Go With The Flow: The Use of Movement Meditation to Reduce Simulation Anxiety in Nursing Students Angela Mulcahy, RN, MS, CMSRN, PhD(c) Kevin Gosselin, Ph.D. Brian Holland, Ph.D., RN Alison Pittman, RN, MSN, CPN, PhD(c)
Learning Objectives 1. Apply a movement meditation intervention for nursing students in clinical simulation scenarios to foster positive educational outcomes. 2. Delineate measurement strategies and approaches to determine effectiveness of movement meditation intervention. 3. Discuss how a movement meditation intervention could reduce student anxiety in other high stress educational experiences.
Overview Simulation is commonly used in nursing curricula Provides opportunity for students to think independently and make decisions without the possibility of causing harm Lack of clinical sites (Casida & Shpakoff, 2012) Observation and anxiety (Beischel, 2013; Nielsen & Harder, 2013) Anectodal information from students
Background Physical activity has long been associated with improved mood and decreased levels of anxiety (Petruzzello, et al., 1991). Movement meditation involves the use of specific physical movements to improve cognitive focus and reduce anxiety. These movements may be specific or a combination of techniques such Yoga or Tai Chi.
Theoretical Framework Social Cognitive Theory (Bandura, 1986) Individual, behavioral, and environmental factors Self-efficacy (Bandura, 1997) Sources Anxiety-self-efficacy-performance continuum Inverted U Model (Yerkes & Dodson, 1908) Association between arousal and performance
Bandura s Theory of Self-Efficacy
Yerkes-Dodson Law Low Performance High Optimal Performance Low Arousal High
Research Questions 1. Will students undergoing a movement meditation intervention experience less anxiety, as assessed by the State Trait Anxiety Inventory, mean arterial pressure, and heart rate, than students in a control condition? 2. Will students undergoing a thirty-minute movement meditation intervention receive higher instructor-rated performance on clinical skills within a simulation experience than students in a control condition? 3. Will students undergoing a thirty-minute movement meditation intervention report higher clinical self-efficacy, as assessed by the modified version of the General Self- Efficacy Scale, than students in a control condition?
Methods Randomized control-group pretest-posttest design Non-probability sample of traditional and second degree accelerated BSN students (N = 63) M age = 22.68, SD = 3.15; Majority were female (n = 59, 93.6%); Random Assignment into Control (n = 31) or Movement Meditation (n = 32) condition
Instruments and Dependent Variables Anxiety State Trait Anxiety Scale for Cognitive and Somatic Anxiety (STICSA) (Ree, MacLeod, French, & Locke, 2000) Self-Efficacy General Self-Efficacy Scale (Schwarzer & Jerusalem, 1995) ICC for three raters = 0.95; 95% CI [0.87 0.97]; Cronbach s coefficient alpha = 0.78 Performance The Nursing Simulation Performance Scale (NSPS) (Gosselin, Holland, & Mulcahy, 2015) CVI = 0.97; ICC = 0.92; Cronbach s α = 0.89
Example Schedule and Activities for Participants Time 0800-0805 Activity Random assignment into control or movement meditation (MM) conditions Pulse and blood pressure were assessed along with administration of the State Trait Anxiety and General Self-Efficacy Scales 0805-0835 Participation in control or MM conditions 0835-0840 2 nd collection of pulse rate, blood pressure, and survey data 0840-0910 Simulation and performance evaluations conducted from instructors 0910-0920 Debrief and collection of performance evaluation data
Simulation Center
Intervention Tai Chi Movement Participants followed a 30 minute Tai Chi video, guiding them through a series of movements. Movements were basic and required no experience in Tai Chi. Students were on their feet, moving their arms and body for 30 minutes.
Intervention Protocol Students were placed in a room to observe the Tai Chi video. Students were observed during the intervention at intervals Prior to the video starting, baseline BP & HR were obtained Post intervention, BP & HR were obtained and students completed surveys
Results No initial group differences were observed on the dependent variables. The MANOVA to assess between group differences at post-test was not significant (p =.11). The results of the second MANOVA to assess the effectiveness of movement meditation on performance and anxiety outcomes was significant, F(2, 61) = 5.83, p =.001, partial eta squared =.14.
Results Contrasts revealed significant reductions in scores on the STICSA-M (p =.002), STICSA-Cognitive (p <.000, and STICSA-Somatic (p <.000) measures from pre to posttest. Self-efficacy (p <.000) and performance (p <.000) were significantly higher in the experimental condition. No difference were observed from pre to posttest on the STACI-General assessment (p =.391).
Results Results indicated a decrease in anxiety and increase in performance and selfefficacy for students participating in Tai Chi prior to simulation, F(2,61) = 5.83, p <.001, partial eta squared =.14
Discussion The study hypotheses were supported. Students participating in movement meditation reported reduced anxiety following the treatment. Higher faculty performance and self-efficacy ratings were observed in the experimental condition. The results support the use of movement meditation to improve educational outcomes for nursing students.
Implications for Future Movement meditation, Tai Chi, was effective in decreasing student anxiety and improving simulation performance. The results support the use of movement meditation to improve educational outcomes for nursing students.
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