The Impact of Mindfulness Meditation on Anxiety and Clinical Practice Accuracy in Adult Nursing Students in Simulated Learning: Preliminary Results of a Primary Research Study

Background A considerable part of nursing students’ training takes place in simulation laboratories where real-life clinical situations are replicated through guided learning experiences1 . Furthermore simulated clinical practice may allow students to familiarise themselves with complicated clinical situations that they can rarely face in a real clinical environment. Despite the safety offered by a simulation laboratory, managing a deteriorating patient can be emotionally and physically highly demanding. The subjective experience of stress and anxiety can significantly reduce the quality of the teaching and learning experience, limit the quality of students’ performance and increase the probability of making mistakes that can compromise patients’ safety2 . Mindfulness meditation is a technique that helps students develop skills of paying attention to themselves and the world in a non- judgemental manner and encourages compassion, acceptance and kindness which are values at the core of the nursing profession. It also fosters the ability to focus on details and the opportunity for our students to deepen their therapeutic relationship with patients3 . A significant body of literature demonstrates its benefits in terms of stress reduction, increased quality of sleep, increased self-awareness and concentration4 .Aim The aim of this project is to explore the potential of mindfulness meditation in improving the quality of the learning and teaching experience of nursing students involved in a simulated clinical scenario based on a case of sudden cardiac death. Method A prospective pilot study took place from January to March 2019 to test the effects of a 21 day mindfulness meditation programme on stress, anxiety, mindfulness, clinical accuracy and quality of the teaching and learning experience on 8 adult nursing students responsible to manage a cardiac arrest in a simulated clinical environment. Three specific investigation tools were used to test participants for stress (Perceived Stress Scale; PSS)5 , anxiety (State Trait Anxiety Inventory Y-1 & Self-Evaluation Questionnaire Y-2; STAI Y- 1 and Y2)6 and mindfulness (Freiburg Mindfulness Inventory; FMI)7 in addition to focus groups. Focus groups aimed at exploring students'’ feelings and opinions on self-monitoring, attention regulation, stress, anxiety and clinical accuracy. Furthermore students’ vital signs were recorded throughout the study to measure their physical responses to stressful situations and compare them with their emotional ones. Results No statistical significant differences were detected between Pre Test, Post Test 1 and Post Test 2 in the PSS, STAI Y-1 and Y2 and FMI. No statistical significant differences were detected between Post Test 1 Day and Post Test 2 Day in the recorded set of vital signs. Data extracted and analysed from the focus groups highlighted four emerging traits on which participants agreed: improved cohesiveness and communication skills (self-monitoring and attention regulation), improved responsiveness, confidence and patient’s safety (clinical accuracy and effectiveness), enhanced sense of inner quite (stress and anxiety) and comprehensive and highly beneficial training experience (learning and teaching experience). Conclusion Objective data acquired through the PSS, STAI Y-1 and Y2 and FMI surveys show how the 21 day mindfulness meditation programme has no statistically significant impact in reducing anxiety, stress and improving mindfulness. The relatively minimal fluctuation of students’ vital signs seems to indicate that the adopted intervention plays no role in relieving stress and anxiety. Conversely, subjective data indicate that students benefited from a teaching and learning experience that they perceived as highly valuable in order to improve their clinical, communication, team- working skills and to contain the negative effects of stress and anxiety. Furthermore, the participants stated that as a result of practicing mindfulness meditation their overall performance contributed to enhance patient safety and chance of survival. Further studies will be necessary to complement these results as the limited sample size doesn’t allow generalisation. The use of a commercial wristband might have also had a negative impact on quality of the data collected. The use of a clinically certified wristband is recommended to improve data reliability.