Effects of a preventive mindfulness intervention on perceived stress and anticipatory anxiety before first clinical training in nursing students: A preregistered randomized controlled trial

Abstract Background Clinical training is a significant stressor for nursing students, and those facing their first placement are particularly vulnerable. This preregistered randomized controlled trial (RCT) evaluated whether a 6-week mindfulness program delivered before first clinical training could prevent stress and anxiety.

Methods: Twenty-nine nursing students were randomly assigned to the intervention (n = 15) or control (n = 14) group; 27 completed the study (intervention: n = 13, control: n = 14). The intervention group received a 6-week mindfulness meditation program; controls received standard curriculum only. Perceived stress (PSS-10) was the primary outcome; anxiety (STAI), depression (BDI-II), sleep quality (PSQI), and mindful awareness (MAAS) were secondary outcomes, assessed at baseline, pre-, mid-, and post-clinical training. Each outcome was analyzed using two-way repeated measures analysis of variance, followed by Bonferroni-corrected between-group t-tests when the group × time interaction was significant.

Results: The primary outcome, perceived stress, did not show a significant intervention effect (F(3, 75) = 0.41, p = .747). Among secondary outcomes, a significant group × time interaction was observed for state anxiety (F(3, 75) = 5.58, p = .002, ηp² = 0.182). The control group showed a sharp increase in state anxiety from baseline to the pre-clinical assessment, indicating anticipatory anxiety before first clinical training. The intervention group showed no such increase, with significantly lower state anxiety than controls at the pre-clinical assessment (d = 0.99, one-tailed Bonferroni-corrected p = .033). No significant effects were observed for trait anxiety, depressive symptoms, sleep quality, or mindful awareness.

Conclusions: In this RCT, the primary outcome of perceived stress was not significantly reduced by the mindfulness intervention. However, the findings indicate that nursing students experience substantial anticipatory anxiety before first clinical placement and suggest that a preventive mindfulness program can attenuate this anticipatory state anxiety. Future research should examine booster sessions during clinical training and evaluate effects in more diverse populations.

Trial Registration: Japan Registry of Clinical Trials (jRCT), jRCT1040240204. Registered 25 March 2025.