Introduction

High stress levels and anxiety are often found among undergraduate nursing students. The new reality of nursing school expectations in the students’ daily routine increases their stress as they are now required to schedule extra time for reading course materials, preparing for lectures, studying for exams and including time for clinical activities. Both traditional and non-traditional students attempt to become experts at multi-tasking when they include full-time nursing school obligations with work and family responsibilities. However, many become targets of physiological and psychological problems as the increased demands take a toll. Current coping mechanisms are often not enough to help the student adapt to this new fast-paced lifestyle. This study was conducted utilizing a group of undergraduate nursing students to explore the use of mindfulness along with coping strategies they currently use to help decrease stress and anxiety in their lives. The findings revealed that numerous nursing students knew the definition of mindfulness, but a very small percentage were routinely integrating this strategy to help reduce anxiety and stress during their daily routines and nursing school activities.

The purpose of this study was to explore the use of mindfulness in undergraduate nursing students to help decrease and alleviate stress, especially while enrolled in the nursing program. Including simple mindfulness activities into the nursing curriculum, such as mindful breathing and listening exercises, can help guide many students to practice staying in the present, thereby better controlling erratic thoughts and improving concentration [1] describe that mindfulness allows student self-awareness for “recognizing their heightened level of stress and enabling effective utilization of the stress management and mindful practices”.

High academic pressure intensifies the stress level of the nursing student [2] identified that nursing students who used ineffective coping strategies reported higher levels of anxiety, stress, and depression. Stress can impact the educational learning environment and negatively influence success in the nursing program. It can become difficult to keep pace with all the demands both academically and non-academically. Distress takes the place of eustress and learning cannot occur. When the student acknowledges that stress is evident and overwhelming, the use of short mindfulness activities can allow activation and regulation of the parasympathetic nervous system, bringing reduced stress and anxiety and more effective coping mechanisms into action.

Keywords: Mindfulness; Mindfulness programs; Mindfulness practices; Nursing student stress; Nursing student anxiety; Nursing student coping; Test anxiety; Undergraduate nursing students

Literature Search

The following databases were utilized: EBSCOhost, CINAHL, ALICE, and MEDLINE. The search consisted of articles within the past 5-year timeframe. However, after many references were found regarding Kabat-Zinn in the research, it was notable to also expand the search to include Kabot-Zinn dating back to 2003.

Literature Review

Kabat-Zinn (2003) describes mindfulness as “the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment” whereby a person blocks both past and future thoughts. A person’s own perception of a situation can determine whether the outcome is negative or positive based on previous experience to the same or similar situation. Mindfulness practice can help to discourage thoughts of how the situation was negatively interpreted in the past, and instead help to positively adjust to the current situation being addressed. Koran (2017) found that using abbreviated mindfulness interventions with nursing students can reduce anxiety and stress. Developing research is establishing that mindfulness practice in the university setting can help to enhance stress reduction and wellbeing [3].

Current research reports that university populations testify to high levels of stress, and that regular mindfulness practice can bestow reduced levels of stress and can contribute to student wellbeing [4]. Mindfulness practices, such as mindful breathing, allow positive intervention by bringing clarity to the present-not focusing on past or future events. Overthinking and worrying can narrow the focus and usually lead to a negative experience. By realizing that thoughts come and go, one can choose to act-or not to act-on those thoughts. The goal is not to live in the past experience or to analyze the future outcome, but to intentionally be in the present so that thoughts and actions are clearer. This can be used any time stress and anxiety are identified, such as taking an exam or preparing for clinical experiences.

Materials and Methods

Research Participants: Internal review board approval was obtained, and data was collected from a regional public university in a rural Appalachian area. An email to nursing faculty and an announcement through Bboard to all students enrolled in the current semester (spring) for both associate degree (ADN) and baccalaureate (BSN) nursing programs was sent describing the research study and asking for voluntarily participation. A total convenience sample of 52 undergraduate students participated. Demographic data, including age, gender, current program (ADN or BSN), and current year in the program (freshman, sophomore, junior, senior) were not obtained.

Procedures: As a basis for identifying the possible need for short mindfulness teaching in future courses, and as a general guideline of topics for future research in the regional public university, a general question survey was distributed through Qualtrics. Questions ranged from asking for the students’ own definition of mindfulness to specific questions asking about personal mindfulness practices, such as time spent with cellphone off and time spent laughing in a 24-hour period. The survey was anonymous and there was no collection of private or personally identifiable information such as name, age, address, etc (Table 1).

Findings

Survey Results:

• Student comments that were submitted describing their definition of mindfulness:

• “The act of presently thinking about your thoughts, actions, and the environment around. It also involves thinking about how your actions and words affect others around you”
• “Being aware of your life and how you are living it”
• “Being in the here and now”
• “Stay present”
• “When you are aware of yourself and your surroundings”.
• “Aware of breathing, your feelings and the world around you”
• “Living in the moment”
• “Present awareness”

Limitations

This study utilized a convenience sample of volunteer student participants from both the ADN and BSN nursing programs, resulting in a small number of participants in the survey (n=52). The questions on the survey were general, and future research could be expanded on each question. Other limitations to consider for future research include: to explore the impact of conducting a time-limited period of using short mindfulness practices; to identify the age of the student as well as in what level of the higher educational system they are currently enrolled (freshman, sophomore, junior, senior); and to increase the sample size as this survey was only conducted at one regional campus of a university [5].

Discussion

The data obtained from this small study concluded that nursing students do not routinely participate in self-awareness and mindfulness activities that could reduce their stress and anxiety. A significant percentage correctly identified the definition of mindfulness. However, most of the participants spent zero minutes in a twenty-four-hour day being mindful of their own health and well-being. The findings of this research demonstrate the need to conduct future mindfulness teaching in the nursing curriculum and the need for future research in this specific area of embracing mindfulness in the classroom.