Calming the Mind, Strengthening the Nurse: A Mindfulness-Based Intervention for Nursing Students

Calming the Mind, Strengthening the Nurse: A Mindfulness-Based Intervention for Nursing Students | 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 Calming the Mind, Strengthening the Nurse: A Mindfulness-Based Intervention for Nursing Students Hatice Pars, Merve AKAY This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7761759/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background: Nursing students are particularly vulnerable to psychological distress due to the combined demands of academic performance and clinical training. The COVID-19 pandemic has further intensified these stressors. Mindfulness-based interventions (MBIs) have shown promising results in reducing anxiety, stress, and emotional dysregulation in student populations. However, there is limited qualitative research exploring how nursing students in Turkey experience such interventions. Objective: To explore the psychological and experiential outcomes of an eight-session mindfulness-based educational program among nursing students in Turkey, with a focus on anxiety, stress management, and mindfulness awareness. Methods: This study employed a qualitative phenomenological design. Fifteen undergraduate nursing students (aged 21–23) who completed the full mindfulness-based program participated in semi-structured, in-depth interviews. Data were analyzed using Braun and Clarke’s six-phase thematic analysis. The intervention integrated breathing exercises, body awareness, and guided meditation delivered weekly by a certified instructor. Results: Thematic analysis revealed five pre-intervention themes: (1) sources of stress and anxiety, (2) coping strategies, (3) physical and cognitive symptoms, (4) impact on daily/academic life, and (5) limited mindfulness awareness. Post-intervention themes highlighted: (1) increased breath awareness and emotional regulation, (2) improved stress management, (3) enhanced academic focus, (4) integration of mindfulness into daily routines, and (5) strengthened self-awareness and emotional observation. Participants reported decreased anxiety symptoms, more adaptive stress coping, and improved present-moment attention. Conclusions: The intervention contributed to significant psychological shifts in nursing students, enhancing emotional resilience, present-moment awareness, and self-regulation. Findings support the integration of mindfulness practices into nursing curricula to address mental health challenges in healthcare education. Further research with larger samples and longitudinal designs is recommended. Mindfulness nursing students anxiety stress qualitative research emotional regulation phenomenology yoga-based intervention Figures Figure 1 Introduction In recent years, particularly following the COVID-19 pandemic, mental health concerns among university students have become increasingly prevalent. Depression, anxiety, and stress are now recognized as the most common psychological symptoms within this population (1–3). This increase can be attributed to the unique developmental and environmental challenges faced by individuals in late adolescence and early adulthood—a period often characterized by identity formation, social adaptation, and transition into independent living (4–6). Among students in health-related disciplines, nursing students are particularly vulnerable to heightened stress and anxiety levels, often stemming from the combined demands of academic rigor and clinical training (7–9). Prior research indicates that nursing students report significantly higher levels of psychological distress compared to their peers in other academic programs (10–12). Such emotional burdens, if unaddressed, can negatively impact academic performance, clinical competency, and overall well-being, and may even contribute to program attrition (13,14). Given the psychological toll of sustained stress and anxiety, there is a growing emphasis on evidence-based interventions that promote mental health resilience among students. Mindfulness-based approaches—which encourage individuals to observe their thoughts, emotions, and bodily sensations in the present moment without judgment—have gained substantial empirical support for their efficacy in reducing psychological distress and enhancing emotional regulation (15–17). Furthermore, mindfulness training is associated with improvements in self-compassion, empathy, and life satisfaction—attributes that are vital not only to students' personal well-being but also to the quality of care they provide in clinical practice (18–20). Recent meta-analytic and qualitative research demonstrates a growing global concern regarding stress, anxiety, and depression among university students, particularly those in health professions such as nursing, where academic and clinical demands converge (21–23). For instance, a global meta-analysis involving nearly 9,000 nursing students across 15 countries reported significant prevalence rates of depression, anxiety, and stress—highlighting a clear need for effective mental health strategies (22). Mindfulness-based interventions (MBIs) have consistently been shown to reduce anxiety, depression, and stress, while increasing mindfulness levels in nursing students (17,24,25). A 2020 meta-analysis of ten randomized controlled trials found clinically meaningful reductions in depression (SMD = -0.42), anxiety (SMD = -0.32), and stress (SMD = -0.50) among nursing students who received MBIs compared to controls. Beyond individual stress reduction, newer research in general university populations indicates that MBIs can foster wider psychosocial benefits, including resilience, empathy, and pro-social behaviors (26,27). For example, the Mindful Students Program extended positive outcomes into ethical and environmental domains, suggesting that MBIs may influence collective and pro-social dimensions of student well-being. Despite this international evidence, empirical research in Turkey remains scarce, particularly studies that qualitatively explore nursing students' lived experiences within mindfulness-based educational programs. To address this gap, our study investigates how nursing students in Turkey perceive and are affected by an eight-session mindfulness-based program, focusing on the psychological constructs of anxiety, stress, and mindfulness awareness. This work offers novel, culturally grounded insights into how mindfulness-based education addresses mental health concerns in future healthcare professionals. It contributes both to national educational policy discussions and to the global evidence base on mindfulness in nursing education—highlighting its significance for curriculum design, student resilience, and the cultivation of empathetic care practices worldwide. This study is among the first in Turkey to explore the experiential outcomes of a mindfulness-based educational program for nursing students using a qualitative research design. By focusing on students’ reflections and personal transformations throughout the program, this research contributes unique and culturally situated insights to the global understanding of mindfulness in nursing education. These findings have the potential to inform both academic curricula and mental health interventions aimed at enhancing psychological resilience in nursing students—both within Turkey and across similar educational contexts worldwide. Methods Study Design This research employed a qualitative phenomenological design to explore the lived experiences of nursing students who participated in a mindfulness-based educational program. The phenomenological approach was chosen to gain in-depth insight into participants' subjective experiences, interpretations, and perceived changes related to anxiety, stress, and mindfulness during and after the intervention. Participants and Sampling Participants were selected using purposive sampling from undergraduate students enrolled in a nursing faculty at a public university in Turkey. Fifteen nursing students (2nd, 3rd, and 4th year) who voluntarily attended all sessions of the mindfulness-based program were included in the study. Inclusion criteria required regular attendance and willingness to reflect on their experience (Fig 1.) Mindfulness-Based Program The intervention was an 8-session mindfulness-based educational program incorporating breathing exercises (pranayama), body awareness (asana), and meditation (dhyana). Each session lasted approximately 60–75 minutes and was delivered weekly by a qualified mindfulness and yoga instructor. The program content was adapted from established mindfulness and yoga protocols, aiming to support emotional regulation, present-moment awareness, and self-compassion. Data Collection Data were collected through semi-structured in-depth interviews conducted within one week after the completion of the program. The interviews were guided by open-ended questions that explored participants’ experiences with stress, anxiety, mindfulness, self-compassion, and emotional awareness. Each interview lasted between 35 and 50 minutes, was audio-recorded with consent, and later transcribed verbatim. Data Analysis Interview transcripts were analyzed using thematic analysis following Braun and Clarke’s six-phase framework: (1) familiarization with the data, (2) initial coding, (3) generating themes, (4) reviewing themes, (5) defining and naming themes, and (6) producing the report. Two researchers independently coded the transcripts and discussed emerging themes to ensure inter-coder reliability. Direct quotations from participants were included to support transparency and trustworthiness of the findings. Ethical Considerations This study was conducted in accordance with the Declaration of Helsinki and ethical approval was obtained from the Atılım University Research Ethics Committee (Approval No:604.01.02-462). Participants were informed about the study’s aim, confidentiality, and their right to withdraw at any time. Informed consent was obtained from all participants prior to the interviews, and all data were anonymized during analysis and reporting. Results A total 15 nursing students participated in the study with ages ranging from 21–23 years. The majority (%80) were female. Thematic