Telehealth Nursing Practice Core Course TNPCC

Telehealth Nursing Practice Core Course TNPCC April 9, Additional Handout Sample Telephone Call Clips Script 1

INTERACTIVE SESSION - COMMUNICATION Chapter 5A Sample A Phone ringing Phone rings Nurse: General Clinic Pediatrics. This is Pam, RN. Caller: Oh, I really need your help. I am so worried about my child. Nurse: Slow down, slow down. What is the problem? Sample B Shorter ring Phone rings Nurse Thank you for calling General Clinics Pediatrics, this is Pam, I am a registered nurse. Caller: Oh, I do really need your help. My child is so sick and I need to bring him in. I am so anxious. Nurse: You do sound anxious and I can help but first I need to get some information from you. Sample C Nurse attitude Nurse: Slow down, what s the problem? Caller: It s my baby Michael. He s been throwing up all night and he doesn t want to eat or drink anything. He s never done this before and I just don t know what to do. Nurse: Okay. Now how many times did he throw up last night and when did he drink last night? Caller: He threw up twice but it was so much. The last time I got him to drink anything was around 1 am. Nurse: Well, what s Michael doing right now? Caller: He s pretty peaceful right now. I didn t want to disturb him after being up all night. Nurse: Well that sounds okay. When he wakes up, try giving him a tablespoon of liquid every hour for 2 hours, then increase to a half a cup and then just keep going from there. If you have any problems you can always call back. Someone should be here or the doctor is on call. Don t worry too much. There s lots of flu going around. Sample D Effective technique Nurse: You do sound very anxious but I can help. Let me see what we can do from here. Script continues and ends with the nurse saying: First give him and then trails off. 2

Sample E Angry Caller No script available Sample F Rambling Callers No script available Sample G Rambling Callers No script available 3

INTERACTIVE SESSION CLINICAL KNOWLEDGE Chapter 15A Sample D - Susie This is Terran. I m a registered nurse. How may I help you? Patient is crying and sobs, I just don t want to go on any more. I just feel so bad. I think I need some help! May I have your name please? Susie Susie, what is your last name? I don t want to tell you that. Ok, may I have the address and phone number from where you are calling? Why do you want all that? I m concerned that we might get disconnected and if we do, I want to be able to reach you again. Well I ll give you my phone number that s all. Alright, that will be fine. Susie, can you tell me what is making you so upset? You just don t understand no one does. My boyfriend, Chris, broke up with me yesterday. We were going to get married someday. I just don t want to live any more without him? Susie, are you thinking about committing suicide? (Patient sobbing), Yes! Susie, have you thought about how you would kill your self? Yes, I have it all planned. I will be home alone tonight while my mom goes to work. I have a whole bottle of her sleeping pills. Chris will feel bad that he broke up with me. I remember how bad I felt when my boyfriend broke up with me. I cried for days. Susie, I m concerned about you. Have you been drinking or have you taken any medication or drugs today? How did you know? (Pause) I just couldn t stand the pain, so I ve drank a half a bottle of Vodka that my mom uses for parties. Susie, I want you to promise me that you will not hurt yourself until I am able to get the help you need. What kind of help do you think I need? Well, we have a nurse who is specially trained to talk to people who are feeling suicidal. I am sure that she will be able to help you. If she doesn t help me--can I call you back? Yes, of course. Ask for Florence. Now I want you to promise me that you will not harm yourself until you have talked to this expert nurse. 4

