Telenursing Tools: Questions Are The Answer

In any healthcare setting, practitioners must constantly triage and assess patients to ensure they receive appropriate care. But how can telenurses truly understand what’s happening with chronic outpatients in their homes – using only phone, video, and digital diagnostic tools?

Good nursing communications style plus great technology equals effective care management. When managing care remotely, the right line of inquiry at the right time will point the way toward better outcomes for patients, families, and care organizations.

With appropriate questioning techniques during phone calls and video check-ins, nurses and therapists can coax faraway patients to give plenty of important information. They can also teach patients about better self-care for chronic conditions, in order to reduce hospital readmissions.

In any healthcare setting, practitioners must constantly triage and assess patients to ensure they receive appropriate care. But how can telenurses truly understand what’s happening with chronic outpatients in their homes – using only phone, video, and digital diagnostic tools?

Good nursing communications style plus great technology equals effective care management. When managing care remotely, the right line of inquiry at the right time will point the way toward better outcomes for patients, families, and care organizations.

With appropriate questioning techniques during phone calls and video check-ins, nurses and therapists can coax faraway patients to give plenty of important information. They can also teach patients about better self-care for chronic conditions, in order to reduce hospital readmissions.

Questions are great tools for triage, therapy & education

It’s been said that “questions are the answer” when helping patients disclose issues that can best be resolved through practitioner intervention. Well-crafted inquiries help telenurses triage and assess people, as well as provide direct therapy and education.

Well-chosen questions can lead to solutions, even when issues are beyond the treatment scope of a given practitioner. For example, a patient might reveal mental health concerns to their oncology nurse. Good questioning will provide enough information for an appropriate consultation for other services.

Questions are great tools for triage, therapy & education

It’s been said that “questions are the answer” when helping patients disclose issues that can best be resolved through practitioner intervention. Well-crafted inquiries help telenurses triage and assess people, as well as provide direct therapy and education.

Well-chosen questions can lead to solutions, even when issues are beyond the treatment scope of a given practitioner. For example, a patient might reveal mental health concerns to their oncology nurse. Good questioning will provide enough information for an appropriate consultation for other services.

Questions are great tools for triage, therapy & education

It’s been said that “questions are the answer” when helping patients disclose issues that can best be resolved through practitioner intervention. Well-crafted inquiries help telenurses triage and assess people, as well as provide direct therapy and education.

Well-chosen questions can lead to solutions, even when issues are beyond the treatment scope of a given practitioner. For example, a patient might reveal mental health concerns to their oncology nurse. Good questioning will provide enough information for an appropriate consultation for other services.

Why questioning works so well

There are various theories about why questioning is such a good tool for telenursing. It’s especially helpful for triage, needs assessment, education, medication adherence, and overall patient compliance.

Some psychologists say that questioning is so effective because no idea can become established in a person’s mind until or unless they’ve first accepted it by stating it in their own words. That’s because people reflexively resist outside suggestions, but they can often be led to talk themselves into complying with those same suggestions – especially if they eventually think it’s their own idea.

The questioner controls a particular conversation at the moment of asking the question. So, skilled telenurses can lead patients to disclose problems, and often discover their own solutions.

While responding to the practitioner’s well-chosen queries, a patient makes valuable disclosures and also takes ownership of a given issue – as well as some responsibility for resolving it. By taking ownership of their care, the patient can be empowered toward better adherence, far beyond ho-hum compliance.

An outsider’s voice is especially powerful. For reducing hospital readmissions of patients with chronic conditions, questioning by outside telenurses instead of inside family caregivers can also have the most impact on the least-compliant group of patients: those who bully family members. That’s because the telenurse is a trusted, impartial authority instead of an easily-manipulated family member.

How to question your patients effectively

Let’s consider the various types of questions that are most helpful in telehealthcare, and walk through a few examples showing how and when to use them.

