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Happy New Year to all!
January 1997 -- Vol 2 Number 1
This is the sixth issue of the Telephone Nursing Telezine. TNT for short.
The start of a New Year symbolizes to many peoples and cultures a time of new beginnings or renewal of the spirit through resolutions and increased energies. The focus of this issue is New Year, New Approaches, a smattering of topics related to new and exciting approaches to telephonic nursing, along with the possibilities of future technologies to enhance our practice.
by: Kathi Webster BSN RN
A calendrical millennium is coming closer. In casual use many people are referring to the beginning of the year 2000 (also abbreviated as Y2K), as the last year of this millennium and THE event. Perhaps they would just like to start the party early. A millennium is actually a period of 1000 years. The true millennium officially starts on 1 January 2001 at Greenwich UK, and will begin the "third millennium" as we move into the 21st century. The correct spelling of "millennium" IS with a double "n" not one. You'll be sure to impress your friends and family with these tidbits.
Regardless of when it actually starts, symptoms of millennium fever are spreading. This is a time for visionaries, creative thinking and new spiritual awakenings. Doomsday soothsayers make points and counterpoints with futuristic thinkers on the Internet. Will the end of the world come, or just an end to old paradigms? It is nice to plan for the latter.
Normally mundane business or operational plans may have a natural excitement when entitled "Strategies and Visions for the Next Millennium". Perhaps the $300 billion dollars needed to update computer programs worldwide to avoid mayhem and accommodate four digits dates by the year 2000 will become a major party spoiler. An unknown number of databases will need to have their program code re-written to conform to the longer date fields needed, along with data converted to the new format. How else will we differentiate between the years 1901 and 2001? Recently neglected COBOL programmers will have a field day (pun intended).
To celebrate this oncoming millennium train, and using the most advanced scientific methods available to me (not including the tarot, I-Ching and a strange crystal ball I recently found in my closest) I peered through the mist into future of Telephonic Nursing via the Internet.
"Great to hear, Mary...do you have any special concerns today?" Mary replied "I have a little rash on my face and I'm concerned because I've had it for about two days." Nurse Jane examines the mild localized pink rash on Mary's cheek via the telemonitor, compares it to some images on her local CD-ROM database of skin lesions, and asks a few more questions using the approved rash guideline. "It might be a sensitivity to some new makeup you're wearing. but this isn't a medical diagnosis. There is a note on your record that you've told us about problems with skin products before. Have you tried anything new recently?". Mary thought a few moments and replied "Well, I did purchase some new makeup and that must be it!" "Well, let's not assume anything, and have you check in with us again if it worsens or continues after you stop using the makeup. You would then need an exam by one of our nurse practitioners or a dermatologist. You can take the free literature on skin sensitivities, breast self-exam and a suggested low cholesterol diet that will be faxed to your kiosk in about two minutes. If there is nothing else new, you can have your mammography done now and we'll be all set for the day. If'd you like, we can review the breast self-exam procedure at your next visit. Please don't forget you can make your next appointment via the Internet at any time. We'll probably have someone from our healthcare team speak to you about decreasing your cholesterol lowering medications if you continue to improve. I'll ask them to review your chart. Have a wonderful day, and let me know if you need any more help." "Thanks so much, Jane!!" said Mary.
Before Mary leaves, she takes the health information faxed to her, has a mammography performed, and will receive results (encrypted for security reasons) via email to her home computer. Notice of her next planned health visit will be sent the same way. She removes her health card, goes to the dressing room to change, and drives home -- confident that she is in good health.
Nurse Jane has just interacted with one of many patients in her caseload for the day. All her nursing notes have been uploaded to the patient's health card at the time of the call, along with automatic notations from the vital sign and blood monitoring devices. Her patients will be asked for satisfaction surveys via email about these televisits during the next week, and Jane almost always gets favorable ratings. She is now off to participate in an international discussion of adult asthma assessment techniques via virtual teleconferencing in the Health Organization's Education Center. She loves being a TeleNurse.
What kind of story is this? Actually it is a tale of TODAY -- all these technologies are presently developed, some are currently in use, and the wide availability of such services is what is expected to change.
