Effects of curriculum-integrated yoga on mindfulness and perceived stress in nursing studentsAbstract
Objective This study aimed to examine the effects of yoga on mindfulness and perceived stress levels in nursing students.
Methods A randomized controlled pre/posttest study with a single-blind, parallel-group design was conducted in a nursing department in western Turkey between September 2019 and January 2020. A total of 56 nursing students participated (29 in the intervention group and 27 in the control group). The intervention group participated in a 15-week yoga course, while the control group participated in a communication course. Data were collected online using the Personal Data Form, the Mindful Attention Awareness Scale, and the Perceived Stress Scale. Data analysis included descriptive statistics, paired samples t-test, independent sample t-test, and Pearson’s chi-squared test.
Results After 15 weeks, the students in the yoga group had significantly higher scores on the Mindful Attention Awareness Scale (mean = 62.24 ± 6.72) compared to those in the control group (mean = 58.18 ± 10.04) (p < 0.05). The yoga group also had significantly lower scores on the Perceived Stress Scale (mean = 17.51 ± 3.51) than the control group (mean = 20.29 ± 5.36) (p < 0.05). Within-group analysis also showed a significant reduction in perceived stress from pretest to posttest in the yoga group (p < 0.05).
Conclusion The findings suggest that integrating yoga into the nursing curriculum may offer an effective non-pharmacological strategy to reduce perceived stress and increase mindfulness among nursing students.
Keywords
Mindfulness; Education, nursing; Stress, physiological; Yoga
Resumo
Objetivo Examinar os efeitos da prática de yoga sobre a atenção plena e os níveis de estresse percebido em estudantes de enfermagem.
Métodos Estudo controlado, randomizado, pré-teste/pós-teste, com delineamento simples-cego e grupos paralelos, conduzido em um departamento de enfermagem no oeste da Turquia entre setembro de 2019 e janeiro de 2020, com participação de 56 estudantes de enfermagem (29 no grupo intervenção e 27 no grupo controle). O grupo intervenção participou de um curso de yoga de 15 semanas, enquanto o grupo controle participou de um curso de comunicação. Os dados foram coletados online utilizando o Formulário de Dados Pessoais, a Escala de Atenção e Consciência Plenas (Mindful Attention Awareness Scale - MAAS) e a Escala de Estresse Percebido (Perceived Stress Scale, PSS). A análise dos dados incluiu estatística descritiva, teste t para amostras pareadas, teste t para amostras independentes e teste qui-quadrado de Pearson.
Resultados Após 15 semanas, os alunos do grupo de yoga apresentaram pontuações significativamente mais altas na Escala de Atenção e Consciência Plenas (média = 62,24 ± 6,72) em comparação com os do grupo controle (média = 58,18 ± 10,04) (p < 0,05), bem como pontuações significativamente mais baixas na Escala de Estresse Percebido (média = 17,51 ± 3,51) do que o grupo controle (média = 20,29 ± 5,36) (p < 0,05). A análise intragrupo também demonstrou uma redução significativa no estresse percebido do pré-teste para o pós-teste no grupo de yoga (p < 0,05).
Conclusão Os resultados sugerem que a integração do yoga no currículo de enfermagem pode oferecer uma estratégia não farmacológica eficaz para reduzir o estresse percebido e aumentar a atenção plena entre estudantes de enfermagem. ClinicalTrials.gov: NCT06405789
Descritores
Atenção plena; Educação em enfermagem; Estresse fisiológico; Yoga
Resumen
Objetivo Examinar los efectos de la práctica del yoga sobre la atención plena y los niveles de estrés percibido en estudiantes de enfermería.
Métodos Estudio controlado, aleatorizado, pretest y postest, con diseño simple ciego y grupos paralelos, realizado en un departamento de enfermería en el oeste de Turquía entre septiembre de 2019 y enero de 2020, con la participación de 56 estudiantes de enfermería (29 en el grupo de intervención y 27 en el grupo de control). El grupo de intervención participó en un curso de yoga de 15 semanas, mientras que el grupo de control participó en un curso de comunicación. Los datos se recopilaron en línea utilizando el Formulario de Datos Personales, la Escala de Conciencia y Atención Plena (Mindful Attention Awareness Scale, MAAS) y la Escala de Estrés Percibido (Perceived Stress Scale, PSS). El análisis de los datos incluyó estadísticas descriptivas, la prueba t para muestras emparejadas, la prueba t para muestras independientes y la prueba ji cuadrado de Pearson.
