Introduction

Mindfulness is to pay attention to the present moment and observe the present experiences with wakefulness [1]. Mindfulness is a well-known construct as an effective strategy for emotion regulation [2]. That is, it is critical for individuals to possess mindful attitudes in order to manage their emotions effectively. Compared to students of other majors and professionals in other fields, mindful attitudes are much more helpful to nursing students and nurses, who need more effective strategies to manage their emotions, considering the situations they are placed in [3, 4]. For example, nursing students experience more stress and unpleasant emotions due to the intense amount of study required and their clinical practicum [5]; nurses confront unfavorable work situations that require effective emotion regulation strategies for their psychological health and ultimately for better nursing practice [6].

There have been two leading schools of thought on mindfulness: one is meditative mindfulness developed by Kabat-Zinn [7], and the other is socio-cognitive mindfulness pioneered by Langer [8]. Kabat-Zinn’s meditative mindfulness is based on Eastern philosophy and focuses on non-judgmentally paying attention to the present through meditation, while Langer’s socio-cognitive mindfulness underlines the cognitive tendencies and attitudes of Western perspectives. Socio-cognitive mindfulness, unlike meditative mindfulness which is familiar to most researchers, argues that short-term interventions can have the effect of mindfulness by applying a variety of simple methods without a long period of meditation or training [9]. In particular, socio-cognitive mindfulness emphasizes flexibility with the environment by promoting openness to external stimuli through simple cognitive interventions without meditation [10, 11]. For example, in problem-solving situations, individuals can try to consider the situation in various different contexts and discuss possible solutions openly with others.

A plethora of research on meditative mindfulness has demonstrated a variety of positive effects in many fields, including the psychology, medicine, education, and nursing domains. In particular, Kabat-Zinn [12] implemented the mindfulness-based stress reduction (MBSR) program based on meditative mindfulness to reduce clients’ psychological symptoms, such as depression and anxiety, as well as patients’ physical pain [10, 13]. Recent studies related to COVID-19 reported the mediating role of mindfulness between self-efficacy and fear of COVID-19 [14] as well as between hardiness and stress of COVID-19 in university students [15]. In addition, mindfulness-based compassion therapy improved sleep quality and life satisfaction in elderly women [16].

Regarding nursing research, mindfulness-based programs for nurses alleviated their negative psychological symptoms, such as burnout, stress, mental distress, depression, and anxiety [17–19]. Mindfulness-based programs also enhanced nurses’ life satisfaction, empathy, emotional experiences, vocation, resilience, and coping abilities, which proved to be effective in not only personal life but also work and interpersonal relationships [18, 20]. For nursing students, meditative mindfulness helped them reduce stress and anxiety, while it improved their stress management skills, coping abilities, and empathy [21–23]. Through meditative mindfulness, nursing students were able to augment their self-esteem, happiness, and psychological well-being and, at the same time, alleviate study stress and depression [24, 25]. As described above, in countless studies meditative mindfulness has been reported as an effective means of improving individuals’ psychological well-being and physical health.

In comparison, research on socio-cognitive mindfulness has not flourished as much as research on meditative mindfulness; some studies exist in psychology, medicine, and education fields. In the psychology discipline, researchers have found that socio-cognitive mindfulness has been shown to be linked to psychological well-being and physical health as well as to cognitive performance. Socio-cognitive mindfulness, for instance, improved the immune system and life satisfaction, and reduced anxiety and depression by inducing cognitive flexibility [10, 11]. It also improved self-acceptance [26] and satisfaction in interpersonal relationships [27], while alleviating burnout and stress [28]. In the medicine field, simple interventions of socio-cognitive mindfulness effectively reduced psychological distress, such as depression and negative moods [29]. Socio-cognitive mindfulness also inhibited maladaptive emotion regulation strategies like rumination in both healthy individuals and clinical patients [29]. In the educational contexts, Langer [9] found that students could improve creativity and learning skills, such as cognitive performance, attention, memory, concentration, and problem-solving skills through mindful thinking. Additionally, students’ socio-cognitive mindfulness correlated positively with a desirable emotion regulation strategy (i.e., reappraisal) and positive emotions, but it correlated negatively with negative emotions [30]. Students’ socio-cognitive mindfulness was negatively associated with negative symptoms, such as compulsive tendency, depression, and anxiety; however, it was positively associated with quality of life [31]. Nevertheless, nursing researchers have yet to pay much attention to socio-cognitive mindfulness.

