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. 2025 May 11;22(3):e70031. doi: 10.1111/wvn.70031

Online and In‐Person Mindfulness‐Based Stress Reduction (MBSR) Improves Stress Resilience in Nursing Education

Rebecca A Schwartz‐Mette 1,2,✉, Maile Sapp 2, Kelley Strout 3
PMCID: PMC12066802  PMID: 40350560

ABSTRACT

Background

Evidence‐based interventions (EBI) can reduce nursing burnout and improve retention and healthcare quality. Nursing school is an ideal time to implement EBI to mitigate burnout and increase resilience in pre‐professional populations.

Aim

The current study tested whether Mindfulness‐Based Stress Reduction (MBSR) significantly improved stress, burnout, and wellness in a university‐based nursing school.

Methods

Using a non‐randomized clinical trial design, multilevel modeling for repeated measures tested intervention effects over time in MBSR participants (n = 73) and matched controls (n = 73), as well as potential moderation of intervention effects by modality (online vs. in‐person MBSR) and subpopulation (students vs. faculty/staff).

Results

MBSR effectively reduced perceived stress, exhaustion, and total burnout and increased positive affect and frequency of using two key mindfulness skills: observing and nonreactivity. No significant effects of the intervention were observed for disengagement from work, satisfaction with life, negative affect, or the mindfulness skills of describing, acting with awareness, and nonjudgment. Effects were similar across modality and subpopulation.

Linking Evidence to Action

MBSR increases stress resilience and can be delivered effectively online and in person. Moreover, MBSR appears equally impactful for nursing students and faculty/staff. Implications for integrating EBI into schools of nursing to improve well‐being are discussed.

Keywords: burnout, faculty, mindfulness‐based stress reduction, nursing students, resilience, staff, stress, wellness

1. Background

The current shortage of registered nurses is fueled by many factors, including increased demand to care for an aging population and turnover due to retirement and workplace stress (American Association of Colleges of Nursing 2024a, 2024b; AMN Healthcare 2023; Auerbach et al. 2022; Smiley et al. 2023). A lack of nursing faculty and subsequent slow growth in nursing school enrollment compound this problem (Buerhaus et al. 2009; Project Management Partnership 2021), necessitating creative solutions to expand workforce capacity. The current study tests whether implementing an evidence‐based intervention (EBI), Mindfulness‐Based Stress Reduction (Kabat‐Zinn 2013), for nursing students, faculty, and staff within a university‐based nursing school significantly improves stress, burnout, and well‐being.

1.1. EBI to Support the Nursing Workforce

Nurses' stress and burnout are critically high (AMN Healthcare 2023). Recent reviews underscore the utility of EBI for reducing burnout and improving wellness in healthcare workers (Cohen et al. 2023; Hsu et al. 2024). Mindfulness‐based interventions (MBIs) are effective in promoting resilience across a wide variety of populations (O'Connor et al. 2023) and are the most frequently evaluated for use with nurses (Lee and Cha 2023). Along with cognitive behavioral interventions, MBIs appear most effective for reducing stress and burnout for nursing populations (Melnyk et al. 2020).

Mindfulness is a cognitive state of intentional awareness, characterized by nonjudgmental acceptance of one's present moment experience, and can serve as a natural antidote to common forms of maladaptive stress reactivity like rumination and avoidance (Kabat‐Zinn 2013). Grounded in transactional models of stress and coping (Lazarus and Folkman 1984), MBIs train individuals to cultivate mindful awareness and acceptance, address malleable cognitions (e.g., maladaptive thinking), and target malleable behaviors (e.g., ineffective coping) to reduce the impact of stress on physical and mental health. Systematic reviews (Green and Kinchen 2021) and meta‐analyses (Suleiman‐Martos et al. 2020) evaluating a range of MBIs for nurses indicate consistent, positive effects. However, most MBIs focus on managing existing burnout in healthcare providers, as opposed to preventing it (Lee and Cha 2023).

