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

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.