Nursing students' trait mindfulness and psychological stress: A correlation and mediation analysis
Introduction
Stress management is critical in nursing education. Research has shown that, world-wide, nursing students often experience a great deal of stress in their academic training and clinical practice (Altiok and Üstün, 2013; Pryjmachuk and Richards, 2007; Pulido-Martos et al., 2012). Without proper stress management, nursing students may develop various physical (e.g., headache, vertigo) and emotional (e.g., depression, anxiety) stress symptoms, which could adversely influence their academic and clinical performance. Among numerous stress-management approaches, in nursing education, mindfulness-based training (MT) has received increased recognition from scholars all over the world (Chen et al., 2013; Kang et al., 2009; Praissman, 2008; Ratanasiripong et al., 2015). Over the past 10 years, many studies have shown that MT can effectively decrease not only nursing students' psychological stress (i.e., self-appraisal of experience as being stressful; e.g., Praissman, 2008), but also stress-related physiological responses (e.g., systolic blood pressure; Chen et al., 2013).
MT comprises various practices that essentially help people cultivate mindfulness as a personal characteristic (i.e., trait mindfulness). It is a long lasting individual trait that features “a receptive attention and awareness of present events and experience” (Brown et al., 2007, p. 212). Empirical evidence supports the notion that the development of trait mindfulness through MT plays a significant role in decreasing one's psychological stress. For instance, Carmody and Baer (2008) reported that the salutary effect of MT on participants' (174 adults) psychological stress was partially mediated by their increase in trait mindfulness during the course of MT. Moreover, Baer et al. (2012) found that participants' (87 adults) increase of trait mindfulness in the first three weeks of MT significantly predicted the decrease of their psychological stress, which occurred in the seventh (last) week of MT. Given these findings, other than studying the effect of MT on stress reduction, researchers need to examine the relationship between trait mindfulness and psychological stress thoroughly. The corresponding results will be particularly useful for nurse educators when they introduce MT to their students as a stress management approach.
Section snippets
Background
Trait mindfulness is multi-faceted. Although no consensus has been reached in the literature regarding how many facets trait mindfulness entails, four facets have received researchers' constant attention. These are observing, acting with awareness, non-judging, and non-reactivity (Baer et al., 2006; Brown et al., 2007; Cardaciotto et al., 2008; Kabat-Zinn, 1994). The facet of observing attends to one's concentration on the details of his/her present-moment experiences, such as body sensations,
Sample Description
A convenience sample of 99 nursing students completed an online questionnaire. Seven (7%) of them were males, and 92 (93%) were females. The average age was 20.31 (SD = 0.70), ranging from 18 to 24 years old. Regarding race/ethnicity, 93 self-identified as Caucasian, one African American, one Hispanic/Latino, three with more than one race, and one missing value. All participants were upper division nursing students. Seventy seven of them were in their first year of upper division (juniors) and
Results
The results on Pearson's bivariate correlations showed that observing had little correlation with acting with awareness and non-judging, but it reached moderately positive correlation with non-reactivity. Except for observing, the remaining three facets of trait mindfulness had moderately positive inter-correlations (r ≈ 0.30, Cohen, 1988). PSS-10 reached moderate to high degrees (r ≈ 0.50, Cohen, 1988) of negative correlations with all other facets, but had zero correlation with observing.
The
Discussion
In this study, observing and acting with awareness had zero correlation and thereby reflected two distinct facets of trait mindfulness that underlined awareness and attention. Observing, which reflects one's ability to concentrate on relevant physical (e.g., headache) and psychological (e.g., worry) symptoms, by itself, was not correlated with individual psychological stress. Interestingly, this correlation was reported as small and negative in Bodenlos et al.'s (2015) study, but as small and
Implications
The results of this study present important considerations for nurse educators who plan to incorporate MT into their teaching or curriculum as a stress management approach for nursing students. MT helps cultivate trait mindfulness, which has been supported by both empirical and anecdote evidence to be closely related to stress reduction (Baer et al., 2012; Carmody and Baer, 2008; Stahl and Goldstein, 2010).