Prevention science suggests that implementing EBI before problems are evident promotes optimal well‐being (National Research Council and Institute of Medicine 2009). Fortunately, many health problems facing nurses are preventable (Catalano et al. 2012). An upstream strategy that enhances protective factors may reduce downstream costs of nurse stress, burnout, and turnover (Michener and Briss 2019). Thus, early EBI may best prepare nurses to face workforce challenges instead of relying on reactive attempts to fix them.

Nursing school is a developmentally ideal time to implement EBI to prevent later burnout and mental health challenges. The American Association of Colleges of Nursing Essentials (2021) emphasizes resilience as required for nursing practice and a powerful mechanism to reduce burnout and enhance retention. By integrating resilience‐building strategies in nursing curricula, educational programs can prepare students to withstand healthcare demands, promoting their well‐being and reducing rates of burnout and exits from the profession.

1.2. Mindfulness‐Based Stress Reduction for Nursing Students

Although fewer studies have tested MBIs in nursing students compared with nurses (Burleson et al. 2023), the literature is rapidly expanding. Reviews (van der Riet et al. 2018) and meta‐analyses (Chen et al. 2021; Li et al. 2020) of a range of MBIs parallel the positive effects of mindfulness observed for practicing nurses. One challenge with synthesizing this emerging literature is that MBIs vary widely in structure, length, and availability of published protocols. An exception is Mindfulness‐Based Stress Reduction (MBSR) (Kabat‐Zinn 2013), a manualized EBI that, among MBIs, results in some of the strongest effects to combat stress and burnout for healthcare professionals (La Torre et al. 2022).

Though mindfulness meditation is rooted in Buddhist philosophy, MBSR is a secular intervention that emphasizes present moment awareness, nonjudgment, nonreactivity, and compassion for self and others (Keng et al. 2011). The course includes eight weekly 2.5‐h teacher‐led classes and an all‐day silent meditation retreat. Participants engage with formal practices, including the body scan, mindful movement (yoga, walking meditation), mindful eating, and sitting meditation to train present moment awareness on the breath, body, emotions, and thoughts. At‐home practice with these exercises is assigned (approximately 45 min per day), and participants are encouraged to practice informally during the week by bringing mindful awareness to daily activity. Teachers educate about the body's stress response and the roles of cognition and behavior in maintaining maladaptive, habitual stress reactivity and encourage participants to explore more flexible, mindful ways of responding to stress.

To date, MBSR remains understudied in nursing schools. A recent systematic review (Sapp et al. 2024) found 22 studies evaluating MBSR or adapted‐from‐MBSR interventions for nursing students, but only five tested manualized MBSR (and, of these, only two involved a control group). The 17 remaining tested modified programs that varied widely regarding format, duration, session length, and core MBSR content coverage. Very few studies employed stringent statistical analyses, underscoring the need for well‐designed, rigorously evaluated MBSR studies in nursing schools. Moreover, all but a handful were reactive, designed to address academic or other competency problems once they appeared during training. Such programs may improve graduation rates but may not effectively target the psychological resilience required to navigate not just heavy course loads and NCLEX but also the day‐to‐day stress and unpredictable demands of a practicing nurse. Effective support is urgently needed to ensure that nursing students do not just survive workforce entry but, instead, thrive upon arrival.

The aim of this pre/post non‐randomized controlled intervention study was to evaluate the effects of the 8‐week MBSR program for nursing students. Quantitative measures of stress, burnout, well‐being, and resilience were taken before and after MBSR, and effects were tested with repeated measures multilevel modeling. It was hypothesized that, relative to controls, MBSR participants would report decreased stress and burnout and increased well‐being and stress resilience. Some faculty and staff also participated in MBSR, allowing for comparison of effects for students vs. faculty/staff. Online and in‐person MBSR courses were offered, allowing also for comparison of effects across intervention modality. As no existing studies were identified that compared effects of manualized MBSR (or any other EBI) for nursing students vs. faculty/staff or for online vs. in‐person applications, group comparison analyses were exploratory in nature, and no hypotheses were made regarding which group may experience stronger effects.

