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A special holiday greeting to TNT readers, wishing you the best of holiday seasons.
December 1996 -- Vol 1 Number 5
This is the fifth issue of the Telephone Nursing Telezine. TNT for short.
The month of December includes a time of celebration for many of us, though the specific holiday we celebrate may vary. The focus of this issue is A Holiday Potpourri, a smattering of topics related to the holidays along with special challenges facing Telephone Nursing during this wondrous season.
by: Kathi Webster BSN RN
December is a special month of caring in many countries across the globe. The holiday name may change but the message and spirit of universal love, compassion or caring is recurring. Christmas, Hannukah, Yule or Winter Solstice, Kwanzaa, Isra' and Mi'raj, Advent, Sinterklaas, and St. Lucia -- are only a few reasons to celebrate in December.
Caring is of special interest to the nursing profession, and sits at the core of our practice every day of the year. It is the reason many of us entered the nursing profession, and why we stay with it, year in and year out.
A significant issue for the modern day nurse is our search for what we have been, what we are, and what we hope to become. One could say we are coming into a new 'season' -- a time of enormous change in health care and our profession, filled with both painful challenges and special opportunities. If "caring" is a defining characteristic of the nursing profession, as stated by author Susanne Williams in an issue of the Detroit Metropolitan Woman Magazine, how do we hold onto this heritage from Florence Nightingale and other nurse heroes amidst downsizing, reorganization, and workplace chaos?
Dr. Jean Watson is Distinguished Professor of Nursing and former Dean of the School of Nursing at the University of Colorado -- and proposes a nursing theory of human caring as a solid basis for daily nursing practice. It states "Caring is the essence of nursing and the most central and unifying focus for nursing practice." As Director of the Center for Human Caring, Jean and others work toward all that furthers 'caring' as the moral and scientific basis of clinical practice. At their World Wide Web site, information on their list service is available, dedicated to ongoing discussions on the topic of human caring in nursing practice via the Internet.
U.S. nurses aren't the only ones interested how much nurses care. The Faculty of Nursing at the University of Western Ontario stresses the importance of caring and how we care for other nurses. From Professor LaForet-Fliesser: "If we want students to be caring in their interactions with their clients, it's important that we work with them in a caring relationship." Their FactSheet about this University-based nursing program pulls in this caring concept as important to student nurse education.
Another caring Canadian nurse from Ontario is Leslie Millson Taylor, currently the moderator of an international discussion group called CARENET. It specifically deals with issues of relevance to the development of Caring Theory and its application to nursing and nursing education. Membership is free and requires only an Internet email account.
International efforts are under way to expand nursing horizons on the power of caring. Åbo Akademi University in Vasa, Finland has a Department of Caring Science founded in 1986. Their aim is to create a humanistic caring science in a spirit of faith, hope and love. Their 19th International Nursing Care Conference is planned for June 1997 in Helsinki.
Are there limits to caring? Perhaps not. Kathy Magee a nurse and social worker helped to found Operation Smile in 1992 with her husband Bill, a craniofacial specialist. Their combined efforts in a single year assisted in providing over 21,000 needed surgeries in the US and 18,000 abroad. In 1996 they were National Caring Award recipients.
Mark Wayne Lockhart of Palmyra Virginia, a Head Nurse at a Burn Center, lost his life as a volunteer on an EMS squad while transporting a cardiac patient. His first child and son was born to his wife (also an RN) six months after his death. Another nurse, Sandy Sigman gave her life attempting to rescue an injured hiker off a mountain in Frisco California. The Tree of Life site at the National EMS Memorial website tells these stories and more.
A nurse named Lynden Cowen stopped to help at an accident near Toronto, and may have helped to save the lives of three teenagers. The National OnLine website honored her as a Canadian hero.
Inspired by an aunt who was a nurse and personal "hero", Dean (psychologist) and Ellen Harris (a retired nurse) were honored as caring disaster volunteers and EveryDay Heroes by the Red Cross for their international efforts.
And as December passes by it would be in keeping with the holiday spirit to remember an especially caring person born on December 25, 1821 -- Clara Barton, dubbed "The Angel of The Battlefield" during the American Civil War, a nurse and founder the American Red Cross.
Few of us will be called upon to make such public heroic efforts or sacrifices on behalf of our patients. But perhaps the example and spirit of all the nurses mentioned here can lend us strength through our daily trials and tribulations to give the best possible effort in our work plus loving compassion to those placed in our care.
And that would make us all heroes indeed.
