Dissertations / Theses on the topic 'Telephone counselling'

This exploratory study examined outcomes of single telephone counselling calls, with a self-selected sample of 38 clients from a family counselling agency. The sample was interviewed by telephone at two days and six weeks after the call to assess crisis counselling outcomes in affect, identification of the problem and action taken, and client equilibrium. Repeated measures of the 'perceptual concordance' of counsellor and client were taken over a period of six weeks, assessing levels of concordance between client and counsellor about perceptions of counselling, and client equilibrium. The sufficiency of a single counselling session was also assessed. 'Perceptual concordance' was suggested by reduced client stress, high levels of agreement between client and counsellor in the identification of the problem and agreed action, and satisfaction with the counselling. Positive indicators of restored client equilibrium included a maintenance of lower stress levels, changes in behaviour, improvement in perceptions of the seriousness of the problem, satisfaction with life and with the counselling. Further research of equilibrium as a concept, and an indicator of crisis resolution is warranted. The sufficiency of a single session of counselling was supported by 56% of clients. The variety of services used by clients as an outcome of the counselling suggests that it could be beneficial for telephone counselling agencies to offer a follow-up call. Verifying the agreed action and assessing equilibrium could be useful indicators of effective telephone counselling.

The aim of this Australian Research Council Linkage doctoral project with industry partners UnitingCare-Lifeline Ballarat and Lifeline Australia was to investigate whether calls to Lifeline – a generalist telephone counselling and referral service – could be used as valid and reliable social indicators of health. The Lifeline Australia service receives approximately 1,000 calls a day and key details of each call are recorded on its Client Services Management Information System (CSMIS). A number of research questions directed this study: (1) What are the characteristics or attributes of callers to Lifeline?; (2) How do the patterns of calls to Lifeline vary spatially?; and (3) What is the statistical relationship between calls to Lifeline and other measures of community health? This thesis presents a detailed descriptive summary and analysis of Lifeline’s national CSMIS call data (N = 90,128 cases) from 01-04-2003 to 29-06-2003. It explores this and other sources of call data, such as the Telstra Exchange data, for their potential to be used as social indicators. The project created a model of generalist telephone counselling and referral use (MGTCRU). The MGTCRU was used as a theoretical base to a call rate indicator, named the Lifeline Indicator of Social Need (LISN), which reflects the community’s capacity to provide social support to its most socially isolated residents. The LISN was found to have useful attributes and a potential for use as a social indicator of community strength. The call rate indicator showed a statistically significant relationship with the Accessibility/Remoteness Index of Australia, measures of socio-economic disadvantage, and suicide rates. However, the CSMIS database was found to have certain limitations. The thesis presents recommendations for this situation to be addressed. While acknowledging that there are limitations to telephone counselling call data it is clear that these call data can be used to create cost effective, rapid, reliable, and potentially valid social indicators. This thesis has made a number of significant empirical and theoretical contributions to knowledge on telephone counselling and referral. The descriptive summary of the CSMIS data provided in this thesis might be used in innovative ways by social researchers. The LISN could be used on its own or included in other social indices. The MGTCRU provides a theoretical framework for understanding telephone counselling and referral services use and may assist these services to organise their operations and meet the needs of their callers. This project may have particular application to a current upgrade of Lifeline Australia’s telephony and call data systems.
Doctor of Philosophy

