Expressive Writing on Stress-Related and Work-Related Outcomes Among Chinese Nursing Interns

Effects of Expressive Writing on Stress-Related and Work-Related Outcomes Among Chinese Nursing Interns: a Randomized Controlled Trial

The goal of this interventional study is to assess the effects of an intervention on stress-related and work-related outcomes among Chinese nursing interns. The main questions it aims to answer are:

• Does expressive writing reduce clinical practice stress and improve coping strategies in nursing interns?
• Does expressive writing increase work engagement and perceived professional benefit among nursing interns?

Participants in the intervention group and control group will perform expressive writing and neutral writing, respectively, based on different given instructions. In both groups, writing will last for 10-15 minutes each time, twice a week, for nine weeks.

Researchers will compare the outcomes of the two groups to see if there are differences between clinical practice stress, coping strategies, work engagement, and perceived professional benefit.

Study Overview

• Status: Completed
• Conditions: Stress, Psychological
• Intervention / Treatment: Other: Neutral writing; Other: Expressive writing

• Study Type: Interventional
• Enrollment (Actual): 52
• Phase: Not Applicable

Contacts and Locations

Study Locations

• China
  • Shanxi
    • Changzhi, Shanxi, China
      • Changzhi Medical College

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Undergraduate nursing interns in their first clinical internship (had no prior clinical practice experience)
• Be willing to fill in questionnaires and write according to the assigned writing prompts
• Never participated in writing therapy or stress management intervention programs

Exclusion Criteria:

• Refusal to participate
• Severe current psychological conditions
• Undergoing any form of psychotherapy
• With a habit of keeping diaries

Withdrawal criteria:

• Termination of internship for whatever reason
• Not submit writing materials twice

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: intervention group	Other: Expressive writing; According to the writing prompts, online expressive writing focuses on stressful events and will be conducted twice a week (every Monday and Thursday) for 10-15 minutes each time, lasting for nine weeks. Writing prompts are developed based on Emotional Processing Theory (EPT) and Cognitive Adaptation Theory (CAT).
Sham Comparator: control group	Other: Neutral writing; According to the writing prompts, online neutral writing focuses on immediate surroundings and will be conducted twice a week (every Monday and Thursday) for 15 minutes each time, lasting for ten weeks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean Change from Baseline in Clinical Practice Stress Scores on the Stress Rating Scale for Nursing Interns in Practice at 9 Weeks, 11 Weeks and 13 Weeks	The scale consists of 6 dimensions and 37 entries, including the nature of work, workload, preparation for an internship, interpersonal relationships, work support, and learning and work impulse. The scale rates on a 4-point Likert scale, with no stress, mild stress, moderate stress, and severe stress, assigned a score of 0, 1, 2, and 3, respectively, and the higher the score, the greater the stress.	At baseline, post-intervention at Week 9, 11-week and 13-week follow-ups.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean Change from Baseline in Positive and Negative Coping Style Scores on the Brief Coping Style Scale at 9 Weeks, 11 Weeks and 13 Weeks	The scale consists of two dimensions, positive and negative coping, with 20 entries. A 4-point Likert scale is used, with 1-4 indicating "not used" to "often used". Positive coping has 12 entries, and negative coping has 8 entries, with higher scores indicating more frequent use of coping strategies.	At baseline, post-intervention at Week 9, 11-week and 13-week follow-ups.
Mean Change from Baseline in Work Engagement Scores on the Utrecht Work Engagement Scale at 9 Weeks, 11 Weeks and 13 Weeks	The scale consists of 3 dimensions: vitality, dedication, and concentration, comprising 15 entries. A 7-point Likert scale is used, with scores ranging from 0-6 for "never," "almost never," "rarely," "sometimes," "often," "frequently," and "always." The total score is the sum of the scores of each entry. An average entry score of 4 or more is defined as a high level of work engagement, 2-4 as a moderate level, and less than 2 as a low level of work engagement.	At baseline, post-intervention at Week 9, 11-week and 13-week follow-ups.
Mean Change from Baseline in Perceived Professional Benefits Scores on the Perceived Professional Benefits Scale at 9 Weeks, 11 Weeks and 13 Weeks	The scale consists of 7 items of positive career sense, 6 items of good nurse-patient relationship, 6 items of sense of belonging to the team, 8 items of self-growth, and 6 items of identification with friends and relatives, totaling 33 items in 5 dimensions, and each item is scored 1 to 5 on a 5-point Likert scale ranging from "strongly disagree" to "strongly agree. The higher the score, the stronger the perceived professional benefit.	At baseline, post-intervention at Week 9, 11-week and 13-week follow-ups.

Collaborators and Investigators

• Sponsor: Changzhi Medical College
• Investigators: Principal Investigator: XUAN JI, Changzhi Medical College

Study record dates

Study Major Dates

• Study Start (Actual): July 15, 2024
• Primary Completion (Actual): October 13, 2024
• Study Completion (Actual): October 13, 2024

Study Registration Dates

• First Submitted: January 24, 2024
• First Submitted That Met QC Criteria: January 31, 2024
• First Posted (Actual): February 2, 2024

Study Record Updates

• Last Update Posted (Actual): March 25, 2026
• Last Update Submitted That Met QC Criteria: March 21, 2026
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Behavioral Symptoms; Behavior; Stress, Psychological
• Other Study ID Numbers: RT2023047

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Individual deidentified participant data underlying the results reported in this article, including demographic information and outcome measures, will be shared.
• IPD Sharing Time Frame: The data will be available beginning one month after manuscript acceptance and will remain accessible for three years thereafter.
• IPD Sharing Access Criteria: The data will be shared with researchers who submit a methodologically sound research proposal for non-commercial academic purposes. Requests should be submitted to the corresponding author, and approved requestors will be required to sign a data use agreement prior to data access.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; ANALYTIC_CODE; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No