This issue of TNT is focused on cultural diversity and how it can and should modify our nursing practice and interventions with patients. Due to a lack of specific online materials on this topic, I have used a collection of the best links that the Internet could offer, woven into a framework suitable for the nursing profession. Where possible I have added material specific to the telephone triage nurse based on my greater than ten years working in the specialty. I hope you find it of benefit. -- K Webster RN, Editor
How often has the culture or ethnicity of a patient caused problems with your ability to assist them with health care needs on the telephone? What do you know about culture, communication and language? Are you unsure what is meant by culture? Culture can be defined as the customary beliefs, social forms and material traits of a racial, religious, or social group. It can also be a set of shared attitudes, values, goals and practices that characterize any group.
There are macro cultures (e.g. national, ethnic or racial groups) and micro cultures (e.g. gender, age, religious beliefs) which can be combined and shape an individuals life view and influence their interaction with others. For the sake of this article, the macro cultures will be focused on. The fact that cultural health practices have an impact on health-seeking behavior is not new despite the recent upsurge of interest. Ignorance of culture factors can affect rapport, cause misinterpretation of communications and behavior, and even influence clinical outcomes. At the same time we are called upon to avoid prejudice -- an attitude about another person or group of people based on stereotypes about their culture or ethnicity.
America is a country with many races and cultures, both native minorities and from immigration. According to the Diversity Rx website, statistics from the 1990 Census indicate 31.8 million residents of the United States, or 14 percent of the total U.S. population, spoke a language other than English at home. Not only a issue in the US, many countries have target populations known to require special approaches for optimal health care and education such as the aboriginal people of Australia.
Transcultural nursing is a special knowledge area that focuses on the diverse lifeways of cultural groups and how to provide optimal nursing care based on this diversity. Nurses should receive at least basic education on the knowledge and skills necessary to deliver competent nursing care in a culturally relevant and sensitive way. According to the Transcultural Nursing Society, the formal area of transcultural nursing practice is over 45 years old, conceived in the mid-1950's by nurse anthropologist, Madeleine Leininger. Dr Leininger recently retired from the faculty at Wayne State University College of Nursing. In 1969 the Council on Nursing and Anthropology was formed by the first nurses to receive doctorates in anthropology. Medical Anthropology is the theory of anthropology applied to nursing, medicine, hospital organization, and the therapeutic environment.
Internet Links for section:
Nurses who use the telephone as a frequently used tool in their practice have long understood the power and importance of language and verbal skills. Recruiters look for superior communication and telephone skills when searching for the best telenurses. Some telehealth managers have been known to perform their first interview of a telenurse applicant over the telephone in order to check for basic skills. The nurse on the phone is essentially blind and handcuffed -- able to use only the senses of hearing and speech to make an assessment. Sights, gestures and body language are not available. The caregiver or patient must touch, probe and feel on behalf of the nurse, a proxy relationship. Callers with different cultural norms are at risk if nurses have little knowledge, sensitivity or appreciation of the diversity in communication styles.
Even a shared language can be problematic when regional idioms or accents enter the picture. Folk terms used in Oklahoma, Arkansas and Texas may not be known by nurses living in other parts of the United States. I vividly remember an early telephone encounter when a caller used the term "a risin" to describe their problem. I had moved from New England to Florida, was new to telephone nursing practice, and was unfamiliar with local health idioms. I asked the person if they meant "a raisen". They didn't. It was embarassing, but after a series of questions I surmised the caller meant a "boil". I quickly substantiated the meaning of the term with a southern-born colleague at the call center and was able to help the caller.
Here are some examples of local expressions of health problems with their "translation".
Idiomatic conflict may lead to excessive interruptions during a telephone call, and the caller may lose their original train of thought. thus appearing disorganized to the nurse. The caller may experience either a lowered self-image due to difficulty in being understood, or have a poor image of and become angry with the nurse who does not seem to understand "plain english."
The language issue is compounded if printed materials are abundantly available but not supplied in minority languages or written with too much medical jargon. Written information and instructions should be clear, consistent with community standards, credible, and relevant. Print materials should never be simply translated verbatim from the English; concepts may differ by culture just as the words do.
