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Johns Hopkins Evidence-Based Practice Model for Nursing and Healthcare Professionals
Individual Evidence Summary Tool
Appendix G
EBP Question:
Reviewer
name(s)
Article
number
Author, date,
and title
Type of
evidence
Population, Intervention
size, and
setting
Findings
that help
answer the
EBP
question
Measures
used
© 2021 Johns Hopkins Health System/Johns Hopkins School of Nursing
Limitations
Evidence
level and
quality
Notes to
team
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Johns Hopkins Nursing Evidence-Based Practice
Individual Evidence Summary Tool (Appendix G)
Directions for use of the Individual Evidence Summary Tool
Purpose: Use this form to document and collate the results of the review and appraisal of each piece of evidence in
preparation for evidence synthesis. The table headers indicate important elements of each article that will contribute to
the synthesis process. The data in each cell should be complete enough that the other team members can gather all
relevant information related to the evidence without having to go to each source article.
See Chapter 11, Lessons from
Practice, for examples of
completed tools.
Reviewer name(s):
Record the member(s) of the team who are providing the information for each article. This will provide tracking if there are follow-up items or additional questions
on an individual piece of evidence.
Article number:
Assign a number to each piece of evidence included in the table. This organizes the individual evidence summary and provides an easy way to reference articles.
Author, date, and title:
Record the last name of the first author of the article, the publication/communication date, and the title. This will help track articles throughout the literature
search, screening, and review process. It is also helpful when someone has authored more than one publication included in the review.
Type of evidence:
Indicate the type of evidence for each source. This should be descriptive of the study or project design (e.g., randomized control trial, meta-analysis, mixed
methods, qualitative, systematic review, case study, literature review) and not simply the level on the evidence hierarchy.
Population, size, and setting:
For research evidence, provide a quick view of the population, number of participants, and study location. For non-research evidence, population refers to the
target audience, patient population, or profession. Non-research evidence may or may not have a sample size and/or location as found with research evidence.
Intervention:
Record the intervention(s) implemented or discussed in the article. This should relate to the intervention or comparison elements of your PICO question.
Findings that help answer the EBP question:
List findings from the article that directly answer the EBP question. These should be succinct statements that provide enough information that the reader does not
need to return to the original article. Avoid directly copying and pasting from the article.
© 2022 Johns Hopkins Health System/Johns Hopkins School of Nursing
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Johns Hopkins Nursing Evidence-Based Practice
Individual Evidence Summary Tool (Appendix G)
Measures used:
These are the measures and/or instruments (e.g., counts, rates, satisfaction surveys, validated tools, subscales) the authors used to determine the answer to the
research question or the effectiveness of their intervention. Consider these measures as identified in the evidence for collection during the implementation of the
EBP team’s project.
Limitations:
Provide the limitations of the evidence—both as listed by the authors as well as your assessment of any flaws or drawbacks. Consider the methodology, quality of
reporting, and generalizability to the population of interest. Limitations should be apparent from the team’s appraisals using the Research and Non-Research
Evidence Appraisal Tools (Appendices E and F). It can be helpful to consider the reasons an article did not receive a “high” quality rating because these reasons
are limitations identified by the team.
Evidence level and quality:
Using the Research and Non-Research Evidence Appraisal tools (Appendices E and F), record the level (I-V) and quality (A, B or C) of the evidence. When
possible, at least two reviewers should determine the level and quality.
Notes to team:
The team uses this section to keep track of items important to the EBP process not captured elsewhere on this tool. Consider items that will be helpful to have easy
reference to when conducting the evidence synthesis.
