Effects of Breathing Exercises Applied to Intensive Care Nurses on Fatigue and Perceived Stress: A Randomized Controlled Trial
Keywords:
Fatigue, Perceived Stress, Breathing Exercise, Intensive Care, NurseAbstract
Background: Fatigue and stress are common challenges for intensive care nurses. Reducing stress and fatigue among nurses is important for improving nurse and patient safety. Breathing exercises are a nonpharmacological approach that effectively reduces fatigue and stress. This study aimed to evaluate the effects of breathing exercises on fatigue and stress among intensive care nurses. Methods: The research was conducted as a randomized controlled trial between October and December 2024. The study included 66 nurses, 33 in the control group and 33 in the intervention group. Nurses in the intervention group performed breathing exercises lasting approximately 20 minutes for 30 days. No intervention was performed in the control group. Data were collected using the Piper Fatigue Scale and Perceived Stress Scale at the beginning of the study, on the 15th day, and on the 30th day. Results: A statistically significant difference was identified in the group effect, time effect, and group-time interaction for the mean scores on the Piper Fatigue Scale and the Perceived Stress Scale (p<0.01). The fatigue and stress scores of nurses in the intervention group decreased on the 15th and 30th days. Conclusions: This study shows that breathing exercises positively affect fatigue and stress among intensive care nurses. The breathing exercise protocol can be applied to intensive care nurses, and these exercises can be taught to nurses through in-service training.
References
1. Marshall JC, Bosco L, Adhikari NK, et al. What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care. 2017;37:270-276. Doi: https://doi.org/10.1016/j.jcrc.2016.07.015
2. Gök Metin Z. Yoğun bakım hemşirelerinde stresin azaltılmasına yönelik nonfarmakolojik yaklaşımlar: Sistematik bir derleme. Yoğun Bakım Hemşireliği Dergisi. 2019;23(2):87-101.
3. Şen Atasayar B. Examination of ‘The Good Nurse’ Movie In The Context Of Intensive Care Nursing. Yoğun Bakım Hemşireliği Dergisi. 2024;28(1):1-7. Doi: 10.62111/ybhd.1408978
4. Steege LM, Drake DA, Olivas M, Mazza G. Evaluation of physically and mentally fatiguing tasks and sources of fatigue as reported by registered nurses. J Nurs Manag. 2015;23(2):179-189. Doi: https://doi.org/10.1111/jonm.12112
5. Chen S, Wu H, Sun M, et al. Effects of shift work schedules, compensatory sleep, and work–family conflict on fatigue of shift-working nurses in Chinese intensive care units. Nursing in critical care. 2023;28(6):948-956. Doi: https://doi.org/10.1111/nicc.12909
6. Graves K, Simmons D. Reexamining fatigue: Implications for nursing practice. Crit Care Nurs Q. 2009;32(2):112-115. Doi: 10.1097/01.CNQ.0000348198.16788.df
7. Querstret D, O'Brien K, Skene DJ, Maben J. Improving fatigue risk management in healthcare: A scoping review of sleep-related/ fatigue-management interventions for nurses and midwives (reprint). Int J Nurs Stud. 2020;112:103745. Doi: https://doi.org/10.1016/j.ijnurstu.2020.103745
8. Sun T, Huang XH, Zhang SE, et al. Fatigue as a cause of professional dissatisfaction among chinese nurses in intensive care unit during COVID-19 pandemic. Risk Manag Healthc Policy. 2023;16:817-831. Doi: 10.2147/RMHP.s391336
9. Younan L, Clinton M, Fares S, et al. The relationship between work-related musculoskeletal disorders, chronic occupational fatigue, and work organization: A multi-hospital cross-sectional study. J Adv Nurs. 2019;75(8):1667-1677. Doi: 10.1111/jan.13952