Socio-cognitive mindfulness is the process of creating new categories of information in open and creative ways, and it looks at phenomena from multiple perspectives by taking contextual situations into consideration [26, 32, 33]. Socio-cognitive mindfulness might be particularly beneficial for nursing students and nurses, aligning with the dynamic demands of their practice. Emphasizing heightened consciousness, flexibility, and engagement [10, 11], this approach would foster decision making and creative problem-solving, essential skills in the nursing profession. In addition, socio-cognitive mindfulness offers immediate benefits through short-term interventions [9], and it effectively reduces stress and negative emotions while promoting positive well-being [30]. This active and adaptable nature makes it suitable for busy nursing settings and education, eliminating the need for prolonged meditation training [10, 11].

Thus, we believe that there are potential advantages in applying socio-cognitive mindfulness to the context of nursing practice and nursing education. Considering little research on socio-cognitive mindfulness in nursing, we introduce this under-examined construct socio-cognitive mindfulness to the nursing field using a scoping review and suggest applying socio-cognitive mindfulness to the field. Specifically, this review aimed to identify what is known in the research field of socio-cognitive mindfulness in nursing.

Methods

This review adopted the Arksey and O’Malley [34] framework for conducting scoping reviews. This framework consists of six stages: 1) identifying research questions, 2) identifying relevant studies, 3) study selection, 4) charting the data, 5) collating, summarizing, and reporting the results, and 6) consultation (this is an optional stage and is not implemented in this review). In addition, this scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for reporting scoping reviews [35].

Results

Fig 1 displays the study selection process using the PRISMA flow diagram, outlining the inclusion and exclusion of papers. Initially, 5,798 articles were identified via electronic database searches. After removing duplicates, 3,213 records underwent inclusion screening. Among these, 3,198 articles were excluded based on title and abstract assessment, leaving 15 articles for eligibility assessment. Subsequently, 8 articles were excluded after a full-text examination for the following reasons: research on meditative mindfulness (n = 2), research on social mindfulness (n = 1), research mentioning Langer’s socio-cognitive mindfulness but not containing any related contents (n = 1), research not identifying the effects of socio-cognitive mindfulness (n = 1), multiple publication (n = 1), research published in Norwegian (n = 1), and no research paper (n = 1). In particular, the reason for excluding one study on social mindfulness [38] was because social mindfulness is a different concept from the socio-cognitive mindfulness investigated in our study. Social mindfulness is defined as a motivational mindset in which individuals, during interpersonal interactions, take into account the needs and interests of others, aiming to enhance others’ control over their own outcomes [39]. Finally, 7 papers were included in the review. Among the 7 papers, 2 publications used the same sample [40, 41]; we treated them as separate independent studies since their research purposes were different.

Download:

• PPT
  PowerPoint slide
• PNG
  larger image
• TIFF
  original image

Fig 1. PRISMA flow diagram for included articles.

https://doi.org/10.1371/journal.pone.0300459.g001

Characteristics of the studies

Table 1 summarizes the characteristics of the seven included studies. The studies were conducted between 2010 and 2022, with all the studies conducted after 2017 except one [42]. They consisted of five journal articles [40, 41, 43–45], one doctoral dissertation [42], and one master’s thesis [46]. Geographically, two studies were conducted in the United States [42, 46], four studies were conducted in South Korea [40, 41, 43, 44], and one study was conducted in Sweden and Norway [45]. Six studies used quantitative research designs with a validated instrument of Langer Mindfulness Scale (LMS) [47] to measure participants’ socio-cognitive mindfulness [40–45]. The one remaining study employed a mixed method [46]. The study populations were comprised of nurses and nursing students, with the sample size ranging from 156 to 459 in six quantitative studies and 22 nurses in the mixed method study.

