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Research Library

The Use of HeartMath Technology as a Quality Improvement Intervention to Reduce Perceived Stress Levels in Pre‑Licensure Nursing Students to Improve Outcomes

    • Published: 2023
    • Melissa Nelsen
    • Dissertation, Doctor of Nursing Practice, Faculty of Keigwin School of Nursing, Jacksonville University, 2023.
    • Download the complete paper, click here.



The mental health of nursing students and nurses is becoming an important national conversation. The AACN has put out a Call to Action that states that undergraduate nursing programs need to incorporate well-being and mindfulness into all nursing curricula. High stress and anxiety levels are often reported among undergraduate nursing students. Nursing students experience stress during their education due to academic stress in addition to stress experienced during clinical. High levels of stress can lead to poor academic performance as well as not being able to adapt and cope to the stressors of the nursing profession.


This study evaluated the effectiveness of the biofeedback technique, HeartMath, in reducing prelicensure nursing students perceived stress levels. Participants were recruited from a pre-licensure nursing program. The intervention includes each participant receiving HeartMath’s Inner Balance device to use daily, along with participating in an online Blackboard course. Along with perceived stress levels, adherence to the technique was also be evaluated.


Although the aim of an overall 20% improvement in perceived stress scores among the group was not achieved, there was an overall improvement of 11.9%. The adherence rate of each participant practicing three or more days a week was not achieved.


Although limitations existed and specific aims were not met, the study suggests that HeartMath can be an effective technique in reducing nursing students perceived stress levels.