Nursing students often experience increased levels of stress and anxiety during prelicensure programs (Song & Lindquist, 2015). One potential stress reduction strategy is mindfulness (Hindman, Glass, Arnkoff, & Maron, 2015; O’Driscoll, Byrne, McGillicuddy, Lambert, & Sahm, 2017). The purpose of this quality improvement pilot project was to evaluate preliminary outcomes and student acceptance of integrating a brief mindfulness-based stress reduction (MBSR) strategy in the classroom of pre-licensure courses (Napora, 2013). Social Cognitive Theory served as the theoretical framework for the development and implementation of the MBSR strategy (Bandura, 2004).
Methods:
A one-group pre- and post-test design was used to pilot adding a brief MBSR strategy in two classrooms with undergraduate prelicensure students in their last term of the program and one class of second-degree graduate students in the first term of the prelicensure program. Outcome measures included anxiety, depression, self-regulation, and perceived stress. In-class mindfulness activities were conducted every week during the last 6 weeks of the term. Participation in data collection activities was voluntary. Data were collected via electronic surveys administered at the beginning (T1), middle (T2), and end of the 14-week term (T3). A focus group was conducted to gather student acceptance data at the end of the project.
Results:
Of 156 students enrolled in the two courses where a brief body scan video was piloted, survey participation rates were 81% at T1 (n=126), 27% at T2 (n=42), and 23% at T3 (n=36). Anxiety levels were reduced significantly from T1 to T3 (paired t=2.307, df=26, p=.029). Similarly group mean scores of perceived stress, depression, and self-regulation decreased from T1 to T3; however, none were statistically significant. The majority of student respondents endorsed inclusion of MBSR for future nursing students throughout the project (T1=67%; T2=80.7%; T3=67.5%). Focus group results revealed students liked the body scan video but thought using the same video each week was redundant. Recommendations included introduction of MBSR early in the prelicensure nursing program, integrating a variety of activities (e.g., music therapy, stretching, aromatherapy), and making MBSR an optional in-class activity.
Discussion:
A pilot project to integrate mindfulness into nursing student courses was conducted. Trends in quantitative analyses of group level data revealed decreased anxiety, depression, perceived stress, and self-regulation from T1 to T3. Low levels of survey participation precluded robust inferential statistical analyses. Qualitative feedback provided valuable suggestions for modifying the timing of implementing MBSR to target students at the start of the pre-licensure programs, integration of a wider variety of mindfulness strategies, and encouraging higher levels of student participation by making MBSR voluntary, rather than required course content.
Limitations:
This pilot project has several limitations including use of a quality improvement design, low student participation rates, and only one project location. Results are not generalizable beyond this specific nursing program.
Conclusion:
Mindfulness practices introduced early in pre-licensure programs may assist students with adoption of strategies to regulate anxiety, depression and perceived stress. Future integration of MBSR into prelicensure courses should be explored.