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| ID | Type | Description | Link |
|---|---|---|---|
| 25/HRA/2201 | Other Identifier | Health Research Authority |
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At the heart of healthcare is the interaction between healthcare practitioners and patients. It is believed that optimisation of this interaction can improve patient relevant outcomes, safety and patient experience. Through utilisation of practitioner physiological data, heart rate variability (HRV), to help practitioners make better decisions and optimise practice, it is considered possible to improve decision making around patient care and improve outcomes and safety.
The modern intensive care unit (ICU) is a dynamic data rich environment requiring rapid and accurate decision making. Advances in ventilator technology, electronic patient monitoring and electronic health records (EHR) have provided exponential growth in data produced for patients and the need for complex decision making. However, data overload and alarm fatigue can result in poor understanding and a delayed response from the practitioner in addressing the patient's needs.
The aim of this study is to present and evaluate a psychophysiology training approach for practitioners derived from their cardiovascular response through the course of the working day, this will be measured using heart rate variability (HRV). Practitioner HRV has been shown to be linked to work related stress and is considered a biomarker of decision-making.
A Critical Participatory Action Research learning model is proposed, whereby practitioners can explore the nature and consequences of their practice utilising their HRV during two intervention periods. The aim is to improve practitioner performance and develop a more context aware approach to patient care.
Impact will be measured through:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Bedside nurses in Enhanced Recovery Unit | Experimental | Baseline collection will consist of data from 20 bedside nurses over 10 shifts (12 hours +/- 3 hrs) each. 5 shifts post first intervention (1st workshop) and 5 shifts post second intervention (2nd workshop). |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Critical Participatory Action Intervention with HRV Feedback | Behavioral | The intervention is based on a Critical Participatory Action Research learning model, using the participant's heart rate variability data collected during clinical shifts. Before the intervention, participants will complete repeated HRV monitoring and use a diary to record clinical events and reflections. The intervention includes facilitated workshops introducing reflective practice, cognitive bandwidth, and related educational concepts. Participants will receive individual coaching to review their HRV data and identify patterns and triggers in their clinical work, followed by group discussions to share experiences and develop strategies to adapt practice. A second workshop builds on this process with further reflection, additional HRV analysis, and collaborative strategy development. Between and after sessions, participants continue data collection and apply insights in practice, aiming to enhance clinical performance and develop a more context-aware approach to patient care. |
| Measure | Description | Time Frame |
|---|---|---|
| Reduction in response time to ventilator patient physiological alarms | Practitioner response time (in seconds) to ventilator-related physiological alarm events measured using ventilator event logs and bedside monitoring system records. | At completion of 20th clinical shift (each shift is 12 hours) |
| Adherence to bedside noise level targets | Duration of time (seconds) bedside noise levels remain outside predefined acceptable clinical thresholds, measured using bedside environmental noise monitoring during clinical shifts. | At completion of 20th clinical shift (each shift is 12 hours) |
| Measure | Description | Time Frame |
|---|---|---|
| Improvement in practitioner heart rate variability during clinical practice | Can practitioners improve their HRV through the iterative stimulated reflection intervention. | At completion of 20th clinical shift (each shift is 12 hours) |
| Participant-reported work effectiveness, job satisfaction, and stress levels |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Clinical Project Manager | Contact | 01223638000 | jeong-min.chun@nhs.net |
| Name | Affiliation | Role |
|---|---|---|
| Robert Gatherer, MBBS | Royal Papworth Hospital NHS Foundation Trust | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Royal Papworth Hospital NHS Foundation Trust | Cambridge | Cambridgeshire | CB2 0AY | United Kingdom |
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Critical Participatory Action Research learning model, whereby practitioners can explore the nature and consequences of their practice utilising their HRV during two intervention periods.
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Participant-reported perceptions of work effectiveness, job satisfaction, and stress levels measured using study questionnaires |
| At completion of 20th clinical shift (each shift is 12 hours) |