The aim of this Australian Research Council Linkage doctoral project with industry partners UnitingCare-Lifeline Ballarat and Lifeline Australia was to investigate whether calls to Lifeline – a generalist telephone counselling and referral service – could be used as valid and reliable social indicators of health. The Lifeline Australia service receives approximately 1,000 calls a day and key details of each call are recorded on its Client Services Management Information System (CSMIS). A number of research questions directed this study: (1) What are the characteristics or attributes of callers to Lifeline?; (2) How do the patterns of calls to Lifeline vary spatially?; and (3) What is the statistical relationship between calls to Lifeline and other measures of community health? This thesis presents a detailed descriptive summary and analysis of Lifeline’s national CSMIS call data (N = 90,128 cases) from 01-04-2003 to 29-06-2003. It explores this and other sources of call data, such as the Telstra Exchange data, for their potential to be used as social indicators. The project created a model of generalist telephone counselling and referral use (MGTCRU). The MGTCRU was used as a theoretical base to a call rate indicator, named the Lifeline Indicator of Social Need (LISN), which reflects the community’s capacity to provide social support to its most socially isolated residents. The LISN was found to have useful attributes and a potential for use as a social indicator of community strength. The call rate indicator showed a statistically significant relationship with the Accessibility/Remoteness Index of Australia, measures of socio-economic disadvantage, and suicide rates. However, the CSMIS database was found to have certain limitations. The thesis presents recommendations for this situation to be addressed. While acknowledging that there are limitations to telephone counselling call data it is clear that these call data can be used to create cost effective, rapid, reliable, and potentially valid social indicators. This thesis has made a number of significant empirical and theoretical contributions to knowledge on telephone counselling and referral. The descriptive summary of the CSMIS data provided in this thesis might be used in innovative ways by social researchers. The LISN could be used on its own or included in other social indices. The MGTCRU provides a theoretical framework for understanding telephone counselling and referral services use and may assist these services to organise their operations and meet the needs of their callers. This project may have particular application to a current upgrade of Lifeline Australia’s telephony and call data systems.
Doctor of Philosophy

Bibliography: leaves 94-99.
This study investigates factors which affect the motivation of volunteer telephone counsellors, including demographic variables as well as volunteers' subjective perceptions of the factors which have influenced their involvement. The study was conducted in two stages. The first consisted of a demographic analysis of two groups of counsellors from an organisation in the Western Cape, while the second stage involved a qualitative analysis of semi-structured in-depth interviews with respondents who were drawn from these groups. 446 volunteers were selected for demographic analysis, of whom 247 were the full complement of current counsellors in the organisation as of April, 1993, and 199 were ex-volunteers who had terminated their involvement during the preceding three years. Eight demographic variables were recorded for each volunteer: current age, gender, age on joining the organisation, educational level, religious orientation, marital and parental status and length of service. Volunteers were predominantly female (75%), and were on average middle-aged, well-educated, and Christian (64%). Approximately half of the group were married. Parents comprised 50% of the group. The average length of service was approximately five years. Length of service was analysed in relation to each of the other demographic variables in turn in order to discover which factors, if any, were implicated in volunteer turnover. Parental status was the only variable found to be significant in terms of length of service across both current and ex-volunteer groups. A regression analysis performed on the data set as a whole identified parental status as a significant predictor of length of service. The second stage of the study consisted of 23 in-depth interviews. Respondents ( 12 current volunteers, 11 ex-volunteers) were selected according to a purposive technique which took the form of a systematic, structured sampling strategy in order to maximize the diversity of obtained responses. A descriptive phenomenological perspective was adopted in order to tap the rich, subjective experiences of respondents. Interview data was analysed according to an inductive, constantly comparative approach. Findings based on respondents' self-report suggest that motivational factors underlying volunteer participation are multifaceted and complex, changing in nature ii and salience during the course of involvement (from initial contact with the organisation until termination of participation). Although self-serving motives seemed to play a major role in influencing participation, especially during the early stages of involvement, altruistic motives appeared to be important in sustaining on-going involvement. On the basis of findings which have emerged from the study, recommendations have been made as to possible strategies that could be adopted by the organisation to improve volunteer management. The most important of these concerns the implementation of a supervision and support structure for all active volunteers.

This master thesis reports on potentially useful applications for “The social layer concept”, consisting of a combination of telephone-based health advice-giving and dynamic marking of shared web pages, with the aim to contribute to the online health counselling domain. An experimental user study was performed to test a web marking tool prototype. The experimental tool was shown to be useful in helping clients focus on relevant health information and dynamic web marking does provide a useful and complementary service to telephone-based advice-giving. It was considered most useful for complex health advice-giving issues.

