Effect of Mindfulness Based Stress Reduction Intervention on Undergraduate Nursing Students’ Stress

Effect of Mindfulness Based Stress Reduction Intervention on Undergraduate Nursing Students’ Stress | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of Mindfulness Based Stress Reduction Intervention on Undergraduate Nursing Students’ Stress Tahsin Raana, Fozia Fatima, Shazia Zaheer, Nadira Nasim, Uzma Shaheen, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8496860/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Stress is a global phenomenon that significantly affects the academic performance and well-being of students. Nursing, being a demanding and high-stake profession, exposes students to considerable stress during their academic and clinical training. Effective interventions such as Mindfulness-Based Stress Reduction (MBSR) can play a vital role in alleviating stress and enhancing coping abilities. Objectives The study aimed to evaluate the effectiveness of MBSR in reducing stress and improving well-being among undergraduate nursing students. Additionally, it sought to examine whether demographic factors such as age, educational background, and region can influence post-intervention stress outcomes. Methodology: A quasi-experimental one-group pretest–posttest design was adopted. Universal sampling was used to recruit 80 second-year undergraduate nursing students from the College of Nursing, AFPGMI Rawalpindi, who had recently commenced clinical rotations. Stress was measured using the stress subscale of the DASS-42 (14 items) at baseline, post-intervention, and one-month follow-up. The 8-week MBSR program, developed by Jon Kabat-Zinn, included mindfulness meditation, yoga, and body scan practices. Data were analyzed using descriptive statistics, repeated measure ANOVA, independent sample t-test, and ANOVA. Results Findings demonstrated a significant reduction in stress across time (pre-intervention, post-intervention, and follow-up) as measured by repeated-measures ANOVA (p 0.05), indicating uniform effectiveness of MBSR. The results suggest both immediate and sustained benefits of the intervention. Conclusion MBSR was found to be an effective strategy for stress reduction and well-being enhancement among nursing students, irrespective of demographic differences. Integration of structured mindfulness programs into nursing curricula may strengthen resilience, improve academic and clinical performance, and prepare students for future professional challenges. Academic Stress Clinical Rotation Mindfulness Mindfulness-based Stress Reduction Stress Undergraduate Nursing Students Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 1. INTRODUCTION Stress is a universal phenomenon that has become a part of life, often viewed as the price humans pay for survival ( 1 ). This is an inevitable reality of everyday life that results after the body's usual physiological and psychological reaction to circumstances interpreted as demanding or harmful ( 2 ). Positive stress has catalyst role in problem solving and confrontation while prolonged and sustained stress can lead to fatal effects on mind and body such as anxiety, depression and other psychological issues. Prolonged stress can negatively impact one's cognition clearly, regulate one's emotions, and feel good about oneself ( 3 – 6 ) In the field of education, stress is particularly significant as it can disrupt learning and academic performance by impairing focus, memory, and problem-solving skills ( 7 ). The academic environment is usually characterized by information overload, academic pressure, unrealistic self-achievements, high family expectations, and competition among students, which exacerbates academic stress and decreases academic performance ( 8 ). The beginning of university life is typically a nerve-racking time, and many students struggle with mental health issues ( 9 ). In this unique academic and social setting, students face pressures like breaking away from social networks, moving away from parental home, learning to live independently, forming new social connections, difficulty in adjustment to the new social milieu, and to balance their academic obligations ( 10 , 11 ). Nursing is one of the most stressful and sensitive discipline due to its rigorous academic and clinical requirements ( 12 ). Nursing education is getting more complex and discerning, which is in line with the tremendous strides in the field over the previous few years ( 13 ). Nursing students face unique challenges in practice-based education, combining didactic and clinical training, resulting in high stress levels, categorized as a high-stress group ( 14 ). They encounter various sources of stress such as academic, clinical, and personal ( 15 ). Nursing students face academic stressors like intensive theoretical coursework, demanding schedules, numerous lectures, and long study hours, interrogation during lectures, anxiety over assessments and exams, missing assignment deadlines, and fear of failing ( 16 , 17 ). Clinical stresses which nursing students encounter during clinical training includes demands of demonstrating technical proficiency, dealing with unpredictability, fear of errors, lack of medical knowledge, witnessing patient suffering and death, unfamiliar settings, excessive workloads, feeling unprepared, new position demands, patient care responsibilities, and negative interactions with peers and staff ( 14 , 18 – 20 ). Nursing students encounter various personal stressors such as family issues, physical problems, intrapersonal stresses stemming from financial loads, interpersonal relationships with classmates, and balancing home life with professional life ( 15 , 18 ). Nursing students need to use coping strategies to organize the stressful situations they encounter in academia and clinical practices ( 21 ). One such therapy is meditation, which falls under the category of Complementary and Alternative Medicine (CAM), which includes practices that integrate interactions between the brain, mind, body, and behavior ( 22 ). Various types of meditation practices exist such as loving-kindness, transcendental, Zen, yoga, compassion, and Buddhist meditation. Among these, mindfulness meditation is a distinct approach which emphasizes being completely present and fully aware in the moment ( 23 ). MBSR is a particular kind of mindfulness meditation established by Jon Kabat-Zinn, Ph.D in 1979 ( 24 , 25 ). MBSR is an eight week educational and behavioral program that provides direct experience with meditation practices, including mindful awareness of daily tasks and interpersonal interactions ( 26 ). Mindfulness is "paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally" ( 27 ). Nursing students throughout their academic program may benefit from MBSR and even practice it as RNs to reduce their stress which can result in enhanced academic and clinical performance and ultimately safer patient care ( 28 ). The laborious strains of academic and clinical training places a heavy burden on nursing students, which can cause negative effect on physical and mental health of undergraduate nursing students, leading to a higher level of stress. MBSR intervention is found to be effective in improving the mental health and well-being of nursing students and reducing stress levels. Globally, the efficacy of MBSR has been evaluated widely on undergraduate students of various disciplines ( 29 – 31 ). But, effectiveness of MBSR for undergraduate nursing students is still underexplored, despite the growing awareness of stress-related issues in nursing academia ( 32 ). Stress management techniques often fall short in addressing the exclusive educational and clinical demands faced by nursing students which ultimately result in poor academic and clinical performance. In Pakistan, researches have been conducted on university students to evaluate the effectiveness of MBSR which revealed higher level of psychological wellbeing, increased mindfulness and lowered stress levels ( 33 ). Nevertheless, there is a paucity of research investigating the effect of mindfulness-based stress reduction among undergraduate nursing students in the local context. Given the multifaceted and significant stress experienced by nursing students and limited use of meditation therapies for reducing stress, this study aims to analyze effectiveness of MBSR interventions for managing stress and enhancing mindfulness in this population. This research will contribute to the development of comprehensive stress management intervention tailored to the unique requirements of nursing students, ultimately reducing stress and enhancing their academic performance, mindfulness, and overall quality of life. 1.1 Statement of Problem Mental health and well-being of nursing students are paramount due to rigorous academic demands and emotional challenges they face during their training. Undergraduate nursing students are specifically susceptible to high levels of stress resulting from demanding academic and clinical responsibilities. This persistent stress negatively affects their academic performance, clinical decision-making, emotional stability, and future professional competence. The demanding nature of nursing education in Pakistan further amplifies these challenges, as students often face academic pressures, intense clinical rotations, limited support systems, and high expectations within healthcare settings. Despite these challenges, there are limited use of structured evidence-based stress reduction intervention to lessen stress in Pakistan. Subsequent research should ought to consider the meditations that could offer nursing students social and psychological support. Although MBSR intervention have been recognized globally for decreasing stress, fostering emotional resilience, focus, and self-regulation, but its effectiveness for stress reduction specifically for nursing students is underexplored in Pakistan. Addressing these concerns is essential to ensure healthier learning environments, enhance students’ emotional well-being, and strengthen the future nursing workforce. Therefore, the aim of this study is to evaluate the effect of MBSR intervention on stress reduction among undergraduate nursing students and ultimately enhancing overall mental health of undergraduate nursing students. 1.2 Research Objectives The objectives of this study are; To assess the baseline stress level of undergraduate nursing students. To analyze post interventional and follow-up stress level of undergraduate nursing students. To examine mean difference between baseline, post-Intervention and follow-up stress level of undergraduate nursing students. To examine mean difference in post- Interventional stress level of undergraduate nursing students on the basis of age, educational level and region. 1.3 Research Question What is the effect of Mindfulness-Based Stress Reduction (MBSR) intervention on stress level of undergraduate nursing students? 1.4 Theoretical Framework This study is based on two models. The first model is the Dimensional Model of Psychological Distress, developed by ( 34 ). This model provides the theoretical basis for the DASS-42 Stress Subscale, which conceptualizes stress not as a discrete state but as a continuum of emotional and physiological arousal. According to this model, stress consists of distinct indicators such as difficulty relaxing, irritability, nervous tension, impatience, overreaction to situations, intolerance of interruptions, and agitation. These 14 stress items collectively capture the core construct of chronic non-specific arousal. In this study, the DASS-42 stress items were used to assess undergraduate nursing students’ stress. The theoretical model of DASS-42 (stress items) is illustrated in Fig. 1 . The second model is the MBSR Framework, which conceptualizes mindfulness as purposeful, non-judgmental awareness. This model explains how mindfulness practices reduce stress through attention regulation, enhanced body awareness, and emotional regulation (Kabat-Zinn, 1979). Principles like acceptance, letting go, patience, trust, non-centering, beginner's mind, non-judgment, and non-striving are all emphasized by MBSR. The eight week MBSR program utilized in this study operationalizes these mechanisms through body scan, meditation, breath work, mindful communication, mindful eating, walking meditation, and yoga ( 35 ). The operational framework of MBSR intervention is described in Fig. 2 . Collectively, these two models explain how mindfulness practices improve emotional and cognitive regulation, which in turn reduces the stress reactions assessed by the DASS-42 stress items. 2. LITERATURE REVIEW 2.1 Stress and its Associated Factors Stress has grown to be a significant problem in today's fast-paced society, with possible negative effects on both our physical and emotional well-being (Voss et al., 2020). It can manifest as either a mental, emotional, or physical reaction to the strain that an event or situation puts on the body ( 37 ). Personal or environmental events that lead to stress are known as stressors, and it is an individual's response to these that ultimately causes stress ( 38 ). The World Health Organization (WHO) identified stress as the source of negative outcomes. Each person experiences stress differently, and ability to endure negative outcomes such as fatigue, high blood pressure, low mood, heightened cravings, poor concentration, irritability, anxiety, tension and strain vary tremendously across people ( 8 , 39 , 40 ). During stressful events, the body triggers a complex set of hormonal and neural responses to cope with the demand ( 39 ). The hypothalamic-pituitary-adrenal (HPA) axis and sympathetic-adrenal-medullary (SAM) system are the primary mediators of the stress response ( 41 ). Following a stressor, the hypothalamus releases corticotrophin-releasing hormone (CRH), which stimulates the anterior pituitary to secrete adrenocorticotropic hormone (ACTH) ( 41 ). ACTH then stimulates the adrenal cortex, which produces cortisol, a glucocorticoid that helps mobilize energy and sustain homeostasis under stress. Simultaneously, the SAM system causes the adrenal medulla to release catecholamine triggering the "fight or flight" response ( 39 ). 2.2.1 Stress and its Associated Factors among Nursing Students The epidemic of stress and burnout among nurses and nursing students has been extensively documented in the literature. It is well established that long-term stress causes nursing professionals and students to get burned out ( 42 ). According to ( 43 ), nursing students face significant obligations in their academic and clinical lives. They must absorb a large amount of theoretical information while honing their practical abilities in clinical settings. The atmosphere is highly stressful due to these two expectations. Furthermore, compounded stress frequently results in psychological distress, such as anxiety, sadness, and burnout, which have a negative impact on clinical competence and academic performance ( 44 ). Several studies have focused on stress among nursing students such as a survey conducted in USA found that stress levels, anxiety and sleep disturbances were at higher level among students in nursing field as compared to other university students ( 45 ). Furthermore, a study conducted in Canada among nursing students revealed that students were shown to have higher levels of stress, anxiety, and depression when they perceived their lives to be more difficult. They also believed that stress was caused by the loads of both their personal and academic lives ( 18 ). Similarly, a study among female nursing students in Saudi Arabia revealed that the primary cause of stress was the academic load and Interface concerns, clinical concerns, and personal issues came in second and third, respectively ( 12 ). In line with this view, a study conducted in Lahore university revealed that there were four main reasons why nursing students face stress are their environment, clinical rotation, personal issues, and coursework ( 46 ). 2.4 Coping Strategies for Stress Reduction Adopting appropriate coping strategy is highly crucial for combating the harmful consequences of stress. Research suggests that effective stress management leads to adaptation, which increases health, mental well-being, and social functioning ( 5 , 14 , 15 , 47 ). To cope with the stressors, nursing students embrace a variety of stress-management strategies, which may be broadly categorized as problem-focused, emotion-focused, or avoidance-based ( 14 ). Despite their reliance on these coping strategies, research shows that many students struggle to discover consistently effective stress management techniques, underscoring the necessity for structured and organized interventions ( 48 ). Inadequate access to standard mental health treatment owing to financial and logistical hurdles highlights the importance of investigating alternative approaches to mitigate stress ( 49 ). Meditation has become a widely accepted CAM technique that improves both mental and physical well-being. Research supports effectiveness of meditation in minimizing anxiety, enhancing focus, and cultivating resilience, making it a valued tool for nursing students navigating high-pressure circumstances ( 21 , 50 – 53 ). MBSR has gained popularity as a structured meditation strategy that incorporates mindfulness meditation with stress management approaches ( 27 ). MBSR helps reappraise stressful circumstances and improve adaptive coping skills ( 54 ). MBSR promotes long-term emotional resilience and helps students handle stress effectively through fostering present-moment awareness and nonjudgmental acceptance ( 28 , 55 ). Given its potential to enhance psychological well-being, integrating MBSR into nursing courses could offer students with sustainable stress management skills, preparing them for the requirements of their education and future professional positions ( 56 ). 2.4.1 Mindfulness-Based Stress Reduction (MBSR) as an Effective Strategy Mindfulness is an internal perception that help individuals to focus on the present moment and their surroundings without being diverted by previous or forthcoming happenings (Chen et al., 2021). Dr. Jon Kabat-Zinn brought the concept of mindfulness, originated from Buddhism, to the West. He describes mindfulness as an understanding of the present moment means “paying attention in a particular way: on purpose, in the present moment and in a non-judgmental manner” (Kabat-Zinn, 2013). Mindfulness involves directly noticing what is happening in the current moment, irrespective of whether the experience is pleasant, unpleasant, or neutral. It also means approaching these experiences with curiosity and interest ( 57 ). It has been demonstrated that practicing mindfulness is an easy and helpful way to enhance mental wellness (Holden, 2022). People who exhibit greater mindfulness tend to demonstrate increased levels of compassion, acceptance, and empathy towards both themselves and others. They also possess improved interpersonal skills and can communicate more proficiently ( 25 ). Mindfulness is strongly associated with stress and anxiety as researches have shown that higher level of mindfulness results in significantly lowered level of stress and anxiety ( 58 ). Mindfulness also improves emotion regulation by promoting acceptance and non-reactivity toward emotional experiences, enabling individuals to respond to stressors more adaptively ( 59 ). MBSR reduces stress via several effective key mechanisms. It enhances mindfulness, making individuals more aware of their thoughts and feelings without becoming entangled in them, breaking the cycle of rumination, a significant contributor to stress and anxiety reduction ( 60 ). Additionally, MBSR can lower physiological stress responses. Regular mindfulness practice reduces the activity of the hypothalamic-pituitary-adrenal (HPA) axis, which mediates the body's reaction towards stress, thereby dwindling cortisol levels and other stress hormones ( 57 ). This physiological stress reduction can have profound effects on overall well-being and flexibility. Another critical mechanism is the enhancement of coping skills and resilience. By nurturing a sense of control over one’s experiences and developing adaptive coping strategies, MBSR equips individuals to manage stress more effectively. This increased resilience not only helps in dealing with immediate stressors but also empowers individuals with tools to handle future challenges more proficiently ( 61 ). 2.4.2 Theoretical Underpinning of MBSR The theory of Modelling and Role Modelling may serve as a theoretical basis for mindfulness practices and help distinguish between shorter, more focused mindfulness training sessions. Self-care, or the capability to take care of oneself, is one of the core concept of the theory of Modeling and Role Modeling ( 62 ). There are three components to the notion of self-care: (a) self-care knowledge; Awareness of what is essential to support health and lifetime development (b) self-care resources that can be used for self-care for both internal and exterior to the person; and (c) self-care activities involve taking care of one-self utilizing one's own resources and knowledge (Erickson, 2006). These concepts are used for practice and training of mindfulness. Self-care knowledge means that students are somehow aware of their stress levels and the importance of maintaining optimal health. Self-care resources involve using external resources like social support and cues from peers, as well as internal resources such as physical and mental capacity. Self-care actions are practicing and implementation of mindfulness technique ( 62 ). The theoretical model underpinning the MBSR intervention is described in Fig. 4 . 