Kirsten Munk, DNP, RN, NCSN1,2 , Ruth Rosenblum, DNP, RN, PNP-BC, CNS1,3, Samantha Blackburn, PhD, RN2, and Eden Donahue, DNP, RN, NCSN2
The Journal of School Nursing2022, Vol. 38(6) 547–557© The Author(s) 2021Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/10598405211059189journals.sagepub.com/home/jsn
Abstract
A growing body of research suggests that incorporating classroom-based mindfulness interventions in elementary schools can lead to improvements in student behavior, self-regulation, and measures of mental health and wellness. This quality improvement project explored the impact of an educational intervention on pre-service teachers’ perceptions, attitudes, and intentions to implement mindfulness interventions in their classrooms. A brief educational intervention and website resource were provided to multidisciplinary teaching credential students. Participants completed a pre- and post-intervention survey to evaluate their intentions to implement mindfulness practices, as well as their perceptions about the acceptability, reasonableness, and effectiveness of incorporating mindfulness interventions in the classroom. Significant differences in pre- to post-intervention survey scores indicate that exposure to mindfulness concepts, practices, and resources may increase the willingness of pre-service teachers to adopt these practices in their classrooms.
Keywordsmindfulness, mental health, wellness, elementary, education, teacher-led, social-emotional learning
Unaddressed mental health needs are one of the most concerning issues impacting school-age children. According to a comprehensive report on children’s mental health, the Centers for Disease Control and Prevention (CDC) estimate that 13%–20% of children experience a mental health disorder in any given year (Perou et al., 2013). Mental health disorders (including anxiety and depression) are associated with substance use, risk-taking behaviors, difficulties in peer relationships, and problems at school and home (Perou et al., 2013). Mental illness is also a risk factor for suicide, the second leading cause of death for children ages 12–17 years (Perou et al., 2013). Suicide risk has climbed in the pediatric population over the last several years, with emergency room visits for suicidal ideation and suicide attempts doubling between 2007 and 2015 (Burstein et al., 2019). Despite the high numbers of youth who are likely to experience mental health disorders, nearly 80% of children between the ages of 6–18 years with a mental health disorder will not receive treatment (Coles et al., 2016). Data indicate that the COVID-19 pandemic may exacerbate existing mental health conditions and lead to increased incidence of depression and anxiety disorders (Moreno et al., 2020), while simultaneously creating barriers to access for mental health services, due to school closures (Lee, 2020).
Due to the short supply, and often overwhelming caseloads, of school-based mental health providers, school-based mental health interventions are largely focused on those students displaying disruptive behaviors and/or learning disabilities (Muggeo & Ginsburg, 2019). The result is that the needs of many students for preventive mental and behavioral health support go unaddressed (Ballard et al., 2013). Innovative, large-scale primary prevention programs are critical to a comprehensive approach for addressing children’s mental health needs in school. Mindfulness interventions are strengths-based preventive strategies that address universal vulnerabilities (Stuart et al., 2017), and can provide this type of global support.
There is growing evidence that incorporating mindfulness practices in the classroom has beneficial effects on students’ self-regulation, emotional regulation, classroom behaviors, cognitive function, and academic achievement (Bergen-Cico et al., 2015; Harpin et al., 2016; Waters et al., 2015), yet few schools have adopted mindfulness strategies as part of their routine. According to a recent survey, only 28% of teachers reported using mindfulness practices in their classrooms (Hamilton et al., 2019). Teacher-identified barriers to social-emotional learning (SEL) interventions (like mindfulness) include lack of time and inadequate training and knowledge (Bridgeland et al., 2013). Implementation of mindfulness strategies at the classroom level requires the “buy-in” of teachers.
School nurses are aware of the social and educational impacts of mental health on education, attendance, and general well-being. Mental health issues and high levels of student stress are frequently associated with somatic symptoms, resulting in increased visits to the school nurse’s office (Shannon et al., 2010). Mental health issues are also symbiotically linked to school absenteeism (Allison & Attisha, 2019). School nurses play a critical role in identifying and supporting the treatment of mental health issues (National Association of School Nurses [NASN], 2018). School nurses also educate other school personnel about mental health and wellness needs, and advocate for the implementation of evidence-based programs and strategies to support student mental health (NASN, 2018).
