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Impact of Complementary Relaxation Therapy Education for Palliative Care Nurses

    • Published: 2018
    • Whitney Barnekoff McKinley
    • Dissertation, Doctor of Nursing Practice in Family and Individual Health, Montana State University, April 2018.
    • Download the complete paper, click here.



CAM interventions can improve symptom management in end of life care. Nursing knowledge and routine integration of CAM in the impatient setting is lacking in palliative care. Education regarding CAM therapies for health providers could help ameliorate this problem.


The purpose of this project was to enhance nursing knowledge and comfort with relaxation therapy, and to evaluate of how this knowledge enhancement could impact palliative care patient outcomes.


Setting was an inpatient Oncology unit. This project had two populations; registered nurses (n=13) with primary employment on the oncology unit and palliative care patients (n=20) with end stage pulmonary disease or pulmonary malignancy.


This quasi-experimental pilot project utilizing before and after comparisons of nursing education and patient symptoms. Three phases were implemented. Phase one included a CAM Health Beliefs Questionnaire distributed to nursing staff. This was followed by an educational intervention for nursing staff regarding relaxation therapy that included instructions on the use of the emWave Heartmath Biofeedback technology. An instrument (Relaxation Therapy Competency), intended to measure change in nursing knowledge, was developed and utilized in a pre-test/post-test format. Once competence was established, nurses implemented the relaxation therapy for palliative pulmonary patients. Subjective and objective measures were gathered before and after relaxation therapy was initiated on enrolled participants. Data collected included inpatient implementation utilizing emWave Heartmath Biofeedback technology, pain, anxiety and breathlessness ratings (utilizing Likert scales), and vital sign measurements.


Knowledge was improved by an average of 35% for nursing participants through enhancing knowledge with an education session. A reduction in breathlessness, pain, and anxiety resulted for nearly all patient participants utilizing a singular biofeedback session. Physiological coherence achieved through relaxation therapy integration was expressed through significant improvement in blood pressure, respiratory rate, heart rate, and pulse oximetry for the patient population as a whole.


The results of this pilot project show that symptom management can be improved for palliative care patients. Nursing knowledge regarding relaxation therapies was greatly improved, and nursing attitudes were positive overall. This safe, effective therapy has the potential to impact palliative care patientsf symptom management and their end of life care.