Part 4: Managing ‘difficult’ calls

Learning Objectives

At the end of this session you be able to describe appropriate ways to:

• respond to distressed callers• deal with a caller in crisis• respond to non-priority callers• manage an aggressive caller

Emotional calls

Sometimes you may receive a call from someone who is tearful, anxious or angry.

This can make communication and triage difficult.

In these circumstances support the client by acknowledging their emotional state.

I can hear you’re anxious/angry/upset and we need to talk

about what your needs are, so I can

give you appropriate help.

Can you do this now or would you like to call me back later

when it’s easier for you to talk?

Caller in crisis

Occasionally you may triage a client who is in crisis.

A crisis is usually brought on by a precipitating event such as domestic violence or rape or thoughts of self harm.

Crisis is a temporary state of distress accompanied by confusion and disorganisation.

This can lead to a reduction in problem solving abilities.

A crisis state can be lethal in that it can result in acts of self harm or harm towards others.

Caller in Crisis

It is important to get a clear understanding of the situation so appropriate action can be taken.

Establish rapport by using a warm, caring friendly tone of voice, invite them to talk or be comfortable with their silence, listen without judgement and paraphrase to indicate what you have understood.

Once you have established a caller in crisis, you may need to advise the caller that you are now handing the call over to a clinician or manager.

Caller in Crisis:Clinician assessment of the risk of self harmThe clinician, may need to gauge the urgency of the situation as it is important to assess the risk of self harm. Some tact may be required.

A caller may present as depressed saying “I’ve had enough.”

Question the caller on what they mean, be direct. “Have you any thoughts of harming yourself?”

If the caller indicates they are at risk , gauge the lethality by asking, “Do you have a plan?”

Maintain a balance of active listening and deciding whether to triage in or escalate to crisis or emergency services.

http://www.suite101.com/content/handling-a-crisis-on-the-telephone-a208646

What should you do when non priority groups

want an appointment?

Non priority groups wanting an appointment

If the caller is adamant that they want to attend the service and they are not triaged as an STI priority …

Be firm -- not defensive or overly apologetic -- and polite.

Be aware of the tone of your voice, it is probably easier to convey empathy in your voice, if you think about what the caller wants and the feelings they are experiencing.

Remember the role of triage includes finding the right service for the caller.

Non priority groups wanting an appointment

Inform the caller you are happy to assist in finding an appropriate service for them.

It may be difficult for some people to communicate over the phone and it may be appropriate to offer to refer them to a nurse or manager.

We are a specialised service and what you are requesting can be done by a GP.

I’m happy to help you find an appropriate service you can attend.

I’m not sure I can assist you any further, would you like to talk to a nurse or manager?

Client wants free services

Sometimes non-priority clients want to come into a sexual health clinic because it is free and some other services that provide testing may come at a cost which the caller is reluctant or unable to pay.

Essentially, there is not enough funding or resources for sexual health services to provide testing to the whole NSW population.

It sounds like the cost of testing may be an issue for you. If you wish, I can suggest a service that may be able to provide you with some other options.

It’s called the NSW Sexual Health Info-line and you will be able to speak to a Sexual Health Nurse….

Verbal aggression and threats

NSW Health has a zero tolerance for any aggression in the workplace and it is not your role to be a recipient of such offensive behaviour.

If a caller becomes verbally aggressive, inform them of your limits.

Verbal aggression and threats

Describe the specific behaviour that you want the caller to stop.

If the caller continues to raise their voice and make threats, inform the caller you will end the call and then do so.

Follow the NSW Health Policy Directive – Zero Tolerance Response to Violence in the NSW Health Workplace.

Follow local procedures related to responding to aggression in the work place.

I can’t assist you if you keep shouting and

swearing. If you don’t stop I’ll have to end

this call.

What listening skills did you demonstrate?

What did the caller want?

How did that make you think and feel?

Did you remain calm?

Reflective Exercise

Think about the last time you dealt with a difficult call

Did you remain patient and in control of your emotions?Did you feel angry and if so, were you able to relax enough to respond calmly to the caller?If you had the same type of call what would you do differently next time?

What did you say to convey empathy and understanding?Were you happy with the information you provided to the caller?

Was your manner positive and professional? Were you able to say no without feeling anger, guilt or fear? Did you avoid responding forcefully and arguing back?

Please click here to test your knowledge