title: Factors facilitating or hampering nurses identification of stroke in emergency calls.
abstract: OBJECTIVE
  To explore the factors that facilitate or hamper identification of stroke in emergency calls concerning patients with stroke who have fallen or been in a lying position.
  
  
  BACKGROUND
  Early identification of stroke in emergency calls is vital but can be complicated as the patients may be unable to express themselves and the callers generally are bystanders. In a previous study, we found presentation of fall or the patient being in a lying position to be the major problem in 66% of emergency calls concerning, but not dispatched as acute stroke.
  
  
  METHODS
  A qualitative study using interpretive phenomenology.
  
  
  METHODS
  Analysis of transcribed emergency calls concerning 29 patients with stroke diagnoses at hospital discharge, in 2011 and presented with fall/lying position.
  
  
  RESULTS
  Patients' ability to express themselves, callers' knowledge of the patient and of stroke, first call-takers' and nurses' authority, nurses' coaching and nurses' expertise skills facilitated or hindered the identification of stroke. Certain aspects are adjustable, but some are determined by the situation or on callers' and patients' abilities and thus difficult to change. Nurses' expertise skills were the only theme found to have a decisive effect of the identification of stroke on its own.
  
  
  CONCLUSIONS
  To increase identification of stroke in emergency calls concerning stroke, the first call-takers' and nurses' action, competence and awareness of obstacles are crucial and if strengthened would likely increase the identification of stroke in emergency calls. In complicated cases, nurses' expertise skills seem essential for identification of stroke.
authors.affiliation: Karolinska Institutet Stroke Research Network at Södersjukhuset, Stockholm, Sweden.|Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.|Karolinska Institutet, Center for Gender Medicine, Stockholm, Sweden.
authors.forename: Annika
authors.initials: A
authors.lastname: Berglund
authors.affiliation: Department of Health and Caring Sciences, Linneaus University, Kalmar, Sweden.
authors.forename: Kristiina
authors.initials: K
authors.lastname: Heikkilä
authors.affiliation: Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
authors.forename: Katarina
authors.initials: K
authors.lastname: Bohm
authors.affiliation: Karolinska Institutet, Center for Gender Medicine, Stockholm, Sweden.|Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Schenck-Gustafsson
authors.affiliation: Karolinska Institutet Stroke Research Network at Södersjukhuset, Stockholm, Sweden.|Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.|Karolinska Institutet, Center for Gender Medicine, Stockholm, Sweden.
authors.forename: Mia
authors.initials: M
authors.lastname: von Euler
mesh_terms: D004632:Emergency Medical Services / Q000379:methods*; D004638:Emergency Treatment / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D015277:Hotlines; D006801:Humans; D008487:Medical History Taking / Q000379:methods; D010358:Patient Participation; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000451:nursing; D013548:Sweden; D014218:Triage / Q000379:methods
keywords: dispatching; emergency call; emergency medical service; facilitators; identification; nurse; nursing; obstacles; prehospital; stroke