The Use of Online Information Retrieval in Telephone Triage: Professional Resources and Social Media
Alice Myers
Linda Todd
Ashley Przybylski Lauriello
We are literally experiencing an information explosion. Unfortunately, this flood of data occurs in an online environment that can easily blur the lines between valuable information, half-truths, and dangerous misinformation. Often, patients call providers about a piece of information they found on the Internet and seek the advice of the triage nurse (Giustini, 2005). For example, of late, patients have asked about recent information on Zika virus. They wonder if there is a vaccine to prevent them from contracting the virus. They further ask about where they can find information on international travel and where Zika is likely to be prevalent. They inquire about screening in the event they have been exposed to Zika. Referral to a reputable source such as the Centers for Disease Control and Prevention website containing the answer to all of these matters proves to be extremely helpful to patients and nurses alike.
Triage providers constantly need to decide whether Internet information is credible. They may also be required to do some independent “Internet searching” to help determine whether the newest information is valid and how their practice should formulate a response to patients’ questions. Finding valid clinical information on the Internet can be challenging. By understanding how Internet search engines work and performing efficient Internet research, triage staff are much better prepared to help both patients and their practice providers interpret current clinical evidence.
This chapter is designed to give triage staff a basic overview of important terms and features of the Internet and will also help them to decide whether information available on the Internet is credible. It is important to remember that although the Internet can be a valuable tool to aid in development of sound patient care standards in a practice, it can also be a double-edged sword.
» IMPORTANT TERMS
Let’s begin by defining some important terms triage nurses will need to understand to navigate Internet information.
A browser is software on a computer that enables one to access and review information on the Internet. There are several different types of browsers that may be found on any given computer. These include Google Chrome, Microsoft Edge, Mozilla Firefox, and Apple Safari.
The uniform resource locator (URL) is a unique address for a specific website or page of information on the Internet. URLs often end with .com, .gov, .org, or .edu, depending on the website (http://www.iana.org/domains/root/db). These suffixes give the reviewer a sense of the source of information. For example,
“.com”—indicates a for-profit company website
“.gov”—denotes a government website
“.org”—is the suffix for a nonprofit organization or association website
“.edu”—refers to an educational website
Common example URLs are http://abc.go.com/ and https://www.nih.gov/.
Once the browser is open, the user can enter a URL or Web address. After several seconds, the browser displays the requested website. Each website is made up of several Web pages that concern topics relevant to that particular organization.
» WEB PAGE ORGANIZATION AND NAVIGATION
As has been noted, a website is a series of Web pages that are connected on the computer by means of something called “hyperlinks,” or “links” for short. A website’s home page is the first page displayed when a website address is entered. The home page provides an overview of the website that is being accessed as well as links and a directory to other pages within the website or to other websites. Hyperlinks are often underlined, bold, highlighted, or colored. A hyperlink is available when a computer cursor changes from an arrow to a “hand” as the computer mouse pointer moves across the link. To access the new Web page, one clicks on the hyperlink. To return to the previous Web page, the individual clicks on the back button. The back button is located in the upper left-hand corner of the browser window. Most staff are familiar with these rudimentary workings a computer uses to navigate around the World Wide Web.
» INTERNET SEARCH ENGINES
Finding information is simple when the website address is known, but what about when the Web address is unknown (McKeown, 1997)? In such cases, one can use Internet search engines, which are websites that accept keywords entered to locate other websites matching specific terms or criteria (Haynes et al., 1994). Once a keyword or words are entered, the search engine displays a list of Web page titles with hyperlinks and a brief description of each website that matches the keyword(s). Search engines are used frequently
for Internet research, and they are designed with easy-to-remember names (Franklin, 2007; Gibbs, 2016). Here are some of the Internet search engines that are often used:
for Internet research, and they are designed with easy-to-remember names (Franklin, 2007; Gibbs, 2016). Here are some of the Internet search engines that are often used:
https://www.google.com/
https://www.yahoo.com/
https://www.msn.com
https://www.bing.com/
https://www.ncbi.nlm.nih.gov/pubmed
A recent article by Boswell (2017) reviews 20 free Internet resources that will likely prove helpful in this regard as well.
How do Internet search engines know about all these different websites? Search engines have programs called spiders/crawlers that traverse the Internet looking for new Web pages. The search engine maintains a catalog of Web pages and then matches user-entered keyword(s). Different search engines have varying ways of operating spiders/crawlers and indexing and retrieving results. The way the catalog of websites is generated may produce different results for various search engines.
» CHOOSING KEYWORDS
Selecting keywords for Internet research is as much an art as it is a science. A good approach is to imagine the title or text for the perfect article. What words or phrases might appear in that article? Once a few keywords are identified, one can list possible synonyms for those keywords. It is helpful to include singular and plural versions of keywords. This sometimes produces different results (Gibbs, 2016; Haase, Follmann, Skipka, & Kirchner, 2007). Different keywords, even small variations, can produce different types of results.
For example, imagine that a nurse is looking for information to help a patient quit smoking. She first enters “quitting smoking” into the search engine, and the number of website results is over 6 million. She then enters “quit smoking” into the search engine. The number of results is lowered to 4 million. This is still a large number of sites to review, and she realizes that most of the websites are targeted to people who are trying to quit smoking. Finally, she changes the keywords to “smoking cessation clinical,” and the number of results drops 1.8 million. The number of results is now more manageable and more focused on what the nurse is looking for. As a triage example, imagine a nurse who receives a call from a patient who needs current information on abnormally heavy periods. She may want to begin the search with the keywords “abnormally heavy periods.” However, possible synonyms that she will want to include in her search are “heavy menstrual flow,” “heavy menstrual bleeding,” and “menorrhagia.”
Table 4-1 Internet Search Tracking Form | |||||
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It is important to track the keywords and search engines used when conducting extensive research. It is very easy to become so involved in Internet searches, listing keywords and search engines, that one reviews the same information over and over again. Table 4-1 is an example of an Internet Search Tracking Form. The column on the far left is used to list keywords and phrases. Across the top, search engines are listed. The use of a tracking form helps one to avoid confusion and duplication of effort while conducting Internet research.
Generating keywords is somewhat of a “trial and error” process. After reading some of the websites, additional keywords may be identified as relevant to the initial search. As the search advances, new keywords found to be helpful can be added to this basic search form.
» ENTERING KEYWORDS
Operator names used in computer search engines typically use such terms as AND (+), OR, and NOT (−). Entering these operators between keywords or phrases tells the search engine what type of results you want.
Using AND (+): The default operator for most search engines is AND. For instance, when you enter “weight loss programs” into a search engine, the search engine looks for pages that include weight AND loss AND programs. Whether one uses the words “and,” “or,” or “not” makes a big difference in terms of how much information will be retrieve.
Using OR: Websites that contain either “labor” or “delivery” in the text can be located by entering the keywords “labor OR delivery” in the search engine.
Using NOT (−): NOT is used to eliminate a word or phrase from search results.
Using Quotation Marks (“ ”): Websites that contain a phrase in a specific order can be identified by putting the phrase inside double quotation marks (“ ”). Websites that contain the separate words are not listed on the results page.
Table 4-2 contains examples of the results that may be found by using specific keywords and operators. An excellent resource for information on search engines and using Boolean operators is the Purdue Online Writing Lab (OWL) (https://owl.english.purdue.edu/owl/resource/558/04/).
Table 4-2 Examples of Keywords, Operators, and Results From Internet Searches | ||||||||||||||||||||
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