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Nurse-Led Deep Breathing Intervention to Reduce Mild Anxiety in Adult Primary Care Patients in a Community Clinic in Miami-Dade County

Anisleidy Alvarez

Florida National University

MSN Capstone Project-DAX-DL01

Dr. Carmen Lazo

June 6, 2026

Nurse-Led Deep Breathing Intervention to Reduce Mild Anxiety in Adult Primary Care Patients in a Community Clinic in Miami-Dade County

Although anxiety is prevalent and is known to affect overall health and quality of life, it remains one of the most under-treated conditions in adult primary care. This review aims to analyze evidence for a nurse-led 2-minute deep breathing intervention versus no structured breathing instruction for adults with mild anxiety symptoms in a community primary care clinic in Miami-Dade County for eight weeks. Specifically, the PICOT question asks: In adult patients presenting with mild anxiety symptoms in a community primary care clinic in Miami-Dade County, does teaching a 2-minute nurse-led deep breathing exercise, compared to no structured breathing intervention, reduce self-reported anxiety levels over eight weeks? Research studies & systematic reviews were synthesized from multiple databases. Overall evidence suggests that deep breathing is clinically relevant, cost-effective, and viable as a non-pharmacological intervention to reduce anxiety symptoms in primary care.

The Scope and Burden of Mild Anxiety in Primary Care

Anxiety disorders are one of the most common mental health issues in the United States, impacting around 1 in 5 adults but only an estimated 20% of people receive the correct treatment (Banushi et al., 2023). This burden is exacerbated by the fact that the majority of the population in Miami-Dade County is Hispanic and Latino, a population that has been documented as experiencing barriers to accessing mental health services, such as stigma, low mental health literacy, language differences, limited insurance coverage, and a shortage of Spanish-speaking mental health specialists (Forcén et al., 2023). Together, these structural and cultural factors converge to delineate the role of primary care as the initial and sometimes final care provider for people with anxiety symptoms.

There is a great need for upgrading the practice. Structured anxiety management tools are not often included in primary care visits in a community setting, and patients do not have any actionable strategy for self-management. Untreated mild anxiety often progresses to more severe anxiety disorders, impacting the management of comorbid chronic diseases and elevating the use of health care services (Wolitzky-Taylor et al., 2025). The change needed in this Capstone project is the development of a structured deep breathing education program for adults 18 and older with mild symptoms of anxiety over 8 weeks to be offered at one primary care clinic in Miami-Dade County under the direction of a nurse.

Evidence Supporting Deep Breathing and Breathwork Interventions

There is a growing body of primary research and systematic reviews that demonstrate that structured deep breathing and breathwork are effective, evidence-based techniques for reducing anxiety symptomology among a variety of adult populations in clinical environments.

Deep Breathing and Physiological Anxiety Reduction

In the study by Magnon et al. (2021), vagal tone was significantly improved following a single session of deep and slow breathing, and self-reported anxiety was significantly decreased in both younger and older adults, demonstrating that deep and slow breathing, even with brief breathwork, engages the parasympathetic nervous system and reduces physiological arousal. In a similar study, Czub et al. (2024) investigated the effects of respiration rate and inhalation-to-exhalation ratio on state anxiety and observed that the slower breathing combined with a longer duration of exhalation led to the highest decrease in anxiety scores. Diaphragmatic breathing (DB) emerges as a physiologically based intervention in both studies with measurable outcomes.

Brief Structured Breathwork and Anxiety Symptom Reduction

In a study by Balban et al. (2023), a remote randomized controlled study was performed with three different breathwork interventions, each lasting 5 minutes per day over a period of 30 days, and compared them to mindfulness meditation. The results indicated that all of the breathwork conditions, cyclic sighing and box breathing, resulted in significantly greater improvement in mood and in reduction of physiological arousal than mindfulness meditation alone, suggesting that brief and structured breathwork is very effective even when sessions are short.

A scoping review conducted by Banushi et al. (2023) also revealed that breathwork interventions reliably improve anxiety symptoms in adults with clinically diagnosed anxiety disorders, and suggested that breathwork should be more widely integrated into primary care practice. Furthermore, a narrative review by Little (2025) showed that interventions as brief as 2 minutes and as long as 12 weeks led to decreases in state anxiety, depression, and negative affect in a range of adult populations.