[A special thanks to the Telemedicine Information Exchange for it's wonderful "Cutting Edge Series"]
Cognizant of the fact the millennium is only four short years away (or three if you want the early bird version), the following is a partial list of technologies either live or in development that will change the face of health care and telenursing in the 21st century.
Wireless communication devices; automated utilities in the home and office; cable and satellite communications improvements (including the Internet via TV); smart cards used commonly for telephone access and portable medical records; broad-band two-way networking access systems; optical networks.
Automated data entry through advanced voice recognition systems (voice commands); intelligent character recognition or ICR (for use with handwriting); cheaper and better Optical Character Recognition (paperless offices), electric pens, high end yet affordable video cameras, scanners, and digital (filmless) cameras; professional agreement on health informatics data gathered by health professionals in various specialties. More peripheral medical devices conform with standards acceptable to telemedicine connectivity including ophthalmoscopes, otoscopes, bronchoscopes, nasopharyngoscopes, laparoscopes, culposcopes; privacy and confidentiality issues addressed through better transactional protocols; interoperability between computer software systems at various locations;
Fully developed and internationally accepted critical paths on disease states that flow smoothly from inpatient to outpatient care (and visa versa) and conform to NIH and international consensus statements; increased attention on disease prevention and wellness; self-care and self-knowledge health databases and libraries readily available to the general public; encouragement of Internet based meetings and self-help groups managed by qualified health care professionals and based on disease states.
With an increasingly higher technology being introduced into the health service industry , the high touch approach (or the new buzz phrase "soft touch") will be important. Special training will be required to teach health care staff how to maintain personalization and patient satisfaction with these services. Personal and management skills that were adequate in an environment of face-to-face contact will need to be fine tuned for telephonics, Internet communications and videoconferencing. This alone may be one of our greatest challenges. No matter how much technology is introduced, nurses need to ensure that our patients are not alienated, made uncomfortable or neglected because of its use. We need to continue to be advocates for compassionate and "soft touch" care in a rapidly evolving world of technology. In addition, we need to work toward improved health care access by the poor (often without computer access) and those patients in rural areas who deserve the best that health care centers can share with them.
While recently scanning a mail order magazine of novelty items, I ran across a wonderful T-shirt logo. It simply says "RUNNING WITH SCISSORS". The message is intended to convey a person sitting on the cutting edge of computers and technology. Many of you who read this ezine on the Internet are among those on the cutting edge of nursing and health care, using Internet communications to network, learn, educate and share. You can also be among those who work hard to ensure our patients do not get accidentally "cut" by the very scissors of technology that we are running with. We make sure the CARE goes into TeleCare.
Kathi Webster BSN RN is the Editor of TNT and can be reached via email at: tnt@katsden.com
The term "telemedicine" means many different things depending on whom you ask for the definition. And it frequently includes the discussion of whether the use of the word 'medicine' should be expanded to the more global teleHEALTH terminology or modified when being specific to teleNURSING, or even perhaps TeleCARE. It can indeed become a contest of words along with an identity crisis for those nurses involved in the practice.
Nurses involved in telephonics can be in some ways likened to the cyberfamily and the identity crisis occurring within the online Internet community -- both sharing the experience of technology forcing a group to "invent themselves". The definition of what cyberpeople or telenurses ARE cannot be located for easy reading and assimilation, there are no existing standards or rules that neatly fit, for they are being built as we move forward. This "allows the construction of new communities, able to generate social bonds that are otherwise lost or impossible. Most of all, virtuality is now an aspect of reality to be reckoned with."
[See an article from the WORLDPAPER at: http://www.worldpaper.com:80/June1996/rodota.html]
So how are nurses in telemedicine represented in cyberspace? The Internet offers a good assortment of web pages dedicated to telehealth projects although some with little or no mention of nursing activities. Take a tour to see the best that the net has to offer.
