Qualitative Analysis. We used thematic content analysis to
inductively characterize the issues raised by nurses and to
construct a provisional coding structure that was then tested
using a subset of transcripts.30 Each set of transcripts was
coded by two independent coders and assessed for inter-rater
agreement at two intervals. During the first interval, inter-rater
agreement for all themes was less than 80 %;31 thus, all
discrepancies in these interviews were discussed until a
consensus between coders was reached. Subsequently, interrater
agreement during the second interval was 100 %. Using a
process known as constant comparison, codes were compared
to identify areas of overlap in the coded segments.32 Related
codes were initially grouped under the following overarching
themes: impact of the intervention, application of 5A’s, and
barriers to implementation. The coding structure was revised
iteratively as new themes emerged. Descriptive statements
about each domain (using the subjects’ words) were identified.