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Eca Corenao Mindulnes Enfermeria
Eca Corenao Mindulnes Enfermeria
a r t i c l e i n f o a b s t r a c t
Article history: Background: Nursing students often experience depression, anxiety, stress and decreased mindfulness which
Accepted 30 June 2014 may decrease their patient care effectiveness. Mindfulness-based stress reduction (MBSR) effectively reduced
depression, anxiety and stress, and increased mindfulness in previous research with other populations, but
there is sparse evidence regarding its effectiveness for nursing students in Korea.
Keywords: Objectives: To examine the effects of MBSR on depression, anxiety, stress and mindfulness in Korean nursing
Mindfulness-based stress reduction
students.
Depression
Anxiety
Design: A randomized controlled trial.
Stress Participants/Setting: Fifty (50) nursing students at KN University College of Nursing in South Korea were
Mindfulness randomly assigned to two groups. Data from 44 students, MBSR (n = 21) and a wait list (WL) control (n =
23) were analyzed.
Methods: The MBSR group practiced mindfulness meditation for 2 h every week for 8 weeks. The WL group did
not receive MBSR intervention. Standardized self-administered questionnaires of depression, anxiety, stress and
mindfulness were administered at the baseline prior to the MBSR program and at completion (at 8 weeks).
Results: Compared with WL participants, MBSR participants reported significantly greater decreases in
depression, anxiety and stress, and greater increase in mindfulness.
Conclusion: A program of MBSR was effective when it was used with nursing students in reducing measures of
depression, anxiety and stress, and increasing their mindful awareness. MBSR shows promise for use with
nursing students to address their experience of mild depression, anxiety and stress, and to increase mindfulness
in academic and clinical work, warranting further study.
© 2014 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.nedt.2014.06.010
0260-6917/© 2014 Elsevier Ltd. All rights reserved.
Y. Song, R. Lindquist / Nurse Education Today 35 (2015) 86–90 87
their patients may be experiencing similar emotions. Thus, nursing Effects of MBSR on Mindfulness
students need to know how to manage their stress and emotions. A
program teaching self-management of stress and anxiety such as In a review of literature on mindfulness studies conducted with sam-
MBSR may provide benefits to the students in their academic pro- ples from the general population, the practice of MBSR resulted in sig-
gram and, if practiced, it may enhance their future professional nurs- nificant increases in mindfulness (Nyklíček and Kuijpers, 2008;
ing practice. Dobkin and Zhao, 2011; Robins et al., 2012). Shirey (2007) reported
Mindfulness is viewed not as something to get or to acquire, but that teaching an evidence-based strategy such as mindfulness may facil-
as an internal resource that already exists, patiently awaiting to be itate student handling of stress, and mindfulness was negatively related
reawakened (Center for Mindfulness, 2014). Increased mindfulness with depression, anxiety and stress in nursing students (Song, 2011).
has been found to be related to improved psychological functions, and Mindfulness studies employing MBSR for nursing students are few
it led to reductions in suffering; it has been shown to be an important and the effects of MBSR on nursing students are less well-known.
predictor of depression in nursing students (Baer, 2009; Song, 2011). South Korean nursing students similar to U. S. counterparts experi-
MBSR programs have been shown to be effective (Chen et al., 2013; ence depression, anxiety, stress and mindfulness which may affect
Dobkin and Zhao, 2011; Warnecke et al., 2011), however, the potential their academic and clinical performance. Therefore, this study was
benefits of MBSR to decrease depression, anxiety, stress and increased designed to examine the effects of the MBSR program on depression,
mindfulness are less well-established among nursing students in anxiety, stress and mindfulness of nursing students in South Korea.
