Expert Input and Prototyping for a Just-in-Time Adaptive Intervention to Support Nursing Students’ Stress and Well-Being

Benjamin Schweinzer, BSc
Master Digital Healthcare, St. Pölten University of Applied Sciences 2026

Aim and Research Question(s)

  1. Which stress situations, constraints and support needs do nursing students and nurses identify?
  2. Which decision points, tailoring variables, intervention options and decision rules can be derived?
  3. How do nursing students rate the prototype's usability, usefulness, acceptability and contextual fit?

Background

Nursing students' stress peaks during clinical placements [1], and mental health apps are often abandoned quickly [2]. Just-in-Time Adaptive Interventions (JITAIs) adapt support to a person's current state and context [3], but no reviewed source described one for nursing students.

Methods

Interviews with two nursing students and two mentoring nurses (n = 4; qualitative content analysis [4]) revised a literature-based Decision Logic Framework, implemented as Pulse, a four-scenario walkthrough (Figure 1). Nursing students from three Austrian universities of applied sciences (33 datasets) rated it with the System Usability Scale (SUS) [5], six adapted Technology Acceptance Model (TAM) items [6] and open questions. Table of the four Pulse scenarios showing stress level, available time, receptivity and the response Pulse selected.

Results and Discussion

Stress level alone was not enough: time and social visibility (being watched by others) also shaped the response. The framework has 4 decision points, 7 tailoring variables, 8 decision rules and 5 intervention options (incl. “no intervention”). Bar chart of the three adapted TAM constructs, mean ± 1 SD: ease of use 4.17, intention 3.61, usefulness 3.48. Ease of use was rated highest (M = 4.17), usefulness lowest (M = 3.48; Figure 2), mean SUS was 65.5 (benchmark ≈ 68 [7]). Six participants doubted use during shifts (time, phone rules): the setting, more than the interface, was the concern.

Conclusion

Adaptive support must consider time and social visibility, not only stress level, and allow for no intervention. Given small samples, a working app should next be tested in placements.

References

  1. Visier-Alfonso et al., Nurse Educ Today, 2024
  2. Linardon et al., Psychiatry Res, 2025
  3. Nahum-Shani et al., Ann Behav Med, 2017
  4. Graneheim & Lundman, Nurse Educ Today, 2004
  5. Brooke, Usability Eval. in Industry, 1996
  6. Davis, MIS Quarterly, 1989
  7. Lewis & Sauro, J Usability Stud, 2018