Imagery: A Treatment for Nursing Student Anxiety

Investigating the Impact of Guided Imagery on Stress, Brain Functions, and Attention: A Randomized Trial

The aim of this study was to investigate the potential impact of guided imagery (GI) on attentional control and cognitive performance and to explore the relationship between guided imagery, stress reduction, alpha brainwave activity, and attentional control using common cognitive performance tests. Executive function was assessed through the use of attentional control tests, including the anti-saccade, Stroop, and Go/No-go tasks. Participants underwent a guided imagery session while their brainwave activity was measured, followed by attentional control tests. The study's outcomes provide fresh insights into the influence of guided imagery on brain wave activity, particularly in terms of attentional control. The findings suggest that guided imagery has the potential to enhance attentional control by augmenting the alpha power and reducing stress levels. Given the limited existing research on the specific impact of guided imagery on attention control, the study's findings carry notable significance.

Effectiveness of Guided Breathing and Social Support for the Reduction of Pre-Exam Anxiety in University Students: A Factorial Study

Anxiety is a state of mind that university students often manifest in exam situations, which can negatively impact their grades. This study aimed to evaluate the effect of different relaxation techniques, including guided breathing and social support, on test anxiety among nursing students a few minutes before taking the final knowledge assessment test. For this purpose, a factorial study with a post-intervention measurement was carried out with three groups of nursing students. One group used the full yogic breathing relaxation technique (abdominal, thoracic, and clavicular), another used a social support technique, and the last group did not receive any intervention. Of 119 participants, 98.2% showed a moderate-high level of anxiety. Regarding the anxiety scale score, it was found that participants with moderate anxiety levels had higher scores on the knowledge test (Rho = -0.222; p = 0.015). The present study found no differences in anxiety levels between the study groups. Combining these relaxation techniques with others shown to be effective could reinforce their positive effect. Starting to work on this anxiety from the beginning of nursing courses appears to be a good strategy, striving to improve students' confidence in their abilities.

Using PETTLEP imagery as a simulation technique in nursing: Research and guidelines

One of the most valuable skill sets developed in nurse education is the ability to develop the clinical and practical skills learned. This can take various forms such as university-based practice, simulation and direct experience with patients. To this end imagery, a process where all of the senses are used to create or recreate an experience in the mind, could represent simulated practice of clinical skills. Research on imagery has indicated that the technique, when used to assist in the performance of skill based procedures carried out by nurses can be beneficial. However, guidelines are lacking in this area of simulated practice. In this article, we review current research on the topic of imagery in enhancing skilled performance and outline a model that can assist in conducting interventions. Furthermore, we consider how this could be implemented within a nursing environment to produce beneficial performance effects in both pre-registration and registered nurses.

A systematic review of prevention programs targeting depression, anxiety, and stress in university students

BACKGROUND

Given the prevalence of anxiety, depression, and stress among university students, it is important to assess the effectiveness of prevention programs for these problems. Beyond examining effect sizes, applying a common elements approach can enhance our understanding of which practice elements are most frequently included in symptom-reducing programs.

METHOD

This review examined effective (i.e., outcome-producing) prevention programs targeting depression, anxiety, and/or stress in university students. Programs could be delivered in a group-based, online/computer-delivered, or self-administered format and at the universal, selective, or indicated prevention level.

RESULTS

The resulting sample of 62 articles covered 68 prevention programs for college, graduate, or professional students across 15 countries. Average effect sizes for programs were moderate (overall g = 0.65), regardless of delivery format or prevention level. The most common practice elements (overall and for programs producing large effects) were: psychoeducation (72%), relaxation (69%), and cognitive monitoring/restructuring (47%). Many programs were limited by: (a) symptom target-outcome mismatches, (b) disproportionately female samples, and (c) inconsistently reported adherence data.

LIMITATIONS

Commonness of practice elements across outcome-producing interventions does not imply their extensiveness nor unique contribution to effectiveness. Coding was based on information in articles rather than manuals, and inter-rater reliability was moderate for some practice elements.

CONCLUSION

The outcome-producing prevention programs in our sample had common practice elements and produced moderate reduction in symptoms overall. Future research of depression, anxiety, and stress prevention programs for university students can investigate practice elements' unique and combined impact on outcomes, further explore under-tested practice elements, and use findings to inform intervention design.

