Heart Rate Variability for Practitioner Stimulated Reflection and Decision-making Optimisation (HRV-PRO)

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.

Study Overview

• Status: Not yet recruiting
• Conditions: Cognition; Mechanical Ventilation; Decision Making; Critical Care Nursing; Heart Rate Variability (HRV)
• Intervention / Treatment: Behavioral: Critical Participatory Action Intervention with HRV Feedback

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)

• Study Type: Interventional
• Enrollment (Estimated): 20
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Clinical Project Manager; Phone Number: 01223638000; Email: jeong-min.chun@nhs.net

Study Locations

• United Kingdom
  • Cambridgeshire
    • Cambridge, Cambridgeshire, United Kingdom, CB2 0AY
      • Royal Papworth Hospital NHS Foundation Trust
      • Contact: Robert Gatherer, MBBS; Phone Number: 01223638000; Email: robert.gatherer@nhs.net
      • Principal Investigator: Robert Gatherer, MBBS

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

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)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Bedside nurses in Enhanced Recovery Unit; 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).

Behavioral: Critical 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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	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)

Secondary Outcome Measures

Outcome Measure	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	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)

Collaborators and Investigators

• Sponsor: Papworth Hospital NHS Foundation Trust
• Investigators: Principal Investigator: Robert Gatherer, MBBS, Royal Papworth Hospital NHS Foundation Trust

Study record dates

Study Major Dates

• Study Start (Estimated): July 16, 2026
• Primary Completion (Estimated): June 1, 2027
• Study Completion (Estimated): June 1, 2027

Study Registration Dates

• First Submitted: May 19, 2026
• First Submitted That Met QC Criteria: July 13, 2026
• First Posted (Actual): July 16, 2026

Study Record Updates

• Last Update Posted (Actual): July 16, 2026
• Last Update Submitted That Met QC Criteria: July 13, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Heart Rate Variability; HRV; Healthcare practitioner; Practitioner HRV
• Other Study ID Numbers: P03174; 25/HRA/2201 (Other Identifier: Health Research Authority)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No