The perspectives of Swedish registered nurses about managing difficult calls to emergency medical dispatch centres: a qualitative descriptive study

Holmström et al. BMC Nursing (2021) 20:150 https://doi.org/10.1186/s12912-021-00657-5 RESEARCH Open Access The perspectives of Swedish registered nurses about managing difficult calls to emergency medical dispatch centres: a qualitative descriptive study Inger K. Holmström1,2*, Elenor Kaminsky2, Ylva Lindberg2, Douglas Spangler2 and Ulrika Winblad2 Abstract Background: Telephone triage at emergency medical dispatch centres is often challenging for registered nurses due to lack of visual cues, lack of knowledge about the patient, and time pressure – and making the right decision can be a matter of life and death. Some calls may be more difficult to handle, and more knowledge is needed about these calls to develop education and coping strategies. Therefore, the aim of this study was to describe the perspectives of registered nurses’ views about managing difficult calls to emergency medical dispatch centres. Methods: A descriptive design with a qualitative inductive approach was used. Three dispatch centers in midSweden were investigated, covering about 950,000 inhabitants and handling around 114,000 calls per year. Individual interviews were carried out with a purposeful sample of 24 registered nurses. Systematic text condensation was conducted. Results: Seven themes were generated: calls with communication barriers, calls from agitated or rude callers, calls about psychiatric illness, calls from third parties, calls about rare or unclear situations, calls with unknown addresses and calls regarding immediate life-threatening conditions. There was a strong consensus among the registered nurses about which calls were experienced as difficult, with the exception of calls about immediate life-threatening conditions. Some registered nurses thought calls about immediate life-threatening conditions were easy to handle as they simply adhered to protocol, while others described these calls as difficult and were emotionally affected. Conclusion: The registered nurses’ descriptions of difficult calls focused on the callers, while their own role, the organisational framework, and leadership were not mentioned. Many types of calls included difficulties, which could be related to the caller, their symptoms, or different circumstances. The registered nurses pointed to language barriers and rude, agitated callers as increasing problems. An investigation of actual emergency calls is warranted to examine the extent and nature of such calls. Keywords: Emergency calls, Emergency medical dispatch centres, Interviews, Nursing, Systematic text condensation * Correspondence: 1 School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden 2 Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Holmström et al. BMC Nursing (2021) 20:150 Background During recent decades, an increased international demand for emergency services has been reported in many countries [1, 2]. This may be due to easier accessibility as the majority of citizens have cell phones, but also to an increasing worry and anxiety in the population [3, 4]. To aid citizens’ contact with healthcare services, telephone nursing and triage have been established as integral parts of healthcare in many countries such as the UK, the US, Canada, and Australia [5]. In Sweden, telephone triage is mainly carried out within three contexts: at primary healthcare centres, at the national telephone nursing service Swedish Healthcare Direct (SHD) and at emergency medical dispatch centres (EMDCs). EMDCs take calls with a higher degree of urgency, including immediate threats to a patient’s life. At EMDCs, triage calls are completed either by registered nurses or non-nurse dispatchers in the primary care-taking role. For the present study, nurses from three emergency dispatch centres staffed exclusively by nurses were interviewed. The communication in EMDC calls has been reported as difficult [6]. Therefore, we sought to dig deeper into nurses’ actual experience of difficulty in such calls. If the difficulties can be pinpointed, strategies can be developed, and nurses trained to provide optimal handling of these calls. Hence, much can be learned from nurses’ experiences of what they find as difficult in EMDC calls. A recent review [7] suggests that EMDC telephone triage takes place in three steps: identifying the event, assessing the caller’s need for support, and prioritizing the response. The dispatcher (in this case a registered nurse) asks questions to identify care needs and analyse the emergency situation, considers sending ambulance assistance to the correct address, and assess how urgent the illness / accident is to decide how fast this should be carried out. Nurses are expected to handle EMDC calls by asking questions, and callers are expected to answer. The nurse often provides concrete first aid and emergency response instructions during the call. The advice given in EMDC calls is more steering, direct, concrete and forceful than in other telephone triage contexts [8]. Sometimes however, callers resist or reject the nurses questioning [8], and may view the questions as irrelevant, believing that the emergency help they need is being delayed [9]. The process of telephone triage is challenging for nurses due to a lack of visual cues, lack of knowledge about the patient, and time pressure [10–12]. Triage in general may also include challenges such as linguistic barriers, cultural differences, personal perceptions, or environmental impacts [13, 14]. Callers in general want to be listened to, taken seriously, to tell their story without interruption, and be treated in an empathic way [15, 16]. Nurses, on the other hand, expect callers to provide Page 2 of 8 accurate information and clear answers to their questions, and that callers trust them in posing the right questions and making credible and competent triage decis (...truncated)