Nature-Based Guided Imagery as an Intervention for State Anxiety

Anxiety is a significant mental health issue in modern society and empirical research into effective interventions to address anxiety has been extensive. Spending time in nature is one approach that has demonstrated anxiolytic effects. However, in some situations and contexts spending time in nature in order to reduce anxiety symptoms may not be possible. For example, in therapeutic settings delivered in a space with no access or exposure to any nature stimuli in the immediate surrounding environment. Guided imagery (GI) has also proven to be effective for reducing anxiety symptoms. Thus, nature-based GI might help to overcome the limitation of access to nature and strengthen the impact of GI interventions. The current study investigated the effectiveness of nature-based GI on anxiety reduction. Participants (n = 48, 18 males, 30 females, M age = 34.54, SD age = 12.91, age range = 19 - 71 years) with moderate levels of either trait or state anxiety as measured by the state-trait anxiety inventory (STAI) were recruited. Participants undertook both a nature-based GI session and a traditional non-nature-based GI session and their pre- and post- state anxiety levels were measured in each GI session. It was anticipated that post state anxiety scores would be significantly lower for both GI conditions and that a significantly greater anxiety reduction would be found in the nature-based GI than the urban-based GI. A two-way analysis of variance for repeated measures revealed results that supported both hypotheses. This study was the first to compare a nature based GI intervention with a traditional (non-nature based) GI intervention. Findings indicate that nature-based GI interventions are effective anxiety management interventions that have the added benefit of being cost-effective and easily accessible.

Interventions for Test Anxiety in Undergraduate Nursing Students: An Integrative Review

AIM

An integrative review was conducted to identify and evaluate interventions for test anxiety (TA) in undergraduate nursing students.

BACKGROUND

Test performance has a major impact on the academic success of nursing students. Therefore, testing is a source of stress and anxiety, which may impair academic performance.

METHOD

A systematic search was conducted to locate peer-reviewed literature about interventions for TA in undergraduate nursing students.

RESULTS

Review of 33 publications dated 1973 to 2014 identified 19 interventions for TA in undergraduate nursing students. Findings included experimental evidence supporting aromatherapy, music therapy, and various cognitive or behavioral interventions. Nonexperimental evidence supporting collaborative testing, crib sheets, and humorous exam items was also found.

CONCLUSION

Many interventions for mitigating TA in nursing students have been evaluated since the 1970s. Current research is needed to corroborate and strengthen the evidentiary support for existing interventions and to evaluate new interventions.

Technology-based interventions for mental health in tertiary students: systematic review

Background

Mental disorders are responsible for a high level of disability burden in students attending university. However, many universities have limited resources available to support student mental health. Technology-based interventions may be highly relevant to university populations. Previous reviews have targeted substance use and eating disorders in tertiary students. However, the effectiveness of technology-based interventions for other mental disorders and related issues has not been reviewed.

Objective

To systematically review published randomized trials of technology-based interventions evaluated in a university setting for disorders other than substance use and eating disorders.

Methods

The PubMed, PsycInfo, and Cochrane Central Register of Controlled Trials databases were searched using keywords, phrases, and MeSH terms. Retrieved abstracts (n=1618) were double screened and coded. Included studies met the following criteria: (1) the study was a randomized trial or a randomized controlled trial, (2) the sample was composed of students attending a tertiary institution, (3) the intervention was delivered by or accessed using a technological device or process, (4) the age range of the sample was between 18 and 25 years, and (5) the intervention was designed to improve, reduce, or change symptoms relating to a mental disorder.

Results

A total of 27 studies met inclusion criteria for the present review. Most of the studies (24/27, 89%) employed interventions targeting anxiety symptoms or disorders or stress, although almost one-third (7/24, 29%) targeted both depression and anxiety. There were a total of 51 technology-based interventions employed across the 27 studies. Overall, approximately half (24/51, 47%) were associated with at least 1 significant positive outcome compared with the control at postintervention. However, 29% (15/51) failed to find a significant effect. Effect sizes were calculated for the 18 of 51 interventions that provided sufficient data. Median effect size was 0.54 (range –0.07 to 3.04) for 8 interventions targeting depression and anxiety symptoms and 0.84 (range –0.07 to 2.66) for 10 interventions targeting anxiety symptoms and disorders. Internet-based technology (typically involving cognitive behavioral therapy) was the most commonly employed medium, being employed in 16 of 27 studies and approximately half of the 51 technology-based interventions (25/51, 49%). Distal and universal preventive interventions were the most common type of intervention. Some methodological problems were evident in the studies, with randomization methods either inadequate or inadequately described, few studies specifying a primary outcome, and most of the studies failing to undertake or report appropriate intent-to-treat analyses.