Visit the DOD Testbed at: http://www.matmo.org
Maria's article is at: http://www.matmo.org/pages/library/papers/nurserol/nursrol.html
The nature of the healthcare organization has demonstrated potential for reducing manpower costs by allowing support personnel to perform routine diagnosis and treatment, and freeing physicians to perform more complex tasks. As healthcare reform proposals emerge, it appears that a re-definition of roles will be an element in the final plan. At an appearance in Austin, Texas, Hillary Rodham Clinton said, "We need to be asking what physicians are doing, and we need to be asking why nurses are not doing more" (Clinton, 1993). The potential for non-physician healthcare providers taking increased responsibilities has long been a tenet of telemedicine. Muller et al., (1977) and Cunningham et al., (1978) described an inner city project in New York with the objective of minimizing costs by using nurses, and not making unnecessary referrals. Cunningham et al. examined whether physicians could be replaced with nurse practitioners assisted by telemedicine links, and concluded that pediatric nurse practitioners could function with televised consultation, rather than on-site supervision, 40% of the time. Muller identified that, because the physician was needed only rarely for consultations, the addition of a physician devoted to telemedicine consultations was only justified if there were at least five satellite clinics and full network utilization of 1,750 hours per year.
In addition, Mary Moore shares information on TeleHealth Cost Justification -- the first I've seen of this type on the Internet, along with Elements of Success in Telemedicine Projects. Her dissertation was entitled "Characteristics of Early Adopters of Telemedicine" and examined the sociodemographic, personality and communication characteristics of those who adopt telemedicine. She shares information on the American Telemedicine Association. To thank Mary for her wonderful contributions to telemedicine on the Internet, visit her home page and send her the title of your favorite "uplifting" movie.
Telemedicine article at: http://naftalab.bus.utexas.edu/nafta-7/telepap.html
Cost justification is at: http://naftalab.bus.utexas.edu/nafta-7/costjust.html
Elements of Success is at: http://naftalab.bus.utexas.edu/nafta-7/elemsucc.html
Mary Moore's Home Page at: http://naftalab.bus.utexas.edu/~mary/mzmoore.html
The ITSR is at: http://www.kumc.edu/instruction/medicine/ITSR/ITSR.html
TIE can be found at: http://tie.telemed.org/
The WAMI site is at: http://www.fammed.washington.edu/telemed/
ITC is at: http://int-telemedicine.com/index.html>
Nurses no doubt are very much a part of all these projects and all these organizations. The presence of nursing on the Internet and in informatics falls well behind that of our physician colleagues. Without citing a supporting research study, one needs only to look at statistics of the Internet male/female ratio, do some quick counting of physician versus nursing web sites, and just generally be positioned with your head out of the sand. But with so many of us in telenursing and nursing now sharing the computer skills necessary to speak together as a cyberfamily, we have the potential to lift ourselves from our sometimes hidden position and move into a more prominent one. We can all get connected.
[The list above of telehealth sites is hardly complete. TNT would be glad to feature any Telemedicine or TeleNursing sites that put focus on the nursing component of TeleHealth. It will also publish editorials with a agreeing or differing view on this topic from nurse readers. If any of the above sites has a nursing component that was omitted, or readers know of a site with nursing involvement that should be featured, contributions are appreciated.]
The abbreviation POTS stands for "plain old telephone system". Telephone triage nurses are quite comfortable with this primary tool of communication with patients, sans the wonderful bells and whistles that telehealth nurses have access to. However, even the simplicity of this tool can have its share of technological problems.
Security of Information
Many nurses rely on cellular phones when on the road or for backup systems, and may make contact with their patients. It is not always common knowledge that armed with certain radio scanners, anyone can listen in on a cellular call from as far as 100 miles away. In fact, eavesdroppers purposefully scan the airwaves for tidbits of information from cellular and cordless phones and baby monitors. Your telephone can literally become a "broadcast station" to anyone -- neighbors or strangers.
What type of radio scanner? The same scanners used by radio enthusiasts in private homes to monitor police, fire and EMS calls. Although newer scanners do not allow for cellular monitoring as sold, older models were easily modified to do this with step by step instructions available in radio and science magazines, bulletin boards, and the Internet. According to one Internet source in an article on scanners, FCC regulations state if you are caught listening to a cellular or cordless phone call for financial gain or not, you can be fined or imprisoned. But do people listen in? You can bet on it.