Download:

• PPT
  PowerPoint slide
• PNG
  larger image
• TIFF
  original image

Table 1. Characteristics of the included studies.

https://doi.org/10.1371/journal.pone.0300459.t001

Discussion

This scoping review aimed to identify the effects of socio-cognitive mindfulness on nurses and nursing students, as well as socio-cognitive mindfulness interventions and their effectiveness in nursing practice and nursing education. The review adopted the Arksey and O’Malley [34] framework following six stages. An electronic search of PubMed, EMBASE, Cochrane Library, CINAHL, Web of Science, ERIC, and ProQuest databases was conducted. The findings of the scarce existing studies have revealed several benefits of applying socio-cognitive mindfulness to the nursing practice and nursing education contexts.

First of all, regarding the effects of socio-cognitive mindfulness on nurses (Research question 1), nurses with a higher level of socio-cognitive mindfulness experienced higher levels of personal accomplishment and a lower rate of burnout or emotional exhaustion [42]. In addition, nurses with higher socio-cognitive mindfulness used the more effective emotion regulation strategy of reappraisal and possessed a higher level of empathy [44]. Heard [42] emphasized that nurses’ flexibility and engagement with increased self-awareness and genuine involvement with patients, main characteristics of socio-cognitive mindfulness, may have enhanced their personal accomplishment but reduced emotional exhaustion and depersonalization. Specifically, more mindful nurses would have fewer problems with the experience of depersonalization and emotional exhaustion; they would seem to experience higher levels of personal accomplishment, thus possibly making them less prone to experience burnout in their work.

Socio-cognitive mindfulness characterized by concentration on the present, openness, and cognitive flexibility will help nurses view nursing environments or situations from multiple viewpoints by considering contexts, eventually producing useful and creative alternatives. Therefore, nurses with socio-cognitive mindfulness could reduce stress perception and burnout while performing nursing practice, as reflected in Heard’s [42] study. In addition, the socio-cognitive mindful process of discovering new distinctions from work environments would help nurses enhance their attention to contexts and retain more open attitudes. This also enables nurses to think about situations from multiple perspectives, helping them regulate their emotions more effectively [44]. For example, when nurses are engaged in active observation of nursing environments that include patients, colleagues, events, or situations, they will have more opportunities to change the way in which they think about disadvantageous situations. This is associated with reappraisal, which is a useful strategy in regulating emotions. Reappraisal can improve nurses’ emotional status by generating more positive feelings, ultimately improving nursing practice for patients [44, 48].

Second, nursing students with a higher level of socio-cognitive mindfulness possessed higher communication self-efficacy compared to the students with lower socio-cognitive mindfulness [45] (Research question 2). This finding supports that mindful learning could improve nursing students’ communication self-efficacy and possibly have a positive influence on communication skills training. In Lee and Jang’ s [40] study, socio-cognitive mindfulness was related to enhancing students’ positive achievement emotions and reducing negative achievement emotions, which could ultimately influence their academic outcomes. In their later investigation, Lee and Jang [41] stated that socio-cognitive mindfulness could encourage students to adopt a reappraisal strategy by accepting new attributes and aspects of information from various perspectives, and guide thoughts to an ideal direction in adverse situations, possibly inhibiting suppression at the same time. Socio-cognitive mindfulness enables students to be flexible and open in their thoughts, so they can expand their cognitive performance and improve learning skills and creativity [9]. By being cognitively flexible, students have the ability to respond creatively to the challenges encountered in learning situations, which could increase their interest in learning [49]. This will encourage students to become more engaged in academic activities, ultimately facilitating positive learning emotions while reducing negative learning emotions, as reflected in the reviewed studies [40, 41, 43].