analysis of pre-intervention interviews with nursing students revealed five primary domains: ( 1 ) sources of stress and anxiety, ( 2 ) coping strategies, ( 3 ) physical and cognitive responses to distress, ( 4 ) impact on academic and personal life, and ( 5 ) perceptions of mindfulness and presence. (Table 1 ). Participants commonly cited exam pressure, time management challenges, and emotional overload as dominant stressors. While some relied on avoidance or material self-rewards, others attempted healthier coping through physical activity or social support. Awareness of mindfulness concepts varied, with several students expressing interest but little prior experience. Table 1 Thematic Analysis Table Theme Sub-Theme Codes (Open Coding) Sources of Stress Academic and Social Stress Factors Being in crowded environments, exam weeks, driving in traffic, early morning wake-up/breakfast pressure, fear of academic failure, financial worries, experiencing injustice, time pressure and multiple responsibilities, first communication with strangers, intense internship pressure, uncertainty about the future, and exam Coping Strategies for Stress Individual and Passive Coping Methods Exercising/pilates/walking, breathing exercises, listening to music, becoming quiet/avoiding environment, rewarding oneself, smoking, trying meditation/yoga, suppressing/ignoring emotions Psychophysiological Reflections of Anxiety Physical and Cognitive Stress Symptoms Acne, stomach ache, sweating, hand tremors, hot flashes, feeling faint, irregular sleep, mental fog, forgetfulness, overeating/junk food consumption Mental Distraction and Difficulty Staying Present Focus Problems and Mental Absentmindedness Worrying about the future/ruminating on the past, inability to focus during emotional distress, multitasking/conflicting roles, feeling trapped (e.g., final exam week) Awareness Perception Experience of Mindfulness and Personal Definitions Feeling present when away from screens, mindfulness during nature walks, inner awareness through daily journaling, empathetic communication with patients, observing the environment Previous Mindfulness Experiences Familiarity with Mindfulness and Yoga Meditation videos, yoga experience (by the seaside), single-session mindfulness practice at school, willingness for practical training but lack of opportunity Most participants reported academic stress, especially during exam periods, as their primary source of anxiety. Several expressed difficulty managing expectations and described maladaptive coping mechanisms such as avoidance, emotional eating, or somatic complaints like skin problems. Awareness of present-moment experience was generally low, though one participant described moments of insight through reflective journaling. In the floowing quotations, the nursing students is deoted as S. The number denotes quotations cited from the15 different interviews. Pre-Intervention Themes Emerging from Participant Interviews A thematic analysis of the pre-intervention open-ended responses from six nursing students revealed several recurring psychological and experiential patterns related to stress, anxiety, and mindfulness awareness. The data were grouped into the following core themes: 1. Sources and Triggers of Stress and Anxiety Most of the participants stated that they faced various sources of stress both in their daily lives and in their academic processes. The most frequently mentioned sources of stress were exams, academic achievement pressure, time management difficulties, difficulties in social interactions and future anxiety. Other contributors to stress included future uncertainty, financial instability, and time constraints from overlapping responsibilities. Some students described being in social settings or crowds as stressful, while others emphasized long-term concerns such as preparation for work life and uncertainty after graduation. Sub-theme 1.1: Social and Environmental Stressors "Being in crowded places or facing unfamiliar people causes my heart to race, especially when I have to speak in front of a group." (S4) "During my hospital internship, I feel stress when entering VIP patient rooms because I’m worried about making mistakes." (S1) Sub-theme 1.2: Academic Pressure and Time Constraints "During exam weeks, the pressure of balancing multiple responsibilities makes me anxious, and my sleep suffers." (S2) "Preparing for big exams always triggers a sense of worry that’s hard to shake off." (S3) 2. Stress and Anxiety Management Strategies Students employed a variety of coping strategies, ranging from maladaptive (emotional eating, avoidance, emotional withdrawal) to more adaptive approaches (breathing exercises, self-reward, walking). However, several students noted that their current strategies offered only short-term relief and did not address the root causes of their anxiety. Sub-theme 2.1: Avoidance and Suppression "When stressed, I tend to ignore it and think I will deal with it later, but it often builds up." (S6) "Sometimes I just get silent and withdraw from others until I feel calmer." (S7) Sub-theme 2.2: Physical and Emotional Coping Mechanisms "I buy myself small gifts or try to eat sweets to calm down, though I know it’s not the best habit." (S1) "I do some breathing exercises and take short walks, which helps temporarily." (S5) "Smoking increases especially around exams, which I know is unhealthy but it helps me manage stress." (S6) 3. Physical and Psychological Symptoms of Stress and Anxiety The effects of stress and anxiety have been reported at both physiological and mental levels. Students experienced symptoms such as acne, stomach pain, trembling hands, shortness of breath, palpitations, changes in appetite and insomnia. Participants reported somatic responses such as increased heart rate, cold sweats, trembling hands, and skin breakouts. Psychologically, symptoms included mental fatigue, racing thoughts, emotional numbness, irritability, and withdrawal from social interactions. On a mental level, difficulty focusing, overthinking, low motivation and emotional fluctuations were frequently reported. Sub-theme 3.1: Physical Manifestations "I notice my hands shaking and my heart pounding when I get anxious." (S5) "Before exams, my stomach hurts, and I sometimes feel dizzy." (S1) "I get tense muscles and sometimes break out in cold sweat." (S6) “My heartbeat quickens, my hands sweat, my breathing becomes shallow...”(S12) Sub-theme 3.2: Cognitive and Emotional Changes "My mind keeps racing with negative thoughts, and I have trouble concentrating." (S9) "When I feel stressed, I become emotionally sensitive and sometimes tearful unexpectedly." (S10) “Sometimes I feel like I’m going to lose control and … the need to eat junk food…”(S11) 4. Impact of Stress and Anxiety on Daily Life and Academics Stress and anxiety were said to impair focus, sleep, self-care, academic performance, and motivation. In some cases, students acknowledged that stress could be performance-enhancing when well-managed, but overall, the impact was predominantly negative. The inability to stay mindful or “in the moment” was a common struggle, especially during times of emotional distress, academic overload, or future-oriented worry. Most of the participants stated that they had difficulty staying in the moment and were mentally preoccupied with the past or the future, especially during stressful periods (e.g. exams or intense academic periods). Sub-theme 4.1: Academic Performance and Focus "Stress sometimes paralyzes me during exams, but when I can calm down, I perform much better." (S13) "When overwhelmed, I struggle to keep up with assignments and participate in class." (S14) “I feel stuck during finals weeks when everything is piling up and I can't keep up with my life.” (S7) “When I’m sad or anxious, I can’t stay in the moment. My mind is filled with what-ifs.” (S15) Sub-theme 4.2: Social and Emotional Effects "Stress makes me more irritable and withdrawn from friends and family." (S12) "I often feel isolated when I’m anxious, which worsens my mood." (S14) “My mind is constantly preoccupied with negative scenarios that could happen in the future.” (S9) In contrast, some participants reported staying in the moment during nature walks, quiet times, moments of solitude or during a specific ritual (e.g. keeping an agenda, drinking tea) “When I look at my agenda, I realize the time that has passed...” (S12) “Sitting alone on the terrace, I looked at the flowing traffic and realized the flow of life.” (S2) 5. Mindfulness Awareness and Its Meaning Students’ conceptual understanding of mindfulness varied. Some associated it with being away from digital devices or noticing one’s environment; others connected it with emotional insight or cognitive clarity. Most participants had little or no formal experience with structured mindfulness or yoga programs. However, several engaged in personal practices such as meditation, YouTube-guided yoga, or journaling. Sub-theme 5.1: Basic Understanding of Mindfulness "I think mindfulness means being aware of what’s happening around me without judgment." (S5) "I don’t know much about mindfulness, but when I put my phone away, I feel more present." (S1) Sub-theme 5.2: Experiencing Mindfulness in Daily Life "When I’m alone and just observe my surroundings, like drinking tea on the terrace, I feel mindful." (S4) "Writing in my journal helps me reflect and realize how my month has been, which feels like being more aware." (S7) Some students attributed personal meanings to the concept of mindfulness and expressed it with definitions such as “seeing what you look at” or “listening to your inner voice”. Post-Intervention Themes Emerging from Participant Interviews 1.Breath Awareness and Emotional Regulation “ Becoming aware of my breath feels like a light breaking through the dark clouds of anxiety. As I inhale and exhale deeply, the chaos in my mind slowly settles and my body feels liberated.” (S1) “ When my heart races uncontrollably, focusing on my breath helps me regain control. Before, I would panic and lose myself, but now I am reborn with each mindful breath.” (S3) 2. Improvement in Anxiety and Stress Management “Exam anxiety had imprisoned me for years; through mindfulness, I realized that anxiety is not part of me but a passing