Conclusions

The findings of this review indicate that although technological interventions targeting certain mental health and related problems offer promise for students in university settings, more high quality trials that fully report randomization methods, outcome data, and data analysis methods are needed.

Interventions to reduce stress in university students: a review and meta-analysis

BACKGROUND

Recent research has revealed concerning rates of anxiety and depression among university students. Nevertheless, only a small percentage of these students receive treatment from university health services. Universities are thus challenged with instituting preventative programs that address student stress and reduce resultant anxiety and depression.

METHOD

A systematic review of the literature and meta-analysis was conducted to examine the effectiveness of interventions aimed at reducing stress in university students. Studies were eligible for inclusion if the assignment of study participants to experimental or control groups was by random allocation or parallel cohort design.

RESULTS

Retrieved studies represented a variety of intervention approaches with students in a broad range of programs and disciplines. Twenty-four studies, involving 1431 students were included in the meta-analysis. Cognitive, behavioral and mindfulness interventions were associated with decreased symptoms of anxiety. Secondary outcomes included lower levels of depression and cortisol.

LIMITATIONS

Included studies were limited to those published in peer reviewed journals. These studies over-represent interventions with female students in Western countries. Studies on some types of interventions such as psycho-educational and arts based interventions did not have sufficient data for inclusion in the meta-analysis.

CONCLUSION

This review provides evidence that cognitive, behavioral, and mindfulness interventions are effective in reducing stress in university students. Universities are encouraged to make such programs widely available to students. In addition however, future work should focus on developing stress reduction programs that attract male students and address their needs.

Application of guided imagery to facilitate the transition of new graduate registered nurses

Traditionally, the new graduate registered nurse (RN) transition has included a didactic and skills-based orientation accompanied by a period of preceptored practice. However, these methods do not ensure that new RNs are in a state of reduced anxiety to fully interact with their new environment. Transition to practice may cause anxiety, and the new graduate RN may perceive moderate to severe stress. One method of stress reduction is the use of guided imagery, which has shown strong potential with a variety of populations undergoing stressful events. Today, new graduate RNs expect institutions to facilitate orientation to their new employment settings and assist in the transition to their role as a professional nurse. This article proposes a model that incorporates guided imagery for refining the new graduate RN transition process. The model can be adapted for use in the context of orienting other adult learners to unfamiliar practice situations.

Nursing student anxiety as a context for teaching/learning

Experiential learning in nursing programs includes role-play, simulation, and live clinical experiences. Anxiety levels can heighten during experiential learning as students attempt to gain psychomotor skills and transfer knowledge into critical thinking. Nursing students may experience anxiety that can interfere with learning and critical thinking. However, the presence of student anxiety can be used to initiate a purposeful caring transaction between nursing faculty and student. The caring transaction is a way for faculty to model both caring and presence, create experiential learning of caring by students, and lead students to initiate self-care interventions to manage anxiety through the nursing program and beyond. Multiple learning outcomes can be achieved as the students integrate faculty-modeled concepts of caring and presence into simulated or real clinical situations, reduce or manage their anxiety, and improve their clinical judgment and critical thinking skills.

Assessing intervention effectiveness for reducing stress in student nurses: quantitative systematic review

AIMS

To identify the types of interventions that are effective in reducing stress in student nurses, and to make recommendations for future research.

BACKGROUND

Student nurses experience significant stress during their training and this may contribute to sickness, absence and attrition. Given the global shortage of nurses and high dropout rates amongst trainees, the importance for developing stress management programmes for student nurses is becoming more evident. To date, only one review has examined the effectiveness of stress interventions for student nurses, but the emergence of recent literature warrants a new review.

DATA SOURCES

Research papers published between April 1981 and April 2008 were identified from the following databases: Medline, CINAHL, Behavioral Sciences Collection, IBSS and Psychinfo.

