Table 5 Professional barriers and facilitators

Knowledge

“They didn’t know about their medication. They didn’t even know about their own care, their fluid restriction or anything… totally dependent on medical staff…here the patients are more educated. They’ve been given more about their care, their diseases…and advice, the treatment, why they’ve got renal failure. It’s a big difference here in their care.” Sheffield1professional

“sheer process of dialysis for the patient their ability to take in information” Sheffield3professional

“So they’re talking about their past, their non-dialysis days, what they’ve been doing, what they’ve been eating…we know more about them and the patient gets more from us…this is a two way combination” Sheffield1professional

“it’s a learning process for each individual constantly” Sheffield3professional

“they used to come to dialyse for 31/2 hours and go to sleep …now they’re discussing with each other…you will hear them discussing about their potassium, phosphates, Hb so they know more about themselves…they go online check their results, ask more questions.” Sheffield1professional

“patients want to learn more about their selves than they did before” Sheffield4professional

“I’ve had lots of things said…’it’s nothing to do with me, it’s not my fault, I come here, you dialyse me that’s your job, I don’t want to know’, right through to the 'I want to know everything about it, I want to know everything you’re doing and I want an explanation for everything you do’.” Sheffield2professional

“it must be awful, you’re not in control of what’s happening to you” York4professional

“it’s good for the staff as well to keep on track of things…cause everything changes all the time” York1professional

“we have an excellent renal service…anybody is encouraged to talk to anybody about anything…if you’ve got a concern about a patient and you want to ring a dietician, you ring the dietician” York4professional

Beliefs about capabilities

“it was difficult to teach a patient who didn’t know anything about their own care” Sheffield1professional

“If they were more compliant and understand the process more” Sheffield3professional

“the little lady who thought it was more important that it looked neat than that is was clean” York3professional

“I’m not a dietician…the dietician are always there, give them a ring and clarify, get the leaflet for the patient which gives me an idea to read it as well… improve my knowledge… if the senior nurses are there, the sisters are there, the ward managers are there, which have more experience…will answer my question as well which will be good for me.” Sheffield1professional

“we’ve had patients with learning disabilities that you would look at and thought “oh I don’t think they’d be up to doing this’ but have got on really well” Sheffield3professional

“the patient even knows …who will be the best to sort it out..they know about their condition, who to get and who not to get.” Sheffield1professional

“they’re more confident..they think oh I could do that and give it a try” Sheffield4professional

“a patient may challenge you but it’s also sometimes a request for information… so “well why am I doing this?’ and 'why do you want me to do that?’ may not be a challenge, it may actually just be a simple way of saying 'explain it to me a little bit further’.” Sheffield2professional

“there’s a fear…because it’s an electronic machine.. I reassure them there’s nothing that can go wrong.. it’s not going to damage anything…or blow up” Sheffield4professional

“they all say 'yeah it’s great’ they feel so much more confident and they feel in control” York4professional

“patients should have the choice” York4professional

Skills

“so we show the staff are training as well as the patient” Sheffield1professional

“They’ve got phobias about needles” Sheffield3professional

“some people are just fine to come on and do whatever you tell them” York3professional

It can be challenging “especially for the more junior members of staff who haven’t got the years of experience behind them” Sheffield2professional

“most of them have the ability and the skill to do a certain amount of it” Sheffield3professional

“they’ve got more control over what they’re doing” Sheffield4professional

“you need it even with the staff, cause you see people cut corners here and there” York3professional

“you would have to put in place some sort of monitoring, revisiting, retraining, reassessment system, people do, we all you know, nurses slip back in habits don’t they” York4professional

Environmental context and resources

“explain to the patient that it isn’t enforceable to go home…they were thinking that the NHS is going into crisis, they’re getting rid of the staff and most of the patients have to go home…their health will be in danger because the nurses won’t be there” Sheffield1professional

“weren’t encouraged to do anything for themselves” Sheffield4professional

“it was just a conveyer belt and all the patients basically had the same prescription and the same flows…it was just a real kind of industrial way of dialysing people, there was very little personalised care and you had no time to spend with them” York3professional

“they’ll take them round to show, let the patient examine the machine, just sit down next to the patient, talk to the patient, you know take the anxiety out of it…Some of them haven’t seen the machine before.” Sheffield1professional

“it was very much you’re the patients, we’re the nurses, we look after you, we do it all for you” York4professional

“it’s really sort of embarrassing some days when you realise you can’t, you’re just doing the absolute bare minimum” York3professional

“the prescription that we keep…some patients think that that’s ours…if it’s left on the table…they want to look at it…they can feel the difference if something’s dropped or something’s too high” Sheffield4professional

“before we bring the change for any equipment, like we introduced the staff training, the patient has been introduced to it as well.” Sheffield1professional

“there’s always somebody around if an alarm goes off…so you have to take a step back and wait for them to look …and they follow like the chain that we’ve said check this first and then that…and we’ll say 'oh what’s wrong with it?’ and they know, they can reel it off” Sheffield4professional

“We still run a production line dialysis unit and we still open at X and we still shut at Y, and the pressures are in actually finding time to allow people to take their time” Sheffield2professional

“spending anything over the allotted time with that patient was always difficult” Sheffield3professional

“Perhaps is where nursing sometimes gets itself wrong, you get to a senior position and you’re expected to sit in the office pushing pieces of paper about when in actual fact really, after 20 years experience perhaps we should be out on the ward, we’re passing on that knowledge and experience” Sheffield1professional

“there’ll always be patients that aren’t suitable to go home” Sheffield3professional

“the dialysis population is growing considerably all the time, so we’re always looking for ways to try and deal with that” Sheffield3professional

“the training process was cut down to 8 weeks from 6-12 months…it’s been really refined…to take them from shared care in the hospital to care at home it could be three weeks” Sheffield3professional

“I find that I’ve been there an hour and I was only scheduled for half an hour, but I don’t think, you’ve got to listen to what’s being said” Sheffield3professional

“It’s just the time and the staffing situation…sometimes it’s impossible to do it” York1professional

“it’s much harder for a main unit…because all, most of the acute work…they struggle with their daily workload…it’s harder for them to have a comprehensive programme or people to be dedicated towards spending time with patients” York4professional

“the chap that was months and months we just couldn’t leave him…if you’re stood there have an hour watching him try and put his needles in, your stood there…because he wanted to try” York4professional