I promise. When will I talk to her? I m going to page her right now. I will be off the phone momentarily while I page her. Don t hang up, alright. I will come back and talk to you. Alright. Sample E Ms. White Thank you for calling MASA Clinic, this is Bruce, I m a registered nurse. How may I help you? This is Martha White, and I m had some chest pain for the last couple of days, but now it is radiating down my right arm and I m aching on that side. Ms. White may I have the telephone number and address from where you are currently calling? Well, it s my mobile phone number and I m on Interstate 40 just past the Wyoming exit. Ms. White, I really need for you to pull over to the shoulder of the road and bring your car to a stop while we talk. But, I m in a hurry. My husband is taking me out to dinner for my 53rd birthday. I m concerned about your welfare and think that it would be best to discuss this issue while the car is stopped. Well, I ll talk to you, but I m not going to stop. My husband hates to be late for dinner. Is there someone else with you in the car? No, just me. How long have you had this pain. I ve had this pain for two days--on and off--but it s getting much worse now. I feel like my chest is really tight. Does anything you do make the pain go away or feel better. No--not really. I m just concerned because it s getting worse. What can I do? Are you having any shortness of breathe? No shortness of breathe. Does anything make this pain feel better or worse? No nothing. Are you having any other symptoms? Well, I am having some right arm pain. 5

Sample F Mr. Sugar Hi, this Joe Sugar. I m calling because I have a fever and I just don t feel very good. My temperature is 101 and I just want to know what to do to get through this fever. Do you have any other symptoms? Nope--I just don t feel well. When did your fever start? About dinner time yesterday. I m so surprised--i just thought that I would be feeling better after I went and got my foot fixed at the podiatrist office last week What did you have done at the podiatrist office? Oh, I had some of my calluses shaved on both of my feet. I just have to have those calluses shaved every couple of years. Since I m diabetic I visit the podiatrist a couple of times a year. Oh, are you on any medication? No. So you take no medication for your diabetes. Well, I take my insulin injections every morning and night. So you aren t taking any other medication other than the insulin? No over the counter medications? Oh, I took some Tylenol last night before I went to bed because I was feeling so poorly. Do you have any other health problems or chronic illnesses? No--just the diabetes. Have you looked at your foot in the last couple of days? Now, why would I do that--i haven t noticed my feet isn t giving me any problems. Would you please take off your shoes and socks and look at your feet. Tell me what you see Ola Mae--look at my feet--that nurse want me to look at my feet Goodness, George--when did you last change your socks? These smell terrible! Ola Mae, you know I change my socks every morning. George, these feet look terrible. Why didn t you have me look at these earlier? You have several red, oozy sores on your right foot. One sore even has a red race mark going up your foot. 6

Sample A The Browns "Hi - this is Mike Brown. I m calling about my wife. She seems to have the flu." "Is Mrs. Brown there, that I might speak directly with her?" "She s here. But she is sleeping right now. I really don t want to wake her up if I don t have to. She knows I was planning on calling you." "We can let her rest for now, but I would still like to speak with her later to make certain that we have covered all of her concerns also. It is helpful and beneficial to always talk to the patient." "Okay, we'll see." "Mr. Brown could we start with you telling me your wife's name and age, please." "Sure, it is Sherri. Sherri Brown. And let's see... I believe she turned 29 her last birthday." "What exactly has you concerned about Mrs. Brown today?" "Well, she has been real well up until the past day or so. I think I had the flu earlier this week, had to miss a day of work. You know, body aches, headache, all that stuff, but I got over in a day or so. Then Sherrie started feeling bad last night, achy and all, kind of like I did, so we just thought it was the same thing - but is seems different also. I just can't quite describe it." "What other symptoms or problems besides being achy is Sherri complaining of?" "Well, she is sleeping a lot more than I did, moaning every once in a while in her sleep and holding her stomach like something is cramping. I could only get her wake up long enough to sip some tea this morning and take some more Tylenol. Then she fell right back to sleep." "Is there anything else you noticed?" "No. No, nothing that really stands out. She is just not Sherri." "You said earlier that Mrs. Brown is typically very healthy. Has she taken any medications today or in the past week other than the Tylenol you gave her this morning?" "She started taking the Tylenol sometime yesterday. Only other pills she takes are some vitamins. Yea, she is usually really on the go and feeling great most of the time. Doesn t really have much use for medications, drugs." Mr. Brown, I believe I need to talk with Mrs. Brown to see what else she can add, so we can decide what is best for her. Okay, (heavy sigh), let me see if I can get her up. It is just about time to feed the baby anyway. "Mrs. Brown, this is Mary, one of Clinic X s telephone nurses. Your husband called me because he is concerned about how you are acting and feeling today." "Un-huh "Can you tell me a little bit about how you are feeling?" Really sleepy, kind of achy you know just like you feel with the flu." Mr. Brown mentioned a baby. How old is the baby? Just a little over six weeks. Have you seen your doctor since your delivery? Yeah, I just saw her Monday. Told me everything was just fine. 7