Effective communication in disease prevention includes "readability testing" of written materials, ensuring they match the educational level of patients. One such system used is called the The SMOG Readability Formula involves counting the number of polysyllabic words and approximating the grade level based on the count. Fine print can make readability impossible for an elderly patient. The proper formatting of text can make or break a health brochure.
Silence and non-verbal communication still have a place in telephone triage nursing, sans body language. The savvy triage nurse will learn to listen to the caller's environment through the telephone receiver, which can give many clues to the problem at hand. Wheezing, stridor and grunting respirations might be heard over the telephone, although not to be counted on. An asthmatic patient who can talk in sentences helps to rule out respiratory distress. Background sounds such as the strange cry of a child or a family argument can assist in the overall assessment. Misinterpretations can also occur, as when a Japanese caller starts to laugh while expressing a negative experience or has long pauses when asked for information. Listening "between the lines" should include cultural awareness.
Telephone skllls are not the same as face-to-face communication skills. Our voice and our attitude may project a different picture to the caller than the one we intended. Professional communcation skills should be a priority for development by all health care professionals, whether they are mostly conducted in person or via telephone.
Points to remember to improve cross cultural communication on the telephone:
Internet Links for section:
Spatial geography may contribute to a homogenous cultural identity, the island of Japan being such an example. But space and culture can also cause considerable difficulties, witnessed by the collective identity of Québécois in Canada. Rather than dwelling on geography boundaries and culture, I will instead focus on issues of interpersonal space.
Every person has a spatial comfort zone that determines how physically close they can be to another in a conversation and still be comfortable. Proxemics is the interrelated observations and theories pertaining to the use of space as a specialized elaboration of culture. This involves such features as posture, body orientation, gestures, seeking or avoiding touch, desired distances between learners, and seating arrangements. Included in proxemics is nonverbal communication such as the amount of physical contact used during communications. People from Latin American countries prefer contact while many Asian people definitely do not.
The telephone is now a major tool of interpersonal communications in many industrialized nations. On the telephone we communicate instantly with each other as if we were in a physical common space and we regard the event as real. But not everyone finds telephone interactions an equally comfortable experience. The Amish banned the telephone from the home in 1909, later banning the radio and TV as well. H. G. Wells, in his "Experiment in Autobiography" (1934), complained about the invasion of privacy spawned by the telephone. The answering machine to screen calls suggests that some in society are still not comfortable with the idea of transparency and instant unannounced communication.
Not all countries have a telephonic culture as in the United States. In Spain, Telefonica reported that telephone customers generally only spend an average of nine minutes per day using its equipment. This may be based partly on the fact that back in the mid-80s, Spainards had to deal with terrible waits for even basic telephone connections. The average wait for a telephone installation in sub-Saharan Africa currently stands at nine years.
In the US not all our patients have telephones in their homes (or even homes if you include the homeless) and they may use a neighbors, family or public phone to contact us. It helps to have special policies in place to expedite answering a telephone call from someone who may be difficult to call back. Some call centers in fact will take incoming calls from pay phone callers immediately rather than risk the loss of a follow up contact. And not to be forgotten, the issue of confidentiality in telephone contacts is important. We must respect our patients private "space" along with adhering to laws related to privary of health information, especially when using cellular phones and leaving messages on answering machines.
Internet Links for section:
There are normal variations in skin color and general body structure among races, a fact that should be a source of joy as we recognize the diversity of human life. Although most skin diseases that occur in the white population also occur in black individuals, certain skin problems are more common among blacks. Skin color is determined by cells called melanocytes and all races have the same number of these cells. In black skin, melanocytes produce more pigment and produce it faster than in white skin. Skin problems more likely to be encountered in blacks include dermatosis papulosa nigra ("flesh moles"), vitiligo (irregular white patches), and keloids (extensive scar formation).
Black women tend to have few wrinkles than their white counterparts, their skin better able to resist sun damage. Some of the most darkly pigmented people in the world live on the Solomon Island. They rarely have any skin cancer (carcinoma or melanoma). Europeans living in Hawaii, on the other hand, have the highest documented skin cancer rate in the United States. It is clear that darker pigmentation protects from skin cancer.
