Therapeutic knitting as a strategy to reduce anxiety in nursing students (2025)

A knitting club where students and staff got together to make hats for babies in need provided an enjoyable and meaningful experience which improved wellbeing

Introduction

Nursing students often report mild to severe anxiety and stress symptoms throughout their educational experience. Anxiety and stress are linked to a difficult curriculum and the pressure to be successful (Zheng et al, 2022). Research studies have found that nursing students experience anxiety and stress at a greater level than undergraduate students from other programmes. Continual exposure to stress and anxiety may have a bearing on students’ mental health and wellbeing (Aloufi et al, 2021).

Knitting has been cited as a therapeutic technique known to reduce anxiety (Anderson et al, 2016) and historically has been shown to “reduce chronic pain, boost mood, reduce stress, treat panic attacks, combat loneliness, boost confidence, curtail caregiver burnout and more” (Medaris Miller, 2016).

Therapeutic knitters find repetitive tactile movements using both hands, in addition to visual and emotional stimuli, producing a positive mental effect (Corkhill, 2014). Furthermore, knitting can be easily done anywhere in private and public settings. Researchers have used knitting to decrease compassion fatigue in oncology nurses and their results demonstrated a significant decrease in burnout and stressor scores of nurses, with qualitative data that supported feeling more relaxed and feelings of positivity (Anderson et al, 2016).

There is little research done on the positive effects of knitting and no research has been reported on the effects of knitting to reduce anxiety in nursing students. Nursing faculty at West Chester University in the US initiated a nursing knitting club for undergraduate nursing students to provide an opportunity for them to reduce stress and anxiety. The objectives of this club included improving students’ interaction with peers and faculty, learning a new skill (or expanding an existing skill), knitting a baby hat to be shared with our maternal-child community partners, and building a lifelong skill that has been linked to better health and wellbeing. This project offered students an opportunity to meet, knit and socialise.

Knitting intervention

The nursing knitting club offered nursing students a starter kit for knitting that included a tote bag, beginner and circular knitting needles, two balls of yarn, and a baby hat knitting pattern (Fig 1), a choice of materials, linked videos to learn knitting basics, and individualised instruction at each meeting. During the meetings, faculty members demonstrated basic stitches, displayed patterns to make baby hats, and provided guidance for knitting skills. Club objectives were developed by faculty to guide and assess club outcomes (Box 1).

Students were informed that they would be creating baby hats for a national non-profit programme. The programme’s purpose is to care for a vulnerable population, improving pregnancy, post-partum and early childhood outcomes. Recognising that mothers from vulnerable populations are at greater risk for delivering pre-term infants who have difficulty in regulating body temperature, the gift of a new handmade baby hat is one way to assist newborn babies to stay warm and educate mothers about the important care of the newborn. While this programme is meant to support our community partner, at our local health department, it is also designed to help undergraduate nursing students reduce their stress and anxiety experienced as students.

Programme results

Surveys were used to evaluate the knitting programme and included student demographics, the General Anxiety Disorder-7 (GAD-7) questionnaire, and a qualitative programme evaluation survey (PES). Demographics were collected once to assess students’ age, gender, race/ethnicity, academic level, and their knitting experience level. Of note, all participants in the nursing knitting club were identified as female (Table 1).

Data collection occurred between 24 January and 2 May 2023. Clubs were held on Wednesday afternoon between 5pm and 7pm. This allowed students to complete academic requirements during the day, and unwind in the evening during knitting club. A total of six sessions were held, and nursing students knitted their baby hats in-between sessions.

The GAD-7 is a valid and reliable measure to screen for general anxiety disorder severity, and focuses on current (within the past two weeks) anxiety severity (Spitzer et al, 2006). This data was collected at the beginning of every knitting club meeting; Table 2 shows the GAD-7 scores obtained in the first and last meeting.

The PES consists of five open-ended questions to determine students’ satisfaction with the knitting club and to assess altruistic programme outcomes. The PES was administered during the final knitting club meeting; Box 2 features a selection of the feedback obtained from the students for questions 1-4 (question 5 responses were minimal and are incorporated in the further considerations discussion later in this article).

Nursing considerations

Anxiety reduction

Knitters find that repetitive tactile movements using both hands, in addition to visual and emotional stimuli, distract the brain by creating a meditative state. The nervous system slows, resulting in reduced anxiety, cortisol release, heart rate and blood pressure (Henry Ford Health, no date). Repetitive hand movement can create a calming effect for individuals; therefore, this practice may be useful during stressful moments. Knitters often report experiencing fewer symptoms of anxiety, depression and chronic pain while knitting. Anderson and Gustavson (2016) suggested that the rhythmical motion of knitting enhances the release of serotonin, a hormone that is a naturally occurring analgesic, which leads to a perceived decrease in pain for some individuals. These physical and mental factors were evident in the knitting club feedback, as students stated focusing on the stitches allowed them to relax and eliminate anxious thoughts from their minds. After three knitting club meetings, 20% of participants reported moderate to severe anxiety levels, a decrease from 43% who reported the same anxiety levels at the first meeting.

