Leah Dymock and Dr. Glenda Christiaens, College of Nursing

As a profession, nursing requires a constant balance between professional standards, individual values, and patient needs (Luquette, 2007.) These responsibilities lead to stress, compassion fatigue, and burnout (ibid.) Thus it follows that an implicit part of nursing school is learning to care for another person without sacrificing your own physical or psychological wellbeing. This question is then raised: What is the best way to cope with stressful situations that are encountered by nurses? Although the best thing for one person will differ from what’s best for another person, there are inherent characteristics of activities that induce a relaxation state; namely, deep breathing, the ability to focus/concentrate, and the perceived effectiveness of any given intervention. The most effective stress relief comes from using a combination of interventions (Luquette, 2007; “Taking control,” 2007.)

Deep breathing techniques are frequently taught to nursing students. These techniques strengthen respiratory muscles and increase the body’s ability to regulate the flow of oxygen and other nutrients into the bloodstream, thus helping the body to relax (“Breath control,” 2008; Conrad, et. Al, 2007; Luqette, 2007; “Taking control,” 2007.) Additionally, research findings have connected the use of deep breathing with music to increase focus and attention. Many studies specifically describe the beneficial effects of vocal training on stress reduction with regards to deep breathing, long-term intervention adherence, and increased focus/attention (Johnson, 2001; “Samplings” 2005.) Among people who have been involved with using music as a therapeutic tool, researchers repeatedly note that participants explicitly state how much they enjoyed using music as therapy or participating in a Music Therapy study (Samplings, 2005.)

Vocal training has a limited quantitative research base as a stress management and relaxation intervention, thus it was the purpose of this pilot study to establish a research method that links music therapy with teaching student nurses to relax. This study evaluated the effectiveness of learning deep breathing through vocal training (singing) in an effort to provide nursing students with another method of relaxation.

Participants in this study were volunteer nursing students with a broad range of musical (or nonmusical) backgrounds. Each participant was taught various deep breathing and singing exercises in a similar format to a “voice lesson.” Pre-intervention and post-intervention data was obtained for participant’s blood pressure, respiratory rate, and heart rate, as well as Likert-scale stress inventories to assess the perceived effectiveness of the intervention. Participants were encouraged to practice this intervention daily and as needed for stress relief. At the four-week post-intervention, follow-up stress inventories and a questionnaire were obtained as well. It is interesting to note that at the time of the intervention, 78% of study participants were at moderate or high risk for stress-related illness.

Immediately following the intervention, participants showed positive physical and psychological responses to the vocal training. The average participant was positively impacted by the intervention in 8 different ways (i.e. feeling more at ease, calmer, less anxious, etc.). Physiological responses (blood pressure, respiratory rate, heart rate) also showed changes, with all but one participant trending towards a more relaxed state.

The four-week follow-up showed that the participants who practiced the intervention three or more times per week maintained a high number of positive indicators for relaxation. The average participant (regardless of practice time) showed 5 indicators of relaxation when compared to their baseline survey. The follow-up questionnaire confirmed that participants enjoyed being involved with the study and stated that they would consider using this technique in the future.

After analyzing both quantitative and qualitative data from this study, it is recommended that further studies provide written instructions for participants to use as a practice guide, and that more study participants be recruited. It is also recommended that participants be given more information on the practical application of how this technique could be used in a nursing setting.

In conclusion, this was a successful pilot study. It established a valid research process to test the efficacy of using a vocal training method of relaxation for nursing students. The study was also effective in obtaining quantitative data, however the statistical significance was difficult to determine because of the small sample size. The qualitative data proved reliability of the method when compared with other similar studies, and the researchers were able to gather valuable information for improvement of the research method for further studies.

This study was presented at the BYU College of Nursing Research Conference in October 2009.

References

• Breath control helps quell errant stress response, (August 2008). Harvard Women’s Health Watch, 13(12), 6-8.
• Conrad, A., Doberenz, S., Kim, S., Meuret, A., Muller, A., Roth, W., & Wollburg, E. (2007). Psychophysiological effects of breathing instructions for stress management. Applied Psychophysiology & Biofeedback, 32(2), 89-99.
• Johnson, G. (2001). The Effect of Instrumental and Vocal Music on Adherence to a Physical Rehabilitation Exercise Program with Persons who are Elderly. Journal of Music Therapy. 38. 82-96.
• Luquette, J. (2007.) Stress, compassion fatigue, and burnout: Effective self-care techniques for oncology nurses. Oncology Nursing Forum, 34(2), 490.
• Samplings: Recent journal articles, (November 2005). Music Educators Journal, 92(2), 14.