Rash assessment is always difficult over the telephone unless the ideal or classical symptoms exist. Skin conditions present quite differently in populations of different ethnic origin and skins of different pigmentation. If a nurse is not familiar with how a skin condition presents on a variety of skin pigmentations, he/she may have great difficultly giving a proper disposition. Using a family member to give a detailed description of a skin condition along with their own experience with similar rashes within family members of the same race is most helpful.
There are normal variations in the size and shape of people within cultures and races in the world, from the pygmies of Zaire to the aboriginal people of Australia. There are growth disorders that can change the normal body structure, caused by genetic, hormonal or nutritional disorders.
Sickle-cell anemia occurs in about one in 400 black newborns in the US. Perhaps not as well known, the disease is also prevalent in many Spanish-speaking regions of the world, such as South America, Cuba, Central America and among the Hispanic community in the United States.
Internet Links for section:
For some indigenous peoples of the world, an important issue is day-to-day survival, such as for the Mayans, Tibetans or the Gwich'in Nation in Canada. The turmoil within their environment has brought the basic needs of food, clothing and shelter to the forefront of their lives.
In the US, the Native American tribe of the Yankton Sioux uncovered in a 1993 health survey major distrust and discontent with health care provided by the Indian Health Service, a lack of preventive and early detection measures in regard to cancer, and a disturbing lack of condom use. Furthermore, alcohol related deaths were particularly high while the practice of breast feeding was uncommon. The rate of diabetes in the Native American community was much higher than the average of the general US population.
The Hispanic/Latino community has experienced a dramatic growth in the US, a group that consists of diverse subgroups, including Mexican Americans, Puerto Ricans, Central Americans, South Americans, and Cubans. The major causes of death for Hispanics in 1992 included (in order):
Although the first two causes of death are shared in the same order with non-Hispanic white and black populations, the last three are not. Life expectancy is lower for both Hispanic men and women than for other non-hispanic whites, although higher than those expected for the black population. From a 1989 CPS survey of health insurance coverage in the US, Mexican American's were most likely to be uninsured, with Cuban Americans, African Americans and Puerto Ricans next in line.
For many Hispanic elderly, God is the only doctor. This culturally-grounded belief can provide a sense of peace and the feeling that everything in life will turn out as God wants it and there is no need to worry about the uncontrollable. However, the belief can interfere with the acceptance of prevention practices. Many Hispanic elderly practice folk medicine, especially for colds and stomach problems.
Internet Links for section:
Be aware your caller may be culturally unaccustomed to an emphasis on punctuality. Westerners and Asians approach time differently. Culturally, Westerners live more in the present and the near future. Asians live more in the ancient past or in the distant future. Asians try to avoid a neurotic slavery to time, viewing life as a passing moment in eternity. and do not require an immediate goal or an urgent objective. Americans, in particular, tend to live by time-pressing schedules and deadlines. In Italy, punctuality is again not of utmost importance and light conversation is expected to precede serious discussion.
Time isn't the only element of measurement that may vary between cultures. Basic units of measurements continue to exist despite efforts toward international standardization. The United States is the only industrialized country in the world not officially using the metric system. Despite two congressional bills, a process of voluntary conversion has not been successful. The Omnibus Trade & Competitiveness Act Of 1988 amended a 1975 law by making metric the "preferred system of weights and measures for United States trade and commerce" and charged Federal agencies with converting to the metric system to the degree economically feasible by the end of fiscal year 1992.
Despite the fact that US hospitals and health systems are comfortably using the metric system in current practice, many of our patients and families in the US still have, buy and use thermometers that have Farenheit rather than Celcius measurement for body temperature. In addition, they may use measures such as teaspoons or tablespoons rather than millimeters or cubic centimeters. As telephone nurses we often find ourselves helping our clients in the conversion process.
Internet Links for section:
Kinship is the most basic principle of organizing individuals into social groups, roles, and categories. Anthropologists study kinship to find universal patterns and the variabilities in society. Features studied include the infant maturation period, marital bond, division of labor by sex, and prohibition of sexual relations between relatives. In a heterogeneous society there is a diversity of customs and belief systems which provides parents with a range of child rearing choices.
