Beliefs, Behaviors, and Health of Undergraduate Nursing Students

Defining young people's mental health self-care: a systematic review and co-development approach

Self-care is among the emerging types of mental health support which operate outside traditional services, although the meaning and practice of self-care for young people with mental health difficulties are currently unclear. This systematic review was pre-registered with PROSPERO (CRD42021282510) and investigated conceptualizations of self-care in academic publications which investigated or discussed self-care for young people's mental health or wellbeing. A Patient and Public Involvement (PPI) workshop facilitated young people with experience of mental health difficulties to respond to the identified concepts and co-develop a definition of self-care. Searches in PsycINFO, MEDLINE, Embase, CINAHL Plus, Scopus, Cochrane Library of Systematic Reviews, and gray literature sources resulted in 90 included publications. Content analysis indicated little conceptual consistency, with health and wellness promotion most commonly used to define self-care. The PPI workshop co-developed a definition of mental health self-care, which attendees felt should emphasize an individual process of self-awareness, self-compassion, and specific strategies to work toward emotional balance. This study highlights the gap between current academic understandings of young people's mental health self-care and young people's experience. The presented definition will enable future research to begin from an understanding of self-care which is relevant to young people with experience of mental health difficulties.

Influence of Stress and Emotions in the Learning Process: The Example of COVID-19 on University Students: A Narrative Review

Emotional instability and stress are the main disturbances that condition the learning process, affecting both teachers and students. The main objective of this review is to analyze the influence of stress and emotions (as part of stress) on the learning environment. Stress is a physiological mechanism that the organism develops to adapt and survive external and internal challenges. In this context, stress tends to be seen as a negative condition in the learning process when it is chronic. Extreme stress situations, such as the COVID-19 pandemic, can generate anxiety and frustration in students. However, other studies indicate that controlled stress can positively enhance the learning process. On the other hand, the quality and intensity of emotions resulting from stress can influence as well the learning process. Positive emotions are healthy and can promote optimal learning. Emotions lead to sentimental, cognitive, behavioral, and physiological changes, which will have a strong influence on intellectual performance. The activation of coping strategies constitutes a key mechanism for dealing positively with problems and challenges, generating positive emotions essential for the self-regulation of learning. In conclusion, correct management of emotions in stressful situations could promote effective learning through enhanced attention and capacity to solve problems.

Evaluation of Dog Presence as a Therapeutic Classroom Intervention

BACKGROUND

The American Association of Colleges of Nursing has called on nurse educators to increase mental health support for nursing students. Animal visit programs reduce stress, anxiety, and negative mental health feelings; however, most are intermittent and occasional. This pilot study explored the feasibility, acceptability, and outcomes of integrating a therapy dog into the classroom.

METHOD

This pretest-posttest, two-group design study included 67 baccalaureate nursing students. Two sections of a course were taught: one section included a therapy dog and one section did not.

RESULTS

At the end of the course, participants in the intervention group showed improvement in stress, anxiety, and happiness, whereas participants in the control group did not demonstrate any improvement. Students reported positive feelings and benefits from the presence of the therapy dog.

CONCLUSION

Integrating a trained therapy dog into the classroom is both feasible and acceptable, with students identifying positively with the experience. [J Nurs Educ. 2023;62(6):355-358.].

Collaborative care in eating disorders treatment: exploring the role of clinician distress, self-compassion, and compassion for others

BACKGROUND

Collaborative care is described as showing curiosity and concern for patient experiences, providing choices, and supporting patient autonomy. In contrast, in directive care, the clinician has authority and the patient is expected to adhere to a treatment plan over which they have limited influence. In the treatment of eating disorders, collaborative care has been shown to be more acceptable and produce better outcomes than directive care. Despite widespread patient and clinician preference for collaborative care, it is common for clinicians to be directive in practice, resulting in negative patient attitudes toward treatment and poor adherence. There is a need to understand factors which contribute to its use.

PURPOSE

This study examined the contribution of clinicians' experience of distress and how they relate to themselves and others in times of difficulty (self-compassion and compassion for others), to their use of collaborative support.