2.5 Effects of MBSR on Stress from an Evidence Lens There is a growing body of literature highlighting the usefulness of MBSR for healthcare professionals, particularly nurses and nursing students in reducing stress, anxiety, and depression. Evidences confirmed that mindfulness based stress reduction intervention demonstrated significant reduction in stress among undergraduate nursing students ( 21 , 63 ), marked decline in depression, anxiety and stress among nurses ( 64 ), discernable decrease in perceived stress and anxiety, underscoring the intervention’s impact on stress regulation ( 60 ), enhanced mindfulness while reduced anxiety and depression in nursing students ( 66 ). Moreover, a modified 8 weeks MBSR program was an efficacious technique for nurses to lessen stress and harmful emotions while boosting constructive affect, resilience, and job satisfaction ( 66 ). Similarly, breath-focused mindfulness intervention improved somatic and autonomic control indices as well as enhanced emotional meta-cognition among undergraduate nursing students ( 67 ). Recent research underscores the importance of embedding mindfulness into nursing education to strengthen students’ coping and emotional capacities. According to Walker and Mann (2016), integrating mindfulness into the nursing prospectus empowered the undergraduates with the skills to manage academic pressures. Moreover, nursing students who received mindfulness coaching had elevated emotional intelligence ( 68 ). Research highlights the affirmative influence of MBSR interventions on nursing students’ cognitive and emotional well-being. ( 69 ) reported that undergraduate nursing students participating in mindfulness program reported improvements in their ability to sleep, focus, think clearly, and have fewer negative thoughts. Similarly, a study conducted in USA revealed that the capacity for working memory and emotional regulation in nursing students was directly and favorably impacted by mindfulness ( 70 ). Mindfulness interventions have also been shown to enhance academic, ethical, and interpersonal outcomes among nursing students and educators. In a study conducted on nursing students, an online asynchronous mindfulness meditation intervention enhanced intellectual skills as attention shifting, focus selection, accuracy, and concentration ( 71 ). Additionally, mindfulness training improved ethical decision-making and awareness in pre-licensure and practicing nurses ( 32 ). Moreover, a study held in Germany on students and teachers revealed that students who participated in the MBSR showed substantial enhancements in their self-reported strain, self-management, school-specific self-efficacy, interpersonal matters and teachers revealed a considerable increase in self-reported mindfulness and a decrease in interpersonal issues ( 30 ). Growing evidence indicates that MBSR plays a pivotal role in reducing stress and enhancing psychological well-being among nursing students. In Korean nursing students, a MBSR program dramatically reduced stress, anxiety, and mental health problems while increased awareness ( 28 ). MBSR has been associated with enhancements in academic and clinical performance in addition to stress reduction. A study by ( 72 ) investigated that nurses who participated in MBSR training scored higher on clinical competency tests, had better patient communication skills, and showed more confidence than their non-MBSR counterparts. Throughout this literature review, researcher has explored a wide range of studies and findings that shed light on importance of MBSR interventions in reducing stress, anxiety, and other mental health issues among various disciplines. From the evidence presented, it is apparent that in Pakistan, nursing students still fail to adopt such stress reduction programs while facing academic or clinical stressors. Therefore, the current study was undertaken to assess the effects of MBSR on undergraduate nursing students’ stress. 3. RESEARCH METHODOLOGY 3.1 Study Design A quasi-experimental study was carried out using non-randomized one-group pre-test/post-test design. Figure 5 illustrates the quasi-experimental study design, depicting the sequence of pre-test assessment, intervention implementation, and post-test evaluation. In this study, undergraduate nursing students’ stress was assessed at Time one (T0) as pre-test and Time two (T1) as post-test after one week of intervention and Time three (T2) as follow-up at one month after intervention. The comparison of stress scores across time points is shown in Fig. 6 . 3.2 Population and Setting The population for this study comprised of 2nd year undergraduate nursing students. This study was conducted at college of nursing AFPGMI Rawalpindi which is affiliated with the National University of Medical Sciences. 3.4 Sampling Technique The universal sampling technique was used to select study participants. This technique involved selecting all 2nd year undergraduate nursing students from college of nursing AFPGMI Rawalpindi. This cohort was especially pertinent to the study’s objectives due to their distinct level of clinical exposure. 3.5 Sample Size To ensure internal consistency and reduce selection bias, the entire class of 2nd year undergraduate nursing students (n = 80) was taken as a sample in this study. A priori power analysis was implemented using G*Power software to determine an appropriate and statistically valid sample size. The parameters included a medium effect size (Cohen’s d = 0.3), an alpha level of 0.05, and a power level of 0.80 to detect a true effect, minimizing the risk of Type I and Type II errors ( 73 ). The calculated sample size was 71 undergraduate nursing students. To account for potential 10% attrition rate, the recruitment target was adjusted to 78 undergraduate nursing students. 3.6 Eligibility Criteria Undergraduate nursing students enrolled in BSN generic program who were in 2nd year and had recently started clinical rotation were included in the study. Students in the 1st year were excluded because they had no clinical experience. Students in the 3rd and 4th year were also excluded because their levels of stress may have decreased dramatically over time due to increased familiarity with environment and adopting coping techniques. Undergraduate nursing students who were already using any meditation therapy were excluded from study as they could confound the effect of intervention and results of study. 3.7 Data Collection Tool The data collection instrument was consisted of two sections. The first part comprised of self-developed demographic characteristics based on the information obtained from previous studies. The demographic factors such as age, region, and academic background were used to scrutinize the degree of influence of these factors on undergraduate nursing students stress. The second part of questionnaire was DASS-42(14 stress items). The stress subscale of the Depression, Anxiety, and Stress Scale (DASS-42), developed by ( 34 ), is a standardized, validated, and widely used instrument for assessing stress symptoms in both clinical and non-clinical populations. It consists of 14 measures that particularly assess chronic non-specific arousal and persistent psychological tension. These items assess factors such as trouble relaxing, anxious arousal, irritability, impatience, over-reactivity, and being easily irritated or agitated. To measure each item’s response, a four point Likert scale was utilized (never: 0, sometimes: 1, often: 2, almost always: 3). The total stress score ranges between 0–42 with higher scores indicating greater stress. The severity of stress is categorized as follows: Normal (0–14), Mild ( 15 – 18 ), Moderate ( 19 – 25 ), Severe ( 26 – 33 ), and Extremely Severe ( 34 – 42 ). The DASS-42 stress subscale reveals strong psychometric properties, with a Cronbach alpha of 0.93, indicating high internal consistency and reliability in measuring stress levels ( 74 ). 3.8 Pilot Testing Pilot testing was performed to assess the validity and reliability of research instrument in context of Pakistan. 3.8.1 Validity of Instrument A panel of five subject-matter experts from the Department of Health Professions Education at NUMS examined the questionnaire to ensure its content validity in the local context. The experts evaluated each item's relevancy, intelligibility, and cultural appropriateness in the Pakistani context. Content validity ratio was established by Lawshe (1975) as a linear translation of a degree of agreement that is proportionate to how many experts within the panel rate an item as "essential." The CVR is determined as follows: CVR= (Ne - N/2)/(N/2) By using the formula for instrument CVR= (Ne - N/2)/(N/2) = 5 − 5/25/2 = 5−(2.5) x (2.5) = (2.5) x (2.5) = 1 The CVR value of 1 indicates a high level of agreement among experts, demonstrating the tool's strong content validity ( 57 ). This comprehensive validation method ensured that the DASS-42 stress subscale maintained its psychometric consistency and was suitable for evaluating perceived stress among undergraduate nursing students in this setting. 3.8.2 Reliability of Instrument The internal consistency of the stress subscale of DASS-42 was evaluated in this study to ensure the measurement tool's accuracy and dependability. The Cronbach's alpha coefficient was used to examine reliability, and it generated a value of 0.80 for the 14 stress-related questions. A Cronbach’s alpha above 0.70 is generally considered acceptable, and a value of 0.80 suggests that the items within the stress subscale are homogenous and reliably measure the construct of stress. This supports the appropriateness of the stress subscale of DASS-42 for evaluating stress levels in this context. 3.8 Ethical Consideration The study protocol was approved by the Ethical Review Committee (ERC) of Armed Forces Post Graduate Medical Institute (Re:569-AAA-ERC-AFPGMI). Moreover, before initiating the data collection process, setting permission was obtained by competent authority of college of nursing AFPGMI RWP. The purpose of study was explained to study participants and obtained written informed consent. Confidentiality and anonymity of data was maintained throughout the study. In terms of benefits, all the participants received information booklet on MBSR intervention before commencement of intervention. No direct risks were related with participation in this study. 3.9 Data Collection Process The data was collected by researcher using Google forms via WhatsApp after permission from ERC AFPGMI RWP and targeted setting. The primary researcher briefed the study participants about the purpose and process of research study. This ensured consistency and uniformity of the data collection process. After taking informed consent, the data were collected on demographics and on T0 stress scores. Data was collected at times convenient for study participants without interrupting their daily classes schedule. Pre-test (T0) assessment was conducted to assess the base-line stress levels of undergraduate nursing students one week before commencement of interventions. This ensured the accurate representation of the participants' stress status prior to the intervention's influence. On the day of first intervention session, a booklet containing the information regarding MBSR was provided to students for guidance throughout the sessions. The content of the booklet was a modified MBSR program, adapted from Dr Jon Kabt Zinn MBSR Intervention guide. The researcher executed 8-weeks mindfulness-based stress reduction interventions (1 session/week, 1.5 hours each) which was supervised by a certified psychologist, delivered in-person. Post-test (T1) was carried out to analyze post-interventional level of stress of undergraduate nursing students one week after the interventional therapy. This time frame was selected for a more accurate assessment of the sustained and practical effects of the intervention rather than capturing immediate, short-term responses. Additionally, a follow-up assessment (T2) was conducted one month after the completion of the intervention to measure the sustainability of its effects. The follow-up data also provided insights into participants’ continued engagement with mindfulness practices and their perceived benefits. 3.10 Intervention The intervention adapted by primary researcher was eight week MBSR group intervention centered on the core principles and practices of MBSR. Consequently, there was a final structured module comprised of 1.5 hour weekly group sessions and 20 minutes of informal mindfulness practice over the course of 8 weeks. The intervention content is described according to weekly schedule as follows: WEEK 1 An outline and purpose of intervention was familiarized. The instructions were centered on the body's reaction to stress, the relaxation response, and its physiological implications. There was discussion about MBSR's mechanism. The MBSR handbooks and group guidelines, such as consistent attendance, at-home routines, and record keeping, were discussed and explained. A guided meditation exercise was used to explain and demonstrate attention processes that are connected to the practice of mindfulness meditation. Nursing students were guided through an activity of focusing on full and relaxed breathing and awareness of physiological sensations. Home practices and daily records were assigned and described. WEEK 2 There were group discussions on home practices. Mindful practice of breathing was introduced in this session. Through breathing exercises, the reciprocal relationship between the patterns of breathing and emotional response was systematically explored. WEEK 3 Exercises centered on mindful eating (such as raisins exercises) were introduced for participants. Mindful eating a raisin involves fully engaging your senses to savor the experience, from observing its appearance and texture to noticing its taste and chewing it slowly, promoting a deeper connection with food. WEEK 4 Mindful movement comprises of practices directed at moving the body in an intentional way to cultivate present-moment awareness. The example of these mindful movements was on introducing mindfulness standing yoga and gentle yoga stretches. These practices focused on fostering both physical relaxation and mental awareness. Other example was a walking meditation where the focus is on walking with the intention of cultivating present-moment awareness and a sense of compassion. WEEK 5 Mindful sitting with choice-less awareness was the theme of this week. The relationship between emotion and cognition was discussed. The application of mindfulness to the awareness of cognitive processes was explored. The characteristics of illogical assumptions, beliefs, and cognitive distortions were explicated. Students were given homework that involved self-monitoring their cognitive assessment in relation to stressful situations and practice. WEEK 6 The principles and techniques of meditation were expanded upon with a body scan activity that guides participants in sensing kinesthetic feedback from every part of their body. Moreover, along with body scanning, Visualization was also practiced in which participants used mental imagery to enhance relaxation and positive emotions. The relationship between mental images and physical reactions was the main focus of visualization. WEEK 7 Mindful communication and love-kindness mediation was exercised. The focus in this session was on enhancing interpersonal communication skills. The purpose behind Loving-kindness meditation, also known as Metta, was to cultivate goodwill towards oneself and others. WEEK 8 This session was the choice of participants. Practice of mindfulness breathing, mindfulness sitting, or yoga was exercised according student’s wish. All mindfulness techniques and practices were reviewed and discussed. 3.11 Data Analysis 3.11.1 Data Management Data was managed by assigning serial numbers to each data file of every participant. Data for T0, T1, and T2 were labelled separately for identification. The Epi-data software version 3.1 was used for data entry. Each data set was checked for accuracy and completeness. Double entry of data was performed by an expert data entry operator to ensure accuracy and reliability. Both data sets were compared for any inconsistency or missing data and correction were made accordingly. After completing data entry and cleaning process, the data was coded and transferred to coding sheets, then entered into Statistical Package for Social Sciences (SPSS- version 26) for quantitative analysis. 3.11.2 Data Analysis Plan The analysis of data was carried out through both descriptive and inferential statistics. Descriptive Statistics The demographic information such as age, academic background and region were analyzed using frequencies and percentages. Participants responses for each question pertaining to stress were evaluated by computing means and standard deviation for every question item. Inferential statistics Before application of any statistical test, a normality test was conducted to check the parametric and non-parametric nature of the data. As the data was parametric, the t-test and ANOVA were used to examine the mean difference of age, region, and academic background on stress level of undergraduate nursing students stress. Paired t-test was used to calculate mean differences between base-line, post intervention and follow-up data regarding stress among undergraduate nursing students. 4. RESULTS 4.1. Descriptive Statistics A- Demographic Information A total of 80 undergraduate nursing students of 2nd year, who had recently started their clinical rotation, completed the study process and were included in the analysis. The demographic characteristics of the participants were analyzed using percentage distributions. This included variables such as age group, educational level, and region (rural or urban). Demographic profile is illustrated in Fig. 7 . As shown in Fig. 4.1, the majority of the study participants (55%) were between 20–22 years of age, followed by 30% in the 23–25 age group, and 15% in the 26–28 age group. This reflects that the sample primarily comprised younger adults typically enrolled in undergraduate nursing programs. In terms of regional distribution, a slightly higher proportion of students (52.5%) were from urban areas, while 47.5% came from rural backgrounds, indicating a relatively balanced representation from both settings. Regarding educational background, most of the participants (68.8%) had completed their FSC (Faculty of Science), whereas 31.3% held a BSC (Bachelor of Science) degree prior to entering nursing education. This shows a predominance of students entering nursing after intermediate-level science education, although a significant portion had prior university-level academic exposure. These demographic characteristics provide insight into the diverse yet youthful and academically inclined profile of the nursing student population included in this study. B- Percentage responses of the participants about questionnaire : By computing the mean and standard deviation for each item on the DASS-42 stress subscale, we examined the participants’ responses regarding their stress symptoms at three stages: pre-intervention, post-intervention, and follow-up. Statistical analysis was used to assess various domains of stress such as difficulty relaxing, nervous tension, irritability, and overreacting to situations. Responses were collected using a 4-point Likert scale ranging from 0 (Never) to 3 (Almost Always). Table 1 Percentage Response for Level of Stress Among Undergraduate Nursing Students Prior to Intervention No Stress Items N ST OF AA Mean ± SD 1 S1 18.8 13.8 31.3 36.3 1.85 ± 1.115 2 S2 16.3 28.7 31.3 23.8 1.63 ± 1.023 3 S3 12.5 21.3 36.3 30.0 1.84 ± .999 4 S4 13.8 16.3 42.5 27.5 1.84 ± .987 5 S5 11.3 18.8 36.3 33.8 1.93 ± .991 6 S6 5.0 32.5 31.3 31.3 1.89 ± .914 7 S7 8.8 17.5 35.0 38.8 2.04 ± .961 8 S8 5.0 25.0 30.0 40.0 2.05 ± .926 9 S9 10.0 18.8 27.5 43.8 2.05 ± 1.018 10 S10 6.3 20.0 38.8 35.0 2.03 ± .900 11 S11 15.0 15.0 40.0 30.0 1.85 ± 1.020 12 S12 6.3 17.5 35.0 41.3 2.11 ± .914 13 S13 41.3 21.3 1.3 36.3 1.33 ± 1.339 14 S14 18.8 21.3 30.0 30.0 1.71 ± 1.093 Pre-intervention Stress level Total stress score = 26.15 Mean item score = 1.86 [*N = Never(0), ST = Sometimes( 1 ), OF = Often( 2 ), AA = Almost Always( 3 )] The Table 1 represents the analysis of pre-intervention data, as measured by the Depression Anxiety Stress Scales-42 (DASS-42) stress subscale, resulted in a total stress score of 26.15 and mean item score of 1.86. According to the DASS-42 stress severity classification, a total score ranging from 26 to 33 falls under the category of severe stress This classification reflects a high level of stress among participants prior to the administration of the MBSR intervention. Further analysis of individual stress items showed that the highest mean scores were observed for items such as “I was in a state of nervous tension” (2.11), “I found that I was very irritable” (2.05), and “I found myself getting touchy” (2.05), indicating that participants frequently experienced emotional irritability, nervous energy, and heightened sensitivity in their day-to-day functioning. These high-frequency responses reflect common psychological manifestations of stress among nursing students, possibly attributed to academic workload, clinical responsibilities, and transitional life stages. In contrast, items such as “I was intolerant of anything that kept me from getting on with what I was doing” showed relatively lower mean scores (1.33), suggesting that task-related frustration was less commonly reported. Nevertheless, the item variability underscores the multidimensional nature of stress symptoms, encompassing both physiological arousal and emotional reactivity. Table 2 Percentage responses for Level of Stress Among Undergraduate Nursing Students after Intervention No Stress items N ST OF AA Mean ± SD 1 S1 51.2 37.5 10.0 1.3 .61 ± .720 2 S2 38.8 42.5 16.3 2.5 .83 ± .792 3 S3 52.2 35.0 12.5 00 .60 ± .704 4 S4 53.8 35.0 11.3 00 .57 ± .689 5 S5 50.0 33.8 11.3 5.0 .71 ± .860 6 S6 42.5 42.5 11.3 3.8 .76 ± .799 7 S7 53.8 33.8 10.0 2.5 .61 ± .771 8 S8 57.5 32.5 6.3 3.8 .56 ± .777 9 S9 52.5 35.0 12.5 00 .60 ± .704 10 S10 38.8 41.3 15.0 5.0 .86 ± .853 11 S11 41.3 42.5 12.5 3.8 .79 ± .807 12 S12 55.0 36.3 7.5 1.3 .55 ± .692 13 S13 51.2 40.0 7.5 1.3 .59 ± .688 14 S14 65.0 26.3 7.5 1.3 .45 ± .692 Post-intervention Stress level Total stress score = 9.09 Mean item score = 0.64 [*N = Never (0), ST = Sometimes ( 1 ), OF = Often ( 2 ), AA = Almost Always ( 3 )] Table 2 presents the descriptive statistics of post-intervention stress levels among undergraduate nursing students, as measured by the DASS-42 stress subscale. The results shown in table 4.3 reveal a decline in stress, with total stress score of 9.09 and a mean item score of 0.64. According to the DASS-42 severity classification, a total score between 0–14 is categorized as “normal”, suggesting that the overall stress level among participants significantly decreased following the eight-week MBSR intervention. Item-wise analysis revealed that the lowest post-intervention mean scores were observed in stress items such as “I found myself getting agitated” (0.45), “I was in a state of nervous tension” (0.55), and “I was intolerant of anything that kept me from getting on with what I was doing” (0.59). These reductions put forward the effectiveness of intervention in addressing stress-related arousal and task-related frustrations. Although some items such as “I found it hard to calm down after something upset me” (0.86) and “I found myself getting upset by quite trivial things” (0.83) showed relatively higher post-intervention means, these were still well below the pre-intervention levels and remained within the normal range. Overall, the post-intervention findings highlighted the effectiveness of MBSR in alleviating stress among undergraduate nursing students. The sharp decline in stress levels from the pre-intervention “severe” range (mean score = 1.86) to post-intervention “normal” range (mean score = 0.64) underscores the positive psychological impact of mindfulness practices. Table 3 Percentage Responses for Level of Stress Among Undergraduate Nursing Student at follow-up No Stress items N ST OF AA Mean ± SD 1 S1 61.3 33.8 3.8 1.3 .45 ± .634 2 S2 53.8 37.5 6.3 2.5 .57 ± .725 3 S3 60.0 33.8 6.3 00 .46 ± .615 4 S4 62.5 32.5 5.0 00 .43 ± .591 5 S5 66.3 30.0 2.5 1.3 .39 ± .606 6 S6 52.5 40.0 3.8 3.8 .59 ± .741 7 S7 63.7 32.5 1.3 2.5 .43 ± .652 8 S8 62.5 31.3 2.5 3.8 .48 ± .729 9 S9 67.5 31.3 1.3 00 .34 ± .502 10 S10 55.0 38.8 2.5 3.8 .55 ± .727 11 S11 55.0 40.0 2.5 2.5 .53 ± .675 12 S12 63.7 33.8 1.3 1.3 .40 ± .587 13 S13 60.0 36.3 2.5 1.3 .45 ± .614 14 S14 71.3 23.8 3.8 1.3 .35 ± .618 Follow-up Stress level Total stress score = 6.42 Mean item score = 0.45 [*N = Never (0), ST = Sometimes ( 1 ), OF = Often ( 2 ), AA = Almost Always ( 3 )] As presented in Table 3 , the follow-up findings demonstrated a sustained reduction in stress levels among undergraduate nursing students after the initial MBSR intervention. The total stress score was 5.62 and mean item score was 0.40, which lies within the “normal” range according to the DASS-42 stress subscale severity classification (0–14). This indicates that not only was the intervention effective in the short term, but its impact on stress reduction persisted over time, even at follow-up. Most participants responded “never” or “sometimes” across all 14 stress items, reflecting minimal stress symptoms. The highest proportion of “never” responses was seen in items such as “I found myself getting agitated” (71.3%), “I felt that I was rather touchy” (67.5%), and “I found myself using a lot of nervous energy” (66.3%). These responses indicate that emotional arousal and irritability had significantly subsided among participants. Additionally, items such as “I found it hard to wind down” (61.3%) and “I was in a state of nervous tension” (63.7%) also had a majority reporting "never," further suggesting improvement in relaxation and emotional regulation. The mean scores across all items ranged between 0.34 and 0.59, showing consistency in stress reduction. Items that previously recorded higher means during the pre-intervention phase, such as “I found it hard to calm down after something upset me” and “I was very irritable”, showed substantial decreases during follow-up (0.55 and 0.48, respectively). While slight variability in standard deviations was observed, the overall pattern indicated stable improvements in stress response and coping. These results confirm the long-term efficacy of the MBSR intervention, with participants continuing to experience reduced levels of stress beyond the immediate post-intervention phase. 