The attitude toward breastfeeding is one aspect studied by anthropologists and scientists alike. In Cambodia, most women breastfeed their babies and breastfeeding in public is common with older mothers. Breastfeeding is thought to make their baby strong, smart, and obedient to his parents. But child rearing cultural patterns can change drastically when mothers find themselves in difficult environments with inadequate support to continue them. With Cambodian immigrants studied in Seattle Washington, many women feel that breastfeeding is very difficult because of school, job, and household responsibilities so they turn to bottlefeeding as more practical, and some start feeding their baby rice soup as early as six weeks. It is well established that breastfeeding protects newborns from disease and should be encouraged.
In Japan with the high cost of housing and lack of child care facilities, a dropping birth rate is expected to continue. The average marriage age is rising, reaching 28.32 years old for men and 25.76 years old for women in 1992. The declining child population will no doubt change all aspects of Japanese life in the future, with an expected growth in the senior population as has occurred in the US.
Internet Links for section:
The ways in which beliefs and behaviours of the population influence the origin of disease on the one hand, or its prevention on the other hand, is of increasing significance in the modern world. The following sampling of multicultural health care tips are good ones for the nurse on the phone.
Anthro-L, general anthropology list service
At the 1997 Annual Meeting held in Chicago, August 19-23, the National Council of State Boards of Nursing (NCSBN) took a giant step forward in the advancement of nursing regulation.
Delegates unanimously adopted the following recommendation:
Under this concept, boards of nursing agree to work toward an interstate compact, under which nurses would hold a license in one state and be able to practice in any state, provided they follow the laws and regulations of the state in which they practice.
According to the National Council of States Boards of Nursing Web site at http://www.ncsbn.org , delegates rose in standing ovation, applauding the historic event. AND SO SHOULD WE!
This proposal is vital to the long range health of both telephone nurses and ALL nurses in the US!
This is only the beginning of a long road toward acceptance. There are many challenges to be overcome before an interstate compact is a reality. Your state board of nursing will need all your support due to the potential for lost revenue under such a model. In the end, laws on the state level will need to be modified and approved by state legislatures.
Knowing it will take a lot of work and a coordinated effort to make this happen and while waiting for implementation details from the NCSBN, I urge all nurse readers to do the following:
Read Telecommunications and Health Care: Interest Escalates as Potential Benefits Are Recognized
Checkout the the August issue of TNT for background issue on the mutual recognition model and why it is so important to telephone nurses, in an editorial entitled A Simmering Editorial: Driving Toward a Definition of Real Nursing
Visit the League of Women Voters webiste at http://www.lwv.org for more info about registering to vote.
Dear TNT
Our hospital-based phone service is reviewing our QA tool. How can I reach other triage programs and ask them to fax me a copy of what they use? The kind of QA we want to cover is patient/caller satisfaction.
Thanks, Mary Frazier, RN
Dear TNT
Just a quick note to let you how much I really like your TNT pages. I'm trying to teach my fellow nurses at work how to use the Web & your place
will definately be one of our stops. Maybe next summer one of your topics could be on Lyme Dz & other nasty bites, bruises & botanicals
(name your poison - oak, ivy, sumac...) that we get a ton of calls on. Keep up the great work!
Signed, Karen Courtney
Karen, in the meanwhile, you might find the following links helpful for your co-workers! -- Kathi, TNT Editor
Lyme Disease, Vineland Pediatrics
A message based chat or "BBS" system for Nurses in Telephone Practices is now available!
This web-based bulletin board is for communications between nurses, physicians and health care professionals specific to the specialty of Telephone Nursing, Telephone Triage/Advice or TeleNursing. You are invited to swap information about your telephone nursing or triage program(s), share information and network with others in your field.
TOPICS include: Staffing issues, software, guidelines, policies and procedures, adult and pediatric triage nursing.
The URL is at: http://www.katsden.com/wwwboard/triagebbs.html
Calling All Nurses: How to Perform Telephone Triage An article from SpringNet's Nursing97 by Sheila Q. Wheeler RN MS and Barbara Siebelt RN BA FASHRM
Use this practical guide to give your remote patient the same level of care you'd give him at the bedside. Includes: adapting your skills, avoiding pitfalls, legals concerns, and how to document.
You can even take the test online and earn 2 CE credits! Not to be missed!