10. Çelik S, Taşdemir N, Kurt A, et al. Fatigue in intensive care nurses and related factors. Int J Occup Environ Med. 2017;8(4):199-206. Doi: 10.15171/ijoem.2017.1137
11. Scott LD, Arslanian-Engoren C, Engoren MC. Association of sleep and fatigue with decision regret among critical care nurses. Am J Crit Care. 2014;23(1):13-23. Doi: 10.4037/ajcc2014191
12. Abdul Rahman H, Abdul-Mumin K, Naing L. Psychosocial work stressors, work fatigue, and musculoskeletal disorders: Comparison between emergency and critical care nurses in Brunei public hospitals. Asian Nurs Res. 2017;11(1):13-18. Doi: 10.1016/j.anr.2017.01.003
13. Aşkar SE, Ovayolu O, Ovayolu N. The effect of progressive relaxation exercise on fatigue level of intensive care nurses: A randomised controlled trial. Aust Crit Care. 2024;37(5):767-774. Doi: 10.1016/j.aucc.2024.01.011
14. Cho Y, Joo JM, Kim S, Sok S. Effects of meridian acupressure on stress, fatigue, anxiety, and self-efficacy of shiftwork nurses in South Korea. Int J Environ Res Public Health. 2021;18(8). Doi: 10.3390/ijerph18084199
15. Ozgundondu B, Gok Metin Z. Effects of progressive muscle relaxation combined with music on stress, fatigue, and coping styles among intensive care nurses. Intensive Crit Care Nurs. 2019;54:54-63. Doi: 10.1016/j.iccn.2019.07.007
16. Aktaş GK, İlgin VE. The effect of deep breathing exercise and 4–7-8 breathing techniques applied to patients after bariatric surgery on anxiety and quality of life. Obes Surg. 2023;33(3):920-929. Doi: 10.1007/s11695-022-06405-1
17. McNair D. Flipping on the creative switch using the 4, 7, 8 breathing technique. The Creativity Workbook for Coaches and Creatives. Routledge; 2020:4-6.
18. Örün D, Karaca S, Arıkan Ş. The effect of breathing exercise on stress hormones. Cyprus J Med Sc. 2021;6(1):22-27. Doi: 10.4274/cjms.2021.2020.2390
19. Bernardi L, Gabutti A, Porta C, Spicuzza L. Slow breathing reduces chemoreflex response to hypoxia and hypercapnia, and increases baroreflex sensitivity. J Hypertens. 2001;19(12):2221-9. Doi: 10.1097/00004872-200112000-00016
20. Ma X, Yue Z-Q, Gong Z-Q, et al. The Effect of diaphragmatic breathing on attention, negative affect and stress in healthy adults. Original Research. Front Psychol. 2017;8:874. Doi:10.3389/fpsyg.2017.00874
21. Klinsophon T, Thaveeratitham P, Janwantanakul P. The effect of three-part breathing exercise on smoking cessation: A 6-month cluster-randomized clinical trial. J Bodyw Mov Ther. 2022;32:156-162. Doi: 10.1016/j.jbmt.2022.04.015
22. Kupershmidt S, Barnable T. Definition of a yoga breathing (Pranayama) protocol that improves lung function. Holist Nurs Pract. 2019;33(4):197-203. Doi: 10.1097/hnp.0000000000000331
23. Konya I, Watanabe K, Shishido I, et al. Post-work recovery from fatigue and sleep episodes among nurses who are engaged in 16-hour night shifts: A prospective observational study. Healthcare (Basel, Switzerland). 2022;10(6):1089. Doi: 10.3390/healthcare10061089
24. Hopewell S, Chan A-W, Collins GS, et al. CONSORT 2025 statement: updated guideline for reporting randomised trials. BMJ. 2025;389:e081123. Doi: 10.1136/bmj-2024-081123
25. Gauthier F, Güneş Ü. The effect of music therapy and breathing exercise on anxiety and pain in patients undergoing coronary angiography: A randomized controlled study. Nurs Crit Care. 2024;29(6):1325-1333. Doi: 10.1111/nicc.13145
26. Parlak AG, Akkuş Y, Araz Ö. The effect of foot reflexology on stress, fatigue, and low back pain in intensive care unit nurses: A randomized controlled trial. Pain Manag Nurs. 2024;25(5):494-500. Doi: 10.1016/j.pmn.2024.05.013
27. Piper BF, Dibble SL, Dodd MJ, et al. The revised Piper Fatigue Scale: psychometric evaluation in women with breast cancer. Oncol Nurs Forum. 1998;25(4):677-84.
