Table 5 Representative quotations for theme 3: Peers influence prescription behaviours and attitudes towards nutrition

Social influence on prescription behaviours

Social/ Professional role and identify/ Emotion

“I don’t like clear fluids because I think they taste terrible and it doesn’t [do anything]. The difficulty here is that some of the bosses do like clear fluids initially, so I have to follow what they do. But my preference would be to give free fluids immediately, rather than clear” [P12: Senior registrar]

“So I make the plan when I’m around and then I say to the boss, ‘I’m changing this diet’…sometimes they will say things like, ‘I think that is a bit quick, but I’m sure we will see’. But at the end of the day they usually just say ‘ok’” [P11: Principal House Officer]

“Teams on the wards are run by junior staff so they sometimes often have different ideas... [it] is something that is out of my control because I am not on the ward every day. We [consultants] suggest what to do, but sometimes they [junior staff] feel that the patient is blowing up [distended] [so] they will delay by one day. But there are sometimes changes in what I normally do because of different people on the wards” [P17: Consultant]

Social influence on attitudes towards nutrition

Social/ Professional role and identify/ Environment context and resources

“I wasn’t made to feel like it [nutrition] was important…the things that I knew were really important were picking up on if things were not going to plan, so complications such as a leak or a massive infection and things that are going to kill them… It was not a priority for us at all…and I definitely wasn’t made aware of it in like, when we do consultant rounds, there was never any focus on feeding” [P13: Intern].

“I have learnt that people can eat sooner than I thought they could after surgery. My bosses have said ‘don’t bother, like, doing graduated things, just change them over. They are fine. They can eat and drink’. I just think most of my bosses want people eating as soon as possible” [P18: Intern].

“Well for me [the importance of nutrition] is personally reasonably high. Nutrition is critical to health and surgical outcomes. But I feel like it is not hugely valued within our profession. I think it is very undervalued by surgeons – the role of nutrition…and I think they may reflect in junior staff in terms of attitude and things as well. But surgeons themselves, I think are really...generally poor advocates for good quality nutrition and they may or may not eat well for themselves and they may or may not know much about nutrition themselves” [P16: Fellow]