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Published on: January 22, 2018
An Enhanced 4A‑Based Stress‑Management Intervention for Nursing Students: A Randomized Controlled Comparison With a
Fatemeh Bakhshi1, Fatemeh Fathi, Tahmineh Farajkhoda
1Author Affiliations: Research Center for Nursing and Midwifery Care, Department of Nursing, School of Nursing and Midwifery, Comprehensive Research Institute for Maternal and Child Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran (Dr Bakhshi); Student Research Committee, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran (Mrs Fathi and Mr Fallahfaragheh); Research Center for Nursing and Midwifery Care, Department of Midwifery, School of Nursing and Midwifery, Comprehensive Research Institute for Maternal and Child Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran (Dr Farajkhoda); Research Center for Nursing and Midwifery Care, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran (Miss Rabiei); and School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran (Miss Mosavi Beni).
Background:
Nursing students frequently experience high levels of clinical stress, which can impair learning, reduce clinical competence, and hinder the development of self-efficacy and professional identity. Structured stress-management approaches may support student well-being.
Purpose:
In this study, we aimed to compare the effects of an adapted 4A-based stress-management intervention with a mobile self-help program on clinical stress, clinical self-efficacy, and professional identity.
Methods:
A parallel randomized controlled trial was conducted with 105 undergraduate nursing students. Participants received either a 4A-based, in-person, 5-week intervention using a peer-teaching design or a 5-week mobile self-help program. Outcomes were measured at baseline and 4 weeks after the intervention.
Results:
The 4A-based intervention produced greater reductions in clinical stress and higher clinical self-efficacy at post-test compared with the mobile program. Neither intervention significantly improved professional identity.
Conclusions:
The adapted 4A-based intervention was more effective than the mobile self-help program, supporting the value of structured, facilitator-led stress-management training in nursing education.
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