feeling. This awareness replaced my intense fear during exams with profound calmness.” (S14) “I used to run from stress, my body would rebel; now I tell myself ‘This feeling will pass’ and observe stress without surrendering. The impact of stress on me has visibly diminished.” (S15) “The heavy burden I felt in my body during stressful moments lightens with my breath. I used to lose control, but now I can calm my mind and body.” (S13) 3. Academic Performance and Concentration “My mind used to wander constantly while studying, but mindfulness training turned focus into a skill. Now I prepare for exams with a more open and attentive mind.” (S5) “During exams, anxiety would grow so large that I’d forget what I learned and feel helpless. Mindfulness taught me to stay present and maintain attention, which improved my performance noticeably.” (S6) 4. Integration of Mindfulness and Yoga into Daily Life “Yoga and mindfulness are no longer just exercises; they have become rituals at the center of my life. Being able to feel my breath and body amid daily chaos guides me through life’s complexity.” (S4) “Thanks to mindfulness, I’ve learned to treat myself with kindness. Taking small daily breaks to connect with my body and mind has increased my quality of life.” (S7) 5. Mental Awareness and Self-Observation “I can now watch the swirling thoughts in my mind like clouds; instead of trying to change them, simply observing them has created a deep sense of freedom inside.” (S3) “During moments of stress and anxiety, telling myself ‘This is not you, it’s just a feeling’ changed my life. This perspective allows me to stand firm against emotional waves.” (S9) “ Mindfulness helped me make peace with the critical voice inside me. I listen to it as an observer, reducing its power over me.” (S10) Discussion This qualitative study explored the effects of an eight-week mindfulness-based intervention on nursing students’ experiences of stress, anxiety, and present-moment awareness. The intervention, consisting of weekly sessions integrating mindfulness practices and yoga, was conducted with 15 nursing students aged 21–23. Findings from thematic analysis of pre- and post-intervention responses indicate substantial improvements in stress management, reduction of anxiety symptoms, and enhanced levels of mindfulness and emotional self-awareness, thereby supporting all three initial hypotheses (H1, H2, H3). Reduction in Anxiety (H1) Before the intervention, participants described feeling overwhelmed by academic uncertainty, future-oriented worry, and physical symptoms such as trembling hands or stomach pain. However, post-intervention narratives reflected significant reductions in anxiety, with students emphasizing a calmer physiological state and improved cognitive control. One participant noted: “My heart no longer races like before, and I’m not reacting with excessive tension anymore.” This aligns with recent findings by Liu et al. ( 16 ) and Smith & Taylor ( 18 ), who demonstrated that mindfulness practices can significantly attenuate symptoms of anxiety among nursing students by enhancing self-regulation and interoceptive awareness. Decrease in Perceived Stress (H2) Participants reported initial difficulties in managing daily and academic stressors, often resorting to avoidance or maladaptive coping (e.g., smoking). After the intervention, they described a more conscious and empowered response to stress: “Now I can direct my attention consciously; I observe my mind rather than getting carried away.” This shift suggests not only reduced stress but an improved stress appraisal process. The stress-buffering effect of mindfulness has been widely supported in the literature ( 28 , 15 , 17 , 22 , 27 ), indicating that such interventions can serve as effective preventive tools for nursing students, a population at high risk for burnout and psychological distress. Increased Mindfulness and Emotional Awareness (H3) A key finding was the notable increase in students’ ability to remain present and observe their emotions nonjudgmentally. While pre-intervention responses reflected difficulty staying in the moment and emotional overwhelm, post-intervention narratives included phrases such as “I learned to ask myself what I’m really feeling in the moment” and “Observing my breath helped me stay grounded and centered.” These experiences resonate with Brown and Ryan’s foundational work ( 4 ) on mindfulness as a means to enhance well-being by fostering non-reactive awareness. Moreover, Abd El-Maksoud et al. ( 1 ) emphasized the role of mindfulness in improving emotion regulation among healthcare professionals, reinforcing the relevance of such practices in nursing education. Educational and Clinical Implications The improvements observed in this study are highly relevant for nursing education. As Kurt et al. ( 14 ) suggest, integrating mindfulness into curricula may not only enhance students’ psychological resilience but also improve academic performance and clinical decision-making. Given the emotional labor inherent in nursing, equipping students with tools like breath awareness, body scanning, and mindful movement may promote long-term mental well-being and professional competency. Strengths, Limitations, and Future Directions A major strength of this study lies in its in-depth, qualitative design, which allowed the researchers to capture nuanced shifts in participants' internal experiences. However, the small sample size and lack of long-term follow-up limit generalizability. Future studies should explore the sustained effects of mindfulness practices across larger and more diverse samples, potentially incorporating mixed-methods approaches for triangulation. Conclusion These preliminary findings suggest that nursing students face multidimensional stressors and experience both cognitive and somatic symptoms of anxiety. Their coping strategies are often intuitive but lack structured support. The generally low familiarity with formal mindfulness practices suggests an opportunity for structured interventions to enhance emotional regulation, present-moment awareness, and psychological resilience. This study underscores the transformative potential of mindfulness-based interventions in reducing anxiety and stress while enhancing awareness and emotional regulation among nursing students. Embedding such practices in health education can serve both preventive and developmental functions, preparing future healthcare professionals to navigate their roles with greater presence, empathy, and balance. Declarations Funding Statement This study was supported by The Scientific and Technological Research Council of Türkiye (TÜBİTAK) within the scope of the 2209-A- Research Project Support Programme for Undergraduate Students. Author Contribution Author Contribution Conceptualization, H.P.; methodology, H.P. and M.A.; validation, M.A.; formal analysis, H.P.; investigation, H.P.; resources, M.A.; data curation, M.A ; writing—original draft preparation, H.P.; writing—review and editing, H.P and M.A; visualization, H.P.; supervision, H.P; project administration, H.P. and M.A; funding acquisition, none. All authors have read and agreed to the published version of the manuscript. Acknowledgement Funding Statement:This study was supported by The Scientific and Technological Research Council of Türkiye (TÜBİTAK) within the scope of the 2209-A - Research Project Support Programme for Undergraduate Students. References Abd El-Maksoud AM, El Sayed HEA, Youssef AS. Effects of a mindfulness-based intervention on emotional regulation among emergency nurses: A quasi-experimental study. Nurse Educ Today. 2024;127:105810. Auerbach RP, Mortier P, Bruffaerts R, Alonso J, Benjet C, Cuijpers P, Murray E. WHO world mental health surveys international college student project: Prevalence and distribution of mental disorders. J Abnorm Psychol. 2018;127(7):623–38. 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. Brown KW, Ryan RM. The benefits of being present: Mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003;84(4):822–48. dos Santos TM, Kozasa EH, Carmagnani IS, Tanaka LH, Lacerda SS, Nogueira-Martins LA. Positive effects of a stress reduction program based on mindfulness meditation in Brazilian nursing professionals: Qualitative and quantitative evaluation. Explore. 2016;12(2):90–9. Erogul M, Singer G, McIntyre T, Stefanov DG. Abridged mindfulness intervention to support wellness in first-year medical students. Teach Learn Med. 2014;26(4):350–6. Falsafi N. A randomized controlled trial of mindfulness versus yoga: Effects on depression and/or anxiety in college students. J Am Psychiatr Nurses Assoc. 2016;22(6):483–97. Fruehwirth JC, Biswas S, Perreira KM. The COVID-19 pandemic and mental health of first-year college students: Examining the effect of COVID-19 stressors using longitudinal data. PLoS ONE. 2021;16(3):e0247999. Galante J, Montero Marín J, Wood W, Streeter A, Lindsay EK, Crane C. Mindfulness training promotes climate-friendly behavior in university students: Results from the Mindful Student Study. Mindfulness. 2024;15(1):1–13. García-Rivas J, Martínez-Rodríguez A, López-Rodríguez MDM, Martínez-Rodríguez A. Emotional competence and mental health in nursing students: A systematic review. Nurse Educ Today. 2024;131:105952. González-Martín AS, Parra-Martínez AS, Fabbian F, Gallego-Gómez JI. Impact of mindfulness interventions on empathy and emotional competencies in health science students: A systematic review and meta-analysis. Mindfulness. 2023;14(7):1631–47. Hamaideh SH, Hamdan-Mansour AM. Psychological, cognitive, and personal variables that predict college academic achievement among health sciences students. Nurse Educ Today. 2014;34(5):703–8. Hojat M. Ten approaches for enhancing empathy in health and human services cultures. J Health Hum Serv Adm. 2009;31(4):412–50. Kurt D, Demir S, Karataş Z. Mindfulness-based interventions in nursing education: A systematic review of randomized controlled trials. Nurse Educ Today. 2024;124:105730. 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. Liu Y, Zhang L, Chen H. Trait mindfulness and perceived stress in medical and nursing students: A longitudinal intervention study. Mindfulness. 