A Mindfulness-Based Stress Reduction Training Program Model

Official title

A Mindfulness-Based Stress Reduction Training Program Model for Empowering Nursing Students

Overview

Mindfulness-based practices are used to regulate mood, alleviate or completely eliminate symptoms that cause stress and depression, and positively influence well-being. The Mindfulness-Based Stress Reduction Program is a mindfulness approach applied to individuals with physical and psychological complaints and aims to reduce stress levels (Kral et al., 2022). The Mindfulness-Based Stress Reduction Program is a widely used meditation practice that includes individual or group practices aimed at creating awareness in individuals, such as breath awareness meditation, body scan, walking meditation, and yoga, taught by a practitioner. Each of the practices involves focusing attention on the experience of the present moment (Kral et al., 2022). However, it aims for individuals under stress to respond consciously to situations instead of automatically reacting (Gotink et al., 2016). Unlike traditional meditation, the Mindfulness-Based Stress Reduction Program is based on focused attention, the individual's clear observation of themselves and events, and breath meditation. The aim is for individuals to recognize their automatic responses to events and to transform their existing responses without judgment (Gotink et al., 2016). The main objective of this study is to determine the effect of a mindfulness-based stress reduction training program on emotion regulation and stress levels of nursing students, thereby enabling them to gain competence in this area.

Detailed description

Mindfulness practices, an approach to skillfully responding to and increasing awareness of emotional distress and maladaptive mental processes, are a widely used method in various fields, primarily healthcare, but also in business, art, politics, and indeed everywhere humans are involved (Wrenn, 2022). When examining studies on mindfulness practices; It has been reported to reduce pain, substance (smoking, alcohol, caffeine, drug abuse) and social media addiction (Tang et al., 2016), improve sleep quality and duration, regulate blood sugar and blood pressure, strengthen the immune system (Black and Slavich 2016), improve quality of life (Van Gordon et al., 2017), and have positive effects on conditions such as anxiety, stress, depression, and burnout (Klainin-Yobas et al., 2016; Tomlinson et al. 2018).

Mindfulness-based practices have been identified as an effective method for healthcare professionals to prevent, manage, and increase psychological resilience related to stress, anxiety, and burnout (Coster et al., 2020; Yüksel and Bahadır Yılmaz, 2020). Mindfulness is a way of paying attention to what is happening in the present moment, noticing the quality of attention, and accepting all that is noticed without judgment. In other words, it plays a mediating role in managing challenging situations and emotions such as stress, anxiety, and anger in daily life by enabling individuals to connect with their emotions. The literature indicates that mindfulness and mindfulness-based approaches are widely used worldwide, both in clinical settings and in daily life (Alkhawaldeh et al., 2024; Karo et al., 2024; Yosep et al., 2023). Studies have shown that mindful awareness is effective in reducing conditions such as stress, anxiety, and depression (Alkhawaldeh et al., 2024; Karo et al., 2024). Furthermore, mindful awareness is reported to be a significant predictor of self-compassion, psychological well-being, empathy, compassion, and self-efficacy (Alkhawaldeh et al., 2024; Cura and Atay, 2023; Yosep et al., 2023). Additionally, enhanced mindful awareness is a significant predictor of increased creativity and clinical competence in daily life, effective emotion management, and improved communication self-efficacy (Sundling et al., 2017). Studies in the field of nursing have reported that mindfulness is predominantly associated with and contributes to stress, anxiety (Ghawadra et al., 2019), depression, burnout (Ceravolo and Raines, 2019; Suleiman Martos et al., 2020), and quality of life (Ceravolo and Raines 2019).

It has been noted that nursing students are exposed to higher levels of stress compared to their peers in other disciplines due to both academic and clinical practices, and therefore mindfulness-based practices have gained importance (Bartlett et al., 2016). It has been stated that mindfulness-based practices have positive effects on the psychological well-being of students. A multicenter cross-sectional study conducted in Northern Italy in 2020 reported that approximately 70% of nursing students experienced significant psychological distress. However, it was noted that students with higher levels of mindfulness experienced lower levels of psychological distress. Based on these findings, the importance of mindfulness-based practices specifically designed for nursing students as a protective factor against stress has been emphasized (Salvarani et al., 2020). Furthermore, it has been reported that nursing students with high mindfulness are better able to understand the perspectives of others, show compassion, and manage negative emotional states more positively (Ardenghi et al., 2023).

It is stated that the Mindfulness-Based Stress Reduction Program helps nursing students reduce their stress levels and regulate their mood, thus enabling them to perceive the educational process more positively and contributing to increased professional success. Studies in the international literature demonstrate the effectiveness of the Mindfulness-Based Stress Reduction Program used to reduce stress levels in nursing students (Chen et al., 2021; Coster et al., 2020; Veigh et al., 2021). McVeigh et al. (2021), in their systematic review, also stated that "mindfulness-based practices" provide effective strategies for nursing students in stress management, developing self-awareness, and improving clinical performance. Another study emphasized that mindfulness-based stress reduction practices increased the awareness levels of nursing students and led to a decrease in their stress levels (Yüksel and Bahadır Yılmaz, 2020).

