Effect of Pranayama Practice on Emotional Intelligence and Spiritual Intelligence in Nursing Students

Abstract

Background and Aims

Emotional intelligence (EI) and spiritual intelligence (SI) are critical for nursing students, enabling them to manage stressors effectively and deliver high-quality, compassionate care. Pranayama, a yogic breathing technique, is known to enhance psychological well-being. This study investigates the effects of ujjayi pranayama on EI and SI in final-year nursing students.

Methods

This quasi-experimental study was conducted among employed 46 final-year nursing students from Kerman University of Medical Sciences in southeastern Iran The participants were included in the study via a census method and were randomly assigned to either an intervention group (n = 23) or a control group (n = 23). The intervention group engaged in 15 min of guided pranayama daily for 20 consecutive days. The control group received no intervention during this period. Both groups completed the King Spiritual Intelligence Questionnaire, and the Schering Emotional Intelligence Questionnaire before and after the intervention. Descriptive statistics (frequency, percentage, mean, standard deviation) and analytical statistics (chi-square, independent t-test, and paired t-test) were used.

Results

EI significantly improved in the intervention group (from 100.17 ± 15.69 to 126.11 ± 16.81; p = .02; Cohen's d = 0.66), whereas the control group showed no improvement. No significant changes were found in SI (p > .05).

Conclusions

These findings suggest that short-term Ujjayi Pranayama practice is an effective, low-cost strategy to enhance EI in nursing students, potentially improving their readiness for emotionally demanding clinical environments. Incorporating such practices into nursing curricula may foster emotional resilience in future professionals.

Introduction

Pranayama, the ancient yogic practice of controlled and mindful breathing, is derived from the Sanskrit words Prana (life force) and Yama (control), signifying “the science of breath and deliberate breath regulation” (İlter & Ovayolu, 2021). This mindful regulation of breath is not merely a physiological exercise; it also influences mental and emotional states, contributing to improved clarity, calmness, and emotional balance (Epe et al., 2021; Joshi et al., 2022). Among its various forms, Ujjayi Pranayama, characterized by a slow, rhythmic breath with slight glottis constriction, has gained attention for its calming effects and ease of learning. This technique is particularly suitable for structured interventions in educational and healthcare settings due to its accessibility and minimal physical demand (Chauhan et al., 2025; Niranjan & Balaram, 2022; Saoji, 2016).

Recent literature has started to explore the psychological and cognitive benefits of pranayama, especially its role in regulating stress, improving focus, and enhancing emotional regulation. For instance, a study by Farha et al. (2022) found that even short-term pranayama practices significantly reduced anxiety and improved mood states in college students (Farha et al., 2022). Similarly, Crisan et al. (2025) demonstrated that breathing-based interventions positively impacted emotional recognition and resilience (Crișan et al., 2025). These findings support the hypothesis that targeted breathwork may enhance emotional intelligence (EI) by reinforcing emotional awareness, regulation, and interpersonal functioning.

EI is a fundamental psychological capacity involving the identification, understanding, and management of emotions—both one's own and those of others (Antonopoulou, 2024). It plays a vital role in decision-making, stress management, empathy, and effective communication. High EI is especially critical for nursing students, who must navigate emotionally charged clinical situations, make ethical judgments, and offer compassionate care (Dou et al., 2022; Sanchis-Giménez et al., 2023; Vishnoi et al., 2024). Research indicates that students with higher EI demonstrate better academic performance and greater clinical competence (Alvares et al., 2023; Ghamar et al., 2019; Goleman & Cherniss, 2024; Saklofske et al., 2020), making EI development a key objective in nursing education.

In tandem, spiritual intelligence (SI)—defined as the ability to seek meaning, purpose, and ethical insight through inner reflection—has gained attention in the context of healthcare professions (Sharifnia et al., 2022). SI underpins resilience, holistic caregiving, and the ability to cope with suffering and uncertainty, all of which are essential attributes for future nurses (Ahmadi et al., 2021; Malayil et al., 2024). Emerging studies suggest that practices like Ujjayi Pranayama can nurture components of SI, such as mindfulness, connectedness, and ethical sensibility, even over short durations (Bhattarai et al., 2024; Sharma et al., 2021).

