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Research Library

Effects of Heart Rate Variability Biofeedback on Perceived Stress, Perceived Coping Ability and Resilience in Accelerated Baccalaureate Nursing Students

    • Published: 2016
    • Andrea J. Harmelink
    • Ph.D. Dissertation, Major Nursing, South Dakota State University, 2016.
    • Download the complete paper, click here.



The purpose of this quasi-experimental randomized controlled two-group pilot study was to test the effectiveness of a Heart Rate Variability Biofeedback (HRVB) intervention on accelerated baccalaureate nursing (ABN) students’ perceived stress, perceived coping ability, and resilience over four weeks during an academic term of ABN coursework. This study was guided by Lazarus and Folkman’s Transactional Theory of Stress and Coping, with a focus on primary appraisal.


ABN students report higher perceived stress and anxiety compared with nursing students in traditional four-year nursing programs due to the compressed and fast-paced format of the ABN curriculum. Qualitative data points to a growing awareness of the high stress associated with ABN programs and the need for adaptive coping strategies, yet few interventional studies have been reported for this population. HRVB reduces autonomic reactivity and regulates homeostatic physiologic mechanisms, which can lead to decreased stress and anxiety, and increased resilience. Interventions such as HRVB are needed for ABN students in order to promote adaptive coping strategies and increase resilience pre-licensure.


Thirty-two students from a nationally accredited nursing program in the upper Midwest region of the U.S. in term four of their ABN curriculum were recruited and randomly assigned to one of two groups: HRVB intervention group or wait-list control group. All participants were given pre- and post-intervention surveys, including demographic information, the Perceived Stress Scale (PSS), the Coping Self-Efficacy Scale (CSE), and the Resilience Scale (RS). HRVB intervention group participants received HRVB training and the use of a personal HRVB device from the Primary Investigator.


Findings indicated that HRVB significantly decreased perceived stress (t = 2.8588, p = 0.003832, α = .05), as well as significantly increased perceived coping ability (t = -4.012, p = 0.0001846, α = .05), and resilience (t = -2.7787, p = 0.004663, α = .05), in the ABN participants in the HRVB intervention group as compared to the ABN participants in the wait-list control group. Conclusion. Despite the stressors and demands of the ABN curriculum, study findings support the use of HRVB as an intervention to assist ABN students in managing stress and increasing resilience.