Studies have revealed that nursing students experience greater amounts of stress and anxiety than the average college student. Nursing students attribute increased stress levels to the twin demands of their classroom and clinical workloads. Higher stress levels frequently result in students reporting symptoms of poor health and lack of psychological well-being. It is important to note that some nursing students are also actively working in clinical settings and contending with the added stress of the recent COVID-19 pandemic. Mindfulness meditation is a natural measure that can help alleviate the feelings of perceived stress and anxiety and improve levels of mindfulness and self-compassion. An experimental two group pretest-posttest randomized controlled design was used to evaluate the effect of a virtual mindfulness meditation intervention on levels of perceived stress, anxiety, self-compassion, and mindfulness of nursing students. Study participants were randomly assigned to either an intervention or control group and received recordings prepared by the study authors. The intervention group received a 10-minute mindfulness meditation recording each week and the control group simultaneously received five 10-minute separate recordings on nursing news and information. Both groups were instructed to listen to the recordings at least three days per week for four weeks. The instruments used in this study were the Perceived Stress Scale (PSS), the Generalized Anxiety Disorder subscale (GAD-7), the Self-Compassion Scale (SCS), and the Mindfulness Attention Awareness Scale (MAAS). These surveys were provided at baseline and at a 4-week follow-up. The study presented in this dissertation is part of a larger study that was a collaboration between this author, Debra Heinrich, and Shohini Holden. Other instruments in the original study that are not discussed here are the Depression, Anxiety, and Stress Scale (DASS) and the Five Factor Mindfulness Questionnaire (FFMQ). This dissertation consists of three articles. The first article provides an analysis of the effect of a mindfulness meditation intervention on the stress and anxiety levels of nursing students. A two-way mixed ANOVA revealed a significant interaction between group assignment and timing of test on participants’ stress levels and on their anxiety levels. Follow-up simple main effects tests involving independent-samples t tests revealed that the intervention group, receiving the online mindfulness meditation recordings, experienced lower levels of stress and anxiety on the posttest surveys than the control group. The second article reports on a study of the effect of the intervention on mindfulness and self-compassion levels. The findings of a two-way mixed ANOVA and independent t tests demonstrated that mindfulness meditation can increase levels of mindfulness and self-compassion in nursing students. The third article compares two instruments used to self-report feelings of anxiety, reports on the demographic variables related to anxiety among nursing students, and explores the correlation between levels of mindfulness and levels of anxiety in this study. There were no significant relationships found between any demographic variable and anxiety scores. The GAD-7 instrument was found to be more sensitive to mild and moderate anxiety then the DASS instrument, and it is, therefore, the recommended instrument for use in nursing programs. There was a significant inverse relationship between levels of mindfulness and anxiety for students in this study. The findings of this study demonstrate that mindfulness meditation can reduce stress and anxiety, while increasing mindfulness and self-compassion levels in nursing students. This could be useful for nurse educators assisting students to manage the stress and anxiety often experienced in nursing education. Nursing programs could screen students to evaluate their levels of stress, anxiety, and mindfulness. Stress relief techniques, such as mindfulness meditation, could be incorporated into nursing programs as part of a wellness program or curricular offering. Mindfulness meditation could also be part of orientation programs in clinical sites for new nurses and offered to all nursing staff as part of continuing education. Further research, using rigorous scientific methods, will be needed to study the most effective methods to evaluate and manage stress and anxiety. This could ultimately decrease the stress and anxiety levels and improve well-being for student nurses and nurses, which could in turn positively impact patient care and outcomes.