© 2022 Johns Hopkins Health System/Johns Hopkins School of Nursing
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Johns Hopkins Evidence-Based Practice Model for Nursing and Healthcare Professionals
Synthesis and Recommendations Tool
Appendix H
EBP Question:
Strength
Overall Quality
Rating
Level
(Strong, good, or
low)
Number of
Sources
(Quantity)
Synthesized Findings With Article Number(s)
(This is not a simple restating of information from each
individual evidence summary—see directions)
Level I
▪ Experimental studies
Level II
▪ Quasi-experimental
studies
Level III
▪ Nonexperimental,
including qualitative
studies
Level IV
▪ Clinical practice
guidelines or consensus
panels
Level V
▪ Literature reviews,
QI, case reports, expert
opinion
© 2022 Johns Hopkins Health System/Johns Hopkins School of Nursing
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Johns Hopkins Evidence-Based Practice Model for Nursing and Healthcare Professionals
Synthesis and Recommendations Tool
Appendix H
Where does the evidence show consistency?
Where does the evidence show inconsistency?
Best evidence recommendations (taking into consideration the quantity, consistency, and strength of the
evidence):
Based on your synthesis, select the statement that best describes the overall characteristics of the body of
evidence.
☐ Strong & compelling evidence, consistent results→ Recommendations are reliable; evaluate for organizational
translation.
☐ Good evidence & consistent results→ Recommendations may be reliable; evaluate for risk and organizational
translation.
☐ Good evidence but conflicting results→ Unable to establish best practice based on current evidence; evaluate
risk, consider further investigation for new evidence, develop a research study, or discontinue the project.
☐ Little or no evidence→ Unable to establish best practice based on current evidence; consider further investigation
for new evidence, develop a research study, or discontinue the project.
© 2022 Johns Hopkins Health System/Johns Hopkins School of Nursing
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Johns Hopkins Evidence-Based Practice Model for Nursing and Healthcare Professionals
Synthesis and Recommendations Tool
Appendix H
Directions for use of the Synthesis and Recommendations Tool
Purpose:
See Chapter 11, Lessons from
Practice, for examples of
completed tools.
This tool guides the EBP team through the process of synthesizing the
pertinent findings from the Individual Evidence Summary (Appendix G), sorted by evidence level, to create an
overall picture of the body of the evidence related to the PICO question. The synthesis process uses quantity,
strength (level and quality), and consistency to generate the best evidence recommendations for potential
translation.
Overall quality rating and the total number of sources:
Record the overall quality rating and the number of sources for each level (strong, good, or low), ensuring
agreement among the team members.
Synthesized findings:
This section captures key findings that answer the EBP question. Using the questions below, generate a
comprehensive synthesis by combining the different pieces of evidence in the form of succinct statements that
enhance the team’s knowledge and generate new insights, perspectives, and understandings into a greater
whole. The following questions can help guide the team’s discussion of the evidence:
•
•
•
•
How can the evidence in each of the levels be organized to produce a more comprehensive
understanding of the big picture?
What themes do you notice?
What elements of the intervention/setting/sample seem to influence the outcome?
What are the important takeaways?
Avoid repeating content and/or copying and pasting directly from the Individual Evidence Summary Tool.
Record the article number(s) used to generate each synthesis statement to make the source of findings easy to
identify.
Using this synthesis tool requires not only the critical thinking of the whole team but also group discussion and
consensus building. The team reviews the individual evidence summary of high- and good-quality articles, uses
subjective and objective reasoning to look for salient themes, and evaluates information to create higher-level
insights. They include and consider the strength and consistency of findings in their evaluation.
Where does the evidence show consistency/inconsistency?
EBP teams must consider how consistent the results are across studies. Do the studies tend to show the same
conclusions, or are there differences? The synthesized evidence is much more compelling when most studies
have the same general results or point in the same general direction. The synthesized evidence is less
compelling when the results from half the studies have one indication, while the findings from the other half
point in a different direction. The team should identify the points of consistency among the evidence as well as
areas where the inconsistency is apparent. Both factors are important to consider when developing
recommendations or determining the next steps.
© 2022 Johns Hopkins Health System/Johns Hopkins School of Nursing
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Johns Hopkins Evidence-Based Practice Model for Nursing and Healthcare Professionals
Synthesis and Recommendations Tool
Appendix H
Best evidence recommendations:
In this section, the EBP team takes into consideration all the above information related to the strength, quantity,
and consistency of the synthesized findings at each level to generate best practice recommendations from the
evidence. Consider:
•
•
•
•
What is the strength and quantity of studies related to a specific evidence recommendation?