Resultados Después de 15 semanas, los alumnos del grupo de yoga obtuvieron puntajes significativamente más altos en la Escala de Conciencia y Atención Plena (promedio = 62,24 ± 6,72) en comparación con los del grupo de control (promedio = 58,18 ± 10,04) (p < 0,05), así como puntajes significativamente más bajos en la Escala de Estrés Percibido (promedio = 17,51 ± 3,51) que el grupo de control (promedio = 20,29 ± 5,36) (p < 0,05). El análisis intragrupo también demostró una reducción significativa del estrés percibido entre el pretest y el postest en el grupo de yoga (p < 0,05).
Conclusión Los resultados sugieren que la integración del yoga en el plan de estudios de enfermería puede ofrecer una estrategia no farmacológica eficaz para reducir el estrés percibido y aumentar la atención plena entre los estudiantes de enfermería.
Descriptores
Atención plena; Educación en enfermeira; Estrés fisiológico; Yoga
Introduction
Nursing students face a high risk of compromised mental and physical well-being.(1) Nursing students face intense workloads, high levels of stress, and a competitive academic environment.(2,3) Throughout their nursing education, students encounter various stressors that may directly or indirectly impede their learning and overall performance.(4) In nursing education, there are three types of stressors:1) academic stressors (e.g. exam pressure and fear of academic failure), 2) clinical stressors (including fear of failure, emotional responses to patient suffering or death, and interpersonal dynamics within the healthcare team), and 3) personal/social stressors (e.g. financial difficulties).(5,6)
Studies stress in nursing students reveal that stress levels vary across countries. In Turkey, nursing students typically report experiencing mild to moderate levels of stress.(7) Similarly, a study conducted in Spain found that approximately half of the nursing students surveyed experienced a moderate level of perceived stress.(8) In contrast, Labrague et al. (2017) reported high levels of stress among nursing students in the Philippines, Greece, and Nigeria.(6) Problem solving, denial of problems, and escape-avoidance are the main coping strategies that nursing students use when faced with stress.(5,8) Various interventions, including improving clinical education, integrating stress management into orientation, enhancing time management skills, offering counseling, and establishing support systems and hospital policies to aid learning, have been proposed for nursing students.(3,5,9) It’s encouraging that certain nursing programs have included self-care interventions in their curricula, yielding positive outcomes.(10) Nursing students actively engage in diverse self-care practices, encompassing dietary maintenance, prayer, meditation, sufficient sleep, and exploration of complementary medicine(6,11,12) concurrently, literature indicates their frequent use of physical activity or yoga as a strategy to alleviate and manage stress.(11,13)
For millennia, the practice of yoga, a blend of art and science, has been embraced. The renowned American doctor, Dr. Dean Ornish, who demonstrated that a yogic lifestyle could reverse heart disease, views yoga as a powerful system of tools for achieving union and healing.(14) Yoga—often regarded as the original mind-body medicine—is a nonpharmacological and noninvasive approach that plays a pivotal role in fostering psycho-somatic and somato-psychic reintegration.(15,16) As a widely embraced integrative medicine modality, yoga is frequently positioned as the most suitable method for reestablishing psychophysiological balance through its philosophical and practice-based framework.(15) Recent reviews also highlight yoga’s comprehensive impact across multiple body systems, emphasizing its value as a powerful and holistic tool for promoting health and well-being.(16) In recent times, numerous scientists have extensively examined its effects, consistently reporting positive physiological and psychological transformations.(10,13,17) By encouraging individuals to maintain constant body awareness, focusing their attention on breathing, emotions, thoughts, or specific body parts, yoga effectively enhances mood and reduces stress.(14) Yoga has been widely recognized as an effective stress management tool, with numerous studies and meta-analyses demonstrating significant improvements in both psychological and physiological outcomes related to stress.(10,18) Yoga is important for nursing students in their personal and professional lives due to their vital role in health care as primary caregivers of patients.(14) Notably, the international nursing authority has officially acknowledged yoga as a nursing intervention by including it in the Nursing Interventions Classification (NIC) and endorsing it as a non-pharmacological approach that nurses can autonomously implement.(19) Given their critical role as primary caregivers who are frequently exposed to high levels of stress, nurses who obtain yoga certification can first apply these practices for their own well-being and subsequently incorporate them into the care of both healthy and ill individuals.(10,19)
Recognizing the value of such self-care interventions, several countries have taken steps to formally integrate yoga into nursing education. For instance, yoga has been officially included in the national nursing curriculum in India since 2016,(20) and some nursing schools in Turkey have adopted it as an elective course.(10) These changes are supported by growing evidence highlighting the benefits of mindfulness-based practices—including yoga, meditation, and breathing exercises—for healthcare professionals’ well-being and resilience.(21) Nursing students worldwide report engaging in these practices with positive outcomes, particularly in stress management and well-being enhancement.(10,14) While research on the use of yoga among nursing students has shown promising results globally,(9,20,22) studies conducted in Turkey remain limited(10,23) was found in Turkey. Despite evidence showing the benefits of mindfulness-based practices, curriculum-integrated yoga interventions remain limited in Turkey. Nursing students experience high levels of stress, and there is a lack of structured, curriculum-based self-care programs in undergraduate nursing education. Therefore, this study aimed to examine the effect of a curriculum-integrated yoga course on the levels of mindfulness and perceived stress in nursing students.