背景: 高擬真情境模擬（HFS）已成為一種流行的護理教育教學法，能讓學生安全及有效地利用高擬真情境模擬人練習護理。許多西方的研究報告指出，HFS對護理學生的自信心培育、解決問題的能力和批判性思維均有正面影響。然而，對本地護理學生所做的研究有限。基於文化差異，以及不同的學習風格，西方國家的證據未必能套用在香港的護理學生身上。 / 目的: 本研究志在探討高級護理文憑課程的學生對研究員研發的高擬真情境模擬訓練課程(HFSTP)的滿意度，及HFSTP對學生的學習自信及批判性思維發展的影響。 / 研究方法: 這項研究採用了混合方法研究設計，分為兩個階段。第一階段為準實驗性研究，利用前測後測設計，以探討HFSTP對護理學生的自信心、滿意度以及批判性思維發展的影響。共90位護理學高級文憑課程二年級學生，按他們就讀課程的要求，參加了第一階段的研究。而HFSTP是参照科爾布的經驗學習週期所研發，當中包括兩個1小時的小組研討和兩個1小時HFS實驗室培訓。第一階段的研究採用了四份問卷，包括學生滿意度和學習中自信量表（SCL），批判性思維調查（CTS），仿真設計量表（SDS）和人口表。而在SCL得分最高及最低各12位學生會被邀請參加第二階段的焦點團體訪談。這階段研究以半結構化面試指南來探索學生們對HFSTP的看法。所得數據以內容分析法作分析。 / 結果: 配對t檢驗結果表明，SCL和CTS的後測平均分均顯著高於前測（P = 0.001）。而對HFSTP的設計評價，學生評定保真度和匯報會為HFSTP學習中最重要的元素。大部份學生在定性訪談中表示滿意這嶄新的學習方法。根據定性數據分析的結果得出四大主題：（1）模擬臨床環境，（2）整體護理經驗，（3）信息和反思的思維，及（4）HFS的用量，研究人員得出結論，參照科爾布的經驗學習週期所研發的高擬真情境模擬訓練課程，是一種有效的教學策略，它能有效地提高學生的學習自信及培養出批判性思維。同時，學生表示滿意這次課程的安排。至於這次研究結果對護理教育，護理實務和高等教育管理的影響將會在這論文的最後部份發表。 / Background: High-fidelity simulation (HFS) has become a popular teaching method in nursing education that allows students to practice their nursing care skills safely and effectively on human patient stimulators. Many studies have reported the positive impacts of nursing students’ learning experience with the use of HFS on their development of self-confidence, problem solving and critical thinking. However, studies done on local nursing students are limited. Acknowledging that there may be cultural differences in the learning styles between Chinese and non-Chinese people, the existing evidence mainly come from western countries, which may have limited generalizability to Hong Kong nursing students. / Aims: This study aims to examine the satisfaction of the higher diploma nursing students on the researcher-developed high-fidelity simulation training program (HFSTP), and the effects of HFSTP on the students’ self-confidence in learning and development in critical thinking. / Methods: A mixed methods study design was used in two phases. In Phase I, a quasi-experimental, one-group pretest-posttest design was employed to investigate the effects of HFSTP on nursing students’ satisfaction, self-confidence, and critical thinking development. A total of 90 year 2 higher diploma nursing students participated in the Phase I study. The Kolb’s experiential learning cycle guided the development of the HFSTP including two 1-hour simulation tutorials and two 1-hour HFS laboratory and debriefing sessions. Four questionnaires including Student Satisfaction and Self-Confidence in Learning (SCL), Critical Thinking Survey (CTS), Simulation Design Scale (SDS), and a Demographic Sheet were employed in the Phase I study. In Phase II, a focus-group interview was conducted to explore students’ perception of HFSTP. A total of 24 students from the highest or lowest scores in the posttest SCL in Phase I were invited for the focus group interview. A self-developed semi-structured interview guide was used to explore the participants’ perception of the HFSTP. Content analysis was used for data analysis. / Results: Results of paired t-test indicated that the mean scores of both SCL and CTS in the posttest were significantly higher than those of the pretest (p = <0.001). With regard to the evaluation of the design of HFSTP, the participants rated the fidelity and debriefing sessions as the most important learning features in the HFSTP. In the qualitative interview, most of the students expressed satisfaction towards the learning of HFSTP. Four main themes (1) A mimic clinical environment, (2) Holistic care experience, (3) Information and reflective thinking, and (4) Dosage of the HFS, emerged from the analysis of the qualitative data based on students’ perceptions of having HFSTP as a new teaching strategy. Researcher concluded that the HFSTP, which is based on Kolb’s experiential learning cycle, is an effective teaching strategy for promoting nursing students’ self-confidence in learning and critical thinking development. Students were satisfied with the program design. Fidelity and debriefing sessions were reported as the two most important learning features of the HFSTP. Implications of the findings for nursing education, nursing practice and higher education administration will be presented at the end of the paper. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Fong, Wan Ching Kathryn. / Thesis (D.Nurs.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 154-161). / Abstracts also in Chinese. / Chapter CHAPTER ONE --- INTRODUCTION --- p.1 / Introduction --- p.1 / Background of the Study --- p.1 / Justification for the Study --- p.5 / Research Questions --- p.6 / Conceptual and Operational Definitions --- p.7 / Significance of the Study --- p.9 / Overview of the Study --- p.10 / Chapter CHAPTER TWO --- LITERATURE REVIEW --- p.12 / Introduction --- p.12 / Search Strategy --- p.13 / Development of Simulation --- p.13 / History of Simulation Learning in Nursing Education --- p.16 / HFS used in Nursing Education --- p.17 / Self-Confidence in Learning --- p.25 / Satisfaction with Learning Experience --- p.37 / Critical Thinking --- p.43 / Theoretical Framework: Kolb’s Experiential Learning Cycle --- p.48 / Conclusion --- p.52 / Chapter CHAPTER THREE --- METHODOLOGY --- p.55 / Introduction --- p.55 / Research Questions --- p.56 / Aims --- p.56 / Research Objectives --- p.56 / Research Design --- p.57 / Setting --- p.61 / Phase I Study --- p.63 / Phase II Study --- p.83 / Ethical Issues --- p.90 / Pilot Study --- p.91 / Summary --- p.91 / Chapter CHAPTER FOUR --- RESULTS --- p.93 / Introduction --- p.93 / Research Hypotheses --- p.94 / Phase I Study --- p.94 / Phase II Study --- p.105 / Summary --- p.126 / Chapter CHAPTER FIVE --- DISCUSSION --- p.128 / Introduction --- p.128 / Participant Recruitment and Response --- p.128 / Issues of Dropouts and Participant Non-attendance --- p.129 / Discussion on Study Findings --- p.129 / The Use of Assessment Tools --- p.142 / Limitations of the Study --- p.143 / Implications for Nursing Education --- p.144 / Implications for Nursing Practice --- p.146 / Implications for Higher Education Administration --- p.148 / Recommendations for Future Studies --- p.150 / Conclusions --- p.151 / REFERENCES --- p.154