IDEAS home Printed from https://ideas.repec.org/a/wly/jocnur/v29y2020i7-8p1175-1186.html
   My bibliography  Save this article

Tinkering and overruling the computer decision support system: Working strategies of telephone triage nurses who assess the urgency of callers suspected of having an acute cardiac event

Author

Listed:
  • Loes T. Wouters
  • Dorien L. Zwart
  • Daphne C. Erkelens
  • Marlies Huijsmans
  • Arno W. Hoes
  • Roger A. Damoiseaux
  • Frans H. Rutten
  • Esther de Groot

Abstract

Aims and objectives To understand clinical reasoning and decision‐making of triage nurses during telephone conversations with callers suspected of having acute cardiac events, and support from a computer decision support system (CDSS) herewith. Background In telephone triage, nurses assess the urgency of callers’ conditions with clinical reasoning, often supported by CDSS. The use of CDSS may trigger interactional workability dilemmas. Design Qualitative study using principles of a grounded theory approach following COREQ criteria for qualitative research. Methods Audio‐stimulated recall interviews were conducted amongst twenty‐four telephone triage nurses at nine out‐of‐hours primary care centres (OHS‐PC). Results Telephone triage nurses use clinical reasoning elements for urgency assessment. Typically in telephone triage, they interpret the vocal—but not worded—elements in communication (paralanguage) such as tone of voice and shortness of breath and create a mental image to compensate for lack of visual information. We confirmed that interactional workability dilemmas occur. Congruence, established when the CDSS supports the triage nurses’ decision‐making, is essential for the CDSS’ value. If congruence is absent, triage nurses may apply four working strategies: (a) tinker to make CDSS final recommendation align with their own assessment, (b) overrule the CDSS recommendation, (c) comply with the CDSS recommendation or (d) transfer responsibility to the GP. Conclusion Triage nurses who assess urgency may experience absence of congruence between the CDSS and their decision‐making. Awareness of how triage nurses reason and make decisions about urgency and what aspects influence their working strategies can help in achieving optimal triage of callers suspected of acute cardiac events at OHS‐PC. Relevance to clinical practice Triage nurses’ reasoning and their working strategies are vital for outcome of triage decisions. Understanding these processes is essential for CDSS developers and OHS‐PC managers, who should value how triage nurses interact with the CDSS, while they have the benefit of callers in mind.

Suggested Citation

  • Loes T. Wouters & Dorien L. Zwart & Daphne C. Erkelens & Marlies Huijsmans & Arno W. Hoes & Roger A. Damoiseaux & Frans H. Rutten & Esther de Groot, 2020. "Tinkering and overruling the computer decision support system: Working strategies of telephone triage nurses who assess the urgency of callers suspected of having an acute cardiac event," Journal of Clinical Nursing, John Wiley & Sons, vol. 29(7-8), pages 1175-1186, April.
    • Handle: RePEc:wly:jocnur:v:29:y:2020:i:7-8:p:1175-1186
    DOI: 10.1111/jocn.15168
    as

