Mindfulness-Based Interventions for Undergraduate Nursing Students: History
Please note this is an old version of this entry, which may differ significantly from the current revision.
Subjects: Nursing

Undergraduate (UG) nursing students are vulnerable to stress throughout their education, known to result in burnout, with high attrition rates of up to 33%. There is a growing body of evidence to suggest that mindfulness-based interventions are effective for the management of anxiety, depression and wellbeing, thereby reducing stress in healthcare provider populations. 

  • mindfulness
  • meditation
  • nurse education
  • nurses
  • nursing students
  • healthcare education
  • stress

1. Introduction

Nursing students are particularly vulnerable to high levels of stress during their education. Common stressors include clinical workload, academic performance concerns, lack of monetary resources, lack of support during clinical placements, and the death and suffering of patients [1]. The associated psychological stress can have significant negative effects on nursing students, often leading to burnout and a desire to leave the profession [2]. A systematic review highlighted that nurses can experience higher levels of stress-related burnout, in comparison with other healthcare professionals [3]. Burnout can have a negative impact on the bio-psychosocial wellbeing of nursing students. Additionally, stress and burnout can lead to higher staff turnover amongst newly qualified nurses [4]. A recent report in 2018 from Health Education England [5] highlighted the concerning rates of student nurse attrition, with a dropout rate of 33.4% for the academic years 2013–2014 and 2014–2015. In addition, 41% of surveyed students had considered leaving their programme of study [5]. The current COVID-19 global pandemic has additionally impacted the psychosocial wellbeing of undergraduate (UG) nursing students [6,7]. It is therefore important to consider the psychological wellbeing of UG nursing students to prepare them for future healthcare challenges.
Mindfulness-based interventions (MBIs) can positively impact stress, anxiety and general wellbeing in healthcare students undertaking clinical training [8,9]. Mindfulness is the psychological process of bringing one’s attention, in a judgement-free manner, to what is being experienced in the present moment [10]. It uses formal meditation techniques, such as the body scan, mindful movement and sitting meditation, and informal daily meditation practice to develop an awareness of one’s experiences [11]. Events are viewed within an attitudinal framework of kindness and curiosity, offering the potential for development of new insights into how one relates to the present moment [12].
Mindfulness-based stress reduction (MBSR) is an evidence-based psycho-educational eight-session programme pioneered by Kabat-Zinn to incorporate mindfulness meditation practice into an accessible format [13]. Originally developed for the treatment of patients with chronic pain, there is now a body of evidence identifying a range of beneficial outcomes, such as decreased fatigue in patients with cancer; improvements in insomnia, anxiety, depression and wellbeing; and improved memory and cognitive functioning in older adults [14,15,16]. Mindfulness-based stress reduction has also been adapted to a wide variety of contexts and highly stressful environments, such as prisons, corporate settings and medical schools [17,18,19]. In addition, MBSR is frequently delivered over varying lengths of time [20], and other interventions such as mindfulness-based cognitive therapy (MBCT) [21] have since been developed with the principles of mindfulness practice embedded within them.

2. Mindfulness-Based Interventions for Undergraduate Nursing Students

Knowing oneself is an essential feature of compassionate nursing care [65]. Accepting one’s limitations can be difficult for nurses; however, it can be argued that it is a necessary strategy for survival [66]. Within this review, it was highlighted that mindfulness-based interventions improved the holistic wellbeing of UG nursing students due to reductions in stress [25,27,29,31,32,34], anxiety [24,26,29,31,34] and depression [31]. Mindfulness was even shown to improve physiological health through a reduction in systolic blood pressure [26]. These results are consistent with other studies which show that mindfulness-based interventions can positively impact stress, anxiety and mindfulness in college [67], UG health and social care [12] and postgraduate nursing [9] students.
By using mindfulness-based skills, UG nursing students can develop a repository of positive coping mechanisms that will increase their capacity to navigate the more stressful aspects of academic and clinical practice. The reported benefits of applying mindfulness skills acquired during interventions included the ability to be more focused, patient and observing, and improved executive attention [25,33,36,38]. These results are consistent with other studies on the effects of mindfulness-based interventions on undergraduate students, which demonstrated increased self-efficacy and use of positive coping strategies [68,69,70,71], with one study reporting a sustained effect 6 years post-intervention [72]. Chen et al. [73] argued that higher levels of self-efficacy in nursing students is a significant predictor of academic achievement and is positively related to clinical competence and performance. Several studies have demonstrated the direct relationship between mindfulness and self-efficacy [74], and the reported link between high self-efficacy and lower stress levels [75].
Previous research has additionally explored the benefits of mindfulness-based interventions for nursing students’ clinical practice, reporting an increased awareness of the connection between mind and body, the importance of considering the patient’s holistic needs, and an ability to acknowledge and accept their own capabilities and limitations as a caregiver [30,33,35,36,37]. Mindfulness-based interventions can also result in increased empathy and communication skills, and greater ability to be present with patients [30,33,35,36,37], enhancing the development of nursing students’ self-awareness. Sanko et al. reported that nursing students not only demonstrated increased mindfulness but also enhanced ethical decision-making when caring for patients [30]. Van Kuiken et al. highlighted that mindfulness interventions additionally helped nursing students in the classroom environment through enabling participants to feel relaxed, calm and more focused when learning in the university setting [33]. Through enhancing internal coping mechanisms [35] and positively impacting sleep, concentration and clarity [36], mindfulness interventions demonstrated a positive impact on how nursing students managed stress. Van der Riet et al.’s findings additionally displayed a reduction in negative cognitions amongst participants [36]. Mindfulness interventions can also improve nursing students’ communication with their patients through enhancement of their ability to be more present and to develop deeper connections with the people in their care [37].
However, there is debate within the literature regarding the delivery method of mindfulness-based interventions. The traditional MBSR programme developed by Kabat-Zinn et al. [13] is typically administered as 2.5 h-long group sessions over 8 weeks, with one 6-h retreat and daily home practice. Whilst there is good evidence to support the effectiveness of the traditional programme in both clinical and non-clinical populations [13], one of the major barriers to mindfulness practice is the time commitment required from participants, resulting in attrition [76]. Despite variations in the duration and type of mindfulness programme utilised in the studies included in the present review, all studies reported a perceived positive impact following the intervention.

This entry is adapted from the peer-reviewed paper 10.3390/healthcare9111493

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