Nurse-Delivered Interventions in Primary Care Settings

Reis et al. (2024) undertook a feasibility study on general practice nurses in their capacity as short-term anxiety brief non-pharmacological behavioral intervention (NMBI) providers and found that general practice nurses can identify anxiety symptoms, deliver the intervention with fidelity, and express confidence in using the relaxation technique of deep breathing, which is part of the intervention, during their routine visits. Physician interventions were less successful than nurse interventions both in terms of the number of patients encountered and the quality of the relationship with patients. In addition, a systematic review by Turi et al. (2023) found that the primary care nurse practitioner-led behavioral health interventions demonstrated clinically meaningful reductions in anxiety symptoms, regardless of study design, underscoring the unique role of nurse practitioners as providers of behavioral interventions at the point of care.

Non-Pharmacological Interventions for Culturally Diverse Populations

In a scoping review, Lantz et al. (2025) found that non-pharmacological and self-management interventions such as breathing and relaxation techniques are feasible and acceptable for Hispanic and Latina women with anxiety and mood symptoms, especially when presented in bilingual formats. In a separate study, Eghaneyan et al. (2022) looked at integrated behavioral health (IBH) interventions for Hispanic/Latino primary care patients, and concluded that brief, culturally adapted interventions delivered in Spanish had significant effects on anxiety and depressive symptoms relative to usual care (UC). The results corroborate the use of bilingual educational materials and culturally responsive delivery as integral parts of the proposed intervention in Miami-Dade County.

The Nurse as Educator and Intervention Leader

Nurses in primary healthcare play a pivotal role in the healthcare system as the initial point of contact for most patients, making them ideally suited for providing brief evidence-based interventions to manage anxiety at the point of care. In this Capstone project, the nurse is the first-line educator and interventionist who will implement the 2-minute-deep breathing technique with each eligible patient in a routine clinic visit. The nurse will also provide bilingual educational handouts for home practice, provide orientation to clinical staff regarding intervention protocol, and follow up with patients on reported symptom feedback.

Evidence across the board shows that a nurse can effectively lead behavioral health interventions in primary care. General practice nurses who delivered the brief non-pharmacological anxiety interventions reported high feasibility and patient acceptability; specifically, nurses felt that the intervention was congruent with their current patient education role (Reis et al., 2024). Likewise, an article published by Turi et al. (2023) validated statistically and clinically significant changes in anxiety outcomes with nurse practitioner-led mental health care in primary care settings with diverse patient populations.

The nurse's involvement in this project is not limited to direct education of patients. Assessing and documenting uptake, monitoring engagement over the 8 weeks, and planning for sustainability are all fundamental roles of nurses, and this approach to practice change is aligned with the framework of DNP for evidence translation and systems-level improvement. Additionally, the nurse's bilingual skills and strong community relationships with patients in Miami-Dade further support the feasibility and cultural appropriateness of the proposed intervention.

Clinical Impact, Cost Savings, and the Case for Practice Change

Anxiety costs the United States a lot of money when it goes untreated. Anxiety disorders cost billions of dollars each year across the health care system in avoidable emergency department visits, unnecessary specialist referrals, and lost productivity in the workplace (Banushi et al., 2023). Additionally, in primary care, patients with untreated anxiety exhibit non-adherence to treatment for other chronic diseases, further exacerbating health care utilization and costs over time.

The proposed intervention is very low in cost. Implementation involves only the cost of bilingual education handouts ($50-$75 printed), which are distributed in print, and a short training session for staff, which can be included in regular nursing meetings without extra cost. This intervention does not require any extra equipment, extra space, or extra personnel, so can be put into practice instantly in a community clinic setting.

The clinical and economic evidence is used to support the case for practice change. In primary care, structured anxiety management tools are not currently a part of standard care, and there is a major treatment gap for mild anxiety patients who may not be referred to a specialist. Magnon et al. (2021) showed that even one brief deep breathing exercise leads to a decrease in anxiety, showing that this intervention has the potential to produce meaningful results in the timeframe of a typical clinic visit. The practice change is non-pharmacological, is culturally adaptable, and is sustainable in the primary care infrastructure.

Appraisal of the Evidence: Strengths, Limitations, and Gaps

The evidence base examined in this paper has some significant strengths. Deep and slow breathing was shown to be effective at reducing self-reported anxiety and physiological arousal in a wide range of adult populations in several randomized controlled trials and systematic reviews. The physiological justification is clear, and parasympathetic nervous system activation by controlled exhalation has been reported in many types of studies. The evidence base for nurse-delivered behavioral intervention in primary care is also expanding, providing a foundation for the theoretical applicability.

