Nurse Media Journal of Nursing, 9(1), 2019, 69-77

Available Online at http://ejournal.undip.ac.id/index.php/medianers

DOI: 10.14710/nmjn.v9i1.22253

Effects of Islamic Spiritual Mindfulness on Stress among

Nursing Students
Badrul Munif1, Sri Poeranto1, Yulian Wiji Utami1
1
Department of Nursing, Brawijaya University, Indonesia
Corresponding Author: Badrul Munif ([email protected])

Received: 4 March 2019 Revised: 29 May 2019 Accepted: 13 June 2019

ABSTRACT

Background: Academic stress is a major problem that often occurs in nursing students.
Islamic spiritual mindfulness (ISM) is an adaptive coping strategy which can be used to
mitigate various negative psychological reactions to respond stressors experienced by
the body to build self-awareness that it is Allah (God) who determines problems that
any individuals experience today.
Purpose: This study aimed to determine the effects of Islamic spiritual mindfulness on
reducing stress among nursing students.
Methods: The present study used a pre-post quasi-experimental design with a control
group. The participants were 36 students of bachelor of nursing who are Muslim and
experienced stress in working on their thesis. The participants were assigned to two
groups: the experimental group receiving Islamic spiritual mindfulness and the control
group. Data were collected using questionnaires of Depression Anxiety Stress Scale
(DASS) and analysed using paired t-test and unpaired t-test.
Results: The results showed that the mean of stress level of students in the intervention
group decreased from 20.6±2.97 to 11.4±5.81 after the intervention. Meanwhile, in the
control group, the mean of student stress level slightly decreased from 19.7±2.82 to
17.8±5.01. The t-test obtained a p-value of 0.001, indicating that there were significant
differences in stress levels between the intervention group and the control group. The
effect size obtained the value of 0.59, meaning the level of influence was in the medium
category.
Conclusion: This study concluded that Islamic spiritual mindfulness was effective in
reducing stress among nursing students working on the thesis. It is recommended for the
nursing profession, especially mental health nurses, to apply Islamic spiritual
mindfulness therapy as one of the psychotherapy interventions.

Keywords: Islamic spiritual mindfulness; nursing students; stress; thesis

BACKGROUND
Mental health is a healthy condition of emotional, psychological, and social aspects,
which is evident from the condition of satisfying interpersonal relationships (Videbeck,
2011). WHO (2018) reported that approximately 300 million of people experience
depression, 60 million experience bipolar disorder, 23 million are affected by
schizophrenia, and 50 million are affected by dementia. The prevalence of mental
disorder, such as mental-emotional disturbance in Indonesia is still high at 6.0% of the

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 Nurse Media Journal of Nursing, 9(1), 2019, 70

total population of Indonesia, and in Jakarta, approximately 5.7% of the population over
the age of 15 years had a mental disorder with symptoms of emotional stress, anxiety,
and depression (Ministry of Health Republic of Indonesian [MOH RI], 2013). American
Psychological Association APA explains that stress is a major contributor to mental
illness emotionally and physically to everyone at all ages (APA, 2012). Mahmoud,
Staten, Hall, and Lennie (2012) stated that conditions of uncontrollable stress would
cause anxiety disorders and anxiety disorders which are not well managed can
contribute to the onset of depression. Stress, anxiety, and depression are forms of
mental-emotional disorders that often occur in students (Zakiyah, 2016).

Research of the latest epidemiological data conducted in baccalaureate nursing students

in Hong Kong indicated that the prevalence of students who experience mild to severe
stress was 41.1% from 661 students (Cheung et al., 2016). A study by Rizvi, Qureshi,
Rajput, and Afzal (2015) on 60 medical students in Islamabad Pakistan also found the
prevalence of stress of 50%. These findings are consistent with the research of Wardi
(2016) that the academic demands are major stressors on students, one of which is the
load of paper. A thesis is one of the requirements that must be met to obtain academic
degrees at undergraduate level (Ministry of Research, Technology and Higher
Education, 2017). Regarding the thesis, a study by Sudarya, Bagia, and Suwendra
(2014) found that the most dominant factor affecting the stress among the students in
the preparation of the thesis are internal factors such as physical condition, behavior,
interests, emotional intelligence, intellectual, and spiritual intelligence, and also external
factors such as extra duty, friends, faculty counselors, and family. These factors affect a
series of psychological response which requires adaptation, causing the pressure inside
the students that causes stress.