Is there a sufficient number of high-strength studies to support one recommendation over another?
Are there any recommendations that can be ruled out based on the strength and quantity of the evidence?
Does the team feel the evidence is of sufficient strength and quantity to be considered a best evidence
recommendation?
Recommendations should be succinct statements that distill the synthesized evidence into an answer to the EBP
question. The team bases these recommendations on the evidence and does not yet consider their specific
setting. Translating the recommendations into action steps within the team’s organization occurs in the next step
(Translation and Action Planning Tool, Appendix I).
Based on the synthesis, which statement represents the overall body of the evidence?
Choose the statement that best reflects the strength and congruence of the findings. This determination will help
the team to decide the next steps in the translation process.
When evidence is strong (includes multiple high-quality studies of Level I and Level II evidence),
compelling, and consistent, EBP teams can have greater confidence in best practice recommendations and
should begin organizational translation
When most of the evidence is good (high-quality Level II and Level III) and consistent or good but
conflicting, the team should proceed cautiously in making practice changes. In this instance, translation
typically includes evaluating risk and careful consideration for organizational translation.
The team makes practice changes primarily when evidence exists that is of high to good strength. Never make
practice changes on little to no evidence (low-quality evidence at any level or Level IV or Level V evidence
alone). Nonetheless, teams have a variety of options for actions that include but are not limited to, creating
awareness campaigns, conducting informational and educational updates, monitoring evidence sources for new
information, and designing research studies.
The exact quantity of sources needed to determine the strength of the evidence is subjective and depends on
many factors, including the topic and the amount of available literature. The EBP team should discuss what they
consider sufficient given their knowledge of the problem, literature, and setting
© 2022 Johns Hopkins Health System/Johns Hopkins School of Nursing
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ORIGINAL RESEARCH
published: 10 November 2021
doi: 10.3389/feduc.2021.744227
Promoting Stress Management and
Wellbeing for Teachers, A Pilot Study
Stevie-Jae Hepburn 1*, Annemaree Carroll 1 and Louise McCuaig 2
1
School of Education, The University of Queensland, Brisbane, QL, Australia, 2School of Human Movement and Nutrition
Sciences, The University of Queensland, Brisbane, QL, Australia
Objectives: Investigate the change in perceived stress, mindful attention awareness,
subjective wellbeing and coping for pre-service teachers (PSTs) and the impact of a pilot 6h Complementary Intervention (CI).
Method: Phase One (N 79) survey at two timepoints. Perceived Stress Scale, Mindful
Attention Awareness Scale, Personal Wellbeing Index and the Brief COPE scale. Phase
Two CI pre- and post-program self-report measures (N 20).
Data analysis: Paired-sample and independent sample t-test.
Edited by:
Manpreet Kaur Bagga,
Partap College of Education, India
Reviewed by:
Nathalie Sandra Reid,
University of Regina, Canada
Laura Sara Agrati,
University of Bergamo, Italy
*Correspondence:
Stevie-Jae Hepburn
[email protected]
Specialty section:
This article was submitted to
Teacher Education,
a section of the journal
Frontiers in Education
Received: 20 July 2021
Accepted: 12 October 2021
Published: 10 November 2021
Citation:
Hepburn S-J Carroll A and McCuaig L
(2021) Promoting Stress Management
and Wellbeing for Teachers, A
Pilot Study.
Front. Educ. 6:744227.
doi: 10.3389/feduc.2021.744227
Frontiers in Education | www.frontiersin.org
Results: The paired-samples t-test confirmed that perceived stress levels (p 0.082) for
PSTs remain elevated across the duration of the academic year. There was not a significant
change for the MAAS and sub-scales of the Brief COPE. There was a significant decrease
in PWI scores (p 0.04). The participants in the CI experienced a significant decrease in
perceived stress (p 0.004) pre-program (M 18.6, SD 7.04) and post-program (M
15.55, SD 6.95), effect size (d 0.48). Increase in mindful attention awareness (p
0.019), pre-program (M 3.49, SD 0.59) and post-program (M 3.94, SD 0.85), effect
size (d −0.57).
