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Table 5 ED Nurse Inductive Results: Dominant Themes and Illustrative Quotations

From: Reducing unnecessary culturing: a systems approach to evaluating urine culture ordering and collection practices among nurses in two acute care settings

Dominant Theme Illustrative Quotation
(Percent of focus group content pertaining to theme)
Patient Traits (13%) “Basically every geriatric patient should get a urinalysis. I’m actually being kind of serious.”
–ED RN E
“[Patients need to have] the supplies to clean themselves adequately because that little piece of paper…really? The people that come down sometimes definitely have some issues that they need to deal with before they give us a sample.”
–ED RN C
Physician Communication and Availability (12%) “If we think the urine looks really nasty and then I’ll go ahead and add the [urine culture] order.”
–ED RN D
“There wasn’t communication [between nurses and physicians]; the order would just go in and the physician would see it.”
–ED RN B
Reflex Culture Protocol (9%) “We did not order [isolated] urine cultures; it was always reflex urinalysis with culture”
–ED RN C
Electronic Health Record (7%) “That’s annoying when [a clinical care reminder] pops up; it’s already being addressed.”
–ED RN E
“I think that in my head I say, ‘that’s the protocol,’ but I don’t actually go into the computer to review it”
–ED RN B
Symptoms (6%) “I always thought that it was lab that looked at the results; said that there the white blood cells were up and then setup the culture. It wasn’t my decision or the physician’s decision, or patient presentation that drove that, rather objective data.”
–ED RN D
Throughput (5%) “People call back the next day and say that the urine was clean while they were in the ER but then their culture grew bacteria, so what about those people? They say that ‘[my] primary care doctor called me and told me that I need to be put on antibiotics.’”
–ED RN A