METHOD

Clinicians working with individuals with eating disorders from diverse professional backgrounds (N = 123) completed an online survey.

RESULTS

Whereas clinician distress was not associated with use of collaborative or directive support behaviours, self-compassion and compassion for others were. Regression analyses indicated that compassion for others was the most important determinant of collaborative care.

DISCUSSION

Relating to their own and others' distress with compassion was most important in determining clinicians' use of collaborative support. Understanding how to cultivate conditions that foster compassion in clinical environments could promote the delivery of collaborative care.

Prevalence and factors associated with academic burnout risk among nursing and midwifery students during the COVID-19 pandemic: A cross-sectional study

AIM

The aim of the study was to assess the prevalence of academic burnout (AB) and its associated factors among nursing and midwifery students during the COVID-19 pandemic.

DESIGN

A correlational cross-sectional study.

METHODS

An online survey was distributed from November to December 2020 to nursing and midwifery students in Belgium. The risk of AB was assessed using the MBI-SS Academic Burnout Inventory scale. Factors associated with AB were related to the personal life and level of education of the student and to the COVID-19 pandemic.

RESULTS

The prevalence of overall AB risk was 50.0% (95% CI 48.5-53.1). Factors significantly associated with higher risk of AB were having a child, having a job, the level of academic training, working overtime, insufficient personal protective equipment against viral contamination during the last internship, work overload due to the pandemic, personal proven or possible SARS-CoV-2 infection and having a relative who died related to COVID-19.

Supporting the well-being of nursing students and student midwives during the COVID-19 pandemic

Throughout the coronavirus disease 2019 (COVID-19) pandemic the Queen's University Belfast Connections (QUB Connections) project has provided online well-being support to nursing students and student midwives. The project, which was co-designed and led by students and academic staff, provided an online well-being service for students who took on front-line roles during the early part of the pandemic and for those who had to pause their studies. Insights gained from responses to an evaluation of the support sessions suggested that some students felt stigmatised, frightened, lost, isolated and abandoned during this period, but that QUB Connections gave them a sense of 'being held' and 'attended to' in a time of uncertainty. The evaluation findings are a reminder of the need to continue to help nursing and midwifery students and newly qualified staff develop self-care and support mechanisms. QUB Connections is now embedded in the university's school of nursing and midwifery pre-registration programmes to support students and those new to nursing and midwifery practice.

Health-related behaviors, self-rated health, and predictors of stress and well-being in nursing students

BACKGROUND

Nursing students are at increased risk for the consequences of stress on wellbeing. Little is known about nursing students' health promoting behaviors and how these relate to health, stress, and well-being.

PURPOSE

The purpose was to describe perceived stress and measures of well-being (self-compassion, happiness, and life satisfaction) along with self-reported health promoting behaviors and health status in order to identify factors that could affect stress and well-being in nursing students.

METHODS

A multi-site team employed cross-sectional research methods to explore well-being, stress, and potential physical and emotional health-relevant factors in undergraduate nursing students. Baccalaureate Nursing students from three nursing programs in North Texas participated in a web-based survey. Undergraduate students (n = 417) reported being junior or senior level in a traditional (74.1%) or an alternative nursing training program (on-line, fast-track, or weekend nursing program; 24.9%) in the fall of 2019. Recruitment fliers went to a total of 2264 potential participants via university e-mail. Consenting students completed online surveys collecting demographic and health related factors as well as measures of well-being and stress.

RESULTS

More than half (56.6%) of students reported worsening health since starting nursing school. Exercise and meditation were related to higher measures of well-being and lower stress, but this relationship diminished in the multivariate model when considering individual demographic and health related factors. Our multivariate model suggests that self-rated health status remains a main potential predictor of reduced stress and improved well-being.

CONCLUSIONS

Self-reported health factors are related to wellbeing in nursing students. Targeted interventions to improve well-being among nursing students may be necessary and would fit with national recommendations for nursing education programs. Resiliency skills training with mindfulness practices may help nursing students reduce stress, improve overall well-being, and equip students to avoid burnout and stress-related illness once in the workforce.