The URL is at: http://www.springnet.com/ce/p707a.htm
Contemporary Forums
- Telephone Triage Conferences
How to Build a Telemedicine Program
Maximize Your Success in a Managed Care Environment by Telephone Management as a Critical Part of 21st Century Patient Care
[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]
During this last week the world suffered the loss of two wonderful women, from different locations and lifestyles yet both noted for their compassion to the common people.
OM MY
A nifty collection of stories from the Orient, mostly Zen and Taoist tales. The website is entitled Zen Stories to Tell Your Neighbors. The webmaster includes readers reactions and interpretations of the stories.
Wanted by Someone
You just never know when your neighbor Harry might be wanted for a bank robbery or murder by the FBI. Here's the FBI's Most Wanted website. Help clear the paranoia from your mind.
A man speaks frantically into the phone, "My wife is pregnant, and her contractions are only two minutes apart!"
"Is this her first child?" the doctor queries.
"No, you idiot!" the man shouts. "This is her husband!"
[EDITORS NOTE: All employment opportunities
have been submitted directly to the Editor of TNT for inclusion. Please
check with the manager or recruiter listed for all details and job requirements.
TNT takes no responsibility for verifying information submitted. Applicants
must deal directly with listed "reply to" or inquiry contacts. There is
no fee charged for posting employment desired or available, but submissions
must be of an acceptable size and format for the ezine.]
August
1996 - Introductory Issue
The Web Page
The Telephone Triage Nursing Web Site is at http://www.katsden.com/telenurse/index.html
Calling All Cultures
Introduction
Cross Cultural Communication Self Test -->http://www.nwrel.org/cnorse/booklets/ccc/table1.html
Care Providers Awareness of Diversity -->http://www.healthweek.com/features/diverse.html
Diversity Rx -->http://www.diversityrx.org
Australian Indigenous Health -->http://www.acithn.uq.edu.au/ihp
Transcultural Nursing Society -->http://www.nursingcenter.com/people/nrsorgs/tcn/
Review of Transcultural Nursing, Giger/Davidhizar -->http://wholenurse.com/review5.html
We Are One, Stop the Prejudice -->http://www.mca.com.au/one/
Communication
A problem with language can be immediately crippling during a telephone call. When a nurse is unable to speak the same language as a patient, an obvious barrier occurs that halts communication. One approach to resolve this problem is to have the patient speak with someone else who can communicate in their native language. An interpreter may be available in-house who has a good command of the language especially in consumer oriented medical terminology. Some telephone nursing call centers hire bilingual nurses for geographical areas with large minority populations such as Hispanics. Other health care systems subscribe to language lines offered by telephone companies or interpretive services. Without such translative options, a nurse could incorrectly assess a patient problem or convey incorrect or misunderstood health information. Many organized telephone nursing call centers have a policy on how to handle any language problem with a caller.
Which cultural pronounciations or dialectical accents are most difficult to understand will be partly dependent upon the nurses upbringing, exposure to accents, and level of previous telephone triage experience. Even a health care professionals own accent may be a barrier to effective communication. Our auditory training and discrimination are affected by the sounds we learned to identify in our native language. During my early years of telephone nursing, I found African-American, Asian and Indian callers most difficult to understand. Through years of practice and exposure to the accents I find them only occasionally an issue in a telephone conversation. Knowing your limits and when to transfer a poorly understood caller to another nurse is a strength in telephone nursing.
