Assessing Workplace Stress Among Nurses Using Heart Rate Variability Analysis With Wearable ECG Device–A Pilot Study

This study aims to measure workplace stress of nurses using heart rate variability (HRV) analysis based on data derived from wearable ECG heart rate monitors. The study population consists of 17 nurses at a major public hospital in China. Data was collected from 7 DON nurses (department of neurosurgery; all females; mean age: 31.43 ± 4.50), and 9 ICU nurses (intensive care unit; 8 females and 1 male; mean age: 31.33 ± 5.43). Each participant was asked to wear a wireless ECG heart rate monitor to measure stress level during work, and to complete the Chinese Nurses Stress Response Scale (CNSRS) after work as subjective response criteria. Demographic information, body posture, heart rate, R-R intervals (RRI), low frequency components (LF) and high frequency components (HF) were collected. LF%, LnHF and the squared root of the mean squared differences of successive NN intervals (RMSSD) based on HRV analysis were used to estimate the stress level of nurses. DON nurses reported a higher LF%, lower LnHF and lower RMSSD than ICU nurses. Work shifts were shown to have significant effects on LF%, LnHF and RMSSD respectively, with nurses in long shifts and night shifts reported high stress levels. Higher LF%, lower LnHF and lower RMSSD were found during work shift. Posture analysis revealed negative correlations with LnHF and RMSSD in walking and standing/sitting positions, and a significant negative correlation with LF% in lying-down position. Nurses with higher LF% reported higher CNSRS scores in all subscales, whereas nurses with lower LnHF or RMSSD reported higher CNSRS scores in social phobia and fatigue subscales. The results of this study support the idea that HRV can be used to investigate workplace stress among nurses under real work condition, and can serve as a preventive measure for identifying stress-related illnesses among nurses.