Bakgrund: Telefonrådgivning är idag en stor del av distriktssköterskans arbetsuppgifter i primärvården. Det är en komplex arbetsuppgift som innebär ett vårdmöte via telefon där distriktssköterskan ska kunna bedöma vårdbehov, brådskandegrad, ge egenvårdsråd och samordna med andra vårdgivare. För att patienten ska få en så korrekt bedömning av sitt vårdbehov som det går är det viktigt att distriktssköterskan får relevant information. Syfte: Denna studie syftar till att beskriva distriktssköterskans erfarenheter av att arbeta i telefonrådgivning i primärvården. Metod: Studien är kvalitativ intervjustudie med en induktiv ansats. Nio distriktssköterskor intervjuades i tre fokusgruppsintervjuer. Resultat: Ur analysen framkom sex övergripande kategorier vilka benämndes; Telefonrådgivning kan vara en stor utmaning, Arbetsmiljön i telefonrådgivningen har betydelse för kvaliteten på samtalet, För och nackdelar med datoriserat beslutsstöd, Kunskap och erfarenhet underlättar telefonrådgivningen, Kvalitet på samtal och bedömningar är viktigt, Samtal med tredje part kan påverka utfallet av samtalet. Konklusion: Denna studie har synliggjort utmaningar i telefonrådgivning vilka kan utgöra risker för patientsäkerheten och den personcentrerade vården. Resultatet kan bidra till att undvika felbedömningar vilket ökar patientsäkerheten och ger samhällsnytta.
Background: Telephone counselling is today a major part of the duties for a district nurse in primary care. It is a complex task that incorporates a care meeting via telephone where the district nurse should be able to assess care needs, urgency, give self care advice and coordinate with other care providers. In order for the patient to get a correct assessment of their care needs as it is possible, it is important that the district nurse receive relevant information. Aim: This study aims to describe the experience of working in telephone counselling for a district nurse in primary care. Method: The study is a qualitative interview study with an inductive approach. Nine district nurses where interviewed in three focus group interviews. Result: Six general categories were identified from the analysis, which were named; Telephone counselling can be a major challenge, The working environment in telephone counselling is important for the quality of the call, Pros and cons of computerized decision support, Knowledge and experience facilitates telephone counselling, Quality at calls and assessments are important and Conversations with third parties can affect the outcome of the call. Conclusion: This study has highlighted challenges in telephone counselling which may pose risks to patient safety and person-centred care. The result can help to avoid misjudgements, which increases patient safety and benefits society.

Introduktion: Telefonrådgivning är ett sätt för vårdsökande att få vård i Sverige och i vissa andra länder i världen exempelvis i Storbritannien, Canada, USA m.fl. Sjuksköterskor arbetar med telefonrådgivning och hänvisar vårdsökande till rätt vårdnivå. Möten med vårdsökande i telefonen är korta och komplexa vilket kräver hög kompetens. Sjuksköterskor upplever olika utmaningar som kan vara hinder i utförandet av sitt arbete. Syfte: Syftet med studien är att beskriva sjuksköterskors upplevelser av utmaningar i telefonrådgivning. Metod: Metoden var en systematisk litteraturöversikt. Datainsamling genomfördes i databaserna CINAHL och PubMed, och nio kvalitativa artiklar ingick i studien. Graneheim och Lundman (2004) kvalitativ innehållsanalys användes i dataanalysen. Dataanalysen genomfördes med kvalitativ innehållsanalys. Resultat: Resultatet visade att sjuksköterskorna upplevde olika utmaningar i telefonrådgivning som påverkade deras arbete. Kommunikativa utmaningar, organisatoriska utmaningar och arbetsmiljöutmaningar upplevdes som en svårighet. Utmaningar i möte med vårdsökande, bedömning och beslutsfattning, teknologiska utmaningar samt etiska utmaningar var också som utmanade. Kompetens är viktigt i telefonrådgivning på grund av en icke-visuell kontakt. Arbetsgivaren har ett ansvar att hitta lösningar så att dessa utmaningar blir hanterbara. Slutsats: Studien kan öka medvetenheten hos arbetsgivare och vårdsökande om sjuksköterskors utmaningar i telefonrådgivning, vilket kan förbättra sjuksköterskornas arbetssituation. För att förbättra sjuksköterskornas arbetssituation behövs investeringar inom arbetsmiljö och kompetenshöjning, vilket bör förbättra vårdkvaliteten.
Introduction: Telephone contact and telephone counselling is a way for care seekers to receive care in Sweden and in certain countries in the world, for example in the United Kingdom, USA and others. Nurses work with telephone counselling and refer care seekers to the right level of care. Interactions with care seekers on the phone are short and complex which requires competence among the nurses. Nurses experience various challenges that can be obstacles in the performance of their work. Aim: The aim of the study is to describe nurses' experiences of challenges in telephone counselling. Method: The method was a systematic literature study. Data collection was performed in the databases CINAHL and PUBMED, nine qualitative articles were included in the study. Graneheim and Lundman (2004) qualitative content analysis was used in the analysis of data. Results: Results showed that the nurses experienced various challenges in telephone counselling that affected their work. Communicative challenges, organizational challenges, work environment challenges were perceived as a difficulty. Challenges in meetings with healthcare seekers, assessment and decision making, technological challenges and ethical challenges were also perceived to be challenging experiences. Competence is important in telephone counselling due to the non-visual contact with the care seeker. The employer has a responsibility to find solutions to solve the challenges and make them more manageable for the nurses. Conclusion: The study may increase employers' awareness about the challenge’s nurses face in telephone counselling in order to improve nurses working conditions. Investments in the work environment and nurse’s skills development are needed to improve the nurses' work situation, which should also improve the quality of care.