In addition, Lee’s [43] study claims that socio-cognitive mindfulness might have enhanced nursing students’ positive emotions and diminished their negative emotions, since students with higher socio-cognitive mindfulness would focus more on the present moment and thereby improve insights. This would foster students’ flexible thinking, learning skills, and cognitive outcomes. Notably, the mediating effects of socio-cognitive mindfulness emphasized that socio-cognitive mindfulness might be one mechanism to explain the relationship between nursing students’ grit and achievement emotions. This supports the significance of socio-cognitive mindfulness in nursing education, highlighting the need of practical mindfulness programs to nurture nursing students’ socio-cognitive mindfulness. When students exhibit socio-cognitive mindful attitudes, they can accept new attributes and various aspects of given information after evaluating them in many perspectives [9, 28]. In this process, they can establish a new kind of thinking ability that can convert the way they think even in unfavorable learning situations, meaning that they can use a reappraisal strategy, adaptive emotion regulation [41, 43]. They are able to consider situations in the contexts utilizing multiple viewpoints and change their thoughts in a desirable direction, which promotes a reappraisal strategy but prohibits a suppression strategy [41, 43]. This evidences that socio-cognitive mindfulness can help nursing students enhance their emotional experiences, and that it can be beneficial for them to apply an effective emotion regulation strategy rather than an ineffective one.

Finally, regarding socio-cognitive mindfulness interventions applied in nursing practice and nursing education and their effects (Research question 3), one study by Rush [46] found that the socio-cognitive mindfulness program helped nurses cope with stress and emotional exhaustion more effectively and view the nursing environments from various perspectives. This program was beneficial for nurses to increase their curiosity, pay attention to small details, approach situations with multiple perspectives, and engage in mindfulness practice. In reality, nurses constantly suffer from burnout or emotional exhaustion on a regular basis at work. Mindful nurses could make an effort to view work tasks from various perspectives and engage themselves in tasks more genuinely and actively to create a less stressful workplace, as indicated in Rush [46].

According to Langer and Moldoveanu’s [49] assumptions, nurses could experience burnout because they are interrupted by old categories or old mindsets. Adherence to old mindsets, for example, feeling comfortable with “the way we always do,” might produce burnout along with job dissatisfaction. This is true of most nursing practice environments. Nurses are likely to continue with the ways they have always executed certain interventions, possibly contributing to their burnout. Nevertheless, nurses with higher socio-cognitive mindfulness might have tried to avert burnout by creating diversity in their nursing tasks and including more flexibility [46, 49].

Conclusion

This scoping review addresses the concept of Langer’s socio-cognitive mindfulness, which has recently started gaining nursing researchers’ attention. This study introduces socio-cognitive mindfulness and suggests applying it to the nursing field. To this end, this research reviewed existing studies to identify what is known in the research field of socio-cognitive mindfulness in the nursing field. Based on the present review findings, we discussed the significance of socio-cognitive mindfulness in nursing practice and nursing education. Additionally, we suggested some feasible strategies of socio-cognitive mindfulness that could be applied to the nursing field as interventions.

In conclusion, integrating socio-cognitive mindfulness into nursing practice and education is crucial for enhancing the well-being and effectiveness of healthcare professionals. Socio-cognitive mindfulness can play an important role in promoting nurses’ positive emotions and effective emotion regulation, improving their psychological well-being, which ultimately will have a positive influence on their nursing performance for their patients. For example, by actively observing novel distinctions in their surroundings and adopting different perspectives, nurses can cultivate socio-cognitive mindfulness. Socio-cognitive mindfulness will also be advantageous for nursing students in that they will be able to experience more positive learning emotions and fewer negative ones. As well, they will be able to more efficiently manage their emotions, which will improve academic outcomes and the quality of college life. To become more mindful, nursing students can approach nursing practicum environments from various perspectives and consider different solutions in simulation scenarios. They could also maintain a mindfulness journal, allocating a brief time for daily reflection.

We hope that this contribution will raise nursing researchers’ awareness of the significance of socio-cognitive mindfulness in nursing, and encourage them to actively conduct further research on this under-examined area in nursing. Furthermore, based on more empirical evidence in the future, it is advised to develop a program so that nurses and nursing students can acquire socio-cognitive mindfulness, apply it to the nursing field, and evaluate its effects.

Supporting information

Acknowledgments

We would like to express our gratitude to Dr. Keum-Seong Jang for her assistance in screening the papers and health science librarian, Myung Ha Kim, for her help in the electronic search.