2024;15(1):76–83. Zhang Y, Wu X, Liang L. Mindfulness-based stress reduction for nursing students: A meta-analysis of randomized controlled trials. J Adv Nurs. 2022;78(5):218–28. Smith LC, Taylor JP. Effects of yoga and mindfulness on nursing students’ stress and anxiety: A mixed-methods evaluation. Complement Ther Clin Pract. 2023;53:101716. Mahmoud JSR, Staten RT, Hall LA, Lennie TA. The relationship among young adult college students' depression, anxiety, stress, demographics, life satisfaction, and coping styles. Issues Ment Health Nurs. 2012;33(3):149–56. Neff KD. The development and validation of a scale to measure self-compassion. Self Identity. 2003;2(3):223–50. Özel Y, Türkleş S, Erdoğan S. Investigation of mental state in university students. Jaren. 2020;6(2):220–8. Pulido-Martos M, Augusto-Landa JM, López-Zafra E. Sources of stress in nursing students: A systematic review of quantitative studies. Int Nurs Rev. 2012;59(1):15–25. Taghizadeh Moghaddam H, Bahreini A, Ajilian Abbasi M, Fazli F, Saeidi M. Adolescence health: The needs, problems and attention. Int J Pediatr. 2016;4(2):1423–38. Tung YJ, Lo KKH, Ho RC, Tam WSW. Prevalence of depression among nursing students: A systematic review and meta-analysis. Nurse Educ Today. 2020;63:119–29. Xinqiao L, Siqing P, Wenjuan G. Changes in undergraduate students’ psychological well-being as they experience university life. Int J Environ Res Public Health. 2019;16(16):2864. Zeng Y, Wang G, Xie C, Hu X, Reinhardt JD. Prevalence and correlates of depression, anxiety and symptoms of stress in vocational college nursing students from Sichuan, China: A cross-sectional study. Psychol Health Med. 2019;24(7):798–811. Kang E, Lee J, Park S. Mindfulness workshop improves nursing students’ academic self-efficacy and emotional well-being: A pre-post study. Nurse Educ Pract. 2024;72:103596. González-Martín AS, Parra-Martínez AS, Fabbian F, Gallego-Gómez JI. Impact of mindfulness interventions on empathy and emotional competencies in health science students: A systematic review and meta-analysis. Mindfulness. 2023;14(7):1631–47. Galante J, Montero-Marín J, Wood W, Streeter A, Lindsay EK, Crane C. Mindfulness training promotes climate-friendly behavior in university students: Results from the Mindful Student Study. Mindfulness. 2024;15(1):1–13. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 26 Nov, 2025 Reviewers agreed at journal 09 Nov, 2025 Reviewers agreed at journal 06 Nov, 2025 Reviewers invited by journal 30 Oct, 2025 Editor invited by journal 07 Oct, 2025 Editor assigned by journal 04 Oct, 2025 Submission checks completed at journal 04 Oct, 2025 First submitted to journal 01 Oct, 2025 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. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-7761759","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":542252448,"identity":"e8803a7e-cfe4-46b5-a2e1-60d4c57fb8e8","order_by":0,"name":"Hatice Pars","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBklEQVRIiWNgGAWjYBACAyA+AGUzPmBgkJBhAzF58GphhmthNmBIkOCBaZHApwUG2CQYEqDm49Nizn7+4IEfFQx5/LOPP6v4+cOCh0/sAOODt20MdeYN2LVY9iQzHOw5w1AscS7H7GYPyGHSCcyGc9uAvjqAXYvBgWSGw4xtDIkNZ3jYbvBAtLBJ8wK14HKZwfnHQC3/GBLnn2F/VvgHooX9N14tN0C2NDAkbjjDYMYMs4UZv5bHBgd7jkkUG57hMZaWSQNpSWyWnHNOQnIGToclPv7wo8YmT+4M+8OPb2zq5ORnJx/88KbMhh9nKEOARAISB+hOPNECBwkEVYyCUTAKRsHIBQBvQ07dl4n/QQAAAABJRU5ErkJggg==","orcid":"","institution":"Atılım University","correspondingAuthor":true,"prefix":"","firstName":"Hatice","middleName":"","lastName":"Pars","suffix":""},{"id":542252449,"identity":"d6f044d2-2f4d-4ad1-b83b-47bf762284a6","order_by":1,"name":"Merve AKAY","email":"","orcid":"","institution":"Atılım University","correspondingAuthor":false,"prefix":"","firstName":"Merve","middleName":"","lastName":"AKAY","suffix":""}],"badges":[],"createdAt":"2025-10-01 18:08:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7761759/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7761759/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":95663444,"identity":"6d743f00-6ce5-4484-afe6-fbaaf5039389","added_by":"auto","created_at":"2025-11-11 16:38:56","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":57303,"visible":true,"origin":"","legend":"","description":"","filename":"CalmingtheMindBMC.docx","url":"https://assets-eu.researchsquare.com/files/rs-7761759/v1/2d20928789718dbd203fa50b.docx"},{"id":95663415,"identity":"3140c081-7107-4984-b0cc-b78d404e2386","added_by":"auto","created_at":"2025-11-11 16:38:52","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":15397,"visible":true,"origin":"","legend":"","description":"","filename":"Table1mindfulness.docx","url":"https://assets-eu.researchsquare.com/files/rs-7761759/v1/d517e7c3b895389e0bf3051e.docx"},{"id":95663431,"identity":"d9856d5f-8337-4eb2-a770-10db678be67a","added_by":"auto","created_at":"2025-11-11 16:38:54","extension":"json","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":5282,"visible":true,"origin":"","legend":"","description":"","filename":"930e22fca9a74920b94883060cd59f5d.json","url":"https://assets-eu.researchsquare.com/files/rs-7761759/v1/0cc253cb1289760056c966d2.json"},{"id":95663498,"identity":"c243c573-b435-4db6-82aa-e40182a3cc8d","added_by":"auto","created_at":"2025-11-11 16:39:00","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":88963,"visible":true,"origin":"","legend":"","description":"","filename":"930e22fca9a74920b94883060cd59f5d1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7761759/v1/da6c753ee024725ada4b5c54.xml"},{"id":95663541,"identity":"db94d90c-68b0-4c39-acb1-8f2d422e1631","added_by":"auto","created_at":"2025-11-11 16:39:05","extension":"dotx","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":376532,"visible":true,"origin":"","legend":"","description":"","filename":"Figure1mindfulness.dotx","url":"https://assets-eu.researchsquare.com/files/rs-7761759/v1/895ffd6ecef626da80e2f35f.dotx"},{"id":95663599,"identity":"f25e5549-ac0f-405f-b777-1b71ef293359","added_by":"auto","created_at":"2025-11-11 16:39:08","extension":"xml","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":84833,"visible":true,"origin":"","legend":"","description":"","filename":"930e22fca9a74920b94883060cd59f5d1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7761759/v1/28db78ef2980ce0e927c8ba3.xml"},{"id":95663549,"identity":"460c4736-1b7a-47c5-9896-59245bcb8a72","added_by":"auto","created_at":"2025-11-11 16:39:06","extension":"html","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":98061,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7761759/v1/e75a32f20f58a45a92ec5ca5.html"},{"id":95663543,"identity":"ca4f3926-993b-4dce-bd8f-ca526f93eac2","added_by":"auto","created_at":"2025-11-11 16:39:05","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":129608,"visible":true,"origin":"","legend":"\u003cp\u003eQualitative thematic analysis based on descriptive phenomenology\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7761759/v1/3c6dc5716e74c02fd85c6d4e.jpg"},{"id":95797517,"identity":"9ff3cd11-9f38-4d49-8384-12cb00e7ce0e","added_by":"auto","created_at":"2025-11-13 08:06:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1204439,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7761759/v1/1480972e-2bc2-4556-a47b-eeea51f09799.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Calming the Mind, Strengthening the Nurse: A Mindfulness-Based Intervention for Nursing Students","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn recent years, particularly following the COVID-19 pandemic, mental health concerns among university students have become increasingly prevalent. Depression, anxiety, and stress are now recognized as the most common psychological symptoms within this population (1–3). This increase can be attributed to the unique developmental and environmental challenges faced by individuals in late adolescence and early adulthood—a period often characterized by identity formation, social adaptation, and transition into independent living (4–6).\u003c/p\u003e\n\u003cp\u003eAmong students in health-related disciplines, nursing students are particularly vulnerable to heightened stress and anxiety levels, often stemming from the combined demands of academic rigor and clinical training (7–9). Prior research indicates that nursing students report significantly higher levels of psychological distress compared to their peers in other academic programs (10–12). Such emotional burdens, if unaddressed, can negatively impact academic performance, clinical competency, and overall well-being, and may even contribute to program attrition (13,14).\u003c/p\u003e\n\u003cp\u003eGiven the psychological toll of sustained stress and anxiety, there is a growing emphasis on evidence-based interventions that promote mental health resilience among students. Mindfulness-based approaches—which encourage individuals to observe their thoughts, emotions, and bodily sensations in the present moment without judgment—have gained substantial empirical support for their efficacy in reducing psychological distress and enhancing emotional regulation (15–17). Furthermore, mindfulness training is associated with improvements in self-compassion, empathy, and life satisfaction—attributes that are vital not only to students' personal well-being but also to the quality of care they provide in clinical practice (18–20).\u003c/p\u003e\n\u003cp\u003eRecent meta-analytic and qualitative research demonstrates a growing global concern regarding stress, anxiety, and depression among university students, particularly those in health professions such as nursing, where academic and clinical demands converge (21–23). For instance, a global meta-analysis involving nearly 9,000 nursing students across 15 countries reported significant prevalence rates of depression, anxiety, and stress—highlighting a clear need for effective mental health strategies (22).\u003c/p\u003e\n\u003cp\u003eMindfulness-based interventions (MBIs) have consistently been shown to reduce anxiety, depression, and stress, while increasing mindfulness levels in nursing students (17,24,25). A 2020 meta-analysis of ten randomized controlled trials found clinically meaningful reductions in depression (SMD = -0.42), anxiety (SMD = -0.32), and stress (SMD = -0.50) among nursing students who received MBIs compared to controls. Beyond individual stress reduction, newer research in general university populations indicates that MBIs can foster wider psychosocial benefits, including resilience, empathy, and pro-social behaviors (26,27). For example, the Mindful Students Program extended positive outcomes into ethical and environmental domains, suggesting that MBIs may influence collective and pro-social dimensions of student well-being.