A review of the literature revealed a wide range of research studies examining the potential benefits of mindfulness. Meditation and mindfulness-based stress reduction are associated with changes in brain structure and neural activity in areas of the brain involved with executive function, including those associated with attention, perspective-taking, metaawareness, introspection, body awareness, memory, processing, self-regulation, and emotional regulation (Fox et al., 2014; Gotink et al., 2016). Another area of emerging research is the relationship between mental health and adverse childhood experiences (ACES), including abuse, neglect, exposure to violence or mental illness, economic hardship, and parental absence. Children with multiple ACES demonstrate higher prevalence of emotional, mental, and behavioral health conditions and are more likely to be disengaged from school or have frequent absences (Bethell et al., 2016). By promoting self-regulation, improved coping, and resiliency, mindfulness can reduce the lifelong impacts of trauma, and is a key evidence-based intervention for mitigating the impact of ACES (Ortiz & Sibinga, 2017).
Multiple randomized controlled trials (RCTs) have examined the impact of school-based mindfulness-based interventions on indicators of student mental health and wellness. Children exhibiting symptoms of anxiety or depression who participated in classroom-based mindfulness-based interventions demonstrated significantly greater improvements in measures of psychosocial and emotional quality of life and reductions in internalizing problems and perceived stress compared to controls (Bazzano et al., 2018; Fung et al., 2019). Other studies found improvements in symptoms of depression, self-hostility, somatization, negative affect, negative coping, rumination, and posttraumatic stress and lower scores on measures of risk for self-harm and suicidal ideation in students participating in mindfulness interventions at school (Britton et al., 2014; Sibinga et al., 2016). A meta-analysis by Klingbeil et al. (2017) revealed small positive treatment effects for children participating in mindfulness interventions over multiple study domains including attention, emotional and behavioral regulation, academic achievement, and school functioning, externalizing and internalizing behaviors, physical health and social competence. Moderate effect size increases were observed for the domain of mindfulness, which is considered a primary therapeutic benefit of mindfulness interventions, with effects in the other domains presumed to result from this change (Klingbeil et al., 2017).
Researchers have also explored the impact of mindfulness on measures of cognitive function and academic achievement. In RCTs, children from preschool to middle school and from varied ethnic and socioeconomic backgrounds participated in mindfulness-based classroom programs. The children demonstrated significant improvements in measures of executive function, working memory, well-being, and prosocial measures (Quach et al., 2016; Schonert-Reichl et al., 2015; Zelazo et al., 2018).
Although most school-based mindfulness studies have focused on benefits for students, multiple studies have also examined the benefits of mindfulness interventions specifically targeting teachers. Significant findings of meta-analyses and systematic reviews of teacher-focused mindfulness interventions include improvements in perceived stress, self-efficacy, emotional awareness and regulation, and measures of well-being; decreases in reactivity, depression, anxiety, and psychological distress; and improvements in measures of teacher performance and student behavior (Emerson et al., 2017; Hwang et al., 2017; Klingbeil & Renshaw, 2018). The results of these studies suggest that an emphasis on teacher-led mindfulness programs would likely result in beneficial outcomes for teachers as well as their students.
Mindfulness interventions have been generally well-received by students and teachers in terms of their acceptability, feasibility, perceived benefits, and levels of engagement (Britton et al., 2014; Harpin et al., 2016; Vickery & Edorjee, 2016). Students have reported using learned mindfulness skills and techniques in a variety of contexts, including before bed, before tests, outside of class, and to manage stressful situations (Butzer et al., 2017; Dariotis et al., 2016; Harpin et al., 2016).
Several studies have examined factors that impact the effectiveness of school-based mindfulness programs. A systematic review by Waters et al. (2015) revealed more consistent significant effects were associated with programs of longer duration (e.g., greater than 24 weeks), those that included more frequent practice, and programs that were directly administered by the classroom teacher (Waters et al., 2015). Fenwick-Smith et al. (2018) explored the implementation criteria and fundamental elements that lead to improved adherence and student engagement for universal school-based mental health interventions geared toward building resiliency and protective factors. The importance of teacher involvement in interventions and the teachers’ ability to adapt content according to the needs of the class emerged as keys to maintaining fidelity and student engagement (Fenwick-Smith et al., 2018).