Kathi Webster is the Editor of TNT and can be reached via email at: tnt@katsden.com
by: Tony Dombrowski BSN RN
Thursday 8:25 AM, I meet Mr G, a patient, in the hallway. He is waiting to register to see his doctor. His wife died Saturday. "I'm sorry about Eileen" I say. Mr G goes on a bit about sadness. "But how are you Al, are you doing OK?" He assures me his life will go on. I grab his shoulder and give him a shake. I need to touch to let him know I'm there for him. He smiles. Then I'm off to the phone race.
The Clinic operates around my desk. At any one time I can hear three or four conversations. There is no way to avoid it and I wouldn't be as effective if I could. A few calls into the day and a few calls on hold I hear the medical assistant trying to room Mr. G for a sigmo. I call on the intercom and advise her that we've booked him in the only space available that day but the visit was for a "long talk". Those are our code words for a visit to discuss serious disease or grief. We like to see or hear from family members when a patient dies. We can't treat them in a vacuum. Our approach is to include all the family members and support systems the patient has available.
Last week I got a call on Monday morning early. Everything around me was very busy, noisy, almost out of control. A womans voice asked to speak to Dr. A. "He's busy at this moment, can I help you?" She asks to leave a message for the Doc. "Sure I can do that I'll let him know whatever" I say in a bright and energetic voice, reflecting the energy around me. "Tell him my husband died last week and I just wanted to let him know." I hear no tears in her voice. She sounds steady, matter of fact. I remember her husband an almond grower telling me the same joke about why we don't prounonce the 'L' in almond. "Because ya gotta farm the *ell out of 'em to get 'em to grow." This was no surprise his death. "I'm sorry to hear that" I say. "Tell me what happened?" She recounts an ER visit and probable MI. She says he didn't suffer and seemed to have an easy time at the end. There is a long pause in the conversation, a sigh, a wimper. You can sense her thoughts returning to that moment. I've learned how to move these conversations now, as an expert, no platitudes. " And you Mrs M how are you holding up?" Fine, the response. "Family in the area?" I need to assess her support system. She relates a story of family and friends. So, through the noise and distraction and carrying-on that is surrounding me, I listen. I listen to the expression of the way she sees herself and listen for the sense of future she expresses. "The neighbors are real close friends". I encourage her to lean on her friends now when she really needs a shoulder. "This is the time to let them do for you, as you have done for them in the past." I keep improving my skill of encouraging people to tell the story that will untie the knots of grief inside them. Let them cry and wash away part of the past, help them see the future. Life goes on.
Mr. G is back in my face now. It doesn't take much to elicit his story. He likes to talk. We are in person now . Different from a phone conversation. I see his eyes and quivering lip as he speaks of the gratitude he has for the hospice crew. He expresses a preference for a quick death. He rambles. I listen. I feel I know him well and he probably feels likewise. At 80 he still works as a street artist at Fishermans Wharf, a former circus performer. Eileen was his third wife. His wife before she died of liver cancer. Before that a fall from a high wire. His hearing aid doesn't prevent him from speaking in a loud voice thru ill-fitting teeth. I direct the conversation to his upcoming esophagus cancer surgery. He discusses this part of his future in real terms. His cancer was detected early so he knows the chance for a cure is good. I am moved by his optimism and spirit. I will let this sense of hope fill up my cracks and crevices. There is a part of you that is worn away by this work. My conversation with Mr G will inspire me to sustain and repair the parts I've lost. I'll end up giving to the next person that needs emotional support. There is a sense of honor or nobility to be a person to whom others divulge the contents of their heart.
Mr G is crowded away from my desk by a gurney with a patient from the wards for endoscopy, NG tube, IV, two student nurses in tow. I close with Mr. G, introduce myself to the students and "the show must go on". Now I'm a role model for the students. I introduce myself to the patient, put my hand on her arm as I answer her questions, take a history, prepare the forms. I give the patient a sense of confidence, speak slowly, look right into her eyes. "Any questions?" I glance at the students and nod to repeat this interogative. Now let me tell the procedure nurse we've got more business. "Students" she shrugged. OK, re-think. I take the students to view the video we usually show to outpatients prior to esophagoscopy. The video won't work. OK, try reading these handouts. I'll be back. More phonecalls, with a few finger snaps I hook the Doc. Placing a hand over the mouthpiece,"Talk to the students in room 6, they'll be observing your endoscopy". He nods.
On the phone, arrange transport for the last patient, relatives lost, urgent care appointments, questions about enemas. Then an 83 y/o lady who can't figure out where and when she sees the doctor. I pry her patient ID number from her and use the computer to find and answer to her query. "Don't ever get old" she cautions me. "Whatever you do don't get old" she laments. "Well Mrs T," I say, "the only alternative to getting old is dying young. Given a choice I'd choose to get old". It worked! She's giggling like a schoolgirl into the phone and thanking me for my help.
