Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Laura L. Kuensting


Laura L. Kuensting, DNP, APRN, PCNS-BC, CPNP, CPEN

Tonya Haynes, DNP, RN

Kathleen Hulsey, MBA, MSN, RN


Problem The emergency department (ED) is a high-stress environment. Nurses exposed to this stress for prolonged periods are subject to compassion fatigue (CF). The purpose of this quality improvement project was to identify and reduce the level of CF in ED nurses by implementing Real Time Transformative Response© (RTR). RTR© is a technique that uses combinations of neurofeedback response awareness, biofield therapy intervention, and clearing of unwanted energy.

Method A purposeful sample of ED nurses working at a moderately-sized, suburban, Midwestern hospital ED who were scheduled to work 24-hours or more per week completed a Professional Quality of Life Scale (ProQOL 5; version 5) before and after three-months of RTR© training.

Results A total of 34 ED nurses (N=34) completed RTR© training and ProQOL 5 surveys. The overall mean score for the pre-RTR© training survey was 107 (sd =1.1385), and the post-RTR© training survey was 106.613 (sd =1.1677) (t =1.6924, df =66, p =0.0476). Mean scores pre-and post-RTR© training: compassion satisfaction was 3.59 (sd = 0.9521) increased to 3.95 (sd = 0.7766) (t = 1.997, df = 66, p = 0.000), burnout was 2.71 (sd = 1.1501) decreased to 2.36 (sd = 0.9120) (t = 1.997, df = 66, p = 0.000), and secondary traumatic stress was 2.45 (sd = 1.0002) decreased to 2.25 (sd = 0.9143) (t = 1.997, df = 66, p = 0.0017).

Implications for practice Training ED nurses on RTR© has implied improved coping abilities in stressful environments and may decrease the incidence of CF.