While multiple researchers have explored the benefits of school-based mindfulness programs, the majority of researchers examined the effects of short-term interventions over a relatively short follow-up period. Results from these studies indicate that the benefits of a brief mindfulness intervention are maintained, in the short term (Fung et al., 2019), and that there are additional benefits of continuing programs (Black & Fernando, 2014; Waters et al., 2015). Most of the interventions studied have been provided by outside experts, rather than the classroom teacher, limiting their scope and duration.
Implementation of mindfulness strategies at the classroom level requires the “buy-in” of teachers. The majority of teachers recognize the value of SEL to improve student knowledge and skills in the areas of self-awareness, self-management, social awareness, relationship skills, and responsible decision-making and would like to see these types of skills integrated into state standards and schoolwide initiatives (Bridgeland et al., 2013). However, only about half of teachers have received training in SEL teaching strategies (Bridgeland et al., 2013). Teachers’ attitudes about implementing SEL evidence-based practices are influenced by a number of factors, including competing priorities in terms of how much time and effort is required to cover core academic subjects (Enrico, 2017). Lack of time and inadequate training and knowledge have been identified as significant barriers to the adoption of SEL evidence-based practices (Bridgeland et al., 2013). In a systematic review of school-based public health interventions, including interventions to support student mental health, Herlitz et al. (2020) identified similar barriers to the sustainability of teacher-led programs. Prioritization of academic curriculum over health promotion programs, insufficient funding, and lack of time and training were noted concerns. Facilitators of program sustainability included administrative support, adaptability of interventions (in terms of time and student needs), direct observation of benefits in students, belief in the importance of the intervention, and staff confidence in delivering the intervention (Herlitz et al., 2020).
While there is an abundance of evidence highlighting the positive impact of school-based mindfulness programs, no identified studies have explored strategies to reduce barriers to adopting integrated, long-term, teacher-led, classroom-based mindfulness interventions.
The design of this project was informed by two theoretical frameworks. The Neuman systems model highlights the dynamic relationships between the system (client or organization) and stressors in the environment, as part of a holistic approach to attainment and maintenance of wellness (Neuman, 2011; Whetsell et al., 2018). Mindfulness interventions strengthen the individual’s lines of defense, mitigate perceptions of (and response to) the many stressors inherent in the school and home environments, and secure greater system integrity, which improve overall mental health and wellness.
To reflect the complex nature of adopting health behaviors, the Health Belief Model was used to develop a mindfulness educational intervention and introduce mindfulness tools for pre-service teachers (LaMorte, 2019). According to this model, the decision-making process about a healthrelated behavior involves weighing the benefits and barriers to the intervention (LaMorte, 2019). In keeping with the principles of the Health Belief Model, the educational intervention was designed to provide general information about the impact of unaddressed mental health issues in the school-aged population (addressing perceived susceptibility and severity of the condition); discuss research about the benefits of mindfulness (increasing perceived benefits of the intervention); and introduce easily accessible tools and practice opportunities (reducing perceived barriers and increasing the sense of self-efficacy).
The purpose of this project was to determine the impact that an educational intervention and web-accessible tools would have on pre-service teachers’ (a) perceptions of; and (b) intentions to implement evidence-based primary prevention mindfulness strategies in the classroom. The goals of the educational intervention were to (a) provide pre-service teachers with general information about the scope and impact of mental health issues on the school-age population; (b) educate participants about the evidence supporting the use of classroom-based mindfulness as an effective primary prevention strategy for supporting student mental health; (c) provide practice opportunities and tips for classroom implementation of mindfulness practices to address perceived barriers related lack of training/knowledge and time; (d) provide easily accessible tools for implementation and further training/study.
The project was designed to determine the impact of a school nurse-led educational intervention on pre-service teachers’ attitudes and intentions to implement mindfulness strategies in the classroom. Outcomes were measured using a pre- postintervention survey to measure changes in the variables of interest: (a) perceived value of mindfulness strategies and (b) intentions to implement mindfulness strategies.
The project received IRB approval from California State University (CSU), Fresno.
The participants in the project were multiple-subject teaching credential candidates (pre-service teachers) at a West Coast state university in their first semester of a 2-year credential program. These pre-service teachers were either bachelor’s prepared or completing their final year in the bachelor’s degree program while concurrently enrolled in the teaching credential program. They attended regular lectures, completed coursework, and were assigned to specific classrooms to fulfill student teaching hours. At the start of the project, there were approximately 133 pre-service teachers enrolled in the multiple subjects credential program, with women (n = 114) outnumbering men (n = 19) (CSU, n.d.a). The average age of graduate students at the university was 30 years old (CSU, n.d.b). The university, as a whole, is ethnically diverse, with 31% of the student population identifying as Hispanic/Latino, 19% Asian, 6% African American, and 27% White (CSU, n.d.b).