The FCC or Federal Communications Commission is a US independent government agency charged with regulating interstate and international communications by radio, television, wire, satellite, and cable. They provide a fact sheet on the interception of radio communications including cellular phones at their Internet site, this one dated January 1997.
The cellular industry is attempting to combat phone fraud through a variety of strategies including the scrambling of signals. But one of the best ways to take personal control now is to be a consumer aware of the problem from the beginning. Enjoy the technology but stay abreast of its limitations.
Rule of thumb: NEVER use a cordless or cellular phone to discuss financial matters, personal health matters, or make credit-card purchases. Switch over to a regular phone whenever you must provide or discuss personal information with anyone. Perhaps technology will ensure a permanent answer for this problem in the future.
For more tips on how to avoid cellular fraud and monitoring, check out this article from the San Diego Union Tribune entitled The Phone is a Broadcast System.
SD Tribune article is at: http://www.uniontrib.com/reports/privacy/950704privacy_side.html
Scanners article is at: http://www.gim.net/cp/1995/0720/src/article004.html
FCC Fact sheet is at: http://www.fcc.gov/investigation.html
Caller ID
Automatic Number Identification or "Caller ID" is becoming a common feature in many parts of the U.S. It is a special telephone service that allows the recipient of a telephone call to easily identify the caller using an "ID box" that lists the phone number of the caller. Many of us who use the ID system proactively enjoy its benefits (such as knowing when NOT to answer the telephone) and who called but didn't leave a message.
Those triage nurses who do make calls from home, a procedure not uncommon during peak call times and seasons or with a decentralized office, appreciate the ability to cancel caller ID with a telephone number "block" code. Who wants to receive a return phone call from a patient at a later date to our homes, especially when one isn't on call!? Some people program their phones to refuse any "blocked" calls, so the nurse cannot return the call without divulging their location. Some call center policies stipulate these calls are returned to someone at the main office to handle.
To make matters more complicated, some citizens consider Caller ID an invasion of privacy because it "compels the disclosure of personal information, without the consent of the caller". This alerts us to issues related to the right to privacy. Any such conflict should remind us that with the introduction of each new information technology, we must carefully examine and assess the impact on personal privacy, and on our relations with those in our care.
An interesting article on Telephone Privacy in the 1990's is at:
http://nemo.weeg.uiowa.edu/clipping/telephone-privacy.html
Nursing Education's Agenda for the 21st Century can be located in a Position Statement at the website of the American Association of Colleges of Nursing. This statement delineates a suggested role for nursing education in the context of Nursing's Agenda for Health Care Reform, the goals of Healthy People 2000, and evolutions in health care delivery. Mandatory reading for nurses and educators alike.
The position statemet is at:http://www.aacn.nche.edu/Pubs/nrsgedag.html
The AACN is at: http://www.aacn.nche.edu/index.html
Instructional Technologies in the Classroom is a topic addressed by Veronica D. Feeg. She discusses how nursing faculty must be able to survive and thrive in future educational environments that are expanded beyond the bricks and mortar of traditional classrooms. Her vision includes: specially targeted listserves and discussion pages on the internet; interactive web pages on the World Wide Web; video, graphic and audio enhanced slide presentations; customized digitized video presentations; interactive clinical and non-clinical learning material; and databases of nursing resources locally and on the internet. This article is part of a the larger E-Dimensions, an electronic publication from the College of Nursing and Health Science at George Mason University.
The URL is at: http://caliban.ido.gmu.edu/dimensions/dimensions_3/insttech.html
E-Dimensions is at: http://www.ido.gmu.edu/dimensions/
The Online Journal of Issues in Nursing helps to educate nurses in current affairs in the nursing world. Published by Kent State University School of Nursing in partnership with the American Nurses Association, it sports special sections on advanced practice, a legislative column, managed care, and letters to the Editor. Well worth reading.