Are you nursing or bottle feeding the baby? Nursing Are your breasts tender or sore? No. Are you having any vaginal discharge? No. That all stopped just a few days before I saw my doctor. She said everything had healed just fine. Have you had a period since your baby was born? No, the doctor told me that I may not have a period for quite a while since I m nursing. That is true for many women. However, it does not mean that you are not ovulating. Are you taking means to prevent pregnancy? Yes, the doctor has started me back on birth control pills. With the achiness and sleepiness you are having right now, do you notice any other signs or symptoms? No nothing I can think of. Mr. Brown mentioned you were moaning in you sleep and holding your stomach. Have you noticed this also? No just must be the achiness. I haven t noticed anything specific. Any nausea, vomiting or diarrhea? No, none of those. I just not very hungry. I know I need to eat and drink so I can have milk for the baby. I have tried to do that whenever I am awake. Mr. Brown shared that earlier today he was only able to get you awake long enough to sip some tea and take some Tylenol. He is concerned about how sleepy you are. Do you remember him waking you earlier? Yeah, (heavy sigh), it s just that the baby had me up several times during the night. I just really need a few good hours of sleep. How much regular Tylenol are you taking? I m taking two tablets of Tylenol #3 every 4 hours. I had them left over from when I had my episiotomy. It would be better for you to take regular Tylenol. The codeine may cause multiple problems such as stomach upset for you and causing both you and the baby to be drowsy. Do you have some regular Tylenol? Yes, I ll go ahead and start taking that instead. Do you have any chronic, ongoing health problems, any surgeries in the past, or any problems during the pregnancy? No, nothing at all. I tend to stay pretty healthy. That is probably why Mike is so concerned now. He is just not used to seeing me not feeling well. Have you taken your temperature since you have not felt well? No, Mike just keeps giving me the Tylenol for the aches, and it does seem to be working. Will that harm the baby? No, the Tylenol #3 will not harm the baby, but it will be better for both of you if you start taking just the plain Tylenol. May I also suggest that you check your temperature before you take the next dose of Tylenol just so we know what your temperature is. If you find that you are running a fever over 100.5, I need for you to call us back. 8

Sure, I can do that. I m sorry. But I really think this is nothing to worry about. Mike has just been overly protective since the baby has been born. I really think this is just the flu like Mike had and I should be better by evening. The baby is crying I need to go so I can feed him. I understand but just a few more things before you go. Have you notice any difficulty breathing or pain when you inhale? No, like I said I really think it is just the flu --- and the baby is crying. I really need to go. One last question, how has the breastfeeding been going for you any problems or recent changes? No, once my milk came in and the baby got on a schedule, it has worked out great. The baby is nursing well on both sides and putting on weight okay. He seems satisfied most of the time. You have already commented that you understand the need for you to continue to eat and drink so that you will have the milk the baby needs. I would like for you to call us back or your physician if any new symptom starts or the ones you have now become worse, or if you are not feeling better in the next 24-48 hours. I would also like you to call back if you notice any changes with the baby. Please be sure to call if you have any other questions or concerns. Yes I ll call if anything comes up but I need to go now. We ll be just fine. Mike just needs to relax a little. Please tell Mr. Brown thank you for calling us. You both should feel free to call anytime you have health questions or concerns. Good-bye. Bye Sample B Jimmy Good morning, this is Betty, a registered nurse. How may I help you? My son Jimmy had me up all night--whining and crying. I tried to give him a drink of water and he wouldn t take anything. Then this morning I gave him some Cheerios and milk for breakfast and he vomited all over my suit-- and I ve got to be to work in 1 hour. My husband is out of town and I don t know what to do. Day care won t take him like this. When I ask him what s wrong--he points to his belly. He looks ok--but he feels warm. What can I give him so I can take him to day care so I can get to work? Sounds like you had a very long night. May I ask you a few questions? Ok. You said that he was feverish. What is his temperature? He feels warm but I ve just been too busy cleaning up things to take his temperature. Can you tell me a little bit more about the vomiting. What do you want to know--he threw up everything--all over my best blue suit! So I understand that he only vomited once--this morning. So how was his appetite last night? Now that you mention it--he didn t eat much dinner last night. But you know how toddlers are--sometimes they eat, sometimes they don t. You know, I don t think that he has had anything to drink since dinner last night. 9