Korea. Therefore, the purpose of this study was to examine whether
MBSR is effective, and has potential as an intervention to decrease Methods
depression, anxiety and stress, and to improve mindfulness of Korean
nursing students. Design and Sample
Randomized (N=50)
the subscales comprise 5 items each. The full scale comprises 20 items The MBSR intervention was led by a trained instructor with over
that are answered on a 5-point Likert-type scale (1 = not at all, 5 = al- 10 years of background experience in MBSR. The main contents of the
most always). All questions include negative content. Therefore, when MBSR program were the standard elements of yoga, sitting, walking,
the score of mindfulness is calculated, raw data are recoded from nega- breath-work, body scan, and eating meditation. This program was pro-
tive to positive scores. Higher scores indicate more mindfulness. The vided on 8 days and each session was 2 h per week for 8 weeks. Par-
Cronbach's alpha at the time of development was .72 (Park, 2006). ticipants followed a guided instruction on mindfulness meditation
The Cronbach's alpha for our sample was .93. practices, gentle stretching, group discussion and home assignments
during the 8 week course. On the first day, participants were informed
about the MBSR program; they stretched for 30 min, practiced mindful
Data Collection and Procedures body scan meditation for 1 h, and shared their feelings for 30 min. The
instructor gave homework at the end of each session which generally
The protocol for this study was reviewed and approved by the related to what was learned and practiced during that weekly session.
Human Ethics Committee of the University in South Korea where the From the second through eighth week, participants discussed the
students were enrolled. Flyers containing detailed information about homework for the first 30 min, stretched and practiced guided instruc-
the MBSR study with inclusion criteria were posted on the web site tions in mindfulness meditation practices including eating (week 2),
and on the community board in the nursing school. 50 students breath-work (week 3), sitting (week 4), walking (week 5), yoga
responded to the invitation to participate, and written informed consent (week 6), combined eating and breath-work (week 7), and combined
was obtained from these students. After consent, students were ran- walking and yoga (week 8) for 1 h, and then during the last 30 min,
domly assigned to either the treatment (MBSR) or the WL control they shared their feelings.
group. Students in both groups completed a demographic form and The students assigned to the WL group did not receive MBSR inter-
questionnaire on depression, anxiety, stress and mindfulness for the vention for 8 weeks when participants in MBSR were engaged in the
baseline, prior to starting the MBSR program. MBSR intervention. Participants in WL group were reminded to not
Y. Song, R. Lindquist / Nurse Education Today 35 (2015) 86–90 89
be in contact with students of the MBSR group in their practice of MBSR; Table 2
they were also assured that they would be taught the practice of MBSR Outcomes of ANCOVA for depression, anxiety, stress and mindfulness between the MBSR
group (N = 21) and WL group (N = 23).
in a program after the study was finished. During the eighth week, at the
conclusion of the program, questionnaires were administered again to Variables Pretest Posttest
evaluate depression, anxiety, stress and mindfulness in both groups. MBSR WL MBSR WL F⁎ p
Mean (SD) Mean (SD) Mean (SD) Mean (SD)
Depression 8.3 (5.1) 8.6 (8.9) 4.1 (4.0) 8.5 (7.6) 10.99 .002
Data Analysis Anxiety 6.7 (12.6) 5.9 (6.3) 2.8 (4.1) 5.9 (7.4) 5.61 .023
Stress 34.5 (12.5) 30.0 (12.2) 7.4 (4.9) 13.7 (8.9) 15.31 b.001
The SPSS program was used to analyze the data. Chi-square and t- Mindfulness 69.8 (10.6) 77.7(16.3) 80.6(11.3) 79.0 (12.6) 5.03 .010
tests were employed to compare the baseline measurements of the de- Note: MBSR = mindfulness-based stress reduction; WL = wait-list.
mographic and dependent variables between the two groups. Analysis ⁎ F score is from Analysis of Covariance with pretest scores as covariates.
Results Compared with the WL group, the MBSR program resulted in sig-
nificantly greater decreases in depression, anxiety and stress, and
Sample Description increases in mindfulness in the present study.
In our study of the effectiveness of MBSR on depression, anxiety and
Table 1 shows socio-demographic variables of nursing students; stress the mean scores of the MBSR group decreased more than the
there were no significant differences between the MBSR and WL groups. mean scores of the WL, in which group the scores had little change.