4.2. Inferential Statistics Prior to conducting inferential analysis, a normality test was conducted using both the Kolmogorov-Smirnov and Shapiro-Wilk tests to examine the distribution of stress scores at pre-test, post-test, and follow-up phases. For a sample size of 80, the Shapiro–Wilk test was preferred due to its higher sensitivity for moderate-sized samples. The results revealed non-significant p-values for all variables (pre-test: p = 0.402; post-test: p = 0.137; follow-up: p = 0.361), indicating that the data were normally distributed. Consequently, parametric statistical tests such as the Repeated Measure ANOVA, T test and ANOVA were deemed appropriate for further inferential analysis. The repeated measures ANOVA was conducted to examine changes in stress levels across three time points: pre-test, post-test, and follow-up. As depicted in Table 4 , the Multivariate Tests indicated a highly significant effect of Time on stress levels, with Pillai’s Trace = .899, F( 2 , 78 ) = 345.76, p = .000, and a very large effect size (Partial Eta Squared = .899). Consistent significance across Wilks’ Lambda, Hotelling’s Trace, and Roy’s Largest Root further confirms that stress scores changed substantially over the three measurement points. This demonstrates a robust effect of the MBSR intervention on reducing stress over time. Table 4 illustrates Multivariate tests. Table 4 Multivariate Tests Effect Value F Hypothesis df Error df Sig. Partial Eta Squared Time Pillai's Trace .899 345.757 2.000 78.000 .000 .899 Wilks' Lambda .101 345.757 2.000 78.000 .000 .899 Hotelling's Trace 8.866 345.757 2.000 78.000 .000 .899 Roy's Largest Root 8.866 345.757 2.000 78.000 .000 .899 In the Table 5 , the Tests of Within-Subjects Contrasts revealed that both the linear and quadratic components of Time were statistically significant. The linear tendency was very strong (F( 1 , 79 ) = 611.99, p = .000, Partial Eta Squared = .886), indicating a consistent, substantial decrease in stress across the three measurements. The quadratic tendency (F( 1 , 79 ) = 93.85, p = .000, Partial Eta Squared = .543) suggests that the reduction was steeper immediately after the intervention and continued to decline, but at a slower pace, toward the follow-up. These findings confirm both immediate and continued improvements after the MBSR program. Table 5 describes tests of Within-Subject Contrasts. Table 5 Tests of Within-Subjects Contrasts Source Time Type III Sum of Squares df Mean Square F Sig. Partial Eta Squared Time Linear 15563.025 1 15563.025 611.993 .000 .886 Quadratic 2736.075 1 2736.075 93.845 .000 .543 Error (Time) Linear 2008.975 79 25.430 Quadratic 2303.258 79 29.155 In the Table 6 , the Tests of Between-Subjects Effects showed a highly significant intercept (F( 1 , 79 ) = 1264.36, p = .000, Partial Eta Squared = .941), demonstrating that the overall average stress level across participants was significantly different from zero and indicating substantial variability in stress levels explained by the intervention period. Table 6 reveals Tests of between-subjects effects. Table 6 Tests of Between-Subjects Effects Source Type III Sum of Squares df Mean Square F Sig. Partial Eta Squared Intercept 46203.750 1 46203.750 1264.358 .000 .941 Error 2886.917 79 36.543 In Table 7 , The Bonferroni-adjusted pairwise comparisons demonstrated statistically significant differences in mean stress scores across the three measurement points, pre-intervention (T 0 ), post-intervention (T 1 ), and follow-up (T 2 ). All comparisons yielded p-values of .000, indicating highly significant differences that remained below the conventional α = .05 threshold, even after applying Bonferroni adjustments for multiple comparisons. The comparison between Time 0 and Time 1 revealed a mean difference of 17.03, indicating a substantial reduction in stress immediately following the MBSR intervention. When comparing Time 0 with Time 2, the mean difference increased to 19.73, suggesting not only an immediate effect but also a continued decline in stress levels by the follow-up period. Similarly, the comparison between Time 1 and Time 2 produced a statistically significant mean difference of 2.70, reflecting further improvement. Although smaller in magnitude, this change indicates sustained and progressively enhanced stress reduction. Table 7 demonstrates pairwise comparison of mean stress scores. Table 7 Pairwise Comparison of mean stress scores across time points (pre-intervention, post-intervention, and follow-up) (I) Time (J) Time Mean Difference (I-J) Std. Error Sig 0 1 17.025 * 1.050 .000 2 19.725 * .797 .000 1 0 -17.025 * 1.050 .000 2 2.700 * .556 .000 2 0 -19.725 * .797 .000 1 -2.700 * .556 .000 Based on these findings, we reject null hypothesis and accept alternative hypothesis (H₁), confirming that the intervention significantly reduced stress levels across all stages of measurement. These results highlight the efficacy of the stress reduction strategy likely a mindfulness-based or cognitive-behavioral intervention in promoting psychological resilience. Furthermore, the statistically significant outcomes support the incorporation of such interventions into nursing education as a proactive measure to manage academic and clinical stress, improve mental health outcomes, and enhance overall student well-being. In Table 8 , a one-way ANOVA was conducted to determine whether there were statistically significant differences in post-interventional stress levels among different age groups. The analysis revealed a between-group sum of squares of 187.47, with an F-ratio of 2.049 and a p-value of 0.136. These results indicate that there were no statistically significant differences in post-intervention stress scores among the different age categories. Despite slight variations, the effectiveness of the MBSR program appeared consistent across age groups, implying that age did not substantially influence stress reduction outcomes. The null hypothesis regarding age is accepted. Table 8 Mean Difference in Post- Interventional Stress Level of Undergraduate Nursing Students on the Basis of Age Age Sum of Squares df Mean Square F Sig. Between age groups 187.473 2 93.736 2.049 .136 Within age groups 3521.727 77 45.737 Total 3709.200 79 Table 9 explores the mean post-intervention stress levels among students based on their prior educational qualification (FSC vs. BSC). The results showed that students with FSC background (n = 55) had a mean stress score of 9.15 (SD = 7.53), while those with a BSc background (n = 25) had a nearly similar score of 9.00 (SD = 5.18). The t-test value was 0.087 with a p-value of 0.931, indicating a highly non-significant difference between the two educational groups. This suggests that the MBSR intervention was equally effective across different educational backgrounds, and educational level did not influence the degree of stress reduction. The null hypothesis regarding educational level is accepted. Table 9 Mean Difference in Post- Interventional Stress Level of Undergraduate Nursing Students on the Basis of Educational level Variable Education level N Mean Std. Deviation Std. Error Mean t value df sig Total Stress Post FSC 55 9.1455 7.53367 1.01584 .087 78 .931 BSC 25 9.0000 5.18009 1.03602 As presented in Table 10 , the post-interventional stress levels of undergraduate nursing students were compared between students from rural and urban backgrounds. The rural group (n = 38) had a higher mean stress score of 10.45 (SD = 7.41) compared to the urban group (n = 42), which reported a lower mean of 7.88 (SD = 6.15). However, the independent samples t-test yielded a t-value of 1.693 with a p-value of 0.095, which exceeds the standard alpha level of 0.05. This indicates that the observed difference in mean stress scores between rural and urban students after the MBSR intervention was not statistically significant. The null hypothesis regarding region is failed to reject. Table 10 Mean Difference in Post- Interventional Stress Level of Undergraduate Nursing Students on the Basis of Region Variable Region N Mean Std. Deviation Std. Error Mean t value df sig Total Stress Post Rural 38 10.4474 7.40598 1.20141 1.693 78 .095 Urban 42 7.8810 6.14540 .94826 5.DISCUSSION The results of present study revealed alarmingly high stress levels among nursing students prior to the MBSR intervention, a finding that echoes the persistent challenge faced by nursing students transitioning from didactic education to the practical challenges of clinical placements. Remarkably, second-year students often experience their first substantive clinical exposure, which places them in unfamiliar, high-stakes environments, contributing to stress. These conclusions are consistent with growing body of literature highlighting the prevalence of high level of stress among nursing students, particularly during their early academic years when they are first exposed to clinical settings while balancing academic and clinical responsibilities simultaneously ( 46 , 75 , 76 ). The current study emphasizes that the dominant stressors are not solely academic but ties to the emotional intensity of early clinical encounters. Similarly, ( 1 ) reported that clinical practice, work load, and increased responsibility for patient care were critical contributors to elevated stress levels among 79.9% nursing students. ( 18 ) observed that students experienced stress before, during, and after clinical practice, primarily due to feeling unprepared and lacking sufficient time to ensure safe and competent care, a phenomenon echoed in the present study’s high mean scores in stress items related to overreaction and emotional dysregulation. Consistent with these findings, ( 77 ) reported that Saudi nursing students experienced high stress during clinical training, primarily due to fear of making mistakes and harming patients. Similarly, ( 78 ) observed that clinical stress was the predominant source of distress among Pakistani nursing students, reinforcing the relevance of these findings in the local context. The consistency across these studies underscores the universality of stress as a prevalent issue in nursing education, irrespective of cultural or institutional context. However, some studies have reported comparatively lower stress levels. For example, ( 79 ) found moderate academic and clinical stress among nursing students, with primary stressors including criticism from instructors (56.0%), encountering dying patients (52.3%), and fear of committing errors (51.4%). This variation may be attributed to differences in students’ academic year or timing of clinical exposure. Similarly, ( 80 ) reported moderate stress levels, but these were primarily attributed to academic performance rather than clinical demands, in contrast to the present study’s findings. The salient findings of this study demonstrated a marked reduction in stress levels following the 8 weeks’ mindfulness-based stress reduction intervention, with further decline observed at fifth-week follow-up. This pattern reflects both immediate and sustained effects of MBSR intervention, suggesting that nursing students integrated mindfulness techniques into their daily routines. This enabled them to manage academic and clinical challenges, regulate emotions, and maintain focus. The positive effect of the MBSR intervention in this study corroborates a substantial body of global research evidence supporting its effectiveness in reducing stress among nursing and healthcare students. For instance, multiple randomized controlled trials across diverse population and settings have consistently revealed significant reduction in stress, anxiety and depression while enhancing mindfulness among nursing students ( 28 , 52 , 53 , 65 , 73 , 81 ). Moreover, ( 21 )demonstrated that first-year nursing students undergoing their initial clinical placements experienced significant stress reduction after engaging in mindfulness practice, thereby supporting the contextual relevance of the current results. The alignment of our findings with these studies suggests that MBSR is a context-sensitive and highly adaptable intervention across diverse cultural, educational, and clinical settings. In line with this, ( 32 ) reported that mindfulness training was also effective in improving students’ emotional balance, ethical awareness, and clinical readiness. ( 82 ) further demonstrated that even brief, regular meditation practice led to sustained improvements in emotional regulation and attentional control. These results parallel the present study’s findings across multiple emotional stress indicators such as irritability, touchiness, impatience, suggesting that MBSR not only mitigates stress but also enhances the underlying cognitive-emotional capacities such as stability, ethical decision-making, and sustained focus, that are essential for nursing competence in high-pressure clinical settings. The current study’s findings revealed that structured face-to-face mindfulness intervention resulted in a significant and enduring reduction in stress probably due to higher participant engagement, real-time instructor feedback, and the supporting dynamics of peer interaction. In contrast, ( 71 ) reported only modest stress reduction following an online asynchronous mindfulness intervention. This could be attributed to minimum interpersonal connection, fewer opportunities for immediate clarification, and diminished group cohesion. These variations underscore the importance of delivery format in optimizing the effectiveness of MBSR, indicating that in-person therapies might foster deeper skill acquisition and longer-term psychological effects as compared to asynchronous online approaches. Moreover, the most crucial aspect of the findings is the sustained reduction in stress levels observed at follow-up. The follow-up findings underscore the long-term effectiveness of the MBSR intervention, demonstrating sustained reductions in stress beyond the immediate post-intervention phase. This continued improvement highlights the enduring psychological benefits of mindfulness practices. These results are in concordance with long-term studies of mindfulness interventions. In line with this, ( 63 ) demonstrated that nursing students who engaged in an 8-week mindfulness-based intervention showed statistically significant reduction in perceived stress and increase in mindfulness at two-month and six-month follow-ups, underscoring the benefits of sustained practice. ( 52 ) found sustained reductions in physiological stress markers following a 12-week mindfulness program, aligning with this study’s follow-up outcome. ( 66 ) similarly reported long-term decreases in perceived stress and enhanced emotional resilience in nurses after MBSR. Despite differences in populations and outcomes, both studies support the sustained efficacy of mindfulness interventions. These findings reinforce the present study’s evidence of long-term stress reduction among nursing students. Importantly, the observed follow-up outcomes also align with qualitative evidence from similar settings. For example, ( 14 ) noted that students who practiced mindfulness reported increased emotional stability, better time management, and improved coping strategies even months after the intervention. Likewise, ( 13 ) found that students exposed to mindfulness training perceived a greater sense of control over their emotions and environment during subsequent clinical rotations. The current study demonstrated no statistically significant variations in post-intervention stress levels based on age, educational level, or region. The participants, predominantly aged 20–22 years, represents a cohort generally more vulnerable to stress due to limited coping skills and early clinical exposure ( 51 , 83 ). The balanced proportion of rural and urban backgrounds and varied educational qualifications indicates that the MBSR intervention was effective across demographic subgroups. This is in line with prior evidence showing that mindfulness-based intervention delivers comparable psychological benefits regardless of educational background or geographic origin ( 33 , 37 ). Consistent with ( 69 ), similar stress reductions were observed across students from diverse backgrounds. While ( 56 ) reported non-significant demographic associations at the pre-test stage, both studies confirm that stress outcomes are largely independent of demographic factors. These findings reinforce MBSR’s universality, suggesting its value as an equitable, adaptable stress management strategy within nursing curricula ( 53 , 84 ). 5.1 Conclusion The findings of this study provide compelling evidence that an eight-week mindfulness-based stress reduction (MBSR) intervention can effectively reduce stress among undergraduate nursing students, particularly during their early clinical exposure. The intervention was well-received by participants and demonstrated significant improvement across emotional, behavioral, and cognitive stress domains. These findings underscore the value of embedding mindfulness into nursing education as a sustainable strategy to strengthen resilience, enhance well-being, and prepare future nurses for the psychological demands of professional practice. Moreover, the positive response from students highlights the acceptability and practicality of integrating mindfulness practices into academic and clinical training environments. 5.2 Recommendations Nursing institutions can formally integrate Mindfulness-Based Stress Reduction (MBSR) modules into their academic curriculum to foster resilience, enhance self-regulation, and mitigate stress during clinical education. These modules should include weekly sessions focused on guided meditation, mindful breathing, and body scan practices. Pre-clinical orientation programs may include mindfulness training to better prepare students for high-stress clinical environments. Simulation-based sessions and reflective journaling can be used to strengthen self-awareness and reduce anticipatory anxiety. Faculty and clinical preceptors can receive training to deliver and model mindfulness practices. Leadership development workshops emphasizing emotional intelligence, mindful communication, and stress management should be conducted. Mindfulness practice groups led by senior students or trained peers can be encouraged to create a collaborative learning environment. These groups should provide a safe space for discussion, shared experiences, and stress debriefing. Policymakers and curriculum developers may use these findings to design large-scale mindfulness-based initiatives. National strategies can standardize supportive learning environments in both academic and clinical contexts. Future research should replicate the study across multiple nursing colleges and universities to enhance the generalizability of the findings. Implementing RCTs with control groups would strengthen the internal validity and provide stronger evidence of causality between MBSR and stress reduction. Future research should include long-term follow-up assessments to evaluate the sustainability of stress reduction and mindfulness practice over time. Mixed-method or qualitative studies are recommended to capture in-depth student experiences, challenges in practicing mindfulness, and contextual factors affecting intervention outcomes. Future researches should investigate the comparative effectiveness of different MBSR delivery models, including face-to-face, online, and hybrid formats, to determine the most accessible and efficient approach for students. 