Why questioning works so well

There are various theories about why questioning is such a good tool for telenursing. It’s especially helpful for triage, needs assessment, education, medication adherence, and overall patient compliance.

Some psychologists say that questioning is so effective because no idea can become established in a person’s mind until or unless they’ve first accepted it by stating it in their own words. That’s because people reflexively resist outside suggestions, but they can often be led to talk themselves into complying with those same suggestions – especially if they eventually think it’s their own idea.

The questioner controls a particular conversation at the moment of asking the question. So, skilled telenurses can lead patients to disclose problems, and often discover their own solutions.

While responding to the practitioner’s well-chosen queries, a patient makes valuable disclosures and also takes ownership of a given issue – as well as some responsibility for resolving it. By taking ownership of their care, the patient can be empowered toward better adherence, far beyond ho-hum compliance.

An outsider’s voice is especially powerful. For reducing hospital readmissions of patients with chronic conditions, questioning by outside telenurses instead of inside family caregivers can also have the most impact on the least-compliant group of patients: those who bully family members. That’s because the telenurse is a trusted, impartial authority instead of an easily-manipulated family member.

How to question your patients effectively

Let’s consider the various types of questions that are most helpful in telehealthcare, and walk through a few examples showing how and when to use them.

Why questioning works so well

There are various theories about why questioning is such a good tool for telenursing. It’s especially helpful for triage, needs assessment, education, medication adherence, and overall patient compliance.

Some psychologists say that questioning is so effective because no idea can become established in a person’s mind until or unless they’ve first accepted it by stating it in their own words. That’s because people reflexively resist outside suggestions, but they can often be led to talk themselves into complying with those same suggestions – especially if they eventually think it’s their own idea.

The questioner controls a particular conversation at the moment of asking the question. So, skilled telenurses can lead patients to disclose problems, and often discover their own solutions.

While responding to the practitioner’s well-chosen queries, a patient makes valuable disclosures and also takes ownership of a given issue – as well as some responsibility for resolving it. By taking ownership of their care, the patient can be empowered toward better adherence, far beyond ho-hum compliance.

An outsider’s voice is especially powerful. For reducing hospital readmissions of patients with chronic conditions, questioning by outside telenurses instead of inside family caregivers can also have the most impact on the least-compliant group of patients: those who bully family members. That’s because the telenurse is a trusted, impartial authority instead of an easily-manipulated family member.

How to question your patients effectively

Let’s consider the various types of questions that are most helpful in telehealthcare, and walk through a few examples showing how and when to use them.

Closed-end questions

These can be answered by a simple “yes” or “no” without further explanation. Examples include “Did you close the door?” and “Are you at home?”

This type should be used whenever the practitioner wants to quickly understand the patient’s situation, and clarify issues. Closed questions can also help the patient refocus more narrowly if they begin to wander off topic.

Outpatient: Sometimes I forget to take the pills. If I fall asleep early, I might forget to take them…

Nurse: Did you take your medication last night?

Outpatient: OK, great.

Closed-end questions are useful when a nurse wishes to stop the patient from proceeding any further down a dangerous conversational pathway. The idea is to focus the conversation at the practitioner’s chosen turning point in order to move forward in the therapeutic or educational conversation.

Outpatient: I’m worried about who will take care of me if my daughter becomes sicker than she is already…

Nurse: A few weeks ago, you mentioned that your son offered to visit each week. Will that help?

When interviewing a patient remotely over Skype or Zoom, the practitioner observes, listens, and makes clinical notes. Skilled telenurses try to ask the best questions to maintain the flow of disclosures, without interrupting it.

Once the patient starts talking, clinical nursing specialists can use closed-end questions to keep the information flowing smoothly. The most important caveat is to avoid using closed questions in a confrontational or obstructive way.

Likewise, it’s usually best not to interrupt the patient’s flow. The nurse should wait for the patient to reach a natural break in their disclosure, perhaps the moment of pausing to take a breath.