2. Method

2.1. Participants and Procedures

All members (students, faculty, and staff) of the School of Nursing at a medium‐sized public university in the northeastern United States were invited to participate in a study of a comprehensive wellness program, WellNurse, in which individuals could choose from MBSR, group fitness, or nutrition classes. Participants in the current study were nursing undergraduates (n = 120), graduate students (n = 4), faculty (n = 8) or staff (n = 14) who enrolled in MBSR courses from March 2022 to May 2023. The mean age was 24.87 years (SD = 10.14; range 18–65), and gender identities paralleled that of enrollment and employment: 96% female, 3% male, 1% non‐binary or transgender. Racial and ethnic identities reported by participants mirrored that of the rural population surrounding the university: 94% White, 2.5% Black, 2.5% Asian, 1% Hispanic.

Assignment to condition was not random, as MBSR participants (n = 73) self‐enrolled in an online (n = 18) or in‐person (n = 55) MBSR course. A list of participants who did not enroll in MBSR was used to match all available controls with MBSR participants based on gender, race, ethnicity, birth year, and role (for some faculty/staff, a matched control was available for all characteristics but birth year). Numbers were then assigned to all available controls, and a random number generator was used to randomly select a matched control (n = 73) for each MBSR participant. Participants in both groups had free, voluntary access to additional wellness initiatives, including chair massage, aromatherapy, and recreational activities.

MBSR courses were offered online and in‐person. For students, the course was offered as a credit‐bearing independent study (two credits) meeting the university's artistic and creative expression general education requirement. Online participants took courses taught by certified MBSR instructors from the UC San Diego Center for Mindfulness during spring 2022. In‐person classes were taught by a licensed psychologist trained and supervised by master MBSR teachers during the 2022–2023 academic year. All courses followed the original curriculum developed by Kabat‐Zinn (2013) and revised by Santorelli et al. (2017). The 8‐week program consists of eight 2.5‐h weekly classes and an all‐day silent meditation retreat. Following each class, 30–45 min of daily home practice was assigned.

The University of Maine Institutional Review Board reviewed and approved all study procedures. Participants provided informed consent and completed pre‐test measures using Qualtrics at Time 1 (T1), a 3‐day period before the first MBSR class, and identical post‐test measures on Qualtrics in the 3‐day period immediately following the last MBSR class (T2). Data were masked using unique, self‐generated identification codes (Galanti et al. 2007) and stored on secure servers accessible only to trained research staff after the last MBSR course. Small gifts were provided to those completing survey measures (e.g., water bottle), and first‐generation students meeting financial need requirements were offered a $5000 scholarship to offset the cost of obtaining course credit and to increase the diversity of the sample.

2.2. Measures

2.2.1. Perceived Stress Scale (PSS)

Participants rated 10 items assessing perceptions of distress related to uncontrollable or overwhelming events (Cohen et al. 1983). Items (e.g., In the last month, how often have you felt that you were unable to control the important things in your life?) are rated on a 5‐point scale from 0 (Never) to 4 (Very Often), and sum scores can range from 0 to 40 (α T1, T2 = 0.91, 0.93).

2.2.2. Oldenburg Burnout Inventory (OBI)

Participants rated 16 items assessing disengagement and exhaustion from work (Demerouti et al. 2003). Items (e.g., During my work, I often feel emotionally drained) are rated on a 4‐point scale from 1 (Strongly agree) to 4 (Strongly disagree). Summed subscale scores (disengagement α T1, T2 = 0.78, 0.76, exhaustion α T1, T2 = 0.81, 0.83) can range from 8 to 32, and a total score (α T1, T2 = 0.88, 0.88) can range from 16 to 64.

2.2.3. Positive and Negative Affect Schedule (PANAS)

Participants rated 20 items assessing the degree to which they currently experienced various emotions in the last week (Watson et al. 1988). Ten items each assessed negative (e.g., upset, irritable) and positive (e.g., attentive and determined) affect on a 5‐point scale from 1 (Very slightly) to 5 (Very much). Sum scores for each can range from 10 to 50 (positive α T1, T2 = 0.88, 0.89; negative α T1, T2 = 0.87, 0.86).

