Elements of intervention | Content/delivery of element | Feasibility and acceptability indicators – quantitative and qualitative | Feasibility and acceptability results | Refinement of the intervention postfeasibility study |
Element one: creating a therapeutic environment in critical care | Content of online training course. | Training course ratings by all staff (% with 4 or 5 (0–5) or ‘good’). | Stimulating: 73%; useful: 86%; well-designed: 84%; right length: 80% (n=260, but missing data for some items). | Online training course shortened and made more visually appealing, with more practical advice on reducing stressors in critical care units and clearer presentation of key messages. |
Favourite parts of course – all staff . | Factual information: 42 %; patient stories : 35%; c ommunication videos : 13%; tests 10% (n = 260) | |||
Nurse qualitative feedback.* | Staff positive, suggested minor improvements . | |||
Delivery of online training and creating a therapeutic environment. | Staff taking course (target: 80%). | 283 (84%). | Provision of training, display materials and slide sets for seminars/workshops for local education teams to support and motivate staff in creating a therapeutic environment. | |
Staff passing final test (score > 80%) . | 277 (98%). | |||
Staff learning scores (% with 4 or 5 (0 – 5) or ‘ good’). | 74 % (n=259). | |||
Nurse qualitative feedback. | POPPI nurses lacked time, due to workload, to support staff in creating therapeutic environment. | |||
Element two: three stress support sessions for patients screened as acutely stressed | Content of screening. | Previously validated.34 | ||
Delivery of screening. | Consenting patients screened. | 127 (100%). | ||
Screened as acutely stressed. | 51 (40%). | |||
Content of stress support sessions. | Median (IQR) difference in patient stress thermometer scores (0–10). | Median difference from start session 1 to end session 3 was −3.0 (−5.0 to –1.0) (n=25 patients who had all three sessions). | Content of stress support sessions clarified for POPPI nurses and patients by reorganising sessions from five components each into three common components in all sessions and three individual components per session. Manual became more tightly focused on stress support sessions (rather than the whole intervention) with clearer signposting to and between sections. | |
Patient satisfaction with stress support sessions (% with 4 or 5 (0–5) or ‘good’) . | Overall: 93 % ; h elped express fears : 93 %; n urse understanding : 100 %; n urse normalised fears : 100 %; f ewer stressful thoughts : 87 % ; fewer stressful feelings : 80 %; number/duration of sessions : 80 % (n=15 , missing data some items). | |||
Patient qualitative feedback . | Stress support from nurses was very helpful . | |||
Nurse qualitative feedback . | Rewarding but challenging to explain to patients. | |||
Delivery of stress support sessions. | Number of stress support sessions patients had. | 25 (49%) had three sessions; 14 (28%) had two sessions; 5 (10%) one session; 7 (14%) had none. | Ensure buy-in and support for POPPI nurses from clinical, education and research staff from the start, making it a team effort. If hospital discharge is near, sessions 2 and 3 can and should be delivered together. | |
Median duration of sessions. | Session 1 : 35 min; s ession 2: 30 min; s ession 3: 30 min. | |||
Nurse qualitative feedback. | Nurses struggled to find time in their daily work schedule to conduct stress support sessions , especially if patients postponed. Patients missed session 3 if they were discharged home early . | |||
Content of POPPI nurse face-to- face training course – 3 days and a feedback/assessment day. | Nurse feedback – postcourse questionnaire (% with 4 or 5 (0–5) or ‘good’). | Stimulating: 100%; useful: 100%; relevant: 90%. Well conducted: 100%; motivating: 100% (n=10). | To reduce burden and increase self-efficacy, the 3-day course became more focused on stress support sessions, particularly session 2, seen as the most difficult session to deliver. More emphasis on skills practice, with actors (not fellow trainees) playing patients. Wider spectrum of patient scenarios used. Assessment to be reframed as ‘skills development’ and carried out one-to-one, with a trainer playing the patient. | |
Nurse self-efficacy (in delivering psychological support) – precourse and post- course and feedback day questionnaires. (% of 4 or 5 (0–5) or ‘good’ ratings of items. | Big increase in self-efficacy from precourse to post-course; maintained at follow-up. 30% of scores (21/70) across items were good pre-course; 73% were good scores (51/70) post-course and on feedback day. | |||
Nurse course learning – an eight -item post course knowledge questionnaire (% of 4 or 5 (0–5) or ‘ good’ scores for items) | 87% of scores (69/79) were ‘good’ for learning on: acute stress; screening; aims of stress support sessions, normalising, psycho-education, communication style, stressful thinking, checking out fears and, coping. | |||
Trainer assessment of nurse competence using six-item checklist (scores 0–12; pass=6). | 100% passed (9 on first attempt, 1 on second). Median (IQR) score of passes 9 (9, 10). | |||
Nurse qualitative feedback. | Course highly valued but tiring. Skills practice stressful. Competence assessment on follow-up day stressful. | |||
Delivery of 3-day training course. | Number of required trainees attending. | 10 (100%).† | Some modules dropped from course; precourse booklet on psychological principles was provided. | |
Content: debriefing support by trainers. | Nurse qualitative feedback. | Debriefing calls useful for reflection, confidence. Assessment should be part of ongoing support. | Assessment to be one-to-one confirmation of skills (as above), as part of ongoing debriefing and support. | |
Delivery: debriefing and support. | Nurse qualitative feedback. | Nurse debriefing and support should start earlier. | First debriefing call after first POPPI patient. | |
Element three: relaxation and recovery programme on app, DVD and booklet (music, relaxation, meditation, patient recovery videos and self-help information) | Content of relaxation and recovery programme. | Patient satisfaction with content of programme (% with 4 or 5 (0–5) or ‘good’). | Content on tablet computer app: 71%; useful post-ICU coping ideas: 67% (15 patients, some missing data). | Content and design of the relaxation app were improved. Balance of contents of DVD were improved, and calming classical music tracks were added. Layout and readability of the patient booklet were improved. |
Nurse-reported qualitative patient feedback. | Varied preferences; relaxation, meditation, nature sounds, patient stories or calming music. Some were disappointed not to find calming classical music on DVD. | |||
Delivery of relaxation and recovery programme. | Patients receiving tablet in session 1. | 40 (90%). | Usability of the relaxation app was improved to make it easier for the less dextrous. Higher spec tablets, including better touch sensitivity, identified for use in future trial. DVD and booklet to be provided in session 2, so more patients would receive them (many missed receiving session 3 due to being sick or discharged from hospital). | |
Patients receiving DVD or booklet. | 27 (61%). | |||
Nurse-reported qualitative patient feedback. | While some liked tablet, others found it hard to use; some preferred DVD or patient booklet. |
*All nurse and patient qualitative data described on pp8-9.
†Four additional nurses were trained at one site due to personnel issues.
ICU, intensive care unit.