In the background I hear Dr G introducing himself to the students and I know they are in good hands. He's good onstage and conveys the sense of wonder inherent in these fiberoptic exams as if it is his first not his zillionth exam.
"Tony!, chest pain, line 70". My next call is a handoff from a medical assistant that got a call patched through the operator. A 75 y/o man with bad lungs and complex hypertension. I know this man by name, we've talked many times. I know all his medical conditions are complicated by his stoicism hardened by time in Auschwitz. I assess the nature of his chest pain, duration, frequency, severity, response to nitro-glycerine. He experiences an attack of pain, gasping he can't speak. I wait, calmly thinking what to do in the event I hear him drop to the floor. I know where I can get his patient ID. The computer will give me his address. When he speaks again I slowly instruct him to dial 911. "But can't I drive in?" "Mr N if you have an attack when you're driving you might have and accident and kill someone" He agrees. "Now when we hang up I want you to dial 911. Tell them you are having chest pain and you've spoken to your nurse and you need an ambulance now". "I'll call back in fifteen minutes to be sure you are on your way". When I look up the students faces are before me blank like a pair of painted "Kilroys" on a fence in a Life magazine photo. Having overheard my conversation, only their eyeballs follow me as I bounce down the hall to notify the doc of this admit then a few steps to ER to inform the triage nurse that a code 3 is inbound. I give a history and get that usual knowing response. I have the greatest respect for emergency nurses. It shows.
Upon returning I pass a medical assistant doing an intake hello to another patient from the wards. "Unless you can speak Farsi he won't understand you. He's from Persia". Her grin widens for both of us as she pats his hand and continues to the paperwork in pantomime.
I confirm with the floor that it is legal for students to transport patients on a gurney, remind Dr G to have a final word with them as he is finishing the chart. To the procedure nurse, "Mr. N is on his way to ER for r/o MI". They are neighbors. I call his wife back. He's gone already. I arrange for her to call me before noon, give her the phone number for ER. We will speak throughout the day. Mr N will be admitted to the ICU for unstable angina. He recovers.
I sip cold coffee, it's 10:30 AM. I check my desk for any disorder in this mess, put my headset back on and plug back into the phone. This is a glimpse of 2 hours of telephone triage/clinic nursing. Making decisions, expressions of caring, adjustments to rapidly changing situations, quality care, expert nursing. I guess I do it well. Taking a deep breath and a stretch I think of the words Mr G had for me earlier when I expressed approval of his plan to visit "show-biz" friends in a nearby town. "Well I've known these people for a long long time. They keep me busy and after all a busy mind has no place for tears".
An afterword: I had dinner with the home health nurse that visited Mr G after his esophagus surgery. He charmed her despite his initial fear of the g-tube and liquid feeding. He recovered completely. Not quite a year later he came in to say goodbye, with his new girlfriend in tow. Equal in age and presence with lots of red curly hair they were moving to Nevada so he could work as an portrait artist in a casino. She made Al smile so his teeth barely stayed in his face. She leaned over my desk to shake my hand, straining her low cut ruffled blouse. "Hi babe", she said "Al tells me you're alright". All I could do was smile and nod. There was nothing more to say.
Tony Dombrowski juggles the phones at a Gastroenterology/Medicine service within a large urban HMO in Oakland California. He is also the Director of NURSEONE (a CE provider) and Webmaster of his own Internet site.
Email to:Nurseone@nurseone.com
Visit his wonderful NURSEONE website at: http://www.nurseone.com/
[Readers who wish to chat with Tony are encouraged to contact him personally]
The American Lung Association's Christmas Seals® have been a holiday tradition since 1907. Donations to Christmas Seals® help fund the American Lung Association's asthma and tobacco control programs of education, research and advocacy. Their website features several fun and caring options for Internet users including: the ability to send a personalized holiday greeting with a picture of your selected "seal" to a family member or friend (which they can view at a special web location), information on their Christmas Drawing contest for kids, plus a free downloadable Christmas Seal screensaver.
The Christmas Seals URL is at: http://www.christmasseals.org/
URL for the American Lung Association at: http://www.lungusa.org
The Marine's Toys for Tots is founded on the premise that "every child deserves a little Christmas." Founded in 1947 by Marine Colonel Bill Hendricks, this is now a national program. If you have an interest in donating a toy to this fine effort, this website allows you to find the closest collection center. In addition, you have a special option to send a Holiday Greeting that will be will be converted into a traditional card and delivered to a child in need. For those with only Internet e-mail access, you can still send a few words of holiday spirit to a child via mantis@mantiscorp.com, where it will be output to a special Christmas card and delivered along with their World Wide Web counterparts.
