Description of codes and themes

The data from the field notes and interviews were transcribed as it was gathered to allow first level analysis (Fink, 2000) and to identify developing themes which were explored further in subsequent interviews and observations. Some of the themes started to emerge during the observations and interviews and some did not become evident until the transcripts were repeatedly reviewed and the researcher was immersed in the data (Silverman, 2010).

In order to develop themes and identify commonalities the data was coded. Coding helps to manage the data, to allow comparisons and help demonstrate patterns within the data (Taylor & Gibbs, 2010) and is part of the analysis process (Miles & Huberman, 1994). Coding was based on terms, phrases, and key words rather than existing concepts (Taylor & Gibbs 2010). Categories were developed from segments of the text and codes developed and defined (Creswell, 2009).

To code the data, sections of text or phrases with similar content were identified and colour coded using coloured pens. Notes or memos were added to the data as the codes were developed (Myers, 2008). Image 3 illustrates this process. If text was identified as related to more than one code all the relevant colours were applied to the text. Other qualitative data analysis tools exist including software programmes to support coding. One of these methods

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was explored (NVivo) but the personal preferences of this researcher and their need for a visual summary means that a manual approach was employed. Figure 8 presents the codes identified.

Image 3. Colour coding of field note data with accompanying memos

Figure 8. Codes identified from the field notes and interview data

Codes Definition

Review of request card Examination of request card to inform examination

Choice of room Choice of x-ray room from 6 DR and CR rooms

available and rationale for choice

Rad IDs patient Communication for identification and justification of examination

Rad communicates with patient

- information seeking

Communication used to inform justification process and or further assess patient e.g. mechanism of injury

Rad communicates with patient

- positioning

Communication to aid positioning, explanation, instruction or feedback on position

Rad communicates with patient

- comfort check

Communication to ensure patient comfort during positioning

73 - general

Rad observes patient Observation of patient when entering room and during the examination, includes general movements, body language and facial expressions

Rad reviews old images Radiographer reviews images from previous examinations for additional information

Rad sets up room prior to patient entering Radiographer sets equipment in approximate position including placing chairs or planning trolley positions

Order of projection Whether the AP examination or lateral was the first image acquired

Rad demonstrates position Radiographer demonstrates positioning to patient

Rad moves a body part Radiographer manually positions body part themselves rotating and moving the limb

Rad lifts a body part Radiographer lifts a body part themselves but does not adjust the position

Rad gets patient/somebody else to position patient/move an immobilised body part

Radiographer does not manually position the patient relying on the patient or escort to position the patient e.g. a nurse lifts the leg while the radiographer positions the image receptor

Rad uses additional equipment Use of positioning pads, static grids, support devices

Rad reviews images immediately on production Radiographer pauses examination to review image produced for additional information

Rad does not review image immediately Radiographer does not pause examination but may review images before all images gathered

Rad reviews images at end of exam Radiographer reviews all the images produced when all the images are acquired

Problem solving/decision making Various methods the radiographer uses to solve the problems presented by the examination

Experience Radiographer refers to experience informing problem

solving

Additional projections Images produced by the radiographer which were not requested but follow department protocols

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The codes were examined and grouped and themes within the data began to emerge. For example it was clear that several of the codes related to the gathering of information about the patient. Figure 9 demonstrates the themes.

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Figure 9. Themes emerging from codes

Code groups Themes Key themes Overarching theme

Review of request card Rad reviews old images Rad observes patient Rad communicates with

patient-information seeking Severity of injury assessment Rad reviews images

Immediately on production

Rad demonstrates position Rad moves a body part Rad lifts a body part

Rad gets patient/somebody else to position patient/move an

immobilised body part Changes in approach to examination Rad uses additional equipment

Rad reviews images immediately on production

Rad does not review image

immediately Timing of review of images Rad reviews images at end

of exam

Rad communicates with patient Changes in use of communication

information seeking positioning comfort check general

Problem solving/decision Changes in approach to examination

making Experience

Additional projections Protocols

Choice of room Protocols

Order of projections -AP projection first

- Lateral projection first Other

Complexity Assessment of complexity Conducting the examination the examination

76 Overarching theme- Complexity

The complexity of the examination was the overarching theme from the research. The radiographers needed to evaluate the complexity of the examination in order to conduct the examination safely, ethically and professionally: to produce diagnostically acceptable images with the minimum discomfort to the patient.

Key Themes

The data revealed two key themes of assessment and conducting the examination both of which were highly influenced by the complexity of the examination (overarching theme). The data suggested that the radiographers used a multistage process to assess the patients’ injury. Having assessed the patient, the complexity of the examination was estimated and the radiographers’ subsequent behaviour and approach to problem solving was modified dependent upon the complexity of the examination.