Zakiyah (2016) identified the characteristics of the stress level among students who
were doing a thesis in Jakarta and found that the majority of students experienced
moderate levels of stress (46%). Wardi (2016) conducted a study to describe the
conditions of stressed students in completing their thesis in views of physiological
reaction, psychological, cognitive, and behavioural aspects. The study found that 35.5%
of students experienced moderate stress levels, 40% had moderate physiological stress
reaction, 38% had moderate psychological stress reactions, 35.5% had moderate
cognitive stress reactions, and 38.7% had moderate behavioural stress reactions. In a
preliminary study conducted by the researchers in June 2018, involving ten nursing
students working on the thesis at a school of health in Banyuwangi, it was found 30% of
students experienced moderate stress levels and 20% experienced severe stress levels.
Stress on students in doing thesis may result in delayed of graduation (Gamayanti,
Mahardianisa, & Syafei, 2018).

Mindfulness is one of the interventions which can be used to deal with stress among
students. Mindfulness is an exercise to be aware of the condition that an individual
experienced at this time to make the objectives and focus on solving the problems faced
(Dwidiyanti, Pamungkas, & Ningsih, 2018). One of the forms of mindfulness is Islamic
spiritual mindfulness. High levels of mindfulness are associated with high Muslim
spiritual welfare (Fourianalistyawati, 2017; Thomas, Furber, & Gray, 2018). Islamic
spiritual mindfulness is a supportive educative action to build self-awareness that the

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 Nurse Media Journal of Nursing, 9(1), 2019, 71

problem an individual is experiencing today is the scenario of Allah, and Allah is most
capable one to cope with it. Islamic spiritual mindfulness is expected to bring a sense of
always being watched by the God, introspection, reception, surrendered (resignation),
invoke the aid of the Almighty God (prayer) and the spirit out of conscience to
encourage perpetrators to good deeds. These are effective issues to cope with stress
coping in Islamic spiritual mindfulness (Dwidiyanti, Fahmi, Ningsih, Wiguna, & Munif,
2019). Islamic spirituality is a dawafi spirit that is motivation and tendency soul that
Allah has bestowed the human soul to always encourage any individuals to the good
deeds which are beneficial to himself and others (Al-Jauziyyah, 2004). Islamic spiritual
therapy including mindfulness has been proven to be effective on preventing depression
and other psychological disorders (Razak, Mokhtar, & Solomon, 2013), and reducing
stress (Kang, Choi, & Ryu, 2009; Song & Lindquist, 2015).

There is a need to investigate the effects of mindfulness intervention based on Islamic

spirituality on decreasing stress as such intervention has not been extensively practiced.
Mindfulness interventions that have been developed at this time are Christian spiritual
mindfulness (Cernetic, 2018), and recently, spiritual mindfulness-based interventions
based on Hinduism values with Gayatri mantra has been implemented and proved to
have a significant effect on the reduction of anxiety and stress among Hindus
(Candrawati, Dwidiyanti, & Widyastuti, 2018). The evidence of the implementation of
Islamic spiritual mindfulness to decrease stress in students working on their theses is
limited. Therefore, it is necessary to investigate how Islamic mindfulness affects the
stress among the students working on the thesis.

PURPOSE
This study aimed to determine the effects of Islamic spiritual mindfulness therapy on
reducing stress among nursing students working on the thesis.

METHODS
Research design and samples
This study used a pre-post quasi-experimental design with a control group. The samples
were 36 nursing students who were working on the thesis. The samples were divided
into two groups, namely the experimental group that received the intervention of
Islamic spiritual mindfulness (n=18), and the control group that did not accept the
intervention (n=18). A purposive sampling method was used to recruit the samples. The
inclusion criteria were final year nursing students working on the thesis assignment and
experienced stress. The exclusion criteria were final year nursing students experiencing
stress in the completion of the thesis who had other stress management therapies and
experienced further mental-emotional disorders such as anxiety and depression.