However, despite promising trends, there remains a paucity of focused research investigating the independent effects of short-term Ujjayi Pranayama on EI and SI. Much of the existing literature combines breathing exercises with broader yogic practices, such as physical postures or meditation, making it difficult to isolate the specific contributions of breathwork. Moreover, studies specifically targeting nursing students under academic and clinical stress are scarce, despite their vulnerability to emotional burnout and spiritual disconnection (Asadi et al., 2021; Khodabakhshi Koolaee et al., 2019; Kushwaha et al., 2024).

Therefore, the present study aims to examine the isolated effect of short-term daily Ujjayi Pranayama practice on EI and SI among final-year nursing students. By focusing on this high-stakes population and a singular, accessible breathing technique, the study contributes to evidence-based approaches for strengthening the psychological and ethical preparedness of future healthcare providers.

Research Hypotheses

1. There is a significant difference in the level of EI between nursing students who practice daily Ujjayi Pranayama and those who do not.

2. There is a significant difference in the level of SI between nursing students who practice daily Ujjayi Pranayama and those who do not.

Materials and Methods

Design and Setting

This quasi-experimental study was conducted at Kerman University of Medical Sciences (October–November 2024). The census method was used to select eligible students. Power analysis calculations with G*Power software (α = 0.05, power = 0.90, effect size = 0.8, number of groups = 2, and number of measurements = 2) indicated that 40 participants required; totally 46 eligible participants to account for potential attrition, finished the study in two groups, intervention (n = 23) and control (n = 23). Participants were randomly assigned to intervention or control groups using the block randomization by an independent researcher who was not involved in the recruitment or data collection processes. Allocation concealment was ensured through the use of sequentially numbered, opaque, sealed envelopes (SNOSE), which contained the group assignments and were opened only after obtaining written informed consent. This method ensured that group assignments were unpredictable for both participants and outcome assessors.

The inclusion criteria were: (1) final-year undergraduate nursing student, due to adequate clinical experience and completion of theoretical nursing courses for ease of implementation of the intervention; (2) absence of chronic respiratory diseases (self-reported), to ensure proper breathing technique is performed correctly; and (3) no prior experience with Pranayama or other structured breathing techniques, in order to eliminate potential confounding variables, ensure a uniform baseline of breath control skills across the intervention group, and accurately assess the effectiveness of the intervention.

The exclusion criteria were: (1) failure to complete more than two-thirds of questionnaire items; (2) absence from three or more intervention sessions; and (3) unwillingness to continue participation.

Due to the nature of the intervention, blinding of participants and researchers was not possible because participants were actively engaged in the breathing exercises. However, to reduce the risk of bias, outcome assessors responsible for analyzing the questionnaire data were blinded to group allocation throughout the data entry and analysis phases. Group assignments were coded and kept confidential, and any personal identifiers were removed from the dataset before analysis to maintain objectivity. Independent data analysts, use of objective standardized tests, predefined protocols, and randomization can reduce systematic bias.

Ethical Considerations

This study was approved by the Research Ethics Committee of Kerman University of Medical Sciences (No. 402000754 and Ethic approval Code.IR.KMU.REC.1402.475) and was conducted in accordance with institutional ethical standards. All participants were fully informed about the study's aims, procedures, potential risks, and benefits. Participation was entirely voluntary, and students were assured that withdrawal would not affect their academic status.

Written informed consent was obtained from all participants prior to enrollment. Confidentiality and anonymity were strictly maintained: all personal data were de-identified and securely stored, accessible only to the research team. During data analysis, group assignments were coded, and outcome assessors remained blinded to ensure objectivity.

Measurement Tools

Three instruments were used for data collection: a Demographic Questionnaire, the King Spiritual Intelligence Questionnaire, and the Schering Emotional Intelligence Questionnaire. These instruments were selected due to their theoretical grounding, prior use in healthcare education research, and proven validity within Iranian academic settings.

• Demographic Questionnaire: Collected data on age, gender, marital status, residence, GPA, income, and prior exposure to EI or SI training.