I bakgrunden presenteras sjuksköterskans och distriktssköterskans ansvarsområde, att arbetet ska utgå från ett etiskt och holistiskt förhållningssätt och främja hälsa genom exempelvis rådgivning. Forskning beskrev att arbetet med telefonrådgivning upplevdes stimulerande samtidigt som det var svårt att vara både grindvakt och vårdare. Som en hjälp i det arbetet kunde beslutsstöd användas, det sågs som ett skyddsnät som kompletterade sjuksköterskans erfarenheter. Det sågs även som ett kvalitétshöjande instrument samt att rädslan för att ta fel beslut och anmälas minskade. Syftet med studien var att beskriva sjuksköterskors och distriktssköterskors erfarenheter av att arbeta med telefonrådgivning utifrån det webbaserade rådgivningsstödet på vårdcentral. För att få fram beskrivningarna användes halvstrukturerade intervjuer som analyserades genom kvalitativ innehållsanalys med induktiv ansats. I resultatet beskrevs det att stödet skapade trygghet då det var en källa till kunskap, ett stöd vid behov, ett bra hjälpmedel och gav bekräftelse. Stödet sågs som otillräckligt och svårarbetat då det var svårnavigerat, tidskrävande, språket satte gränser, det kunde inte ersätta den kliniska blicken och stämde inte med verkligheten. Slutligen beskrevs det att den egna erfarenheten styr hur stödet används. Erfarenheterna var övervägande positiva, men omvårdnadsfokus minskade då dyrbar tid användes till att hantera rådgivningsstödet.
In the background we present the responsibilities of nurses and district nurses, namely that the duties will begin with an ethical and holistic point of view, and to promote health through for example giving advice. Research described that working with telephone counselling was perceived as stimulating, though hard being both a gatekeeper and a caretaker. One kind of help in that task could be decision support, it was seen as a safety net and a complement to the experience of the nurse. It was also seen as an instrument to improve quality, as well as reducing the fear of making the wrong decisions and being reported. The purpose of the study was to describe the experience of nurses and district nurses to work with telephone counselling using the web-based counselling support in health centres. To get the descriptions half structured interviews were used, which were analyzed by qualitative content analysis with an inductive approach. It was described in the result that the support created a sense of assurance, because it was a source of knowledge, a support when needed, a good aid, and gave confirmation. The support was also seen as insufficient and not user-friendly, since it was hard to navigate, time consuming, had a language barrier, it could not replace the clinical “eye”, and did not correspond with reality. Lastly it was said that the experience of each individual was a key in how the support was used. Most had positive experiences, but focus from taking care of patients was lost due to valuable time being used for handling the counselling support.