Conclusion: The findings suggest that perceived stress for PSTs are at above-average
levels and a yoga-based CI may provide support for promoting wellbeing and stress
management.
Keywords: health, wellbeing, pre-service teachers, stress management, mindfulness, yoga, teacher training
1 INTRODUCTION
Teacher stress and wellbeing is an established area for educational research spanning over 40 years
(e.g. Jelinek, 1986). Early research highlighted that in some cases, stress could be a motivating factor
that encourages behaviour change and improves work ethic among pre-service teachers (PSTs).
Conversely, stress has been identified as creating a deleterious effect on PSTs’ performance and erode
confidence, professional identity and morale. Psychological distress can manifest as physiological
ailments or symptoms associated with anxiety, depression, decreased productivity and performance
(Wong et al., 2006). Those entering the teaching profession are more likely to have ideological
motivation based on empathy and service to others. As reported by the OECD (2020, p. 8) “around
90% of teachers say that serving a larger social purpose was a major motivation to enter the
profession.” The contrast between idealistic expectations and the reality of the classroom can be
overwhelming and individuals that are “empathetic, sensitive, dedicated, idealistic, and peopleorientated, tend to be the most vulnerable” (Greer and Greer, 1992, p. 169). Often the expectations of
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Hepburn et al.
Integrated Wellbeing and Stress Management
PSTs do not match the reality of the classroom. How they ‘frame’
their teaching experience is based on their own experiences as a
student, and there can be vast differences between when they were
in the classroom as a student and when they return as a teacher
(Turner et al., 2012). To cope with professional inadequacy
frequently experienced during practicum, PSTs may modify
their professional ideals to be less empathic, compassionate
and caring and focus on content and student achievement
(Lindqvist et al., 2017).
In the general Australian population, psychological and
behavioural conditions reported in the Australian National Health
Survey are rising. The Australian National Health Survey (Australian
Research Council and Universities, 2018) indicated increased
psychological and behavioural conditions from 2017 to 18
(20.1%). Women reported a higher rate than men for high or
very high levels of psychological distress in 2017–18 (12.0%). In
2017–18 the age group with the highest ratings were women aged
18–24 years (18.5%) followed by 55–64 years (16%) and 25–34 years
(15%). The highest ratings for men were 45–54 years (15%), followed
by 18–24 years (12.4%). This information is pertinent to the present
study due to the demographic of the teaching profession. The highrisk groups outlined from the Australian National Health Survey
align with the demographics of individuals entering the teaching
profession. For instance, 76.6% of registered teachers were female,
average 45.6 years in 2020 and 51.7% aged 45 years and over. The
average age of applicants for teacher registration was 35.8 years in
2020 (QCT, 2021). It has been reported that women report higher
levels of psychological distress than men in the teaching profession
(Deasy et al., 2014). The study was conducted before the COVID-19
pandemic and the Australian Bureau of Statistics reported that 19%
(one in five) Australians reported their mental health was worse or
much worse than before the onset of the pandemic in March 2020
(Australian Bureau of Statistics, 2021).
PSTs are reported as experiencing elevated perceived stress
scores (Geng et al., 2015; Stallman, 2010). It has been suggested
that the elevated level of distress experienced by PSTs is chronic,
with slight variance throughout the academic year (Stallman and
Hurst, 2016). Conversely, others argue that stress experienced by
PSTs can increase throughout their academic studies and reach a
peak during placement due to financial concerns resulting from
placement workload, family and work commitments and
academic assessment (Goddard and O’Brien, 2006; GustemsCarnicer and Calderón, 2013; Le Maistre and Paré, 2010).
