Table 1.
Percentage of total coded barriers and facilitators for each Theoretical Domains Framework (TDF) domain with exemplar quotes (N=1236).
| TDF domain | Total coded barriers (N=819), n (%) | Exemplar quotes—barriers | Total coded facilitators (N=417), n (%) | Exemplar quotes—facilitators |
| 1. Knowledge | 28 (3.4) | 1. “So many mistakes being made as so many ways to interpret” [SPa313] | 11 (2.6) | 2. “If people know how to use it properly then it’s brilliant” [FGb8Pc1] |
| 2. Skills | 72 (8.8) | 3. “Everyone’s not proficient in EMRd and different level experience” [FG6P1] | 64 (15.4) | 4. “We were actually talking at work um before maybe we needed just another session, like maybe 6 months into EMR, which we are doing now...which is wonderful.” [FG4P1] |
| 3. Social or professional role and identity | 82 (10) | 5. “I just wonder where the, you know, the future of nursing is going to go if this is if this is how we're going to do our job. You know, we're ticking boxes.” [FG16P1] | 63 (15.1) | 6. “But I think most important thing would obviously still just be the patient care and then your EMR and then I think the fact that you can just double click on things means that you could spend more time with your patient and you're not stressing about documentation, cause you can always go back to it...you can just do everything you need for your patient and then document everything after.” [FG9P2] |
| 4. Beliefs about capabilities | 47 (5.7) | 7. “I do default to asking the 20 year olds help me I don’t know where to find that thing. And it actually gives me a feeling of being very disempowered...I was previously a really experienced senior nurse that people would come to for help, and now I’m like, I’m useless at this.” [FG1P1] | 29 (7) | 8. “Where you feel you've done a good thing...where you, you find your worth in your job...if you've engaged with someone, and you've made a difference, then you go home feeling better about the job that you do.” [FG16P1] |
| 5. Optimism | 30 (3.7) | 9. “The program is not user friendly.” [SP175] | 52 (12.5) | 10. “It’s so time efficient. It’s so easy to ah communicate with other team members through EMR um and it’s easy to look up things, everything is on the computer in front of you. So I have really, really loved using EMR.” [FG21P1] |
| 6. Beliefs about consequences | 18 (2.2) | 11. “It does slow things down when it comes to the double checking and administering the medications.” [FG21P1] | 0 (0) | N/Ae |
| 7. Reinforcement | 13 (1.6) | 12. “To me if the system's not as good, if not better than the system we've got, not for the coroner, but for each other, then it's not meaningful, and it's not worth it.” [FG1P1] | 9 (2.2) | 13. “And that was the one of the other success to be honest...policies updated.” [FG5P1] |
| 9. Goals | 4 (0.5) | 14. “I actually don't know where to give advice on the EMR or where to give feedback on it.” [FG1P2] | 21 (5) | 15. “It’s most important to be like, very user friendly, so that we can make sure that everything's documented properly for patients and for their safety.” [FG22P1] |
| 10. Memory, attention and decision processes | 106 (12.9) | 16. “Sort of find EMR more complicated than it needed to be...there's more stuff in there then you really need from a day-to-day point of view.” [FG16P1] | 67 (16.1) | 17. “For the most part, it’s an effective system and helps I think, the teams, nursing, allied health, everyone work a bit more cohesively because it’s all in one spot. And things can’t go missing on EMR, which, which can only benefit patient care at the end of the day.” [FG20P2] |
| 11. Environmental context and resources | 250 (30.5) | 18. “I feel that my nursing assessment is less valuable, I can only record limited data that fits in to pre-determined tick boxes.” [SP231] | 52 (12.5) | 19. “Everything is a click away, or a couple of clicks away...information about the patient...rather than rummaging through paperwork and decipher someone's writing, whether they've been referred, whether they've been seen, everything's so yeah, clearer and easy to find” [FG20P1] |
| 12. Social influences | 27 (3.3) | 20. “And I think praising that, and role modeling, that is super important. And I think that’s the risk when you've got senior nurses that are not role modeling the appropriate management or the appropriate use of the system.” [FG14P1] | 44 (10.6) | 21. “But then the other helpful thing is your colleagues...share with your colleagues...because they will know something that you don't know, and you know something that they don't know, and then you communicate and you, you get these things done, and it it's not as difficult.” [FG4P1] |
| 13. Emotion | 142 (17.3) | 22. “I was in tears, like, three times over EMR...everyone knew I was struggling with EMR.” [FG15P1] | 2 (0.5) | 23. “With EMR medication mistakes have reduced to such a great extent like personally for myself, I don't have that anxiety anymore that am I looking through the chart properly and not missing anything, EMR is doing that for me.” [FG21P1] |
| 14. Behavioral regulation | 0 (0) | N/A | 3 (0.7) | 24. “I know some, I'm probably one of them still sort of pine a little bit for the paper but I think we, you know, things went missing with paper or things don't go missing on EMR, we have to adapt and move on, we've all sort of resigned ourselves to it.” [FG20P2] |
aSP: survey participant number.
bFG: focus group interview or individual interview number.
cP: participant number.
dEMR: electronic medical record.
eN/A: not applicable.