\u003c/p\u003e\n\u003cp\u003eDespite this international evidence, empirical research in Turkey remains scarce, particularly studies that qualitatively explore nursing students' lived experiences within mindfulness-based educational programs. To address this gap, our study investigates how nursing students in Turkey perceive and are affected by an eight-session mindfulness-based program, focusing on the psychological constructs of anxiety, stress, and mindfulness awareness.\u003c/p\u003e\n\u003cp\u003eThis work offers novel, culturally grounded insights into how mindfulness-based education addresses mental health concerns in future healthcare professionals. It contributes both to national educational policy discussions and to the global evidence base on mindfulness in nursing education—highlighting its significance for curriculum design, student resilience, and the cultivation of empathetic care practices worldwide.\u003c/p\u003e\n\u003cp\u003eThis study is among the first in Turkey to explore the experiential outcomes of a mindfulness-based educational program for nursing students using a qualitative research design. By focusing on students’ reflections and personal transformations throughout the program, this research contributes unique and culturally situated insights to the global understanding of mindfulness in nursing education. These findings have the potential to inform both academic curricula and mental health interventions aimed at enhancing psychological resilience in nursing students—both within Turkey and across similar educational contexts worldwide.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research employed a \u003cstrong\u003equalitative phenomenological design\u003c/strong\u003e to explore the lived experiences of nursing students who participated in a mindfulness-based educational program. The phenomenological approach was chosen to gain in-depth insight into participants\u0026apos; subjective experiences, interpretations, and perceived changes related to anxiety, stress, and mindfulness during and after the intervention. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants and Sampling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were selected using \u003cstrong\u003epurposive sampling\u003c/strong\u003e from undergraduate students enrolled in a nursing faculty at a public university in Turkey. Fifteen nursing students (2nd, 3rd, and 4th year) who voluntarily attended all sessions of the mindfulness-based program were included in the study. Inclusion criteria required regular attendance and willingness to reflect on their experience (Fig 1.)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMindfulness-Based Program\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe intervention was an 8-session mindfulness-based educational program incorporating breathing exercises (pranayama), body awareness (asana), and meditation (dhyana). Each session lasted approximately 60\u0026ndash;75 minutes and was delivered weekly by a qualified mindfulness and yoga instructor. The program content was adapted from established mindfulness and yoga protocols, aiming to support emotional regulation, present-moment awareness, and self-compassion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected through \u003cstrong\u003esemi-structured in-depth interviews\u003c/strong\u003e conducted within one week after the completion of the program. The interviews were guided by open-ended questions that explored participants\u0026rsquo; experiences with stress, anxiety, mindfulness, self-compassion, and emotional awareness. Each interview lasted between 35 and 50 minutes, was audio-recorded with consent, and later transcribed verbatim.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInterview transcripts were analyzed using\u0026nbsp;thematic analysis\u0026nbsp;following Braun and Clarke\u0026rsquo;s six-phase framework: (1) familiarization with the data, (2) initial coding, (3) generating themes, (4) reviewing themes, (5) defining and naming themes, and (6) producing the report. Two researchers independently coded the transcripts and discussed emerging themes to ensure inter-coder reliability. Direct quotations from participants were included to support transparency and trustworthiness of the findings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki and ethical approval was obtained from the Atılım University Research Ethics Committee (Approval No:604.01.02-462). Participants were informed about the study\u0026rsquo;s aim, confidentiality, and their right to withdraw at any time. Informed consent was obtained from all participants prior to the interviews, and all data were anonymized during analysis and reporting.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total 15 nursing students participated in the study with ages ranging from 21\u0026ndash;23 years. The majority (%80) were female. Thematic analysis of pre-intervention interviews with nursing students revealed five primary domains: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) sources of stress and anxiety, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) coping strategies, (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) physical and cognitive responses to distress, (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) impact on academic and personal life, and (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) perceptions of mindfulness and presence. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Participants commonly cited exam pressure, time management challenges, and emotional overload as dominant stressors. While some relied on avoidance or material self-rewards, others attempted healthier coping through physical activity or social support. Awareness of mindfulness concepts varied, with several students expressing interest but little prior experience.\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\u003eThematic Analysis Table\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSub-Theme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCodes (Open Coding)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSources of Stress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAcademic and Social Stress Factors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBeing in crowded environments, exam weeks, driving in traffic, early morning wake-up/breakfast pressure, fear of academic failure, financial worries, experiencing injustice, time pressure and multiple responsibilities, first communication with strangers, intense internship pressure, uncertainty about the future, and exam\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCoping Strategies for Stress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIndividual and Passive Coping Methods\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExercising/pilates/walking, breathing exercises, listening to music, becoming quiet/avoiding environment, rewarding oneself, smoking, trying meditation/yoga, suppressing/ignoring emotions\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychophysiological Reflections of Anxiety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhysical and Cognitive Stress Symptoms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAcne, stomach ache, sweating, hand tremors, hot flashes, feeling faint, irregular sleep, mental fog, forgetfulness, overeating/junk food consumption\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMental Distraction and Difficulty Staying Present\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFocus Problems and Mental Absentmindedness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWorrying about the future/ruminating on the past, inability to focus during emotional distress, multitasking/conflicting roles, feeling trapped (e.g., final exam week)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAwareness Perception\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExperience of Mindfulness and Personal Definitions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFeeling present when away from screens, mindfulness during nature walks, inner awareness through daily journaling, empathetic communication with patients, observing the environment\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrevious Mindfulness Experiences\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFamiliarity with Mindfulness and Yoga\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMeditation videos, yoga experience (by the seaside), single-session mindfulness practice at school, willingness for practical training but lack of opportunity\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\u003eMost participants reported academic stress, especially during exam periods, as their primary source of anxiety. Several expressed difficulty managing expectations and described maladaptive coping mechanisms such as avoidance, emotional eating, or somatic complaints like skin problems. Awareness of present-moment experience was generally low, though one participant described moments of insight through reflective journaling.\u003c/p\u003e\u003cp\u003eIn the floowing quotations, the nursing students is deoted as S. The number denotes quotations cited from the15 different interviews.\u003c/p\u003e\n\u003ch3\u003ePre-Intervention Themes Emerging from Participant Interviews\u003c/h3\u003e\n\u003cp\u003eA thematic analysis of the pre-intervention open-ended responses from six nursing students revealed several recurring psychological and experiential patterns related to stress, anxiety, and mindfulness awareness. The data were grouped into the following core themes:\u003c/p\u003e\u003cp\u003e\u003cb\u003e1. Sources and Triggers of Stress and Anxiety\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMost of the participants stated that they faced various sources of stress both in their daily lives and in their academic processes. The most frequently mentioned sources of stress were exams, academic achievement pressure, time management difficulties, difficulties in social interactions and future anxiety. Other contributors to stress included future uncertainty, financial instability, and time constraints from overlapping responsibilities. Some students described being in social settings or crowds as stressful, while others emphasized long-term concerns such as preparation for work life and uncertainty after graduation.