Laughter Yoga for Nursing Students Going Into Clinical Practice for the First Time
Condition: Happiness; Laughter Yoga; Nursing Student; Stress; Clinical Practice
Study type: Interventional

Summary: 
      Clinical practice is an unseparated part of nursing curricula and crucial for students to
      learn professional skills and gain professional identity. Besides, the clinical practices
      have an important role in the development of professional identity, are also emotionally
      challenging and stressful. All these experiences can negatively affect the happiness of
      nursing students. The unhappiness and stress affect nursing students negatively in terms of
      their physical and mental health, and lead to decreased performance, increased risk of error,
      and decreased quality of nursing care. Additionally, nursing students' perspectives on the
      profession might be negatively affected. Therefore, increased the level of happiness and
      reduced stress level in nursing students is important in the clinical learning environment.

      Study authors could not find any studies which examining the effect of laughter yoga on the
      level of happiness and stress in nursing students who experienced clinical practice for the
      first time. Therefore, this project aimed to examine the effect of laughter yoga on the
      happiness and stress levels of nursing students. Study population composed of 61 students
      studying in the nursing department of a university located in the Central Anatolia Region.
      Students included in the study will be randomized into intervention and control groups
      according to a simple randomization rule. A total of 8 sessions of laughter yoga will be
      applied to the intervention group by the primary researcher for 4 weeks. Personal Information
      Form, Happiness Scale and Perceived Stress Scale for Nursing Students will be used as data
      collection tools in the research. Data collection tools will be applied in the form of
      pre-test and post-test. within the scope of this project, increased students' happiness and
      decreased stress levels were expected.
    

Detailed description: 
      Clinical practice in nursing education; It is a process that gives the opportunity to
      transfer knowledge into practice, gains experience and also enables the transition from
      student to professionalism . This process; Nursing students face many difficulties and
      negatively affect the sense of happiness, which is one of the basic human needs. Increasing
      happiness in nursing students, on the other hand, helps to positively affect quality nursing
      care by supporting physical and mental health, which is important for patient care. Also
      happiness; it reduces nursing care errors by increasing resilience, life satisfaction and
      performance. Happiness is expressed as a cognitive assessment of life satisfaction based on
      experience. However, current evidence shows that nursing students have low levels of
      happiness. Happiness is very important in the training and development of nursing students as
      future nurses; because people are more willing to help others when they are happy. When
      nursing students live a happy life and have personal qualities that will create happiness in
      others, they may be interested in caring for their patients and ensuring their happiness.
      However, some studies report that nursing students may experience psychological problems such
      as increased stress levels as well as unhappiness due to the intense curriculum and
      difficulties in clinical practice.

      Clinical practice, which prepares students for professional nursing roles and aims to improve
      their clinical decision-making skills, can cause stress in students. Since the 1970s, many
      researchers have investigated clinical practice-related stress in nursing students and
      identified it as one of the major problems worldwide. Stress is a situation that challenges
      or exceeds the individual's coping methods of internal and external demands or both.
      Therefore, going into clinical practice for the first time is considered one of the important
      factors that cause stress in nursing students. Current evidence shows that nursing students
      experience moderate to high levels of stress related to clinical practice. Factors causing
      stress; fear of uncertainty, engaging in various clinical activities, dealing with patients,
      lack of knowledge and skills, fear of failure, clinical inadequacy, fear of making mistakes,
      lack of control associated with patients, and the experience of witnessing death. In
      addition, situations such as lack of communication with interdisciplinary team members,
      avoidance of peers and clinicians are among the factors that cause stress. Any of these
      factors can negatively affect the education process of the nursing student and reduce their
      academic performance. In addition, unhappiness and increased stress levels can negatively
      affect clinical learning outcomes and clinical competence. When the literature was examined,
      it was seen that the studies focused on reducing the stress of the students who went into
      clinical practice. In these studies, it was emphasized that nursing interventions such as
      mindfulness and peer support were effective in reducing stress.

      Laughter yoga, which is one of the stress-reducing methods based on laughter; It is a type of
      exercise that combines unconditional laughter and breathing techniques. In this exercise
      method; one begins to laugh without first being a humor, a joke, or a funny incident. Natural
      and imitated laughter cannot be distinguished by the brain; It is known to have similar
      effects on the body, such as decreasing muscle tone and increasing muscle relaxation by
      stimulating the parasympathetic system. Laughter yoga; It helps to improve interpersonal
      relationships by reducing negative emotions such as tension, anxiety, hatred and anger, and
      relieving stress and depression in individuals. Stated that laughter yoga positively affects
      general health, improves sleep disorder symptoms, decreases anxiety and depression levels,
      and improves social functions. Confirming this view, some studies have also found that
      laughter yoga reduces depression symptoms, anxiety and stress levels. In addition,
      self-confidence, happiness, energy, positively affects memory, creative thinking and
      problem-solving ability; it increases interpersonal relationships, social interaction,
      cooperation, group identity and solidarity. In addition, laughter yoga is a very effective
      and practical method as it is low cost and can be performed easily regardless of time. In the
      light of this information, it is seen that laughter yoga is practiced in samples of patients
      diagnosed with diabetes, end-stage renal failure and cancer, the elderly, postpartum and
      menopausal women, students and individuals in the general society.

      Laughter yoga sessions with nursing students have been shown to have positive effects on
      stress, happiness, general health and anxiety levels. However, no study has been found in the
      literature examining the effect of laughter yoga on happiness and stress levels in nursing
      students who are practicing for the first time. Laughter yoga may have a positive effect on
      the happiness and stress levels of nursing students who are in clinical practice for the
      first time. Thus, it is thought that the laughter yoga that will be applied within the scope
      of the project will increase the happiness level and reduce the stress level of the nursing
      students who will go into clinical practice for the first time.
    

Intervention name(s): laughter yoga; Control
Intervention type(s): Behavioral; Other
Intervention description(s): Therefore, the laughter yoga program; It was planned as a face-to-face group session, for four (4) weeks, twice a week, for a total of eight (8) sessions and 20-25 minutes.; The students in the control group did not receive any intervention. Nursing students were followed for four weeks. Before the study, data collection tools were applied to the students. Again, after the start of the study and the end of the study, all other data collection tools except the "Student Information Form" were applied.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Supportive Care