Measurement
Before the study, the researchers conducted an initial screening using the DASS 42
(Depression Anxiety Stress Scales) to determine the level of stress among students
subjectively, with the criteria for stress levels, i.e., a normal stress (0-14), mild level
(15-18), moderate level (19-25), severe level (26-33) and very severe level (>34). The
DASS questionnaire was given to 95 final-level of nursing students who were working
on the thesis, and 36 participants who met the inclusion criteria were recruited.

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Intervention
The intervention in this study was the Islamic spiritual mindfulness which was given in
five sessions for five days with a duration of 20 minutes each. In each session, the
participants did the following activities: (1) raising the desire to develop spiritual energy
and spirit of worship, (2) analyzing the problem for introspection, (3) developing full
awareness of mistakes, (4) feeling the heart’ response, (5) dzikr, (6) acceptance, and (7)
relaxation.

Data analysis
The Saphiro-wilk test was used to find out the distribution of data in each group. The
collected data were further analysed using the t-test and unpaired t-test.

Ethical consideration
This research has received an ethical approval from the research ethics committee of
Universitas Brawijaya Malang-Indonesia with number 351/EC/KEPK-S2/12/2018.

RESULTS
General characteristics of participants
The general characteristics of respondents were based on gender, age, and stress level.
In this study, it was found that the characteristics of participants in the experimental
group and the control group by sex were mostly female 29 (81%), the mean age was
21.56 years old (0.65) and mean of stress were 21.17 (2.89) (Table 1).

Differences in the mean score of stress before and after intervention in the
experimental group and control group
Based on Table 2, there was a difference in the mean score of stress in the intervention
group between before and after the intervention with a difference of 9.2, and the results
of further analysis obtained a p-value of 0.000 (p<0.05). Furthermore, there was also a
difference in the mean score of stress between before and after the treatment in the
control group with a difference of 1.9, and the results of further analysis obtained a p-
value of 0.148 (p>0.05)

Table 1. General characteristics of respondents (n=36)

Variable f %
Gender
Male 7 19
Female 29 81
Age (21.56±0.65) 17
23 years old 6 50
22 years old 18 33
21 years old 12
Stress (21.17±2.89) 0
Normal (0-14) 0 28
Mild (15-18) 10 67
Medium (19-25) 24 5
Severe (26-33) 2 0
Very Severe (>33) 0 0

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 Nurse Media Journal of Nursing, 9(1), 2019, 73

Table 2. The mean score of stress before and after the intervention

95% confidence
Group Time Mean SD Difference t p
Lower Upper
Pre test 20.6 2.97 0.000
Experimental 9.2 6.89 11.55 8.37
Post test 11.4 5.81
Pre test 19.7 2.82 0.148
Control 1.9 -0,76 4.65 1.52
Post test 17.8 5.01

Differences in the mean score of stress after intervention in the experimental group
and control group
Based on Table 3, it can be explained that there were significant differences in the mean
score of stress between the two groups. The experimental group has a mean score of
11.4, and has a difference of 9.2, which is higher than the control group. A further
analysis obtained p=0.000 (p<0.05). The effect size score was 0.59, indicating that the
effect of Islamic spiritual mindfulness on the decrease of stress among nursing students
working on the thesis was in the moderate category.

Table 3. The difference in the mean score of stress after the intervention

95% Confidence
Group Mean SD Difference t p ES
Lower Upper
Experimental 11.4 5.81 9.2
-10.06 -2.71 -3.53 0.001 0.59
Control 17.8 5.01 1.9

DISCUSSION
Working on a thesis for university students may result in stress. The level of stress can
be in the moderate category (Gamayanti Mahardianisa, & Syafei, 2018; Zakiyah, 2016).
In this study, it was found female students tend to have more opportunities to get
stressed. Videbeck (2011) stated that the stress disorder is more often experienced by
women. In her study, Zakiyah (2016) reported that characteristics of nursing students
experiencing stress were aged 21-23 years, female gender (78%), and the level of stress
was moderate (52%). These findings are in accordance with the results of the present
study, in which the majority of respondents’ gender was female as many as 28 (78%),
the mean of age was 22 years old (50%) and the majority experienced stress in moderate
category as many as 24 (67%). Calvarese (2015) reported that there were significant
differences between male and female students to stress reactions. Women experience
more stress reactions at a higher level of depression, frustration, and anxiety than men.
This is because women tend to put forward feelings rather than rational so that it makes
women more difficult to forget it when experiencing academic failure (Matud, 2004;
Rivera-torres, Araque-padilla, & Montero-simó, 2013).

