Definitions of the elements of the NANDA-I nursing diagnosis “Imbalanced Energy Field”: an integrative review

Carneiro, Camila de Souza; Sá, Ana Cristina de; Hirano, Gisele Saraiva Bispo; Barros, Alba Lúcia Bottura Leite de

doi:10.1590/0034-7167-2024-0317

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REVIEW • Rev. Bras. Enferm. 78 (3) • 2025 • https://doi.org/10.1590/0034-7167-2024-0317 linkcopy

Definitions of the elements of the NANDA-I nursing diagnosis “Imbalanced Energy Field”: an integrative review

Definiciones de los elementos del diagnóstico de enfermería NANDA-I “Campo Energético Desequilibrado”: una revisión integradora

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives: to synthesize literature on imbalanced energy field to conceptually and operationally define the defining characteristics and related factors of diagnosis “Imbalanced Energy Field” (00273) (NANDA-I).

Methods: a study developed in two phases: integrative literature review (Whittemore & Knafl) and improvement of definitions of diagnostic elements. The CINAHL, Scopus, LILACS, BDENF, FIOCRUZ, Web of Science, INTEGRALIDADE and PubMed databases were used from 2016 to 2022.

Results: a total of 524 articles were identified, and 14 articles were selected for analysis. Five addressed therapeutic touch outcomes; three studies addressed Reiki outcomes; and six studies addressed mixed integrative practices with levels of evidence, according to the Melnyk and Fineout-Overholt criteria: level II (six studies); VI (three studies); III (three studies); IV (1 study); and V (one study).

Conclusions: the articles analyzed favored the improvement of the conceptual and operational definitions of defining characteristics and related factors of the diagnosis under study.

Descriptors:
Nursing Diagnosis; Review Literature as Topic; Spiritual Therapies; Integrality in Health; Health Promotion

Title	First author/country/year	Outline	Findings	Level of evidence
The effect of Therapeutic Touch on Back Pain in Adults on a Neurological Unit: An Experimental Pilot Study	Mueller G/Austria/2019(¹⁹)	Pilot intervention study (case-control)	Pain improvement was found in the intervention group according to the mean Quebec Back Pain Disability Scale score (day 1: 72.53, standard deviation [SD] ± 14.10). The score of the Numerical Pain Assessment Scale had a mean of 4.33 points (SD ± 2.09).	IV
Massage and Reiki to reduce stress and improve quality of life: A randomized clinical trial	Kurebayashi LFS/Brazil/2020(²⁰)	Randomized controlled clinical trial in three groups	The study was conducted with 101 participants. Massages followed by rest (G1) or Reiki (G2) were effective in reducing stress levels and improving quality of life when compared to the control group (G3), and were observed in the mental domain of quality of life, emphasizing the effects of Reiki on mental and psychological aspects.	II
Reiki in the relief of biopsychoemotional signs and symptoms related to chemotherapy	Beulke SL/Brazil/2019(²¹)	Integrative review	Patients who received Reiki reported improved overall well-being, quality of life, pain, depression, anxiety, fatigue, and mood when compared to the control group.	VI
Percepções de profissionais de enfermagem de um hospital geral sobre a intervenção com Reiki	Costa JR/Brazil/2021(¹⁰)	Qualitative research that involved intervention	Participants were six nurses and eight nursing technicians, who reported a picture of well-being, improvement in sleep pattern and self-esteem, increased tranquility, change in attitudes and reduction of symptoms of pain and irritability.	VI
Benefícios das práticas integrativas e complementares no cuidado de enfermagem	Mendes DS/Brazil/2019(¹⁵)	Integrative review	Relaxation, well-being, relief of pain and anxiety, reduction of signs and symptoms of diseases, reduction of the use of medications and adverse reactions, strengthening of the immune system and improvement of quality of life were evidenced.	VI
Effect of therapeutic touch on daytime sleepiness, stress and fatigue among students of nursing and midwifery: A randomized sham-controlled trial	Vural DB/Turkey/2021(²²)	Randomized sham-controlled trial	There was a decrease in stress levels, fatigue, daytime sleepiness, and an increase in sleep quality.	II
Therapeutic Sensations: A New Unifying Concept	Beissner F/Germany/2020(²³)	Systematic review	Physical sensations of tingling, heat, bothersome pain, and heaviness are common phenomena in mind-body interventions.	V
The Effect of Therapeutic Touch on the Comfort and Anxiety of Nursing Home Residents	Alp FY/Turkey/2021(²⁴)	Quasi-experimental randomized control study	TT reduces anxiety and increases the comfort level of older adults (p < 0.05).	II
Effects of Hand Massage and Therapeutic Touch on Comfort and Anxiety Living in a Nursing Home in Turkey: A Randomized Controlled Trial	Yücel SC/Turkey/2020(²⁵)	Randomized controlled experimental study (with a pre- and post-test control group)	The study sample included 30 elderly patients, who were divided into HM (n = 10), TT (= 10) and control (n = 10) groups. It was identified that TT and HM decreased anxiety and increased the comfort levels of older adults.	II
Effect of Therapeutic Touch on Sleep Quality in Elders Living at Nursing Homes	Bağcı H/Turkey/2020(²⁶)	Randomized controlled experimental study (pre-test-post-test control group)	Although there was a significant increase (p < 0.05) in the sleep quality of each group, no significant difference was found between groups (p > 0.05).	II
Effect of therapeutic touch on sleep quality and anxiety in individuals with chronic obstructive pulmonary disease: A randomized controlled trial	Çalıskan MA/Turkey/202(²⁷)	Randomized control study	There was a decrease in anxiety levels (p < 0.001) and an increase in sleep quality (p < 0.001).	II
The Effect of Bio-Energy on Stress for University Faculty, Staff, and Students During Finals Week	Running A/USA/2017(²⁸)	Quasi-experimental study	A one-sample t-test indicates that bioenergetic therapy significantly reduces stress (t(35) = 7.74, p < 0.0001), and decreases in stress levels are marginally significantly greater for older participants.	III
Reiki for Pain During Hemodialysis A Feasibility and Instrument Evaluation Study. Journal of Holistic Nursing	Zins S/USA/ 2019(²⁹)	Quasi-experimental clinical study	Participants reported feelings of relaxation with Reiki. There were significant and strong correlations with established symptom scales and the validity of the adopted assessment instruments.	III
The effect of bioenergy on postoperative pain in patients experienced abdominal surgery: A nonpharmacological approach	Aslan B/Turkey/ 2019(³⁰)	Non-randomized clinical trial	There was a statistically significant difference between the groups at 60 (p = 0.020), 90 (p = 0.008) and 120 (p = 0.033) minutes.	III