The URL is at: http://www.nursingworld.org/ojin/ojinhome.htm
Not devoted to nursing but of note here, the New Millennium is a UK based Internet ezine focusing on the future. Included on their journalist team is Carrie Hind, a "practising Midwife with 16 years nursing experience. She covers health issues for the zine and has a keen interest in promoting sexual health amongst both men and women." Carries shows us the potential for nurses to interact with the community and cyberspace. Check out her articles, Healthy sperm and Is it still different for girls?.
The ezine URL is at: http://www.garfnet.org.uk/new_mill/index.htm
For the full listing of US Health Observances, check out:
http://nhic-nt.health.org/nho97a.htm
The Himalayan Rescue Association - Nepal has a site with information about altitude sickness. Acute mountain sickness or AMS can range from mild to severe symptoms. High altitude cerebral edema (HACE) and high altitude pulmonary edema (HAPE) are two diagnoses found on the severe end. Nurses will find this site quite informative, both in general information and the clinical treatment guide. Other trekkers topics are: travelers' diarrhea, water treatment, high altitude cough, and helicopter rescues.
The URL is at: http://www.gorge.net/hra/
For a glimpse at nursing in the Netherlands, check out Warrink's Homepage. Derk Jan Warrink RN lives in a town called Drachten in Friesland, a province in the north of the Netherlands. Derk teaches Nursing and Pathology at the department Nursing, Care and Welfare of Friesland College. Much of this site is in English, for those of us unacquainted with the Dutch language. The Dutch Nursing Home Page can also be found at this site. Do visit.
Warrinks HomePage is at: http://www.cybercomm.nl/~warrink/index.html
The Israel Cancer Association has been at the forefront of this country's fight against cancer since 1952. The ICA is responsible for Israel being counted among the most advanced nations for Linear Accelerators per capita, equipment which is vital for providing the most advanced treatment of cancer. The organization is also responsible for having generated public awareness to the extent that screening for early detection of breast cancer increased ten-fold over a three year period. As per this site "The fight against cancer is a matter of global concern."
The URL is at: http://www.cancer.org.il/
1997 Annual HIMSS Conference & Exhibition: "The Big Picture"
What: HealthCare Information and Management Systems Society annual event
When: February 16-20, 1997
Where: San Diego, California
Contact: About conference activities or HIMSS Membership
Call: 312/664-HIMSS (312/664-4467) (9:00 am - 5:00 pm Central)
E-mail: himss@himss.org
URL: http://www.himss.org
Free Faxback Forms and Information: 1-800/HIMSS-11 (1-800/446-7711) Request document #2003
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
Global Forum III, Telemedicine: A Bridge to the 21st Century
When: 4-6 March, 1997
Where: Sheraton Premiere Hotel, Tyson's Corner, 8661 Leesburg Pike, Vienna, VA 22182
What: The U.S. Army Medical Research And Materiel Command, in conjunction with Georgetown University and the Association of the U.S. Army, will conduct Global Forum III. As dramatic changes in health care delivery continues, information and communication technologies have become critically important enabling tools to improve quality, and reduce the cost of care. In traditional military, government and private sector health care systems, many intended and unintended barriers have evolved making delivery of health care to all beneficiaries difficult and at times impossible. Proper use of information and communication
technologies can obliterate these barriers. New health care processes must be developed to take advantage of these new technologies. In the past two years, the National Forum on Telemedicine focused on the projection of health care capabilities to remote areas and the deployed environment. This year, the Global Forum will focus on ways in which new technologies will be integrated at the home base as well as in the remote and deployed environments. Professionals in health care and information technology from the military, civilian government agencies, academia, and industry will meet to continue the partnerships established in the earlier National Forums, and to forge new progress in the building the medical bridge to the 21st century.
URL is at: http://www.matmo.org/global/forum.html
Nursing Research: Guiding Practice into the Next Millennium
When: March 14-15, 1997
Where:Honolulu, Hawaii
Keynote Speaker: Vernice D. Ferguson, RN, MA, FAAN, FRCN, Senior Fellow, Fagin Family Chair in Cultural Diversity, University of Pennsylvania School of Nursing
URL: http://www.tamc.amedd.army.mil/news/newscopy/research.htm
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.