Evaluation of a Brief Mindfulness Intervention on Examination Anxiety and Stress

BACKGROUND

Nursing students report increasing levels of stress and anxiety related to academic performance. Mindfulness programs have been found to reduce stress, yet such programs have been identified as a time-burden for students. This study evaluated the integration of a brief preexamination mindfulness reflective intervention for nursing students. Perceived stress, anxiety, resilience, and acceptability were evaluated.

METHOD

A mixed-methods experimental design with random assignment was used. Forty-nine nursing students were randomized to either an intervention group (N = 25) who participated in the brief preexamination mindfulness intervention or a control group (N = 24) who took their examinations without any intervention. Self-report tools measured stress, resilience, and mindfulness. Qualitative responses were collected.

RESULTS

Outcomes revealed decreased feelings of helplessness and anxiety in the intervention group. Although students had positive views of mindfulness, barriers were indicated.

CONCLUSION

Brief preexamination mindfulness interventions provide students with anxiety-reducing options. [J Nurs Educ. 2021;60(11):625-628.].

Enhancing conceptual clarity of self-care for nursing students: A scoping review

OBJECTIVE

This paper aims to explore how self-care is currently defined and conceptualized in nursing education literature and identify gaps in current conceptualizations of self-care for nursing students.

BACKGROUND

Given the considerable stressors experienced by nursing students, self-care is an important concept for enhancing well-being. However, self-care has been poorly defined in the literature to date, contributing to challenges in integrating self-care into nursing education in support of student mental health and well-being.

DESIGN

A scoping review was undertaken in accordance with Arksey and O'Malley's (2005) framework and Levac et al.'s (2010) subsequent guidance.

METHODS

The search was conducted up to 1 September 2020 across three databases: Medline (OVID), PsycINFO and CINAHL. Search terms 'self-care', 'nursing students' and 'nursing education' were used. Criteria for inclusion of articles included peer-reviewed articles published in English that addressed self-care in the context of nursing education and/or nursing students and provided a definition of self-care. Two reviewers independently screened 1181 records by title and abstract, with a third reviewer resolving discrepancies. Subsequently, full-text review was completed for 119 articles.

RESULTS

Twenty-seven studies were included in the review, including 21 empirical articles and 6 non-empirical articles. Sixteen (59%) articles described an educational intervention, including self-care courses, assignments, or integration of self-care modalities as a classroom activity. Qualitative thematic analysis of article aims, and self-care definitions illustrated three central themes in the conceptualization of self-care: self-care as an aspect of holistic nursing; self-care as practices that ensure a healthy lifestyle; and self-care as activities undertaken in response to stress.

CONCLUSIONS

There is considerable variability in how self-care for nursing students is conceptualized, contributing to inconsistencies in the integration of this concept into nursing education. Nurse educators are encouraged to support students in identifying their own self-care strategies and engage in reflection and action toward shifting systemic contributors to stress and burnout among nursing students.

Exploring the relationship between first-year nursing student self-esteem and dropout: A cohort study

AIM

To describe nursing student self-esteem prior to the influence of nursing education and to explore the relationship between self-esteem and dropout.

DESIGN

Cohort study.

METHODS

At the beginning of their first year of study, in October 2017, 464 nursing students completed a questionnaire that assessed their self-esteem level via Tafarodi & Swann Scale and self-esteem profile following Mruk's model, along with sociodemographic information, state anxiety, self-efficacy, intention to continue and social support. One year later, data on grades and re-enrolment were collected. Multivariate analyses explored the factors influencing self-esteem level (multiple regression), self-esteem profile (multinomial logistic regression) and dropout (binary logistic regression).

RESULTS/FINDINGS

The mean level of self-esteem was 50.8 (9.0), scale of 16 to 80. Forty-nine per cent of self-esteem profiles were classified as 'high', 20.1% as 'defensive acceptance based', 11.2% as 'defensive achievement based' and 19.6% as 'low'. State anxiety (p < 0.0001), self-efficacy about completion of the nursing programme (p < 0.0001) and self-efficacy about internship (p < 0.0001) were associated with self-esteem. The dropout rate was 21.5%. Self-esteem level (p = 0.039) and academic performance (p < 0.0001) were associated with dropout.