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eSub-theme 1.1: Social and Environmental Stressors\u003c/h2\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\"Being in crowded places or facing unfamiliar people causes my heart to race, especially when I have to speak in front of a group.\"\u003c/em\u003e (S4)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\"During my hospital internship, I feel stress when entering VIP patient rooms because I\u0026rsquo;m worried about making mistakes.\"\u003c/em\u003e (S1)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSub-theme 1.2: Academic Pressure and Time Constraints\u003c/h3\u003e\n\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\"During exam weeks, the pressure of balancing multiple responsibilities makes me anxious, and my sleep suffers.\"\u003c/em\u003e(S2)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\"Preparing for big exams always triggers a sense of worry that\u0026rsquo;s hard to shake off.\"\u003c/em\u003e (S3)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e2. Stress and Anxiety Management Strategies\u003c/b\u003e\u003c/p\u003e\u003cp\u003eStudents employed a variety of coping strategies, ranging from maladaptive (emotional eating, avoidance, emotional withdrawal) to more adaptive approaches (breathing exercises, self-reward, walking). However, several students noted that their current strategies offered only short-term relief and did not address the root causes of their anxiety.\u003c/p\u003e\n\u003ch3\u003eSub-theme 2.1: Avoidance and Suppression\u003c/h3\u003e\n\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\"When stressed, I tend to ignore it and think I will deal with it later, but it often builds up.\"\u003c/em\u003e (S6)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\"Sometimes I just get silent and withdraw from others until I feel calmer.\"\u003c/em\u003e (S7)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\n\u003ch3\u003eSub-theme 2.2: Physical and Emotional Coping Mechanisms\u003c/h3\u003e\n\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\"I buy myself small gifts or try to eat sweets to calm down, though I know it\u0026rsquo;s not the best habit.\"\u003c/em\u003e (S1)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\"I do some breathing exercises and take short walks, which helps temporarily.\"\u003c/em\u003e (S5)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\"Smoking increases especially around exams, which I know is unhealthy but it helps me manage stress.\"\u003c/em\u003e (S6)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e3. Physical and Psychological Symptoms of Stress and Anxiety\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe effects of stress and anxiety have been reported at both physiological and mental levels. Students experienced symptoms such as acne, stomach pain, trembling hands, shortness of breath, palpitations, changes in appetite and insomnia. Participants reported somatic responses such as increased heart rate, cold sweats, trembling hands, and skin breakouts. Psychologically, symptoms included mental fatigue, racing thoughts, emotional numbness, irritability, and withdrawal from social interactions. On a mental level, difficulty focusing, overthinking, low motivation and emotional fluctuations were frequently reported.\u003c/p\u003e\n\u003ch3\u003eSub-theme 3.1: Physical Manifestations\u003c/h3\u003e\n\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\"I notice my hands shaking and my heart pounding when I get anxious.\"\u003c/em\u003e (S5)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\"Before exams, my stomach hurts, and I sometimes feel dizzy.\"\u003c/em\u003e (S1)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\"I get tense muscles and sometimes break out in cold sweat.\"\u003c/em\u003e (S6)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u0026ldquo;My heartbeat quickens, my hands sweat, my breathing becomes shallow...\u0026rdquo;(S12)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eSub-theme 3.2: Cognitive and Emotional Changes\u003c/h2\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\"My mind keeps racing with negative thoughts, and I have trouble concentrating.\"\u003c/em\u003e (S9)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\"When I feel stressed, I become emotionally sensitive and sometimes tearful unexpectedly.\"\u003c/em\u003e (S10)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Sometimes I feel like I\u0026rsquo;m going to lose control and \u0026hellip; the need to eat junk food\u0026hellip;\u0026rdquo;(S11)\u003c/em\u003e\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e4. Impact of Stress and Anxiety on Daily Life and Academics\u003c/b\u003e\u003c/p\u003e\u003cp\u003eStress and anxiety were said to impair focus, sleep, self-care, academic performance, and motivation. In some cases, students acknowledged that stress could be performance-enhancing when well-managed, but overall, the impact was predominantly negative. The inability to stay mindful or \u0026ldquo;in the moment\u0026rdquo; was a common struggle, especially during times of emotional distress, academic overload, or future-oriented worry. Most of the participants stated that they had difficulty staying in the moment and were mentally preoccupied with the past or the future, especially during stressful periods (e.g. exams or intense academic periods).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSub-theme 4.1: Academic Performance and Focus\u003c/h3\u003e\n\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\"Stress sometimes paralyzes me during exams, but when I can calm down, I perform much better.\"\u003c/em\u003e (S13)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\"When overwhelmed, I struggle to keep up with assignments and participate in class.\"\u003c/em\u003e (S14)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I feel stuck during finals weeks when everything is piling up and I can't keep up with my life.\u0026rdquo;\u003c/em\u003e (S7)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;When I\u0026rsquo;m sad or anxious, I can\u0026rsquo;t stay in the moment. My mind is filled with what-ifs.\u0026rdquo;\u003c/em\u003e(S15)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\n\u003ch3\u003eSub-theme 4.2: Social and Emotional Effects\u003c/h3\u003e\n\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\"Stress makes me more irritable and withdrawn from friends and family.\"\u003c/em\u003e (S12)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\"I often feel isolated when I\u0026rsquo;m anxious, which worsens my mood.\"\u003c/em\u003e (S14)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;My mind is constantly preoccupied with negative scenarios that could happen in the future.\u0026rdquo;\u003c/em\u003e (S9)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eIn contrast, some participants reported staying in the moment during nature walks, quiet times, moments of solitude or during a specific ritual (e.g. keeping an agenda, drinking tea)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;When I look at my agenda, I realize the time that has passed...\u0026rdquo;\u003c/em\u003e (S12)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Sitting alone on the terrace, I looked at the flowing traffic and realized the flow of life.\u0026rdquo;\u003c/em\u003e (S2)\u003c/p\u003e\u003cp\u003e\u003cb\u003e5. Mindfulness Awareness and Its Meaning\u003c/b\u003e\u003c/p\u003e\u003cp\u003eStudents\u0026rsquo; conceptual understanding of mindfulness varied. Some associated it with being away from digital devices or noticing one\u0026rsquo;s environment; others connected it with emotional insight or cognitive clarity. Most participants had little or no formal experience with structured mindfulness or yoga programs. However, several engaged in personal practices such as meditation, YouTube-guided yoga, or journaling.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eSub-theme 5.1: Basic Understanding of Mindfulness\u003c/h2\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\"I think mindfulness means being aware of what\u0026rsquo;s happening around me without judgment.\"\u003c/em\u003e (S5)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\"I don\u0026rsquo;t know much about mindfulness, but when I put my phone away, I feel more present.\"\u003c/em\u003e (S1)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eSub-theme 5.2: Experiencing Mindfulness in Daily Life\u003c/h2\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\"When I\u0026rsquo;m alone and just observe my surroundings, like drinking tea on the terrace, I feel mindful.\"\u003c/em\u003e (S4)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\"Writing in my journal helps me reflect and realize how my month has been, which feels like being more aware.\"\u003c/em\u003e(S7)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eSome students attributed personal meanings to the concept of mindfulness and expressed it with definitions such as \u0026ldquo;seeing what you look at\u0026rdquo; or \u0026ldquo;listening to your inner voice\u0026rdquo;.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003ePost-Intervention Themes Emerging from Participant Interviews\u003c/h2\u003e\u003cdiv id=\"Sec14\" class=\"Section3\"\u003e\u003ch2\u003e1.Breath Awareness and Emotional Regulation\u003c/h2\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eBecoming aware of my breath feels like a light breaking through the dark clouds of anxiety. As I inhale and exhale deeply, the chaos in my mind slowly settles and my body feels liberated.\u0026rdquo;\u003c/em\u003e (S1)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eWhen my heart races uncontrollably, focusing on my breath helps me regain control. Before, I would panic and lose myself, but now I am reborn with each mindful breath.