NHS Direct: issues for education, management and research

A retrospective quality assessment of the 7119 call triage system in Tokyo - telephone triage for non-ambulance cases

Summary We assessed the accuracy of telephone triage at the 7119 telephone consultation centre in Tokyo. We evaluated walk-in patients at primary care facilities in a clinic or hospital. Nurses asked all patients calling 7119 to join the study and gave them a specific identification number (ID no) at the end of the telephone consultation. The outcome of the consultation was defined as discharge to home (home), admittance to hospital (hospitalization), referral, or transfer to another hospital. After matching consultation records and patient data by ID no, emergency medical physicians reviewed the protocol for problems. During the study, consultation nurses issued an ID no in 17,141 cases, and hospitals and clinics sent back the data on 1205 patients. Among these patients, 1119 cases (93%) were home, 59 cases (5%) were hospitalization, 18 cases (2%) were referral and 9 cases (1%) were transfer. Of the 86 cases which had an outcome of hospitalization, referral or transfer, there were 56 cases with matched patient data. Among these 56 cases, review showed no significant problems with 37 cases. However, there were 11 cases with patient refusal to comply with the triage recommendation, 4 cases with 7119 staff education problems and 4 cases with problems with the protocol itself. We were able to evaluate the 7119 telephone triage system in Tokyo. The study identified three types of problems with the triage process: refusal of telephone triage recommendations, problems with staff education and problems with the protocol itself.

Student nurses' use of their interpersonal skills within clinical role-plays

Heron's six-category intervention analysis is a component of many counselling courses and is used extensively by teachers of interpersonal skills within nursing curricula. In addition, researchers have used six-category intervention analysis as a theoretical framework for exploring nurses' perceptions of their interpersonal skills. This study aimed to advance previous research by using Heron's framework to analyse student nurses' actual skills, as deployed in clinical role-plays, and then to compare them to earlier findings. Analysis of the data produced the following rank order of interventions based on Heron's framework: catalytic, prescriptive, supportive, informative, confronting and cathartic. The findings both challenge and support previous findings on nurses' perceptions of their interpersonal skills. The paper discusses these findings and their implications for clinical practice.

Contemporary issues in the care of sick children and their families

This article considers the response of children's nurses to contemporary change in the management of sick children and their families throughout the last decade. In recognizing the rich and diverse history of children's nursing the impact of those factors which have led to the development of operational strategies to manage children's services will be considered. The quest, not always successful, to coordinate care as a seamless web of services to children and their families will be investigated, as will the role dimensions encompassed by specialist children's nurses and their interface with interprofessional colleagues. A range of nurse-led services in a variety of contemporary child health settings will be explored.

Assessing therapeutic intervention used by NHS Direct nurse advisers

The National Service Framework for Mental Health has identified NHS Direct as a "new point of access" to appropriate mental health services. Mental health calls account for approximately 4% of all calls received by NHS Direct but raise the greatest level of anxiety among advisers and take twice as long to deal with as other calls. In order to provide adequate advice, it is essential to ensure nurse advisers can deal with this type of call. As a first step in meeting these needs this short research article reports on the types of interventions deployed by 18 nurse advisers during role-plays with a mental health "client" expressing self-harm.