CONCLUSION

While nursing student self-esteem is often described as low, we know little about its baseline before entering the nursing programme and the factors that influence it. The dropout rate among first-year nursing students is high, but self-esteem is rarely explored as a possible explanation. We found that students had medium, and potentially fragile, self-esteem when starting their nursing education, and that self-esteem was associated with dropout.

IMPACT

Given that association and the impact of self-esteem on well-being and professional behaviour, educational institutions should foster self-esteem both generally and in students with anxiety or low self-efficacy. Future research should explore nursing student self-esteem using a longitudinal mixed methods approach. Society should value nurses and nursing students.

Clinical stress among undergraduate nursing students: perceptions of clinical nursing faculty

Clinical faculty have a critical role in recognizing the stress students experience in the clinical environment. Despite an increasing body of research on stress and student perceptions of stress, faculty perceptions of student stress have been relatively unexplored. A qualitative descriptive design provided a rich description of clinical nursing faculty perceptions of undergraduate baccalaureate nursing student stress in the clinical environment. Colaizzi's method guided data analysis. Four themes that emerged from the interview data were: feeling overwhelmed when encountering the unknown, which included the sub-themes of facing self-doubt and experiencing insecurity in nursing actions; struggling with personal life factors; enduring uncivil clinical interactions; and contending with nursing faculty interactions. This study assists in filling the gap for nursing education by providing a rich description of student stress as described by faculty. Implications include providing faculty a clearer understanding of the stress phenomenon so they may better educate and evaluate students.

Perceived stress, physiological stress reactivity, and exit exam performance in a prelicensure Bachelor of Science nursing program

Objectives High-stakes exams are a source of chronic stress that may adversely affect nursing students' thinking, behavior, and overall health. The purpose of this study was to explore the relationships of perceived stress, physiological stress reactivity, and exit exam performance. Methods A within-subjects design allowed measurement of perceived stress, salivary cortisol, and salivary alpha amylase in pre-licensure nursing students under two different conditions: a high-stakes exit exam and a low-stakes homework assignment. Results Perceived stress and salivary alpha amylase were significantly higher after the high-stakes exam compared to the homework condition. Perceived stress after the exam was correlated with lower exam score. Conclusion Study findings suggest that in response to a high-stakes exam, prelicensure nursing students experience high levels of perceived stress coupled with sympathetic activation but not activation of the hypothalamic-pituitary adrenal axis.

Adverse childhood experiences, post-traumatic stress disorder symptoms, and self-reported stress among traditional and nontraditional college students

Objective: To investigate the relationships between adverse childhood experiences (ACEs), post-traumatic stress disorder symptoms (PTSD-S), and self-reported stress among college students. Participants: A total of 236 undergraduate students enrolled in nursing courses participated. Method: Using a correlational design, participants completed questionnaires online. To examine PTSD moderation between ACE and self-reported stress, multiple regression was employed. Stress outcomes were examined using a 4-group variable. Mean differences in stress response between these four groups were examined. Differences in ACE, PTSD-S, and stress response between traditional and nontraditional students were also examined. Results: PTSD-S moderated the relationship between ACEs, and self-reported stress. This indicates that students who report PTSD-S following childhood adversity perceive higher levels of stress. Nontraditional and traditional students differed in their responses to the ICLRE scale. Conclusion: Individuals who report PTSD-S following childhood adversity perceive higher levels of stress later in life. Stress reduction programs may be beneficial for students.

Implementation of a Smartphone App to Measure and Manage Anxiety in Undergraduate Clinical Nursing Students

Various causes exist for nursing student anxiety in the clinical setting. There is a need for further intervention research that may be effective to reduce student anxiety related to clinical. The purpose of this pilot research study was to measure and manage anxiety for nursing students in the clinical area with the assistance of a smartphone app. The usefulness of the app was evaluated by means of a focus group.

