"You'll have to be my eyes and ears": A conversation analytic study of physical examination on a health helpline.

To explore the accomplishment of physical examination on a health helpline. By focusing on the ways in which callers are asked to examine themselves and report information to nurses, we aim to provide insight into how physical examination at a distance is achieved. Physical examination is a routine feature of healthcare encounters. In face-to-face settings, patients are subject to professional scrutiny through talk, touch and observation. Health professionals working on helplines face challenges in assessing signs of illness when they do not have physical access to patients. Conversation analysis was used to explore sequences of interaction between nurses and callers that involved physical examination. Analysis examined how physical examination was routinely accomplished in a helpline environment. Nurses typically guided callers in self-examination by drawing on gross categorisations that required reporting of large-scale characteristics of symptoms (e.g., whether a body part looked "normal"). Physical examination was also regularly accomplished by nurses through two-component speaking turns: a prefacing component that involved instructions about self-examination; followed by a second component that included an information-soliciting question. These practices resulted in callers successfully accomplishing physical examination, despite their lack of professional medical knowledge. This study identifies the communicative practices used by nurses to accomplish physical examination in helpline calls. Such practices involved asking questions that sought general, rather than specific, information and the prefacing of questions with simple instructions on how to undertake self-examination. Previous research indicates that physical examination in telehealth can be challenging, particularly in environments where clinicians need patients to examine themselves. This study identifies how nurses on a helpline manage this challenge. The findings highlight ways in which nurses can recruit patients to undertake tasks that would typically be undertaken by clinicians in physically co-present consultations.

Lopriore S ，LeCouteur A ，Ekberg K ，Ekberg S ... -  《-》

Delivering healthcare at a distance: Exploring the organisation of calls to a health helpline.

Health helplines are integral to contemporary healthcare, offering fast, low-cost, and geographically unrestricted access to health information and advice. Although some health helplines offer support services (e.g., counselling), many function in ways that are similar to physically co-present (i.e., face-to-face) primary care consultations. However, due to the lack of physical presence, there are differences in the way health consultations are routinely managed on the telephone. This article explores some ways in which healthcare is managed at a distance, on a telephone helpline. Data are 196 recorded calls from the helpline, Healthdirect Australia. Using conversation analysis, this paper compares the delivery of healthcare over the telephone with what is known about physically co-present primary care consultations. Through an exploration of the overall structure of these helpline calls, we show how Healthdirect Australia calls are organised in terms of eight distinct phases: call opening, establishment of reason-for-calling, check of caller safety, creation of a confidential patient file, medical information-gathering, health advice, caller survey questions, and call closing. We demonstrate how interactants organise their talk around these phases, with a particular focus on the shift between mandated administrative tasks and traditional medical tasks. Findings from this study suggest that there are systematic differences between the overall structure of health helplines and physically co-present primary care consultations. We demonstrate that the delivery of health information and advice via helplines can be challenging, but that service can be enhanced through continued efforts to inform understanding about how medical encounters routinely unfold in over-the-phone environments.

Lopriore S ，LeCouteur A ，Ekberg S ，Ekberg K ... -  《-》

The league of extraordinary generalists: a qualitative study of professional identity and perceptions of role of GPs working on a national after hours helpline in Australia.

McKenzie R ，Williamson M 《BMC HEALTH SERVICES RESEARCH》

Physical Examinations via Video for Patients With Heart Failure: Qualitative Study Using Conversation Analysis.

Video consultations are increasingly seen as a possible replacement for face-to-face consultations. Direct physical examination of the patient is impossible; however, a limited examination may be undertaken via video (eg, using visual signals or asking a patient to press their lower legs and assess fluid retention). Little is currently known about what such video examinations involve. This study aimed to explore the opportunities and challenges of remote physical examination of patients with heart failure using video-mediated communication technology. We conducted a microanalysis of video examinations using conversation analysis (CA), an established approach for studying the details of communication and interaction. In all, seven video consultations (using FaceTime) between patients with heart failure and their community-based specialist nurses were video recorded with consent. We used CA to identify the challenges of remote physical examination over video and the verbal and nonverbal communication strategies used to address them. Apart from a general visual overview, remote physical examination in patients with heart failure was restricted to assessing fluid retention (by the patient or relative feeling for leg edema), blood pressure with pulse rate and rhythm (using a self-inflating blood pressure monitor incorporating an irregular heartbeat indicator and put on by the patient or relative), and oxygen saturation (using a finger clip device). In all seven cases, one or more of these examinations were accomplished via video, generating accurate biometric data for assessment by the clinician. However, video examinations proved challenging for all involved. Participants (patients, clinicians, and, sometimes, relatives) needed to collaboratively negotiate three recurrent challenges: (1) adequate design of instructions to guide video examinations (with nurses required to explain tasks using lay language and to check instructions were followed), (2) accommodation of the patient's desire for autonomy (on the part of nurses and relatives) in light of opportunities for involvement in their own physical assessment, and (3) doing the physical examination while simultaneously making it visible to the nurse (with patients and relatives needing adequate technological knowledge to operate a device and make the examination visible to the nurse as well as basic biomedical knowledge to follow nurses' instructions). Nurses remained responsible for making a clinical judgment of the adequacy of the examination and the trustworthiness of the data. In sum, despite significant challenges, selected participants in heart failure consultations managed to successfully complete video examinations. Video examinations are possible in the context of heart failure services. However, they are limited, time consuming, and challenging for all involved. Guidance and training are needed to support rollout of this new service model, along with research to understand if the challenges identified are relevant to different patients and conditions and how they can be successfully negotiated.

Seuren LM ，Wherton J ，Greenhalgh T ，Cameron D ，A'Court C ，Shaw SE ... -  《-》

"How can I help?" Nurse call openings on a cancer helpline and implications for call progressivity.

Helplines are a key service used for information and support by people affected by cancer. Little is known about the process of delivering and seeking cancer related telephone help. Using conversation analysis 52 calls between callers and specialist nurses on a major UK cancer helpline are analysed; focusing on the openings of helpline calls by specialist nurses. The helpline involves a triage system from a frontline call-taker to a specialist nurse. The triage system introduces challenges to the interactions for nurses and callers. This paper demonstrates how calls commence, and outlines implications for how they progress. Four key elements to the nurse's initial opening of the call were identified, which together contribute to managing an effective transition from the frontline call-taker to the current call with the specialist cancer nurse. The smooth exchange of information and provision of support in a trusted call environment is a critical goal of the cancer helpline; an effective call opening in a triage environment may significantly optimise the possibility of this goal being realised. A simple strategy is recommended to avoid the difficulties identified, a script for how the triaged call openings may be optimally formulated.

Leydon GM ，Ekberg K ，Drew P 《-》