General information. Adopting the convenience sampling method, 100 stroke patients who were hospitalized in the Department of Neurology of a tertiary general hospital in Kaifeng City, China in February 2024 were selected and divided into two groups (control group (n = 50); experimental group (n = 50)) using a randomized numerical table. The inclusion criteria were ① adults aged ≥ 18 years; ②Stroke confirmed by head CT or MRI; ③ those who had a clear consciousness and could cooperate with the treatment; and ④ those who provided informed consent. The exclusion criteria were ① patients with other serious complications (e.g., heart failure, malignant tumors, respiratory failure); ② patients with dementia, psychosis, and hearing impairment; and ③ patients who took psychotropic drugs or had drug dependence within 1 month. All enrolled patients signed an informed consent form, and the study was approved by the Ethics Committee of our hospital(2024-03-50).All experiments were performed in accordance with relevant named guidelines and regulations.
Research methods
Nursing care of the control group. Both groups of patients were given routine treatment and nursing care for stroke after hospitalization. The patients in the control group were given routine treatment and nursing care after admission to the hospital. Their medication was administered in accordance with the doctor's instructions, and the dosage was increased, decreased, or adjusted according to the patients' conditions. After the patients in the control group were admitted to the hospital, the receiving nurse provided the routine admission education, arranged suitable beds, led familiarized the patients with the ward environment and roommates in the same ward, introduced the supervising physician and the nurse in charge, and signed a letter of admission. On the second day, the nurse in charge informed the patient and family members of the patient’s condition, including the characteristics of the disease, precautions, and the next step in the treatment, and answered the patients and their family members questions; in the process of conversation, the patients' psychological problems were discovered, according to which the patients were treated for stroke. In the process of conversation, according to the patient's psychological problem(s), nurses provide appropriate psychological guidance (e.g., assess patients’ anxiety levels, conduct a depression rating scale survey), identify high-risk patients, make timely reports to the physician, dispense medication in accordance with the doctor's orders, conduct shift handover for high-risk patients shift, focus on key concerns, provide appropriate psychological care, and prevent the occurrence of accidents.
Nursing care of the test group. The patients in the both the test and control groups were admitted to the hospital and arranged with suitable beds. On the second day, a professionally trained nurse conducted a comprehensive individualized assessment of the patients, aiming to understand the patients' health status, the effects of stroke, rehabilitation needs, and the type and severity of psychological symptoms. An individualized hyper-awareness meditation training plan was then developed based on the results of the assessment. The goals of the program are to reduce anxiety, improve emotional regulation, increase self-awareness, and promote introspection. Training usually commences when the patient has been admitted to the hospital for treatment for a period of time (usually about 5 days) and their vital signs are relatively stable. Before providing treatment, patients were introduced to the method, purpose, and significance of the training and signed an informed consent form.
Transcendental awareness meditation. This is a means of meditation practice that takes place twice a day for 30 min at a time. It is usually done in the morning and before bedtime in a special training room that is quiet and environmentally-controlled (e.g., the right temperature, humidity, and light intensity). Before starting, patients need to understand the basic principles of transcendental meditation, breath control, meditation postures, and concentration techniques. The training is gradual; patients initially engage in a brief meditation practice and gradually increase the duration. Over time, more complex meditation techniques can be introduced such as positive thinking meditation or body scanning. Breathing is a key element of meditation, and patients need to learn to calm their thoughts and emotions by breathing deeply and evenly. The basic exercises are breathing regulation and relaxation. Patients begin with 5–10 min of deep breathing and muscle relaxation exercises to slow the heart rate and relax the body. Meditation exercises take up the last 20–30 min, during which the patient is guided to focus on their breath or other meditation objects to cultivate inner peace. Another aspect is emotional regulation and cognitive restructuring, with 5–10 min of emotional monitoring and regulation provided in the middle of the session to teach emotional regulation techniques and enhance emotional stability. Patients also engage in cognitive reconstruction and awareness building: cognitive-behavioral techniques are used to change negative self-talk and improve self-affirmation and emotional management skills. Individualized and continuous counseling may also be provided. In individualized adjustments, the practitioner adjusts the difficulty and content of exercises according to the patient's needs and stage of recovery to ensure relevance and effectiveness. They may also provide continuous counseling and guidance, with regular individual counseling and group discussions that help patients solve problems and share experiences. Finally, there is long-term tracking and assessment: patients are continuously encourage patients to practice on their own after the course, conduct long-term tracking and assessment, and adjust the intervention program.