Needing permission: The experience of self-care and self-compassion in nursing: A constructivist grounded theory study

BACKGROUND

Healthcare is delivered in a culture of ongoing change, with many nurses highlighting the impact of this on their own wellbeing. However, there is a dearth of literature focusing on how nurses care for themselves as they try to provide compassionate care in a challenging job.

OBJECTIVES

This study explored nurses' experience of self-care and self-compassion and how this may relate to compassionate care giving towards patients.

DESIGN

A constructivist grounded theory approach was used to develop a theoretical understanding of nurses' experience.

SETTINGS

This study included participants from two National Health Service (NHS) Trusts within the United Kingdom (UK).

PARTICIPANTS

Purposive and theoretical sampling were used to recruit general, mental health and learning disability nurses, at different levels of seniority.

METHOD

Between September 2015 and March 2016 semi-structured interviews were conducted. Analysis was completed in line with the process set out within constructivist grounded theory. Using constant comparison and memo writing, analysis moved from initial coding to focused coding, through to theoretical coding, resulting in the production of core concepts and categories, and theory development.

RESULTS

Thirty participants were included in the study. Three concepts were derived from the data: (1) 'Hardwired to be caregivers' - vocation versus role, (2) needing a stable base, (3) Managing the emotions of caring. All three concepts linked to a core process: needing permission to self-care and be self-compassionate. Nurses needed permission from others and from themselves to be self-caring and self-compassionate. An inability to do this affected their wellbeing and compassionate care giving to others. Interviewees described how they struggled particularly with self-compassion. Helping nurses to be proactively more self-caring and self-compassionate may increase their ability to manage emotions and prevent some of the negative consequences of nursing such as burnout and compassion fatigue. A conceptual framework is proposed which identifies that formal permission (e.g., within nursing guidance) may be necessary for some nurses to look after themselves.

CONCLUSION

Findings identified the need for permission as key in enabling nurses to self-care and be self-compassionate, which may facilitate them to address patients' needs. The study highlights the importance of self-care and self-compassion within nursing education and nursing guidance.

Don't spend, eat less, save more: Responses to the financial stress experienced by nursing students during unpaid clinical placements

Using an online survey, this study explored the impact of participation in unpaid clinical placements on the financial wellbeing of 160 nursing students attending an Australian university. The research found that the majority of respondents struggle financially during clinical placements, yet are financially adequate or secure outside of semester or during normal periods of study. Increased transport costs and loss of income are the most significant financial stressors during this time, with additional meals, work-appropriate clothing, purchasing additional resources and materials, and childcare costs other causes of financial stress. Most students used savings, budgeting, borrowing, and changed expenditure patterns to cope with the financial impact of unpaid placement. These findings have important implications for the ability of students to successfully complete their nursing degree and draw into question the equity of unpaid clinical placements as a formal degree requirement. However, while participation in unpaid clinical placements can impact financial well-being in the short term, participation does have the potential to increase the financial resilience of students over time, as students learn and grow from these experiences. To achieve this, however, greater attention must be placed on the financial support and personal finance education available for nursing students.

Coping and Pre-Licensure Registered Nursing Students: An Integrative Literature Review

Despite a wealth of information and growing diversity among nursing students, little is known about coping behaviors employed by these students or students educated in diverse environments. The aim of this integrative literature review was to examine what is known about stress, coping, measures of coping, and interventions to enhance coping, and in pre-licensure nursing students. Twenty-six peer-reviewed research articles were included. Stress, coping styles and behaviors, support, interventions, and instruments to measure coping were identified as key themes. Variations in coping were noted by gender, age, length of time in the program, and culture. Analysis of the literature illuminated the importance of support for students, and strong indications suggested educators play a pivotal role in helping students develop adaptive coping strategies. Nursing programs should consider incorporating coping instruction into the curricula.

Transition to practice experiences of first- and second-career nurses: A mixed-methods study

AIMS AND OBJECTIVES

To explore the transition to nursing practice experiences of first- and second-career nursing students.

