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Table 1 Potential barriers to prescribing and setting individualized dialysate temperatures (IDTs) (n = 18)

From: Barriers and facilitators to healthcare professional behaviour change in clinical trials using the Theoretical Domains Framework: a case study of a trial of individualized temperature-reduced haemodialysis

Themes Sub-theme Belief statement Frequency (out of 18) Theoretical Domains Framework, domain(s)
Theme 1: awareness of clinical guidelines and how IDT fits with local policies Awareness of guidelines - We don't use guidelines for individualized cooler dialysate temperatures 14 Knowledge
- There are no guidelines for dialysate temperature 5
Potential for conflict of IDT with local policies - Individualized cooler dialysate temperatures will/may conflict with local policies 3 Knowledge/Goals
Theme 2: benefits and motivation to use IDT Not a priority - It’s a little priority at this point 10 Goals
No rewards in place - I can’t think of any rewards 8 Reinforcement
Motivation limited to subset of patients - I am more motivated to set or prescribe cooler dialyste temperatures when my patients have hypotension on dialysis 6 Intention
- I am not inclined to use individualized cooler dialysate temperatures for patients doing well on current dialysate temperatures 5
- You have to weigh the benefits of preventing hypotension with patient complaints of feeling cold 3
Theme 3: IDT alignment with usual prescribing and setting practices and roles Currently not individualizing dialysate temperatures at each treatment - We don't individualize dialysate temperatures 10 Nature of the Behaviour
- When setting or prescribing cooler dialysate temperatures it is usually 0.5 degrees below standard 8
Sometimes individualize the dialysate temperature - I occasionally or rarely prescribe or set cooler dialysate temperatures 11 Social Professional Role and Identity/Nature of the Behaviour/ Beliefs about Capabilities
Nurses require physicians' order for permanent change in dialysate temperature - We need a global order/ policy change/ medical directive so nurses can set individualized cooler dialysate temperatures 7 Social Professional Role and Identity/Social Influences
- We would need a doctor's order to set individualized cooler dialysate temperatures 5
- I need an order from the doctor for a permanent change in dialysate temperature beyond one treatment session 3
Theme 4: thermometer availability/ accuracy and dialysis machine characteristics Outdoor temperature and drinks can influence temperature reading - Climate in winter or summer can impact accuracy of core body temperature readings 3 Environmental Context and Resources
- Consumption of warm beverages or ice can impact accuracy of core body temperature readings 3
Thermometer availability - Potential limited thermometer availability 2 Environmental Context and Resources
Dialysis machine can be adjusted in 0.5 or 0.1 increments up to 35 degrees Celsius - Can adjust dialysate temperatures by 0.5 increments 2 Environmental Context and Resources
Theme 5: impact on workload Negative impact on workload - Physicians say nurses’ workload will increase 6 Beliefs about Capabilities/ Beliefs about Consequences
- My workload will increase 4
Theme 6: patient comfort Negative clinical management consequences - Patients may feel too cold on cooler dialysate temperatures 11 Beliefs about Consequences
- It is common for patients to feel cold on dialysis 7
Coping plans that lead to increased dialysate temperature - If patients are really complaining of being cold we may increase dialysate temperature by 0.5 9 Behavioural Regulation
- I may increase the dialysate temperature for someone with hypertension to see if that decreases their blood pressure 2
- If patients are feeling cold and have no issues with blood pressure or fever and request an increase in dialysate temperature I would not have evidence to deny their request 2
Emotions related to patient comfort - I may feel worried or concerned if patients are feeling cold 6 Emotion
Theme 7: forgetting to prescribe or set IDT Potential to forget - I may forget to prescribe or set an IDT if I am busy 9 Memory, Attention and Decision Making /Emotion
- We would need reminders for IDTs 6
- It may be easy to forget in emotional or tense situations 2