5.3 Limitations This study was conducted at a single nursing institution and included only second-year undergraduate students, limiting the generalizability of findings to broader nursing populations or other academic years. The study employed a quasi-experimental one-group pretest-posttest design, which did not include a control group, thereby restricting the ability to make causal inferences. Potential confounding variables such as prior mental health status, personality traits, or external stressors were not controlled. Additionally, the use of self-reported measures (DASS-42) may have introduced response bias, including social desirability or inaccurate self-perception. Adherence to home-based mindfulness practices was not monitored, which may affect the consistency of intervention exposure. Finally, the short follow-up period did not allow for a comprehensive assessment of long-term intervention effects. Abbreviations MBSR Mindfulness-based stress reduction ERC Ethical review Committee CON College of Nursing AFPGMI Armed forces post graduate medical RWP Rawalpindi DASS Depression anxiety stress scale CAM Complementary and Alternative Medicine ACTH Adrenocorticotropic hormone Declarations Funding No funding for research was provided. Competing Interests The authors declare that they have no competing interests Clinical Trial Clinical trial not applicable Consent for Publication Not applicable. Data Availability The datasets analyzed during the current study are available from the corresponding author upon reasonable request. Ethics Approval Ethical approval for this study was obtained from the relevant Ethical Review Committee (Re:569-AAA-ERC-AFPGMI) prior to data collection. Ethics Standard Statement The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Consent to Participate Written informed consent was obtained from all participants prior to participation in the study. Author’s Information TahsinRaana 1 E Mail: [email protected] Contact no: 03218755005 MSN Scholars College of Nursing Armed Forces Post Graduate Medical Institute Rawalpindi, Pakistan Fozia Fatima 2 E Mail: [email protected] Contact no: 03400150471 Assistant Professor, Department of Health Professions Education, National University of Medical Sciences, Rawalpindi, Pakistan Shazia Zaheer 3 E Mail: [email protected] Contact no: 03454757421 PhD Scholar, CMH Thal, Pakistan Nadira Nasim 4 E Mail: [email protected] Contact no: 03061608297 MSN Scholars College of Nursing Armed Forces Post Graduate Medical Institute Rawalpindi, Pakistan Uzma Shaheen 5 E Mail: [email protected] Contact no: 03139655288 MSN Scholars College of Nursing Armed Forces Post Graduate Medical Institute Rawalpindi, Pakistan Neelum Naz 6 E Mail: [email protected] Contact no: 03357515160 MSN Scholars College of Nursing Armed Forces Post Graduate Medical Institute Rawalpindi, Pakistan Corresponding Author Tahsin Raana E Mail: [email protected] Contact no: 03218755005 Author’s Contribution TR (Tahseen Raana) conceived and designed the study, developed and coordinated the Mindfulness-Based Stress Reduction intervention, conducted data collection, performed statistical analysis and interpretation, and drafted the manuscript. FF (Fozia Fatima) provided primary supervision, methodological guidance, oversight of the research process, and critically revised the manuscript for important intellectual content. SZ (Shazia Zaheer) contributed as co-supervisor by assisting in study design refinement, monitoring intervention implementation, and reviewing the manuscript. NN (Nadira Nasim) contributed to literature review of the manuscript for intellectual content. US (Uzma Shaheen) assisted with participant coordination, data collection support, and preliminary data management. NN (Neelum Naz) provided methodological guidance, and critically reviewed the final manuscript. All authors read and approved the final manuscript. Acknowledgements The authors thank the subjects who participated in the study. References Ali AAM, El-Sherbini HH. Academic Stress and Its Contributing Factors among Faculty Nursing Students in Alexandria. Alexandria (EG): Faculty of Nursing, Alexandria University; 2018. 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Random House Publishing Group; 2013. p. 722. Song Y, Lindquist R. Effects of mindfulness-based stress reduction on depression, anxiety, stress and mindfulness in Korean nursing students. Nurse Educ Today. 2015;35(1):86–90. Goodman MJ, Schorling JB. A Mindfulness Course Decreases Burnout and Improves Well-Being among Healthcare Providers. Int J Psychiatry Med. 2012;43(2):119–28. Gouda S, Luong MT, Schmidt S, Bauer J, Students. and Teachers Benefit from Mindfulness-Based Stress Reduction in a School-Embedded Pilot Study. Front Psychol [Internet]. 2016 Apr 26 [cited 2024 July 2];7. Available from: http://journal.frontiersin.org/Article/ 10.3389/fpsyg.2016.00590/abstract Liu Y, Liu Y, Wang C. The effect of mindfulness meditation on academic performance of students in Kunming, China. Proc Int Conf Educ Innov. Paris: Atlantis; 2022. pp. 112–8. Sanko J, Mckay M, Rogers S. Exploring the impact of mindfulness meditation training in pre-licensure and post graduate nurses. 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Indian J Continuing Nurs Educ. 2020;21(2):171. Amanya SB, Nakitende J, Ngabirano TD. A cross-sectional study of stress and its sources among health professional students at Makerere University, Uganda. Nurs Open. 2018;5(1):70–6. Morey JN, Boggero IA, Scott AB, Segerstrom SC. Current directions in stress and human immune function. Curr Opin Psychol. 2015;5:13–7. Ribeiro ÍJS, Pereira R, Freire IV, De Oliveira BG, Casotti CA, Boery EN. Stress and Quality of Life Among University Students: A Systematic Literature Review. Health Professions Educ. 2018 June;4(2):70–7. McEwen BS, Akil H. Revisiting the Stress Concept: Implications for Affective Disorders. J Neurosci. 2020;40(1):12–21. Turkal M, Richardson LG, Cline T, Guimond ME. The effect of a mindfulness based stress reduction intervention on the perceived stress and burnout of RN students completing a doctor of nursing practice degree. JNEP. 2018;8(10):58. Goff AM, Stressors A, Performance, and Learned Resourcefulness in Baccalaureate Nursing Students. International Journal of Nursing Education Scholarship [Internet]. 2011 Jan 24 [cited 2024 June 28];8(1). Available from: https://www.degruyter.com/document/doi/ 10.2202/1548-923X.2114/html Cheung T, Yip P, Depression. Anxiety and Symptoms of Stress among Hong Kong Nurses: A Cross-sectional Study. IJERPH 2015 Sept 7;12(9):11072–100. Bartlett ML, Taylor H, Nelson JD. Comparison of Mental Health Characteristics and Stress Between Baccalaureate Nursing Students and Non-Nursing Students. J Nurs Educ. 2016;55(2):87–90. Afzal M. Sources of Stress among the Nursing Students of Private Universities of Pakistan. TIJNR [Internet]. 2016 July 22 [cited 2024 July 3];2(1). Available from: http://www.texilajournal.com/nursing/article/498-sources-of-stress Ajibade BL, Olabisi OO, Fabiyi B, Ajao OO, Ayeni AR. Stress, types of stressors and coping strategies amongst selected nursing schools students in South-West, Nigeria. Eur J Biology Med Sci Res. 2016;4(3):1–15. Galbraith ND, Brown KE. Assessing intervention effectiveness for reducing stress in student nurses: quantitative systematic review: Reducing stress in student nurses. J Adv Nurs. 2011;67(4):709–21. Lake J, Turner MS. Urgent Need for Improved Mental Health Care and a More Collaborative Model of Care. Perm J. 2017;21:17–024. Rafati F, Nouhi E, Sabzevari S, Dehghan-Nayeri N. Coping strategies of nursing students for dealing with stress in clinical setting: A qualitative study. Electron Physician. 2017;9(12):6120–8. Smith GD, Yang F. Stress, resilience and psychological well-being in Chinese undergraduate nursing students. Nurse Educ Today. 2017;49:90–5. Voss A, Bogdanski M, Langohr B, Albrecht R, Sandbothe M. Mindfulness-Based Student Training Leads to a Reduction in Physiological Evaluated Stress. Front Psychol. 2020;11:645. Yüksel A, Bahadır Yılmaz E. The effects of group mindfulness-based cognitive therapy in nursing students: A quasi-experimental study. Nurse Educ Today. 2020;85:104268. Lazarus P, Folkman P. Stress, Appraisal, and Coping. Springer Publishing Company; 1984. p. 460. Foureur M, Besley K, Burton G, Yu N, Crisp J. Enhancing the resilience of nurses and midwives: Pilot of a mindfulnessbased program for increased health, sense of coherence and decreased depression, anxiety and stress. Contemp Nurse. 2013;45(1):114–25. Gautam A, Palanivelu S, Kaur G. Effectiveness of mindfulness based stress reduction program (MBSR) on stress among nursing students- a mixed method study. Int J Community Med Public Health. 2020;7(9):3547. Creswell JD, Lindsay EK. How Does Mindfulness Training Affect Health? A Mindfulness Stress Buffering Account. Curr Dir Psychol Sci. 2014;23(6):401–7. Bergen-Cico D, Possemato K, Cheon S. Examining the Efficacy of a Brief Mindfulness-Based Stress Reduction (Brief MBSR) Program on Psychological Health. J Am Coll Health. 2013;61(6):348–60. Gu J, Strauss C, Bond R, Cavanagh K. How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clin Psychol Rev. 2015;37:1–12. Baer RA. Mindfulness-Based Treatment Approaches: Clinician’s Guide to Evidence Base and Applications. Elsevier; 2015. p. 452. Shapiro S, Siegel R, Neff KD. Paradoxes of Mindfulness. Mindfulness. 2018;9(6):1693–701. Koren ME. Mindfulness interventions for nursing students: application of modelling and role modelling theory. Int J Hum Caring. 2017;21(3):154–60. Liu YL, Lee CH, Wu LM. A mindfulness-based intervention improves perceived stress and mindfulness in university nursing students: a quasi-experimental study. Sci Rep. 2024 June;8(1):13220. Ksiksou J, Maskour L, Alaoui S. The impact of a mindfulness-based stress reduction training program on depression, anxiety, and stress in Moroccan nurses. Kontakt. 2023 Sept 21;25(3):200–6. Aye AL, Win HH, Thandar M, Oo SM. Effect of the mindfulness-based program on stress, anxiety and physiological changes among nurse aid students attending the 9 months course of nurse aid training in Myanmar. Int J Community Med Public Health. 2024 June;28(7):2554–62. Lin L, He G, Yan J, Gu C, Xie J. The Effects of a Modified Mindfulness-Based Stress Reduction Program for Nurses: A Randomized Controlled Trial. Workplace Health Saf. 2019;67(3):111–22. Zhang W, Ouyang Y, Tang F, Chen J, Li H. Breath-focused mindfulness alters early and late components during emotion regulation. Brain Cogn. 2019;135:103585. Snowden A, Stenhouse R, Young J, Carver H, Carver F, Brown N. The relationship between emotional intelligence, previous caring experience and mindfulness in student nurses and midwives: a cross sectional analysis. Nurse Educ Today. 2015;35(1):152–8. Van Der Riet P, Rossiter R, Kirby D, Dluzewska T, Harmon C. Piloting a stress management and mindfulness program for undergraduate nursing students: Student feedback and lessons learned. Nurse Educ Today. 2015;35(1):44–9. Dubert CJ, Schumacher AM, Locker L, Gutierrez AP, Barnes VA. Mindfulness and Emotion Regulation among Nursing Students: Investigating the Mediation Effect of Working Memory Capacity. Mindfulness. 2016;7(5):1061–70. Spadaro KC, Hunker DF. Exploring The effects Of An online asynchronous mindfulness meditation intervention with nursing students On Stress, mood, And Cognition: A descriptive study. Nurse Educ Today. 2016;39:163–9. Zeller JM, Johnson AM, Hoffman A, Hoyem RL, Alexander MB, Yudkowsky R, et al. Mindfulness Training to Improve Nurse Clinical Performance: A Pilot Study. West J Nurs Res. 2021;43(3):250–60. Irawan. Am A, Putri AP, Nisha M, Widiastuti A. The Effect of Mindfulness Meditation on Nursing Students’ Stress and Anxiety Levels. IJGHR 2024 Sept 2;7(1):1–8. Crawford JR, Henry JD. The Depression Anxiety Stress Scales (DASS): Normative data and latent structure in a large non-clinical sample. Br J Clin Psychol. 2003 June;42(2):111–31. Al-Zayyat AS, Al‐Gamal E. Perceived stress and coping strategies among J ordanian nursing students during clinical practice in psychiatric/mental health courses. Int J Mental Health Nurs. 2014;23(4):326–35. Abasimi E, Atindanbila S, Mahamah MM, Gai X. The Experience of Stress among Nursing Students in Nursing Training Colleges in Tamale, Ghana. Int J Psychol Behav Sci. 2015. Mohamed NA, Ali SO, Ehrahim EEE, Ahmed AL, Wahba AM. Predictors of Academic and Clinical Stress Among Nursing Students. SAGE Open Nursing [Internet]. 2024 Jan [cited 2025 July 27];10. Available from: https://journals.sagepub.com/doi/ 10.1177/23779608241290392 Ullah H, Arbab S, Liu C, Du Q, Khan SA, Khan S, et al. Sources of stress-associated factors among medical and nursing students: a cross-sectional study. BMC Med Educ. 2022;22(1):614. Yilmaz EB. Academic and clinical stress, stress resources and ways of coping among Turkish first-year nursing students in their first clinical practice. Kontakt 2016 Sept 30;18(3):e145–51. Shehadeh J, Hamdan-Mansour AM, Halasa SN, Hani MHB, Nabolsi MM, Thultheen I et al. Academic Stress and Self-Efficacy as Predictors of Academic Satisfaction among Nursing Students. TONURSJ. 2020 June 18;14(1):92–9. Verweij H, Van Ravesteijn H, Van Hooff MLM, Lagro-Janssen ALM, Speckens AEM. Mindfulness-Based Stress Reduction for Residents: A Randomized Controlled Trial. J GEN INTERN MED. 2018;33(4):429–36. Burger KG, Lockhart JS. Meditation’s Effect on Attentional Efficiency, Stress, and Mindfulness Characteristics of Nursing Students. J Nurs Educ. 2017 July;56(7):430–4. Sun FK, Long A, Tseng YS, Huang HM, You JH, Chiang CY. Undergraduate student nurses’ lived experiences of anxiety during their first clinical practicum: A phenomenological study. Nurse Educ Today. 2016;37:21–6. Dias JM, Subu MA, Al-Yateem N, Ahmed FR, Rahman SA, Abraham MS, et al. Nursing students’ stressors and coping strategies during their first clinical training: a qualitative study in the United Arab Emirates. BMC Nurs. 2024;23(1):322. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8496860","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":590410668,"identity":"ffc492fc-01cf-4cb0-ad4d-3a641d1417cd","order_by":0,"name":"Tahsin 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items)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8496860/v1/2f3b81b70efa71bc605586ab.png"},{"id":102963826,"identity":"05cfbbe8-b44b-4475-b3ae-fb5684cd56a0","added_by":"auto","created_at":"2026-02-19 04:20:39","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":94881,"visible":true,"origin":"","legend":"\u003cp\u003eMindfulness-Based Stress Reduction Module\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8496860/v1/f22564bbf881c852f2038da6.png"},{"id":102964048,"identity":"7bbd9e6b-81a5-44e6-afd1-91fdbc70028a","added_by":"auto","created_at":"2026-02-19 04:21:18","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":167548,"visible":true,"origin":"","legend":"\u003cp\u003eFig 4 : Self-care model from Modeling and Role-Modeling theory applied to Mindfulness Based Stress 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design\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-8496860/v1/d861e4557ea3af5708e1334f.png"},{"id":102894077,"identity":"19bd937c-12a4-45fa-93b2-2de54ca99d2e","added_by":"auto","created_at":"2026-02-18 05:59:12","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":47334,"visible":true,"origin":"","legend":"\u003cp\u003eFig 7: \u0026nbsp;Demographic Profile of participants\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-8496860/v1/d4e6390461ce8458dc0ae37a.png"},{"id":103071439,"identity":"24097de1-5f06-4d3f-aa4e-b0d44eb77c59","added_by":"auto","created_at":"2026-02-20 12:27:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2259847,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8496860/v1/8b5f7cbb-de5e-41bf-947f-ccc19f76a488.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEffect of Mindfulness Based Stress Reduction Intervention on Undergraduate Nursing Students’ Stress\u003c/p\u003e","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cp\u003eStress is a universal phenomenon that has become a part of life, often viewed as the price humans pay for survival (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). This is an inevitable reality of everyday life that results after the body's usual physiological and psychological reaction to circumstances interpreted as demanding or harmful (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Positive stress has catalyst role in problem solving and confrontation while prolonged and sustained stress can lead to fatal effects on mind and body such as anxiety, depression and other psychological issues. Prolonged stress can negatively impact one's cognition clearly, regulate one's emotions, and feel good about oneself (\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn the field of education, stress is particularly significant as it can disrupt learning and academic performance by impairing focus, memory, and problem-solving skills (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The academic environment is usually characterized by information overload, academic pressure, unrealistic self-achievements, high family expectations, and competition among students, which exacerbates academic stress and decreases academic performance (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The beginning of university life is typically a nerve-racking time, and many students struggle with mental health issues (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In this unique academic and social setting, students face pressures like breaking away from social networks, moving away from parental home, learning to live independently, forming new social connections, difficulty in adjustment to the new social milieu, and to balance their academic obligations (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNursing is one of the most stressful and sensitive discipline due to its rigorous academic and clinical requirements (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Nursing education is getting more complex and discerning, which is in line with the tremendous strides in the field over the previous few years (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Nursing students face unique challenges in practice-based education, combining didactic and clinical training, resulting in high stress levels, categorized as a high-stress group (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). They encounter various sources of stress such as academic, clinical, and personal (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Nursing students face academic stressors like intensive theoretical coursework, demanding schedules, numerous lectures, and long study hours, interrogation during lectures, anxiety over assessments and exams, missing assignment deadlines, and fear of failing (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eClinical stresses which nursing students encounter during clinical training includes demands of demonstrating technical proficiency, dealing with unpredictability, fear of errors, lack of medical knowledge, witnessing patient suffering and death, unfamiliar settings, excessive workloads, feeling unprepared, new position demands, patient care responsibilities, and negative interactions with peers and staff (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Nursing students encounter various personal stressors such as family issues, physical problems, intrapersonal stresses stemming from financial loads, interpersonal relationships with classmates, and balancing home life with professional life (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNursing students need to use coping strategies to organize the stressful situations they encounter in academia and clinical practices (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). One such therapy is meditation, which falls under the category of Complementary and Alternative Medicine (CAM), which includes practices that integrate interactions between the brain, mind, body, and behavior (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Various types of meditation practices exist such as loving-kindness, transcendental, Zen, yoga, compassion, and Buddhist meditation. Among these, mindfulness meditation is a distinct approach which emphasizes being completely present and fully aware in the moment (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMBSR is a particular kind of mindfulness meditation established by Jon Kabat-Zinn, Ph.D in 1979 (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). MBSR is an eight week educational and behavioral program that provides direct experience with meditation practices, including mindful awareness of daily tasks and interpersonal interactions (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Mindfulness is \"paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally\" (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Nursing students throughout their academic program may benefit from MBSR and even practice it as RNs to reduce their stress which can result in enhanced academic and clinical performance and ultimately safer patient care (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe laborious strains of academic and clinical training places a heavy burden on nursing students, which can cause negative effect on physical and mental health of undergraduate nursing students, leading to a higher level of stress. MBSR intervention is found to be effective in improving the mental health and well-being of nursing students and reducing stress levels. Globally, the efficacy of MBSR has been evaluated widely on undergraduate students of various disciplines (\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). But, effectiveness of MBSR for undergraduate nursing students is still underexplored, despite the growing awareness of stress-related issues in nursing academia (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Stress management techniques often fall short in addressing the exclusive educational and clinical demands faced by nursing students which ultimately result in poor academic and clinical performance. In Pakistan, researches have been conducted on university students to evaluate the effectiveness of MBSR which revealed higher level of psychological wellbeing, increased mindfulness and lowered stress levels (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Nevertheless, there is a paucity of research investigating the effect of mindfulness-based stress reduction among undergraduate nursing students in the local context. Given the multifaceted and significant stress experienced by nursing students and limited use of meditation therapies for reducing stress, this study aims to analyze effectiveness of MBSR interventions for managing stress and enhancing mindfulness in this population. This research will contribute to the development of comprehensive stress management intervention tailored to the unique requirements of nursing students, ultimately reducing stress and enhancing their academic performance, mindfulness, and overall quality of life.