Box Breathing and Physiological Feedback Before Endoscopy

The Effect of Pre-Endoscopy Box Breathing and Real-Time Physiological Feedback on Stress, Comfort, and Vital Signs

This study aims to evaluate the effects of box breathing exercises and real-time physiological feedback-administered alongside standard nursing care prior to endoscopy-on patients' stress levels, comfort levels, and vital signs. Endoscopy procedures can induce pre-procedural stress and anxiety in patients, potentially affecting their comfort and physiological status. The study will be conducted as a two-group randomized controlled trial. Participants will be randomly assigned to either the study group or the control group. In addition to standard nursing care, the study group will receive guided box breathing exercises and real-time physiological feedback before the endoscopy. The control group will receive only standard nursing care. The study will assess the impact of the intervention on patients' stress levels, comfort levels, and vital signs. It is hypothesized that box breathing exercises and real-time physiological feedback will reduce stress levels, enhance patient comfort, and positively influence vital signs. The findings are expected to contribute to the development of non-pharmacological nursing interventions for managing patient stress and comfort during the pre-endoscopy period.

This study is a two-group randomized controlled trial designed to evaluate the effects of box breathing exercises and real-time physiological feedback-administered prior to the endoscopy procedure-on patients' stress levels, comfort levels, and vital signs. The research will be conducted within the scope of routine clinical practice, and no additional invasive procedures beyond standard nursing care will be performed. During the study, patients in the intervention group will receive guided box breathing exercises and real-time physiological feedback in addition to standard nursing care prior to the endoscopy. Patients in the control group will continue to receive standard nursing care without any additional interventions.

The box breathing exercise employed in this study is a non-pharmacological nursing intervention that is easy to implement in clinical settings, low-cost, and free of known serious side effects. Real-time physiological feedback will enable the monitoring of changes in patients' physiological indicators during the procedure and the provision of appropriate feedback to the patient. All measurement tools used in the study have proven validity and reliability, and the data obtained will be used solely for research purposes. Participants' personal information will be kept confidential; data will be analyzed using coding, and personally identifiable information will not be shared with third parties.

Participation in the study is entirely voluntary, and participants may withdraw at any time without providing a reason. A decision to withdraw from the study will not affect the participants' endoscopy procedures or their right to access healthcare services. The box breathing exercise will be administered with due consideration of the participants' physical and cognitive conditions. The practice will be terminated immediately should any dizziness, shortness of breath, discomfort, or other adverse reactions occur during the exercise. Participant safety will be prioritized throughout the study, and any necessary clinical assessment and intervention will be provided without delay in the event of discomfort or an adverse incident.

The findings of this study are expected to provide evidence-based data for nursing care practices aimed at managing patient stress and comfort during the pre-endoscopy period, and to support the integration of non-pharmacological interventions-such as box breathing exercises and real-time physiological feedback-into clinical practice.

Inclusion Criteria:

• Individuals who present to the Endoscopy Unit of Mersin City Training and Research Hospital between February 15 and September 15, 2026,
• Are aged 18 years or older,
• Are literate in Turkish,
• Are undergoing a scheduled (non-emergency) endoscopy procedure for the first time,
• Do not receive any analgesic or anesthetic medication before or during the procedure,
• Have no diagnosis of, nor are receiving medical treatment for, an anxiety disorder,
• Have no cognitive, affective, or verbal impairments that would hinder communication,
• And agree to participate in the study will be included.

Exclusion Criteria:

• The following individuals will be excluded,
• Those who have previously undergone endoscopy,
• Those who have used analgesics within the last 24 hours,
• Those scheduled for endoscopy with sedation,
• Those using other complementary methods (yoga, reflexology, acupuncture, etc.) during the procedure,
• Patients with unstable general condition or vital signs,
• Those unable to perform breathing exercises due to severe cognitive impairment or psychiatric illness,
• Patients regularly using beta-blockers or antiarrhythmic drugs-making the interpretation of physiological parameters difficult,
• Pregnant individuals,
• Individuals who do not consent to participate in the study.