REVIEW METHODS

A quantitative systematic review with narrative synthesis was conducted. Key terms included 'nurses OR nursing OR nurse', 'student OR students', 'intervention', 'stress OR burnout'. In addition to database searches, reference lists of selected papers were scanned, key authors were contacted and manual searches of key journals were conducted.

RESULTS

The most effective interventions provided skills for coping with stressful situations (typically relaxation) and skills for changing maladaptive cognitions. Interventions which promoted skills to reduce the intensity or number of stressors were also successful. In most cases, stress interventions did not improve academic performance.

CONCLUSION

The design of stress interventions should be driven by theory. Future studies should focus on interface and organizational factors and the long-term benefits of interventions for student nurses are yet to be demonstrated.

Effects of guided imagery on blood pressure in pregnant women with hypertension: a pilot randomized controlled trial

BACKGROUND

Hypertension occurs in nearly 10 percent of pregnancies, and is associated with higher risk of infant and maternal morbidity and mortality than in normal pregnancies. Previous studies have suggested that relaxation therapies reduce blood pressure in nonpregnant adults. The objectives of this pilot randomized trial were to provide preliminary evidence of whether relaxation by means of guided imagery would reduce blood pressure in hypertensive pregnant women, and to assess the feasibility of a larger trial.

METHODS

A total of 69 pregnant women with hypertension were randomized to periods of guided imagery or of quiet rest, twice daily for 4 weeks or until delivery, whichever came first. Daytime ambulatory mean arterial pressure, systolic and diastolic blood pressure, and anxiety were measured weekly for up to 4 weeks.

RESULTS

Women allocated to guided imagery had lower mean arterial pressure elevations over time than those allocated to quiet rest (guided imagery: M = 1.58 mmHg, SD = 7.63; quiet rest: M = 5.93 mmHg, SD = 6.55; t = 2.36, p = 0.02). However, when adjusted for baseline mean arterial pressure and gestation, the effect was not significant (p = 0.14). Numbers of women prescribed antihypertensive medication postrandomization were similar (guided imagery: n = 16; quiet rest: n = 13, χ(2) = 0.74, p = 0.46). There was also no evidence of an effect on women's anxiety. Nearly 90 percent (n = 26) of the guided imagery group indicated that they would use it again.

CONCLUSIONS

Further rigorous study is warranted to determine effects of guided imagery on maternal blood pressure and perinatal health outcomes.

Interventional strategies to decrease nursing student anxiety in the clinical learning environment

The clinical setting is a significant learning environment for undergraduate nursing students. However, the learning that occurs in this environment presents challenges that may cause students to experience stress and anxiety. High levels of anxiety can affect students' clinical performance, presenting a clear threat to success in a clinical rotation. It is crucial for clinical nursing faculty to foster a supportive learning environment conducive to undergraduate nursing student learning. The purpose of this article is to provide clinical nursing faculty with the current literature related to humor, peer instructors and mentors, and mindfulness training as strategies to decrease undergraduate student nurse anxiety in the clinical setting. The Neuman Systems Model is used as a theoretical framework, and the application of this model to humor, peer instructors and mentors, and mindfulness training is examined.

Stress management during pregnancy: designing and evaluating a mind-body intervention

The objective of this 12-week study was to determine whether a relaxation-guided imagery (R-GI) intervention designed as a primary prevention strategy for stress management was perceived as beneficial to African American women during the second trimester of pregnancy. All participants documented perceived benefits of the R-GI intervention that included the following: (1) improved breathing; (2) ability to relax, clear one's mind, and become calm; (3) ability to channel and decrease stress; (4) release of anxiety; (5) use of R-GI throughout the day helped control anger and state of mind, leading to a smoother day; and (6) improved ability to fall and stay asleep.

A qualitative study of nursing student experiences of clinical practice

Background

Nursing student's experiences of their clinical practice provide greater insight to develop an effective clinical teaching strategy in nursing education. The main objective of this study was to investigate student nurses' experience about their clinical practice.

Methods

Focus groups were used to obtain students' opinion and experiences about their clinical practice. 90 baccalaureate nursing students at Shiraz University of Medical Sciences (Faculty of Nursing and Midwifery) were selected randomly from two hundred students and were arranged in 9 groups of ten students. To analyze the data the method used to code and categories focus group data were adapted from approaches to qualitative data analysis.

