The Effect of Progressive Muscle Relaxation using Biofeedback on Stress Response and Natural Killer Cell in first Clinical Practice of Nursing Students

Kim, Keum Soon

Abstract

Increasingly nursing science is embracing the concepts and methodology derived from psycho-neuroimmunology. It has been previously shown that stress increases and immune function declines in students undergoing examinations. To date, however, no many studies have been reported on stress levels, immune function and interventions in Korean students undergoing their first clinical nursing rotation. It was proposed that nursing students during their first clinical rotation experience increase in stress because of the novelty of the situation and their lack of clinical knowledge. It was also hypothesized that biofeedback and progressive relaxation, methods of self-regulation of involuntary autonomic nervous system responses, would reduce the stress response. The purpose of this study is to test the effectiveness of progressive muscle laxation using biofeedback. The effectiveness of the experimental methods was tested by measuring the degree of symptoms of stress (SOS) and the values of ephinephrine, pulse rate, blood pressure and natural killer cells. The subjects of this study were thirty nursing students divided into two groups: experimental group was progressive muscle relaxation group using biofeedback and control group. This study was conducted for 8 weeks of clinical practice. Biofeedback training was done by software developed by J&J company (1-410 form for progressive muscle training). Progressive muscle relaxation training according to Jacobson's Theory was done by messaged word from biofeedback. The data was analyzed using Chronbach' alpha and t-test of the SPSS program and the significance level of statistics was 5%. The results of the study were: 1) The progressive muscle relaxation training using biofeedback was effective for the reduction of symptoms of stress (t=-4.248, p<.001) under clinical practice stress conditions. 2) The progressive muscle relaxation training using biofeedback was not effective for the values of epinephrine (t=-1.294, p=0.206). 3) The progressive muscle relaxation training using biofeedback was effective for the reduction of systolic blood pressure (t=-2.757, p=0.01). 4) The progressive muscle relaxation training using biofeedback was effective for the reduction of diastolic blood pressure (p=-2.032, p=0.05). 5) The progressive muscle relaxation training using biofeedback was not effective for the reduction of pulse rate(t=-0.15, p=0.988). 6) The progressive muscle relaxation training using biofeedback was effective for the maintenance of natural killer cells (t=2.381, p=02). The first clinical rotation for student nurses is a stressful experience as seen by the rise in the SOS in the control group. Biofeedback using progressive muscle relaxation were effective in preventing the rise of symptoms of stress and the blood pressure means when comparing the pre to post clinical experience. The mean natural killer cell count was depressed in the control group but not significantly different in the experimental groups. It is proposed here that stress via the hypothalamic - pituitary - adrenal axis suppressed the NK cell count whereas the relaxation methods prevented the rise in stress and the resulting immune depression. We recommend relaxation techniques using biofeedback as a health promotion technique to reduce psychological stress. In summary, the progressive muscle relaxation training using biofeedback was effective for the reduction of symptoms of stress under clinical practice stress conditions.