Stress Coping Training for Nurses and Diabetes Control (SCT/T2MD/GLYCO)

Nurses will receive the 16-hour Psychological Stress and Coping Mechanism Training Program in four 4-hour sessions plus monthly follow-up, training manual and coping journals.

The intervention will be grounded in the Transactional Model of Stress and Coping (Lazarus and Folkman, 1984) and in Self-Efficacy Theory (Bandura, 1977). It will comprise 16 hours of face-to-face training delivered in four 4-hour sessions by the principal investigator, a registered nurse educator with training in stress management, to groups of nurses at the participating facilities.

Module 1 will address the nature of psychological stress in nursing, common stressors in diabetes care, and early signs of burnout. Module 2 will cover problem-focused and emotion-focused coping and will introduce mindfulness, relaxation, cognitive restructuring, and time-management techniques. Module 3 will examine how nurse stress may affect patient communication, adherence, self-management, and glycemic control, using case studies of nurse-patient interactions. Module 4 will focus on practical skills through role-play, simulated clinical scenarios, group problem-solving, and the use of stress logs and

Nurses will continue routine nursing care for patients with Type 2 Diabetes Mellitus without the training program. Patients will receive standard diabetes care and follow-up.

Demographic and professional characteristics collected using a researcher-designed form, including: gender, age group, marital status, educational level in nursing, years of nursing experience, job position, and nationality.

Nurses' stress will be measure with the 14-item Perceived Stress Scale (PSS- 14; Cohen et al., 1983). Items are rated from 0 (never) to 4 (very often) with reference to the past month. The seven positively worded items (perceived self-efficacy/control) will be reverse score, and all items will be sum to give a total score from 0 to 56, with higher scores indicating greater stress. Subscale scores were computed for helplessness (seven negatively worded items, 0-28) and perceived self-efficacy/control (seven positively worded items, raw scoring, 0-28; higher scores indicating greater perceived control).

Coping will be measure with the 29-item revised Ways of Coping Checklist (WCCL; Vitaliano et al., 1985), which comprises five subscales: problem-focused coping (12 items), seeking social support (3 items), self-blame (3 items), wishful thinking (6 items), and avoidance (5 items). Items are rated from 1 (not at all) to 4 (to a great extent).

Patients will be complete the 20-item Diabetes Management Self-Efficacy Scale (DMSES; van der Bijl et al., 1999), which covers blood glucose monitoring (3 items), dietary control (10 items), physical activity (3 items), foot care (1 item), and medication intake and follow-up (3 items). Items are rated from 0 (cannot do at all) to 10 (certainly can do); total scores range from 0 to 200, with higher scores indicating greater self-efficacy, and were classified as low (<120), moderate (120-149), or high (≥150).