However, there are gaps in the literature. The follow-up period was short in several of the studies, and so conclusions regarding long-term symptom maintenance of anxiety after brief breathwork training are limited. Breathing protocols, session lengths and outcome measurement tools vary between studies, making it difficult to directly compare them. Also, self-reported outcome measures have the potential for response bias. One significant gap is a lack of research on deep breathing interventions delivered by nurses in primary care settings with a Hispanic majority patient population in an urban South Florida context. Although there are these gaps, the overall evidence is adequate to support the proposed practice change at this time.

Conclusion

The current body of literature strongly suggests that nurse-led deep breathing education is effective, feasible, and cost-effective in reducing mild anxiety symptoms in primary care adult patients. Brief, structured breathwork is found to reduce anxiety in multiple designs and populations, and nurse-led primary care interventions are acceptable and clinically effective. The evidence justifies the proposed practice change; the practice change is needed because there is a large gap in the current standard of care, and the practice change is appropriate for the population served in terms of culture and structure.

References

Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., & Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine, 4(1), 1–15. https://doi.org/10.1016/j.xcrm.2022.100895

Banushi, B., Brendle, M., Ragnhildstveit, A., Murphy, T., Moore, C., Egberts, J., & Robison, R. (2023). Breathwork Interventions for Adults with Clinically Diagnosed Anxiety Disorders: A Scoping Review. Brain Sciences, 13(2), 256. https://doi.org/10.3390/brainsci13020256

Czub, M., Kowal, M., Esteve Zarazaga, R., Serrano‐Ibáñez, E. R., Ruíz‐Párraga, G. T., Ramírez‐Maestre, C., López‐Martínez, A. E., Paccione, C., & Piskorz, J. (2024). A slow diaphragmatic breathing intervention for anxiety: How do respiration rate and inhalation/exhalation ratio influence self‐reported anxiety? Stress and Health. https://doi.org/10.1002/smi.3496

Eghaneyan, B. H., Killian, M. O., & Sanchez, K. (2022). The Integration of Behavioral Health and Primary Care for Hispanic/Latino Patients with Depression and Comorbid PTSD. The Journal of Behavioral Health Services & Research. https://doi.org/10.1007/s11414-022-09824-1

Forcén, F. E., Flórez, M. C. V., Medina, R. B., Zambrano, J., Pérez, J. H., Rodríguez, A. M., & Santos, L. H. (2023). Deconstructing cultural aspects of mental health care in Hispanic/Latinx people. Psychiatric Annals, 53(3), 127–132. https://doi.org/10.3928/00485713-20230215-02

Lantz, L. B., Gregory, A. A., Brown, R., Bodnar-Deren, S. M., Case, K. A., & Kinser, P. A. (2025). Scoping review of non-pharmacological or self-management interventions for perinatal mood and anxiety disorders tested with Hispanic and Latina women. Frontiers in Psychiatry, 16. https://doi.org/10.3389/fpsyt.2025.1644798

Little, A. L. (2025). The A52 Breath Method: A Narrative Review of Breathwork for Mental Health and Stress Resilience. Stress and Health, 41(4). https://doi.org/10.1002/smi.70098

Magnon, V., Dutheil, F., & Vallet, G. T. (2021). Benefits from one session of deep and slow breathing on vagal tone and anxiety in young and older adults. Scientific Reports, 11(1). https://doi.org/10.1038/s41598-021-98736-9

Reis, J., Hills, S., Robinson, T., & Hills, D. (2024). The feasibility and impact of a brief behavioural intervention for anxiety in later life: perceptions of general practice nurses. Contemporary Nurse, 1–11. https://doi.org/10.1080/10376178.2024.2310254

Turi, E., McMenamin, A., Kueakomoldej, S., Kurtzman, E., & Poghosyan, L. (2023). The effectiveness of nurse practitioner care for patients with mental health conditions in primary care settings: A systematic review. Nursing Outlook, 71(4), 1–23. https://doi.org/10.1016/j.outlook.2023.101995

Wolitzky-Taylor, K., Wen, A., Freimer, N., & Craske, M. G. (2025). Anxiety and depression in emerging adults: The STAND program as a model of scalable screening and intervention. Neuropsychopharmacology. https://doi.org/10.1038/s41386-025-02174-4