Clinical Aspects of Telephone Triage
When: May 3, 1997 Saturday 8:00-4:30
Who: Sponsored by The Children's Hospital After Hours Care Program Denver, CO 80218
Notes: Featured Speaker - Bart Schmitt, MD, Keynote Address "Office Telephone Triage: The Basics"
All inquiries for brochures should go to:
The Children's Hospital, Nursing Education/Conferences Department
Telephone: 303-861-6150 or 303-861-6123
Critical and Feminist Perspectives in Nursing Conference
When: 12 June 1997 - 15 June 1997
Where: Whistler, BC.
What: "Crossing Borders-Exploring Connections," is the title of a conference that brings together nurses and others interested in exploring issues of healthcare delivery that are explicit in their aims of exposing socially constructed boundaries as they exist in the practice and research of health care.
Who: Call 412/578-6322 for information
9th International Nursing Research Congress
When: June 21, 1997 Canada
What: "Sharing the Health Challenge: A Research Perspective," the 9th International Nursing Research Congress, will be held in conjunction with the 21st Quadrennial Congress of the International Council of
Nurses, June 15-20, 1997, Vancouver, British Columbia, at the University of British Columbia Conference Center. Sponsors: Sigma Theta Tau International in cooperation with The University of British Columbia School of Nursing and Xi Eta.
For more information contact:
Vancouver Congress
Sigma Theta Tau International
550 West North Street
Indianapolis, IN 46202 USA
URL: http://stti-bl.iupui.edu/
The American Medical Informatics Association has recently posted its call for participation for the Fall Symposium to be held in Nashville on Oct. 25-29. The conference theme is "Internetable Health Care" and "Systems that Really Work". Any nurses active in systems work should pay attention to this opportunity. The Nursing informatics world needs to hear about what you are doing - submit an abstract! This conference is a great forum for interdisciplinary contribution. It is important that nurses involved in this domain be heard by other professionals. Otherwise - we become once again the invisible or silent partner....The deadline for abstract submission is March 20, 1997.
For more information visit: http://www.gl.umbc.edu/~abbott/nurseinfo.html
[information modified from an email message to a nursing listserv by Patricia Abbott, MS, RN,C]
[Some conference information is obtained directly from the Web. The editor of TNT is not responsible for any errors related to conference detail and all information should be confirmed with conference directors]
The word is out that a new specialty Nursing organization is forming devoted entirely to telephonic nursing. You can confirm this rumor as TRUE. You can expect to see leaders in the field taking part in its formation and that telephone triage nurses will be included. More information will be forthcoming when details are available.
The Nightingale Legacy
An intriguing article starts with the quote, "The time has come the walrus said to talk of many things, of sailing ships and sealing wax and cabbages and kings" from Lewis Carroll's Through the Looking Glass. Using Research To Make A Difference in Clinical Nursing Practice is written by Heather F. Clarke, RN, PhD, Nursing Research Consultant for the Registered Nurses Association of British Columbia, Vancouver, B.C., Canada.
She points to Florence's view, that nursing should be a search for truth. The next two lines of this same verse which she did not quote are also relevant -- "And why the sea is boiling hot -- And whether pigs have wings." All nurses should read this insightful article on evidence-based nursing practice. And while you're there, check out that site that houses this article, the International Child Health Nursing Alliance.
The article is at: http://www.ido.gmu.edu/ICHNA/clarke.html
The ICHNA is at: http://www.ido.gmu.edu/ICHNA/
OJNI
The Editors of the On-Line Journal of Nursing Informatics (OJNI), Dr. Renee M. Eggers and Dr. Dee McGonigle, have announced the e-publication of their first issue. For those who have access to the WWW, you can access the Journal by going to OJNI's website and clicking on "To the Journal." Subscribers who do not have access to the WWW will be able to obtain an e-mail version of Journal after the first of the year; an announcement will be made when the e-mail version is available. They encourage all subscribers to submit articles for publication consideration. OJNI's subscribers are from around the world, so there is a wealth of knowledge that can be shared! Keep in mind that OJNI is a peer-reviewed, professional journal.
