title: "Your ears become your eyes": managing the absence of visibility in NHS Direct.
abstract: OBJECTIVE
  To identify and describe nurses' perceptions of interactional practices they use to manage the absence of visual cues in telephone consultations with callers at an NHS Direct site.
  
  
  BACKGROUND
  A routine activity in telephone consultations is visualizing the patient and the situation from which the call is made, that is, "building a picture of the patient". Little is known about interactional practices between nurse and caller that contribute to shaping a conception of the caller, or other activities that nurses do to manage the absence of visibility in the consultation.
  
  
  METHODS
  Qualitative analysis of semi-structured interviews conducted with nurses new to NHS Direct telephone consultations, the first immediately prior to the NHS Direct site's opening, and the second 6 months later.
  
  
  RESULTS
  The activity of visualizing patients and their environment is closely linked to interactional practices carried out between nurse and caller. Nurses described a range of interactional activities that they perceive help callers to describe with more precision what the nurse cannot see. Nurses also tailor interaction to a nonvisual environment in order to manage the more emotional aspects of telephone consultations, such as delivering information, advice, reassurance, and building trust and rapport.
  
  
  CONCLUSIONS
  Nurses developed skills to manage interaction with callers in order to compensate for the absence of visibility. Skills were based on their professional backgrounds and experience and developed in an ad hoc way. Further research could examine the efficacy of these strategies, and be a prerequisite to adding them to training programmes.
authors.affiliation: Immediate Access Project, Department of General Practice and Primary Care, Guy's, Kings' and St Thomas' School of Medicine, Cutcombe Road, London SE5 9PJ, UK. catherine.pettinari@kcl.ac.uk
authors.forename: C J
authors.initials: CJ
authors.lastname: Pettinari
authors.forename: L
authors.initials: L
authors.lastname: Jessopp
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D016529:Emergency Nursing / Q000193:education / Q000379:methods / Q000592:standards; D015277:Hotlines / Q000458:organization & administration*; D006801:Humans; D008131:London; D009633:Nonverbal Communication; D009723:Nurse-Patient Relations; D009730:Nursing Assessment / Q000379:methods* / Q000592:standards; D015404:Nursing Methodology Research; D009740:Nursing Staff / Q000193:education / Q000523:psychology*; D010353:Patient Education as Topic; D012017:Referral and Consultation; D013222:State Medicine; D011795:Surveys and Questionnaires; D014218:Triage / Q000379:methods* / Q000592:standards