Coerência cardíaca e eficácia do biofeedback cardiovascular na equipe de enfermagem: ensaio clínico randomizado

Liliana Antoniolli; Andréia Barcellos Teixeira Macedo; Edwing Alberto Urrea Vega; Daiane Dal Pai; Carolina Baltar Day; Sônia Beatriz Cócaro de Souza

doi:10.5294/aqui.2024.24.2.3

Authors

Liliana Antoniolli Author Federal University of Rio Grande do Sul https://orcid.org/0000-0003-0806-9910
Andréia Barcellos Teixeira Macedo Author Federal University of Rio Grande do Sul https://orcid.org/0000-0003-4219-4731
Edwing Alberto Urrea Vega Author Federal University of Rio Grande do Sul https://orcid.org/0000-0002-9578-4252
Daiane Dal Pai Author Federal University of Rio Grande do Sul https://orcid.org/0000-0002-6761-0415
Carolina Baltar Day Author Pontifical Catholic University of Rio Grande do Sul https://orcid.org/0000-0002-5998-5735
Sônia Beatriz Cócaro de Souza Author Federal University of Rio Grande do Sul https://orcid.org/0000-0002-6980-1098

DOI:

https://doi.org/10.5294/aqui.2024.24.2.3

Keywords:

Clinical Trial, Nursing team, Biofeedback psychology, Emotional adjustment, Occupational health

Abstract

Introduction: Through guided and conscious deep breathing, cardiovascular biofeedback, an innovative technological tool that enables improved cardiac coherence and activation of the parasympathetic nervous system, which are vital for recovering and maintaining homeostasis and psycho-emotional health. Objective: To verify the effect of cardiovascular biofeedback on heart rate variability parameters in nursing professionals. Materials and Methods: This is a randomized clinical trial conducted in two groups — biofeedback and placebo — with 115 nursing professionals working in clinical and surgical inpatient units at a university hospital, who presented an overall stress level higher than 1, according to the Stress Symptom Scale. The groups participated in nine appointments over three weeks. The outcome was assessed by rMSSD parameters and cardiac coherence at the end of each appointment, which were measured using EmWave Pro Plus®, which uses photoplethysmography to quantify physiological data related to the heartbeat. The analysis was performed using generalized estimation equations, considering α = 5 %. Results: There was a significant time-group interaction in cardiac coherence parameters; the intervention group presented an increase in the mean cardiac coherence parameters at all measurement times, when compared to the control group (p < 0.001; r > 0.98). There was no significant time-group interaction in the rMSSD parameters at any of the measurement times (p = 0.432). As a mind-body therapy, cardiovascular biofeedback proved to be useful and promising. By promoting parasympathetic activation and relaxation, it is possible to prevent the deleterious effects associated with occupational stressors. Conclusion: The intervention with cardiovascular biofeedback proved to be superior to placebo in improving cardiac coherence, resulting in the recovery of the body’s homeostasis.

Downloads

Download data is not yet available.

References

Jilou V, Duarte JMG, Gonçalves RHA, Vieira EE, Simões AL de A. Fatigue due to compassion in health professionals and coping strategies: A scoping review. Rev. Bras. Enferm. 2021;74(5). DOI: https://doi.org/10.1590/0034-7167-2019-0628

Pinheiro JMG, Macedo ABT, Antoniolli L, Vega EAU, Tavares JP, Souza SBC de. Qualidade de vida profissional e estresse ocupacional em trabalhadores de enfermagem durante pandemia por COVID-19. Rev. Gaúcha Enferm. 2023;44:20210309. https://www.scielo.br/j/rgenf/a/FVnQBK5Mz4WQd83m7FVCD3F/abstract/?lang=pt

Souza SBC de, Milioni KC, Dornelles TM. Análise do grau de complexidade do cuidado, estresse e coping da enfermagem num hospital sul-riograndense. Texto Contexto - Enferm. 2018;27(4):e4150017. DOI: https://doi.org/10.1590/0104-07072018004150017

Salari N, Khazaie H, Hosseinian-Far A, Khaledi-Paveh B, Kazeminia M, Mohammadi M et al. The prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients: A systematic review and meta-regression. Hum Resour Health. 2020;18(1):100. DOI: https://doi.org/10.1186/s12960-020-00544-1

Zhang Y, Wang C, Pan W, Zheng J, Gao J, Huang X et al. Stress, burnout, and coping strategies of frontline nurses during the COVID-19 epidemic in Wuhan and Shanghai, China. Front. Psychiatry. 2020;11. DOI: https://doi.org/10.3389/fpsyt.2020.565520

Ribeiro RP, Marziale MHP, Martins JT, Galdino MJQ, Ribeiro PHV. Estresse ocupacional entre trabalhadores de saúde de um hospital universitário. Rev. Gaucha Enferm. 2018;39:e65127. DOI: https://doi.org/10.1590/1983-1447.2018.65127

Kim HG, Cheon EJ, Bai DS, Lee YH, Koo BH. Stress and heart rate variability: A meta-analysis and review of the literature. Psychiatry Investig. 2018;15(3):235-45. DOI: https://doi.org/10.30773/pi.2017.08.17

Araújo LM de, Carvalho CMS de, Amaral MM, Santos L dos. Variability of Heart Rate as a biomarker of stress: Integrative review. Res. Soc. Dev. 2020;9(12):e34991211125. DOI: https://doi.org/10.33448/rsd-v9i12.11125