Therapeutic innovation

Similar to previous statements regarding physical and mental therapeutic factors, needle art is also a recognised occupational therapy and has been in use since the Second World War to treat combat veterans. Knitting improves fine motor skills, and cognitive abilities by creating new pathways, or strengthening existing areas of the brain (Natalo-Lifton, 2018).

Memory and attention span are specifically noted as the two cognitive factors most associated with improved brain function resulting from knitting activity. Students expressed their love of learning a new skill, and felt overall that knitting was a good, therapeutic strategy that allowed them to focus on a project, rather than what was occurring around them.

Their experience is reflected in ‘art as therapy’ literature, which mentions therapeutic factors associated with making something, such as loss of awareness, immersive experience, and distraction through quiet focus (Desmarais, 2016). Student feedback highlights the meditative state produced while knitting. Thus, by engaging nursing students in needle art therapy, faculty were able to meet the knitting club programme goal of using knitting as a therapeutic innovation to reduce anxiety.

Socialisation and mentoring

Students developed new friendships with peers and received academic mentorship from upper-level nursing students. Club members also formed relationships with nursing faculty who provided academic and career mentorship during club meetings. Students described a positive atmosphere and community environment, which was maintained during club meetings. Establishing supportive social groups will allow students to develop relationships that assist with current challenges they experience while improving their overall wellbeing. Engaging within a knitting group enabled students to meet others in a safe, social environment to enjoy fun, easy banter and the company of others. A knitting club offered a space where students could overcome social isolation and loneliness, as they formed supportive relationships that are linked with a longer, happier and healthier life.

Service to community

Creating and donating knitted baby hats (Fig 2) to local families in need has endeared our students and faculty to our community members and nurse partners. Community nurses expressed gratitude for the hats then provided to newborns and toddlers. Additionally, students often commented on the altruism incorporated into the knitting club. They felt excited to finish their hats and send them along to a baby in need. They enjoyed working on a knitting project that was for someone else, and also aiding nurses in their mission to serve the community.

Some of the students even mentioned feeling less guilty while watching a TV programme if they were knitting at the same time. What was initially deemed as a non-productive leisure activity, suddenly became a productive activity, carrying a positive connotation, because students were making hats for someone else simultaneously.

Life skills

Self-esteem and confidence grow from seeing progress, feeling successful and being able to contribute to others. Feeling successful is empowering. Therapeutic knitting provides a portable activity. It is a life-long skill to enable one to learn, achieve and change. Knitting provides immediate visual and tactile feedback and taps into students’ creativity and is mentally stimulating. The ideal of perfection is reshaped during a knitting project, which requires flexibility, adaptation and correction – so it teaches problem solving and acceptance of imperfection. Learning how to experiment with various materials, “be messy” and flexible leads to greater satisfaction, as it removes anxiety and frustration associated with the unknown, and, therefore, builds self-efficacy (Desmarais, 2016).

One student reported, “I learned how to knit, which is a great hobby to get off my phone”. Many students noted that they enjoyed working together to accomplish a common goal. Some students provided feedback stating their varied knitting skill levels were not an issue, as they were able to help each other and less worried about perfecting their baby hats. They learned to be present with each other, without having any expectations except learning a new skill and having fun. They learned that it was OK to be imperfect and messy sometimes. Attempting to learn a new skill can provide people with creative freedom and the ability to improvise when needed (Desmarais, 2016). Through this experience, the students’ behaviours evolved, resulting in life lessons and newly gained life skills that will translate into their everyday life and future nursing career.

Further considerations

Students expressed a desire for increased frequency of meetings to help build their knitting skills, and expansion of club participation for those who were not studying nursing. Two specific factors prevented the faculty from fully meeting those requests – a lack of adequate funding to purchase additional knitting materials, and lack of enough experienced knitters to provide instruction and troubleshoot knitting errors within a large group.

Knitting materials were free to students thanks to a small grant and donated materials, but those resources were limited, and only meant to assist with programme development. To respond to the request for increased knitting time, a faculty member encouraged students to stop by her office in-between club meetings to receive one-to-one or small group knitting support. Beginner knitters regularly visited her office for basic skill support, but this created a burden for that faculty member. Solutions to these identified issues are being explored and include training additional faculty members so they can teach basic knitting skills, and identifying funding sources to ensure programme sustainability.

This study was a pilot study designed to explore initial trends and feasibility, providing preliminary data that offered insights into the potential impact of knitting on anxiety in nursing students. The findings from this phase will inform necessary refinements and guide the development of a more comprehensive study. Based on these results, we plan to continue research with a larger sample size and expanded methodology to validate and extend our initial conclusions.

Conclusion

The knitting club provided nursing students with a unique, creative outlet that reduced their anxiety levels. The calming nature of knitting helped students manage stress, promoting a sense of relaxation and wellbeing. Additionally, the club fostered stronger peer relationships, as students bonded over shared interests and supported each other. The inclusive environment also facilitated meaningful interactions between students and nursing faculty.