Recruiter Examples in Telephone Nursing -->http://www.katsden.com/telenurse/employ.html
Local Idiomatic Expressions -->http://www.onehorse.com/lexicon.txt
Dialects and Accents -->http://host.web12198.claimname.com/accentenglish/1dialect_acnt.html
SMOG -->http://www.emerson.edu/acadepts/cs/healthcom/Resources/message.htm#smogtable
Effective Communication -->http://www.emerson.edu/acadepts/cs/healthcom/Resources/commrole.htm
Japanese Non-verbal Communication -->http://virtualtimes.com/writers/ueda/thenon.htm
Professional Communication Skills Slideshow-->http://www.medinfo.ufl.edu/year1/bcs/slides/comm/index.html
Cross-Cultural Communication -->http://www.nwrel.org/cnorse/booklets/ccc/
Space
Materials for Adult Learners -->http://www-distance.syr.edu/train1.html
Cultural Communication and Proxemics -->http://www.unl.edu/casetudy/456/traci.htm
Protecting Privacy in Computerized Medical Info -->http://www.acl.lanl.gov/sunrise/Medical/ota/chapter1.html
MED-PRIVACY listserv -->http://www.essential.org/listproc/med-privacy/
Biological Variations
"Many of the systematic differences among races are adaptations to climate: melanin protects the skin against the tropical sun, eye lid folds insulates eyes from dry cold and snow. But the skin, the part of the body seen by the weather, is also the part of the body seen by other people. Race is, quite literally, skin deep, but the extent that perceivers generalise from external to internal differences, nature have duped them into thinking that race is important."
[ Stephen Pinker in Language Instinct ]"What exactly causes sickle cell anemia and how did it spread to so many different parts of the world? The answer lies in a curious coincidence. It turns out that anyone who carries the inherited trait for sickle cell anemia, but does not have the actual illness, is protected against the severe form of malaria. So in countries that had a problem with malaria, children born with sickle cell trait survived. Instead they grew up, had their own children, and passed the gene for sickle cell anemia on to these offspring. As populations migrated, the sickle cell trait and sickle cell anemia moved throughout the world."
[ MedAccess information ]
AAP info on black skin problems -->http://www.aad.org/aadpamphrework/black.html
Black and White Skin Diseases (book) -->http://www.blacksci.co.uk/products/books/27.htm
Black Women Have Fewer Wrinkles -->http://www.o2facial.com/bwrinkle.html
Human Growth Disorders -->http://www.genetic.org/hgf/index.shtml
Clinical Genetics Home Page -->http://www.kumc.edu/gec/geneinfo.html
MCC Anthropology Web Connection -->http://www.mc.maricopa.edu/academic/cult_sci/anthro/acwc2.html
MedAccess: Sickle Cell Anemia -->http://www.medaccess.com/h_child/sickle/sca_01.htm
Environmental Control
The Seattle area in Washington state has experienced an influx of refugee and immigrants from southeast Asia and east Africa. The Harborview Medical Center at the University of Washington has a website called EthnoMed where clinical pearls are shared on cross cultural medicine. This website states that patients from southeast asia may have health practices based on their traditional medicine which includes the concept of "hot" and "cold" conditions and foods. Homemade rice wine, herbal medicines, and coconut juice are taken to help give the baby good quality skin. For Cambodians, beer is thought to make the delivery easier. Ethiopian women prefer female doctors and interpreters, especially for child birth. Many think that US physicians are quick to perform Cesarean sections for what Ethiopians consider to be normal variations. For this reason, they may wait at home until well into labor in order to avoid unwanted procedures.
Cultural Survival -->http://www.cs.org/index.html
Tibet -->http://www.katsden.com/webster/tibet.html
EthnoMed -->http://healthlinks.washington.edu/clinical/ethnomed/
Health Status of Hispanics -->http://chico.rice.edu/projects/HispanicHealth/Courses/mod2/mod2.html
Closing the Gap: Aging and Minority Health -->http://www.os.dhhs.gov/progorg/ophs/omh/mayjun96.htm
Time and Measurement
Cultural and religious holidays are special events in the lives of many, and it may be easy to forget that not all celebrate those we are most familiar with in the United States. Kwanzaa and Martin Luther Kings Birthday may have more significance to African Americans than Thanksgiving or Christmas. Even the calendar year may vary. Chinese New Year, for example, can vary from mid-January to mid-Februrary of the Gregorian Calendar. Wishing someone a "Merry Christmas" during a telephone conversation may be culturally incorrect. Try to gain clues from your caller as to the significance of a holiday if you feel it will impact the outcome of the call. Being aware and supportive of people at times that have significance can help create harmonious connections.