Bakgrund: Av alla telefonsamtal från föräldrar till vårdcentralen får hälften av dessa egenvårdsråd till sina barn, vilket kan främja hälsa, förhindra och förebygga sjukdom. Om förmågan till egenvård sviktar hos föräldrarna har distriktssköterskorna en viktig roll i att stötta och undervisa. Syfte: Att beskriva distriktssköterskors erfarenheter av att ge egenvårdsråd till föräldrar i telefonrådgivning på vårdcentral. Metod: Studien genomfördes med kvalitativ metod med induktiv ansats. Datainsamlingen bestod av 12 semistrukturerade intervjuer med distriktssköterskor på vårdcentral. Materialet analyserades med hjälp av en kvalitativ innehållsanalys och tre kategorier och nio subkategorier framkom. Resultat: Tre kategorier framkom i resultatet. Verktyg för samtalet med underkategorierna kommunikation, undervisning, stöd och hjälpmedel. Nyttan med egenvårdsråd med underkategorierna stärkt föräldraroll, tillgänglig som samtalskontakt och färre vårdbesök. Utmaningen med egenvårdsråd med underkategorierna komplexiteten i telefon, föräldrar är olika och kulturella olikheter och språksvårigheter. Distriktssköterskorna erfor att föräldrarna fick stöttning, råd och hjälp med sin oro i telefonsamtalen. Det fanns svårigheter i telefonsamtalet som att inte kunna se barnet och stressen när samtal drog ut på tiden. Slutsats: Distriktssköterskorna arbetade personcentrerat och stöttade föräldrarna till egenvård så att de kunde verka för god hälsa och förebygga sjukdom hos sina barn. Undervisning i egenvårdsråd stärkte föräldrarollen samt minskade deras oro.
Background: Of all telephone calls to the health care centres, half come from parents’ who receive self-care advice for their children, which can promote health and prevent illness in children. If the parents’ ability to self-care fails, the district nurse has an important role in supporting and teaching. Aim: To describe district nurses’ experiences to provide self-care advice to parents in telephone counselling in health care centrals.     Method: The study was implemented with a qualitative method with an inductive approach. The data collection consisted of 12 semi-structured interviews with district nurses at health care centres. The material was analysed with a qualitative content analysis that resulted in three categories and nine subcategories. Results: Three categories emerged in the result. Tools for the conversation with the subcategories communication, teaching, support and aids. The benefit of self-care advice with the subcategories strengthened parenting role, available as a conversational contact and fewer care visits. The challenge with self-care advice with the subcategories of the complexity of the telephone, parents are different and cultural differences and language difficulties. The district nurses experienced that the parents received support, advice and help with their concerns in the telephone conversations. There were difficulties in the phone call such as not being able to see the child and the stress when the call dragged on. Conclusion: District nurses worked person-centered and supported parents in self-care so they could work for good health and prevent illness in their children. Teaching in self-care advice strengthened the parental role and reduced their worries.

Bakgrund: Psykisk ohälsa ökar i samhället enligt tidigare forskning och många gånger sker den första vårdkontakten med en distriktssköterska vid telefonrådgivning. Tidigare studier visar hur komplex och krävande arbetsuppgift telefonrådgivning kan vara och distriktsköterskan förväntas ha kompetens och kunskap för bedömning av patienten utan tillgång till den kliniska blicken. Syfte:  Syftet med föreliggande studien var att beskriva distriktssköterskors erfarenheter av att samtala med patienter med oro och ångest vid telefonrådgivningen. Metod: Kvalitativ metod med deskriptiv design användes i studien. Semistrukturerade intervjuer genomfördes där nio distriktssköterskor från fyra olika hälsocentraler medverkade med sina erfarenheter av telefonrådgivning. Datamaterialet bearbetades och analyserades utifrån kvalitativ innehållsanalys. Huvudresultat: Ur dataanalysen framkom ett tema och tre kategorier med tillhörande nio underkategorier. Resultatet visade att det är viktigt att skapa goda förutsättningar för ett bra samtal med patienten. Distriktsköterskorna beskrev även vilka svårigheter som fanns med dessa samtal och hur yrkeserfarenheten och det kollegiala stödet underlättade distriktssköterskornas arbete vid telefonrådgivning. Slutsats:  Studien visar att samtala med patienter med oro och ångest vid telefonrådgivning kan vara tidskrävande och komplext. Genom flexibilitet och kreativitet kan distriktssköterskan skapa goda förutsättningar för en trygg och säker vård.
Background: Mental illness is increasing in society according to previous research and many times the first contact with a district nurse is done by telephone counseling. Previous studies show how complex and demanding the task of telephone counseling can be and the district nurse is expected to have the expertise and knowledge for assessing the patient without access to the clinical view. The aim: The aim of the present study was to describe district nurses' experiences of talking to patients with concern and anxiety during telephone counseling Method: Qualitative method with descriptive design was used in the study. Semi-structured interviews were conducted in which nine district nurses from four different healthcare centres participated with their experience of telephone counseling. The data was processed and analysed based on qualitative content analysis. Main results: From the data analysis, one theme and three categories with nine subcategories emerged. The result showed that it is important to create good conditions for a good conversation with the patient. The district nurses also described the difficulties encountered with these conversations and how the professional experience and the collegial support facilitated the district nurses' work in telephone counselling. Conclusion: The study shows that talking to patients with anxiety and anxiety during telephone counselling can be time consuming and complex. Through the flexibility and creativity, the district nurse can create good conditions for safe and secure care.

