Faculty Research

Lotus Flower

Development of a Mindfulness-Based Intervention for Graduate Nursing Students, poster presentation at the 2014 Western Institute of Nursing’s Annual Communicating Nursing Research Conference in Seattle, Washington, April 11.

Authors – Lois C. Howland, DrPH, RN, Susan Instone, DNSc, NP, Susie Hutchins, DNP, RN, Michael Terry, DNP, NP, Cheryl Butera, MSN, NP and Nadine Kassity-Krich, MBA, BSN, RN, Hahn School of Nursing and Health Science, University of San Diego, San Diego, CA

Purpose – To describe the process of developing and feasibility of delivering a customized mindfulness-based intervention (MBI) targeting mental distress, self-compassion, and mindfulness/awareness/attention among entering graduate nursing students.

Background – Nursing students are at risk for high levels of stress related to heavy academic demands and the challenge of mastering complex psychomotor clinical skills (Hutchinson & Goodin, 2013). Pre-licensure nursing students in accelerated, graduate programs are at risk for even higher levels of stress, given the required rapid acquisition of knowledge and skills demanded by this type of program. Stress is frequently linked to mood disorders including anxiety and depression.  Elevated levels of stress and anxiety are linked with impaired learning and critical thinking (McNiesh, 2011). Students are often unaware that stress can impact their ability to learn, and may have limited strategies to reduce the stress they are experiencing.  Learning effective stress reduction skills may be an essential component of the teaching-learning experience in nursing programs (Moscaritolo, 2009).  Developing effective stress management skills while in school may continue to fortify and protect nursing students after they graduate reducing professional burnout (Gelsema, Niemann, Schmidt & Walach, 2004; O’Haver Day & McNelis, 2012). Mindfulness-based interventions (MBIs) are effective self-care strategies in reducing mental distress and improving psychological well-being among healthy individuals as well as a variety of clinical populations (Brown & Ryan, 2003; Chiesa & Serretti, 2009). Our primary aims were to develop and to test the feasibility of a mindfulness-based intervention (MBI) in a cohort of beginning Master’s Entry to Nursing Program (MEPN) students.

Methods – A core group of faculty developed the MBI during the spring and summer preceding the study.  A mixed method 14-week interventional study to test the MBI was implemented in Fall 2013 after approval by the University of San Diego Institutional Review Board.  Forty-three of 61 eligible first year MEPN students signed consent and enrolled in the study. The MBI consisted of weekly, brief (15-20 minute) training sessions immediately following their last class.  These MBI training sessions were led by faculty and included various mindfulness practices, such as mindful eating, conducting a compassionate mental scan of the body, and awareness of breath meditation.  The participants were then asked to practice the MBI skill daily for the rest of the week using audio recordings they could downloaded from a secure website devoted exclusively to the study.  They were asked to submit weekly reflections about their “mindfulness journey” using a series of structured questions designed to elicit their experience. Monthly pizza suppers were held with faculty for face-to-face discussion. Three self-report questionnaires measuring levels of mental distress, mindfulness/attention, and self-compassion were administered at baseline, Week 8, and Week 14. Participants completed a final evaluation exploring the feasibility and acceptability of the MBI.

Results – 41/60 students indicated initial interest in developing mindfulness skills by signing study consent; 32 attended Week 1 session; 20 attended Week 4 session; 11 attended Week 8 session; and 15 attended final group session on Week 14.  Students had difficulty staying after class for the short weekly training sessions citing fatigue, need to get home to do school work, family and work commitments. Students found the faculty-guided practices and audio recordings very beneficial, but felt burdened by the reflective writing. Students liked the group meetings over pizza to discuss the effects of mindfulness training on their work and school stress, but found it difficult to meet due to time constraints.  The online platform was not easy to use.

Conclusions – Simplify curriculum to reduce activity burden for students.  Embed mindfulness practices and guidance within the existing school online learning platform.  Develop and evaluate other strategies to provide awareness, training and support for cultivating mindfulness skills in students. Work to integrate mindfulness theory and brief practice within students’ MEPN curriculum. The majority of students wanted to know how to better manage their stress.  Students found the mindfulness training and activities easy to do and reflected instances when they found certain practices (e.g. walking mindfully or “going to the breath” helping in stressful situations. Nursing school faculty could improve students’ stress levels by making mindfulness-based training available to students.


2014 State of the Science Congress on Nursing Research, September 20, Washington DC [LINK]

Mantram Technique Benefits Veterans with PTSD: May 2013 VA Research Currents [LINK]

Vets Find Mantram Repetition Helps PTSD Symptoms – (YouTube, KPBS, April 3, 2012) [LINK]