Calendar and Culture -->http://curry.edschool.Virginia.EDU/curry/centers/multicultural/papers/richpaper.html
Amherst Eductional Publishing -->http://www.crocker.com/~amedpub/
Toward a Metric America -->http://ts.nist.gov/ts/htdocs/200/202/mpo_home.htm
US Metric Association -->http://lamar.colostate.edu/~hillger/
Social Organization
Kinship and Social Organization Tutorial -->http://www.umanitoba.ca/faculties/arts/anthropology/kintitle.html
Anthropology Resources on the Net -->http://www.nitehawk.com/alleycat/anth-faq.html
A BioCultural Approach to Breastfeeding -->http://www.lalecheleague.org/NB/NBNovDec96.html
Family Sizes in Japan -->http://www.jetro.go.jp/JETROINFO/SEEKING/4.html
Conclusion
Other Multicultural Resource Links
Conference: Through the Eyes of Others
Description: Celebrating Culture in the Nursing Home
Description: Impact of Cultural/Ethnicity on Perception of Health
Description: TransCultural Nursing Course
GlobalRN List service - discussion of nursing, culture and health care
Minority Health Network (MHNet)
Minority Health Project at University of NC at Chapel Hill
Minority Health Resources from Michigan State University
Resource Bibliography in Cross Cultural Nursing Theory
Resource Bib: Culture and Alzheimer Care
Recent Articles on Transcultural Nursing
Teaching Guide: Stereotypes and Prejudices
TransCultural Psychology List Service
Voice of the Shuttle - Minority Studies Page
US Nursing Takes a Giant Step
"That the National Council of State Boards of Nursing endorses a mutual recognition model of nursing regulation and authorizes the Board of Directors to develop strategies for implementation to be adopted by the Delegate Assembly."
Letters to TNT
Readers should feel welcome to respond directly
to any letters with e-mail addresses provided
fax: 510-376-6310 email: MFraz4641@aol.com
American College of Physicians - Lyme Disease
FAIRS: Lyme Disease
Insect Bites and Stings, MedAccess
Poison Ivy, Oak, Sumac: Univ of GA Cooperative Extension Service
Poison Ivy, Sumac, Oak: AAD Derminfo Net
In The Telephone Triage World
WWWBoard HOSTS:
Sheila Wheeler's website is at: http://205.186.245.11:80/teletriage/
Selected Conferences
When/Where:
September 28-30, 1997 in Seattle WA
October 12-14, 1997 in St. Louis, MO
November 6-8, 1997 in Washington DC
Intended audience: all telephone triage
practitioners, no matter what the setting,HMO, Home Health, ED, Public
Health, Community clinic or office. For nurse entrepreneurs, system managers
and administrators
For more information
contact: Contemporary Forums at (510) 828-7100
URL at: http://www.cforums.com
*****THIS IS A
CONFERENCE THAT IS NOT TO BE MISSED
BY ANY TELEPHONE
NURSES! THE BEST!**** [Editor's comment]
**THURSDAY, SEPTEMBER 11, 1997 registration deadline**
WHAT: An intensive, four-day symposium co-presented by The University of Vermont and top-ten telemedicine site Fletcher Allen
Health Care.
WHEN: Symposium Date: Sunday, October 12 - Wednesday, October 15, 1997
WHERE: On-site at Fletcher Allen Health Care--one of the top ten telemedicine
sites in the nation, The University of Vermont and The Sheraton Hotel & Conference Center, Burlington, Vermont
SPECIAL TRAINING FEATURES include required readings; hands-on training at more than 15 specially-designed telemedicine workstations; oral
presentations; small group interaction and networking; in-depth supportive instructional materials.
CONTACT: Register today by phone at 800-639-3188 or via e-mail at lphillip@zoo.uvm.edu to save $75 per person off the registration rate.
Creating Effective Medical Call Centers
WHAT: - Determine your medical call center's goals and objectives
- Understand the benefits for outsourcing vs. internal call center operations
- Learn about the latest issues, challenges, and additional functions for your call center
- Develop a communications strategy to market your call center
- Gain insight into the next generation of medical call centers
WHEN: October 30-31, 1997
WHERE: Westin Horton Plaza San Diego, 910 Broadway Circle, San Diego, CA 92101
CONTACT: Call 1-800-599-4950
WHAT: An opportunity for all health care staff to enhance their critical telephone management skills. Focus on: Legal Perspectives,
Communication Skills, Documentation Strategies. For all personnel working with patients on the phone (nursing and support staff). Speakers include
Carol Stock, JD, MN, RN. a national known expert on legal issues and telephone management and Patricia Lynch Grover, Manager of Customer
Service from Frontier Telephone of Rochester.
