Wednesday, February 15, 2017

Validating the Caller

It has been a while since I posted, and I apologize. I took a hiatus, but I am back.
During the hiatus, I learned about something called motivational interviewing. You may have heard about it, and wonder how it can have anything to do with triage. It can work as a great compliment to telephone triage for that matter, and here is how.
I have talked in previous posts about educating to comply. This is a very important part of triage. With motivational interviewing, you empower the caller to make the correct choices, and you make them a very importance part of that choice making without making them feel like they are being belittled or looked down upon. I think we, as triage nurses, are so caught up in getting from one call to another, that we tend to find ourselves repeating the same advice and instructions without considering the level of education of the caller or their knowledge of medication or diagnosis. If we are not careful with our approach, we can leave the caller feeling like they were not heard or we did not really help them with their problem at hand.
The history of MI is marked by a consistent commitment to respecting and caring for the patient. The technique is to learn how to implement this spirit through the use of specific verbal techniques that guide ambivalent or resistant patients to change their current behavior or method for dealing with the problem at hand, and guiding them to seek the correct treatment.
The first step is to establish an interpersonal connection that respects and honors the perspective of the caller. By not shaming or blaming the caller, the triage nurse can create a sense of safety that will allow the caller to be honest and open about the problem they are dealing with.
One important step is to express empathy. If you have a caller that is dealing with a traumatic illness or occurrence in their lives, letting them know by your choice of words, that they have been heard, understood and respected, goes a long way. When the triage nurse empathizes with the caller, they are essentially telling them that how they are making sense of their situation matters to that nurse.
For example, a mother of a 2 yr old with a fever for 3 days calls, and  the child has no other symptoms or history, except that child finished chemo 6 months ago for leukemia. Chances are, the fever is related to a benign virus, but to this mother, it could mean the leukemia is back, and she is panicked. Choosing to say, "It is understandable that you would be so concerned",compared to "I understand why you are so concerned", could make a huge difference in how that mother perceives how much she feels you are really being empathetic and listening to her. Unless you have had a child with leukemia also, you cannot completely relate to what that mother is going through. So, to say, "I understand', compared to saying "That is understandable", can have a great bearing on the rest of the conversation, and the goal should be to assess the situation, educate on the correct choice for next steps, and any follow up the caller needs to make. If the caller feels they were heard and respected, they are more likely to listen to the triage nurse, follow the advice given, and be pleased with the outcome of the call.