How wet was the diaper that you changed this morning. Soaked, as usual but it was sure strong smelling. How is your child acting right now.? Well--ever since he threw up he s been playing with his toys. Based on the information you have given me, here is what I think we should do: Take time to finish cleaning things up Take Jimmy s temperature Call work and let them know you have a sick child this morning. Do not give Jimmy anything to eat or drink for right now. I will call you back in 30 minutes to see what his temperature is and how things are going. If Jimmy gets worse or anything changes call me immediately. What is the phone number that I may call you back? Are you willing to follow this plan? Yes, I will take his temperature and get things under control. I understand not to give him anything to eat or drink for now. Thank you for listening to me. I feel better now that I have talked to you - oh, and I am Susie Green. So you will call me in 30 minutes. Yes, I will call you at 343-8976 at 7:30. Goodbye. Hello, Ms. Green, this is Betty from MASA calling you back. How are things going with Jimmy? Oh, better now. I have relaxed and he went to sleep while I was taking his temperature. He seems to be resting quietly for now. What was the temperature? It was up just a little - 99.8 And how did you take that temperature? Under his arm - like the nurse showed me. That s great. Since there has been no change with Jimmy in the last 30 minutes, these are things that you can do for him at home today. (Home care as per facility per pediatric vomiting guidelines.) Do you have any questions or concerns with this information? No, I think I understand everything. I called work and I will be staying home today. If there are any new symptoms or symptoms get worse with Jimmy today, or the home care does not work as we have discussed, call me back today. Sample C Mrs. Jones Hi, this is Mrs. Clarence Jones. My daughter told me to call Dr. Brown s nurse. She s so nice but she s so busy. Is she on today? No, Sherry is not working today. How may I help you? It s alright, I ll hold for Sherry. The nurse speaks a little louder into the phone, Ms. Jones, Sorry honey, I just can t hear you very well--i ll turn up my hearing aide. Sound effect of squealing hearing aid. Now what were you saying? Dr. Brown s nurse, Sherry, is not in today. I m Penny, a registered nurse. May I help you? I haven t been feeling well for several days. My daughter told me to call. 10

What symptoms are you having. I m just not feeling well--achy, tired, and just not very hungry. I m just not up to par. Ms Jones, are you on any medication--including over the counter. I take that little white pill and a brown pill every morning for my blood pressure. Do you know the names of those medications? Oh honey, I can barely remember my own name much less those long names on those bottles--those generic names are awful! Can you go get the medication bottle and read the name to me? Sure, they re right on the kitchen table. I ll go get them. (After a pause) I m back. Are you still there? Hello!!! Yes, Ms. Jones--did you get your medication bottles? Yes--I have them right here. Can you read the names to me off the bottles? I can t read those tiny words (there is a doorbell ringing in the background)--just a second my daughter is at the door. Hang on. Hi, I m Ellen Lowe, Ms. Jones daughter. You re the nurse? Yes, I m Penny, a registered nurse working at MASA Clinic Nurse Line. Yes, I told mom to call you, I was concerned about how she sounded on the phone this am. Mom wants me to read you the names of the medications that she s on I d appreciate that. She s on furosemide and benzylprichloride. Does she any other chronic illness other than the high blood pressure? No, mom is always on the go. This is so unlike her because she just doesn t feel like going any where. She told me that she s been leaking urine. Have you noticed other recent problems with your mother or has she shared anything else with you that you think might help us? 11