Grant-Smith et al. (2018) surveyed students from the Faculties
of Health and Education at the Queensland University of
Technology, Australia (N 552) with education students (n
172) reporting financial stress, study and work-life balance,
interactions with staff/supervising teachers, practicum
structure and academic stress as negative aspects of practicum
experience. When investigating the experiences of graduate (n
151) and undergraduate (n 159) PSTs, Geng and colleagues
(2016) reported that graduate PSTs perceived stress levels were
significantly higher than undergraduate PSTs and that the two
groups experienced different stressors.
Deasy et al. (2014) indicated that 41.9% of the 1,557 nursing/
midwifery (n 473) and education students (n 1,104) reported
high psychological distress. Positive coping strategies, including
Frontiers in Education | www.frontiersin.org
seeking social support, were positively correlated to psychological
wellbeing. Avoidance behaviours and maladaptive coping
strategies identified in the study were linked to adverse health
and wellbeing consequences. It was noted that some behaviours
that could be seen as helpful for managing stress could result in an
increase in distress; for example, alcohol consumption to reduce
stress can increase an individual’s response to stress. The students
were reluctant to utilize professional support services provided at
the university. Gustems-Carnicer and Calderón identified that
proactive, problem solving coping strategies positively influenced
symptoms of phobic anxiety, depression, and psychological
distress for PSTs (N 98) whereas avoidance coping strategies
were associated with increased psychological distress. The
findings indicate a need for health promotion and health
education during university education. The argument for
providing mindfulness-based training to assist with coping and
stress management during university training is presented by
Soloway (2016). In particular, the practice of non-judgement is a
key element for reducing reactive behaviours and increasing an
individual’s awareness of the activity within the mind and
subsequent habitual behaviours and coping strategies.
Forming positive relationships and interactions within the
school community is a significant factor for professional identity,
feelings of helplessness and resilience (Lindqvist et al., 2017)
during the pre-service and early career period. How a teacher
manages the stressors of the profession can be influenced by an
individual’s sense of wellbeing (Turner et al., 2012) and the
transition from PST to early career teacher (ECT) is a critical
time (Hemmings and Hockley, 2002) that can significantly
influence an individual’s career pathway (Murray-Harvey
et al., 2000; Le Maistre and Paré, 2010; Le Cornu, 2013).
Greater resilience and enjoyment of teaching increase when
teachers manage their stress, regulate emotions and experience
more positive emotions (Gu and Day, 2007). Mindfulness
training has been shown to improve teacher-student
communication and interactions (Skinner and Beers, 2016)
and promote prosocial interaction (Kemeny et al., 2012;
Jennings et al., 2013, 2017). Providing PSTs with skills to
manage stress may positively influence their career pathway.
Although it has been argued that stress-management
programs need to be included in university-level teacher
training (Harris, 2011; Hepburn, 2020), there are limited
studies investigating the feasibility and benefits of
implementing university-level training programs. To date, the
research surrounding PSTs includes interventions utilizing a
modified Mindfulness-based Stress Reduction (MBSR)
program (e.g., Hue and Lau, 2015; Miyahara et al., 2017).
Mindfulness-based Interventions (MBIs) specifically designed
for younger participants have been adapted for pre-service
teachers, for example, the “Learn to Breathe” program
(Broderick et al., 2013) (originally targeting adolescents) see
Kerr et al. (2017). The present study does not present the
argument that a complementary intervention (CI) would
create a solution for the complex and multifaceted issue that is
PST stress and wellbeing. The issue of teacher stress and the
current educational climate and culture in our schools requires a
dialectic approach, that is, attention must be directed towards
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Integrated Wellbeing and Stress Management
stress management strategies and promoting positive wellbeing
for teachers. A systems or department level intervention was not
feasible in the present study therefore the focus was directed
towards secondary (individual) level stress management
interventions.
