Cognition, Critical Care Nursing, Decision Making, Heart Rate Variability (HRV), Mechanical Ventilation
Conditions
Keywords
Heart Rate Variability, HRV, Healthcare practitioner, Practitioner HRV
Brief summary
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.
Detailed description
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: * improvement in HRV of the practitioners * measurement of response times to ventilator related events (decreased response times) * improvement of time spent at bedside * improvement in ventilation related outcomes for the patients. * Reduction in bedside noise (reduced response time to alarms and reduction in inappropriate alarms)
Interventions
BEHAVIORALCritical Participatory Action Intervention with HRV Feedback
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.
Sponsors
Papworth Hospital NHS Foundation Trust
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
Critical Participatory Action Research learning model, whereby practitioners can explore the nature and consequences of their practice utilising their HRV during two intervention periods.
Eligibility
Sex/Gender
ALL
Age
21 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Nurse working in Enhanced Recovery Unit at Royal Papworth Hospital NHS Foundation Trust * Willingness to participate in the trial
Exclusion criteria
* Staff with permanent pacemakers * Staff on medication that could affect HRV (e.g. b-blockers)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Reduction in response time to ventilator patient physiological alarms | At completion of 20th clinical shift (each shift is 12 hours) | Practitioner response time (in seconds) to ventilator-related physiological alarm events measured using ventilator event logs and bedside monitoring system records. |
| Adherence to bedside noise level targets | At completion of 20th clinical shift (each shift is 12 hours) | Duration of time (seconds) bedside noise levels remain outside predefined acceptable clinical thresholds, measured using bedside environmental noise monitoring during clinical shifts. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Improvement in practitioner heart rate variability during clinical practice | At completion of 20th clinical shift (each shift is 12 hours) | Can practitioners improve their HRV through the iterative stimulated reflection intervention. |
| Participant-reported work effectiveness, job satisfaction, and stress levels | At completion of 20th clinical shift (each shift is 12 hours) | Participant-reported perceptions of work effectiveness, job satisfaction, and stress levels measured using study questionnaires |
Countries
United Kingdom
Contacts
CONTACTClinical Project Manager
PRINCIPAL_INVESTIGATORRobert Gatherer, MBBS
Royal Papworth Hospital NHS Foundation Trust
Outcome results
None listed