSC operates 24 hours a day, 7 days a week, and received more than 2,260,000 calls in 1997. This article will report the findings from the first province-wide survey of the service, based on a stratified random sample of 4,696 callers. The findings revealed that most respondents were highly satisfied with the service; they followed the nurses' advice and carried out self-care measures as recommended. Nursing interventions helped respondents feel self-reliant, like they could solve the same or similar problems should they occur in the future. The vast majority of respondents considered that the call they made to Info-Santé CLSC was useful in finding a solution to their problems. The vast majority also claimed that they would certainly call Info-Sante CLSC again should another problem occur. The majority reported they would have turned to another type of resource if Info-Santé CLSC had not existed; half of the respondents stated that they would have used emergency departments and a third would have consulted a doctor in private practice.
Adolescent↗
An update on NHS direct.
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Emergency Nursing↗