Table 1

The three elements of the POPPI intervention to reduce stress in critical care patients

Patient interventionsWho receives?Where?Proposed mechanisms of changeTraining methodsWho is trained?
Element one:
creating a therapeutic environment in critical care		All critical care patients.In the critical care unit.Raise staff awareness of patients’ stress and psychological morbidity.
Motivate staff to reduce stressors in the unit.
Train staff in communication skills.
Emphasise positive recovery messages.		An online training course.
Promotional materials and local education sessions to reinforce key messages.		All clinical critical care staff.
Element two:
three stress support sessions for patients screened as acutely stressed		Patients screened by Intensive Care Psychological Assessment Tool22 as acutely stressed (scores 7, range 0–20).In the critical care unit, on wards following discharge from critical care.Help patients to express fears or concerns, and process traumatic memories (S1/2).
Reduce catastrophic misinterpretations by (A) normalising stressful thoughts and feelings, and (B) testing the reality of fears or concerns (S1/2).
Promote hope and motivation for recovery (S3).		A 3-day face-to-face training course for ‘POPPI’ nurses to learn to deliver stress support sessions and coach patients in using the relaxation and recovery programme.
Provision of educational materials (precourse theory booklet, manual and training folder) for POPPI nurses, and ongoing debriefing and support (clinical supervision) from trainers.		Three ‘POPPI’ nurses per critical care unit, selected by units with reference to suitability criteria.
Element three:
relaxation and recovery programme on app, DVD and booklet (music, relaxation, meditation, patient recovery videos and self-help information).		Patients screened as acutely stressed and receiving stress support sessions.In the critical care unit, on wards (via tablet computer) and at home (via DVD and self-help booklet).Provide distraction and meaningful activity.
Reduce stress by teaching patients relaxation and coping strategies (in S1/2).
Normalise emotional reactions and promote optimism by providing former patients’ recovery videos (in S1/2).
Promote recovery by providing information and helping to create a personal plan for future well-being (DVD and booklet; S3).

  • S1, session one; S2, session two; S3, session three.