• King Spiritual Intelligence Questionnaire (SISRI-24): The King Spiritual Intelligence Questionnaire (SISRI-24), developed by King (2009), consists of 24 items across four subscales: Critical Existential Thinking, Personal Meaning Production, Transcendental Awareness, and Conscious State Expansion. In King's study, the alpha coefficients for the subscales were 0.88, 0.87, 0.89, and 0.94, respectively. The five possible responses were considered for this scale from “0 = not at all true of me” to “4 = completely true of me.” Higher scores reflecting greater SI (King, 2009). Raghib et al.'s study on Iranian students showed that the SISRI-24 was a valid scale for measuring SI and reported its reliability of Cronbach's alpha equal to 0.88 and confirming its validity within the Iranian cultural and educational context (Raghib et al., 2010).

• Schering Emotional Intelligence Questionnaire: The questionnaire consists of 33 questions scored on a five-point scale from 1 to 5. The sum of the scores makes up the total score. The questionnaire evaluates five EI subscales: Self-Awareness, Social Awareness, Motivation, Self-Control, and Social Skills (Shariatpanahi et al., 2022).

The reliability and validity of this questionnaire have been confirmed in Iran by Ganji et al. (2006), and the reliability of the questionnaire according to the Cronbach alpha method is 0.83. Mansouri (2001) validated the Persian version of the questionnaire in Iran in a group of students; the reliability and validity of the questionnaire were assessed, with Cronbach's α of 0.85.

Intervention

The intervention consisted of Ujjayi Pranayama, also known as the “Victorious Breath,” characterized by slow, deep inhalations and exhalations through a slight constriction of the glottis, creating an audible sound.

Prior to the intervention, participants in the experimental group attended a live 45-min virtual training session via Google Meet, delivered by a certified yoga therapist with over 10 years of clinical and academic experience. This session covered key components of Ujjayi breathing, including:

• Diaphragmatic engagement

• Controlled glottal constriction

• Timing and rhythm (5 s inhalation, 15 s exhalation)

• Posture and relaxation techniques

• Safety considerations and contraindications

Participants also received an instructional video, a printed step-by-step guide, and access to a WhatsApp support group for asking questions and sharing experiences.

Participants practiced Ujjayi breathing for 15 min daily over 20 consecutive weekdays (Aranberri-Ruiz et al., 2022; Nagendrappa et al., 2025), between 8:00–9:00 a.m. before breakfast, in a quiet and comfortable environment of their choice.

To monitor adherence, each participant completed a daily logbook, reporting the time, duration, and perceived quality of practice. Logs were submitted every three days via WhatsApp or email. The researcher provided reminders and support messages twice weekly to encourage compliance.

Adherence was considered satisfactory if participants completed at least 85% of sessions (≥17 out of 20 days). Those missing more than three sessions were excluded from final analysis.

During practice, participants sat upright with eyes closed, maintaining a relaxed posture. The protocol consisted of:

• Inhalation through both nostrils for 5 s

• Exhalation through both nostrils for 15 s

• Optional gentle closure of the auditory canal using the index fingers for focus

• Cycle repeated 3–4 times per minute, with one-minute rest between rounds (Srivastava et al., 2017).

The control group received no structured intervention but continued their routine academic schedule. To address ethical considerations, they were invited to attend a post-study Ujjayi workshop.

Data Analysis

IBM SPSS Statistics version 25 was used for the data analysis. Descriptive statistics (frequency, percentage, mean, and standard deviation) were applied to describe the demographic characteristics of the sample. Independent t-tests and Chi-square tests were used to evaluate the similarity of the two groups in terms of demographic characteristics and confounding variables (Figure 1).

Figure 1.

Flowchart of the Study Process.

Results

The mean age of the subjects in the intervention group was 22.33 ± 0.08 years and in the control group 23.14. ± 1.6 years. In both groups, the majority of participants were female, single, with an income of less than 10MT and resident in the city. Also, the findings showed that almost the majority of participants had no experience of SI and EI courses.

The results showed that there were no significant differences between the two intervention and control groups in terms of gender, marital status, income, grade point average, city or village residence, and having experience of SI and EI courses. Therefore, the two groups were identical in terms of demographic variables (Table 1).

Table 1.

Description and Comparison of Demographic Characteristics of the Subjects.

