Iran Journal of Nursing

Introduction
Aquality patient care requires nurses’ self-efficacy in dealing with challenging situations. Self-efficacy affects the beliefs, actions and behavior of nurses during patient care. It is known as a powerful variable affecting motivation, thoughts, and decision-making processes, prioritizing interventions, and encouraging nurses to continue caring for patients. Self-efficacy helps the nurses to remain stable and flexible when facing various difficulties and situations. Gender has been proposed as a factor affecting self-efficacy, such that the level of self-efficacy in female nurses is lower than that in male nurses. One of the interventions that can be effective in improving self-efficacy is mindfulness training by reducing stress. This training, using stress reduction and relaxation techniques, can be effective in improving the nurses’ self-efficacy. This study aims to determine the effect of Mindfulness exercises training on female nurses’ self-efficacy.

Materials & Methods
This is an experimental study. The study population consists of all female nurses working in Afshar Hospital in Yazd, central Iran, in 2019. Sixty samples were selected using a convenience sampling method and based on the inclusion criteria. Then, the samples were randomly assigned into two intervention (n=30) and control (n=30) groups. The inclusion criteria were willingness to participate in the study, work experience of at least two years, ability to attend all training sessions without being absent and outside the hours of shift work, and not receiving any other training programs before and during the study. Nurses who were on leave, using anti-anxiety or anti-depression drugs, and with a history of participation in similar programs, were excluded from the study. The data collection tool was a two-part questionnaire that was completed as a self-report tool before and immediately after the intervention. The first part was the demographic checklist and the second part was the Sherer (1982)’s general self-efficacy scale. 
The Mindfulness exercises was conducted in the intervention group based on the Kabat-Zinn model at eight 2-hour sessions for two months by the second author under the supervision of a psychologist. The main topics in the meetings were the general principles of mindfulness and body scan meditation, discussing barriers and possible solutions, practicing to see and hear non-judgmentally, attention to breathing and reaction in difficult situations, sitting meditation, thought exercises, four-dimensional meditation, and meditation in nature. The control group did not receive any intervention during this period; however, after the study, the video of the sessions was provided to them in a CD. The data were analyzed in SPSS software, version 19 using descriptive (Mean±SD, absolute and relative frequency) and inferential (chi-square test, independent t-test, and paired t-test) statistics. The significance level was set at 0.05.

Results
There was no statistically significant difference between the two groups in terms of age, work experience, and education level. The mean self-efficacy was higher in the control group (47.23±5.65) than in the intervention group (46.36±3.89) before the intervention, but the independent t-test results showed no significant difference between the two groups (P=0.49). After the intervention, the mean self-efficacy score reached 50.40±5.33 in the intervention group and 47.86±4.91 in the control group. However, the independent t-test results did not show any significant difference between the two groups (P=0.06). The paired t-test results showed a significant difference in the scores before and after the Mindfulness exercises training in the intervention group (P=0.002), but the difference was not significant in the control group (P=0.21).

Conclusion
The present study revealed the non-significant effect of Mindfulness exercises on the self-efficacy of female nurses. In previous studies, gender has been mentioned as a key moderating factor in self-efficacy, and it has been attributed to the three phenomena of attribution, comparison and self-fulfilling. The Mindfulness exercises, through calming the mind, aim to direct the person’s attention from external factors to the internal factors, so that the person faces her true desires and is not influenced by external factors. Based on to the results of this study, attention to mindfulness per se is not enough for improving the self-efficacy of female nurses. The inefficacy of Mindfulness exercises on self-efficacy in this research can be due to the short duration of mindfulness exercises. What is certain is that mindfulness training enable nurses to face unpleasant events in their lives without judgment and consider them as experiences, recognize negative thoughts, and challenge them which can create an insight that copes with feelings of ineffectiveness and inadequacy. More studies should be conducted in this field by controlling the effects of intervening factors as much as possible and by performing thee exercises for a longer time and using a follow-up phase.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the ethics committee of Islamic Azad University, Isfahan (Khorasgan) Branch (Code: IR.IAU.KHUISF. REC.1398.236).

Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Authors' contributions
Supervision, data analysis and interpretation: Maasoumeh Barkhordari-Sharifabad; preparing initial draft, project administration, editing & review: Mahdieh Fallah.

Conflict of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank all the nurses participated in this research for their cooperation. and also appreciate Farahmand (Psychologist) for her cooperation in training nurses.

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