The first aim of the present study was to identify the change in
mindful attention awareness, perceived stress and subjective
wellbeing for PSTs from the start (Time One, start of Semester
One) to the conclusion (Time Two, end of Semester Two) of the
academic year (Research Question 2). Based on the literature
reviewed it is predicted that the PSTs participating in the study
may be experiencing elevated perceived stress levels. Given the
argument that there may be a significant link between attention
awareness (mindfulness as a state), perceived stress and wellbeing
(Hepburn, 2020), the second aim was to investigate the potential
for a CI for pre-service teachers to provide personal knowledge
and practice strategies for increasing attention awareness and
decreasing the stress response (Research Question 2). Based on
the literature surrounding MBIs for educators, it is predicted that
a CI will result in an increase in MAAS and decrease in PSS.
and tension in the body (relaxation techniques). Furthermore,
Greer and Greer stressed the importance of healthy dietary
choices and physical exercise must be included. A stress
management program or intervention must be holistic in
addressing all facets of wellbeing. This approach is supported
by the more recent research of Soloway (2016) and the impact of
the Mindfulness-Based Wellness Education (MBWE) program.
The MBWE from the University of Toronto provides a
multifaceted approach to increasing awareness of the
importance of wellbeing and stress management through the
inclusion of professional development relating to a specific facet
of wellbeing; however, the program is primarily a modified
Mindfulness-based Stress Reduction (mMBSR) program
(Kabat-Zinn, 1991).
The MBSR program developed by Kabat-Zinn (1991) has been
extensively trialled in clinical settings, positive psychology (see
Ivtzan, 2016) and modified for school settings (e.g. Gold et al.,
2010; Flook et al., 2013; Frank et al., 2015). Reported
improvements include decreased perceived stress, anxiety,
depression and increases in wellbeing and mindfulness. The
delivery of the different interventions (e.g. contact time,
duration, method of instruction) has varied however, the
mindfulness-based techniques and strategies are consistent.
There has been extensive growth in mindfulness-based
interventions (MBIs) for educators in school settings and the
development of a variety of programs. For example, the
Cultivating Awareness and Resilience in Education (CARE)
program (see Jennings et al., 2013; Sharp and Jennings, 2016;
Jennings et al., 2017) and the Stress Management and Relaxation
Techniques in education (SMART) program (Roeser et al., 2013).
The Community Approach to Learning Mindfully (CALM)
program for educators (Harris et al., 2016) moves away from
the traditional MBSR program structure (8-weekly sessions, 2-h
in length) and includes 16 weekly sessions (20-min in length).
The CALM program is also one of the limited studies that include
a yoga-based CI.
Carmody and Baer (2008) note that it is worth investigating
the benefits of mindful yoga after the unexpected finding from
their study of nine different MBSR programs (n 174). The
findings indicated that the home yoga practise (versus sitting
meditation and body scan) was more strongly associated with
increased mindfulness (non-judgement), wellbeing and
decreased perceived stress and anxiety, even though the home
yoga practise was reported for less total hours than the other
formal practices. An interesting point raised by Harris et al.
(2016) is that CIs for educators include some yoga postures;
however, there are scarce studies that investigate primarily yogabased programs for teacher wellbeing. In fact, in Australia, there
are limited yoga-based programs for teachers. However, there
have been recent developments in mindfulness-based programs
for teachers based on or including the MBSR program (e.g.,
Hwang et al., 2019).
In the present study, the CI promoted integrated wellbeing and
included strategies for stress management drawn from the system
of Yoga. The aim was to highlight the need for stress management
and health and wellbeing promotion through professional
learning and practical experience. Teachers who receive
2 BACKGROUND
2.1 Recommendations for Educators
It is argued that very little time in teacher education courses is
devoted to teaching PSTs the importance of recognizing signs of
stress and practical coping strategies they can implement
(Gustems-Carnicer and Calderón, 2013). In a study of Primary
PSTs (N 54) from an Australian University, Hemmings and
Hockley (2002, p. 25) identified that “teachers have not been
trained either to handle their stressors or to develop a variety of
successful coping mechanisms.”
