Table 2 Examples of participant quotes for theme 1 The ‘Fit’ of the workbook

1.1 A stressful working environment

FG3-P7: Coming to them with more paperwork is just like ‘Are you kidding me?’ It’s like asking for […] a limb.

FG1-P1: In a ward where things happen so quickly, you might not have the time to be able to sit with the patient and actually go through this.

FG2-P2: Recently we had one, she actually broke the door …..the team are all trying to deal with her but she had broken the fire and the doors are wide open and she managed to leave.

I2: The institution has to be run to keep the institution running and keep the people safe – it’s not centred on the needs of the people who are in it.

FG3-P7: I think it’s how it’s sold to them. And how you sit and talk through and say, you know, ‘you do provide one-to-one to your patient, all’s we’re asking is that you bring this book… I think it’s my job and it’s [my clinical team leader’s] job to stand there and go ‘We need to stop and think why exactly why are we here - we are here for the patients and to provide them one-to-one time.’

1.2 A culture of emotional neglect

FG4-P6: Some of our patients we have to forcibly give IM medication, we have to put them in seclusion….You’re chemically calming someone down with medication.

I2: The hospital is very medical though, in that it is symptom-focused, it’s not emotion-focused… there often isn’t an interest in the phenomenology of emotion because it isn’t really part of the medical model… [it’s] about stabilising people medically and getting them back into the community.

FG3-P3: We witness lots and lots of…distress symptoms and emotions from people …some staff that don’t have, necessarily, the confidence – will feel very resistant. I think that they’re going to be quite scared of what people might say and then how to deal with that.

FG2-P1: We’ve tried to …get patients to reflect just recently about small, superficial self-harming behaviours, and they don’t want to make the connections with their emotions. They’re just demanding …cigarettes and medication. They don’t want to look inwards at their emotions

FG3-P3: A lot of people who come through our doors haven’t actually gained those words in their youth….What are emotions? What actually are the emotions you experience? Therefore they can’t describe them because they don’t know them.

1.3 Adding structure and confidence to current nursing practice

FG1-P4: A few things that you point out [are] what we do already anyway…. things like trying to encourage patients to try and distract themselves ….And other situations where we’ve tried to sit down with the patients and identify why they got so emotionally aroused in the first place.

FG3-P7: For their one-to-ones it’s definitely something they’re [already] doing…. this is just more formally put on paper, it’s structured and if you’re sitting with somebody with this in front of you it feels more like an engagement, it just seems more therapeutic.

FG1-P5: This book is very informative, educative, there is a lot of useful information that we can actually deduce from this book. It actually refreshes what you know…it’s very helpful.

FG1-P1: The questions in there to ask would be quite helpful [for]…trying to get them to use their own insight to figure out why they feel like this.

FG2-P2: I think it’s good to read through to get ideas for engagement tactics …it helps me understand my clients better and then …gives me ideas for more positive interactions I can have with my patients.