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Statement of Problem\u003c/h2\u003e \u003cp\u003eMental health and well-being of nursing students are paramount due to rigorous academic demands and emotional challenges they face during their training. Undergraduate nursing students are specifically susceptible to high levels of stress resulting from demanding academic and clinical responsibilities. This persistent stress negatively affects their academic performance, clinical decision-making, emotional stability, and future professional competence. The demanding nature of nursing education in Pakistan further amplifies these challenges, as students often face academic pressures, intense clinical rotations, limited support systems, and high expectations within healthcare settings. Despite these challenges, there are limited use of structured evidence-based stress reduction intervention to lessen stress in Pakistan. Subsequent research should ought to consider the meditations that could offer nursing students social and psychological support. Although MBSR intervention have been recognized globally for decreasing stress, fostering emotional resilience, focus, and self-regulation, but its effectiveness for stress reduction specifically for nursing students is underexplored in Pakistan. Addressing these concerns is essential to ensure healthier learning environments, enhance students\u0026rsquo; emotional well-being, and strengthen the future nursing workforce. Therefore, the aim of this study is to evaluate the effect of MBSR intervention on stress reduction among undergraduate nursing students and ultimately enhancing overall mental health of undergraduate nursing students.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.2 Research Objectives\u003c/h2\u003e \u003cp\u003eThe objectives of this study are;\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo assess the baseline stress level of undergraduate nursing students.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo analyze post interventional and follow-up stress level of undergraduate nursing students.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo examine mean difference between baseline, post-Intervention and follow-up stress level of undergraduate nursing students.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo examine mean difference in post- Interventional stress level of undergraduate nursing students on the basis of age, educational level and region.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e1.3 Research Question\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eWhat is the effect of Mindfulness-Based Stress Reduction (MBSR) intervention on stress level of undergraduate nursing students?\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e1.4 Theoretical Framework\u003c/h2\u003e \u003cp\u003eThis study is based on two models. The first model is the Dimensional Model of Psychological Distress, developed by (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). This model provides the theoretical basis for the DASS-42 Stress Subscale, which conceptualizes stress not as a discrete state but as a continuum of emotional and physiological arousal. According to this model, stress consists of distinct indicators such as difficulty relaxing, irritability, nervous tension, impatience, overreaction to situations, intolerance of interruptions, and agitation. These 14 stress items collectively capture the core construct of chronic non-specific arousal. In this study, the DASS-42 stress items were used to assess undergraduate nursing students\u0026rsquo; stress.\u003c/p\u003e \u003cp\u003eThe theoretical model of DASS-42 (stress items) is illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe second model is the MBSR Framework, which conceptualizes mindfulness as purposeful, non-judgmental awareness. This model explains how mindfulness practices reduce stress through attention regulation, enhanced body awareness, and emotional regulation (Kabat-Zinn, 1979). Principles like acceptance, letting go, patience, trust, non-centering, beginner's mind, non-judgment, and non-striving are all emphasized by MBSR. The eight week MBSR program utilized in this study operationalizes these mechanisms through body scan, meditation, breath work, mindful communication, mindful eating, walking meditation, and yoga (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). The operational framework of MBSR intervention is described in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eCollectively, these two models explain how mindfulness practices improve emotional and cognitive regulation, which in turn reduces the stress reactions assessed by the DASS-42 stress items.\u003c/p\u003e \u003c/div\u003e"},{"header":"2. LITERATURE REVIEW","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Stress and its Associated Factors\u003c/h2\u003e \u003cp\u003eStress has grown to be a significant problem in today's fast-paced society, with possible negative effects on both our physical and emotional well-being (Voss et al., 2020). It can manifest as either a mental, emotional, or physical reaction to the strain that an event or situation puts on the body (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Personal or environmental events that lead to stress are known as stressors, and it is an individual's response to these that ultimately causes stress (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). The World Health Organization (WHO) identified stress as the source of negative outcomes. Each person experiences stress differently, and ability to endure negative outcomes such as fatigue, high blood pressure, low mood, heightened cravings, poor concentration, irritability, anxiety, tension and strain vary tremendously across people (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDuring stressful events, the body triggers a complex set of hormonal and neural responses to cope with the demand (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). The hypothalamic-pituitary-adrenal (HPA) axis and sympathetic-adrenal-medullary (SAM) system are the primary mediators of the stress response (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Following a stressor, the hypothalamus releases corticotrophin-releasing hormone (CRH), which stimulates the anterior pituitary to secrete adrenocorticotropic hormone (ACTH) (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). ACTH then stimulates the adrenal cortex, which produces cortisol, a glucocorticoid that helps mobilize energy and sustain homeostasis under stress. Simultaneously, the SAM system causes the adrenal medulla to release catecholamine triggering the \"fight or flight\" response (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 Stress and its Associated Factors among Nursing Students\u003c/h2\u003e \u003cp\u003eThe epidemic of stress and burnout among nurses and nursing students has been extensively documented in the literature. It is well established that long-term stress causes nursing professionals and students to get burned out (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). According to (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e), nursing students face significant obligations in their academic and clinical lives. They must absorb a large amount of theoretical information while honing their practical abilities in clinical settings. The atmosphere is highly stressful due to these two expectations. Furthermore, compounded stress frequently results in psychological distress, such as anxiety, sadness, and burnout, which have a negative impact on clinical competence and academic performance (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSeveral studies have focused on stress among nursing students such as a survey conducted in USA found that stress levels, anxiety and sleep disturbances were at higher level among students in nursing field as compared to other university students (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). Furthermore, a study conducted in Canada among nursing students revealed that students were shown to have higher levels of stress, anxiety, and depression when they perceived their lives to be more difficult. They also believed that stress was caused by the loads of both their personal and academic lives (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Similarly, a study among female nursing students in Saudi Arabia revealed that the primary cause of stress was the academic load and Interface concerns, clinical concerns, and personal issues came in second and third, respectively (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). In line with this view, a study conducted in Lahore university revealed that there were four main reasons why nursing students face stress are their environment, clinical rotation, personal issues, and coursework (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Coping Strategies for Stress Reduction\u003c/h2\u003e \u003cp\u003eAdopting appropriate coping strategy is highly crucial for combating the harmful consequences of stress. Research suggests that effective stress management leads to adaptation, which increases health, mental well-being, and social functioning (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). To cope with the stressors, nursing students embrace a variety of stress-management strategies, which may be broadly categorized as problem-focused, emotion-focused, or avoidance-based (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Despite their reliance on these coping strategies, research shows that many students struggle to discover consistently effective stress management techniques, underscoring the necessity for structured and organized interventions (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). Inadequate access to standard mental health treatment owing to financial and logistical hurdles highlights the importance of investigating alternative approaches to mitigate stress (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMeditation has become a widely accepted CAM technique that improves both mental and physical well-being. Research supports effectiveness of meditation in minimizing anxiety, enhancing focus, and cultivating resilience, making it a valued tool for nursing students navigating high-pressure circumstances (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan additionalcitationids=\"CR51 CR52\" citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e). MBSR has gained popularity as a structured meditation strategy that incorporates mindfulness meditation with stress management approaches (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). MBSR helps reappraise stressful circumstances and improve adaptive coping skills (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e). MBSR promotes long-term emotional resilience and helps students handle stress effectively through fostering present-moment awareness and nonjudgmental acceptance (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e). Given its potential to enhance psychological well-being, integrating MBSR into nursing courses could offer students with sustainable stress management skills, preparing them for the requirements of their education and future professional positions (\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.4.1 Mindfulness-Based Stress Reduction (MBSR) as an Effective Strategy\u003c/h2\u003e \u003cp\u003eMindfulness is an internal perception that help individuals to focus on the present moment and their surroundings without being diverted by previous or forthcoming happenings (Chen et al., 2021). Dr. Jon Kabat-Zinn brought the concept of mindfulness, originated from Buddhism, to the West. He describes mindfulness as an understanding of the present moment means \u0026ldquo;paying attention in a particular way: on purpose, in the present moment and in a non-judgmental manner\u0026rdquo; (Kabat-Zinn, 2013). Mindfulness involves directly noticing what is happening in the current moment, irrespective of whether the experience is pleasant, unpleasant, or neutral. It also means approaching these experiences with curiosity and interest (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIt has been demonstrated that practicing mindfulness is an easy and helpful way to enhance mental wellness (Holden, 2022). People who exhibit greater mindfulness tend to demonstrate increased levels of compassion, acceptance, and empathy towards both themselves and others. They also possess improved interpersonal skills and can communicate more proficiently (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Mindfulness is strongly associated with stress and anxiety as researches have shown that higher level of mindfulness results in significantly lowered level of stress and anxiety (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e). Mindfulness also improves emotion regulation by promoting acceptance and non-reactivity toward emotional experiences, enabling individuals to respond to stressors more adaptively (\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMBSR reduces stress via several effective key mechanisms. It enhances mindfulness, making individuals more aware of their thoughts and feelings without becoming entangled in them, breaking the cycle of rumination, a significant contributor to stress and anxiety reduction (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e). Additionally, MBSR can lower physiological stress responses. Regular mindfulness practice reduces the activity of the hypothalamic-pituitary-adrenal (HPA) axis, which mediates the body's reaction towards stress, thereby dwindling cortisol levels and other stress hormones (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e). This physiological stress reduction can have profound effects on overall well-being and flexibility. Another critical mechanism is the enhancement of coping skills and resilience. By nurturing a sense of control over one\u0026rsquo;s experiences and developing adaptive coping strategies, MBSR equips individuals to manage stress more effectively. This increased resilience not only helps in dealing with immediate stressors but also empowers individuals with tools to handle future challenges more proficiently (\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e2.4.2 Theoretical Underpinning of MBSR\u003c/h2\u003e \u003cp\u003eThe theory of Modelling and Role Modelling may serve as a theoretical basis for mindfulness practices and help distinguish between shorter, more focused mindfulness training sessions. Self-care, or the capability to take care of oneself, is one of the core concept of the theory of Modeling and Role Modeling (\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e). There are three components to the notion of self-care: (a) self-care knowledge; Awareness of what is essential to support health and lifetime development (b) self-care resources that can be used for self-care for both internal and exterior to the person; and (c) self-care activities involve taking care of one-self utilizing one's own resources and knowledge (Erickson, 2006). These concepts are used for practice and training of mindfulness. Self-care knowledge means that students are somehow aware of their stress levels and the importance of maintaining optimal health. Self-care resources involve using external resources like social support and cues from peers, as well as internal resources such as physical and mental capacity. Self-care actions are practicing and implementation of mindfulness technique (\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe theoretical model underpinning the MBSR intervention is described in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Effects of MBSR on Stress from an Evidence Lens\u003c/h2\u003e \u003cp\u003eThere is a growing body of literature highlighting the usefulness of MBSR for healthcare professionals, particularly nurses and nursing students in reducing stress, anxiety, and depression. Evidences confirmed that mindfulness based stress reduction intervention demonstrated significant reduction in stress among undergraduate nursing students (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e), marked decline in depression, anxiety and stress among nurses (\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e), discernable decrease in perceived stress and anxiety, underscoring the intervention\u0026rsquo;s impact on stress regulation (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e), enhanced mindfulness while reduced anxiety and depression in nursing students (\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e). Moreover, a modified 8 weeks MBSR program was an efficacious technique for nurses to lessen stress and harmful emotions while boosting constructive affect, resilience, and job satisfaction (\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e). Similarly, breath-focused mindfulness intervention improved somatic and autonomic control indices as well as enhanced emotional meta-cognition among undergraduate nursing students (\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRecent research underscores the importance of embedding mindfulness into nursing education to strengthen students\u0026rsquo; coping and emotional capacities. According to Walker and Mann (2016), integrating mindfulness into the nursing prospectus empowered the undergraduates with the skills to manage academic pressures. Moreover, nursing students who received mindfulness coaching had elevated emotional intelligence (\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e). Research highlights the affirmative influence of MBSR interventions on nursing students\u0026rsquo; cognitive and emotional well-being. (\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e) reported that undergraduate nursing students participating in mindfulness program reported improvements in their ability to sleep, focus, think clearly, and have fewer negative thoughts. Similarly, a study conducted in USA revealed that the capacity for working memory and emotional regulation in nursing students was directly and favorably impacted by mindfulness (\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMindfulness interventions have also been shown to enhance academic, ethical, and interpersonal outcomes among nursing students and educators. In a study conducted on nursing students, an online asynchronous mindfulness meditation intervention enhanced intellectual skills as attention shifting, focus selection, accuracy, and concentration (\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e). Additionally, mindfulness training improved ethical decision-making and awareness in pre-licensure and practicing nurses (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Moreover, a study held in Germany on students and teachers revealed that students who participated in the MBSR showed substantial enhancements in their self-reported strain, self-management, school-specific self-efficacy, interpersonal matters and teachers revealed a considerable increase in self-reported mindfulness and a decrease in interpersonal issues (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGrowing evidence indicates that MBSR plays a pivotal role in reducing stress and enhancing psychological well-being among nursing students. In Korean nursing students, a MBSR program dramatically reduced stress, anxiety, and mental health problems while increased awareness (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). MBSR has been associated with enhancements in academic and clinical performance in addition to stress reduction. A study by (\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e) investigated that nurses who participated in MBSR training scored higher on clinical competency tests, had better patient communication skills, and showed more confidence than their non-MBSR counterparts.\u003c/p\u003e \u003cp\u003eThroughout this literature review, researcher has explored a wide range of studies and findings that shed light on importance of MBSR interventions in reducing stress, anxiety, and other mental health issues among various disciplines. From the evidence presented, it is apparent that in Pakistan, nursing students still fail to adopt such stress reduction programs while facing academic or clinical stressors. Therefore, the current study was undertaken to assess the effects of MBSR on undergraduate nursing students\u0026rsquo; stress.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. RESEARCH METHODOLOGY","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Study Design\u003c/h2\u003e \u003cp\u003eA quasi-experimental study was carried out using non-randomized one-group pre-test/post-test\u003c/p\u003e \u003cp\u003edesign. Figure\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e5\u003c/span\u003e illustrates the quasi-experimental study design, depicting the sequence of pre-test assessment, intervention implementation, and post-test evaluation.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn this study, undergraduate nursing students\u0026rsquo; stress was assessed at Time one (T0) as pre-test and Time two (T1) as post-test after one week of intervention and Time three (T2) as follow-up at one month after intervention. The comparison of stress scores across time points is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Population and Setting\u003c/h2\u003e \u003cp\u003eThe population for this study comprised of 2nd year undergraduate nursing students. This study was conducted at college of nursing AFPGMI Rawalpindi which is affiliated with the National University of Medical Sciences.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Sampling Technique\u003c/h2\u003e \u003cp\u003eThe universal sampling technique was used to select study participants. This technique involved selecting all 2nd year undergraduate nursing students from college of nursing AFPGMI Rawalpindi. This cohort was especially pertinent to the study\u0026rsquo;s objectives due to their distinct level of clinical exposure.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Sample Size\u003c/h2\u003e \u003cp\u003eTo ensure internal consistency and reduce selection bias, the entire class of 2nd year undergraduate nursing students (n\u0026thinsp;=\u0026thinsp;80) was taken as a sample in this study. A priori power analysis was implemented using G*Power software to determine an appropriate and statistically valid sample size. The parameters included a medium effect size (Cohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.3), an alpha level of 0.05, and a power level of 0.80 to detect a true effect, minimizing the risk of Type I and Type II errors (\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e). The calculated sample size was 71 undergraduate nursing students. To account for potential 10% attrition rate, the recruitment target was adjusted to 78 undergraduate nursing students.