Simulation-based learning (SBL) in healthcare is a key teaching strategy in nursing education but often induces anxiety, which can increase cognitive load and hinder learning. Evidence suggests mindfulness-based activities (MBAs) reduce anxiety and cognitive load, potentially improving memory retention and knowledge application. This study explored the effect of MBAs on anxiety and cognitive load during SBL for prelicensure nursing students.
Junior-level Bachelor of Science in Nursing (BSN) students participating in SBL in a Clinical Nursing Foundations (CNF) course were randomly assigned to a control or intervention group. Both groups received a standardized prebrief aligned with the Healthcare Simulation Standards of Best Practice. The intervention group also received a 2-minute, 44-second scripted mindfulness body scan (MBA). Pre-simulation state anxiety was assessed using the State-Trait Anxiety Inventory (STAI) before and after the prebrief. Post-simulation cognitive load was measured via the NASA Task Load Index (NASA TLX). Results were compared to assess the MBA’s impact on anxiety and cognitive load, and the relationship between anxiety and cognitive load was analyzed.
The MBA significantly reduced pre-simulation state anxiety in the intervention group compared to the control group (t(167)=3.805, p<0.001, Cohen’s d=0.594). Paired t-tests within the intervention group showed a large reduction in anxiety from baseline (t(87)=8.992, p<0.001, Cohen’s d=0.959), while no significant change occurred in the control group. Although global cognitive load scores on the NASA TLX did not differ significantly between groups, frustration—a subscale of the NASA TLX—was significantly lower in the intervention group (t(163)=2.170, p=0.031). In the control group, anxiety correlated positively with cognitive load (r=0.411, p=0.002), but no meaningful correlation appeared in the intervention group.
Integrating MBAs into SBL prebriefing effectively reduces pre-simulation anxiety, fostering an emotionally supportive learning environment. While overall cognitive load was unaffected, reduced frustration highlights potential benefits for learning outcomes. The positive relationship between anxiety and cognitive load in the control group underscores the need to manage anxiety to optimize learning. This study supports MBAs as a simple, practical strategy to enhance the SBL experience for prelicensure nursing students.
Jennifer Roye, EdD, MSN, RN, CHSE, CNE, PNAP, is The Assistant Dean for Simulation and Technology and a Clinical Assistant Professor at the University of Texas at Arlington College of Nursing and Health Innovation. She is the lead faculty for the Fundamentals of Telehealth course and the Director of the Undergraduate Health Informatics Certificate Program. Dr. Roye is an affiliate of the Center for Innovation in Health Informatics. She is active in INACSL, serving on the Board of Directors. She received her EdD at The University of Alabama in Instructional Leadership. She practiced as a CPNP and as an RN in the Emergency Department at Cook Children’s Medical Center in Ft. Worth, Texas for 16 years. Her areas of research interest include simulation, robotics, telehealth, artificial intelligence, health informatics, rural health, interprofessional simulation education, accessibility in nursing education, and extended reality (XR) simulation.
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