The Holiday Greeting section of Toys for Tots is at: http://www.mantiscorp.com/toys/card.html
The main WWW URL is at: http://www.mantiscorp.com/toys/
Need some healthy recipes for the holiday season? The American Diabetes Association website features a daily recipe selected from the Flavorful Seasons Cookbook, with seasonal and lowfat ingredients. Worried about your risk for diabetes? Their main page featurs a Diabetes Risk Test that can be taken with any web browser supporting forms.
ADA's Daily recipe is found at: http://www.diabetes.org/ada/rcptoday.html
ADA's Diabetes Risk Test is at: http://www.diabetes.org/ada/risktest.html
The American Diabetes Association is at: http://www.diabetes.org/
December can be either eerily quiet or a raging river of calls for Telephone Nurses. Certain problems become more active during the holiday season, stressing the Telephone Nurse to give the best answers and most appropriate referrals. Here are some web resources most likely to be of benefit during the winter and holiday season.
Dreaming of a white Christmas? Some areas of the U.S. and world experience freezing temperatures and sudden snow storms during the winter months. Cold stress or hypothermia can occur quickly and may be fatal. It is more dangerous to those under 1 year of age along with the elderly. In addition, certain medications such as anti-depressants, sedatives, tranquilizers, and cardiovascular drugs can alter the body's ability to regulate temperature. In a special report from the U.S. Office of Consumer Affairs, the risks, symptoms and actions to take are discussed. Even people living in the warmer climates may be affected, especially if they enjoy activities like boating or fishing. The University of Minnesota provides information about hypothermia prevention related to survival in cold water. And yet another potential hazard when dealing with cold winds or conditions is frostbite. The American Institute for Preventive Medicine shares information and self-care tips related to the treatment of cold feet and hands. From their website, symptoms to look for include: Fingers or toes turning pale white or blue then red in response to cold, tingling or numbness, and pain during the white phase of discoloration.
The special report on cold stress is at: http://www.hoptechno.com/book41.htm
The details on cold water survival is at: http://seagrant.d.umn.edu/pubs/hypothermia.html
Frostbite info at: http://206.135.37.254/LIBRARY/Books/Healthyself/coldhands.htm
The spirit of the holidays may include the consumption of alcohol for many people. According to the U.S. Department of Health and Human Services (HHS), alcohol use cost society an estimated $98 billion in 1990. An estimated 25 to 40% of patients in general hospital beds are being treated for complications of alcoholism. In incidents of domestic violence, as many as 57% of men and 27% of women had been drinking. These are just samples of statistics from an article on alcohol consumptions at the Coalition for Consumer Health and Safety website.
For info on alcohol consumption go to: http://www.essential.org/cchs/alcohol.html
Visiting with friends and family over the holidays is often an event looked forward to. The increase in holiday traffic brings with it risks. The National Highway Traffic Safety Administration has an excellent site including Campaign Safe and Sober. A variety of materials are available for downloading, including a mini-fact sheet that can be copied and distributed to the public. Other interesting subjects include: driving at night, employer traffic safety programs, and a doctor's prescription for safer life on the streets.
The NHTSA website is located at: http://www.nhtsa.dot.gov/
Poinsettas and holly are frequent plant decorations around the winter holidays. Contrary to popular belief, the poinsetta is not a poisonous plant per a listing at the Arizona Poison and Drug Information Center website, although it may cause local irritation. Holly (llex aquifolium), however, is listed in the poisonous category, along with mistletoe, philodendron and aloe. If any indoor or outdoor plants are ingested, Poison Control Center or medical advice should be sought. Exposure to toxic plants may produce symptoms ranging from skin irritation and gastrointestinal upset, to more uncommon systemic symptoms such as convulsions, heart beat irregularities and fatalities (rare). This Arizona site also includes a Holiday Safety edition of their news tips. Telephone nurses most often refer callers with problems related to actual or possible poisoning to the nearest Poison Control Center. You might even want to take their "Tox-Trivia" quiz while you're visiting!
For plant information: http://www.pharm.Arizona.EDU/centers/poison_center/index.html
For holiday poisoning tips: http://www.pharm.arizona.edu/centers/poison_center/newstips/
State listings of Poison Control Centers at: http://198.79.220.3/aapcc/lststate.htm
Toys are a delightful part of Christmas for a small child, but small items and toys designed for older children can mean a choking episode for a baby. The American Academy of Pediatrics recommends the abdominal thrust technique (Heimlich maneuver) for treatment of a choking child, except in infants younger than 1 year old. For infants younger than age 1, the Academy says that back blows and chest thrusts, if needed, are still the best treatment for choking to avoid injury to the abdominal organs. They also urge families receive formal training in first aid techniques for choking. Local chapters of the American Heart Association or American Red Cross teach first aid classes for choking in children. It is important to know when to intervene with a choking child and when NOT to. The Department of Public Safety OnLine at the University of Oklahoma has a web-based refresher page for people with First Aid training. Both adult and child choking first aid is covered here.