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e3.6 Eligibility Criteria\u003c/h2\u003e \u003cp\u003eUndergraduate nursing students enrolled in BSN generic program who were in 2nd year and had recently started clinical rotation were included in the study. Students in the 1st year were excluded because they had no clinical experience. Students in the 3rd and 4th year were also excluded because their levels of stress may have decreased dramatically over time due to increased familiarity with environment and adopting coping techniques. Undergraduate nursing students who were already using any meditation therapy were excluded from study as they could confound the effect of intervention and results of study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e3.7 Data Collection Tool\u003c/h2\u003e \u003cp\u003eThe data collection instrument was consisted of two sections. The first part comprised of self-developed demographic characteristics based on the information obtained from previous studies. The demographic factors such as age, region, and academic background were used to scrutinize the degree of influence of these factors on undergraduate nursing students stress.\u003c/p\u003e \u003cp\u003eThe second part of questionnaire was DASS-42(14 stress items). The stress subscale of the Depression, Anxiety, and Stress Scale (DASS-42), developed by (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), is a standardized, validated, and widely used instrument for assessing stress symptoms in both clinical and non-clinical populations. It consists of 14 measures that particularly assess chronic non-specific arousal and persistent psychological tension. These items assess factors such as trouble relaxing, anxious arousal, irritability, impatience, over-reactivity, and being easily irritated or agitated. To measure each item\u0026rsquo;s response, a four point Likert scale was utilized (never: 0, sometimes: 1, often: 2, almost always: 3). The total stress score ranges between 0\u0026ndash;42 with higher scores indicating greater stress. The severity of stress is categorized as follows: Normal (0\u0026ndash;14), Mild (\u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), Moderate (\u003cspan additionalcitationids=\"CR20 CR21 CR22 CR23 CR24\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), Severe (\u003cspan additionalcitationids=\"CR27 CR28 CR29 CR30 CR31 CR32\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), and Extremely Severe (\u003cspan additionalcitationids=\"CR35 CR36 CR37 CR38 CR39 CR40 CR41\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). The DASS-42 stress subscale reveals strong psychometric properties, with a Cronbach alpha of 0.93, indicating high internal consistency and reliability in measuring stress levels (\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e3.8 Pilot Testing\u003c/h2\u003e \u003cp\u003ePilot testing was performed to assess the validity and reliability of research instrument in context of Pakistan.\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section3\"\u003e \u003ch2\u003e3.8.1 Validity of Instrument\u003c/h2\u003e \u003cp\u003eA panel of five subject-matter experts from the Department of Health Professions Education at NUMS examined the questionnaire to ensure its content validity in the local context. The experts evaluated each item's relevancy, intelligibility, and cultural appropriateness in the Pakistani context. Content validity ratio was established by Lawshe (1975) as a linear translation of a degree of agreement that is proportionate to how many experts within the panel rate an item as \"essential.\" The CVR is determined as follows:\u003c/p\u003e \u003cp\u003eCVR= (Ne - N/2)/(N/2)\u003c/p\u003e \u003cp\u003eBy using the formula for instrument\u003c/p\u003e \u003cp\u003eCVR= (Ne - N/2)/(N/2)\u003c/p\u003e \u003cp\u003e=\u0026thinsp;5\u0026thinsp;\u0026minus;\u0026thinsp;5/25/2\u003c/p\u003e \u003cp\u003e=\u0026thinsp;5\u0026minus;(2.5) x (2.5)\u003c/p\u003e \u003cp\u003e= (2.5) x (2.5)\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003cp\u003eThe CVR value of 1 indicates a high level of agreement among experts, demonstrating the tool's strong content validity (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e). This comprehensive validation method ensured that the DASS-42 stress subscale maintained its psychometric consistency and was suitable for evaluating perceived stress among undergraduate nursing students in this setting.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section3\"\u003e \u003ch2\u003e3.8.2 Reliability of Instrument\u003c/h2\u003e \u003cp\u003eThe internal consistency of the stress subscale of DASS-42 was evaluated in this study to ensure the measurement tool's accuracy and dependability. The Cronbach's alpha coefficient was used to examine reliability, and it generated a value of 0.80 for the 14 stress-related questions. A Cronbach\u0026rsquo;s alpha above 0.70 is generally considered acceptable, and a value of 0.80 suggests that the items within the stress subscale are homogenous and reliably measure the construct of stress. This supports the appropriateness of the stress subscale of DASS-42 for evaluating stress levels in this context.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e3.8 Ethical Consideration\u003c/h2\u003e \u003cp\u003e The study protocol was approved by the Ethical Review Committee (ERC) of Armed Forces Post Graduate Medical Institute (Re:569-AAA-ERC-AFPGMI). Moreover, before initiating the data collection process, setting permission was obtained by competent authority of college of nursing AFPGMI RWP. The purpose of study was explained to study participants and obtained written informed consent. Confidentiality and anonymity of data was maintained throughout the study. In terms of benefits, all the participants received information booklet on MBSR intervention before commencement of intervention. No direct risks were related with participation in this study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003e3.9 Data Collection Process\u003c/h2\u003e \u003cp\u003eThe data was collected by researcher using Google forms via WhatsApp after permission from ERC AFPGMI RWP and targeted setting. The primary researcher briefed the study participants about the purpose and process of research study. This ensured consistency and uniformity of the data collection process. After taking informed consent, the data were collected on demographics and on T0 stress scores. Data was collected at times convenient for study participants without interrupting their daily classes schedule. Pre-test (T0) assessment was conducted to assess the base-line stress levels of undergraduate nursing students one week before commencement of interventions. This ensured the accurate representation of the participants' stress status prior to the intervention's influence.\u003c/p\u003e \u003cp\u003eOn the day of first intervention session, a booklet containing the information regarding MBSR was provided to students for guidance throughout the sessions. The content of the booklet was a modified MBSR program, adapted from Dr Jon Kabt Zinn MBSR Intervention guide. The researcher executed 8-weeks mindfulness-based stress reduction interventions (1 session/week, 1.5 hours each) which was supervised by a certified psychologist, delivered in-person. Post-test (T1) was carried out to analyze post-interventional level of stress of undergraduate nursing students one week after the interventional therapy. This time frame was selected for a more accurate assessment of the sustained and practical effects of the intervention rather than capturing immediate, short-term responses.\u003c/p\u003e \u003cp\u003eAdditionally, a follow-up assessment (T2) was conducted one month after the completion of the intervention to measure the sustainability of its effects. The follow-up data also provided insights into participants\u0026rsquo; continued engagement with mindfulness practices and their perceived benefits.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e3.10 Intervention\u003c/h2\u003e \u003cp\u003eThe intervention adapted by primary researcher was eight week MBSR group intervention centered on the core principles and practices of MBSR. Consequently, there was a final structured module comprised of 1.5 hour weekly group sessions and 20 minutes of informal mindfulness practice over the course of 8 weeks. The intervention content is described according to weekly schedule as follows:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eWEEK 1\u003c/strong\u003e \u003cp\u003eAn outline and purpose of intervention was familiarized. The instructions were centered on the body's reaction to stress, the relaxation response, and its physiological implications. There was discussion about MBSR's mechanism. The MBSR handbooks and group guidelines, such as consistent attendance, at-home routines, and record keeping, were discussed and explained. A guided meditation exercise was used to explain and demonstrate attention processes that are connected to the practice of mindfulness meditation. Nursing students were guided through an activity of focusing on full and relaxed breathing and awareness of physiological sensations. Home practices and daily records were assigned and described.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eWEEK 2\u003c/strong\u003e \u003cp\u003eThere were group discussions on home practices. Mindful practice of breathing was introduced in this session. Through breathing exercises, the reciprocal relationship between the patterns of breathing and emotional response was systematically explored.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eWEEK 3\u003c/strong\u003e \u003cp\u003eExercises centered on mindful eating (such as raisins exercises) were introduced for participants. Mindful eating a raisin involves fully engaging your senses to savor the experience, from observing its appearance and texture to noticing its taste and chewing it slowly, promoting a deeper connection with food.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eWEEK 4\u003c/strong\u003e \u003cp\u003eMindful movement comprises of practices directed at moving the body in an intentional way to cultivate present-moment awareness. The example of these mindful movements was on introducing mindfulness standing yoga and gentle yoga stretches. These practices focused on fostering both physical relaxation and mental awareness. Other example was a walking meditation where the focus is on walking with the intention of cultivating present-moment awareness and a sense of compassion.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eWEEK 5\u003c/strong\u003e \u003cp\u003eMindful sitting with choice-less awareness was the theme of this week. The relationship between emotion and cognition was discussed. The application of mindfulness to the awareness of cognitive processes was explored. The characteristics of illogical assumptions, beliefs, and cognitive distortions were explicated. Students were given homework that involved self-monitoring their cognitive assessment in relation to stressful situations and practice.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eWEEK 6\u003c/strong\u003e \u003cp\u003eThe principles and techniques of meditation were expanded upon with a body scan activity that guides participants in sensing kinesthetic feedback from every part of their body. Moreover, along with body scanning, Visualization was also practiced in which participants used mental imagery to enhance relaxation and positive emotions. The relationship between mental images and physical reactions was the main focus of visualization.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eWEEK 7\u003c/strong\u003e \u003cp\u003eMindful communication and love-kindness mediation was exercised. The focus in this session was on enhancing interpersonal communication skills. The purpose behind Loving-kindness meditation, also known as Metta, was to cultivate goodwill towards oneself and others.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eWEEK 8\u003c/strong\u003e \u003cp\u003eThis session was the choice of participants. Practice of mindfulness breathing, mindfulness sitting, or yoga was exercised according student\u0026rsquo;s wish. All mindfulness techniques and practices were reviewed and discussed.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003e3.11 Data Analysis\u003c/h2\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003e3.11.1 Data Management\u003c/h2\u003e \u003cp\u003eData was managed by assigning serial numbers to each data file of every participant. Data for T0, T1, and T2 were labelled separately for identification. The Epi-data software version 3.1 was used for data entry. Each data set was checked for accuracy and completeness. Double entry of data was performed by an expert data entry operator to ensure accuracy and reliability. Both data sets were compared for any inconsistency or missing data and correction were made accordingly.\u003c/p\u003e \u003cp\u003eAfter completing data entry and cleaning process, the data was coded and transferred to coding sheets, then entered into Statistical Package for Social Sciences (SPSS- version 26) for quantitative analysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003e3.11.2 Data Analysis Plan\u003c/h2\u003e \u003cp\u003eThe analysis of data was carried out through both descriptive and inferential statistics.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eDescriptive Statistics\u003c/strong\u003e \u003cp\u003eThe demographic information such as age, academic background and region were analyzed using frequencies and percentages. Participants responses for each question pertaining to stress were evaluated by computing means and standard deviation for every question item.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInferential statistics\u003c/strong\u003e \u003cp\u003eBefore application of any statistical test, a normality test was conducted to check the parametric and non-parametric nature of the data. As the data was parametric, the t-test and ANOVA were used to examine the mean difference of age, region, and academic background on stress level of undergraduate nursing students stress. Paired t-test was used to calculate mean differences between base-line, post intervention and follow-up data regarding stress among undergraduate nursing students.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. RESULTS","content":"\u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003e4.1. Descriptive Statistics\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eA- Demographic Information\u003c/strong\u003e \u003cp\u003eA total of 80 undergraduate nursing students of 2nd year, who had recently started their clinical rotation, completed the study process and were included in the analysis. The demographic characteristics of the participants were analyzed using percentage distributions. This included variables such as age group, educational level, and region (rural or urban). Demographic profile is illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e7\u003c/span\u003e.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAs shown in Fig.\u0026nbsp;4.1, the majority of the study participants (55%) were between 20\u0026ndash;22 years of age, followed by 30% in the 23\u0026ndash;25 age group, and 15% in the 26\u0026ndash;28 age group. This reflects that the sample primarily comprised younger adults typically enrolled in undergraduate nursing programs. In terms of regional distribution, a slightly higher proportion of students (52.5%) were from urban areas, while 47.5% came from rural backgrounds, indicating a relatively balanced representation from both settings. Regarding educational background, most of the participants (68.8%) had completed their FSC (Faculty of Science), whereas 31.3% held a BSC (Bachelor of Science) degree prior to entering nursing education. This shows a predominance of students entering nursing after intermediate-level science education, although a significant portion had prior university-level academic exposure. These demographic characteristics provide insight into the diverse yet youthful and academically inclined profile of the nursing student population included in this study.\u003c/p\u003e \u003cp\u003e \u003cb\u003eB- Percentage responses of the participants about questionnaire\u003c/b\u003e: By computing the mean and standard deviation for each item on the DASS-42 stress subscale, we examined the participants\u0026rsquo; responses regarding their stress symptoms at three stages: pre-intervention, post-intervention, and follow-up. Statistical analysis was used to assess various domains of stress such as difficulty relaxing, nervous tension, irritability, and overreacting to situations. Responses were collected using a 4-point Likert scale ranging from 0 (Never) to 3 (Almost Always).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePercentage Response for Level of Stress Among Undergraduate Nursing Students Prior to Intervention\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStress Items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eST\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMean\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e36.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.85\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;1.115\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.63\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;1.023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.84\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.84\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.987\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.93\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.991\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.89\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.914\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.04\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.961\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.05\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.926\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e43.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.05\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;1.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e10\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.03\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.900\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e11\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.85\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;1.020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e12\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e41.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.11\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.914\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e13\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e36.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.33\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;1.339\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e14\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.71\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;1.093\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePre-intervention Stress level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e \u003cp\u003eTotal stress score\u0026thinsp;=\u0026thinsp;26.15 Mean item score\u0026thinsp;=\u0026thinsp;1.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e[*N\u0026thinsp;=\u0026thinsp;Never(0), ST\u0026thinsp;=\u0026thinsp;Sometimes(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), OF\u0026thinsp;=\u0026thinsp;Often(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), AA\u0026thinsp;=\u0026thinsp;Almost Always(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)]\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e represents the analysis of pre-intervention data, as measured by the Depression Anxiety Stress Scales-42 (DASS-42) stress subscale, resulted in a total stress score of 26.15 and mean item score of 1.86. According to the DASS-42 stress severity classification, a total score ranging from 26 to 33 falls under the category of severe stress This classification reflects a high level of stress among participants prior to the administration of the MBSR intervention.\u003c/p\u003e \u003cp\u003eFurther analysis of individual stress items showed that the highest mean scores were observed for items such as \u0026ldquo;I was in a state of nervous tension\u0026rdquo; (2.11), \u0026ldquo;I found that I was very irritable\u0026rdquo; (2.05), and \u0026ldquo;I found myself getting touchy\u0026rdquo; (2.05), indicating that participants frequently experienced emotional irritability, nervous energy, and heightened sensitivity in their day-to-day functioning. These high-frequency responses reflect common psychological manifestations of stress among nursing students, possibly attributed to academic workload, clinical responsibilities, and transitional life stages. In contrast, items such as \u0026ldquo;I was intolerant of anything that kept me from getting on with what I was doing\u0026rdquo; showed relatively lower mean scores (1.33), suggesting that task-related frustration was less commonly reported. Nevertheless, the item variability underscores the multidimensional nature of stress symptoms, encompassing both physiological arousal and emotional reactivity.