Methods
This randomized, controlled, pre/post test study with a single-blind design and parallel groups was conducted in the nursing department of a public university in western Turkey between September 2019 and January 2020. A detailed description of the randomization process, group allocation, and intervention steps has been provided to enhance clarity and reproducibility. Inclusion criteria were: being a first-year nursing student, over 18 years old, volunteering to participate, and providing written informed consent. Exclusion criteria included physical limitations preventing yoga practice, hearing or visual impairments, unwillingness to continue, or school absenteeism. Pretest and posttest data were collected online via Google Forms. As shown in the CONSORT flow diagram (Figure 1), three students in the intervention group (IG) and six in the control group (CG) withdrew before the start of classes and were excluded from baseline assessment. In addition, two students from each group declined to complete the posttest questionnaire. The final per-protocol analysis included 29 participants in the IG and 27 in the CG (Figure 1).
After all first-year nursing students (n = 69) were informed about the aim of the study, those who volunteered provided written informed consent prior to randomization. An independent statistician, who had no role in the intervention or data collection, generated the random allocation sequence using an online list randomizer (http://www.random.org). Students were randomly assigned to groups A and B. The allocation of group A as the intervention (yoga) and group B as the control (communication course) was determined by coin toss. To ensure allocation concealment, students were not informed about the specific course content (yoga vs. communication) until enrollment was completed. This approach minimized selection bias and prevented participants from choosing groups based on preference.
At the beginning of the study, to ensure reliable data matching, participants were asked to create a personal code or pseudonym that they could easily recall. This identifier was used to link pre-and post-test questionnaires without revealing personal information. Research data were coded as groups A and B and entered into SPSS (Version 25.0) by a statistician blinded to group allocation. All analyses and reporting were conducted under blinded conditions to minimize bias.
Pretest and posttest data were collected online using a structured questionnaire administered via Google Forms. The link was distributed through Instagram and WhatsApp, and participants completed the forms anonymously in approximately ten minutes. This approach minimized contact between groups during both pretest and posttest data collection.
Data collection tools included the Personal Data Form, the Mindful Attention Awareness Scale, and the Perceived Stress Scale. The Personal Data Form, developed by researchers based on relevant literature, included three questions related to age, gender, and prior yoga experience.(10,18) The Mindful Attention Awareness Scale was originally developed by Brown and Ryan (2003)(24) to measure individual differences in the ability to attend and be aware of present-moment experiences. The scale consists of 15 items rated on a 6-point Likert-type scale (1 = almost always to 6 = almost never), with higher scores indicating greater mindfulness. The Turkish adaptation of the scale was conducted by Catak (2012), who confirmed its unidimensional structure and reliability in Turkish populations.(25) The 6-point Likert scale ranges from 1 (almost always) to 6 (almost never), with higher scores indicating greater mindfulness.(24) The Cronbach’s alpha was .82 in the original study,(24).85 in the Turkish adaptation,(25)and .86 in the current study. The Perceived Stress Scale was developed by Cohen, Kamarck, and Mermelstein (1983) to assess the degree to which individuals perceive situations in their lives as stressful.(26)It includes 10 items across two subdimensions: perceived self-efficacy and perceived helplessness. Each item is rated on a 5-point Likert scale (0 = never to 4 = very often), with four positively worded items (items 4, 5, 7, 8) reverse-coded. Higher total scores indicate greater perceived stress. The Turkish adaptation was carried out by Eskin, Harlak, Demirkıran, and Dereboy (2013).(27) The Cronbach’s alpha was reported as .82 in the original scale, .84 in the Turkish version, and .78 in this study.