The educational mindfulness-based intervention was incorporated into regularly scheduled class time as a special lecture topic, with 85 pre-service teachers in attendance. Participants were recruited prior to the intervention during the lecture period. Those who consented to take part in the survey (n = 51) were immediately directed to the pre-survey. Surveys with missing or irregular data (e.g., multiple answers to questions, missing or incomplete survey codes, failure to complete the post-survey) were excluded from data analysis. Data analysis was performed using the remaining participants’ responses (n = 26) (see Figure 1).
The intervention consisted of a brief multimedia educational presentation provided by the mindfulness educator, who was a credentialed school nurse and faculty in the school nurse credential program at the university. The mindfulness educator’s background included training in an evidence-based mindfulness and SEL curriculum and regular, established personal mindfulness practice, including yoga and meditation, for several years. The mindfulness educator conducted an extensive review of the literature on effective school-based mindfulness programs and reviewed available on-line resources to develop the educational presentation and create a website of evidence-based mindfulness resources for educators. The PowerPoint presentation included information and statistics about current youth mental health trends, a brief video and description of mindfulness, a review of current research indicating the benefits of mindfulness, classroom implementation tips (including appropriate times for incorporating mindfulness practice and how to identify classroom-appropriate resources), and the introduction of the mindfulness resource website. The mindfulness educator provided opportunities for practicing evidence-based mindfulness exercises throughout the presentation. Participants were invited to practice a mindful movement exercise, with an emphasis on integrating breath with movement, and a recorded, appbased exercise focused on mindful breathing and visualization. The final practice opportunity was a mindful eating exercise, during which participants focused on the experience of all of their senses, while eating a dried cranberry. This exercise was adapted from a curriculum listed on the website and other mindful eating exercises widely available on-line. Each exercise was followed by discussion of appropriate grade levels for introducing the exercise and how the exercise might be incorporated into the school day, and participants were invited to notice and reflect on how they felt following the exercise.
All pre-service teachers present in the lecture were given ongoing access to the website resource presented in the intervention, regardless of survey participation. The website (mindful-matters.org) was developed by the mindfulness educator and included general information, definitions, and links to informational resources about mindfulness and SEL strategies. There were separate pages dedicated to mindfulness resources for teachers, parents, and children, with links to apps, websites, videos, and other media, as well as information about further training opportunities and SEL curricula. Another page of the site contained dedicated links to a variety of classroomfriendly mindfulness resources, including apps, websites, and instructional materials to be used with students. Although no well-established criteria exist for evaluating mindfulness apps and resources and there is not a single widely-recognized certification for mindfulness educators, app resources were selected based on a brief review of included exercises to determine alignment with mindfulness principles (e.g., focus on the present moment experience through breath, visualization, body scan, etc.) and background and training of the featured mindfulness teacher/leader(s). Research data support the use of each of the social emotional curricula and training resources included on the website as resources for promoting student mental health and well-being. The website was reviewed by two classroom teachers and two school nurses using a pre-established list of criteria for usability, ease of navigation, and appropriateness of resources (for grade level). It was also reviewed by another mindfulness educator for ease of use and appropriateness, in keeping with mindfulness principles. The educational presentation was reviewed by two school nurse faculty with experience in training teachers on health-related topics.
Data were collected via an on-line survey using two validated survey measures. A modified version of the Intentions to Use Scale (IUS) was used to assess pre-service teachers’ intentions for implementing mindfulness strategies in the classroom (Appendix A). The original survey was developed by Kortteisto et al. (2010) to explore health practitioners’ intentions to follow evidence-based clinical practices. Cook et al. (2017) modified the tool to measure teachers’ intentions for implementing wellness-focused evidence-based practices. For this project, a similarly modified version of the IUS tool was used, with four items using 7-point Likert-type ratings, as well as several background questions. The Intervention Rating Profile (IRP-15), which was developed by Martens et al. (1985) to evaluate teachers’ perceptions of the acceptability, reasonableness, and effectiveness of a classroom-based behavioral intervention, is a 15-item survey using 6-point Likert-type ratings. The language of this tool was modified to reflect its use for general mindfulness classroom-based interventions versus specific, individualized behavioral interventions (Appendix B). The mindfulness educator secured permission to use modified versions of these surveys from their originators. Some additional demographic questions, including gender, age, district, and previous experience with mindfulness, were included. There were also open-ended questions about other perceived barriers to implementing mindfulness interventions to provide insight into areas for future intervention and study.
