Effect of cardiovascular biofeedback on nursing staff stress: a randomized controlled clinical trial

Macedo, Andréia Barcellos Teixeira; Vega, Edwing Alberto Urrea; Antoniolli, Liliana; Pinheiro, Jessica Morgana Gediel; Tavares, Juliana Petri; Souza, Sônia Beatriz Cócaro de

doi:10.1590/0034-7167-2023-0069

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 76 (6) • 2023 • https://doi.org/10.1590/0034-7167-2023-0069 copy

Effect of cardiovascular biofeedback on nursing staff stress: a randomized controlled clinical trial

Efecto del biofeedback cardiovascular sobre el estrés del personal de enfermería: un ensayo clínico controlado aleatorizado

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to assess the effect of cardiovascular biofeedback on nursing staff stress when compared to an activity without self-monitoring.

Method:

a randomized controlled clinical trial, carried out with nursing professionals from a university hospital. The intervention group (n=58) performed cardiovascular biofeedback, and the control (n=57) performed an online puzzle without self-monitoring, totaling nine meetings over three weeks. The outcome was assessed using the Stress Symptoms and Work-Related Stress scales, and the biological marker heart rate variability. The generalized estimating equations method was used.

Results:

the intervention had no effect on self-reported instruments (p>0.050). However, there was an effect of time (p<0.050) on all heart rate variability indicators, demonstrating changes over the sessions.

Conclusion:

cardiovascular biofeedback showed promising results in the biological marker, suggesting that it can be used in nursing staff as a complementary therapy by promoting better autonomic nervous system regulation.

Descriptors:
Occupational Stress; Nursing; Team; Occupational Health; Biofeedback; Randomized Controlled Trial

Characteristics	Sample	Intervention group	Group control	p
Characteristics	(n=115)	(n=58)	(n=57)	p
Sociodemographic
Age (years)^* * Média/desvio padrão (Teste t);	43.2±8.4	42.3±7.5	44.0±9.3	0.283
Female^† † n/% (Qui-Quadrado)	96(83.5)	45(77.6)	51(89.5)	0.860
Labor
Professional category^† † n/% (Qui-Quadrado)				0.995
Nurse	44(38.3)	22(37.9)	22.0(38.6)
Nursing assistant	18(15.7%)	9(15.5)	9(15.8)
Nursing technician	53(46.1%)	27(46.5)	26(45.6)
Shift^† † n/% (Qui-Quadrado)				0.788
Day	86(74.8)	44(75.9)	42(73.7)
Night	29(25.2)	14(24.1)	15(26.3)
Nursing tenure (years)^* * Média/desvio padrão (Teste t);	17.6±7.2	16.9±6.6	18.3±7.8	0.285
Job tenure (years)^* * Média/desvio padrão (Teste t);	10.2±7.7	10.1±6.7	10.2±8.6	0.891
With another employment relationship^† † n/% (Qui-Quadrado)	19(16.5)	8(13.8)	11(19.3)	0.427
Work overtime^† † n/% (Qui-Quadrado)	100(86.9)	52(89.7)	48(84.3)	0.640
Health-related
Any physical health problem^† † n/% (Qui-Quadrado)	29(25.2)	16(27.6)	13(22.8)	0.555
Use medication^† † n/% (Qui-Quadrado)	65(56.5)	32(55.2)	33(57.9)	0.768
Follow-up for mental health^† † n/% (Qui-Quadrado)	28(24.3)	13(22.4)	15(26.3)	0.626
Smoker^† † n/% (Qui-Quadrado)	14(12.2)	6(10.3)	8(14.0)	0.545
Drink alcohol (at least once a week)^† † n/% (Qui-Quadrado)	46(40)	26(44.8)	20(35.1)	0.286
Hours of sleep in the 24 hours^* * Média/desvio padrão (Teste t);	6.7±1.4	6.6±1.5	6.8±1.4	0.346
Overweight and obesity^† † n/% (Qui-Quadrado)	64(55.6)	33(56.8)	31(54.4)	0.710
Use stimulating drink (> 300 ml per day)^† † n/% (Qui-Quadrado)	87(75.7)	46(79.3)	41(71.9)	0.357

	Indicators
	SDNN		rMSSD		LF/HF		Heart coherence
	IG	CG	IG	CG	IG	CG	IG	CG
D0	58.9±4.8	49.2±3.5	54.9±6.4	56.6±7.5	2.9±0.5	1.7±0.3	43.9±2.1	35.8±1.5
D1	74.3±6.2^* * Mean difference is significant at the 0.05 level when comparing session mean with D0.	56.8±4.6^* * Mean difference is significant at the 0.05 level when comparing session mean with D0.	65.7±8.6	58.1±6.5	9.2±1.2^* * Mean difference is significant at the 0.05 level when comparing session mean with D0.	1.5±0.2	64.5±2.3	36.4±1.4
D2	70.3±4.7	54.8±4.7	61.8±5.9	58.1±6.9	8.0±0.8^* * Mean difference is significant at the 0.05 level when comparing session mean with D0.	1.5±0.2	62.1±2.4	34.2±1.0
D3	84.8±8.3^* * Mean difference is significant at the 0.05 level when comparing session mean with D0.	64.2±5.3^* * Mean difference is significant at the 0.05 level when comparing session mean with D0.	82.0±12.2^* * Mean difference is significant at the 0.05 level when comparing session mean with D0.	67.9±7.4	8.2±1.1^* * Mean difference is significant at the 0.05 level when comparing session mean with D0.	1.7±0.3	62.3±2.6	33.7±1.2
D4	77.1±6.9^* * Mean difference is significant at the 0.05 level when comparing session mean with D0.	68.4±7.5^* * Mean difference is significant at the 0.05 level when comparing session mean with D0.	70.5±9.8	78.7±10.6^* * Mean difference is significant at the 0.05 level when comparing session mean with D0.	8.5±0.8^* * Mean difference is significant at the 0.05 level when comparing session mean with D0.	3.4±1.9	61.0±2.4	32.4±1.4^* * Mean difference is significant at the 0.05 level when comparing session mean with D0.
D5	68.4±4.1	58.7±5.3	56.2±5.1	67.3±8.1	8.9±0.8^* * Mean difference is significant at the 0.05 level when comparing session mean with D0.	1.1±0.1	70.2±6.3	33.6±1.2
D6	74.7±4.9	58.7±5.6	66.3±7.0	65.4±7.9	8.2±0.8^* * Mean difference is significant at the 0.05 level when comparing session mean with D0.	1.6±0.2	60.3±2.4	34.3±1.2
D7	73.3±5.4	60.8±6.8	64.6±7.7	67.5±9.8	8.8±1.0^* * Mean difference is significant at the 0.05 level when comparing session mean with D0.	1.3±0.1	59.5±2.4	32.7±1.1^* * Mean difference is significant at the 0.05 level when comparing session mean with D0.
D8	79.0±7.5^* * Mean difference is significant at the 0.05 level when comparing session mean with D0.	64.5±7.5^* * Mean difference is significant at the 0.05 level when comparing session mean with D0.	73.4±10.9^* * Mean difference is significant at the 0.05 level when comparing session mean with D0.	72.3±11.0	8.4±8.1^* * Mean difference is significant at the 0.05 level when comparing session mean with D0.	1.3±0.2	59.4±2.4	33.9±1.1
p	0.907		0.486		<0.001^* * Mean difference is significant at the 0.05 level when comparing session mean with D0.		<0.001^* * Mean difference is significant at the 0.05 level when comparing session mean with D0.

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[1] Corresponding author: Andréia Barcellos Teixeira Macedo, abtmacedo@gmail.com