A Mindfulness-Based Approach to Student Self-Care

Purpose:  The purpose of this study was to determine if an 8 week mindfulness based stress reduction (MBSR) and cognitive behavioral intervention would decrease stress, improve sleep and positively impact wellbeing among first semester junior nursing students. The first clinical semester has been identified as inducing the highest levels of stress during the nursing curriculum. Students are confronted with the reality of the profession and are often flooded with fears and anxieties that negatively affect their wellbeing. The National College Health Association’s 2015 National College Health Assessment identified stress as the top ranked impediment to academic performance and wellbeing. Unmanaged stress has been connected to increased student attrition (Kukkonen, Suhonen, & Salminen, 2016), negative physical and psychological consequences, and interpersonal and relationship problems (Hensel & Laux, 2014). Studies employing MBSR and cognitive behavioral interventions among university students support the efficacy of these approaches in increasing student wellbeing and decreasing anxiety and stress (van der Riet, Rossiter, Kirby, Dluzewska, & Harmon, 2015; Regehr, Glancy & Pitts, 2013). Pender’s Health Promotion Model guided this research study. In Pender’s model, perceived barriers, sense of self-efficacy, and situation factors can contribute to action or inaction in the performance of health promoting behaviors. The Student Nurse Stress Inoculation Study (SNSIS) protocol was designed to increase student self-care behaviors and sense of self efficacy through the use of mindfulness based stress reduction and cognitive behavioral strategies.

Methods:

Approval from the university Institutional Review Board was obtained prior to conducting this pilot experimental research study. Students were randomly assigned to an 8 week mindfulness based protocol which included a 12 minute body scan meditation and a 5 minute “brain dump” journal. Both control and experimental groups completed pretest/posttest measures including the Student Nurse Stress Index (SNSI), WHO-5 Wellbeing Index and a questionnaire on coping strategies, sleep, and lifestyle. An Independent t-Test was performed to compare experimental and control groups and paired t-Test for comparing pre and post test scores of each group to measure the effect of the protocol on nursing student wellbeing and stress. Data were analyzed using SPSS 20.

Results:

Fifteen junior level nursing students were recruited for the study. Nine students completed the study. The post-test experimental group scores for the WHO-5 (M = 16.75) were 3.75 points higher than the pre-test scores (M = 13.00). Control group post-test WHO-5 scores (M=11.20) were 3.40 points lower than pretest scores (M = 14.60). Comparison of both groups for WHO-5 post- test scores was significant (p=.046). SNSI scores for both groups were higher than pre test scores indicating a higher level of stress at the completion of the study. SNSI scores for the experimental group increased by 6.5 points while students in the control group SNSI scores increased by 1.40 points.
Qualitative findings included themes of academic stress overload, relationship strain, feeling overwhelmed with “no life”, anxiety and sadness, and clinical pressures. Students in the experimental group did not consistently complete the protocol throughout the 8 weeks. The one participant who consistently completed the protocol reported improved sleep and ability to “relax at night”. Several students apologized in their journals for not maintaining the protocol and noted a sense of guilt and feeling overwhelmed with all the academic work that needed to be completed. While the protocol was intended to decrease stress and improve sleep, qualitative data indicated that the protocol induced stress.

Conclusion:  This study highlighted the importance of building coping skills and self-care strategies proactively. The study began at the beginning of the semester and ended the week after midterm examinations. The failure to consider the timing of the protocol as it aligned with the academic calendar resulted in unintended added stress at midterm which fell on the week that posttest measures were being collected. The study provided significant evidence that a stress inoculation intervention improved wellbeing. Curriculum design should incorporate MBSR, cognitive behavioral strategies and wellness initiatives throughout the program. Future longitudinal research should explore this type of stress inoculation strategy following students across the curriculum.