Results

Four themes emerged from the focus group data. From the students' point of view," initial clinical anxiety", "theory-practice gap"," clinical supervision", professional role", were considered as important factors in clinical experience.

Conclusion

The result of this study showed that nursing students were not satisfied with the clinical component of their education. They experienced anxiety as a result of feeling incompetent and lack of professional nursing skills and knowledge to take care of various patients in the clinical setting.

Níveis de ansiedade de alunos de graduação em enfermagem frente à primeira instrumentação cirúrgica

A finalidade deste estudo foi verificar o nível de ansiedade de alunos de graduação em enfermagem frente à primeira instrumentação cirúrgica. A amostra foi constituída por 30 estudantes do sexto semestre, que cursaram a disciplina Enfermagem em Centro Cirúrgico. Utilizou-se o Teste de Ansiedade IDATE (Inventário de Ansiedade Traço-Estado). Identificou-se que 27 alunos (90,0%) apresentaram baixo nível de ansiedade-traço. Quanto à ansiedade-estado, verificou-se como maiores incidências: baixo nível de ansiedade no primeiro dia de aula teórica (76,7% dos alunos), médio nível de ansiedade no laboratório (53,4% dos alunos) e médio nível de ansiedade no estágio supervisionado (80,0% dos alunos). Identificou-se, ainda, baixa percentagem de alunos com alto nível de ansiedade. As análises estatísticas comprovaram haver diferenças significantes entre as médias de ansiedade-estado nas três etapas da coleta dos dados.

Qualidade de vida dos acadêmicos de enfermagem

Esta pesquisa foi realizada junto a seis Cursos de Enfermagem, localizados na Região Sul do Brasil, com o objetivo de conhecer e avaliar a qualidade de vida dos estudantes. A metodologia utilizada, tanto para coleta quanto análise dos dados, foi o modelo WHOQOL Bref, da Organização Mundial da Saúde, que se mostrou sensível para o diagnóstico pretendido. Os resultados indicaram que 64% dos alunos refere satisfação com sua qualidade de vida, mas 36% apresentam problemas significativos, que demandam necessidades específicas e que justificam a implantação de programas de apoio e suporte para enfrentamento das situações de sofrimento.

Effects of relaxation and imagery on the sleep of critically ill adults

The purpose of this study was to determine the effects of relaxation and imagery on the sleep of critically ill adults. The study was an experimental clinical trial with random assignment to two groups. Analysis used repeated measures ANOVA. Thirty-six adults (17 males and 19 females) with a variety of physical diagnoses in three critical-care units in two large metropolitan hospitals were studied. Outcome measures were scores on a visual analog sleep scale, measured on three mornings. The intervention was a combination of relaxation and imagery, delivered on two evenings. All subjects' sleep improved over time. There were significant interaction effects between the intervention, gender, and time, with males' scores improving rapidly, and females' scores first dropping, then improving rapidly. A combination of relaxation and imagery is effective in improving the sleep of the critically ill adult, with men responding immediately to relaxation and imagery with improved sleep, and women taking more time to respond to the intervention.

Reducing distress in first level and student nurses: a review of the applied stress management literature

Following recent evidence of continuing high levels of distress in both trained and student nurses, a critical review of the stress reduction and stress management literature targeting both trained and student nurses is presented. Using a systematic approach, some 36 studies dating from 1980 until the present day were identified adopting either pre-experimental, quasi-experimental or experimental designs. While many work-site programmes in this series were successful in terms of adaptive changes in problem-solving, self-management skills including relaxation and interpersonal skills, affective well-being, and work performance, a number of design and evaluation inadequacies were identified. The relative lack of home-work interface or organizational level programmes to reduce work-related distress, and the scarcity of interventions targeting aspects of the work environment likely to contribute to such outcomes may have contributed to continuing high levels of distress in trained and student nurses. Recommendations regarding the future design, provision and evaluation of such work-site interventions include the further clarification of the structure of perceived stressors, and development of causal models of the stress process to identify the job characteristics 'causing' work-related distress. Such an approach would inform the design and implementation of evidence-based organizational level interventions augmenting strategies to target the health behaviour, lifestyle/risk factors and self-management skills of practitioners and students with attempts to amend problematic elements of the psychosocial work environment.