Intervention/Yoga Course: The duration of the intervention (15 weeks) was determined to align with one academic semester in the nursing curriculum. A study(10) in Turkey have implemented 14-week yoga programs among nursing students with positive outcomes. Furthermore, the Nursing Interventions Classification identifies yoga as a nursing intervention delivered over a flexible period with regular weekly sessions.(19) Therefore, a 15-week program was considered both feasible and consistent with the evidence. The yoga course was offered as an elective within the nursing curriculum, with prior approval from the faculty administration, which ensured regular attendance and academic credit.
The course content was developed based on literature and prior studies, and delivered by the principal investigator, a certified yoga instructor.(10,11,14,18) The IG attended 15 weeks of structured yoga sessions, each lasting 1.5 hours per week (30 minutes theory, 60 minutes practice). Each session included breathing exercises (pranayama), warm-up, postures (asanas), and deep relaxation (shavasana). Students also received optional daily mindfulness practices for use outside the classroom. Attendance was recorded, and fidelity of implementation was ensured by standardized session outlines. The course materials included instructor notes and guided practices. After the study concluded, the control group was offered a one-time yoga session. The experimental group received a yoga course that integrated both practical and theoretical components, delivered in part via PowerPoint presentations. Practical elements included breathing exercises (pranayama), physical postures (asanas), and relaxation/meditation (e.g. corpse pose). The theoretical components involved introducing yoga philosophy (e.g. mind–body integration and the concept of mindfulness/dharana), teaching loving-kindness meditation (dhyana), and reviewing evidence-based frameworks that explain yoga’s effectiveness in stress reduction and psychological wellbeing. In contrast, the control group participated in communication skills.
Control Group: The control group received the communication course for 15 weeks delivered once a week. This communication course content includes the purpose and elements of communication, types and tools of communication, influencing factors, communication techniques, therapeutic communication techniques, communication in some special situations, ineffective/non-therapeutic communication techniques, self-knowledge and expression, empathy, way to use “I-language” and “You-language”, behavioral styles, conflict and its management are presented to students theoretically for 1.5 hours per week.
An independent statistician, blinded to group allocation, coded and entered the anonymized data into SPSS (Version 25.0, IBM Corp). Prior to analysis, data accuracy was double-checked to ensure reliability. Sample size was determined using G*Power (Version 3.1, Heinrich Heine University, Düsseldorf, Germany). Normality assumptions were tested using the Shapiro–Wilk test, and homogeneity of variances was checked. The significance was set at p < 0.05. Descriptive statistics (frequency, percentage, mean, standard deviation) were calculated. Group homogeneity at baseline was assessed with the chi-square test for categorical variables and independent t-tests for continuous variables. Within-group changes (pre/post) were analyzed using paired-sample t-tests, while between-group differences were examined using independent-sample t-tests. To examine the interaction between group (intervention vs. control) and time (pre vs. post), a two-way repeated measures ANOVA was performed. Effect sizes (Cohen’s d and partial η2) were reported to indicate the magnitude of differences.
Ethical approval was obtained from the İzmir Democracy University Non-Invasive Clinical Research Ethics Committee (Decision no: 2019/05-03). Prior to data collection, the study’s purpose was explained, and students were informed that participation was voluntary, anonymous, and unrelated to course grading. Written informed consent was obtained before randomization. Only students who voluntarily provided consent could access the questionnaire. Participants were assured of confidentiality and their right to withdraw at any time. To match pre- and post-test forms, pseudonyms were used. Permissions were obtained for the use of all scales. The study was conducted in accordance with the Declaration of Helsinki and reported in line with CONSORT guidelines. It was registered at ClinicalTrials.gov (NCT06405789).
Results
The mean age of the IG was 18.51±0.82 years and that of the CG was 18.70±0.77 years in the intervention and control groups were similar before the intervention in terms of age, gender, and previous yoga experience (p>0.05). With respect to gender, 69% of the IG and 70.4% of the CG were female (Table 1). Baseline characteristics showed that almost all participants were yoga-naïve, with 96.6% of the IG and 88.9% of the CG reporting no prior yoga experience (Table 1).