A listing of AAP positions can be read at: http://www.aap.org/about/Wwestand.htm
The American Academy of Pediatrics is found at: http://www.aap.org/
OUDSP First Aid for Choking site is at: http://www.ou.edu/oupd/choke.htm
The Holiday Blues can be a SAD state of affairs according to Dr. Gila Lindsley, PhD, ACP, a psychologist accredited by the American Board of Sleep Medicine. Seasonal Affective Disorders can include symptoms such as sadness, anxiety, irritability, and violence. In this article, Dr Lindsley explores the causes, and treatment related to light exposure. She further relates it to how Festival of Lights at the holidays help to "light up the spirits". A well done piece with some insightful information that makes it well worth your time to read. Just one part of the Phantom Sleep Page.
Holiday Blues and SAD article is at: http://world.std.com/~halberst/contrib/sad.html
Phantom Apea, Snoring and Sleep Disorders: http://world.std.com/~halberst/index.html
A common winter virus is called RSV or Respiratory Syncytial Virus. According to the CDC, RSV infection is most common during infancy and early childhood, but may also occur in adults. The infection usually causes mild or moderately severe upper respiratory illness. It's symptoms are indistinguishable from other viral respiratory infections, and physicians rely on a culture of respiratory secretions for diagnosis.
According to the American Lung Association, the Respiratory Syncytial Virus is responsible for many respiratory infections such as bronchiolitis, bronchopneumonia, and the common cold -- and causes approximately 90,000 hospitalizations and 4,500 deaths each year. Typically widespread outbreaks during the winter months, peaking in January and February. Although most cases of RSV cause a mild respiratory infection with nasal stuffiness and discharge, cough, wheeze and sometimes ear infections, it can be fatal to the very young child, especially premature infants and those who have chronic diseases or are immunocompromised. RSV is often spread by hand-to-hand or droplet transmission (e.g. sneezing). If you want more information, you can also contact the American Lung Association at 1-800-LUNG-USA.
The Children's Medical Center in Dayton Ohio provides an online "handout" for parents on RSV. In addition to the RSV pamphlet, their "Parents Active in Learning and Sharing" project features information on croup, chickepox, wheezing and more. Worth checking out, especially if you are a Telephone Nurse serving the Pediatric population.
RSV info at the CDC: http://www.cdc.gov/ncidod/diseases/hip/pneumonia/1_rsv.htm
RSV at ALA: http://www.lungusa.org/noframes/global/news/report/pedlung/pedresvifac.html
RSV info at CMC-Dayton is at: http://www.cmc-dayton.org/pals/pals1111.htm
Am Lung Assoc site: http://www.lungusa.org
CDC site: http://www.cdc.gov
Dayton Children's Med Center: http://www.cmc-dayton.org/
One Flu Over the Christmas Tree?
Many symptoms encountered over the phone during the winter season by Triage Nurses are those attributable to influenza, commonly known as the flu. In fact, the flu season can cause a real traffic jam on your phone lines, requiring increased staffing needs and stressed out triage nurses.
From the Center for Disease Control in Atlanta Georgia, typical clinical features or symptoms of influenza include "fever (usually 100° F to 103° F in adults and often even higher in children) and respiratory symptoms, such as cough, sore throat, runny or stuffy nose, as well as headache, muscle aches, and often extreme fatigue. Although nausea, vomiting, and diarrhea can sometimes accompany influenza infection, especially in children, gastrointestinal symptoms are rarely prominent. The term "stomach flu" is a misnomer that is sometimes used to describe gastrointestinal illnesses caused by other microorganisms."
Groups at increased risk for influenza-related complications are:
CDC's website contains more information including the clinical features of influenza, a natural history of human influenza, the optimal time to receive the vaccine (which WAS mid-November), and information on antiviral drugs such as amantadine and rimantadine for Influenza Type A.
Triage nurses, get yourselves ready, take a deep breath, then pick up that phone! RING!
For CDC's Influenza page: http://www.cdc.gov/ncidod/diseases/flu/fluvirus.htm
The CDC is found at: http://www.cdc.gov/
Just how satisfied are our patients with the "care" delivered? Do you perform a patient satisfaction survey to determine this? What does satisfaction mean and how does one measure it? Here is a letter from last month's issue of TNT, along with some interesting and related resources on the Internet to help you find the answers.
