Efficacy of auriculotherapy for decreasing anxiety and stress among perioperative nursing workers: a mixed study

Munhoz, Oclaris Lopes; Morais, Bruna Xavier; Luz, Emanuelli Mancio Ferreira da; Greco, Patrícia Bitencourt Toscani; Ilha, Silomar; Magnago, Tânia Solange Bosi de Souza

doi:10.1590/1518-8345.7218.4275

Accessibility / Report Error

Brazil

Revista Latino-Americana de Enfermagem

Português Español

Brazil

Português Español

table of contents « previous current next »

Table of contents

Original Article • Rev. Latino-Am. Enfermagem 32 • 2024 • https://doi.org/10.1590/1518-8345.7218.4275 copy

Efficacy of auriculotherapy for decreasing anxiety and stress among perioperative nursing workers: a mixed study^* * This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) - Finance Code 001, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

to analyze the effectiveness of auriculotherapy for decreasing anxiety and stress of perioperative nursing professionals.

Method:

mixed methods research, embedded experimental model. In the quantitative stage, a randomized, triple-blind clinical trial was conducted with perioperative nursing professionals, who answered a characterization questionnaire, the List of Signs and Symptoms of Stress, and the General Anxiety Disorder-GAD 7. The participants attended eight auriculotherapy sessions with semi-permanent needles. The qualitative stage was exploratory and descriptive, in which data were collected through semi-structured interviews. Data were mixed with the incorporation of qualitative findings to examine the intervention in the experimental study.

Results:

13 professionals participated in the intervention group and 14 in the control group. Anxiety and stress levels decreased significantly within groups, though no statistical difference was found between groups (p>0.05). The central category, “Auriculotherapy as an intervention to treat anxiety and stress,” emerged from the qualitative data, which was subdivided into a base unit and three categories concerning the therapy’s benefits.

Conclusion:

applying real and sham auriculotherapy had the same effect on the participants’ anxiety and stress levels; the reports reinforced such evidence. Non-pharmacological interventions, such as auriculotherapy, are essential for recovering and promoting the health of perioperative nursing professionals. Brazilian Clinical Trials Registry: RBR-3jvmdn.

Descriptors:
Anxiety; Occupational Stress; Auriculotherapy; Perioperative Nursing; Occupational Health; Nursing

Highlights:

(1) Significant decrease in intragroup anxiety and stress, with no differences between groups.

(2) Real and sham auriculotherapy presented similar effects.

(3) Mixed study, incorporating qualitative data to investigate the intervention.

(4) Pioneering data on auriculotherapy, anxiety, and stress in perioperative units.

(5) Non-pharmacological interventions are essential to promote the health of workers.

Variables		Intervention Group (n=13)		Placebo Group (n=14)		p-value
		n	%	n	%
Marital Status	Married	7	53.9	8	57.2	0.928*
	Single	4	30.8	3	21.4
	Divorced	2	15.3	3	21.4
Job position	Nurse	5	38.5	3	21.4	0.645^†
Job position	Nursing technician/aide	8	61.5	11	78.6	0.645^†
Intention to quit	Yes	2	15.4	2	14.3	0.546*
	No	8	61.5	10	71.4
	Maybe	3	23.1	2	14.3
Weight gain in the last six months	Yes	7	53.8	9	64.3	0.704^†
Weight gain in the last six months	No	6	46.2	5	35.7	0.704^†
Physical exercise	Yes	6	46.2	3	21.4	0.613*
	No	5	38.5	6	42.9
	Sometimes	2	15.3	5	35.7
Have time for leisure	Yes	3	23.0	4	28.6	0.851*
	No	5	38.5	3	21.4
	Sometimes	5	38.5	7	50.0
Have a diagnosed health condition	Yes	9	69.2	6	42.8	0.168^‡
Have a diagnosed health condition	No	4	30.8	8	57.2	0.168^‡
		Mead	SD^§	Mead	SD^§
Age		41.75	8.92	43.38	6.88	0.611^\|\|
Prevalence of anxiety before the 1^st session		13.50	2.61	14.23	3.14	0.535^\|\|
Prevalence of stress before the 1^st session		77.58	16.64	82.69	32.03	0.626^\|\|

Outcome	Group	Session (I)	Session (J)	Difference in means (I-J)	p-value
Anxiety*	Intervention	1^st	4^th	4.96	0.001
			8^th	5.50	0.004
			Follow-up	5.30	0.000
		4^th	1^st	-4.96	0.001
			8^th	0.53	0.73
			Follow-up	0.33	0.82
		8^th	1^st	-5.50	0.004
			4^th	-0.54	0.73
			Follow-up	-0.19	0.88
		Follow-up	1^st	-5.30	0.000
			4^th	-0.34	0.82
			8^th	0.19	0.88
	Placebo	1^st	4^th	6.46	0.000
			8^th	5.16	0.004
			Follow-up	5.83	0.000
		4^th	1^st	-6.36	0.000
			8^th	-1.30	0.37
			Follow-up	-0.63	0.66
		8^th	1^st	-5.16	0.004
			4^th	1.30	0.37
			Follow-up	0.67	0.59
		Follow-up	1^st	-5.83	0.00
			4^th	0.63	0.66
			8^th	-0.67	0.59
Stress^†	Intervention	1^st	4^th	14.72	0.015
			8^th	26.65	0.002
			Follow-up	17.50	0.025
		4^th	1^st	-14.72	0.015
			8^th	11.93	0.016
			Follow-up	2.78	0.59
		8^th	1^st	-26.65	0.002
			4^th	-11.93	0.016
			Follow-up	-9.14	0.09
		Follow-up	1^st	-17.50	0.025
			4^th	-2.78	0.59
			8^th	9.15	0.09
	Placebo	1^st	4^th	22.58	0.000
			8^th	27.00	0.001
			Follow-up	27.45	0.001
		4^th	1^st	-22.58	0.000
			8^th	4.41	0.30
			Follow-up	4.87	0.31
		8^th	1^st	-27.00	0.001
			4^th	-4.41	0.30
			Follow-up	0.45	0.93
		Follow-up	1^st	-27.45	0.001
			4^th	-4.87	0.32
			8^th	-0.46	0.93