WHEN: Friday, November 14th, 19978:00-4:30
WHERE: Rochester General Hospital Hinshaw Auditorium. 1425 Portland Avenue Rochester, NY 14621
CONTACT: Call Division of Education with questions @ x716-338-4381
Internet On the Line
Diana and Teresa
The Death of Princess Diana is a website from CNN interactive focusing on Princess Diana.
Mother Teresa, Angel of Mercy is also from CNN interactive, with lovely stories and photos.
The Death of Princess Diana -->http://www.cnn.com/WORLD/9708/diana/index.html
A tribute to the "Saint of the Gutters" -->http://www.cnn.com/WORLD/9709/mother.teresa/index.html
Zen Stories to Tell Your Neighbors --> http://www1.rider.edu/~suler/zenstory/zenstory.html
FBI's Most Wanted --> http://www.fbi.gov/wanted.htm
Humor in FrontLine Stories
Telephone Misunderstanding
The following was snagged directly from the Internet...but it certainly sounds real to me!
Employment Line
==Florida==
All Children's
Hospital in St Petersburg FL is seeking
RN's for their telephone triage program which is currently setting the
clinical standard of excellence for Pediatric
services. This position offers RNs the opportunity to manage after hour
pediatrician office calls providing education, information, guidance, emotional
support, and counseling.
For more information contact: Wendy
Smith RN, Nurse Recruiter at 813-892-8222. Resumes may be sent to
All Children's Hospital, Human Resources, 500 6th Street South, POB 31020,
St Petersburg FL 33731-8920.
==Indiana==
Manager of Referral Systems and Physician Relations
RN needed to manage expanding medical call center in South Bend,
Indiana. Must have experience managing RN's and be proficient in using
a computer and quick to learn new software applications. Must also have
experience working with physicians and making presentations to medical
groups.
Position is with Memorial Health System in South Bend, Indiana
Please mail resume to Diane Stover, Memorial Health System, 615 N.
Michigan Street, South Bend, IN 46601 or Call Carol Lyle Ford at
219-284-3274.
Memorial is a community-owned independent health system
with over 2,200 employees.
==Utah==
Come and ski Utah while working for a busy
and rapidly expanding 24 hour call center.
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.
== AZ, CA, CO, IL ==
Access Health, Inc:
With call centers in Sacramento, CA, Phoenix, AZ,
Arlington Heights, IL and Broomfield, CO, we are a leading provider
of consumer information and referral programs for the health care industry.
Since 1986, our employees and products have been satisfying consumers'
needs for the information necessary to make appropriate health care decisions.
Our registered nurse counselors utilize our telephone-based products to
provide reliable medical information, and help consumers find appropriate
health care within a network of programs and services. We believe that
when individuals are empowered with information about the condition their
options and the resources available to them, they can make enlightened
decisions before seeking treatment. Opportunities exist in a variety of
shift options for Registered Nurses with exceptional communication skills.
You must have a current license in the state you desire to work, with a
minimum of 5 years acute care experience, and basic computer and typing
skills. In return for your expertise, we offer you competitive salaries
with shift and weekend pay differentials and premiums for holidays. If
you're interested in joining a nursing team that is focused on contributing
it's talents for a healthier population, give us a call or send us your
resume.
Our job line
is 800/246-5627. Or you may fax your resume to (916)856-3680. Our corporate
headquarters is located at 11020 White Rock Rd., Rancho Cordova, CA 95670
Can't Get Enough on
Telephone Nursing?
Review Previous Issues
of TNT
September
1996 - Featuring: OB Telephone Nursing
October
1996 - Hospice and Telephone Nursing
November
1996 - Telephone Nursing and Seniors
December
1996 - Special Holiday Issue
January
1997 - New Year, New Approaches [Telenursing/Telemedicine]
February
1997 - Spring Ahead!
March
1997 - Marching Forward
April/May
1997 - Celebration of Nursing
June/July
1997 - Men's Health
August 1997 - Summertime
Next months topic:
Just A HeartBeat Away
WANTED!