City Research Online

Abstract

Introduction: Patients who clinically deteriorate in acute hospital wards who do not receive optimal care are at risk of harm. Track-and-trigger tools have been implemented internationally to facilitate the detection of clinical deterioration and prompt a response. Despite these tools, patients continue to deteriorate without optimal care. To address this, a theory-based behaviour change intervention (the Promoting Recognition Of deterioraTion and EsCalaTion of care [PROTECT] intervention) was developed to promote detection and response behaviours from nursing staff. While the PROTECT intervention followed a robust development process, its acceptability to end-users (those who could receive or deliver it) was unknown.

Aim: The aim of this study was to prospectively evaluate the acceptability of the PROTECT intervention to end users in a research context.

Design: A mixed-method study was conducted with a sequential explanatory design underpinned by the theoretical framework of acceptability.

Methods: Ward-based nursing staff members and critical care outreach nurses from three hospitals were recruited. Research materials were developed using theoretical framework of acceptability constructs. Participants received a presentation about the PROTECT intervention before completing a questionnaire using a live poll. Questionnaire results, displayed in real time, guided which acceptability constructs were explored in a subsequent focus group. Participant's demographics and questionnaire data were reported descriptively. Qualitative data were analysed using Framework Method.

Results: Research was conducted with 19 participants. The PROTECT intervention was rated as (highly) acceptable for four constructs (Affective Attitude, Perceived Effectiveness, Intervention Coherence, and Self-efficacy) and less acceptable for three constructs (Opportunity Costs [and Gains], Burden, and Ethicality). Participants praised the intervention's multifaceted nature and the familiarity of components that aligned with the existing strategies. Concerns were raised about its potential for components to induce psychological harm and the burden of engaging with the intervention.

Conclusion: The PROTECT intervention was broadly rated as (very) acceptable, suggesting progression to delivery and piloting in acute hospitals is appropriate. Findings from this work will be used to refine the PROTECT intervention and inform development of the implementation package.

Publication Type:	Article
Additional Information:	© 2026. This manuscript version is made available under the CC-BY-NC-ND 4.0 license https://creativecommons.org/licenses/by-nc-nd/4.0/
Publisher Keywords:	Acute care, Critical care, Focus groups, Mixed-methods design, Qualitative approaches, Research implementation
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine R Medicine > RT Nursing
Departments:	School of Health & Medical Sciences School of Health & Medical Sciences > Department of Nursing & Midwifery
SWORD Depositor:	Symplectic Administrator

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