Outcome	Group	n	1^st session	4^th session	8^th session	Follow-up
Outcome	Group	n	Mean (SD*)	Mean (SD*)	Mean (SD*)	Mean (SD*)
Anxiety	Intervention	11	13.5(2.6)	8.7(4.7)	7.4(4.7)	9.4(4.1)
Anxiety	Placebo	13	14.2(3.1)	9.0(5.5)	9.0(6.8)	7.6(5.1)
Stress	Intervention	11	77.5(16.6)	63.5(18.5)	51.2(27.9)	62.1(24.4)
Stress	Placebo	13	82.6(32.0)	59.4(31.5)	54.9(32.2)	50.3(26.1)

QUAN* Results	Qual^† Results	Meta-inferences
Auriculotherapy significantly decreased intragroup anxiety and stress symptoms between the 1^st and 8^th sessions and the follow-up (Table 1).	Base unit: “Benefits of auriculotherapy (intervention and placebo points) for anxiety and stress among perioperative nursing workers.”	Perioperative nursing workers reported significant stress and anxiety symptoms before the intervention. Auriculotherapy showed positive results in decreasing intragroup stress and anxiety, i.e., both for the intervention and placebo groups, reinforcing the benefits of non-pharmacological practices.
A difference in anxiety levels was found in the Intervention Group between the 1^st, 4^th (p^‡=0.001), 8^th sessions (p^‡=0.004) and the follow-up (p^‡=0.001); between the 4^th and 1^st (p^‡=0.001); between the 8^th and 1^st sessions (p^‡=0.004); and, between follow-up and 1^st session (p^‡=0.000). Differences regarding stress were found between the 1^st, 4^th (p^‡=0.015), 8^th sessions (p=0.002) and follow-up (p^‡=0.025); between the 4^th and 1^st (p^‡=0.015) and 8^th session (p^‡=0.016); between the 8^th and 1^st (p^‡=0.002) and the 4^th sessions (p^‡=0.016); and, between follow-up and 1^st session (p^‡=0.025) (Table 2).	Category of analysis: “Auriculotherapy to treat anxiety and stress in the intervention group.”	Auriculotherapy was beneficial in controlling anxiety and stress symptoms; no differences were found between the groups, though. It contributed to improving the foremost common symptoms such as sleep disorders, appetite, irritability, and tobacco consumption, improving the participants’ self-perception.
		The participants reported that they started adopting coping strategies to deal with stressors after the auriculotherapy sessions.
Anxiety levels decreased by 44.5% between the 1^st and 8^th sessions in the Intervention Group, with a slight increase in the follow-up. The Placebo Group showed a decrease of 36.75% in the same period, which remained at the follow-up.	Category of analysis: “Auriculotherapy for anxiety and stress in the placebo group.”	Real and sham point (placebo) stimulation in auriculotherapy produced physiological or belief-related effects for the nursing professionals in the placebo group, as they reported decreased anxiety and stress symptoms. This result is explained by the fact that these conditions tend to respond positively to listening and attention given to those affected. Furthermore, the ankle point was one of the points used in the sham treatment. According to Traditional Chinese Medicine, despite being a specific point used to treat muscle pain in this site, it has an analgesic effect.
Regarding the stress outcome in the Intervention Group, a 34.01% decrease was obtained between the 1^st and 8^th sessions, though it did not remain at the follow-up. Regarding the Placebo Group, a decrease of 33.67% was found between the 1^st and 8^th sessions, which remained at the follow-up (Table 3).		Having anxiety or stress symptoms is a unique experience, and how the participants perceive the effects of auriculotherapy is subjective. Some participants reported improved sleep, appetite, and other symptoms, while others did not. Furthermore, this practice improved the individuals’ overall well-being, providing emotional balance, decreasing irritability, and a better disposition for work.
	Category of analysis: “Auriculotherapy side effects.”	Auriculotherapy was minimally invasive, safe, and demanded little time.
	Category of analysis: “Auriculotherapy side effects.”	The adverse events linked to the auriculotherapy were minimal. The participants reported temporary, tolerable symptoms, discomfort at the site where the semi-permanent needles were inserted, skin irritation, and hyperemia (redness).

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

Stay informed of issues for this journal through your RSS reader

[1] Corresponding author: Oclaris Lopes Munhoz E-mail: oclaris_munhoz@hotmail.com https://orcid.org/0000-0001-8901-7148

Brazil

Brazil

Efficacy of auriculotherapy for decreasing anxiety and stress among perioperative nursing workers: a mixed study* * This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) - Finance Code 001, Brazil.

Abstract

Objective:

Method:

Results:

Conclusion:

Highlights:

Efficacy of auriculotherapy for decreasing anxiety and stress among perioperative nursing workers: a mixed study^* * This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) - Finance Code 001, Brazil.