Developing a codebook to guide content analysis of expressive writing transcripts.

This article describes a team-based approach to the development of a comprehensive codebook for multiple researchers to use during content analysis of the transcripts of the expressive writings of women (in this study, N = 89) with metastatic breast cancer. The codebook structure was developed iteratively by reaching a consensus on the analysis of shared transcripts to create an all-encompassing set of codes, with definitions, inclusion and exclusion criteria, and exemplar text from the transcripts. The Qualitative Solutions and Research International NVivo software program was used to maintain an electronic database of the consensus analysis of transcripts, information about each code, and a detailed log about the process of developing the codebook. The team ultimately created a comprehensive codebook that contained 27 codes with definitions, inclusion and exclusion criteria, and example text. The codes were verified by each team member through reanalysis of a set of shared transcripts that had been previously coded using an earlier version of the codebook. The team met to discuss individual coding and reached a consensus on the final version of the codebook. No new code was identified during the reanalysis, and there was fairly uniform agreement on the coding. The final version of the codebook will be used to guide each team member's individual analysis of the remaining (74) transcripts, which will be divided among the team. Periodic meetings are planned to discuss the individual analysis and to resolve any issue associated with using the codebook. As new codes are identified and agreed upon by the team, they will be added to the codebook. A team-based approach can facilitate the development of a practical and accurate codebook to guide the analysis of a large amount of qualitative data.

Thinking strategies used by Registered Nurses during emergency department triage.

AIM: This paper is a report of a study to describe and compare thinking strategies and cognitive processing in the emergency department triage process by Registered Nurses with high and low triage accuracy. BACKGROUND: Sound clinical reasoning and accurate decision-making are integral parts of modern nursing practice and are of vital importance during triage in emergency departments. Although studies have shown that individual and contextual factors influence the decisions of Registered Nurses in the triage process, others have failed to explain the relationship between triage accuracy and clinical experience. Furthermore, no study has shown the relationship between Registered Nurses' thinking strategies and their triage accuracy. METHOD: Using the 'think aloud' method, data were collected in 2004-2005 from 16 RNs working in Swedish emergency departments who had previously participated in a study examining triage accuracy. Content analysis of the data was performed. FINDINGS: The Registered Nurses used a variety of thinking strategies, ranging from searching for information, generating hypotheses to stating propositions. They structured the triage process in several ways, beginning by gathering data, generating hypotheses or allocating acuity ratings. Comparison of participants' use of thinking strategies and the structure of the triage process based on their previous triage accuracy revealed only slight differences. CONCLUSION: The wide range of thinking strategies used by Registered Nurses when performing triage indicates that triage decision-making is complex. Further research is needed to ascertain which skills are most important in triage decision-making.