Communication Basics and Challenges in Telephone Triage
Katherine D. Mooney
Most health care settings utilize the telephone as a major source of communication between the practitioner and the patient. In telephone triage, the health care professional, usually a nurse, speaks directly to the patient by phone in an effort to identify the nature and urgency of the health concern and determine the appropriate disposition. Reviewing therapeutic communication skills and putting them into practice is one of the most important elements necessary for establishing rapport with a patient. After establishing rapport, trust will begin to develop, which will facilitate an accurate understanding of what the patient may be experiencing in a safe and timely manner. As a telephone triage provider, one may feel challenged to provide care in a nontraditional manner, having no physical contact with the patient and thus relying heavily on the use of keen assessment skills, active listening, and critical thinking skills. Communicating effectively is an acquired skill and one that improves drastically with practice (Blank et al., 2012; Meer, Gwerder, Duembgen, Zumbrunnen, & Zimmermann, 2012). This chapter serves as a brief overview of the challenges faced in telephone triage and as a resource for providers to learn how to effectively communicate with confidence and ease.
» HELPFUL THERAPEUTIC COMMUNICATION TECHNIQUES
It is important to review therapeutic communication techniques to sharpen one’s awareness of how dynamic words really are. Following are some of the most commonly used therapeutic communication techniques and rationales for why they are so valuable.
Silence: This allows the patient time to think and reflect. It conveys acceptance and allows the patient to take the lead in conversation.
Exploring: This technique requires delving further into a subject, idea, or experience. It is used often with patients who communicate on the surface or at a superficial level. The following is an example of exploring: “Please explain that situation in more detail.” While exploring, if the provider notices the patient is uncomfortable, he or she should refrain from exploring further because it would then be considered probing.
Focusing: This is often used for patients who are excessively anxious or rapidly moving from one topic to another. The provider takes notice and focuses on a common theme, idea, or even a single word. The following is an example of focusing: “This point seems worth looking at more closely.”
Restating: Restating what the patient has said using similar words to let them know that they have either been understood or not understood is a valuable tool for illustrating understanding. For example, the patient states, “I can’t study. My mind keeps wandering.” The provider responds, “You have difficulty concentrating.”
Broad Opening: This technique encourages the patient to talk, indicates a genuine interest about the patient, and allows the patient to choose the subject.
Clarification: This fosters recall of details regarding a particular experience, encourages description of feelings, seeks explanations, and pinpoints specifics.
Empathy: This is one of the most important characteristics of a therapeutic relationship; it connotes feeling into the patient, maintaining objectivity, and staying emotionally separate from the other person.
» COMMUNICATION BASICS IN TELEPHONE TRIAGE
This section describes how to put therapeutic communication to work in telephone triage. Advice delivered over the phone is not performed in a vacuum. At its best, telephone triage is more than a casual conversation about a health-related problem. It is a dialogue meant to get to the truth of the matter at hand.
Self-Awareness
How we view ourselves is a critical component in telephone triage. Taking a self-inventory of personal biases, stereotypes, beliefs, and values may be the single most important step toward improving interpersonal communication skills. It is important to understand that the ability and extent to which one can effectively help others in time of need is strongly influenced by his or her internal value system, a combination of intellect and emotions. Values, attitudes, and beliefs are learned ways of thinking and can influence communication in numerous ways.
Tele Charisma
The manner in which communication is presented is just as significant, if not more so, than the actual message delivered. In their timeless book, Telephone Triage: Theory, Practice and Protocol Development, Wheeler and Windt (1993) identify this as “telephone charisma.” Regardless of setting and clinical situation, the therapeutic relationship is impactful and should be established initially through a warm, friendly, and welcoming introduction. Tele charisma is a commonly used term to describe the characteristics that are unique to a tele nurse: the marvelous ability to connect, listen, respond, and ask questions while demonstrating trust and genuine concern for the patient (Wheeler, 2014). For example, a smile can be heard over the phone, which in turn may serve as a welcoming base for the conversation.
Paralanguage
Paralanguage is the gestural component of the spoken word. Examples of paralanguage include volume, pitch, tone, and rate, all of which are verbal cues that greatly influence the way messages are interpreted. These signals play a major role in determining responses by the health care practitioner and the patient. Accurate perceptions on the part of the provider can aid the patient in identification of feelings that may otherwise be overlooked, thus allowing an opportunity to focus on a single idea or explore a topic further to reveal pertinent information needed during triage.
Establish Trust
Authentic communication is well respected and in high demand throughout the health care industry. Patients want to feel engaged in a two-way conversation where there is validation that they have been heard and understood. It is important to be open, be genuine, and be yourself. To trust another, one must feel confidence in that person’s presence, reliability, integrity, veracity, and sincere desire to provide assistance. On a surface level, this concept may seem inconsequential if the primary goal is to focus on the patient; however, the skill of authenticity will prove beneficial in building rapport quickly, which will enhance communication under challenging time constraints.
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