Pursuing higher education to college is a priority of young adults. Stuart (2007) stated
that age could affect the individuals in the face of stressors, as age is one factor that can
affect an individual’s coping. College students are individuals at adulthood (18-24

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 Nurse Media Journal of Nursing, 9(1), 2019, 74

years). At this age, the students tend to use maladaptive coping mechanisms when faced
with the stressor; therefore, it is very easy for the students to experience stress
(Krisdianto & Mulyanti, 2015). Maladaptive coping is performed by ignoring stress,
avoiding others, blaming others, consuming alcohol, quitting the study, and suicide
(McCarthy et al., 2018).

This study showed that Islamic mindfulness could reduce the stress among the students.
This result is in accordance with the opinion of Lazaridou and Pentaris (2016) who said
that the mindfulness therapy performed by enhancing spiritual values is very effective,
as mindfulness is closely related to spirituality, and both have strong relationships, since
this mindfulness-based intervention originates from the eastern spiritual traditions,
especially Buddhism (Thomas, Raynor, & Bakker, 2016). This statement is also
supported by a study of Sadipun, Dwidiyanti, and Andriany (2018) which reported that
spiritual-based mindfulness intervention had a significant effect on improving emotional
control of adult patients with pulmonary TB, in addition to its effective stress reduction.
Another study also found that controlling anger and calm the heart of schizophrenic
clients through spiritual mindfulness could decrease with the risk of violent behavior
(Sari & Dwidiyanti, 2014).

Mindfulness-based interventions, in addition to effectively lowering stress spiritual,

have also proven effective in controlling anger and reassurance to clients schizophrenia
with the risk of violent behaviour (Sari & Dwidiyanti, 2014). Islamic spiritual is proven
effective to give influence on the prevention of depression and other psychological
disorders. Spiritual therapy aims to build a sense of self-acceptance so that the client
does not feel depressed anymore. Even otherwise, the client will be able to express his
feelings to life and better mental health. The spiritual approach plays an important role
in expressing feelings and provide comfort for the client. Acceptance of ill will
encourage the individual client to be closer to God and accept the illness as a trial from
God. In the Islamic spiritual therapies, the heart and the mind as a therapeutic target in
dealing with various psychological diseases (Mardiyono et al., 2011; Razak et al.,
2013).

This study has the limitation that it was implemented in a small sample size.
Furthermore, the researchers could not able to control several confounding factors
which might influence the results of the study. Further research may be conducted in a
larger sample and control the factors influencing the intervention.

CONCLUSION
There were differences in the mean score of stress levels between the groups receiving
Islamic spiritual mindfulness, and the group which did not receive such treatment. The
experimental group receiving Islamic spiritual mindfulness showed a higher decrease of
stress levels than the control group. Based on the results, it is recommended that nurses
apply Islamic spiritual mindfulness therapy as one of the psychotherapy interventions to
provide the first treatment to clients who experience stress. Nurses can work with
educational institutions to open opportunities to provide psychotherapy interventions to
deal with students who experience stress due to academic burdens.

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 Nurse Media Journal of Nursing, 9(1), 2019, 75

ACKNOWLEDGMENT
The authors would like to thank students for their participation in this study.

CONFLICT OF INTEREST
The authors declare no conflict of interest.