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePercentage responses for Level of Stress Among Undergraduate Nursing Students after Intervention\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStress items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eST\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMean\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.61\u0026thinsp;\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.720\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.83\u0026thinsp;\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.792\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.60\u0026thinsp;\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.704\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.57\u0026thinsp;\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.689\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.71\u0026thinsp;\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.860\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.76\u0026thinsp;\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.799\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.61\u0026thinsp;\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.771\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.56\u0026thinsp;\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.777\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.60\u0026thinsp;\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.704\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.86\u0026thinsp;\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.853\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.79\u0026thinsp;\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.807\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.55\u0026thinsp;\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.692\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.59\u0026thinsp;\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.688\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.45\u0026thinsp;\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.692\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePost-intervention Stress level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e \u003cp\u003eTotal stress score\u0026thinsp;=\u0026thinsp;9.09 Mean item score\u0026thinsp;=\u0026thinsp;0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e[*N\u0026thinsp;=\u0026thinsp;Never (0), ST\u0026thinsp;=\u0026thinsp;Sometimes (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), OF\u0026thinsp;=\u0026thinsp;Often (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), AA\u0026thinsp;=\u0026thinsp;Almost Always (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)]\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the descriptive statistics of post-intervention stress levels among undergraduate nursing students, as measured by the DASS-42 stress subscale. The results shown in table 4.3 reveal a decline in stress, with total stress score of 9.09 and a mean item score of 0.64. According to the DASS-42 severity classification, a total score between 0\u0026ndash;14 is categorized as \u0026ldquo;normal\u0026rdquo;, suggesting that the overall stress level among participants significantly decreased following the eight-week MBSR intervention. Item-wise analysis revealed that the lowest post-intervention mean scores were observed in stress items such as \u0026ldquo;I found myself getting agitated\u0026rdquo; (0.45), \u0026ldquo;I was in a state of nervous tension\u0026rdquo; (0.55), and \u0026ldquo;I was intolerant of anything that kept me from getting on with what I was doing\u0026rdquo; (0.59). These reductions put forward the effectiveness of intervention in addressing stress-related arousal and task-related frustrations. Although some items such as \u0026ldquo;I found it hard to calm down after something upset me\u0026rdquo; (0.86) and \u0026ldquo;I found myself getting upset by quite trivial things\u0026rdquo; (0.83) showed relatively higher post-intervention means, these were still well below the pre-intervention levels and remained within the normal range. Overall, the post-intervention findings highlighted the effectiveness of MBSR in alleviating stress among undergraduate nursing students. The sharp decline in stress levels from the pre-intervention \u0026ldquo;severe\u0026rdquo; range (mean score\u0026thinsp;=\u0026thinsp;1.86) to post-intervention \u0026ldquo;normal\u0026rdquo; range (mean score\u0026thinsp;=\u0026thinsp;0.64) underscores the positive psychological impact of mindfulness practices.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePercentage Responses for Level of Stress Among Undergraduate Nursing Student at follow-up\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStress items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eST\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMean\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.45\u0026thinsp;\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.634\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.57\u0026thinsp;\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.725\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.46\u0026thinsp;\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.615\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.43 \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e .591\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.39 \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e .606\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.59 \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e .741\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.43\u0026thinsp;\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.652\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.48 \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e .729\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.34 \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e .502\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.55 \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e .727\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.53\u0026thinsp;\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.675\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.40\u0026thinsp;\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.587\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.45\u0026thinsp;\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;.614\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eS14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.35 \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e .618\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFollow-up Stress level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e \u003cp\u003eTotal stress score\u0026thinsp;=\u0026thinsp;6.42 Mean item score\u0026thinsp;=\u0026thinsp;0.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e[*N\u0026thinsp;=\u0026thinsp;Never (0), ST\u0026thinsp;=\u0026thinsp;Sometimes (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), OF\u0026thinsp;=\u0026thinsp;Often (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), AA\u0026thinsp;=\u0026thinsp;Almost Always (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)]\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, the follow-up findings demonstrated a sustained reduction in stress levels among undergraduate nursing students after the initial MBSR intervention. The total stress score was 5.62 and mean item score was 0.40, which lies within the \u0026ldquo;normal\u0026rdquo; range according to the DASS-42 stress subscale severity classification (0\u0026ndash;14). This indicates that not only was the intervention effective in the short term, but its impact on stress reduction persisted over time, even at follow-up. Most participants responded \u0026ldquo;never\u0026rdquo; or \u0026ldquo;sometimes\u0026rdquo; across all 14 stress items, reflecting minimal stress symptoms. The highest proportion of \u0026ldquo;never\u0026rdquo; responses was seen in items such as \u0026ldquo;I found myself getting agitated\u0026rdquo; (71.3%), \u0026ldquo;I felt that I was rather touchy\u0026rdquo; (67.5%), and \u0026ldquo;I found myself using a lot of nervous energy\u0026rdquo; (66.3%). These responses indicate that emotional arousal and irritability had significantly subsided among participants. Additionally, items such as \u0026ldquo;I found it hard to wind down\u0026rdquo; (61.3%) and \u0026ldquo;I was in a state of nervous tension\u0026rdquo; (63.7%) also had a majority reporting \"never,\" further suggesting improvement in relaxation and emotional regulation. The mean scores across all items ranged between 0.34 and 0.59, showing consistency in stress reduction. Items that previously recorded higher means during the pre-intervention phase, such as \u0026ldquo;I found it hard to calm down after something upset me\u0026rdquo; and \u0026ldquo;I was very irritable\u0026rdquo;, showed substantial decreases during follow-up (0.55 and 0.48, respectively). While slight variability in standard deviations was observed, the overall pattern indicated stable improvements in stress response and coping. These results confirm the long-term efficacy of the MBSR intervention, with participants continuing to experience reduced levels of stress beyond the immediate post-intervention phase.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec30\" class=\"Section2\"\u003e \u003ch2\u003e4.2. Inferential Statistics\u003c/h2\u003e \u003cp\u003ePrior to conducting inferential analysis, a normality test was conducted using both the Kolmogorov-Smirnov and Shapiro-Wilk tests to examine the distribution of stress scores at pre-test, post-test, and follow-up phases. For a sample size of 80, the Shapiro\u0026ndash;Wilk test was preferred due to its higher sensitivity for moderate-sized samples. The results revealed non-significant p-values for all variables (pre-test: p\u0026thinsp;=\u0026thinsp;0.402; post-test: p\u0026thinsp;=\u0026thinsp;0.137; follow-up: p\u0026thinsp;=\u0026thinsp;0.361), indicating that the data were normally distributed. Consequently, parametric statistical tests such as the Repeated Measure ANOVA, T test and ANOVA were deemed appropriate for further inferential analysis.\u003c/p\u003e \u003cp\u003eThe repeated measures ANOVA was conducted to examine changes in stress levels across three time points: pre-test, post-test, and follow-up. As depicted in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, the Multivariate Tests indicated a highly significant effect of Time on stress levels, with Pillai\u0026rsquo;s Trace\u0026thinsp;=\u0026thinsp;.899, F(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;345.76, p\u0026thinsp;=\u0026thinsp;.000, and a very large effect size (Partial Eta Squared\u0026thinsp;=\u0026thinsp;.899). Consistent significance across Wilks\u0026rsquo; Lambda, Hotelling\u0026rsquo;s Trace, and Roy\u0026rsquo;s Largest Root further confirms that stress scores changed substantially over the three measurement points. This demonstrates a robust effect of the MBSR intervention on reducing stress over time. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e illustrates Multivariate tests.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate Tests\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eEffect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eValue\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHypothesis df\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eError df\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePartial Eta Squared\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePillai's Trace\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.899\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e345.757\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e78.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.899\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWilks' Lambda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e345.757\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e78.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.899\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHotelling's Trace\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.866\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e345.757\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e78.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.899\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRoy's Largest Root\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.866\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e345.757\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e78.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.899\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, the Tests of Within-Subjects Contrasts revealed that both the linear and quadratic components of Time were statistically significant. The linear tendency was very strong (F(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;611.99, p\u0026thinsp;=\u0026thinsp;.000, Partial Eta Squared\u0026thinsp;=\u0026thinsp;.886), indicating a consistent, substantial decrease in stress across the three measurements. The quadratic tendency (F(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;93.85, p\u0026thinsp;=\u0026thinsp;.000, Partial Eta Squared\u0026thinsp;=\u0026thinsp;.543) suggests that the reduction was steeper immediately after the intervention and continued to decline, but at a slower pace, toward the follow-up. These findings confirm both immediate and continued improvements after the MBSR program. Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e describes tests of Within-Subject Contrasts.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTests of Within-Subjects Contrasts\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSource\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eType III Sum of Squares\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean Square\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePartial Eta Squared\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLinear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15563.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15563.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e611.993\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.886\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuadratic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2736.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2736.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e93.845\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.543\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eError\u003c/p\u003e \u003cp\u003e(Time)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLinear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2008.975\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.430\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuadratic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2303.258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29.155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the Table \u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e, the Tests of Between-Subjects Effects showed a highly significant intercept (F(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;1264.36, p\u0026thinsp;=\u0026thinsp;.000, Partial Eta Squared\u0026thinsp;=\u0026thinsp;.941), demonstrating that the overall average stress level across participants was significantly different from zero and indicating substantial variability in stress levels explained by the intervention period. Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e reveals Tests of between-subjects effects.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTests of Between-Subjects Effects\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSource\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eType III Sum of Squares\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean Square\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePartial Eta Squared\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntercept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46203.750\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46203.750\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1264.358\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.941\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eError\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2886.917\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.543\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn Table \u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e, The Bonferroni-adjusted pairwise comparisons demonstrated statistically significant differences in mean stress scores across the three measurement points, pre-intervention (T\u003csub\u003e0\u003c/sub\u003e), post-intervention (T\u003csub\u003e1\u003c/sub\u003e), and follow-up (T\u003csub\u003e2\u003c/sub\u003e). All comparisons yielded p-values of .000, indicating highly significant differences that remained below the conventional α\u0026thinsp;=\u0026thinsp;.05 threshold, even after applying Bonferroni adjustments for multiple comparisons. The comparison between Time 0 and Time 1 revealed a mean difference of 17.03, indicating a substantial reduction in stress immediately following the MBSR intervention. When comparing Time 0 with Time 2, the mean difference increased to 19.73, suggesting not only an immediate effect but also a continued decline in stress levels by the follow-up period.\u003c/p\u003e \u003cp\u003eSimilarly, the comparison between Time 1 and Time 2 produced a statistically significant mean difference of 2.70, reflecting further improvement. Although smaller in magnitude, this change indicates sustained and progressively enhanced stress reduction. Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e demonstrates pairwise comparison of mean stress scores.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePairwise Comparison of mean stress scores across time points (pre-intervention, post-intervention, and follow-up)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(I) Time\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(J) Time\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean Difference (I-J)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStd. Error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSig\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.025\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.725\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.797\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-17.025\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.700\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.556\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-19.725\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.797\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-2.700\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.556\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBased on these findings, we reject null hypothesis and accept alternative hypothesis (H₁), confirming that the intervention significantly reduced stress levels across all stages of measurement. These results highlight the efficacy of the stress reduction strategy likely a mindfulness-based or cognitive-behavioral intervention in promoting psychological resilience. Furthermore, the statistically significant outcomes support the incorporation of such interventions into nursing education as a proactive measure to manage academic and clinical stress, improve mental health outcomes, and enhance overall student well-being.\u003c/p\u003e \u003cp\u003eIn Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e, a one-way ANOVA was conducted to determine whether there were statistically significant differences in post-interventional stress levels among different age groups. The analysis revealed a between-group sum of squares of 187.47, with an F-ratio of 2.049 and a p-value of 0.136. These results indicate that there were no statistically significant differences in post-intervention stress scores among the different age categories. Despite slight variations, the effectiveness of the MBSR program appeared consistent across age groups, implying that age did not substantially influence stress reduction outcomes. The null hypothesis regarding age is accepted.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean Difference in Post- Interventional Stress Level of Undergraduate Nursing Students on the Basis of Age\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSum of Squares\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean Square\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBetween age groups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e187.473\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93.736\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.136\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWithin age groups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3521.727\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.737\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3709.200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab9\" class=\"InternalRef\"\u003e9\u003c/span\u003e explores the mean post-intervention stress levels among students based on their prior educational qualification (FSC vs. BSC). The results showed that students with FSC background (n\u0026thinsp;=\u0026thinsp;55) had a mean stress score of 9.15 (SD\u0026thinsp;=\u0026thinsp;7.53), while those with a BSc background (n\u0026thinsp;=\u0026thinsp;25) had a nearly similar score of 9.00 (SD\u0026thinsp;=\u0026thinsp;5.18). The t-test value was 0.087 with a p-value of 0.931, indicating a highly non-significant difference between the two educational groups. This suggests that the MBSR intervention was equally effective across different educational backgrounds, and educational level did not influence the degree of stress reduction. The null hypothesis regarding educational level is accepted.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab9\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 9\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean Difference in Post- Interventional Stress Level of Undergraduate Nursing Students on the Basis of Educational level\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStd. Deviation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eStd. Error Mean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003esig\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal Stress Post\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFSC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.1455\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.53367\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.01584\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.931\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBSC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.18009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.03602\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs presented in Table\u0026nbsp;\u003cspan refid=\"Tab10\" class=\"InternalRef\"\u003e10\u003c/span\u003e, the post-interventional stress levels of undergraduate nursing students were compared between students from rural and urban backgrounds. The rural group (n\u0026thinsp;=\u0026thinsp;38) had a higher mean stress score of 10.45 (SD\u0026thinsp;=\u0026thinsp;7.41) compared to the urban group (n\u0026thinsp;=\u0026thinsp;42), which reported a lower mean of 7.88 (SD\u0026thinsp;=\u0026thinsp;6.15). However, the independent samples t-test yielded a t-value of 1.693 with a p-value of 0.095, which exceeds the standard alpha level of 0.05. This indicates that the observed difference in mean stress scores between rural and urban students after the MBSR intervention was not statistically significant. The null hypothesis regarding region is failed to reject.