Interventions

• Behavioral The mindfulness group-"Mindfulness-Based Stress Reduction Program"
  Week 1: Introduction, defining group dynamics, establishing group rules. Week 2: What is mindfulness? The breathing exercise, autopilot, raisin eating exercise. Homework: Creating mindfulness routines (brushing teeth, walking, showering, cooking or eating). Week 3: Stress, the physiology of stress, and the relationship between mindfulness and stress. Sitting meditation. Homework: Doing sitting meditation twice a week. Week 4: The relationship between thought, emotion, and behavior, Body scan
• Behavioral The life skills workshop group-"Lifestyle Management and Well-being Workshop"
  Week 1: Introduction, defining group dynamics. Week 2: Physiological Relaxation (Progressive Relaxation Exercises) Week 3: Sleep Hygiene: Circadian Rhythm and Biological Clock, Melatonin and Light Relationship, Sleep Stages and Restorative Effect Week 4: Nutrition and Stress: The effect of nutrition on stress and anxiety will be discussed: Blood Sugar Balance and "False Anxiety" (Glycemic Index), Gut-Brain Axis and Serotonin, Caffeine and Cortisol Interaction. Week 5: Social Support and Problem

Primary outcome measures

• Participant Information Form [Time frame: At the end of the training, at the end of the 6th week]
• Mindful Attention Awareness Scale (MAAS) [Time frame: At the end of the training, at the end of the 6th week]
• Depression, Anxiety, Stress Scale (DASS-21) [Time frame: At the end of the training, at the end of the 6th week]
• WHO (Five) Well-being Index [Time frame: At the end of the training, at the end of the 6th week]
• Emotion Regulation Difficulty Scale-Short Form [Time frame: At the end of the training, at the end of the 6th week]

Eligibility criteria

Inclusion criteria

• Volunteering to participate in the study,
• Being a nursing student,
• Having completed the pre-test,
• Not having a stress score within the normal range,
• Not having received any prior training on this subject,
• Not having a severe psychiatric illness (psychosis, schizophrenia, etc.) diagnosed by a physician and requiring medication.

Exclusion criteria

• Not volunteering to participate in the study,
• Not being a nursing student,
• Not completing the pre-test,
• Having a stress score within the normal range in the pre-test results,
• Not having received any prior training on this subject,
• Having a psychiatric illness (psychosis, schizophrenia, etc.) diagnosed by a physician and requiring medication.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Prevention

Study locations

Center list to be confirmed — check the primary protocol.

Publications

• Alkhawaldeh JM, Khawaldeh MA, Mrayyan MT, Yehia D, Shudifat RM, Anshasi HA, Al-Shdayfat NM, Alzoubi MM, Aqel A. The efficacy of mindfulness-based programs in reducing anxiety among nurses in hospital settings: A systematic review. Worldviews Evid Based Nurs. 2024 Aug;21(4):395-406. doi: 10.1111/wvn.12722. Epub 2024 Apr 2. PMID 38563435
• Bartlett ML, Taylor H, Nelson JD. Comparison of Mental Health Characteristics and Stress Between Baccalaureate Nursing Students and Non-Nursing Students. J Nurs Educ. 2016 Feb;55(2):87-90. doi: 10.3928/01484834-20160114-05. PMID 26814818
• Black DS, Slavich GM. Mindfulness meditation and the immune system: a systematic review of randomized controlled trials. Ann N Y Acad Sci. 2016 Jun;1373(1):13-24. doi: 10.1111/nyas.12998. Epub 2016 Jan 21. PMID 26799456
• Ceravolo D, Raines DA. The Impact of a Mindfulness Intervention for Nurse Managers. J Holist Nurs. 2019 Mar;37(1):47-55. doi: 10.1177/0898010118781620. Epub 2018 Jun 18. PMID 29909707
• Coster S, Gould RL, Coulson M, Norman IJ. An online mindfulness intervention to enhance compassion in nursing practice: A feasibility and acceptability study with nursing students. Int J Nurs Stud Adv. 2020 Jun 14;2:100004. doi: 10.1016/j.ijnsa.2020.100004. eCollection 2020 Nov. PMID 38745902
• Ghawadra SF, Abdullah KL, Choo WY, Phang CK. Mindfulness-based stress reduction for psychological distress among nurses: A systematic review. J Clin Nurs. 2019 Nov;28(21-22):3747-3758. doi: 10.1111/jocn.14987. Epub 2019 Jul 22. PMID 31267619
• Gotink RA, Meijboom R, Vernooij MW, Smits M, Hunink MG. 8-week Mindfulness Based Stress Reduction induces brain changes similar to traditional long-term meditation practice - A systematic review. Brain Cogn. 2016 Oct;108:32-41. doi: 10.1016/j.bandc.2016.07.001. Epub 2016 Jul 16. PMID 27429096
• Karo M, Simorangkir L, Daryanti Saragih I, Suarilah I, Tzeng HM. Effects of mindfulness-based interventions on reducing psychological distress among nurses: A systematic review and meta-analysis of randomized controlled trials. J Nurs Scholarsh. 2024 Mar;56(2):319-330. doi: 10.1111/jnu.12941. Epub 2023 Nov 13. PMID 37955233

Identifiers

NCT: NCT07544355 · IstanbulMU23

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