Mindfulness Interventions for Nursing Students

Overview

            Nursing students report higher levels of stress, anxiety and depression than university students in general or working adults in the same age category (Chernomas & Shapiro, 2013). Mindfulness exercises are one method for coping with stress. Mindfulness increases awareness of the present moment by blocking past and future thoughts (Moscaritolo, 2009). An integrative literature review found the most effective evidence-based intervention to increase productivity and well-being of health care providers was mindfulness training (Koren & Purohit, 2014).  Studies suggest mindfulness training maybe an effective intervention for nursing students as well (Beddoe & Murphy, 2004; Kang, Choi, & Ryu, 2009). Most mindfulness classes are conducted during one hour practice sessions during a four to eight week period of time. Lack of sufficient time for training and practice however, commonly leads to attrition in mindfulness (Koren & Purohit, 2014). Shorter mindfulness training and practice sessions may reduce attrition.

Purpose

            The purpose of this quasi-experimental pilot study was to evaluate differences in reported perceived mindfulness, stress levels, and self-compassion scores between nursing students who participated in 10-minute instructional sessions of mindfulness exercises compared with those with no intervention.

Methods

            After IRB approval from the affiliated university, a convenience sample of nursing students from section one of a nursing research class (n=8) were assigned to the experimental group and students from section two of the research class (n=5) served as the control group. Both groups completed the Mindfulness Attention Awareness Scale (MAAS), a measure a measure of day-to-day attentiveness; the Perceived Stress Scale (PSS) a measure of thoughts and feelings; and the Self-Compassion Scale (SCS), a measure of how one acts towards self during stressful times, at the beginning and end of a six week period of time. The MAAS instrument is scored using the mean of the 15 items, and mean scores could range between 1.00 and 6.00 with higher scores indicating higher levels of mindfulness. The PSS instrument is scored using the mean of four items, and mean scores could range between 0 and 4.00 with higher scores indicating higher levels of stress. The MAAS instrument is scored using the mean of 12 items, and mean scores could range between 1.00 and 5.00 with higher scores indicating higher levels of self-compassion. The experimental group also participated in a 10-minute mindfulness training once a week. Participants in the experimental group learned four mindfulness exercises: deep breathing, progressive muscle relaxation, meditation, and mantra. Once a week for six weeks, the researcher met with students from the experimental group to practice one of the mindfulness interventions. Experimental participants were encouraged to use the learned mindfulness exercises throughout the week and were asked to record the frequency of their use and any comments regarding their mindfulness practice.

Results

            All study participants were female with a mean age of 27 years and age range 20-52 years. All but one participant, who was in the control group, reported some type of previous mindfulness practice.

            The experimental group mean MASS scores increased from pretest (u= 3.31) to posttest (u=3.81) to a greater extent than the control group pretest (u= 3.36) to posttest (u= 3.73), but the differences were not significant.  Likewise, the experimental group mean PSS scores decreased from pretest (u= 2.75) to posttest (u= 2.31) to a greater extent than the control group pretest (u= 2.58) to posttest (u= 2.31), but the differences were not significant. There was little change in SCS scores for either the experimental group pretest (u= 2.95) to posttest (u= 3.01) or control group pretest (u= 3.0) to posttest (u= 2.96), and none were significant.

 Only four subjects in the experimental group recorded the frequency of their mindfulness practice. One of the four participants practiced mindfulness exercises four times during the six week period of time. Two participants practiced mindfulness for five minutes almost daily, and the fourth participant used mindfulness strategies during the hour long commute to school.  

Discussion

            It was no surprise that all that subjects were female since the majority of students enrolled in this nursing program are female; however, the students who participated in this study were older than the national average of pre-licensure students (NLN, 2012). It might be that older students are more interested in a mindfulness practice, and therefore more likely to volunteer to participate.

            Study participants in the experimental group did increase their MAAS scores and decrease their PSS scores after only six weeks of 10 minutes of instruction to a great extent than the control group, although the changes did not reach significance. This is noteworthy on two accounts. One, the participants practiced these interventions on an average of five minutes per day, yet there was definite progress in mindfulness techniques as evidence by the higher MAAS scores and lower PSS scores. This is promising since most studies recommend longer periods of practice.  Time is a precious commodity and in short supply. Nevertheless, the participants practiced the interventions an average of five minutes per day.

          Study limitations include small sample size and the small number of practice sessions with the nursing students and non-random assignment. For future studies, larger group sizes and a larger number of practice sessions are recommended. Random assignment of participants to treatment and control groups would enhance generalizability of the findings.  Results from this pilot suggest that as few as 10 minutes of a mindfulness instruction and short daily practice may have an impact on mindfulness practice sessions as a transformative nursing  practice that may ultimately enhance clinical, patient and educational outcomes.