Telephone counselling plays an important role within the mental service context. This study explores, describes and analyses the dynamics of crisis telephone counselling provided by Lifeline Melbourne. The study is important as there is limited empirical research on the processes and outcomes of telephone counselling. The study identifies the implications of the Lifeline service model for provision of counselling services that are appropriate to the Lifeline context and address client needs.

Self-administered, Internet-based cognitive behaviour therapy (CBT) programs have been shown to be effective in reducing symptoms of depression. Evidence suggests that the effects of these programs may be enhanced by the provision of guidance from therapists and non-specialists (i.e. trained research staff and lay people). Telephone counselling helplines are frequently and repeatedly used by individuals with chronic mental health problems and Internet-based interventions may be an effective tool for reducing depression in this population. The delivery of web-based interventions within a telephone counselling setting also enables the combination of Internet treatments with monitoring provided by a telephone counsellor, which may improve treatment adherence and outcome, and prevent dropout. A randomised controlled trial was used to assess the effectiveness of a 6 week, Internet-based CBT program (MoodGYM and BluePages) with and without weekly telephone tracking provided by a telephone counsellor. 155 callers to Lifeline (a national telephone counselling/service) with moderate to high levels of psychological distress were recruited and randomised to receive either (a) Internet-based CBT plus weekly telephone tracking, (b) Internet-based CBT only, (c) weekly telephone tracking only, or (d) neither Internet-based CBT nor telephone tracking (control condition). Participants were assessed at pre-intervention, post-intervention, 6 month follow-up and 12 month follow-up. Depression and anxiety symptoms were the primary outcome measures. A range of secondary outcomes were examined, including dysfunctional thinking, quality of life, hazardous alcohol use, suicidal ideation, knowledge of various treatments for depression, helpseeking, stigma, depression literacy and CBT literacy. Depression symptoms were significantly reduced in participants who received the Internet only (g = 0.76) and Internet plus tracking (g = 1.04) interventions, compared with the control condition at post-intervention. Significant reductions in depression were also found at 6 month follow-up for participants in the Internet only (g = 1.19) and Internet plus tracking (g = 1.26) conditions relative to the control condition. The intervention was not found to be effective for anxiety symptoms, although between group contrasts favoured the intervention conditions over the control condition. Telephone tracking did not confer any advantage over delivery of the Internet intervention alone, in terms of both treatment adherence and outcome. Regarding secondary outcomes, participants who completed the Internet intervention either with or without telephone tracking had lower levels of hazardous alcohol use, improved quality of life, improved knowledge of psychological treatments for depression, improved knowledge of alternative treatments for depression, and improved knowledge of CBT compared to those allocated to the control condition at post-intervention. Higher educational level and higher pre-intervention motivation for treatment predicted greater adherence to the intervention. Higher baseline depression symptom severity was associated with greater reductions in depression symptoms at post-intervention, 6 month follow-up and 12 month follow-up. There is clear potential for Internet-based treatments to be disseminated through telephone counselling settings. Additional research is needed to validate this model of Internet intervention delivery and to further examine the role of therapist and non-specialist guidance in Internet-based treatments. Depression is associated with significant personal and economic burden, and the positive results of the trial suggest that the delivery of Internet-based treatments through telephone helplines may prove to be a valuable new model for the delivery of psychological services.