Outpatient: …..Then things went from bad to worse, first they put me in the hospital, and then within the first week after I returned home my beloved pet dog died blah blah blah….

Therapist: Wow, it sounds like a lot of bad things happened last year, it sounds overwhelming. But you certainly enjoy being at home instead of in the hospital, right?!?

Outpatient: Of course! That hospital food was terrible!

Therapist: So, now let’s talk about a few simple things that we can do together to help keep you out of the hospital. Does that sound good to you?

Outpatient: OK, great.

Open-end questions

Open-end questions can’t be answered by a simple “yes or no.” They require that people think deeply before answering.

They allow patients to pry open mental doors and look into spaces that were previously ignored. That’s why this type of question is so helpful for practitioners as well as patients.

Nurse: You mentioned that you’re having trouble sleeping at night, what’s going on?

Outpatient: That’s right, I’ve been having trouble falling asleep.

Nurse: When did your insomnia begin?

Outpatient: About a week ago.

Nurse: Sometimes a change in daytime activities can lead to insomnia. During the past week, what have you been doing differently in your daily routine?

Outpatient: Well, recently I’ve been taking a short nap in the afternoon, but just a quick wink of shut-eye before the grandkids visit me…

Nurse: Yes, that makes sense. Let’s keep in mind that napping during the day might disturb nighttime sleeping patterns. What do you think is the best way to enjoy the kids and still fall asleep quickly at bedtime?

Outpatient: Hmm….That’s a good question. Let me think about it. I enjoy my nap, but I also want to sleep well at night. Since I wake up at 5 each morning, maybe I could just lie down for a few minutes around noon, instead of napping at 3 in the afternoon…..

Nurse: It sounds like a good solution for falling asleep at a normal bedtime. Let me know if there’s something I can help with.

With good open-end questioning techniques, clinical nursing specialists can walk patients step by step toward a clearer understanding of issues and possible solutions. A mixture of open and closed questions lets patients work their way forward while allowing plenty of breathing room and time for reflection.

Power questions

These questions are strong tools that telenurses can use to stop a patient from wandering too far off-topic. They’re also helpful anytime the patient looks like they’re feeling too much emotional stress, which might stop the disclosure process.

Power questions are really just statements masquerading as questions. As such, they should be used sparingly because any form of confrontation may stall the patient’s disclosure and education process.

They usually start with a command phrase such as “Tell me…” or “Let’s…” or similar imperatives which morph into a question.

Outpatient: …. Then the herbal medicine guru in the video recommended that I start taking these ABC and XYZ dietary supplements every day, and he said it would stop my cancer fast…..

Nurse: Tell me something: Who do you trust more for your wellbeing: an herbal guru selling expensive pills on YouTube, or Dr. Jones?

Outpatient: I trust Dr. Jones, but I’m worried about what will happen next in the treatment process.

Nurse: I hear your concern. It’s natural to worry, but from what I’ve seen in my ten years of experience, your treatment process is on-track and we should see good results soon. Please be careful with those supplements, since they contain chemicals that might interfere with the prescriptions that Dr. Jones gave you!

Outpatient: OK, you’re right, I’ll stop taking the supplements. I do trust Dr. Jones, and I’ll give the treatments he prescribed a bit more time so I can see good results.

A power question can be used to block an avenue of conversation by instantly redirecting the patient toward a more-focused topic. Or, it can be used to help restart the flow of patient disclosures.

Outpatient: A few days ago my best friend told me that he saw my ex-wife with some other guy, and I got so mad……

Therapist: Let’s imagine this scenario – Soon you’ll be enrolled in a behavioral treatment program that can help you make great changes in your life. After completing this program, will you still feel so bothered by your ex-spouse?

Outpatient: Of course not. I’ll be so busy building a new life for myself that I won’t have time to worry about her anymore……

Therapist: Good to hear it. It’s better to focus on changing the things that we can change in our own lives, and consider the past as a learning experience for future growth.