Survey data were analyzed using IBM SPSS Statistics (Version 25). Two-tailed paired t-tests were performed for each of the survey measures. Results with a p-value <.05 were considered significant. Descriptive statistics were used to analyze demographic data provided by participants. Demographic data were also analyzed using independent samples t-tests to determine any correlations between specific demographic variables and survey scale scores.
Demographic data collected from participants included self-reported age, gender, previous experience with formal mindfulness or meditation practice, and current mindfulness practice (see Table 1). The majority of survey participants (96.2%) were women. The pre-service teachers who completed the surveys were primarily based in Title I schools (80.8%), which are schools that receive additional federal funding based on the percentage of students who are considered low-income. This reflects the priority given by the credential program to Title I school placements, to provide pre-service teachers with the experience of working with children in low-income communities. Nearly half of the participants (46.2%) were 20 to 24 years of age, and the remainder (53.8%) were 25 to 34 years old. Over a third of participants (38.5%) reported having previous experience with formal mindfulness practices, and 46% indicated that they currently engage in mindfulness practices themselves. Mindfulness practices reported by participants included yoga, mindful/focused breathing, meditation, relaxation and grounding exercises, prayer, and controlled breathing.
Participants were asked to complete the on-line presurvey prior to the intervention and the post-survey immediately following the intervention. Cronbach’s alpha was calculated for each of the survey measures to determine the internal consistency of these measures within the study group. Alpha scores for the IRP 15 and Intentions to Use scale were 0.87 and 0.81, respectively, indicating satisfactory reliability for both survey measures.
Pre-intervention scores on the IRP 15 ranged from 56 to 88 (out of a possible total of 90); post-intervention scores ranged from 56 to 90. Pre- and post-intervention mean scores for the IRP 15 were compared using two-tailed paired t-tests to determine changes in participants’ perceptions of the acceptability, reasonableness, and effectiveness of mindfulness as a behavioral intervention. There was a significant increase in IRP 15 survey scores from preintervention (M = 70.69, SD = 8.16) to post-intervention (M = 78.54, SD = 8.46; t(25) = 5.979, p < .001, d = 1.196) (see Figure 2).
Pre-intervention scores on the Intentions to Use Scale ranged from 43 to 84 (out of a possible total of 84); postintervention scores ranged from 40 to 84. Mean scores for the Intentions to Use scale were compared to measure changes in participants’ intentions for implementing mindfulness-based interventions. Two-tailed paired t-tests for the Intentions to Use Scale demonstrated a statistically significant increase from pre-intervention (M = 56.50, SD = 10.28) to post-intervention (M = 64.88, SD = 10.91; t(25) = 4.785, p < .001, d = 0.94) (see Figure 2).
In response to an additional question on the survey in which participants were asked to describe any perceived barriers to implementing mindfulness strategies in the classroom, many noted that time was a significant concern. Additional considerations included resistance from parents and administrators, concerns that students might be resistant or unwilling to focus on the activities and take them seriously, lack of formal training, cost and resources, and cultural or religious opposition from parents or families.
This project examined the impact of a school nurse-led educational intervention, accompanied by web-accessible tools, on pre-service teachers’ attitudes and intentions to implement mindfulness strategies in the classroom. Data analysis suggests that the intervention positively impacted participants’ perceptions of the acceptability, reasonableness, and effectiveness of mindfulness-based behavioral interventions, and their intentions to implement these strategies in the classroom. However, there was a low survey completion rate, which raises some concerns about the overall willingness of this population of pre-service teachers to actively participate in a novel classroom intervention or may instead reflect a lack of time or interest in completing the survey. It should be noted that the mindfulness training intervention and related pre-/post-intervention survey were not introduced by course faculty to the credential students in advance of the class. Incorporation of mindfulness practices into course syllabi and expected learning outcomes, would likely result in greater interest and participation in mindfulness trainings among pre-service teaching credential students.
