Impact of an intervention program with reinforcement on nursing students’ stress and anxiety levels in their clinical practices

Abstract

Background and objectiveSeveral interventions have resulted in effectively reducing stress and anxiety in nursing students, however the efficacy of these interventions has only been investigated in the short term. This study had to objectives 1) to determine the effect of an intervention program to manage stress and anxiety in nursing students during clinical practices with two phases, phase I composed by cognitive behavioral therapy and progressive muscle relaxation and phase II or reinforcement phase with progressive muscle relaxation and 2) to determine the effect of phase I of the intervention program to manage stress and anxiety in nursing students during clinical practices. DesignAn experimental, analytical, longitudinal and prospective study. MethodsData were collected between April 2018 to June 2019 with 4 measurements of KEZKAK questionnaire and State-Trait Anxiety Inventory. An intervention program composed of cognitive behavioral therapy and progressive muscle relaxation was developed. The intervention program was divided in two phases, phase I and phase II or reinforcement phase. Fifty-nine nursing students from a Spanish university participated. A control group (n = 29), an intervention group one (n = 15) that received phase I and an intervention group 2 (n = 15) that received phase I and phase II or reinforcement phase were formed. ResultsAfter completing phase I, significant differences were found in the state of stress and anxiety between nursing students who received this phase and those who did not and after 3 months they continued to show differences. After phase II or reinforcement phase, the inter-groups did not present significant differences between them.The inter-group comparison of the stress and anxiety values at the end of the intervention program minus the initial values indicated that the CG presented significant differences with both intervention groups in the total of the KEZKAK and also with the IG1 in factors 3 (p = 0.030) and 4 (p = 0.027) and with the IG2 in factors 1 (p = 0.006) and 7 (p = 0.018). On the other hand, no differences were found between both intervention groups, IG1-IG2, in levels of stress and anxiety (p > 0.05) ConclusionsThe intervention program contributes to provide evidence on the effectiveness of cognitive behavioral therapy and progressive muscle relaxation for stress and anxiety management in nursing students during clinical practices. This study suggests that we should continue in this line of research to improve the available evidence.