Coping is viewed as a process rather than a trait or outcome
(Deasy et al., 2014) and a coping strategy is an adaptive response
to a specific stressor (Folkman et al., 1986). An individual’s ability
to prevent psychological distress is linked to personal resources
and coping strategies (Khramtsova et al., 2007). The importance
of interpersonal skills for coping with stress was identified by
Lindqvist and colleagues (2017). The education students in the
study shared that their mentors were important for support yet
on the other hand, created additional stress. An important
consideration is that individuals’ wellbeing can influence how
they interact and engage with their peers and colleagues (Le
Cornu, 2013).
The importance of programs for PSTs and ECTs that prioritize
wellbeing and stress management strategies are consistently cited
in research (e.g., Morris and Morris, 1980; Greer and Greer, 1992;
Lindqvist et al., 2017). In particular, this research emphasizes the
importance of providing information surrounding how stress
manifests in the body, and the long-term impact of stress; the
importance of nutrition and exercise; muscle relaxation
techniques, mentoring, and time management skills. Early
research, for example, Greer and Greer (1992) highlighted the
need for explicit professional development sessions educating
individuals on how stress manifests (physically and
psychologically) and provided techniques to counteract stress
Frontiers in Education | www.frontiersin.org
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Integrated Wellbeing and Stress Management
and mindfulness are used interchangeably. The system of yoga
includes mindfulness practices (e.g., focused attention [FA] and
open monitoring [OM] meditation) which are included in the
present study intervention. In fact, research surrounding body
awareness and mindfulness have indicated that the same
mechanisms may operate in yoga and mindfulness-based
interventions (Gard et al., 2012).
Mind-body therapies are not easily classified as either topdown or bottom-up mechanisms. Yoga and progressive muscle
relaxation (‘body scan meditation’) include both bottom-up and
top-down mechanisms, for example, peripheral sensory vessels
stimulated by visceral activities (e.g., decreased muscle tension)
and top-down mechanisms of focused attention and conscious
relaxation (Taylor et al., 2010). Importantly, initiating
bidirectional mechanisms creates reciprocal feedback and
evidence suggests “mind-body practices incorporate numerous
therapeutic effects on stress responses, including reductions in
anxiety, depression, and anger, and increased pain tolerance, selfesteem, energy levels, ability to relax, and ability to cope with
stressful situations” (Kim et al., 2013, p. 827).
An intervention for educators that includes an integrative
practice of yoga has the potential to provide a holistic approach
for promoting wellbeing. The six-factory model of psychological
wellbeing (Ryff and Singer, 1996; 2006) was adopted in the
present study. The six-factor model includes the following
dimensions:
TABLE 1 | Steps/Limbs in the system of yoga.
Limb/Step
1
2
Yama
Niyama
Focus
Description
External focus
Internal focus
Ethical approach
3
Asana
Steady posture
Postures
4
Pranayama
Expansion of energy
Breathing techniques
5
6
7
8
Pratyahara
Dharana
Dhyana
Samadhi
Sensory withdrawal
Concentration
Meditation
Self-realization
Meditation practices
training in health promotion (at university) are more likely to
engage in health promotion activities once employed as a
registered teacher (Speller et al., 2010). This supports the
argument for health promotion and wellbeing initiatives at the
pre-service level.
2.2 The System of Yoga and Dimensions of
Wellbeing
Given the extensive history of the practice of yoga, there is no one
single definition. Patanjali defines yoga as “the controlling or
stilling” (Pradhan, 2014). Modern interpretations of yoga are
drawn from Patanjali’s Sutras and the teachings from the
Bhagavad Gita (circa 600–100BCE). The Yoga Sutras are
grouped into “eight limbs” in the system of Yoga. Limbs one
through five are preparatory steps for limbs six through eight (see
Table 1). The Ethical Principles (limb one and two) yamas and
niyamas are not based on moral or value judgements or religious
connection; the aim is to regulate emotions, promote positive
social behaviours and quiet the mind (Cope, 2006), therefore
promoting emotion regulation. Asana were traditionally used to
prepare the body for
