Mindfulness: Pay Attention in Simulation and Life

By: Robin Cunningham

When four of us participated in the NLN Leadership Institute program for simulation leaders in 2017, we worked together to identify a group project. Finding little on mindfulness in nursing student simulations, we decided to implement our resulting Mindfulness Simulation Leader project during simulation prebriefing at each of our four schools of nursing — three universities in the southern US and a community college in the Midwest. The undergraduate nursing students who participated included PN, ADN, BSN, and ABSN students.

We thought of the topic of mindfulness as a life skill, a tool that would help decrease anxiety while increasing students’ situational awareness. We also believed that mindfulness skills would be beneficial in clinical situations to improve the novice nurses’ ability to focus and to remain in the moment, despite all the tasks and distractions that nurses face today.

Mindfulness is defined as the awareness that emerges from paying attention on purpose, in the present moment, without judgment to the unfolding experience (Warnecke, Quinn, Ogden, Towle, & Nelson, 2011). Mindfulness has been shown to reduce stress and anxiety in studies involving healthy and chronically ill individuals and crosses all spiritual and cultural barriers. Nursing school has been shown to cause high levels of stress for individuals related to the demands of academic and clinical performance (Manocchi, 2017). Thus, the first-semester nursing student population seemed appropriate for the mindfulness intervention.

Several weeks before the simulation we instructed participants on the principles of mindfulness including the evidence that it can increase self-awareness during simulations, as well as enhance safe care in the clinical setting. We started every session with a three-minute guided meditation using the popular Headspace App.

The benefits of incorporating mindfulness were reviewed with students on the morning of simulation, along with the importance of making mindfulness skills a habit. Simulation faculty also participated in the three-minute mindfulness session. Responses have been overwhelmingly positive, with students reporting that the mindfulness exercise helped them remain calm during the scenario. Some common responses at the end of the simulation day included: “I feel calmer, more relaxed,” “I feel less stressed,” “I feel I could use this with patients and before taking a test,” “I can use this when I am stressed.” Overall, the vast majority of students stated that they planned to incorporate mindfulness into their personal and professional lives.

More detailed information on this Mindfulness Simulation Leader project and a complete list of published references as well as other NLN Simulation Leader Projects can be found on the NLN SIRC site.


Manocchi, P. (2017). Fostering Academic Success in Nursing Students Through Mindfulness: A Literature Review. Teaching and Learning in Nursing, (12), 298-303.

Warnecke, E., Quinn, S., Ogden, K., Towle, N., Nelson, M. (2011). A Randomized controlled trial of the effects of mindfulness practice on medical student stress levels. Medical Education 45(4), 381-388. doi: 10.1111/j.1365-2923.2010.03877.x

Sites & Mobile Apps that can be used to facilitate a mindfulness experience:

Introduction to mindfulness: https://www.youtube.com/watch?v=AWJUv1lH-Ng   

(3-minute introduction to what mindfulness is)

Music Only: https://www.youtube.com/watch?v=cI4ryatVkKw  

(3 minutes of relaxing/calming background music)

Relaxation event: https://www.youtube.com/watch?v=SEfs5TJZ6Nk

Headspace: https://www.headspace.com/register

Calm: https://www.calm.com/meditate

Whil: https://www.whil.com 

Insight Timer:  https://insighttimer.com 

Buddahify: http://buddhify.com/

The Mindfulness Simulation Leader project team

Robin Cunningham, MSN, RN, LNCC, CNE, CHSE, University of North Carolina, Wilmington, North Carolina

Jeanne Cleary, MA, BSN, RN, Ridgewater College, Willmar, Minnesota

Marci Dial, DNP, MSN, ARNP, NP-C, RN-BC, LNC, CHSE, Valencia College, Orlando, Florida

Margory Molloy, DNP, RN, CNE, CHSE, Duke University School of Nursing, Durham, North Carolina

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