Hardiness and Anxiety as Predictors of Academic Success in First-Year, Full-Time and Part-Time RN Students

BACKGROUND

The levels of hardiness and anxiety and their relationship with academic success were examined using the Personal Views Survey and the State-Trait Anxiety Inventory.

METHOD

The instruments were administered to a nonprobability convenience sample of 41 full-time and part-time RN students enrolled in a BSN completion program.

RESULTS

Participants perceived themselves as possessing moderately high levels of hardiness (mean = 72.90) and low levels of anxiety (state mean = 39.33; trait mean = 40.18), but for some, these characteristics did not relate to academic achievement. Statistical significance was set at .05.

CONCLUSION

These findings indicate how hardiness and anxiety can affect academic success, particularly in adult students, and provide some direction for educators and administrators in maximizing educational endeavors.

Mind-body therapies for primary care physicians

Evidence is accumulating that mental and emotional processes can affect disease states. Mind-body therapies are effective adjuncts to conventional medical treatments, and they are easy to teach and learn. This article offers a review of relevant literature and introduces several mind-body techniques.

Imagery: Stimulating Critical Thinking by Exploring Mental Models

The use of guided imagery in the classroom or clinical setting has traditionally been directed at decreasing anxiety or increasing skill performance (Rodriguez, 1991; Stephens, 1992; Tuyn, 1994). This article describes an innovative use of imagery as a teaching strategy to unearth and possibly reframe, what Senge (1990) has identified as "mental models." The approach described differs from traditional uses of imagery related to decreasing anxiety and increasing skill performance. This approach is directed at increasing critical thinking and has offered new insights for both students and faculty. By using both guided imagery as a teaching strategy and Senge's concepts of mental models, educators can encourage students to become critical thinkers and what Senge calls "systems thinkers." Mental models are deeply ingrained, often unacknowledged, assumptions or images that individuals develop as a result of their life experiences. These images influence values, thoughts, and actions, albeit at times, unknowingly. These images, or mental models, also influence the ability to learn and translate learning into action. Lack of knowledge and awareness of one's mental models can be an obstacle to high-quality critical thinking. The concept of mental models has been best articulated by Senge (1990), who is known for his work in systems-thinking. Senge believed that new insights are rarely followed with substantive action because the new learning, at some level, conflicts with deeply held, internal images. One way to remove this gap between insight and action is to examine mental models that may prohibit both insight and action.

Nursing Students' Stress During the Initial Clinical Experience

The purpose of this exploratory longitudinal study was to identify nursing students' perceptions of stress in their initial clinical experiences in a hospital setting. Guided by the relational view of stress, a Nursing Student's Stress Scale (NSSS) was developed to include six subscales: adequate knowledge, close supervision, averse sights, causing pain, insufficient resources, and reality conflict. The NSSS was administered three times during the clinical experience to 46 nursing students. Results showed significant differences between the students' preclinical expected stress levels and the actual levels of stress in the clinical setting. Theoretical, methodological, and practical implications of the findings are discussed. Nurse educators are encouraged to acknowledge students' perceptions of stressful situations as a basis for stress reduction intervention. Students must first cope with their own stress in the clinical reality before being expected to deal with patients' stress.

Stress Intervention: A Model of Stress Inoculation Training

1. The initial clinical experience in a hospital setting has been identified as a major area of threat for beginning nursing students. 2. A stress inoculation program, in which students were exposed to situation similar to future clinical experience, was used to help students develop confidence and coping skills. 3. The program was found to be an effective preparation for clinical experience, mainly in terms of the students clinical performance.

Use of alternative therapies among Mexican Americans in the Texas Rio Grande Valley

Alternative therapies have gained increasing recognition and usage in North America during the past decade. In a descriptive study with a convenience sample of 213 Mexican Americans, three research questions were asked: (1) What specific kinds of alternative therapies do Mexicans in the Rio Grande Valley use? (2) What percentage of the sample group uses alternative therapies? and (3) Do the users of alternative therapies self-report these visits to their established, conventional, primary health care provider? Findings showed that 44% of respondents had used an alternative practitioner one or more times during the previous year. The most commonly sought therapies were herbal medicine, spiritual healing and prayer, massage, relaxation techniques, chiropractic, and visits to a curandero (Mexican folk healer). The majority (66%) never report visits to alternative practitioners to their established primary health provider.