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