Comparisons of the MAAS and PSS scores of the intervention and control groups are shown in table 2. After 15 weeks, the MAAS scores of the students in the IG were significantly greater (62.24 ± 6.72) than those of the students in the CG (58.18 ± 10.04) (p<0.05) (Table 2). After the 15 weeks the change in IG in terms of posttest MAAS was found to be significantly greater than the pretest (p< 0.05). The effect size of IG and CG on MASS Cohen’s d=0.84; 95% CI -5.19 to -.36 was found. Two* way repeated measure for group* time was found significant (p<0.05) (Table 2). After the 15 weeks IG had lower PSS (17.51 ± 3.51) than the scores in CG (20.29 ± 5.36) and the difference were significant (p< 0.05). After the intervention the change in IG in terms of posttest PSS was found to be significantly lower than the pretest (p<0.05). The effect size of IG and CG on PSS was 0.62. IG tended to have a greater improvement on MASS than the CG (Cohen’s d=0.84; 95% CI -5.19 to -.36). The effect size on PSS was 0.62, exceeding a “moderate” effect size of 0.50.
Discussion
This study assessed the impact of a 15-week curriculum-integrated yoga course on mindfulness and perceived stress in first-year nursing students. Although yoga and mindfulness have been widely studied in nursing education, in Turkey, curriculum-based applications remain limited. This intervention, which was delivered by a certified yoga instructor and supported by validated scales, presents a feasible and replicable educational model. Most participants lacked prior yoga experience, underscoring the accessibility of such programs for beginners. Consistent with findings in previous nursing programs, most participants in the IG and a notable portion of the CG had not engaged in yoga prior to the study—an observation that aligns with prior evidence indicating low baseline exposure to yoga among undergraduate nursing students.(22,28) This study contributes to the literature by demonstrating that even nursing students with no prior yoga experience can benefit from curriculum-integrated yoga, highlighting its accessibility and applicability in undergraduate nursing education.
Mindfulness is the ability to focus intently on one’s inner and outer experiences and to consciously notice the present moment.(29) College nursing instructors recommend the integration mindfulness practices such as yoga into nursing education to improve students’ psychological well-being.(3,10,13) In this study, students in the IG who practiced yoga demonstrated higher levels of mindful awareness compared to those in the CG. The post-intervention MASS scores of the IG were significantly higher than those of the CG (p < 0.05), and the IG showed a greater tendency to improve, with a large effect size (Cohen’s d = 0.84). Some scholars found that adopting mindfulness interventions can significantly elevate levels of mindfulness and reduce the stress, anxiety and depression of nursing students,(3,10)whereas other scholar have reached no statistically significant result.(2) Chen et al. (2021)(3) examined the mindfulness scores of six studies in a meta-analysis involving a total of 1318 nursing students 637 in the IG and 681 in the CG. Except for one of the studies, five studies reported statistically significant results regarding the development of mindfulness.(3) In a literature review, it is recommended to integrate mindfulness programs including exercises that develop breath awareness, meditation, and yoga into the curriculum for nursing students in the first year of the undergraduate nursing program.(18) It has been shown that mindfulness increases in nursing programs where mindfulness and yoga are integrated.(10,30) Similar to the literature, this study proves that integrating yoga courses into the nursing curriculum increases mindfulness.
Mindfulness-based approaches such as breathing techniques, yoga, and meditation have been shown to significantly reduce nursing students’ negative emotions and enhance their ability to manage stress.(3,31) Building on this foundation, the findings of this study suggest that integrating yoga into the nursing curriculum may enhance students’ emotional regulation and stress management skills. Such improvements can not only support students’ academic performance and personal well-being but may also positively influence their future patient care, as emotionally resilient nurses are better equipped to provide compassionate, attentive care. The intervention was particularly effective in reducing perceived stress among students who participated in the curriculum-integrated yoga. Rather than focusing solely on statistical significance, these findings point to the practical benefit of yoga as a non-pharmacological tool that supports coping in high-stress learning environments such as nursing education. Although validated and reliable self-reported instruments (MAAS and PSS) were used in this study, these tools rely on participants’ subjective perceptions. Future research should consider integrating objective physiological measures, such as salivary cortisol or heart rate variability, to more accurately assess stress reduction and corroborate self-reported outcomes.(32) These findings hold valuable practical implications for nursing education and clinical training. By integrating curriculum-based yoga programs into clinical training environments, nursing educators can reinforce a culture of mindfulness, stress resilience, and self-care among undergraduate nursing students. Evidence indicates that yoga programs implemented among healthcare staff significantly reduce burnout and enhance well-being—one review found that nurses participating in extended yoga interventions experienced notable reductions in stress and emotional exhaustion, even in demanding work environments.(13,33) Scaling the program at institutional or inter-facility levels could amplify its benefits, improving not only student well-being and clinical readiness but also resilience among practicing nurses. As studies show, integrating accessible group yoga in workplace settings—whether 6 or 8-week modules—effectively reduces stress, burnout, and improves overall quality of life. Supporting nursing staff through such interventions could in turn enhance patient care quality, staff retention, and institutional health outcomes.
