Exploring a metacognitive approach for case analysis based learning of anxiety adjustment in nurses: a qualitative study

OBJECTIVES: This study aimed to investigate the effectiveness of a metacognitive learning program in enhancing nurses’ anxiety adjustment skills. METHODS: A qualitative exploratory study was conducted using semi-structured individual interviews with Japanese nurses who participated in a metacognitive learning program at Keio University Hospital. The program included a 90-minute classroom workshop followed by five online reflection sessions over three months. Participants were selected through purposive sampling, targeting those with at least four years of oncology nursing experience. Of the nine program participants, five met the inclusion criteria and consented to participate. Data were recorded and interviews transcribed three months post-program completion and analyzed using “Steps for Coding and Theorization.” RESULTS: Two main themes emerged from the analysis. The first theme, “Development of Metacognitive Understanding,” highlighted the participants' progress in comprehending metacognition through structured exercises and reflection. The second theme, “Cultivating Anxiety Adjustment Skills through Metacognition,” revealed improvements in coping with anxiety, including increased selfawareness, proactive strategies, and the application of metacognitive techniques in clinical practice. CONCLUSIONS: This study found that metacognitive approaches could promote anxiety adjustment skills among nurses. Using learning scaffolds and reflecting on personal experiences, nurses could strengthen their metacognitive skills to adjust anxiety. These findings suggest that incorporating metacognitive approaches in nursing education could be beneficial. Future research should explore this approach in diverse clinical settings to generalize the results and examine the long-term impacts on nurses' anxiety management.