REFERENCES
Al-Jauziyyah, I. Q. (2004). Kunci kebahagiaan [The key to happiness]. (A. H. Al-
Katani, H. K. S.S., M. K. R. SHi, & S. Habibullah Rasidin, Lc, Eds.). Jakarta:
Akbar Media Eka Sarana.
American Psychological Association APA. (2012). Guidelines for lesbian,
psychological practice with gay, and bisexual clients. American Psychologist,
67(1), 10–42. doi: 10.1037/a0024659
Candrawati, A. K., Dwidiyanti, M., & Widyastuti, R. H. (2018). Effects of mindfulness
with Gayatri mantra on decreasing anxiety in the elderly. Holistic Nursing and
Health Science, 1(1), 35-45.
Calvarese, M. (2015). The effect of gender on stress factors: An exploratory study
among university students. Social Science, 4(4), 1177-1184. doi:
10.3390/socsci4041177
Cernetic, M. (2018). Mindfulness in Christian spiritual practices and connections with
psychotherapy. Journal of Spirituality in Mental Health, 13, 99-123.
Cheung, T., Wong, S. Y., Wong, K. Y., Law, L. Y., Ng, K., Tong, M. T., … Yip, P. S.
F. (2016). Depression, anxiety, and symptoms of stress among baccalaureate
nursing students in Hong Kong: A cross-sectional study. International Journal Of
Environmental Research and Public Health, 13(8), 1-25. doi:
10.3390/ijerph13080779
Dwidiyanti, M., Fahmi, A. Y., Ningsih, H. E. W., Wiguna, R. I., & Munif, B. (2019).
Seni mindfulness spiritual Islam [The arts of Islamic spiritual mindfulness] (1st
ed.). Semarang: UNDIP Press.
Dwidiyanti, M., Pamungkas, A. Y. F., & Ningsih, H. E. W. (2018). Mindfulness caring
pada stress [Mindfulness caring on stress] (1st ed.). Semarang: UNDIP Press.
Fourianalistyawati, E. (2017). Kesejahteraan spiritual dan mindfulness pada majelis
sahabat shalawat [Spiritual welfare and mindfulness at the assembly of friends
companions]. Journal Psychologist Islam, 3(2), 79-85.
Gamayanti, W., Mahardianisa, M., & Syafei, I. (2018). Self-disclosure dan tingkat stres
pada mahasiswa yang sedang mengerjakan skripsi [Self-disclosure and stress
levels for students who are working on a thesis]. Jurnal Ilmiah Psikologi, 5(1),
115. doi: 10.15575/psy.v5i1.2282
Kang, Y. S., Choi, S. Y., & Ryu, E. (2009). The effectiveness of a stress coping
program based on mindfulness meditation on the stress, anxiety, and depression
experienced by nursing students in Korea. Nurse Education Today, 29(5), 538–
543. doi: 10.1016/j.nedt.2008.12.003
Krisdianto, A., & Mulyanti, M. (2015). Mekanisme koping dengan tingkat depresi pada
mahasiswa tingkat akhir [Coping mechanism with depression level on last level
students]. Jurnal Keperawatan dan Kebidanan Indonesia, 3(2), 71-76. doi:
10.21927/jnki.2015