Consistent with our findings, previous research has shown that mindfulness-based interventions—including yoga, breathing techniques, and meditation—can significantly reduce stress, anxiety, and depression while enhancing students’ academic performance and life satisfaction.(3,18)For example, a recent systematic review and meta-analysis demonstrated that mindfulness programs, many of which incorporated yoga practices, effectively improve mental health outcomes by reducing stress, anxiety, and depression among university students.(17) Similarly, more recent evidence highlights that mindfulness programs integrating yoga and other mind–body techniques not only reduce negative psychological symptoms but also improve sleep quality and life satisfaction in student populations.(34) Among healthcare professionals, a network meta-analysis revealed that mind–body practices are the most effective interventions for reducing occupational stress, with yoga emerging as the most efficacious modality.(35) Recent trials in nursing students also show that yoga-based or mindfulness programs significantly reduce perceived stress and improve well-being.(13)
This study has several strengths, including the use of validated and reliable instruments (Mindful Attention Awareness Scale and Perceived Stress Scale), a randomized controlled design, and a curriculum-integrated yoga intervention led by a certified nurse educator. However, some limitations must be acknowledged.
First, blinding was applied only to the statistician, which may introduce bias during intervention delivery and data collection. Future studies could improve methodological rigor by involving independent facilitators or assessors who are blinded to group assignments. Second, data collection was conducted online, which may have introduced potential response errors. These may include internet connectivity issues, participants becoming distracted during survey completion, or misinterpreting items without the possibility to ask for clarification. Future research may benefit from in-person data collection, allowing researchers to ensure environmental control and provide real-time support. Third, although the use of self-reported tools is common in psychological research, they rely on participants’ subjective perceptions and may be subject to response bias. Incorporating objective physiological markers such as salivary cortisol or heart rate variability in future studies could provide more robust insights into the stress-reducing effects of yoga. Fourth, the intervention was limited to a relatively short follow-up period (one academic semester). Longer-term studies are needed to determine whether the benefits of yoga are sustained over time. Fifth, while almost all participants were yoga-naïve, the study was conducted at a single university with only first-year nursing students. Therefore, the findings cannot be generalized to students in other academic years, disciplines, or institutions. Educational systems, cultural practices, and socioeconomic characteristics vary across universities and regions in Turkey, which may affect how students perceive and engage with yoga.
Finally, although the results highlight the promise of curriculum-integrated yoga, the study did not address issues of feasibility and cost. Future research should evaluate the resources, faculty training, and institutional capacity required for scaling such programs, as these practical considerations may influence the broader implementation of yoga within nursing curricula.
Conclusion
This randomized controlled study suggests that a 15-week curriculum-integrated yoga course may improve mindfulness and reduce perceived stress in first-year nursing students. Unlike short-term or extracurricular approaches, integrating yoga as an academic course appeared to enhance student engagement and perceived value. The observed improvements may potentially support emotional regulation, stress management, and resilience, which are skills that are considered important in healthcare practice; however, further research is needed to confirm this impact. These findings highlight the promise of incorporating yoga into nursing curricula, though additional studies are warranted to examine long-term outcomes, objective physiological indicators, and the feasibility of wider implementation across diverse educational and cultural contexts. The effect size for the improvement in mindfulness was large (Cohen’s d = 0.84), while the effect size for reduction in perceived stress was moderate (Cohen’s d = 0.62), indicating that the observed changes were not only statistically significant but also practically meaningful. Future research should also include longitudinal studies to assess sustained effects, clinical outcome investigations, and the use of objective physiological measures. In addition, feasibility and cost-effectiveness analyses are needed to evaluate the practical integration of yoga into nursing curricula, as institutional resources, faculty training, and scheduling constraints may affect implementation.
Acknowledgments
The author would like to thank all participants for their interest and valuable contributions to this study. Statistical analyses and randomization processes were supported by ISTAR Consultancy. The author also wishes to express sincere gratitude to Dr. James Whedon and Dr. Barbara Gibson for their invaluable input. Although this research was conducted as a single-author study, their critical reading, constructive feedback, and insightful academic perspectives provided significant support to the work. This study was presented as a poster at the 15th Annual IM4US Conference, held on August 14–16, 2025, at the UCI Susan Samueli Integrative Health Institute, California, USA.
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