Specific training process. Patients train in loose and comfortable clothing, according to their own situation, sitting cross-legged, kneeling, or lying down in a big shape. They are instructed to close their eyes and slowly empty themselves. The heart silently reads the words to exclude distractions, one is to forget about the self, returning the consciousness to the depths of the soul. To experience the purity of consciousness, the body is completely relaxed and the body and mind enter a deep state of rest, but the inner consciousness is awake. The mind becomes blank; should patients experience intrusive thoughts, they are instructed to not forcefully restrain and repress them but let them go, let nature take its course, and focus on their inner peace. They should ignore external action, adjust their own breathing, feel the aura of heaven and earth, and focus on their own breathing and emotional changes. Nurses also need to guide patients to focus on self-awareness and introspection in order to help them gain a deeper understanding of their thinking, feeling, and behavioral patterns, which can help improve self-perception and mental health. During meditation training, the patient's progress and feedback are regularly assessed, which helps to adjust the meditation program to ensure that it is appropriately adapted to the patient's needs and abilities. After the patients are familiar with it, they can train on their own, and the therapist can visit the patients when needed to answer questions and observe the patient's training from time to time so as to correct and fill in the gaps in a timely manner. Therapists also remind patients that the method should be practiced consistently and repeated later after work and study.
Evaluation indicators
Quality control. After the patients were randomly divided into the test and control groups, formally trained nurses instructed the patients in hyper-awareness meditation training, and the beds of the two groups were arranged separately. The test group stayed in the east ward, and the control group stayed in the west ward, so as to avoid interactions between the groups, which would interfere with the results of the test.
General information. Participants’ general demographic information, including name, gender, age, education level, and religious beliefs, was collected.
Self-rating Anxiety Scale (SAS) 8 The patients' subjective anxiety was assessed. Higher scores representing more severe anxiety. A standard score is 50. A score of less than 50 is considered normal with no anxiety, 50–59 denotes mild anxiety, 60–69 indicates moderate anxiety, and 70 and above signifies severe anxiety, which requires close observation of the patient and shift-to-shift handover to avoid the occurrence of adverse events.
Self -Rating Depression Scale 8 Responses are indicated using a 4-point Likert scale (1 = no or very little time, 2 = a small amount of time, 3 = quite a lot of time, 4 = the vast majority or all of the time), with higher scores representing more severe depression. Taking 53 points as the standard score, below 53 points is considered normal with no depression, 53–62 points indicates mild depression, 63–72 points indicates moderate depression, and 72 points and above indicates severe depression.
Mini-Mental State Examination (MMSE) The scale consists of 30 entries in seven dimensions, with a full score of 30. The higher the score, the higher the cognitive level. For internal consistency, the Cronbach’s alpha coefficient was 0.91 and the retest reliability was 0.80. The scale has been widely used in clinical practice.
Stroke-Specific Quality of Life Scale (SS-QOL) The scale was compiled by Williams10 and others in 1999 and translated into Chinese by Wang Congjun11 in 2009. The scale is a self-assessment scale with 12 dimensions (i.e., energy, family role, emotion, personality, social role, thinking, language, mobility, self-care ability, upper limb function, vision, work or labor) assessed using a total of 49 items. The scale adopts the Likert 5-point scale, with higher scores indicating a higher patient quality of life. In past studies, the scale has demonstrated good reliability and validity.
Statistical methods. The data were entered using double entry, and SPSS 22.0 was applied to statistically analyze the data. The count data were described by frequency and percentage, and the measurement data were expressed by (± s). The comparison of the data before and after the intervention was performed using the paired t-test, and the t-test of independent samples was used to assess differences between the experimental and the control groups; statistical significant was set at P < 0.05.