2.2.4. Satisfaction With Life Scale (SWLS)

Participants rated five items assessing the degree to which they are satisfied with their current life (Diener et al. 1985). Items (e.g., The conditions of my life are excellent) are rated on a 7‐point scale from 1 (Strongly agree) to 7 (Strongly disagree), and sum scores can range from 5 to 35 (α T1, T2 = 0.88, 0.86).

2.2.5. Five‐Factor Mindfulness Questionnaire (FFMQ)

Participants rated 39 items measuring their use of five facets of mindfulness in daily life (Baer et al. 2008): observing (noticing present moment experiences), describing (expressing experiences in words), acting with awareness (attending to experience vs. operating on “autopilot”), nonjudging of inner experience (accepting experiences as neither good nor bad), and nonreacting to inner experience (detaching from experiences without becoming overly involved). Items were rated on a 5‐point scale from 1 (Never/very rarely true) to 5 (Very often/always true), and scores were summed. The possible range for Observing (α T1, T2 = 0.81, 0.87), Describing (α T1, T2 = 0.90, 0.93), Awareness (α T1, T2 = 0.89, 0.88), and Nonjudgment (α T1, T2 = 0.93, 0.93) is 8–40; Nonreactivity (α T1, T2 = 0.76, 0.76) and the total score (α T1, T2 = 0.93, 0.93) can range from 7 to 35 and from 39 to 195, respectively.

3. Results

Some participants had missing data. We used Little's test (1988) to examine any significant patterns of missingness; results suggested data were missing completely at random (MCAR) in both groups (MBSR: χ 2 [114] = 70.05, p = 1.00; Control: χ 2 [141] = 145.32, p = 0.38). Imputing missing data are preferable to listwise/pairwise deletion given the reduced power and estimation bias such procedures may introduce (Kang 2013), and missing data were imputed using an estimation maximization (EM) procedure in SPSS 29.0. Post hoc power analyses indicated that all models were sufficiently powered above 0.90 to detect medium and large effects.

First, we examined whether there were significant differences between MBSR and Control groups at T1 by testing one‐way ANOVAs in which Group (MBSR, Control) predicted each variable (Table 1). MBSR participants reported slightly lower stress (F [1, 199] = 4.45, η 2 = 0.02; 95% CI [0.00, 0.08], p = 0.04) and positive affect (F [1, 168] = 6.29, η 2 = 0.04 [0.00, 0.11], p = 0.01) and slightly higher mindful awareness (F [1, 166] = 6.20, η 2 = 0.04 [0.00, 0.11], p = 0.01) at T1. These differences were small (η 2 = 0.02–0.04), and confidence intervals for each included zero, indicating that these differences were not meaningful.

TABLE 1.

Baseline descriptives and group differences.

MBSR participants (n = 73) Control participants (n = 73) Effect size
T1 M (SD) T1 observed range T1 M (SD) T1 observed range η 2 (95% CI)
Perceived stress 19.81 (6.21) 6.00–40.00 23.42 (9.36) 8.00–37.00 0.02 (0.00, 0.08)
Burnout (total) 40.64 (4.10) 19.00–57.00 40.64 (2.90) 23.00–54.00 0.00 (0.00, 0.04)
Disengagement 19.28 (4.27) 9.00–28.00 19.28 (3.33) 9.00–27.00 0.00 (0.00, 0.04)
Exhaustion 21.28 (4.36) 10.00–29.00 2.68 (3.16) 14.00–28.00 0.00 (0.00, 0.02)
Positive affect 29.50 (6.38) 11.00–41.00 30.21 (6.72) 15.06–47.35 0.04 (0.00, 0.11)
Negative affect 23.81 (7.37) 10.00–41.00 23.27 (6.85) 10.00–43.00 0.00 (0.00, 0.03)
Satisfaction with life 24.26 (6.61) 5.00–35.00 23.98 (5.57) 10.00–35.00 0.00 (0.00, 0.04)
Mindfulness (total) 102.92 (26.25) 47.00–175.00 81.96 (46.97) 39.0–174.00 0.01 (0.00, 0.06)
Observing 22.71 (6.88) 6.00–38.00 16.87 (10.69) 8.00–36.00 0.00 (0.00, 0.04)
Describing 21.64 (7.20) 5.00–38.00 16.48 (11.37) 8.00–39.00 0.01 (0.00, 0.05)
Acting with awareness 19.49 (6.57) 7.00–32.00 15.84 (10.54) 8.00–39.00 0.02 (0.00, 0.11)
Nonreactivity 18.38 (4.22) 9.00–30.00 16.67 (5.65) 7.00–30.00 0.01 (0.00, 0.06)
Nonjudgment 20.69 (7.21) 7.00–38.00 16.10 (10.89) 8.00–35.00 0.00 (0.00, 0.03)
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3.1. Effects of MBSR Intervention