Four participants in each group were males, and more than 81% of each This finding is consistent with the study of Nyklíček et al. (2014)
group were females. The mean age was 19.6 years. (SD 1.7) in the MBSR which examined the effects of MBSR on 107 percutaneous coronary in-
group and 19.5 (SD 2.0) in the WL group. Participants reported specific tervention patients. Nyklíček et al. reported that an MBSR program com-
religious affiliation as Christian, Buddhist, Catholic, and none; 52.4% of prising instructions of 90–120 min for just three sessions weekly (a brief
MBSR group and 60.9% of WL group had no religious belief. MBSR program) was effective in reducing depression, anxiety and
stress. Chen et al. (2013) found anxiety and depression that decreases
in anxiety scores were significantly greater in the MBSR group than in
Outcomes of Pretest and Posttest Between the two Groups the WL group. Meanwhile, it was not significant for depression between
the two groups. For Chen et al., the study program on MBSR was prac-
At the baseline, there were no significant differences between the ticed for 30 min daily for 7 consecutive days; the possible reason for
groups in depression, anxiety, stress and mindfulness. To examine the this negative finding was that the short-length intervention program
treatment effects between groups, ANCOVA, using pre-test scores as in comparison with the full-length MBSR program did not have any in-
the covariates, was used. Table 2 presents results of the scores and fluence on depression.
statistics for each outcome variable. Scores of depression in the MBSR In prior research on MBSR using 32 nursing students, the MBSR pro-
group were decreased by more than half (from 8.3 to 4.1) and those gram was provided for 1.5–2 h weekly for 8 weeks (Kang et al., 2009). In
of depression in the WL group were slightly decreased (from 8.6 to another study, the MBSR program was practiced for 2.5 h each week for
8.5), and there was a significant difference between the two groups 8 consecutive weeks, and it demonstrated significant reductions in de-
(F = 10.99, df = 1, p = .002). Mean anxiety in the MBSR group was re- pression and stress for 83 chronically ill patients (Dobkin and Zhao,
duced by 3.9 points, whereas scores in the WL group were unchanged; 2011). It is possible that the duration of the MBSR programs (per one
there was a statistically significant difference between the two groups session) should be at least 1.5 h in order to have any significant effects
(F = 5.61, df = 1, p = .023). Mean stress in the MBSR group decreased on psychological symptoms such as depression, anxiety and stress.
by 27.1, and stress decreased by 16.3 in the WL group; there was a Our study supports that a standard MBSR program having 2–2.5 h per
statistically significant difference between the groups (F = 15.31, week of practice can decrease depression, anxiety and stress for nursing
df = 1, p b .001). The effect of MBSR on mindfulness was also significant. students. Therefore, for the effects on depression, anxiety and stress, the
Mindfulness increased an average 10.8 in the MBSR group, versus 1.3 in length of the MBSR program needs to be attained from a program of
the WL group (F = 5.03, df = 1, p = .010). standard intensity.
With respect to mindfulness, the mean score of the MBSR group
had increased 10.8 points, however the mean was increased by only
1.3 points in WL group; there was a statistically significant difference
Table 1 between groups in the present study. In prior studies, mindfulness
Demographic comparisons of nursing students in the MBSR (N = 21) and WL (N = 23) scores post-MBSR were significantly increased while the score of the
groups. WL groups decreased for patients with symptoms of distress and adults
Characteristic MBSR WL χ2 (t) p
(Nyklíček and Kuijpers, 2008; Robins et al., 2012). In addition, the
n(%) or M ± SD n(%) or M ± SD current findings of the positive effects of MBSR are consistent with the
reports from Dobkin and Zhao (2011) in which mindfulness was posi-
Gender
17(81.0) 19(82.6) .02 .887 tively changed post-MBSR for 83 chronically ill patients. Through at-
Female
tending in the MBSR program, this study shows that nursing students
4(19.0) 4(17.4)
Male may control and improve their mindfulness. In so doing, they can direct
Age 19.6 ± 1.7 19.5 ± 2.0 .33 .744 their energy and attention to support patients and to provide high qual-
Religion ity, patient-centered care.
10(47.6) 9(39.1) .32 .570 In this study, 84% of participants were analyzed in the MBSR group.
Yes
11(52.4) 14(60.9) Of those who completed and were analyzed, compliance was good
None
and the data supported the feasibility of providing an MBSR program
Note: MBSR = mindfulness-based stress reduction; WL = wait-list. for the nursing students. The present study provides supporting
90 Y. Song, R. Lindquist / Nurse Education Today 35 (2015) 86–90