APPLICATION OF THE TELEPHONE NURSING PROCESS MODEL
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1 APPLICATION OF THE TELEPHONE NURSING PROCESS MODEL M. Elizabeth Greenberg, PhD, RN-BC, C-TNP Assistant Clinical Professor Northern Arizona University Tucson, Arizona
2 OBJECTIVES Describe the Telephone Nursing Process Model Discuss model application to practice 2
3 WHY DO WE NEED A MODEL OF THE TELEPHONE NURSING PROCESS? 3
4 THE STUDY Method Grounded Theory Sample 10 RN s 4 TN programs Analysis In-depth interviews Data comparison Validation by participants 4
5 ESSENTIAL COMPONENTS OF TELEPHONE NURSING Three phase model of care delivery One central unifying concept Factors influencing the call 5
6 THE MODEL OF CARE DELIVERY IN TELEPHONE NURSING PRACTICE > < PHASE 1 Gathering Information GETTING STARTED Connecting Questioning Redirecting Getting to know INFORMATION SEEKING Investigating Focusing Verifying Clarifying Comparing Ruling out SECONDARY GATHERING Information Seeking > INTERPRETING: Translating data from the caller into healthcare information Translating healthcare information into language the caller can understand < PHASE 2 Cognitive Processing DETERMINING Relating Processing Verifying DECISION-MAKING Signs & symptoms Other caller needs PLANNING Thinking ahead PHASE 3 Output DISPOSITION 911 ER UC Appointment Advice Referral Other SUPPORTING Reassuring Encouraging Validating Teaching Aftercare > < COLLABORATING Giving options Problem solving Following-up CLOSING THE CALL M. Elizabeth Greenberg RNC, PhD
7 INTERPRETING One central unifying concept Related to all other model concepts Two-way process Explicit and implicit data 7
8 THREE PHASE MODEL OF CARE DELIVERY Gathering Information Cognitive Processing Output Generally sequential but also simultaneous and recurring Goal oriented 8
9 THE MODEL OF CARE DELIVERY IN TELEPHONE NURSING PRACTICE > < PHASE 1 Gathering Information GETTING STARTED Connecting Questioning Redirecting Getting to know INFORMATION SEEKING Investigating Focusing Verifying Clarifying Comparing Ruling out SECONDARY GATHERING Information Seeking > INTERPRETING: Translating data from the caller into healthcare information Translating healthcare information into language the caller can understand < PHASE 2 Cognitive Processing DETERMINING Relating Processing Verifying DECISION-MAKING Signs & symptoms Other caller needs PLANNING Thinking ahead PHASE 3 Output DISPOSITION 911 ER UC Appointment Advice Referral Other SUPPORTING Reassuring Encouraging Validating Teaching Aftercare > < COLLABORATING Giving options Problem solving Following-up CLOSING THE CALL M. Elizabeth Greenberg RNC, PhD
10 FACTORS INFLUENCING THE CALL Internal Prioritization Complexity External Nurse Characteristics Organizational resources Process and Output Validation 10
11 MODEL VALIDATION > 80 Participants, 16 groups of 5 or more Fit your TNP experience? Yes 14/16 groups Is anything missing? No 11/16 groups This model is useful for Educating/orienting, developing competencies & benchmarks, adds consistency to practice, guiding research 11
12 APPLICATION OF THE MODEL Practice Education System Support 12
13 APPLICATION OF THE MODEL Practice Develop benchmarks for evaluating practice outcomes Improve consistency of TN care Guide research to determine optimum execution of the phases of the TN process. 13
14 APPLICATION OF THE MODEL Education Educate & orient nurses in TN practice 14
15 APPLICATION OF THE MODEL System Support Promote organization valuing of, and resources for, TN practice 15
16 THE MODEL OF CARE DELIVERY IN TELEPHONE NURSING PRACTICE > < PHASE 1 Gathering Information GETTING STARTED Connecting Questioning Redirecting Getting to know INFORMATION SEEKING Investigating Focusing Verifying Clarifying Comparing Ruling out SECONDARY GATHERING Information Seeking > INTERPRETING: Translating data from the caller into healthcare information Translating healthcare information into language the caller can understand < PHASE 2 Cognitive Processing DETERMINING Relating Processing Verifying DECISION-MAKING Signs & symptoms Other caller needs PLANNING Thinking ahead PHASE 3 Output DISPOSITION 911 ER UC Appointment Advice Referral Other SUPPORTING Reassuring Encouraging Validating Teaching Aftercare > < COLLABORATING Giving options Problem solving Following-up CLOSING THE CALL 16 M. Elizabeth Greenberg RNC, PhD 2005
17 QUESTIONS/COMMENTS 17
18 REFERENCES Greenberg, M.E. (2009). A comprehensive model of the process of telephone nursing. Journal of Advanced Nursing, 65(12), Rutenberg, C. & Greenberg, M.E. (2012). The art and science of telephone triage: How to practice nursing over the phone. Hot Springs AR: Telephone Triage Consulting, Inc. 18
19 Liz Greenberg PhD, RN-BC, C-TNP
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