		Intervention		Control
Group variable		Frequency	Percentage	Frequency	Percentage	X2	p-value
Gender	Female	14	60.9	20	87	0.6	.44
	Male	9	39.1	3	13
Marital status	Yes	2	8.7	3	13	0.24	.63
	No	21	91.3	20	87
Income	≤10 MT a	7	30.4	6	26	0.68	.41
	>10 MT	16	69.6	17	73.9
Resident	city	22	95.7	23	100	1.03	.31
	village	1	4.3
Spiritual intelligence courses	Yes	1	4.3	1	4.3	0.1	.75
	No	22	95.7	22	95.7
Emotional intelligence courses	Yes	1	4.3	1	4.3	0.1	.75
	No	22	95.7	22	95.7
		Mean standard deviation		Mean standard deviation		Independent t-test
Age		22.33 ± 0.08		23.14. ± 1.6		−1.34	0.23
Grade point average		16.82 ± 1.4		17.32 ± 0.96		−1.4	0.34

^aMT: Million tomans.

In the intervention group, the mean scores of SI before and after the intervention were 70.37 ± 11.41 and 73.54 ± 12.12 respectively (p = .37), Cohen's d = 0.27(a moderate effect size). This indicates that the effect of pranayama practice on the SI of nursing students is observable. Therefore, it is clear that there was no statistically significant difference in SI in the intervention group during the study. Although it increased by 3.17 points in the post-test. These changes are clinically significant (Figure 2).

Figure 2.

Comparison of the Average SI Between Two Groups.

In the control group, the mean scores of SI before and after intervention were 75.73 ± 12.54 and 74.91 ± 11.32 respectively (p = .74). In the control group, SI did not change much. There wasn’t a statistical difference between the two groups in terms of SI during the study (Table 2).

Table 2.

Comparison of the Mean Scores of SI of the Subjects.

Groups	Pretest		Posttest		Mean difference	ES (Cohen's d)	Paired-t-test	95%CI	p-value
SI	Mean	SD	Mean	SD
Intervention	70.37	11.41	73.54	12.12	3.17	0.27	0.91	70.03–77.05	.37
Control	75.73	12.54	74.91	11.32	0.82	0.07	0.34	71.6–78.19	.74
Independent t-test		0.4		2.33
p-value		.58		.16
ES (Cohen's d)		0.09		0.12

Effect size (ES): (ES < 0.20), small; (ES ≥ 0.20 < 0.50), moderate; (ES ≥ 0.50 < 0.80), large; (ES ≥ 0.80), very large effect.

In the intervention group, the mean scores of EI before and after the intervention were 100. 17 ± 15.69 and 126.11 ± 16.81 respectively (p = .02), and Cohen's d = 0.66 (a large effect size). This indicates that the effect of pranayama practice on the EI of nursing students leads to significant improvement. Therefore, it is clear that during the study in the intervention group, the increase in EI was statistically significant, which indicates significant clinical significance (Figure 3). In the control group, the mean scores of EI before and after intervention were 106.56 ± 16.17 and 102.34 ± 15.12 respectively. In the control group, EI did not change much (p = .87). There was a statistical difference between the two groups in terms of EI during the study (Table 3).

Figure 3.

Comparison of the Average EI Between Two Groups.

Table 3.

Comparison of the Mean Scores of EI of the Subjects.

Groups	Pretest		Posttest		Mean difference	ES (Cohen's d)	Paired t-test	95%CI	p-value
EI	Mean	SD	Mean	SD
Intervention	100.17	15.69	126.11	16.81	25.94	0.66	2.19	95.63–104.6	. 02
Control	106.56	16.17	102.34	15.12	4.22	0.27	1.18	100.5–110.12	.87
Independent t-test	0.66		1.02
p-value	.31		.03
ES (Cohen's d)	0.14		0.24

Bold p-value is significant at level of ≤.05.

Effect size (ES): (ES < 0.20), small; (ES ≥ 0.20 < 0.50), moderate; (ES ≥ 0.50 < 0.80), large; (ES ≥ 0.80), very large effect.

Discussions

This study demonstrates that Ujjayi Pranayama practice significantly improved the EI of nursing students, aligning with existing literature suggesting that breath-focused interventions foster emotional awareness, regulation, and interpersonal competence (Kushwaha et al., 2024). These findings are consistent with results from Mandaliya et al. (2024), who observed enhanced EI in students following integrated yogic training (Mandaliya et al., 2024), and with Stec et al. (2023), who reported improved emotional processing after short-term breath-based interventions (Stec et al., 2023).