Martínez-Zaragoza F, Fernández-Castro J, Benavides-Gil G, García-Sierra R. How the lagged and accumulated effects of stress, coping, and tasks affect mood and fatigue during nurses’ shifts. Int. J. Environ. Res. Public Health. 2020;17(19):1-15. DOI: https://doi.org/10.3390/ijerph17197277

Martinez PF, Okoshi MP. Heart rate variability in coexisting diabetes and hypertension. Arq. Bras. Cardiol. 2018;111(1):73-4. DOI: https://doi.org/10.5935/abc.20180118

Vidal DV, Corrêa A. Biofeedback: um recurso terapêutico para os transtornos de ansiedade. Disciplinarum Scientia. 2020;21(2):217-28. DOI: https://doi.org/10.37777/dscs.v21n2-018

Kennedy L, Parker SH. Biofeedback as a stress management tool: A systematic review. Cogn Tech Work. 2019;21(2):161-90. DOI: https://doi.org/10.1007/s10111-018-0487-x

Dantas EM, Kemp AH, Andreão RV, da Silva VJD, Brunoni AR, Hoshi RA et al. Reference values for short-term resting-state heart rate variability in healthy adults: Results from the Brazilian Longitudinal Study of Adult Health — ELSA-Brasil study. Psychophysiology. 2018;55(6). DOI: https://doi.org/10.1111/psyp.13052

Oliveira Júnior IG, Camelo L V, Mill JG, Ribeiro AL, De Jesus Mendes Da Fonseca M, Härter Griep R et al. Job Stress and heart rate variability: Findings from the ELSA-Brasil Cohort. Psychosom Med. 2019;81(6):536-44. DOI: https://doi.org/10.1097/PSY.0000000000000708

Betke K, Basińska MA, Andruszkiewicz A. Sense of coherence and strategies for coping with stress among nurses. BMC Nurs. 2021;20(1):107. DOI: https://doi.org/10.1186/s12912-021-00631-1

Kloudova G. Coping with stress reactions using biofeedback therapy in elite athletes: Case report. Cogn. Remediat. J. 2021;10(2):1-8. DOI: https://doi.org/10.5507/crj.2021.003

Lorente L, Vera M, Peiró T. Nurses’ stressors and psychological distress during the COVID‐19 pandemic: The mediating role of coping and resilience. J Adv Nurs. 2021;77(3):1335-44. DOI: https://doi.org/10.1111/jan.14695j

De Witte NAJ, Buyck I, Van Daele T. Combining biofeedback with stress management interventions: A systematic review of physiological and psychological effects. Appl Psychophysiol Biofeedback. 2019;44(2):71-82. DOI: https://doi.org/10.1007/s10484-018-09427-7

Millspaugh J, Errico C, Mortimer S, Kowalski MO, Reifsnyder C. Jin Shin Jyutsu® Self-Help Reduces Nurse Stress. J Hol. Nurs. 2021;39(1):4-15. DOI: https://doi.org/10.1177/0898010120938922

Antoniolli L. Efeito do Biofeedback cardiovascular sobre o coping da equipe de enfermagem: ensaio clínico randomizado [Tese]. Porto Alegre: Universidade Federal do Rio Grande do Sul; 2022. Disponível em: http://hdl.handle.net/10183/249381

Macedo ABT, Vega EAU, Antoniolli L, Pinheiro JMG, Dornelles TM, Souza SBC de. Intervenções para o estresse e ansiedade na enfermagem: revisão integrativa. Rev. Enferm. Atual In Derme. 2021;95(35):e-21108. DOI: https://doi.org/10.31011/reaid-2021-v.95-n.35-art.1141

Antoniolli L, Macedo ABT, Vega EAU, Pinheiro JMG, Tanaka AKS da R, Souza SBC de. Effect of biofeedback on nursing team coping: a randomized clinical trial. Acta Paul Enferm 2023;36:eAPE00502. DOI: https://doi.org/10.37689/acta-ape/2023AO00502

Alkhawaldeh JM, Soh KL, Mukhtar F, Peng OC, Alkhawaldeh HM, Al‐Amer R et al. Stress management training program for stress reduction and coping improvement in public health nurses: A randomized controlled trial. J Adv Nurs. 2020;76(11):3123-35. DOI: https://doi.org/10.1111/jan.14506

Lima FV, Formiga NS, Melo GF De. Elaboração e validação de Escala de Sintomas de Estress. PsicologiaPt. 2018;1-13. Disponível em: https://www.psicologia.pt/artigos/textos/A1203.pdf

Van der Zwan JE, Vente W de, Huizink AC, Bögels SM, Bruin EI de. Physical activity, mindfulness meditation, or heart rate variability biofeedback for stress reduction: A randomized controlled trial. Appl Psychophysiol Biofeedback. 2015;40(4):257-68. DOI: https://doi.org/10.1007/s10484-015-9293-x

Lo JC, Sehic E, Meijer SA. Measuring mental workload with low-cost and wearable sensors: Insights into the accuracy, obtrusiveness, and research usability of three instruments. J Cogn Eng Decis Mak. 2017;11(4):323-36. DOI: https://doi.org/10.1177/1555343417716040

Schlatter S, Schmidt L, Lilot M, Guillot A, Debarnot U. Implementing biofeedback as a proactive coping strategy: Psychological and physiological effects on anticipatory stress. Behav. Ther. 2021;140:103834. DOI: https://doi.org/10.1016/j.brat.2021.103834