IMPACT OF THE GUIDED PROGRESSIVE MUSCLE RELAXATION INTERVENTION ON STRESS AND ANXIETY IN ICU NURSES

Abstract

Background: Intensive care unit nurses are consistently exposed to high emotional demands, critically ill patients, and rotating shift schedules. These occupational stressors substantially increase the risk of stress, anxiety, sleep disturbance, and burnout. In low- and middle-income countries, including Pakistan, evidence supporting feasible, low-cost psychological interventions tailored for ICU nurses remains limited. Objective: To evaluate the effectiveness of a guided progressive muscle relaxation intervention in reducing perceived stress and anxiety among ICU nurses working in a tertiary care hospital in Pakistan. Study Design: Prospective two-arm controlled trial. Settings: Adult intensive care units of a tertiary care hospital in Pakistan. Duration of Study: January to July 2025. Methods: Ninety registered ICU nurses were enrolled and allocated equally to an intervention group receiving guided progressive muscle relaxation plus usual routine care (n = 45) or a control group receiving usual routine care alone (n = 45). The intervention consisted of supervised and self-guided relaxation sessions conducted over the intervention period. Primary outcomes were perceived stress assessed using the Perceived Stress Scale-10 and anxiety assessed using the Generalized Anxiety Disorder-7 scale. Secondary outcomes included sleep quality and emotional exhaustion. Outcomes were measured at baseline and post-intervention. Analysis of covariance was performed with baseline scores adjusted for, and effect sizes were calculated using Cohen's d. Results: Baseline demographic characteristics and outcome measures were comparable between groups. Post-intervention, nurses in the guided progressive muscle relaxation group demonstrated significantly lower stress and anxiety scores than those in the control group (Perceived Stress Scale-10: 16.7 ± 4.9 vs 22.9 ± 5.5, p < 0.001; Generalized Anxiety Disorder-7: 7.1 ± 3.2 vs 11.2 ± 3.7, p < 0.001). Mean reductions in stress and anxiety were substantially greater in the intervention group, with large effect sizes (Cohen's d = 1.50 for stress and 1.38 for anxiety). Significant improvements were also observed in sleep quality and emotional exhaustion. Allocation to the intervention group independently predicted clinically meaningful improvement after adjustment for demographic and occupational variables. Adherence to the intervention was high, and no adverse events were reported. Conclusion: Guided progressive muscle relaxation is a safe, feasible, and highly effective intervention for reducing stress and anxiety among ICU nurses. Incorporation of this low-cost strategy into routine workplace wellness programs may enhance psychological wellbeing and occupational resilience in resource-limited critical care settings.