MT often starts with cultivating the trait mindfulness facet of observing, particularly
Limitations and Research Recommendations
Considering the study only included a convenience sample of primarily female nursing students at a university in the south-eastern United States, readers need to raise caution when applying our findings to male nursing students and/or nursing students studying in other parts of the country or those outside the United States. The small sample size also limited the generalizability of this study. To address aforementioned issues, more research replications are needed in the field of nursing
Conclusion
Nurse educators can play a vital role in helping nursing students manage stress by cultivating trait mindfulness through MT. The results of this study could help nurse educators better understand the intricate relationships between various facets of trait mindfulness and psychological stress. Specifically, facets (i.e., acting with awareness, non-judging, and non-reactivity) that promote an attitude of acceptance are directly relevant to the reduction of psychological stress. Therefore,
Declarations of Interest
None.
Funding Information
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Ethical Approval
This study was approved by the Institutional Review Board of the University of Alabama.
References (32)
- et al.
A randomized controlled trial of the effects of brief mindfulness meditation on anxiety symptoms and systolic blood pressure in Chinese nursing students
Nurse Educ. Today
(2013) - et al.
The relationship between trait mindfulness, personality and psychological distress: a revised reinforcement sensitivity theory perspective
Personal. Individ. Differ.
(2016) - et al.
The effectiveness of a stress coping program based on mindfulness meditation on the stress, anxiety, and depression experienced by nursing students in Korea
Nurse Educ. Today
(2009) - et al.
Mechanisms of mindfulness training: monitor and acceptance theory (MAT)
Clin. Psychol. Rev.
(2017) - et al.
The stress sources of nursing students
Educ. Sci. Theory Pract.
(2013) - et al.
Using self-report assessment methods to explore facets of mindfulness
Assessment
(2006) - et al.
Weekly change in mindfulness and perceived stress in a mindfulness-based stress reduction program
J. Clin. Psychol.
(2012) - et al.
The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations
J. Pers. Soc. Psychol.
(1986) - et al.
Facets of dispositional mindfulness and health among college students
J. Altern. Complement. Med.
(2015) - et al.
Mindfulness: theoretical foundations and evidence for its salutary effects
Psychol. Inq.
(2007)
The assessment of present-moment awareness and acceptance: the Philadelphia Mindfulness Scale
Assessment
Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program
J. Behav. Med.
Statistical Power Analysis for the Behavioral Sciences
Perceived stress in a probability sample of the US
The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis
Psychol. Methods
Teaching mindfulness in medical school: where are we now and where are we going?
Med. Educ.
Cited by (22)
Mindfulness for stress and anxiety management in nursing students in a clinical simulation: A quasi-experimental study
2023, Nurse Education in PracticeCitation Excerpt :According to the analysis of the FFMQ instrument, the intervention showed no differences between the groups and the time points, suggesting it had no bearing on increasing mindfulness. However, Zeidan et al. (2010) and Lu et al. (2019) showed that meditation sessions increase mindfulness scores. The findings of this study and the literature consulted appear to indicate that the results of that mindfulness intervention are explained by its brevity.
Perceived stress, coping style and burnout of Chinese nursing students in late-stage clinical practice: A cross-sectional study
2022, Nurse Education in PracticeMaladaptive coping behaviors in pre-licensure nursing students: An integrative review
2022, Journal of Professional NursingCitation Excerpt :The relationship of the clinical environment and performance evaluated check-offs is related to reported levels of maladaptive coping behaviors in students (McDermott et al., 2021; McKee-Lopez et al., 2019). Nursing students with prolonged school-related distress are vulnerable to increased incidence of maladaptive coping behaviors and specific physical and psychological behaviors (Forster et al., 2018; Lu et al., 2019; Santangelo et al., 2019; Yüksel & Bahadır-Yılmaz, 2019). While recent research indicated the likely components related to an increased incidence of maladaptive coping behaviors, one predictor can be prior trauma in nursing students as a potential factor in the frequency of maladaptive coping behavior in this population (Guo et al., 2017; Z. Li & Hasson, 2020; McDermott et al., 2021; Santangelo et al., 2019; Van der Riet, Levett-Jones, & Aquino-Russell, 2018).
Health-related behaviors, self-rated health, and predictors of stress and well-being in nursing students
2022, Journal of Professional NursingCitation Excerpt :Cohen (1994) reported the mean PSS-10 as 14.2 out of 40 (SD 6.2) for ages 19–26. More recently, mean PSS-10 in large samples of college students, including nursing students, have usually ranged from 17.6 to 20 (Stutts et al., 2018; Vore et al., 2019) and up to as high as 29.8 in one small sample (Lu et al., 2019). Mean SC scores were also similar to other college student populations, slightly above or below 78 (Yarnell et al., 2019).