\u0026rdquo;\u003c/em\u003e (S3)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e2. Improvement in Anxiety and Stress Management\u003c/h2\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Exam anxiety had imprisoned me for years; through mindfulness, I realized that anxiety is not part of me but a passing feeling. This awareness replaced my intense fear during exams with profound calmness.\u0026rdquo;\u003c/em\u003e (S14)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I used to run from stress, my body would rebel; now I tell myself \u0026lsquo;This feeling will pass\u0026rsquo; and observe stress without surrendering. The impact of stress on me has visibly diminished.\u0026rdquo;\u003c/em\u003e (S15)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;The heavy burden I felt in my body during stressful moments lightens with my breath. I used to lose control, but now I can calm my mind and body.\u0026rdquo;\u003c/em\u003e (S13)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e3. Academic Performance and Concentration\u003c/h2\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;My mind used to wander constantly while studying, but mindfulness training turned focus into a skill. Now I prepare for exams with a more open and attentive mind.\u0026rdquo;\u003c/em\u003e (S5)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;During exams, anxiety would grow so large that I\u0026rsquo;d forget what I learned and feel helpless. Mindfulness taught me to stay present and maintain attention, which improved my performance noticeably.\u0026rdquo;\u003c/em\u003e (S6)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e4. Integration of Mindfulness and Yoga into Daily Life\u003c/h2\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Yoga and mindfulness are no longer just exercises; they have become rituals at the center of my life. Being able to feel my breath and body amid daily chaos guides me through life\u0026rsquo;s complexity.\u0026rdquo;\u003c/em\u003e (S4)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Thanks to mindfulness, I\u0026rsquo;ve learned to treat myself with kindness. Taking small daily breaks to connect with my body and mind has increased my quality of life.\u0026rdquo;\u003c/em\u003e (S7)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003e5. Mental Awareness and Self-Observation\u003c/h2\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I can now watch the swirling thoughts in my mind like clouds; instead of trying to change them, simply observing them has created a deep sense of freedom inside.\u0026rdquo;\u003c/em\u003e (S3)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;During moments of stress and anxiety, telling myself \u0026lsquo;This is not you, it\u0026rsquo;s just a feeling\u0026rsquo; changed my life. This perspective allows me to stand firm against emotional waves.\u0026rdquo;\u003c/em\u003e (S9)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eMindfulness helped me make peace with the critical voice inside me. I listen to it as an observer, reducing its power over me.\u0026rdquo;\u003c/em\u003e (S10)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis qualitative study explored the effects of an eight-week mindfulness-based intervention on nursing students\u0026rsquo; experiences of stress, anxiety, and present-moment awareness. The intervention, consisting of weekly sessions integrating mindfulness practices and yoga, was conducted with 15 nursing students aged 21\u0026ndash;23. Findings from thematic analysis of pre- and post-intervention responses indicate substantial improvements in stress management, reduction of anxiety symptoms, and enhanced levels of mindfulness and emotional self-awareness, thereby supporting all three initial hypotheses (H1, H2, H3).\u003c/p\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eReduction in Anxiety (H1)\u003c/h2\u003e\u003cp\u003eBefore the intervention, participants described feeling overwhelmed by academic uncertainty, future-oriented worry, and physical symptoms such as trembling hands or stomach pain. However, post-intervention narratives reflected significant reductions in anxiety, with students emphasizing a calmer physiological state and improved cognitive control. One participant noted: \u0026ldquo;My heart no longer races like before, and I\u0026rsquo;m not reacting with excessive tension anymore.\u0026rdquo; This aligns with recent findings by Liu et al. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) and Smith \u0026amp; Taylor (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), who demonstrated that mindfulness practices can significantly attenuate symptoms of anxiety among nursing students by enhancing self-regulation and interoceptive awareness.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eDecrease in Perceived Stress (H2)\u003c/h2\u003e\u003cp\u003eParticipants reported initial difficulties in managing daily and academic stressors, often resorting to avoidance or maladaptive coping (e.g., smoking). After the intervention, they described a more conscious and empowered response to stress: \u0026ldquo;Now I can direct my attention consciously; I observe my mind rather than getting carried away.\u0026rdquo; This shift suggests not only reduced stress but an improved stress appraisal process. The stress-buffering effect of mindfulness has been widely supported in the literature (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), indicating that such interventions can serve as effective preventive tools for nursing students, a population at high risk for burnout and psychological distress.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eIncreased Mindfulness and Emotional Awareness (H3)\u003c/h2\u003e\u003cp\u003eA key finding was the notable increase in students\u0026rsquo; ability to remain present and observe their emotions nonjudgmentally. While pre-intervention responses reflected difficulty staying in the moment and emotional overwhelm, post-intervention narratives included phrases such as \u0026ldquo;I learned to ask myself what I\u0026rsquo;m really feeling in the moment\u0026rdquo; and \u0026ldquo;Observing my breath helped me stay grounded and centered.\u0026rdquo; These experiences resonate with Brown and Ryan\u0026rsquo;s foundational work (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) on mindfulness as a means to enhance well-being by fostering non-reactive awareness. Moreover, Abd El-Maksoud et al. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) emphasized the role of mindfulness in improving emotion regulation among healthcare professionals, reinforcing the relevance of such practices in nursing education.\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eEducational and Clinical Implications\u003c/h2\u003e\u003cp\u003eThe improvements observed in this study are highly relevant for nursing education. As Kurt et al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) suggest, integrating mindfulness into curricula may not only enhance students\u0026rsquo; psychological resilience but also improve academic performance and clinical decision-making. Given the emotional labor inherent in nursing, equipping students with tools like breath awareness, body scanning, and mindful movement may promote long-term mental well-being and professional competency.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eStrengths, Limitations, and Future Directions\u003c/h2\u003e\u003cp\u003eA major strength of this study lies in its in-depth, qualitative design, which allowed the researchers to capture nuanced shifts in participants' internal experiences. However, the small sample size and lack of long-term follow-up limit generalizability. Future studies should explore the sustained effects of mindfulness practices across larger and more diverse samples, potentially incorporating mixed-methods approaches for triangulation.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThese preliminary findings suggest that nursing students face multidimensional stressors and experience both cognitive and somatic symptoms of anxiety. Their coping strategies are often intuitive but lack structured support. The generally low familiarity with formal mindfulness practices suggests an opportunity for structured interventions to enhance emotional regulation, present-moment awareness, and psychological resilience.\u003c/p\u003e\u003cp\u003eThis study underscores the transformative potential of mindfulness-based interventions in reducing anxiety and stress while enhancing awareness and emotional regulation among nursing students. Embedding such practices in health education can serve both preventive and developmental functions, preparing future healthcare professionals to navigate their roles with greater presence, empathy, and balance.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding Statement\u003c/h2\u003e\u003cp\u003eThis study was supported by The Scientific and Technological Research Council of T\u0026uuml;rkiye (T\u0026Uuml;BİTAK) within the scope of the 2209-A- Research Project Support Programme for Undergraduate Students.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor Contribution Conceptualization, H.P.; methodology, H.P. and M.A.; validation, M.A.; formal analysis, H.P.; investigation, H.P.; resources, M.A.; data curation, M.A ; writing\u0026mdash;original draft preparation, H.P.; writing\u0026mdash;review and editing, H.P and M.A; visualization, H.P.; supervision, H.P; project administration, H.P. and M.A; funding acquisition, none. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eFunding Statement:This study was supported by The Scientific and Technological Research Council of T\u0026uuml;rkiye (T\u0026Uuml;BİTAK) within the scope of the 2209-A - Research Project Support Programme for Undergraduate Students.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbd El-Maksoud AM, El Sayed HEA, Youssef AS. Effects of a mindfulness-based intervention on emotional regulation among emergency nurses: A quasi-experimental study. Nurse Educ Today. 2024;127:105810.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAuerbach RP, Mortier P, Bruffaerts R, Alonso J, Benjet C, Cuijpers P, Murray E. WHO world mental health surveys international college student project: Prevalence and distribution of mental disorders. J Abnorm Psychol. 