BACKGROUND

To address the nursing shortage, alternative educational programmes have been increasingly developed and implemented with to help individuals with prior career experiences transition into a career in nursing (second-career nurses). However, we know little about the transition to practice experiences of second-career nurses.

DESIGN

This mixed-methods study utilised qualitative interviews with nurses who had completed a year of practice and a longitudinal survey of nurses' perceptions of stress, coping and burnout throughout their first year of nursing practice.

METHODS

Qualitative data (n = 15) were analysed using latent thematic analysis and following COREQ guidelines. Descriptive and effect size analysis of quantitative data (n = 122) was conducted in order to assess for significant differences across time points.

RESULTS

The thematic analysis identified three themes: Stressors and Coping, Prevalence of Burnout and Presenteeism, and Difficulty Describing Nursing's Role. The quantitative findings showed that participants' self-compassion decreased over their first year of practice. Levels of stress, presenteeism and burnout increased by the year mark. These increases were meaningfully significant between time points.

CONCLUSIONS

Differences in the stressors and coping of first- and second-career nurses should be considered in developing transition to practice programmes for new nurses. Increasing rates of stress, burnout and presenteeism highlight the ongoing need to address these issues. Improving the nurse work environment may aid in the transition to nursing practice of both first- and second-career nurses.

RELEVANCE TO CLINICAL PRACTICE

First- and second-career nurses have increasing rates of stress, burnout and presenteeism that need to be addressed. However, there are differences in stressors and coping between first- and second-career nurses.

Perceived stress, coping strategies, and emotional intelligence: A cross-sectional study of university students in helping disciplines

BACKGROUND

Post-secondary students in training for helping profession disciplines, including nursing, may be at elevated risk for high stress levels. Stress among students has been linked with adverse physical and psychological health. In addition to the common stressors associated with post-secondary education, sources of stress for students in the helping professions include balancing academic and clinical demands. Previous research indicates perceived stress levels are correlated with emotional intelligence (EI) and with the coping strategies employed by students.

OBJECTIVES

The aim of this study was to examine (1) the relationship between EI and perceived stress, and (2) the potential mediating role of coping responses.

DESIGN

A cross-sectional survey design was employed.

SETTING

Participants were recruited from a public university in the United States.

PARTICIPANTS

A sample of 203 undergraduate and graduate students majoring in psychology, nursing, and social work was recruited.

METHOD

Participants were recruited on-campus and through campus online resources and completed an online survey or a paper-and-pencil version of the survey. Descriptive statistics and mediation analyses were used to test the study hypotheses.

RESULTS

Higher EI was associated with lower perceived stress, and this association was partially mediated by both adaptive and maladaptive coping responses. Higher EI was associated with greater use of adaptive coping and lower use of maladaptive coping, and these, in turn, were negatively and positively (respectively) associated with perceived stress.

CONCLUSION

The findings suggest that interventions aimed at increasing emotional intelligence may help to reduce perceived stress for students in the helping disciplines.

Exploring Self-Perceptions of Anxiety among Nursing Students in the Clinical Setting and Select Demographics

Clinical learning experiences are essential in nursing education but they are often anxiety provoking for learners. Understanding the factors associated with the anxiety levels of nursing students in clinical placements has become more complex over the years with increasing heterogeneity within the nursing population. A correlational study was conducted to examine the relationships between nursing students’ self-perceived anxiety levels, as measured by the State-Trait Anxiety Inventory (STAI), and the students’ age, gender, previous employment, and previous education. The findings revealed that nursing students have a higher than average level of anxiety and that male nursing students reported higher levels of anxiety compared to female nursing students. No significant correlations were found between age, previous education, previous employment, and self-perceived anxiety levels. Findings from this study provide an opportunity for discussion by nursing educators and identify a need for future research and practice.

Nursing Students' Attitudes and Use of Holistic Therapies for Stress Relief

PURPOSE

The purpose of this study was to explore student nurses' openness to using or recommending holistic therapies, the strategies they use to manage stress from school or work, and their perceptions of the impact of holistic therapies on personal health.

STUDY DESIGN

Qualitative component of a quasi-experimental, mixed-methods study.