Dear TNT,
I am working on my master's degree to practice as a Nurse Practitioner and I work at a Telephone Triage after hours answering service. We service many physician's office in this area (Peoria, IL). My research project for my degree is on parent perception of satisfaction with an after hours telephone triage service. I have not been able to find a suitable tool to use to assess satisfaction in this particular
area. Do you or readers of TNT know of an available tool? I look forward to reading more of the Telezine!
Thank you,
Bonita Dietrich, RN, BSN
email to BGDRN@aol.com
[Readers are encouraged to contact Bonita if they have information to share]
Dear Bonita,
Since your letter arrived, TNT has done some investigating on the Internet for the best resources related to patient satisfaction and health. I hope these resources are of some benefit to you and other TNT readers. I am aware that many Telephone Nursing Call Centers do perform telephone patient satisfaction surveys for their organizations -- including HMOs, physician practices or hospitals.
RAND is a non-profit institution that works to improve public policy through research and analysis. A document available by this group is Conducting a Consumer Satisfaction Survey by Lisa Schmidt and Elizabeth A. McGlynn. This piece provides good coverage of the "why, who and how" of a consumer satisfaction survey and is not to be missed. Found at the Quality Measurement Advisory Service or QMAS website.
Survey article is at: http://chmis.org/qmas/chds3.html
QMAS is at: http://chmis.org/qmas/index.html
Those who wish to vist the RAND site: http://www.rand.org/
But can patient satisfaction surveys improve your practice? An article by the same title at the American College of Physicians states it does. In addition "patients who are happy with their care are less likely to sue, more likely to stay with a physician and to refer their friends and family, motivating both physicians and HMOs to view the world from a patient's perspective."
Article on pt. satisfaction: http://www.acponline.org/journals/news/satisfac.htm
American College of Physicians is at: http://www.acponline.org/index.html
Do you need tips to increase patient satisfaction? The American Academy of Allergy, Asthma and Immunology shares information for practitioners on this topic. They stress the need for better communication along with some steps to get there.
The article is at: http://www.aaaai.org/profinfo/resource/practmgm/practman.html
The AAAAI website is at: http://www.aaaai.org/index.html
Patient satifaction may differ by type of practice, as shown in this synopsis of an outcome of this Medical Outcomes Study. The study found it desirable for physicians to reduce patients' office waits and to spend more time with patients even in small practices. After reading the results, you will most likely want to stop by the Medical Outcomes web page of Carl Slater MD. Also included is material from his doctoral level course at University of Texas School of Public Health.
The URL is at: http://utsph.sph.uth.tmc.edu/www/utsph/CS/risser4.htm.
Dr Slater's page is at: http://utsph.sph.uth.tmc.edu/www/utsph/cs/outcomes.html
An intriguing article deals with the problem of Illiteracy and Mail-Out Surveys by Jill Reeves of PRC. She points out that the mail-out survey may not be the best way. "A telephone survey,scientifically administered, might exclude the approximate five percent of homes that currently do not have telephone service. The mail-out survey has the potential to miss a much larger segment of the population with illiteracy levels ranging near 40 percent in the U.S. population." Well written article with references included.
This article is found at: http://www.prof-rsrch.com/surveys/mailout.html
The National Committee for Quality Assurance is the well-known independent, not-for-profit organization dedicated to assessing and reporting on the quality of managed care plans, including health maintenance organizations (HMOs). HEDIS has been their answer to health plan performance benchmarking, and the final version of HEDIS 3.0 is due to be formally released in January 1997. It will contain and member survey instrument and protocol for sampling and administration.
The NCQA website is at: http://www.ncqa.org/
Here is a sampling of Patient Satisfaction Surveys from a variety of websites on the Internet.
The National Health Observances for 1997 has been released by the National Health Information Center, a U.S. govt organization. This calendar lists monthly U.S. health observances along with key contact organizations, some which provide free materials for distribution to the consumer. A *must* see if you plan community health fairs or special outreach programs.
As an example, the month of January 1997 is National Autism Awareness Month - with the Autism Society of America as the contact organization. If unable to access this website where you can order free information online, check out their Fax-on-demand line at:(800)329-0899.
The Autism Society of America is at: http://www.autism-society.org/
The NHIC 1997 health calendar is at: http://nhic-nt.health.org/nho97a.htm
The NHIC is at: http://nhic-nt.health.org
Need a quick guide to Espanol? A website provides Medical spanish terminology for health care workers. Another Internet site provides a multi-Lingual glossary of popular medical terms in nine European languages including Italian, Danish, Dutch, French and German.
