Effectiveness and experiences of integrating Mindfulness into Peer-assisted Learning (PAL) in clinical education for nursing students: A mixed method study.

Introduction: Nursing students can find clinical learning to be challenging, unpredictable and stressful. To address this problem, this study integrated Mindfulness into Peer-assisted Learning (PAL) for nursing clinical education and investigated the feasibility and effectiveness on improving student participants' emotional reactions, and explored the perception and experience towards the programme.

Method: This quasi-experimental, repeated-measure, mixed methods study was conducted in a convenience sample of 126 Year 2 and Year 3 university nursing students. The participants engaged in an online mindfulness peer-assisted learning (PAL) programme that consisted of mindfulness practice, senior students sharing their experiences, and peer-assisted group learning. Emotional status (in terms of depression, anxiety and stress), burnout and self-efficacy were measured at baseline, 8 weeks after programme commencement and immediately after programme completion. Linear mixed-effects models and an intention-to-treat analysis were used to investigate changes in the dependent variables over time. Thirty-nine participants were also invited to engage in semi-structured interviews to explore their learning experiences in the programme.

Results: The programme significantly improved the participants' self-reported self-efficacy (β = 1.44, 95 % confidence interval (CI): 0.58 to 2.30, p = 0.001) and decreased their level of burnout (β = -2.31, 95 % CI: -3.24 to -1.38, p < 0. 001) but did not significantly alleviate their depression, anxiety or stress across time (p > 0.05). Three themes emerged from the qualitative data, namely 1) nurturing self-care capacity through mindfulness; (2) empowering essential skills for clinical placement; (3) maintaining momentum alongside various challenges and enablers.

Conclusion: The mindfulness PAL programme may facilitate nursing students' clinical preparedness. Further trials are recommended to investigate its applicability and use in clinical nursing education.