METHODS

A convenience sample of undergraduate nursing students in a southeastern U.S. university completed baseline surveys, including demographics and three open-ended questions regarding attitudes toward holistic therapies and strategies used for stress management. Qualitative thematic analysis was undertaken to identify recurring themes in textual data.

FINDINGS

Students are open to using or recommending holistic therapies but identify lack of knowledge and lack of time as barriers to their practice. Among strategies used by student nurses to manage stress from school or work were physical activity, prayer and meditation, time management, distraction, socialization, artistic pursuits, animal interactions, and other activities. Themes describing holistic therapies' impact on personal health were wholeness, self-empowerment, relaxation/restoration, and alternative/complement to traditional medicine.

CONCLUSIONS

Findings indicate receptiveness by student nurses to the use of holistic therapies but point to the need for the inclusion of informational as well as experiential education on holistic therapies within nursing curricula.

Care for the Caregiver: Evaluation of Mind-Body Self-Care for Accelerated Nursing Students

Stress affects the well-being of both nursing students and the individuals with whom they work. With the theory of cognitive appraisal as a framework for this study, it is proposed that mind-body self-care strategies promote stress management by stabilization of emotions. Outcomes will be a perception of less stress and more mindful engagement with the environment. Objective of the study was to describe an evaluation of student perceived stress and mindfulness to 1-hour per week of class time dedicated to mind-body self-care (yoga, mindful breathing, Reiki, and essential oil therapy). It was a quasi-experimental study; data collection took place at 4 time points. Participants were entry-level accelerated nursing students from 3 US universities: 50 in the treatment group, 64 in the comparison group. Data included health-promoting practices using Health-Promoting Promotion Lifestyle Profile II as a control variable, stress and mindfulness (Perceived Stress Scale [PSS] and Mindful Attention Awareness Scale [MAAS]), and demographic information; analysis using mixed-design repeated-measures analysis of variances. There was a statistically significant interaction between intervention and time on PSS scores, F(3, 264) = 3.95, P = .009, partial η(2) = 0.043, with PSS scores of the intervention group decreasing from baseline to T3 when intervention ended whereas PSS scores of the comparison group increased from baseline. The average scores on the MAAS did not differ significantly. Evaluation of an embedded mind-body self-care module in the first nursing course demonstrated promising improvements in stress management. The findings support the appropriateness of integrating mind-body self-care content into nursing curricula to enhance students' ability to regulate stress.

Stress and anxiety among nursing students: A review of intervention strategies in literature between 2009 and 2015

Undergraduate nursing students experience significant stress and anxiety, inhibiting learning and increasing attrition. Twenty-six intervention studies were identified and evaluated, updating a previous systematic review which categorized interventions targeting: (1) stressors, (2) coping, or (3) appraisal. The majority of interventions in this review aimed to reduce numbers or intensity of stressors through curriculum development (12) or to improve students' coping skills (8). Two studies reported interventions using only cognitive reappraisal while three interventions combined reappraisal with other approaches. Strength of evidence was limited by choice of study design, sample size, and lack of methodological rigor. Some statistically significant support was found for interventions focused on reducing stressors through curriculum development or improving students' coping skills. No statistically significant studies using reappraisal, either alone or in combination with other approaches, were identified, although qualitative findings suggested the potential benefits of this approach do merit further study. Progress was noted since 2008 in the increased number of studies and greater use of validated outcome measures but the review concluded further methodologically sound, adequately powered studies, especially randomized controlled trials, are needed to determine which interventions are effective to address the issue of excessive stress and anxiety among undergraduate nursing students.

Student perceptions of stress, coping, relationships, and academic civility: a longitudinal study

Academic incivility can increase student stress, jeopardize learning, damage relationships, and negatively impact the academic environment. This 3-year longitudinal study measured a cohort of prelicensure nursing students' progressive perceptions of stress, coping, student-student and faculty-student relationships, and levels of academic civility. While civility scores remained mild to moderately high overall, there was a slightly declining trend over the 3-year period. Perceived stressors and coping strategies and ways to improve academic civility are identified and discussed.