Introduction: Meta-analytic evidence confirms a range of in- terventions, including mindfulness, physical activity and sleep hygiene, can reduce psychological distress in university stu- dents. However, it is unclear which intervention is most ef- fective. Artificial intelligence (AI) driven adaptive trials may be an efficient method to determine what works best and for whom. The primary purpose of the study is to rank the effec- tiveness of mindfulness, physical activity, sleep hygiene and an active control on reducing distress, using a multi-arm con- textual bandit-based AI-adaptive trial method. Furthermore, the study will explore which interventions have the largest ef- fect for students with different levels of baseline distress sever- ity. Methods and analysis: The Vibe Up study is a pragmatically-oriented, decentralised AI-adaptive group se- quential randomised controlled trial (RCT) comparing the ef- fectiveness of one of three brief, two week digital self-guided interventions (mindfulness, physical activity, or sleep hygiene) or active control (ecological momentary assessment) in reduc- ing self-reported psychological distress in Australian univer- sity students. The adaptive trial methodology involves up to 12 sequential mini-trials that allow for the optimisation of al- location ratios. The primary outcome is change in psycho- logical distress (DASS-21 total score) from pre-intervention to post-intervention. Secondary outcomes include change in depression, anxiety, and stress (measured by DASS-21 sub- scales) from pre-intervention to post-intervention. Planned contrasts will compare the four groups (i.e., the three interven- tion and control) using self-reported psychological distress at pre-specified time points for interim analyses. The study aims to determine the best performing intervention, as well as rank- ing of other interventions. Ethics and dissemination: Ethical approval was sought and obtained from the UNSW Sydney Human Research Ethics Committee (HREC A, HC200466). A trial protocol adhering to the requirements of the Guideline for Good Clinical Prac- tice [1] was prepared for and approved by the Sponsor, UNSW Sydney (Protocol number: HC200466_CTP). Registration details: The trial is registered with the Australian New Zealand Clinical Trials Registry (AC- TRN12621001223820).
Background
Nurses' harm prevention practices during the admission of older persons to hospital have important consequences for patient safety, preventable patient harm and length of hospital stay. Novel solutions are needed to assist nurses to balance complexity, high workload burden and patient safety during admission processes.
Aim
Explore the nurses' experiences of harm prevention practices during the admission of an older person to the hospital.
Design
A multi‐method qualitative study informed by frameworks of behaviour change and human‐centred co‐design.
Methods
The purposive sample included 44 nurses, 5 clinicians from other disciplines and 3 consumers recruited from five general medicine wards across three hospitals of a large public health service in metropolitan Melbourne, Australia. Data were collected over 12 h of naturalistic observations of nurses during eight patient admissions, and during four participatory human‐centred co‐design workshops between August 2019 and January 2020. Observation, field notes and workshop artefact data were integrated for qualitative content and thematic analysis.
Results
Analysis revealed a 5‐step journey map, with a temporal logic, that captured nurses' experiences, as well as the enablers and barriers to harm prevention practices when admitting an older person to the hospital. The consensus was reached on three priority features to assist nurses to implement harm prevention practices when they admit an older person to the hospital: (1) prioritize important care; (2) tailor care to the individual and (3) see the big picture for the patient.
Conclusion
The novel research approach identified five steps in nurses' activities and harm prevention practices during admission of an older person to the hospital, and key features for a solution to assist nurses to keep patients safe. The findings provide the foundation for further research to develop interventions to assist nurses to manage high workloads during this complex activity.
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