Data from T1 and T2 were nested within individuals; thus, multilevel modeling (MLM) (Raudenbush and Bryk 2002) was preferable to traditional OLS analysis (e.g., repeated measures ANOVA) as a more powerful, precise analytic tool that is robust to missing data and can accommodate different cohorts' assessment schedules (Verbeke and Molenberghs 2000). We used repeated measures MLM to test intervention effects across time and within groups. Each model (one per outcome) included a random intercept, the fixed effects of Time and Group, and the Time × Group interaction as predictors. A significant interaction indicated that the change in outcome from T1 to T2 differed significantly by group (Table 2).

TABLE 2.

Intervention effects.

DV Time Group Time × Group
b (95% CI) SE b (95% CI) SE b (95% CI) SE
Perceived stress −3.37*** (−4.32, −2.42) 0.93 3.59** (0.98, 6.20) 1.32 2.66*** (1.32, 4.00) 0.68
MBSR −3.37*** (−4.51, −2.23) 0.57
Control −0.71 (−1.44, 0.02)
Burnout (total) −0.23*** (−0.32, −0.14) 0.05 0.01 (−0.13, 0.15) 0.07 0.14* (0.01, 0.26) 0.06
MBSR −0.23*** (−0.32, −0.13) 0.05
Control −0.09* (−0.18, −0.01) 0.04
Disengagement −0.19*** (−0.28, −0.10) 0.05 0.00 (−0.15, 0.15) 0.08 0.11 (−0.02, 0.24) 0.07
Exhaustion −0.26*** (−0.36, −0.16) 0.05 0.02 (−0.13, 0.16) 0.07 0.16* (0.02, 0.30) 0.07
MBSR −0.26*** (−0.37, −0.16) 0.05
Control −0.10* (−0.20, −0.01) 0.05
Positive affect 3.81*** (2.36, 5.26) 0.74 0.76 (−1.39, 2.91) 1.09 −2.78** (−4.84, −0.73) 1.04
MBSR 3.81*** (2.24, 5.38) 0.79
Control 1.03 (−0.33, 2.38) 0.68
Negative affect −1.81* (−3.43, −0.19) 0.82 −0.41 (−2.74, 1.91) 1.17 0.70 (−1.60, 2.99) 1.16
Satisfaction with life 1.68** (0.58, 2.78) 0.56 −0.13 (−2.11, 1.86) 1.00 −1.22 (−2.78, 0.33) 0.79
Mindfulness (total) 16.48*** (12.11, 20.86) 2.21 −20.74*** (−33.03, −8.45) 6.24 −4.61 (−10.80, 1.58) 3.13
Observing 3.54*** (2.48, 4.60) 0.54 −5.77*** (−8.71, −2.82) 1.49 −1.68* (−3.18, −0.19) 0.76
MBSR 3.54*** (2.35, 4.73) 0.60
Control 1.86*** (0.94, 2.78) 0.46
Describing 3.24*** (1.98, 4.50) 0.64 −5.17*** (−8.30, −2.04) 1.58 0.51 (−1.27, 2.29) 0.90
Acting with awareness 2.66*** (1.45, 3.88) 0.61 −3.62* (−6.45, −0.80) 1.44 −0.35 (−2.07, 1.36) 0.87
Nonreactivity 2.95*** (2.28, 3.63) 0.34 −1.63 (−3.26, 0.00) 0.83 −1.88*** (−2.83, −0.93) 0.48
MBSR 2.95*** (2.18, 3.73) 0.39
Control 1.08*** (0.51, 1.64) 0.28
Nonjudgment 4.09*** (2.93, 5.25) 0.59 −4.55** (−7.58, −1.52) 1.53 −1.21 (−2.85, 0.43) 0.83
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Note: Dummy codes for Time: 0 = pre, 1 = post, and Group: 0 = MBSR, 1 = Controls. b = parameter estimate. *p < 0.05, **p < 0.01, ***p < 0.001.

