Telephone Triage Nursing: Communication and Cultural Challenges

Introduction to the Telephone Triage Nurse Role

One of the roles a nurse who manages patients plays is that of initiator. An initiator lays the foundation of care to be provided (Hesketh, 1997). Increasingly, telephone triage is an initiator role being used to address the problem of same-day appointment overload in general practice (Chaffee, 1999). In addition, patients are able to discuss their problems with a triage healthcare professional within minutes rather than days. Through my work at a large health organization as a Telephone Triage Nurse, I receive calls from patients, conduct interviews to assess their health issues, and then triage their signs and symptoms for either home advice, clinic appointments, emergent care, or telephone treatment and protocols. In performing this role, I have discovered several personal challenges related to communication, patience, cultural diversity, and stress caused by the large number of calls that must be processed within an acceptable time frame.

Without well-defined communication skills, a nurse cannot establish therapeutic relations with a patient (Hood & Leddy, 2003). Without the ability to communicate directly, it is also difficult to perform well in the initiator role (Hesketh, 1997). A recent and frustrating call I received underscored just how important good communication is in the telephone triage process. The call was from a patient of Vietnamese descent. A Cantonese interpreter who works for our organization assisted me with the conversation; however, the interpreter had only medical and legal translation skills and could only repeat what the patient was saying verbatim, limiting my ability to interpret the full meaning of what the caller was trying to communicate.

Communication Barriers and a Challenging Call

The call was lengthy, and I discovered that I need greater patience when dealing with non-English-speaking callers. I quickly became irritated after not being able to get straightforward answers to my assessment questions, most of which required only yes or no answers. Despite my repeated inquiries, the patient kept repeating the same signs and symptoms — chest congestion for three days — and kept demanding to see a medical doctor rather than speaking with me.

My role in this particular situation was to triage the chest congestion complaint for either home care advice or a clinic appointment to rule out bronchitis or pneumonia. However, in order to triage effectively, I first needed clear answers to questions such as: "Fever?", "Chest pains?", and "Wheezing?", as well as information about what the patient had already done to care for herself. Based on the answers to such questions, the computer program I use would then assign an urgent same-day appointment or recommend home care advice. It was clear from the start, however, that this patient was not interested in receiving telephone advice, and I feared she would not qualify for an appointment based on the cold-like symptoms I had gathered.

Cultural Diversity and Patient Expectations

It is well documented that America's cultural diversity challenges nurses' ability to respond with sensitivity to client needs (Mayo, 1996). According to Mayo, a nurse's ability to incorporate an individual's culturally based beliefs and values is an integral component in designing nursing interventions. Through my work with patients from Asian cultures, I have learned that they often do not wish to receive advice from registered nurses; instead, they frequently accept guidance only from a medical doctor or in the form of a clinic appointment. Even with this cultural awareness, I still find it difficult to reconcile different cultural expectations with formalized procedures.

As a resolution in this instance, I explained via the interpreter that I was arranging an appointment, but that the patient must first answer questions her physician had requested. I used this framing in hopes that she would be more cooperative (Quinn et al., 2003). She seemed somewhat irritated but reluctantly answered my questions. Acknowledgement of the cultural aspects of the person is necessary if nurses are to provide holistic care to the recipients of healthcare services (Slusher & Newell-Withrow, 1996). Exposure to and personal interaction with people of diverse cultures can also foster an acceptance of multiculturalism that benefits nursing practice (Thobaben & Mattingly, 1993). However, I believe my awareness of this patient's cultural belief — that only a medical doctor could truly help her — ultimately interfered with my ability to assist her objectively.