The population of pre-service teachers was selected as the focus for this project, based on accessibility (this was a relatively large population that could be easily coordinated and provided with the intervention simultaneously) and because of the mindfulness educator’s belief that, due to the overwhelming prevalence of mental health issues in the school-aged population, knowledge and skills for supporting student mental health should be part of the foundational teacher credentialing curriculum. Current research suggests that most pre-service teachers do not receive this type of instruction, with only 16% of teachers reporting that they received training in methods for supporting student social and emotional skills as part of their pre-service training (Hamilton et al., 2019). Although the current project does not allow for projections about anticipated participation rates in a mindfulness educational intervention for currently practicing teachers, there is evidence to suggest that most teachers are interested in training in social-emotional support strategies (like mindfulness). In a study by Bridgeland et al. (2013), 82% of teachers expressed an interest in further training in SEL.
The educational intervention was designed to address previously identified barriers to SEL implementation including time, lack of training, and cost and materials (Bridgeland et al., 2013 ; Enrico, 2017; Herlitz et al., 2020). The intervention also capitalized on known facilitators, including adaptability of interventions and staff belief in the importance of interventions (Herlitz et al., 2020). Although the impact of the intervention on perceived barriers was not directly measured pre- post-intervention, the significant increase in pre to post-intervention survey scores may reflect pre-service teachers’ decreased concern with those barriers.
This project was limited by a number of factors, including a small sample size, due to the high number of surveys that were excluded from data analysis because of incomplete information. The participants were not representative of the university’s overall population of multiple subjects credential candidates in terms of gender, with only 3.8% of participants being male compared to an overall male population of 14%. Representativeness of the sample regarding race and ethnicity could not be ascertained, as these were not included in the demographic section of the survey. Generalizability of the results may also be impacted by the fact that 46% of participants reported currently engaging in mindfulness practices. Inclusion of a measure that addressed participants’ perceptions about specific barriers like time and cost at pre- and post-intervention would have provided valuable insight about the impact of the intervention on perceptions of specific barriers. Additionally, it would have been beneficial to include racial and ethnic demographics in the survey and simplify the survey process (to decrease the number of surveys lost due to missing or incomplete responses).
While pre-licensure teaching credential students identified many of the same barriers to incorporating mindfulness into the classroom as currently practicing classroom teachers in previous studies (Enrico, 2017; Hamilton et al., 2019), their responses and interest in mindfulness interventions could differ significantly, based on their knowledge and experience, other classroom and administrative demands, and multiple other factors. The results of the current study cannot, therefore, be generalized to the population of currently practicing teachers. It should also be noted that, although survey results indicate a change in pre-service teachers’ attitudes and intentions to implement mindfulness strategies, these results do not necessarily translate to actual changes in behavior or practice in the classroom. Future studies should include follow-up with participants to examine the impact on actual teaching practices.
The results of this project suggest that incorporating this type of educational intervention into the curriculum for teaching credential candidates is a feasible method for introducing the concept of mindfulness that may positively impact pre-service teachers’ attitudes about including mindfulness strategies in their teaching practice. However, as previously mentioned, formal integration of SEL and mindfulness content into the credential curriculum (i.e. through inclusion in course syllabi and learning outcomes) would likely boost participant engagement and require support and collaboration of education faculty and department leadership. Since the implementation of this project, the mindfulness educator has been invited back annually by teaching credentials faculty to present the mindfulness content to first semester credential candidates, indicating that faculty are interested in and value this type of content.
Studies exploring the responses of fully credentialed teachers to this type of intervention are needed, to determine whether the intervention is feasible and effective with teachers, who are already struggling with how to support students’ social emotional health. School nurses are well positioned to lead mindfulness training interventions with teachers in their schools and would have ongoing access to their teacher participants to evaluate implementation of mindfulness practices afterwards. Additionally, longitudinal studies exploring academic, social, and health outcomes for school-aged children participating in school-based mindfulness are still needed, to make determinations about the long-term impact of these interventions.
Schools have an unparalleled opportunity to act as a central player in supporting children’s mental health. This has become particularly critical during the current COVID-19 pandemic, as preliminary research indicates increased rates of depression, anxiety, and stress in the general public (Moreno et al., 2020). Young people may face an even greater risk for development of mental health disorders or exacerbation of existing mental health issues (Moreno et al., 2020). Even though school nurses frequently provide triage, referral, and support to students with mental health needs, they are often not recognized as part of the interdisciplinary mental health support team (Bohnenkamp et al., 2015).