    Download full text from publisher

    File URL: https://doi.org/10.1111/jocn.15168
    Download Restriction: no
    File URL: https://libkey.io/10.1111/jocn.15168?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Ocde, 2016. "Professionnalisme des enseignants," L'enseignement à la loupe 14, OECD Publishing.
    2. Murdoch, Jamie & Barnes, Rebecca & Pooler, Jillian & Lattimer, Valerie & Fletcher, Emily & Campbell, John L., 2015. "The impact of using computer decision-support software in primary care nurse-led telephone triage: Interactional dilemmas and conversational consequences," Social Science & Medicine, Elsevier, vol. 126(C), pages 36-47.
    3. Ocde, 2016. "Professionnalisme des enseignants," L'enseignement à la loupe 14, OECD Publishing.
    4. William E. Shafer & Richard S. Simmons & Rita W. Y. Yip, 2016. "Social responsibility, professional commitment and tax fraud," Accounting, Auditing & Accountability Journal, Emerald Group Publishing Limited, vol. 29(1), pages 111-134, January.
    5. Oecd, 2016. "Teacher Professionalism," Teaching in Focus 14, OECD Publishing.
    6. Anna Carin Wahlberg & Annica Bjorkman, 2018. "Expert in nursing care but sometimes disrespected—Telenurses’ reflections on their work environment and nursing care," Journal of Clinical Nursing, John Wiley & Sons, vol. 27(21-22), pages 4203-4211, November.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Changkun Cai & Qiyao Shen & Na Tang, 2022. "Do visiting monks give better sermons? “Street‐level bureaucrats from higher‐up” in targeted poverty alleviation in China," Public Administration & Development, Blackwell Publishing, vol. 42(1), pages 55-71, February.
    2. Murdoch, Jamie & Salter, Charlotte & Ford, John & Lenaghan, Elizabeth & Shiner, Alice & Steel, Nicholas, 2020. "The “unknown territory” of goal-setting: Negotiating a novel interactional activity within primary care doctor-patient consultations for patients with multiple chronic conditions," Social Science & Medicine, Elsevier, vol. 256(C).
    3. Douglas Cumming & Wenxuan Hou & Edward Lee, 2016. "Business Ethics and Finance in Greater China: Synthesis and Future Directions in Sustainability, CSR, and Fraud," Journal of Business Ethics, Springer, vol. 138(4), pages 601-626, November.
    4. Jianlei Han & Jing He & Zheyao Pan & Jing Shi, 2018. "Twenty Years of Accounting and Finance Research on the Chinese Capital Market," Abacus, Accounting Foundation, University of Sydney, vol. 54(4), pages 576-599, December.
    5. Elenor Kaminsky & Marta Röing & Annica Björkman & Inger K. Holmström, 2017. "Telephone nursing in Sweden: A narrative literature review," Nursing & Health Sciences, John Wiley & Sons, vol. 19(3), pages 278-286, September.
    6. Dellaportas, Steven & Xu, Lina & Yang, Zhiqiang, 2022. "The level of cross-disciplinarity in cross-disciplinary accounting research: analysis and suggestions for improvement," CRITICAL PERSPECTIVES ON ACCOUNTING, Elsevier, vol. 85(C).
    7. Garcia-Blandon, Josep & Argilés-Bosch, Josep Maria & Ravenda, Diego & Castillo-Merino, David, 2022. "Board gender quotas, female directors and corporate tax aggressiveness: A causal approach," International Review of Financial Analysis, Elsevier, vol. 79(C).
    8. Stefanie Lopriore & Amanda LeCouteur & Katie Ekberg & Stuart Ekberg, 2019. "“You'll have to be my eyes and ears”: A conversation analytic study of physical examination on a health helpline," Journal of Clinical Nursing, John Wiley & Sons, vol. 28(1-2), pages 330-339, January.
    9. Inger K. Holmström & Susan Gustafsson & Josefin Wesström & Karin Skoglund, 2019. "Telephone nurses’ use of a decision support system: An observational study," Nursing & Health Sciences, John Wiley & Sons, vol. 21(4), pages 501-507, December.
    10. Imad Al Zeer & Amjad Abdallah Alkhatib & Majed Alshrouf, 2019. "Determinants of Organisational Commitment of Universities’ Employees," International Journal of Academic Research in Accounting, Finance and Management Sciences, Human Resource Management Academic Research Society, International Journal of Academic Research in Accounting, Finance and Management Sciences, vol. 9(1), pages 136-141, January.
    11. Doyle, Elaine & Frecknall-Hughes, Jane & Summers, Barbara, 2022. "Ethical reasoning in tax practice: Law or is there more?," Journal of International Accounting, Auditing and Taxation, Elsevier, vol. 48(C).
    12. Smailhodzic, Edin & Boonstra, Albert & Langley, David J., 2021. "Social media enabled interactions in healthcare: Towards a taxonomy," Social Science & Medicine, Elsevier, vol. 291(C).
    13. Deqiang Deng & Chenchen Ye & Fan Wu & Yijing Guo & Hao Li & Changsheng Wang, 2023. "Effect of organizational ethical self-interest climate on unethical accounting behaviour with two different motivations in China: the moderating effect of Confucian ShiZhong Thinking," Palgrave Communications, Palgrave Macmillan, vol. 10(1), pages 1-13, December.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:wly:jocnur:v:29:y:2020:i:7-8:p:1175-1186. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: https://doi.org/10.1111/(ISSN)1365-2702 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.