Table 1 Coding system for the directed content analysis associated with appropriate communication and relationship dynamics

Shared goal

The SG asks, “How long will it be before you are ready to take the next patients?” The SN responds, “We may as well go on at once, we just need to clean and make over our preparation.” The AN nurse adds, “Also for our part!” The SG answers, “Then it’s a deal, it’s what we do!” [Team16]

Shared knowledge

The CN and SN have just realized that the repulsive saw is missing [a specific instrument usually used for that type of surgery]. The saw will be in the OR in 1½ hours at the earliest. The SN and AN nurse are talking together to coordinate the new time perspective. They agree that the SN might clear the situation with the SG. The CN calls the SG and asks, “The patient is in OR now, would you please come and mark the hip? But there is an issue, the repulsive saw is missing and will be here about 1½ hours at the earliest. They [AN nurses] would like to perform the spinal anaesthesia now”. They talk on the phone a little. The CN informs the SN and AN nurse and says, “He will come now, and he doesn’t care about the saw. We can move on now”. [Team 24]

Mutual respect

OR-Nurse 34 and OR-Nurse 36 are preparing the next surgical procedure and talking about how to allocate the day’s work. OR-Nurse 34 says, “Shall I take the first [be the surgical nurse], then you can see how I manage, and you can do it yourself afterward?” OR-Nurse 36 answers, “Yes, we can do that, but I would like to take the cemented hip. Yesterday, I was the surgical nurse for three “cementless hips.” I need training with the cementing, so I would really like to do that.” OR-Nurse 34 says, “Okay, that’s fine. I’ll take the first two and you take the hip and the last patient with the fasciotomy!” OR-Nurse 36 says, “Okay!” [Team16]

Accurate communication

The AN nurse is reading from a paper – name of the patient, ID number, and type of surgical procedure. She mentions, “Ciproxin has been given”. The SG replies, “Yes, superb and no expected surgical implications. Estimated time for the surgical procedure, half an hour!” [Team 16]

Timely communication

The SG takes off his gloves, having just finishing the surgical procedure. The CN says, “Look at these pictures [X-rays]. It is from the next patient! What did we agree about? What are we going to do?” Then, they talk about which type of hip replacement materials they are going to use for the next patient. They walk together to the closet and look at the different replacement materials and instrument boxes. They make a choice and decide together. [Team 12]

Problem solving communication

The SN says “Oh, these two, () they don’t fit together!” The CN thinks and says “Oh, NO, we have to stop him [the surgeon]. The head [one part of the replacement materials] he has chosen doesn’t fit in”. She knocks on the door to the room, where the AN nurse is preparing the patient for aesthesia and says, “Wait a minute!” Then she calls the surgeon. The CN and SN discuss the size of the replacement materials and what to do now. The CN says “He will come, and he is very annoyed that the person who prescribed the operation was so focused on the thighbone part when the patient’s acetabulum is so damaged”. They are talking about which solutions they should go for. The surgeon arrives, and together they discuss the possibilities and decide. “We will continue! Never going down on equipment!” the surgeon exclaims. [Team 29]