The URL is at: http://cac.psu.edu/~dxm12/OJNI.html
A Lead on Leeds
The Nuffield Institute of Health located in Leeds UK, is internationally known for its excellence as an academic institution in the fields of health and social policy and management practice. More recently, it has broadened its base to include public health, health services research and community care research, underpinning the renewed focus on needs assessment and health and social care outcomes. The Institute provides the core of multi-agency projects such as the UK Clearing House on Health Outcomes, the European Clearing Houses on Health Outcomes, the series of Effective Health Care Bulletins, the national Health Management Information Service (HELMIS), the European Health Reform Network and Database, as well as the Community Care Innovative Practices Database.
Nuffield Institute of Health is at: http://www.leeds.ac.uk/nuffield/home.html
UK ClearingHouse on Health Outcomes: http://www.leeds.ac.uk/nuffield/infoservices/UKCH/home.html
The White Dove Flies
The Internet offers the frequent possibility to make new friends around the world via your modem. Solveig Hansen from Oslo, Norway extends himself and his ideas via his brainchild, The Global Human Web page. An interesting feature includes his White Dove that flies around the globe in virtuality, and reports are issued almost daily as to where this dove of peace has landed. Solveig is most interested in global matters (and Nobel Peace Prize laureates) and appreciates hearing from visitors to his website.
The Global Human is at: http://home.sn.no/~solhanse/global2.htm
Caring Sharing
February 14th is Valentines Day, and the Internet is gearing up for the event. Although named for a third century Christian martyr (the patron saint of lovers whose feast day falls on February 14th), the day is traditionally celebrated by the sending of cards or gifts to express love and affection. The cards are called "valentines" which are often decorated with hearts to symbolize love and carry messages of caring and endearment. The Home Arts Valentine's Day Special starts you on your way to a lovely day in cyberspace. Their links are fun to explore, even for the Valentine cynical. Next, a special edition of the Sugerplum Ezine links the sensual elements of food and love for your gourmet pleasure. For the romantic remarks impaired, the Cyrano Server helps to write your love letters for you, or assist you in dumping someone electronically.
The History of the Day: http://www.zia.com/holidays/valentine/history/default.htm
Homearts Valentine: http://homearts.com/depts/toc/00valec1.htm
Sugarplums is at: http://www.sugarplums.com/ezine.html
Cyrano is at: http://www.nando.net/toys/cyrano.html
Get Your Licks in
You definitely need a sense of humor to start a new Telephone Triage Nurse position. It is not always the clinical issues that I have learned the hard way. As a brand new Resource Nurse in 1990 I was mentioning how many calories I might be gaining daily while licking the envelopes closed on response letters to patients. The staff laughed at me, explaining that the hospital post office had a machine that sealed the envelopes closed. My response was: "Well this is definitely something to include in orientation instructions!" To this day I feel silly about this, but always get a good laugh.
[Submitted by Elizabeth Barnett RN - email to ebarnett@pond.com]
Come and ski Utah while working for a busy and rapidly expanding 24 hour call center.
Review Previous Issues of TNT
August 1996 - Introductory Issue
September 1996 - Featuring: OB Telephone Nursing
October 1996 - Hospice and Telephone Nursing
November 1996 - Telephone Nursing and Seniors
December 1996 - Special Holiday Issue
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 specialty.
Require all submissions by the 10th of the month for next issue inclusion.
Utah
IHC TeleHealth Services is part of Intermountain Health Care (IHC), which is widely known for its community based health information, triage/referral service. IHC TeleHealth Services has expanded into facilitating personal health management across the health care
continuum for IHC Health Plan members in Utah, Idaho and Wyoming, while maintaining
our community service line. IHC TeleHealth Services answers between 1100-1400 calls per
day.
We are currently hiring RNs for full and part time evening positions. Both these positions are benefit eligible. Minimum qualifications include a current Utah RN license with a minimum of 3 years high acuity nursing experience. Must enjoy
working with people on the telephone. Must be able to sit for extended periods of time and
talk while typing with few errors.
Send all inquires via E-mail to aajcall@ihc.com or call Jan at 801-978-4045.
Please include your name and phone numbers where you can be reached.
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.
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