An Enhanced 4A‑Based Stress‑Management Intervention for Nursing Students: A Randomized Controlled Comparison With a Mobile Self‑Help Program Publisher



Bakhshi F ; Fathi F ; Farajkhoda T ; Fallahfaragheh A ; Rabiei E ; Mosavi Beni SA
Source: Nurse Educator Published:2026

Abstract

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. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.