The Spanish glossary is at: http://pw1.netcom.com/~seajr/medical_spanish.html
The multilingual glossary is at: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
Interested in what's happening globally? You can read "Fifty Facts" from the 1996 World Health Report from the World Health Organization. Tidbits include:
Fifty facts is at: http://www.who.org/whr/1996/50facts.htm
The WHO URL is: http://www.who.org/
The 1997 National Nurse Practitioner Summit will be held in Washington DC at the Renaissance Mayflower Hotel from February 21- 24, 1997. The theme is Critical Issues, Critical Choices and features a pre-summit workshop about Nursing Informatics and the Internet.
For information/registration:
CALL 800.525.MEET or FAX 303.894.0448
or MAIL to PO Box 18P, Denver, CO 80218
or E-MAIL Servicent@aol.com
The URL for this summit is at: http://www.nurse.org/acnp/97summit.html
Successfully Launching a Call Center from the National Managed Health Care Congress will be held Feb 6-7, 1997 at the Loews Vanderbilt Plaza in Nashville TN.
To register with NMHCC:
Call 1-888-446-6422
or MAIL to PO Box 360034, Boston MA 02241-0634
The American Academy of Ambulatory Care Nursing will be having their Annual Conference, "Creating Balance: Business, Technology, and Caring in Ambulatory Nursing soon. This group has a SIG (special interest group) for Telephone Nursing.
When: March 12-15, 1997
Where: Seattle Washington, Sheraton Seattle Hotel and Towers
For more information contact:
AAACN National Office at 1-800-AMB-NURSE or FAX (609)589-7463
or email to aaacn@mail.ajj.com
American Telemedicine Association
When: Apr 2, 1997 - Apr 6, 1997
Where: Atlanta, GA
Sponsor: ATA
Contact: Natalie Shear, Conference Coordinator, 1629 K Street NW, Suite 802, Washington, DC 20006
Call (800) 833-1354 or (202) 833-4456 (voice) (202) 775-7465 (fax)
or email to: ata@idi.net or nshear@usa.pipeline.com
Note: Call for session, exhibit, or sponsorship information may be requested from the email address.
Books related to Telephone Nursing should be an important part of your Nursing Library. If you can't find these books at your local Medical Library, consider checking out the Internet online bookstores and search for "telephone nursing". Two such sites are provided below.
Books #2 through 6 [some are special orders]
Where: Amazon Books at http://www.amazon.com
The National Council of State Boards of Nursing [NCSBN] has updated it's website with more information related to TeleNursing and the regulatory implications for multi-state regulation. In their Issues, Volume 17 Number 3 1996 is one definition of TeleNursing along with the following statement:
"The use of the telephone in telephone triaging and checking biometric testing equipment is probably the most widely recognized example of telenursing today. However, the advent of managed care has brought forth the concept of case managers, and the practice of telenursing has, in turn, emerged through the wide application of the use of the telephone in performing patient follow-up activities. Additionally, providing patient education and professional consultations, obtaining test results and assisting physicians in the implementation of medical treatment protocols (e.g., taking physician orders, etc.) using telecommunications technology are also illustrations of telenursing."
The article goes on to discuss nursing across state lines including some interesting facts from a national survey of boards of nursing done by the NCSBN in fall 1995. These facts include:
Task forces of the NCSBN are in the process of conceptualizing approaches to nursing regulation that would legally authorize the practice of nursing across state lines and/or multistate practice, with a final report to be presented to the 1997 Delegate Assembly in Chicago, August 19-23.
TNT encourages all health professionals involved in TeleNursing to visit this website personally and read the entire article carefully. It contains important information for the development of Telephone Nursing practice. The NCSBN is also currently adding their position papers to the website for your viewing pleasure.
Issues, Volume 17 Number 3 1996: http://www.ncsbn.org/pfiles/issues/vol173/telenurs173.html
NCSBN main web site: http://ncsbn.org
Bob Baxter RN CNOR has ordered and is distributing a pin that nurses can wear to identify themselves as being "online" (users of the Internet) and/or the NURSENET list service.
To quote Bob "The pin is largely bright gold color with ocean blue lettering (Pantone 286C, to be precise). The two images in blue are an outlined Nightingale nursing lamp below and the symbol "@" above it. The Nightingale lamp was the most universal symbol of nursing I could imagine, and the "@" symbol is recognized by the online as part of the E-mail address. The pin is slightly rectangular, 3/4 inch (1.9 cm) wide by 7/8 in (2 cm) high. The top is half-circle, and the bottom is squared."
To checkout an online picture of the pin, see Judy Norris' NURSENET site.
To order address postal envelope to:
Nursing Online Pin
Room # 142
10924 Mukilteo Speedway
MUKILTEO, WA 98275 USA
Bob is asking for $5 US funds, check or money order per pin. Make it payable to: Bob Baxter. Canadians can if they wish, send cash ($6.65 CDN at current rates).
NOTE: Per Bob, a portion of the proceeds from the sale of this pin will go to Operation SMILE International, a medical mission team that provides plastic and reconstructive services for children in developing countries.