The role of the school nurse in supporting primary prevention mental health strategies like SEL and classroombased mindfulness has not been explicitly detailed in the current literature. However, successful implementation of SEL programs is reliant on appropriate training and support not only for teachers in providing classroom-based instruction, but for all school support staff who interact with students (including the school nurse) (Jones et al., 2021). School nurses understand the importance of addressing the needs of the whole child and can take an active leadership role in promoting primary prevention mental health practices. They are uniquely positioned to educate teachers and other school staff about the mental health benefits of mindfulness interventions for students and staff and to advocate for the adoption of mindfulness and other SEL programs in their schools.
The school nurse is a trusted member of the inter-professional school team who, through collaboration and education, can address perceived barriers and reluctance on the part of other school-based personnel to adopt new evidence-based measures to support student mental health. Previous studies suggest that providers may be more open to information about evidence-based practices that comes from colleagues within the same work environment than from research articles (Aarons & Sawitzky, 2006). School nurses can educate staff about research related to the use of mindfulness practices to support student mental health and advise administrators about evidence-based curriculum and other resources. School nurses can use resources, such as those found in the mindful-matters.org website, to educate themselves about mindfulness practices to share with teachers and other school staff. School nurses can also incorporate mindfulness strategies into their nursing practice to support students with chronic health conditions, those with mental health needs, and those who frequently visit the nurse’s office, providing a model for teachers and other school staff.
To address perceived barriers related to lack of training and knowledge, school nurses can advocate for and lead interprofessional continuing education opportunities for teachers and other staff to learn about and participate in mindfulness interventions. Research indicates that adoption of SEL practices (like mindfulness) is also influenced by school climate and perceptions about the priority placed on these interventions (Enrico, 2017). To address these barriers, school nurses can advocate for the inclusion of mindfulness and other social emotional learning (SEL) strategies into their local school wellness policy at the school and/or district level, to support student mental health and improve school climate. School nurses can also advocate for policy change at the state level to require adoption of evidence-based SEL curriculum as part of mandated health education, and propose funding for SEL programs as part of their district’s budgeting framework to support the mental health of vulnerable student populations.
Unaddressed mental health needs can take a significant toll on students’ academic success and overall health. The COVID-19 pandemic has highlighted the need to bolster our strained mental health system and bridge the gap between the need for mental health supports and the availability of intensive mental health services. The adoption of mindfulness interventions in schools can help bridge that gap by equipping all children with tools and strategies to support increased resiliency and well-being. Mindfulness practices have the potential to improve both health and academic outcomes for all school-aged children. The results of this project suggest that a focused educational intervention and introduction of web-based implementation tools may positively impact pre-service teachers’ attitudes and intentions to include mindfulness-based interventions in their classrooms. Web-based resources can be tailored to the needs and goals of the specific school or classroom and may be accessed during remote learning. By promoting the widespread adoption of mindfulness strategies in schools, school nurses can help address students’ mental health needs and secure happier, healthier futures for their students and school communities.
Eden Donahue is now at Humboldt State University.
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The authors received no financial support for the research, authorship and/or publication of this article.
Kirsten Munk https://orcid.org/0000-0002-8029-4218
Eden Donahue https://orcid.org/0000-0001-9423-8666
Supplemental material for this article is available online.
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Kirsten Munk is an assistant professor at School of Nursing, California State University, Sacramento.
Ruth Rosenblum is an associate professor at The Valley Foundation School of Nursing, San Jose State University.
Samantha Blackburn is an associate professor and School Nurse Program and Graduate Program coordinator at School of Nursing, California State University, Sacramento.
Eden Donahue is an assistant professor and associate director of nursing at Humboldt State University.
1 Department of Nursing, California State University, Northern California Consortium, Fresno and San Jose, CA, USA
2 School of Nursing, California State University, Sacramento, CA, USA
3 The Valley Foundation School of Nursing, San Jose State University, San Jose, CA, USA
Corresponding Author:Kirsten Munk, School of Nursing, California State University, Sacramento, 6000 J Street, Sacramento, CA 95819, USA.Email: kirsten.munk@csus.edu
