Table 2.
Potential facilitators to prescribing and setting individualized dialysate temperatures (IDTs) (n = 18)
| Theme | 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 need for more evidence | - It needs to be studied | 18 | Knowledge |
| Awareness of evidence | - An intervention that’s been studied for which there’s reasonable evidence of benefit | 10 | ||
| Awareness of guidelines | - There are guidelines for dialysis treatment | 7 | ||
| Link with existing policies | - Individualized cooler dialysate temperatures will not conflict with local policies | 12 | Goals | |
| Centres have existing temperature standards | - Centre standard is 36.5 or higher | 10 | Knowledge/Goals | |
| - Centre standard is less than 36.5 | 6 | |||
| Theme 2: benefits and motivation to use IDT | Positive clinical management consequences | - Cooler dialysate temperatures can help manage or prevent hypotension during dialysis | 17 | Beliefs about Consequences |
| - Cooler dialysate temperatures can help with fluid removal during dialysis | 7 | |||
| Positive potential long-term consequences | - Individualized cooler dialysate temperature may lead to better cardiovascular outcomes | 8 | Beliefs about Consequences | |
| - Individualized cooler dialysate temperatures may lead to a reduction in morbidity and mortality or increase longevity | 3 | |||
| - Individualized cooler dialysate temperatures may preserve cognitive function | 2 | |||
| Optimistic | - Based on what I'm hearing, I'm quite optimistic | 16 | Optimism | |
| Patient benefit is inherently reinforcing | - If you can prevent symptomatic hypotension for your patients, that’s rewarding | 11 | Reinforcement | |
| Priority | Setting/prescribing IDTs is a priority because we need to know the answer | 7 | Goals | |
| Theme 3: IDT alignment with usual prescribing and setting practices and roles | Procedures and roles specific to physicians | - The physician would order or prescribe individualized cooler dialysate temperatures | 14 | Social Professional Role and Identity/Nature of the Behaviour/Beliefs about Capabilities |
| - Physicians are responsible for prescribing dialysate temperatures | 11 | |||
| - Prescriptions are applicable over all treatments until changed again | 8 | |||
| - I would have to be able to prescribe IDTs in a way that I wouldn't have to review every treatment because that would not work | 5 | |||
| Procedures and roles specific to nurses | - We usually measure core body temperature before and after treatment | 8 | Social Professional Role and Identity/Nature of the Behaviour/Beliefs about Capabilities | |
| - Nurses can modify dialysate temperature during treatment | 5 | |||
| - Dialysate temperature is set automatically or is a default | 5 | |||
| - We usually accept treatment parameters | 3 | |||
| Influences among health care professionals | - Nurses follow the doctor's orders or prescription | 12 | Social Professional Role and Identity/Nature of the Behaviour/Beliefs about Capabilities | |
| - Nurses influence physicians when prescribing dialysate temperature | 10 | |||
| It will be easy to prescribe or set IDTs | - I am confident that I will be able to prescribe IDTs for all my patients | 10 | Beliefs about Capabilities | |
| - It will be easy to set individualized cooler dialysate temperatures | 8 | |||
| - It will be easy to prescribed IDTs | 8 | |||
| Theme 4: thermometer availability/accuracy and dialysis machine characteristics | Dialysis machine can be adjusted in 0.5 or 0.1 increments up to 35 Celsius | - Can adjust dialysate temperature by 0.1 increments | 3 | Environmental Context and Resources |
| Theme 5: Impact on workload | Impact on workload | - My workload will increase minimally | 10 | Beliefs about Capabilities/Beliefs about Consequences |
| - Reducing episodes of hypotension during dialysis can decrease workload | 7 | |||
| - My workload will not increase | 6 | |||
| Theme 6: patient comfort | Tolerability | - Patients are not likely to notice the cooler temperature/not likely to be side effects/generally well-tolerated | 8 | Beliefs about Consequences |
| Coping plans for patients who say they are cold | - We give blankets to patients who feel cold on dialysis | 12 | Behavioural Regulation | |
| - For patients who feel cold on dialysis, we suggest that they wear warm clothing and bring blankets | 5 | |||
| No emotion related to IDTs | - I don’t or I won’t have any emotions related to dialysate temperature | 6 | Emotion | |
| Theme 7: forgetting to prescribe or set IDT | Unlikely to forget | - I won’t forget | 7 | Memory, attention and decision making |