MBSR participants reported significantly greater reductions in perceived stress, exhaustion, and total burnout following intervention compared with controls. Specifically, only MBSR participants reported significantly decreased perceived stress; the effect of time was not significant for controls. Exhaustion and total burnout decreased significantly for both groups, but MBSR participants reported reductions that were more than twice as large as controls. Only MBSR participants reported increased experiences of positive affect following intervention. Both groups reported increases in observing and nonreactivity mindfulness skills, but the increase in observing was nearly twice as large in the MBSR group as it was in the control group, and the increase in nonreactivity was almost 3× as large.

3.1.1. Role (Students vs. Faculty/Staff) and Format (Online vs. In‐Person MBSR)

We then conducted exploratory analyses to determine whether intervention effects differed by role or format. Predictors in each model were the main effects of Time, Group, and Role (or Format), and all possible two‐way and three‐way interactions. A significant three‐way interaction (Time*Group*Role/Format) indicated that intervention effects over time and by group differed significantly for students vs. faculty/staff or for online vs. in‐person MBSR. The three‐way interaction, including role was not significant, indicating that effects were equivalent for students and faculty/staff. The three‐way interaction of Time*Group*Format was significant in predicting Nonreactivity, (PE = 2.36 [0.21, 4.52], SE = 1.09, p < 0.05), which improved in both online and in‐person groups, but the effect was stronger for online (PE = 4.70 [3.24, 6.17], SE = 0.69, p < 0.001) as compared to in‐person MBSR (PE = 2.38 [1.50, 3.27], SE = 0.44, p < 0.001).

4. Discussion

Nursing school is an ideal environment to implement EBI, such as MBSR, to better prepare new nurses to face today's professional challenges. The current study aimed to evaluate the effectiveness of MBSR for reducing burnout and improving stress resilience in nursing students, faculty, and staff. Results generally suggested that, compared with controls, MBSR participants experienced greater improvements in stress, burnout, and use of some mindfulness skills regardless of delivery modality or role.

Specifically, MBSR participants had greater reductions in stress and burnout compared with controls. MBSR is designed to change an individual's relationship to stress, acknowledging that although we cannot prevent stress altogether, we can change our physiological, cognitive, emotional, and behavioral responses to it. When individuals feel better equipped to handle stressors, they are less likely to experience the harmful effects of stress reactivity, breaking the cycle of stress and burnout. These findings are similar to results from limited past studies testing the effects of MBSR on nursing student stress (Song and Lindquist 2015) and one past study of the effects of modified MBSR on nursing student burnout (Cheli et al. 2020).

Increased use of mindfulness may, in part, help to explain these reductions in stress and burnout. MBSR participants reported greater use of two key skills: observing and nonreactivity. To change our relationship to stress, we first must consciously observe stress, becoming aware of triggers and habitual stress reactions. Mindful observation helps enhance acceptance of the stress that is present. MBSR then teaches participants how to create space between the stressor and response; it is in this space where nonreactivity resides. Nonreactivity helps individuals avoid habitual, “knee‐jerk” reactivity to stress (e.g., avoidance, catastrophizing, and impulsive action).