If you'd like to contact Bob for more info, he is available at: bobaxter@sprynet.com
Your Brain on Managed Care
Does your brain start to scream when you hear about the five stages of managed care"? Nope, "denial" isn't one of the official five, though some might think it should be. An online article by Russell C. Coile, Jr. in Cost and Quality can help you sort through the maze of the managed care takeovers, what U.S. states are most and least transformed, and you might even find your hospital or health system mentioned in passing.
Five Stages of Managed Care at: http://www.cost-quality.com/stages.html
The URL for Cost & Quality is at: http://www.cost-quality.com
More Than Grits
The Good Karma Cafe is a graphically pleasing site with recipes from Kristi Sadler's The Reluctant Vegetarian Cookbook. Part of what makes this site so *special* is that it has many traditionally southern foods made with meat substitutes. Her December issue is jammed with healthy holiday alternatives, vegetarian alternatives to the turkey meal, along with the sinful cookie exchange. Kristi is also looking for some good recipe submissions, so do visit and improve your karma.
Good Karma Cafe is at: http://www.babyville.com/gkc/
The Guy in Red
And last, but not least, you can visit Santa's Workshop. A neat holiday page in both English and Spanish to add to your festivities. Bring the kids.
Visit Santa at: http://home1.gte.net/santa/
Are you a nurse or physician surfing the net, yet without your own web page? Well, now there is NO EXCUSE!
Stanford's MEDWORLD is offering a Free Web Page where at the time of this posting both physicians and nursings were seen listed. It's a hassle-free web page construction kit. You provide basic information including your background, interests, e-mail address and 3 favorite web sites, they create the web page for you automatically. All you need is a web browser to get there! Suggest you check out example pages before you enter your own so that you understand how the final page will look. Their main site is a definite PLUS of medical and health information for anyone in the health care community. Check 'em out!
The free webpage URL: http://www-leland.stanford.edu/group/MSSG/datafiles/homepgdir.html
Stanford's MEDWORLD is at: http://medworld.stanford.edu/medworld/
Chuckles once again strike in Tampa Bay by reports from an After-Hours Pediatric Call Center:
One mother recently asked a Triage Nurse, "Can you answer some questions about the un-biological cord?" The nurse gently corrected the mispronunciation and gave the correct information about routine umbilical cord care.
Another call involved a mother reporting a temperature of over 106 degrees. The concerned nurse asked the logical question about the route used to take this temperature, and discovered the 17 month old child had his temperature taken with a tympanic thermometer set on "rectal" -- but with the tip inserted into the child's RECTUM. Ouch.
Review Previous Issues of TNT
August 1996 issue - Introductory Issue
September 1996 issue - Featuring: OB Telephone Nursing
October 1996 issue - Hospice and Telephone Nursing
November 1996 issue - Telephone Nursing and Seniors
The Web Page
The Telephone Triage Nursing Web Site is at http://www.katsden.com/telenurse/index.html
Submissions of interest to Telephone Nurses in all occupations and environments. Preferred material is from Registered Nurses, Physicians and other health care professionals currently involved in the speciality.
Require all submissions by January 10th 1997 for next issue.
Mississippi
Telephone Resource Representative (RN) responsible for marketing services to potential clients through telephone inquiries facilitating referral to associated physicians and hospital services.
Minimum qualifications: Bachelor's degree in Nursing, 5 years experience in diversified clinical role, eligible for licensure by Mississippi State Board of Nursing.
Position: Full-time, 8:30AM to 5:00PM, Monday through Friday.
Contact: Myrna Stinson, Teleservices Coordinator at (601) 973-1694
South West Florida
Call Center Executive Director: location is within South West Florida and responsibilities include managing a regional call center that processes incoming calls for several hospital systems and subsidaries. BS required and a MS is preferred. A knowledge of clinical systems and managed care are a must; as is a minimum of three years in managing a multi county and multi facility demand management call center. A familiarity with NHES software is a plus!.
Triage Nurses: Location in South West Florida. A minimum of two years nursing, triage, emergency room, or physician office experience is required. In addition, a BSN is preferred but not required. Experience
in triage, medical sales, marketing or telemarketing is a definite plus. Nursing Triage Supervisor: BSN is a plus and a minimum of three years ( 5 years preferred ) experience is required. Location in South West Florida. Familarity with NHES software and call center training is a
definite plus.
Send all responses to: Marketing Consultant, 2920 Chancery Lane, Clearwater, Fl. 34619. Please include present salary and availability for interviews, and relocation preferences.
Can't Get Enough on Telephone Nursing?
Next months topic:
New Year, New Approaches
WANTED!
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