28. Can G, Durna Z, Aydiner A. Assessment of fatigue in and care needs of Turkish women with breast cancer. Cancer nursing. 2004;27(2):153-61. Doi: 10.1097/00002820-200403000-00009
29. Aslankoç R, Yalçın A, Tunca Ü, et al. The relationshıp between the fatigue and sleep quality of the workers in the intensive care unit. Uyku Bülteni. 2020;1(2):32-37.
30. Demir OB, Yilmaz FT. The effect of posture regulation training on musculoskeletal disorders, fatigue level and job performance in intensive care nurses. BMC nursing. 2024;23(1):778. Doi: 10.1186/s12912-024-02387-w
31. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385-96.
32. Eskin M, Harlak H, Demirkıran F, Dereboy Ç. Algılanan stres ölçeğinin Türkçeye uyarlanması: güvenirlik ve geçerlik analizi. New/Yeni Symposium Journal. 2013;51(3):132-140.
33. Mehta CR, Patel NR. A hybrid algorithm for Fisher's exact test in unordered rxc contingency tables. Commun Stat Theory Methods. 1986;15(2):387-403.
34. Cohen J. The analysis of variance and covariance. Statistical power analysis for the behavioural sciences. 1988;2nd ed. Doi: https://doi.org/10.4324/9780203771587
35. Duarte J, Pinto-Gouveia J. Effectiveness of a mindfulness-based intervention on oncology nurses’ burnout and compassion fatigue symptoms: A non-randomized study. Int J Nurs Stud. 2016;64:98-107. Doi: https://doi.org/10.1016/j.ijnurstu.2016.10.002
36. Neşe A, Samancıoğlu Bağlama S. The effect of progressive muscle relaxation and deep breathing exercises on dyspnea and fatigue symptoms of COPD patients: A randomized controlled study. Holist Nurs Pract. 2022;36(4):E18-e26. Doi: 10.1097/hnp.0000000000000531
37. Serçe S, Ovayolu Ö, Bayram N, et al. The effect of breathing exercise on daytime sleepiness and fatigue among patients with obstructive sleep apnea syndrome. J Breath Res. 2022;16(4). Doi: 10.1088/1752-7163/ac894d
38. Zaccaro A, Piarulli A, Laurino M, et al. How breath-control can change your life: A systematic review on psycho-physiological correlates of slow breathing. Systematic Review. Front Hum Neurosci. 2018;12:353.
39. Gerbarg PL, Dickson F, Conte VA, Brown RP. Breath-centered virtual mind-body medicine reduces COVID-related stress in women healthcare workers of the Regional Integrated Support for Education in Northern Ireland: a single group study. Original Research. Front Psychiatry. 2023:14:1199819.
40. Morgan SP, Lengacher CA, Seo Y. A Systematic review of breathing exercise interventions: An integrative complementary approach for anxiety and stress in adult populations. J Holist Nurs. 2024:08980101241273860. Doi: 10.1177/08980101241273860
41. Fincham GW, Strauss C, Montero-Marin J, Cavanagh K. Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials. Scientific reports. 2023;13(1):432. Doi: 10.1038/s41598-022-27247-y
42. Bernstein AM, Kobs A, Bar J, et al. Yoga for stress management among intensive care unit staff: A pilot study. Altern Complement Ther. 2015;21(3):111-115. Doi: 10.1089/act.2015.28999.amb
43. Yu X, Fumoto M, Nakatani Y, et al. Activation of the anterior prefrontal cortex and serotonergic system is associated with improvements in mood and EEG changes induced by Zen meditation practice in novices. Int J Psychophysiol. 2011;80(2):103-11. Doi: 10.1016/j.ijpsycho.2011.02.004
44. Yu F, Somerville D, King A. Exploring the impact of 12-hour shifts on nurse fatigue in intensive care units. Applied nursing research: ANR. 2019;50:151191. Doi: 10.1016/j.apnr.2019.151191
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