INTERACTIVE SESSION DOCUMENTATION Chapter 8A Nurse: Good afternoon. Thank you for calling Hillstreet Clinic. My name is Julie. I m a registered nurse. How may I help you? Caller: I hope you can. I have back pain and it is really hurting me. Nurse: I can help you. I need to get some information from you first. What is your name please? Caller: Hollie Hurte. Nurse: How do you spell that? Caller: H-o-l-l-i-e-H-u-r-t-e Nurse: What is your address? Caller: 1250 Coffey Lane Nurse: That is 1250 K-O-F-E-Y Lane? Caller: No, you spell it C-O-F-F-E-Y Nurse: All right. What is the phone number you are at right now? Caller: 456-8257 Nurse states: I have a few more questions. What is your date of birth? Caller: 7-25-78 Nurse: What is your patient identification number? Caller: Let me see. Here it is. It is 123987 Nurse: Who is your primary care physician? Caller: Dr. Smith Nurse: What prior medical history do you have? 12

Caller: Well, just hay fever. That s really it. I m pretty healthy. Nurse: Are you currently taking any medications, over the counter or prescription? Caller: Actifed for my hay fever. I also take birth control pills. Nurse: Are you allergic to any medications? Caller: No. Nothing that I know of. Nurse: When was your last normal menstrual period? Caller: Let s see uhm 2 weeks ago. Nurse: Okay. Let s discuss your back pain. Are you having the pain right now? Caller: Yes. Nurse: On a scale with 0 10 with 0 being no pain and 10 being the worse pain you have ever had, how would you rate your back pain right now? Caller: About a 4 Nurse: How long have you had the back pain? Caller: Uhm about 2 days. Nurse: Can you describe the pain? Caller: Well, it hurts all over my lower back and it comes and goes. Nurse: Can you point to the pain? Caller: No, it hurts all over my lower back. Nurse: Have you ever had this pain before? Caller: No. Nurse: Have you tried anything to relieve the pain? 13

Caller: Well, I take Tylenol and it helps a little. Nurse: How often do you take the Tylenol? Caller: Once or twice a day. Nurse: Think back to when your back pain started. Can you remember anything you were doing differently or anything that may have caused the pain? Caller: I don t know what is causing the pain. I am really tired. I started a new job and it is hard work. I work at DM factory. Nurse: What is your job at the factory? Caller: My job is to lift the rotors after they are put together and carry them to the packaging section across the room. After I pack the rotor, I carry it to shipping. Nurse: How much do the rotors weigh? Caller: Oh about 30 pounds. Nurse: Did you have the back pain before you started your job? Caller: Well, now that I think about it I noticed my back hurting a couple of days after I started my new job. Nurse: Based on what you have told me, I can give you some information that may help relieve your back pain. (The nurse then gives the caller home care information.) Nurse: We have discussed how you can manage your back pain at home. Are you comfortable doing the things we discussed? Caller: Yes. I will try those things. I hope it helps my back. Nurse: I hope so too. Do you have any questions about the instructions I gave to you? Caller: No. I understand what I need to do. Caller: I will. Thank you. You have been very helpful. Nurse: Thank you for calling. Good bye Ms. Hurte. Caller: Good bye. M:\TNPCC\TnpCourse\INSTRUCTOR MATERIALS FOR ON SITE COURSE\2005 Interactive Communication w CD Tracks COMPLETE MINI 7_11.doc 14