Beyond its psychological effects, pranayama exerts its influence on EI through well-documented neurophysiological mechanisms: the deliberate regulation of breathing patterns stimulates the vagus nerve, enhancing parasympathetic activity and dampening sympathetic arousal (Kumari et al., 2024). This autonomic shift facilitates emotional balance by improving prefrontal cortex modulation of the amygdala and increasing heart rate variability—both crucial for adaptive emotional responses and resilience (Novaes et al., 2020).

Such mechanisms may explain why EI, which involves self-regulation and social-emotional awareness, responds positively even to relatively short-term physiological interventions like Ujjayi breathing.

However, the absence of a significant effect on SI underscores the complex and multifaceted nature of SI, which encompasses existential cognition, ethical reasoning, and transcendent awareness (Vidal, 2023). This suggests that the cultivation of SI likely requires a broader experiential and philosophical engagement than that offered by breath regulation alone. Effective development of SI may depend on the integration of reflective practices, ethical dialogue, and guided introspection alongside breathing exercises (İlter & Ovayolu, 2021). Furthermore, the brief 20-day duration of this intervention may not have allowed sufficient time for the deeper cognitive and spiritual processes that underlie SI to emerge fully (Bhattarai et al., 2024).

While previous studies have reported improvements in EI and SI among yoga practitioners (Mandaliya et al., 2024; Sharma & Samita, 2024), these interventions typically incorporate a broad array of yogic practices—including meditation, postural exercises, and philosophical teachings. In contrast, this study's use of Ujjayi Pranayama as a standalone technique permits a more focused investigation into its unique contributions, revealing that while EI appears amenable to physiological modulation, SI may require multidimensional interventions.

Implications for Nursing Practice

These findings carry important implications for nursing education and clinical preparation. Enhancing EI through simple and accessible techniques like Ujjayi Pranayama may help students better manage stress, navigate ethical dilemmas, and maintain composure in high-pressure environments. By incorporating breathwork into nursing curricula or clinical training modules, educators could foster emotional readiness and resilience, potentially reducing burnout and improving patient care outcomes.

Strengths and Limitations

This study offers several notable strengths. The randomized design with allocation concealment and blinded outcome assessment enhances internal validity and minimizes potential researcher bias. Importantly, isolating Ujjayi Pranayama as a standalone intervention—rather than embedding it within a broader yoga protocol—allowed for a clearer examination of its distinct psychological effects, specifically in the context of EI among nursing students.

Nonetheless, the study is not without limitations. The reliance on self-report instruments may introduce biases such as social desirability, recall inaccuracy, or subjective misperception, potentially affecting the reliability of the findings. Furthermore, the absence of objective, performance-based assessments limits the ability to draw strong conclusions about the behavioral manifestations of improved EI. Future studies should consider incorporating simulation tasks, peer evaluations, or clinical performance metrics to assess real-world relevance.

Another limitation concerns the relatively small sample size, which was drawn from a single academic institution. This restricts the generalizability of the results and raises questions about their applicability to other cultural or educational settings. In particular, the unique features of Iranian nursing education may influence how interventions like pranayama are received and practiced. Multisite, cross-cultural investigations are needed to explore variability in outcomes.

The short duration of the intervention (20 days) also limits the ability to assess long-term sustainability. While initial gains in EI were observed, it remains unclear whether these effects persist over time without continued practice. Longitudinal follow-ups would be instrumental in addressing this gap.

Finally, the null findings regarding SI suggest that Ujjayi Pranayama alone may not be sufficient to influence deeper existential or meaning-related dimensions. Future interventions could benefit from combining pranayama with other spiritually enriching practices such as mindfulness meditation, values clarification, or narrative-based self-reflection. Moreover, adopting a mixed-methods design may help capture nuanced, experiential changes that standardized quantitative tools often overlook.

Conclusions

Short-term Ujjayi Pranayama practice significantly improves EI in nursing students, making it a promising, low-resource intervention to integrate into nursing education. Future research should explore longer interventions, integrate complementary techniques (e.g., mindfulness or ethical reflection), and assess long-term and behavioral outcomes in varied cultural contexts.