Copyright © 2019, NMJN, p-ISSN 2087-7811, e-ISSN 2406-8799

 Nurse Media Journal of Nursing, 9(1), 2019, 76

Lazaridou, A., & Pentaris, P. (2016). Mindfulness and spirituality: Therapeutic

perspectives. Journal Person-Centered & Experiential Psychotherapies, 44(0), 1-
21.
Mahmoud, J. S. R., Staten, R. T., Hall, L. A., & Lennie, T. A. (2012). The relationship
among young adult college students’ depression, anxiety, stress, demographics,
life satisfaction, and coping styles. Issues in Mental Health Nursing, 33(3), 149–
156. doi: 10.3109/01612840.2011.632708.
Mardiyono, Songwathana, P., & Wongchan. (2011). Spirituality Intervention and
Outcomes : Corner stone of Holistic Nursing Practice. Nurse Media Journal of
Nursing, 1(January), 117-127.
Matud, M. P. (2004). Gender differences in stress and coping styles. Personality and
Individual Differences, 37(7), 1401-1415. doi: 10.1016/j.paid.2004.01.010
McCarthy, B., Trace, A., O’Donovan, M., Brady-Nevin, C., Murphy, M., O’Shea, M.,
& O’Regan, P. (2018). Nursing and midwifery students’ stress and coping during
their undergraduate education programmes: An integrative review. Nurse
Education Today, 61, 197-209. doi: 10.1016/j.nedt.2017.11.029
Ministry of Health Republic of Indonesian (MOH RI). (2013). Riset Kesehatan Dasar
[Basic health research]. Retrieved from http://www.depkes.go.id/resources/
download/general/HasilRiskesdas2013.pdf
Ministry of Research, Technology and Higher Education. (2017). Statistik pendidikan
tinggi [Higher education statistics]. Jakarta: Pusdatin Iptek Dikti, Setjen,
Kemenristekdikti.
Razak, A., Mokhtar, M.K., & Solomon, W. S. W. (2013). Islamic spiritual therapy a
model for depression disorder prevention. Da'wah Tabligh Journal, 14(1), 141-
151.
Rivera-torres, P., Araque-padilla, R. A., & Montero-simó, M. J. (2013). Job stress
across gender : The importance of emotional and intellectual demands and social
support in women. International Journal of Environmental Research and Public
Health, 10(1), 375-389. doi: 10.3390/ijerph10010375
Rizvi, F., Qureshi, A., Rajput, A., & Afzal, M. (2015). Prevalence of depression,
anxiety and stress (by DASS scoring system) among medical students in
Islamabad, Pakistan. British Journal of Medicine and Medical Research, 8(1), 69-
75. doi: 10.9734/BJMMR/2015/17193
Sari, S. P., & Dwidiyanti, M. (2014). Mindfulness dengan pendekatan spiritual pada
pasien skizoprenia dengan resiko perilaku kekerasan [Mindfulness with a spiritual
approach in schizophrenic patients at risk of violent behavior]. Prosiding
Konferensi Nasional XI Keperawatan Kesehatan Jiwa, 290-294.
Sadipun, D. K., Dwidiyanti, M., & Andriany, M. (2018). Effect of spiritual mindfulness
intervention on emotional control in adult patients with pulmonary tuberculosis.
Belitung Nursing Journal, 4(2), 226-231.
Selye, H. (2013). Stress in health and disease (3rd ed.). London: Butterworth Group.
Song, Y., & Lindquist, R. (2015). Effects of mindfulness-based stress reduction on
depression, anxiety, stress, and mindfulness in Korean nursing students. Nurse
Education Today, 35(1), 86-90. doi: 10.1016/j.nedt.2014.06.010
Sudarya, I. W., Bagia, I. W., & Suwendra, I. W. (2014). Analisis faktor-faktor yang
mempengaruhi stres dalam penyusunan skripsi jurusan manajemen Undiksha
angkatan 2009 [Analysis of factors affecting stress on student in preparation

Copyright © 2019, NMJN, p-ISSN 2087-7811, e-ISSN 2406-8799

 Nurse Media Journal of Nursing, 9(1), 2019, 77

thesis on department of management of Undiksha] (Thesis). Universitas

Pendidikan Ganesha.
Thomas, J., Furber, S. W., & Grey, I. (2018). The rise of mindfulness and its resonance
with the Islamic tradition. Mental Health, Religion & Culture, 20(2), 1-13. doi:
10.1080/13674676.2017.1412410
Thomas, J., Raynor, M., & Bakker, M. (2016). Mindfulness-based stress reduction
among Emirati muslim women. Mental Health, Religion & Culture, 10(3), 295-
304. doi: 10.1080/13674676.2016.1168389
Videbeck, S. L. (2011). Psychiatric-mental health nursing. Philadelphia: William &
Wilkins.
Wardi, R. (2016). Stress conditions in students completing thesis. Jurnal Ilmu
Pendidikan, Psikologi, Bimbingan dan Konseling, C(2), 190-194. doi:
10.24127/gdn.v6i2.512
WHO. (2018). Mental disorders. Retrieved from https://www.who.int/news-room/fact-
sheets/detail/mental-disorders
Zakiyah. (2016). Gambaran karakteristik, tingkat stres, ansietas, dan depresi pada
mahasiswa keperawatan yang sedang mengerjakan skripsi [Characteristics, stress
levels, anxiety, and depression in nursing students working on a thesis]. Jurnal
Impuls, 2(September), 140-145.

Copyright © 2019, NMJN, p-ISSN 2087-7811, e-ISSN 2406-8799