Question

Describe the importance of performing the initial count

Answer 1

The data on which this study is based were collected as part of a larger study examining communication and power relationships between nurses and doctors,16,17 which took an ethnographic approach.18,19 Eleven nurses were recruited for their ability to act as key informants18 about operating room practice and the surgical count. Their characteristics (table 1​1)) were representative of the predominant demographic of Australian nurses.20 Key informants were closely observed on how they interacted with surgeons, anaesthetists and other nurses, and the interactions were included as data. Follow‐up interviews and focus groups about the observations were conducted with the 11 nurses. Patients were also informed about the study before their operation.Unlike hospitals in the UK, where operating department practitioners form a part of the surgical team,21operating rooms in Australia are staffed by three registered nurses who work in the capacity of instrument nurse, circulating nurse and anaesthetic nurse. Instrument nurses “scrub”, and prepare and handle sterile equipment for the procedure, remaining at the operating table, whereas circulating nurses remain “unscrubbed” and “scout” on the periphery of the sterile field to retrieve supplies and equipment. Anaesthetic nurses sometimes assist as circulating nurses.

Data were collected sequentially by RR, an experienced operating room nurse, from three different clinical departments: a large metropolitan not‐for‐profit hospital, an outer suburban public hospital and an inner city publicly funded specialist hospital in Melbourne, Victoria, Australia Ethical approval was obtained from each hospital and from the university, in accordance with national guidelines in Australia.22 Pseudonyms were used to protect the identity of all participants and hospitals.More than 230 h of observational field work of clinical operating room practice was undertaken. Eleven individual, semistructured interviews using the technique of “photo‐voice” and four group interviews with participants from each hospital were conducted. All interviews were audiotaped and data transcribed verbatim. RR also kept a diary for 2 years, in which she recorded observations from the position of an operating room nurse, and interactions with surgeons, anaesthetists and nurses. In this diary, she also recorded and monitored her own and participants' behaviour and attitudes to the research process. This information provided an audit trail for the study, thereby contributing to the credibility of the study findings.

Data collection and analysis were conducted concurrently. Field notes, diary entries and interview transcripts were listened to repeatedly, generating ideas and lines of inquiry that directed further work in the discipline. Rather than performing a thematic analysis, we sought to understand the power relationships and the taken‐for‐granted assumptions that influenced the surgical count by undertaking a deconstruction of the data.Conducted at two levels, the deconstruction included, firstly, categorising the discursive practices used by nurses in the management of the surgical count. Initially, we asked the question, “What are the different clinical practices and processes in which operating room nurses engage?” Through ongoing reflection on the transcribed data from field work, interviews and diary entries, we formulated a tentative framework in which we categorised the different types of practice. Secondly, we formulated theoretical questions based on the work of Michel Foucault to explore how power relationships influenced and governed the conduct of the surgical count. provided a means of breaking down the practice of nurses to show the influences on their work as they conducted the surgical count. The preliminary analysis was tested by giving written summaries to participants, who were then provided with opportunities for feedback. RR and EM conducted the initial data analysis independently of one another and achieved total agreement.

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