DC/RF	CD and OD
DC: Congested patterns of the energy field DC: Slow Energy Field Patterns DC: Fast Energy Field Patterns DC: Strong Energy Field Standards DC: Weak Energy Field Patterns DC: Pulsations felt in the energy flow DC: Tumultuous Energy Field Patterns DC: Dissonant rhythms felt in the energy flow DC: Energy field patterns with frequency ranging from pulsatile to throbbing DC: Random Energy Field Patterns DC: Irregular patterns of the energy field DC: Hot temperature differentials in the energy stream DC: Cold temperature differentials in the energy flow DC: Magnetic Pull for an Area of the Energy Field DC: Energy Deficit of Energy Flow DC: Hyperactivity of energy flow DC: Energy flow congestion DC: Blocking the energy flow DC: Tingling sensation in the energy flow DC: Dissonant rhythms of energy field patterns Ref: (¹⁰.¹⁹–³⁸)	CD: Perceptions of changes in energy flow patterns, such as movement (wave, peak, tingling, dense, flowing), sounds (tone, words), temperature change (heat, freshness), visual changes (image, color), field disruption (deficit), hole, peak, bulge, obstruction, congestion, decreased. OD: The procedure should be explained to participants, and then the evaluator should: (1) consciously center focusing on the participant and thus activating a state of extended perception; (2) assess the energy field by keeping the hands at a distance of 5 cm to 10 cm from the patients’ body to explore deficits or increases in energy and Imbalanced Energy; (3) treat the affected areas by modulating, balancing and directing the energy in its flow and symmetry, treating the person holistically with the aim of promoting the free flow of energy; and (4) assess energy field and complete treatment.
DC: Expression of the need to recover the experience of the whole Ref: (³¹–³⁴,³⁸,³⁹)	CD: Expression about the perceptions associated with general well-being, self-care, daily motivation, improvements in interpersonal relationships and other improvements in their daily life choices, which allows them to contemplate the positive aspects of life. OD: What do you expect from improvements in your life after being submitted to the laying on of hands intervention?
RF: Anxiety Ref: (¹⁵,²⁴–²⁸,³⁰,³³)	CD: Signs and symptoms of stress, phobias, agonies in moments of tension or not. OD: State-Trait Anxiety Inventory.
RF: Discomfort Ref: (²¹,³¹,³³,³⁴)	CD: Changes in general well-being and the presence of some signs and symptoms such as pain, fatigue, stress, anxiety. OD: “Was the intervention relaxing?” and “Was any discomfort remedied after the laying on of hands therapy?”.
RF: Pain Ref: (²¹,³³,³⁴)	CD: Physical sensation that, regardless of its cause, causes a pathophysiological reaction, inducing stress in the body. OD: Visual Analog Scale.
RF: Excessive stress Ref: (²⁰,²¹,³³,³⁴)	CD: It is a complex psychoneuroimmunological phenomenon, which affects the individual physically, mentally, emotionally and socially. OD: Vasconcellos List of Stress Symptoms.
RF: Interventions that disrupt the flow or the energy pattern Ref: (¹⁵,²¹,²⁹,³¹,³³,³⁴)	CD: Individuals undergoing chemotherapy, hemodialysis, radiation therapy, hematopoietic stem cell transplantation, spinal anesthesia, mental health hospitalizations, labor care, palliative care, and surgeries OD: Profile of Mood States-Short Form Questionnaire.

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Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
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[TFN1] HM - hand massage; TT - therapeutic touch.