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab10\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 10\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean Difference in Post- Interventional Stress Level of Undergraduate Nursing Students on the Basis of Region\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStd. Deviation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eStd. Error Mean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003cp\u003evalue\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003esig\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal Stress Post\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.4474\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.40598\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.20141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.693\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e.095\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.8810\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.14540\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.94826\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"5.DISCUSSION","content":"\u003cp\u003eThe results of present study revealed alarmingly high stress levels among nursing students prior to the MBSR intervention, a finding that echoes the persistent challenge faced by nursing students transitioning from didactic education to the practical challenges of clinical placements. Remarkably, second-year students often experience their first substantive clinical exposure, which places them in unfamiliar, high-stakes environments, contributing to stress. These conclusions are consistent with growing body of literature highlighting the prevalence of high level of stress among nursing students, particularly during their early academic years when they are first exposed to clinical settings while balancing academic and clinical responsibilities simultaneously (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e). The current study emphasizes that the dominant stressors are not solely academic but ties to the emotional intensity of early clinical encounters. Similarly, (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) reported that clinical practice, work load, and increased responsibility for patient care were critical contributors to elevated stress levels among 79.9% nursing students. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) observed that students experienced stress before, during, and after clinical practice, primarily due to feeling unprepared and lacking sufficient time to ensure safe and competent care, a phenomenon echoed in the present study\u0026rsquo;s high mean scores in stress items related to overreaction and emotional dysregulation. Consistent with these findings, (\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e) reported that Saudi nursing students experienced high stress during clinical training, primarily due to fear of making mistakes and harming patients. Similarly, (\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e) observed that clinical stress was the predominant source of distress among Pakistani nursing students, reinforcing the relevance of these findings in the local context. The consistency across these studies underscores the universality of stress as a prevalent issue in nursing education, irrespective of cultural or institutional context.\u003c/p\u003e \u003cp\u003eHowever, some studies have reported comparatively lower stress levels. For example, (\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e) found moderate academic and clinical stress among nursing students, with primary stressors including criticism from instructors (56.0%), encountering dying patients (52.3%), and fear of committing errors (51.4%). This variation may be attributed to differences in students\u0026rsquo; academic year or timing of clinical exposure. Similarly, (\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e) reported moderate stress levels, but these were primarily attributed to academic performance rather than clinical demands, in contrast to the present study\u0026rsquo;s findings.\u003c/p\u003e \u003cp\u003eThe salient findings of this study demonstrated a marked reduction in stress levels following the 8 weeks\u0026rsquo; mindfulness-based stress reduction intervention, with further decline observed at fifth-week follow-up. This pattern reflects both immediate and sustained effects of MBSR intervention, suggesting that nursing students integrated mindfulness techniques into their daily routines. This enabled them to manage academic and clinical challenges, regulate emotions, and maintain focus. The positive effect of the MBSR intervention in this study corroborates a substantial body of global research evidence supporting its effectiveness in reducing stress among nursing and healthcare students. For instance, multiple randomized controlled trials across diverse population and settings have consistently revealed significant reduction in stress, anxiety and depression while enhancing mindfulness among nursing students (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e). Moreover, (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)demonstrated that first-year nursing students undergoing their initial clinical placements experienced significant stress reduction after engaging in mindfulness practice, thereby supporting the contextual relevance of the current results. The alignment of our findings with these studies suggests that MBSR is a context-sensitive and highly adaptable intervention across diverse cultural, educational, and clinical settings.\u003c/p\u003e \u003cp\u003eIn line with this, (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) reported that mindfulness training was also effective in improving students\u0026rsquo; emotional balance, ethical awareness, and clinical readiness. (\u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e) further demonstrated that even brief, regular meditation practice led to sustained improvements in emotional regulation and attentional control. These results parallel the present study\u0026rsquo;s findings across multiple emotional stress indicators such as irritability, touchiness, impatience, suggesting that MBSR not only mitigates stress but also enhances the underlying cognitive-emotional capacities such as stability, ethical decision-making, and sustained focus, that are essential for nursing competence in high-pressure clinical settings. The current study\u0026rsquo;s findings revealed that structured face-to-face mindfulness intervention resulted in a significant and enduring reduction in stress probably due to higher participant engagement, real-time instructor feedback, and the supporting dynamics of peer interaction. In contrast, (\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e) reported only modest stress reduction following an online asynchronous mindfulness intervention. This could be attributed to minimum interpersonal connection, fewer opportunities for immediate clarification, and diminished group cohesion. These variations underscore the importance of delivery format in optimizing the effectiveness of MBSR, indicating that in-person therapies might foster deeper skill acquisition and longer-term psychological effects as compared to asynchronous online approaches.\u003c/p\u003e \u003cp\u003eMoreover, the most crucial aspect of the findings is the sustained reduction in stress levels observed at follow-up. The follow-up findings underscore the long-term effectiveness of the MBSR intervention, demonstrating sustained reductions in stress beyond the immediate post-intervention phase. This continued improvement highlights the enduring psychological benefits of mindfulness practices. These results are in concordance with long-term studies of mindfulness interventions. In line with this, (\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e) demonstrated that nursing students who engaged in an 8-week mindfulness-based intervention showed statistically significant reduction in perceived stress and increase in mindfulness at two-month and six-month follow-ups, underscoring the benefits of sustained practice. (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e) found sustained reductions in physiological stress markers following a 12-week mindfulness program, aligning with this study\u0026rsquo;s follow-up outcome. (\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e) similarly reported long-term decreases in perceived stress and enhanced emotional resilience in nurses after MBSR. Despite differences in populations and outcomes, both studies support the sustained efficacy of mindfulness interventions. These findings reinforce the present study\u0026rsquo;s evidence of long-term stress reduction among nursing students. Importantly, the observed follow-up outcomes also align with qualitative evidence from similar settings. For example, (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) noted that students who practiced mindfulness reported increased emotional stability, better time management, and improved coping strategies even months after the intervention. Likewise, (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) found that students exposed to mindfulness training perceived a greater sense of control over their emotions and environment during subsequent clinical rotations.\u003c/p\u003e \u003cp\u003eThe current study demonstrated no statistically significant variations in post-intervention stress levels based on age, educational level, or region. The participants, predominantly aged 20\u0026ndash;22 years, represents a cohort generally more vulnerable to stress due to limited coping skills and early clinical exposure (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e). The balanced proportion of rural and urban backgrounds and varied educational qualifications indicates that the MBSR intervention was effective across demographic subgroups. This is in line with prior evidence showing that mindfulness-based intervention delivers comparable psychological benefits regardless of educational background or geographic origin (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Consistent with (\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e), similar stress reductions were observed across students from diverse backgrounds. While (\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e) reported non-significant demographic associations at the pre-test stage, both studies confirm that stress outcomes are largely independent of demographic factors. These findings reinforce MBSR\u0026rsquo;s universality, suggesting its value as an equitable, adaptable stress management strategy within nursing curricula (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003ch2\u003e5.1 Conclusion\u003c/h2\u003e \u003cp\u003eThe findings of this study provide compelling evidence that an eight-week mindfulness-based stress reduction (MBSR) intervention can effectively reduce stress among undergraduate nursing students, particularly during their early clinical exposure. The intervention was well-received by participants and demonstrated significant improvement across emotional, behavioral, and cognitive stress domains. These findings underscore the value of embedding mindfulness into nursing education as a sustainable strategy to strengthen resilience, enhance well-being, and prepare future nurses for the psychological demands of professional practice. Moreover, the positive response from students highlights the acceptability and practicality of integrating mindfulness practices into academic and clinical training environments.\u003c/p\u003e \u003cp\u003e \u003cb\u003e5.2 Recommendations\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eNursing institutions can formally integrate Mindfulness-Based Stress Reduction (MBSR) modules into their academic curriculum to foster resilience, enhance self-regulation, and mitigate stress during clinical education. These modules should include weekly sessions focused on guided meditation, mindful breathing, and body scan practices.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePre-clinical orientation programs may include mindfulness training to better prepare students for high-stress clinical environments. Simulation-based sessions and reflective journaling can be used to strengthen self-awareness and reduce anticipatory anxiety.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eFaculty and clinical preceptors can receive training to deliver and model mindfulness practices. Leadership development workshops emphasizing emotional intelligence, mindful communication, and stress management should be conducted.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eMindfulness practice groups led by senior students or trained peers can be encouraged to create a collaborative learning environment. These groups should provide a safe space for discussion, shared experiences, and stress debriefing.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePolicymakers and curriculum developers may use these findings to design large-scale mindfulness-based initiatives. National strategies can standardize supportive learning environments in both academic and clinical contexts.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eFuture research should replicate the study across multiple nursing colleges and universities to enhance the generalizability of the findings.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eImplementing RCTs with control groups would strengthen the internal validity and provide stronger evidence of causality between MBSR and stress reduction.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eFuture research should include long-term follow-up assessments to evaluate the sustainability of stress reduction and mindfulness practice over time.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eMixed-method or qualitative studies are recommended to capture in-depth student experiences, challenges in practicing mindfulness, and contextual factors affecting intervention outcomes.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eFuture researches should investigate the comparative effectiveness of different MBSR delivery models, including face-to-face, online, and hybrid formats, to determine the most accessible and efficient approach for students.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec33\" class=\"Section2\"\u003e \u003ch2\u003e5.3 Limitations\u003c/h2\u003e \u003cp\u003eThis study was conducted at a single nursing institution and included only second-year undergraduate students, limiting the generalizability of findings to broader nursing populations or other academic years. The study employed a quasi-experimental one-group pretest-posttest design, which did not include a control group, thereby restricting the ability to make causal inferences. Potential confounding variables such as prior mental health status, personality traits, or external stressors were not controlled. Additionally, the use of self-reported measures (DASS-42) may have introduced response bias, including social desirability or inaccurate self-perception. Adherence to home-based mindfulness practices was not monitored, which may affect the consistency of intervention exposure. Finally, the short follow-up period did not allow for a comprehensive assessment of long-term intervention effects.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eMBSR \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Mindfulness-based stress reduction\u003c/p\u003e\n\u003cp\u003eERC\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Ethical review Committee\u003c/p\u003e\n\u003cp\u003eCON \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; College of Nursing\u003c/p\u003e\n\u003cp\u003eAFPGMI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Armed forces post graduate medical\u003c/p\u003e\n\u003cp\u003eRWP \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Rawalpindi\u003c/p\u003e\n\u003cp\u003eDASS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Depression anxiety stress scale\u003c/p\u003e\n\u003cp\u003eCAM \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Complementary and Alternative Medicine\u003c/p\u003e\n\u003cp\u003eACTH \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Adrenocorticotropic hormone\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding for research was provided.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClinical trial not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the relevant Ethical Review Committee (Re:569-AAA-ERC-AFPGMI) prior to data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Standard Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from all participants prior to participation in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTahsinRaana\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eE Mail: [email protected]\u003c/p\u003e\n\u003cp\u003eContact no: 03218755005\u003c/p\u003e\n\u003cp\u003eMSN Scholars College of Nursing Armed Forces Post Graduate Medical Institute Rawalpindi, Pakistan\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFozia Fatima\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eE Mail: [email protected]\u003c/p\u003e\n\u003cp\u003eContact no: 03400150471\u003c/p\u003e\n\u003cp\u003eAssistant Professor, Department of Health Professions Education, National University of Medical Sciences, Rawalpindi, Pakistan\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eShazia Zaheer\u003csup\u003e3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eE Mail: [email protected]\u003c/p\u003e\n\u003cp\u003eContact no: 03454757421\u003c/p\u003e\n\u003cp\u003ePhD Scholar, CMH Thal, Pakistan\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNadira Nasim\u003csup\u003e4\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eE Mail: [email protected]\u003c/p\u003e\n\u003cp\u003eContact no: 03061608297\u003c/p\u003e\n\u003cp\u003eMSN Scholars College of Nursing Armed Forces Post Graduate Medical Institute Rawalpindi, Pakistan\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUzma Shaheen\u003csup\u003e5\u003c/sup\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eE Mail: [email protected]\u003cbr\u003e\u0026nbsp;Contact no: 03139655288\u003c/p\u003e\n\u003cp\u003eMSN Scholars College of Nursing Armed Forces Post Graduate Medical Institute Rawalpindi, Pakistan\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNeelum Naz\u003csup\u003e6\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eE Mail: [email protected]\u003c/p\u003e\n\u003cp\u003eContact no: 03357515160\u003c/p\u003e\n\u003cp\u003eMSN Scholars College of Nursing Armed Forces Post Graduate Medical Institute Rawalpindi, Pakistan\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding Author\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTahsin Raana\u003c/p\u003e\n\u003cp\u003eE Mail: [email protected]\u003c/p\u003e\n\u003cp\u003eContact no: 03218755005\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTR (Tahseen Raana) conceived and designed the study, developed and coordinated the Mindfulness-Based Stress Reduction intervention, conducted data collection, performed statistical analysis and interpretation, and drafted the manuscript.\u003c/p\u003e\n\u003cp\u003eFF (Fozia Fatima) provided primary supervision, methodological guidance, oversight of the research process, and critically revised the manuscript for important intellectual content.\u003c/p\u003e\n\u003cp\u003eSZ (Shazia Zaheer) contributed as co-supervisor by assisting in study design refinement, monitoring intervention implementation, and reviewing the manuscript.\u003c/p\u003e\n\u003cp\u003eNN (Nadira Nasim) contributed to literature review of the manuscript for intellectual content.\u003c/p\u003e\n\u003cp\u003eUS (Uzma Shaheen) assisted with participant coordination, data collection support, and preliminary data management.\u003c/p\u003e\n\u003cp\u003eNN (Neelum Naz) provided methodological guidance, and critically reviewed the final manuscript.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the subjects who participated in the study.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAli AAM, El-Sherbini HH. 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BMC Nurs. 2024;23(1):322.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Academic Stress, Clinical Rotation, Mindfulness, Mindfulness-based Stress Reduction, Stress, Undergraduate Nursing Students","lastPublishedDoi":"10.21203/rs.3.rs-8496860/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8496860/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eStress is a global phenomenon that significantly affects the academic performance and well-being of students. Nursing, being a demanding and high-stake profession, exposes students to considerable stress during their academic and clinical training. Effective interventions such as Mindfulness-Based Stress Reduction (MBSR) can play a vital role in alleviating stress and enhancing coping abilities.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eThe study aimed to evaluate the effectiveness of MBSR in reducing stress and improving well-being among undergraduate nursing students. Additionally, it sought to examine whether demographic factors such as age, educational background, and region can influence post-intervention stress outcomes.\u003c/p\u003e\u003ch2\u003eMethodology:\u003c/h2\u003e \u003cp\u003eA quasi-experimental one-group pretest\u0026ndash;posttest design was adopted. Universal sampling was used to recruit 80 second-year undergraduate nursing students from the College of Nursing, AFPGMI Rawalpindi, who had recently commenced clinical rotations. Stress was measured using the stress subscale of the DASS-42 (14 items) at baseline, post-intervention, and one-month follow-up. The 8-week MBSR program, developed by Jon Kabat-Zinn, included mindfulness meditation, yoga, and body scan practices. Data were analyzed using descriptive statistics, repeated measure ANOVA, independent sample t-test, and ANOVA.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFindings demonstrated a significant reduction in stress across time (pre-intervention, post-intervention, and follow-up) as measured by repeated-measures ANOVA (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No significant differences were found across demographic variables (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating uniform effectiveness of MBSR. The results suggest both immediate and sustained benefits of the intervention.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eMBSR was found to be an effective strategy for stress reduction and well-being enhancement among nursing students, irrespective of demographic differences. Integration of structured mindfulness programs into nursing curricula may strengthen resilience, improve academic and clinical performance, and prepare students for future professional challenges.\u003c/p\u003e","manuscriptTitle":"Effect of Mindfulness Based Stress Reduction Intervention on Undergraduate Nursing Students’ Stress","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-18 05:59:07","doi":"10.21203/rs.3.rs-8496860/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7d2c4c2a-9c1a-4660-b2db-08e75a95aae6","owner":[],"postedDate":"February 18th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-20T12:26:47+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-18 05:59:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8496860","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8496860","identity":"rs-8496860","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}