Changes in other skills (describing, acting with awareness, and nonjudgment) did not differ significantly by group. The skills of describing and acting with awareness build on observation and nonreactivity, respectively. To describe what one is thinking and feeling, one must first notice it, and to act with awareness, one must first inhibit reactive action. It may be that gains in describing and acting with awareness come later, with additional mindfulness practice. Further, nonjudgment is a complex skill requiring awareness and nonreactivity of one's emotional experiences (e.g., shame) and emotionally charged stressors (e.g., interpersonal stress). Taking a nonjudgmental stance toward such difficult topics may require more than only 8 weeks of training. Future studies with longer follow‐up periods and assessment of practice compliance (e.g., dosing) would be better equipped to test this potentiality and the timing of improvements in specific mindfulness skills. The Sapp et al. (2024) review found that of four of five published studies testing changes in nursing students' use of mindfulness skills following MBSR reported increased mindful attention or total mindfulness; notably, no published studies used the FFMQ.

The current study was the first to consider changes in the experience of affect following MBSR. MBSR participants reported significantly greater gains in the experience of positive affect. Strong evidence has accumulated to show that, without mindful awareness, individuals pay more attention to negative aspects of their experience than they do to positive aspects (Vaish et al. 2008). MBSR explicitly trains attention to all aspects of present experiences, which can result in increased awareness and experience of positive emotions. Interestingly, this enhanced awareness did not result in significantly greater experiences of negative emotions, suggesting, perhaps, that mindfulness training may result in more balanced perceptions of reality.

Importantly, intervention effects generally did not differ depending on whether MBSR was delivered online or in person. Past studies have tested online vs. in person mindfulness practice for other healthcare trainees (Hoover et al. 2022) and online vs. in person MBSR for military populations (Rice and Schroeder 2021), but the current study was the first to examine modality differences in MBSR delivery for nursing students. Both past studies found that in person mindfulness training was more beneficial, which contrasts with our finding that effects were generally equally beneficial regardless of modality. This finding is encouraging, as the flexibility of modality may enhance accessibility, particularly for advanced students spending less time on campus and more time in clinicals. Moreover, the effects were identical for students and for faculty/staff. As nursing schools may wish to implement EBI that reaches a breadth of stakeholders, this finding underscores the efficiency of selecting MBSR as an intervention that has utility to reach a majority of community members.

Although the current study has many strengths, including its rigorous testing of a manualized EBI to address a breadth of important outcomes for all members of a nursing school community, limitations and future research directions are noted. The sample was relatively homogeneous, and results may not generalize to populations with greater diversity. Participants were not randomly assigned to condition; thus, it is possible that participants who chose MBSR were better suited to benefit from the intervention. Random assignment to condition would assuage concerns that effects could be driven by participant characteristics. Longer‐term follow‐ups are required to understand the timing and duration of effects. Ongoing practice (e.g., booster sessions) may be required to maintain initial gains. Although results generally did not differ by MBSR format, some aspects of the in‐person experience (e.g., talking with instructor after class, one‐on‐one guidance, and sense of community) were anecdotally observed but not measured. Such aspects may enhance the intervention's acceptability, and future research should assess these aspects of participants' experiences to test this notion.

Although further rigorous research is needed, this study demonstrates that implementing MBSR as an EBI to enhance resilience and reduce burnout in nursing schools is both valuable and impactful. In this way, MBSR can be considered alongside other beneficial EBIs for healthcare trainees, such as cognitive behavioral skills training programs like MINDSTRONG (adapted from COPE; Melnyk et al. 2022) and MINDBODYSTRONG (Sampson et al. 2019). Like others (Manocchi 2017; McVeigh et al. 2021), we encourage nursing schools to consider integrating evidence‐based MBIs into their curricula. Doing so may circumvent challenges students perceive in adding a course to their already busy schedules. Furthermore, curriculum integration (Strout et al. 2025) communicates the value a nursing school places on developing resilience as a required competency, which also may have positive impacts for learning and retention.

Ethics Statement

All study protocols for the protection of human rights and informed consent were reviewed and approved by the University of Maine Institutional Review Board.

Conflicts of Interest

The authors declare no conflicts of interest.

Acknowledgments

Support for this project was provided by HRSA 6 U3NHP45419‐01‐01 (PI: Strout Co‐Is: Schwartz‐Mette, McNamara). Appreciation is expressed to Dr. Jade McNamara, Dr. Kayla Parsons, and Dyan Walsh for their assistance with this project.

Funding: This study was supported by Health Resources and Services Administration.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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