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.
Nurse working in Enhanced Recovery Unit at Royal Papworth Hospital NHS Foundation Trust
Willingness to participate in the trial
Staff with permanent pacemakers
Staff on medication that could affect HRV (e.g. b-blockers)
Single group
Critical Participatory Action Intervention with HRV Feedback
BehavioralThe 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.
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.
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.
Improvement in practitioner heart rate variability during clinical practice
Can practitioners improve their HRV through the iterative stimulated reflection intervention.
Participant-reported work effectiveness, job satisfaction, and stress levels
Participant-reported perceptions of work effectiveness, job satisfaction, and stress levels measured using study questionnaires
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