2018;127(7):623\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBartlett 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\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrown KW, Ryan RM. The benefits of being present: Mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003;84(4):822\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003edos Santos TM, Kozasa EH, Carmagnani IS, Tanaka LH, Lacerda SS, Nogueira-Martins LA. Positive effects of a stress reduction program based on mindfulness meditation in Brazilian nursing professionals: Qualitative and quantitative evaluation. Explore. 2016;12(2):90\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eErogul M, Singer G, McIntyre T, Stefanov DG. Abridged mindfulness intervention to support wellness in first-year medical students. Teach Learn Med. 2014;26(4):350\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFalsafi N. A randomized controlled trial of mindfulness versus yoga: Effects on depression and/or anxiety in college students. J Am Psychiatr Nurses Assoc. 2016;22(6):483\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFruehwirth JC, Biswas S, Perreira KM. The COVID-19 pandemic and mental health of first-year college students: Examining the effect of COVID-19 stressors using longitudinal data. PLoS ONE. 2021;16(3):e0247999.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGalante J, Montero Mar\u0026iacute;n J, Wood W, Streeter A, Lindsay EK, Crane C. Mindfulness training promotes climate-friendly behavior in university students: Results from the Mindful Student Study. Mindfulness. 2024;15(1):1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGarc\u0026iacute;a-Rivas J, Mart\u0026iacute;nez-Rodr\u0026iacute;guez A, L\u0026oacute;pez-Rodr\u0026iacute;guez MDM, Mart\u0026iacute;nez-Rodr\u0026iacute;guez A. Emotional competence and mental health in nursing students: A systematic review. Nurse Educ Today. 2024;131:105952.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGonz\u0026aacute;lez-Mart\u0026iacute;n AS, Parra-Mart\u0026iacute;nez AS, Fabbian F, Gallego-G\u0026oacute;mez JI. Impact of mindfulness interventions on empathy and emotional competencies in health science students: A systematic review and meta-analysis. Mindfulness. 2023;14(7):1631\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHamaideh SH, Hamdan-Mansour AM. Psychological, cognitive, and personal variables that predict college academic achievement among health sciences students. Nurse Educ Today. 2014;34(5):703\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHojat M. Ten approaches for enhancing empathy in health and human services cultures. J Health Hum Serv Adm. 2009;31(4):412\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKurt D, Demir S, Karataş Z. Mindfulness-based interventions in nursing education: A systematic review of randomized controlled trials. Nurse Educ Today. 2024;124:105730.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSong 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\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu Y, Zhang L, Chen H. Trait mindfulness and perceived stress in medical and nursing students: A longitudinal intervention study. Mindfulness. 2024;15(1):76\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang Y, Wu X, Liang L. Mindfulness-based stress reduction for nursing students: A meta-analysis of randomized controlled trials. J Adv Nurs. 2022;78(5):218\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSmith LC, Taylor JP. Effects of yoga and mindfulness on nursing students\u0026rsquo; stress and anxiety: A mixed-methods evaluation. Complement Ther Clin Pract. 2023;53:101716.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMahmoud JSR, Staten RT, Hall LA, Lennie TA. The relationship among young adult college students' depression, anxiety, stress, demographics, life satisfaction, and coping styles. Issues Ment Health Nurs. 2012;33(3):149\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNeff KD. The development and validation of a scale to measure self-compassion. Self Identity. 2003;2(3):223\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e\u0026Ouml;zel Y, T\u0026uuml;rkleş S, Erdoğan S. Investigation of mental state in university students. Jaren. 2020;6(2):220\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePulido-Martos M, Augusto-Landa JM, L\u0026oacute;pez-Zafra E. Sources of stress in nursing students: A systematic review of quantitative studies. Int Nurs Rev. 2012;59(1):15\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTaghizadeh Moghaddam H, Bahreini A, Ajilian Abbasi M, Fazli F, Saeidi M. Adolescence health: The needs, problems and attention. Int J Pediatr. 2016;4(2):1423\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTung YJ, Lo KKH, Ho RC, Tam WSW. Prevalence of depression among nursing students: A systematic review and meta-analysis. Nurse Educ Today. 2020;63:119\u0026ndash;29.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXinqiao L, Siqing P, Wenjuan G. Changes in undergraduate students\u0026rsquo; psychological well-being as they experience university life. Int J Environ Res Public Health. 2019;16(16):2864.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZeng Y, Wang G, Xie C, Hu X, Reinhardt JD. Prevalence and correlates of depression, anxiety and symptoms of stress in vocational college nursing students from Sichuan, China: A cross-sectional study. Psychol Health Med. 2019;24(7):798\u0026ndash;811.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKang E, Lee J, Park S. Mindfulness workshop improves nursing students\u0026rsquo; academic self-efficacy and emotional well-being: A pre-post study. Nurse Educ Pract. 2024;72:103596.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGonz\u0026aacute;lez-Mart\u0026iacute;n AS, Parra-Mart\u0026iacute;nez AS, Fabbian F, Gallego-G\u0026oacute;mez JI. Impact of mindfulness interventions on empathy and emotional competencies in health science students: A systematic review and meta-analysis. Mindfulness. 2023;14(7):1631\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGalante J, Montero-Mar\u0026iacute;n J, Wood W, Streeter A, Lindsay EK, Crane C. Mindfulness training promotes climate-friendly behavior in university students: Results from the Mindful Student Study. Mindfulness. 2024;15(1):1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Mindfulness, nursing students, anxiety, stress, qualitative research, emotional regulation, phenomenology, yoga-based intervention","lastPublishedDoi":"10.21203/rs.3.rs-7761759/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7761759/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eNursing students are particularly vulnerable to psychological distress due to the combined demands of academic performance and clinical training. The COVID-19 pandemic has further intensified these stressors. Mindfulness-based interventions (MBIs) have shown promising results in reducing anxiety, stress, and emotional dysregulation in student populations. However, there is limited qualitative research exploring how nursing students in Turkey experience such interventions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eTo explore the psychological and experiential outcomes of an eight-session mindfulness-based educational program among nursing students in Turkey, with a focus on anxiety, stress management, and mindfulness awareness.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis study employed a qualitative phenomenological design. Fifteen undergraduate nursing students (aged 21–23) who completed the full mindfulness-based program participated in semi-structured, in-depth interviews. Data were analyzed using Braun and Clarke’s six-phase thematic analysis. The intervention integrated breathing exercises, body awareness, and guided meditation delivered weekly by a certified instructor.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThematic analysis revealed five pre-intervention themes: (1) sources of stress and anxiety, (2) coping strategies, (3) physical and cognitive symptoms, (4) impact on daily/academic life, and (5) limited mindfulness awareness. Post-intervention themes highlighted: (1) increased breath awareness and emotional regulation, (2) improved stress management, (3) enhanced academic focus, (4) integration of mindfulness into daily routines, and (5) strengthened self-awareness and emotional observation. Participants reported decreased anxiety symptoms, more adaptive stress coping, and improved present-moment attention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe intervention contributed to significant psychological shifts in nursing students, enhancing emotional resilience, present-moment awareness, and self-regulation. Findings support the integration of mindfulness practices into nursing curricula to address mental health challenges in healthcare education. Further research with larger samples and longitudinal designs is recommended.\u003c/p\u003e","manuscriptTitle":"Calming the Mind, Strengthening the Nurse: A Mindfulness-Based Intervention for Nursing Students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-11 16:31:16","doi":"10.21203/rs.3.rs-7761759/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-11-26T17:01:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"316672243370430611032042694379328562404","date":"2025-11-09T18:33:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"294144099387694451302728131038735269604","date":"2025-11-06T13:51:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-30T16:25:06+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-07T13:15:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-05T02:48:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-05T02:47:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2025-10-01T18:05:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"40607d9c-ce8e-4bd4-8c18-89770c92f7cb","owner":[],"postedDate":"November 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-11T16:31:16+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-11 16:31:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7761759","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7761759","identity":"rs-7761759","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}