Table 4 Examples of participant quotes for theme 3 Getting the timing right

3.1 A gradual trajectory towards recovery

FG3-P6: They might be too unwell to even sit down and engage with you and …let alone take a book and try to understand what they’re feeling.

FG2-P5: They might not even understand what you are saying. ….Somebody that is psychotic - you are telling the person to go and watch TV, and the person is telling you that somebody is talking to him or her through the TV.

FG3-P8: If you just have the booklet and …we go through as much as we can on the assessment wards and then once they are transferred to recovery they can then pick up where we’ve left off.

FG3-P7: I think there is some patients you get …that just would not engage at that time that they’re on assessment, but once they are transferred, let’s say they do go to recovery, they can continue to try and…d’you know encourage somebody to engage in that.

FG3-P3: It’s about knowing that we work with people that don’t necessarily engage, we just continue to try….. And that’s the best that we can do at this present moment. And it might not be for weeks before they’re actually at a place …to even explore anything like this.

3.2 The eye of the storm

FG2-P2: I think maybe giving someone this in the middle of when they’re like crying their eyes out, really, really distressed is probably not gonna do much initially…

FG1-P1: But patients on PICU - sometimes they are very settled and stable but maybe the next day or in a few hours, they’d be like that. So, if you can catch them in a stable moment and use it then and maybe you can sow the seeds that might work then.

FG3-P6: You can adopt it after that initial…d’you know, crisis period. […]when you’re reflecting back on what happened: ‘what led to that?’, ‘how are you feeling now?’ and then go through it.

FG1-P1: That’s the main focus isn’t it, getting the glass off them, getting the instrument that they’re using…so, to bring out the book, I’m afraid, would be completely the wrong timing. Yeah, it’s all about timing.