The purpose of this randomized controlled trial is to evaluate the effects of a connection-enhancement program on resilience, perceived stress, burnout, and intention to stay among newly employed Generation Z nurses in a military hospital. Approximately 80 eligible nurses will be randomly assigned to either an intervention group or a control group. The control group will receive conventional orientation education for newly employed nurses, whereas the intervention group will receive the connection-enhancement program in addition to conventional orientation education. The intervention will be delivered over four weeks, with one 50-60-minute session per week. Outcomes will be assessed before and after the intervention using self-reported questionnaires and salivary cortisol measurements.
Nurses play a critical role in frontline healthcare and directly contribute to the quality of patient care. Newly employed nurses, however, may experience considerable stress during the transition into professional clinical practice. Developing supportive interventions that facilitate workplace adaptation, strengthen resilience, reduce stress and burnout, and promote intention to stay is therefore important for supporting the well-being and professional development of newly employed nurses. This study is a randomized controlled trial designed to develop and evaluate a connection-enhancement program for newly employed Generation Z nurses working in a military hospital. Approximately 80 eligible nurses will be recruited and randomly assigned to an intervention group or a control group. Participants in the control group will receive conventional orientation education for newly employed nurses. Participants in the intervention group will receive conventional orientation education plus the connection-enhancement program. The connection-enhancement program is a four-week intervention designed according to characteristics and needs of Generation Z nurses. The program incorporates technology-assisted learning and emphasizes interpersonal connection, relationship building, resilience, emotional awareness, self-compassion, stress management, and workplace adaptation. The intervention will be delivered by trained research personnel once weekly for approximately 50-60 minutes per session. Sessions may be conducted individually or in groups depending on clinical circumstances and will incorporate presentations, multimedia materials, guided exercises, case-based activities, reflection, and brief discussions. The first session, "Workplace Adaptation and Stress Awareness for Newly Employed Nurses," focuses on common sources of workplace stress, transition into the professional nursing role, psychological safety, recognition of psychological and physical responses to stress, and basic stress-management concepts. The second session, "Emotional Awareness and Mindfulness-Based Regulation," introduces emotional awareness and emotion-regulation concepts through multimedia materials and presentations. Participants will also engage in brief mindfulness breathing exercises to enhance awareness of their emotional and physical responses and develop strategies for regulating emotions in stressful situations. The third session, "Self-Support, Psychological Resilience, and Team Connection," introduces concepts of self-compassion and self-care and uses guided reflection to facilitate positive self-talk and self-support. Participants will learn about psychological resilience and coping strategies, identify support resources that may be used in clinical practice, and develop listening skills to strengthen interpersonal and team connections. The fourth session, "Physical and Psychological Relaxation and Adaptation to Shift Work," introduces relaxation techniques, including progressive muscle relaxation and breathing exercises, to facilitate rapid physical and psychological regulation during stressful situations. Strategies related to circadian rhythm adjustment, sleep, and adaptation to shift work will also be discussed. Experiences shared by senior nurses will be incorporated to help participants understand strategies for adapting to shift work. The session will conclude with a review of the program and participant feedback. Workplace scenarios and clinical experiences provided by the research team or experienced nurses will be incorporated into the program to facilitate participants' understanding of common workplace stressors and coping strategies. Participants may voluntarily share their own experiences but will not be required to disclose personal information. Study outcomes will be assessed before and after the intervention. Participants will complete online questionnaires assessing psychological resilience, perceived stress, nurse burnout, self-compassion, professional commitment, and self-efficacy, along with demographic information. Salivary cortisol will also be collected as a physiological measure. Saliva samples will be collected between 8:00 AM and 10:00 AM using a disposable saliva collection device. Participants will be instructed to brush their teeth or rinse their mouths beforehand and to refrain from eating or drinking, particularly caffeinated beverages, for one hour before sample collection. The study will evaluate whether the connection-enhancement program improves resilience and related psychological and occupational outcomes among newly employed Generation Z nurses and will provide evidence regarding its potential application as a supportive intervention for newly employed nurses in military hospital settings.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE
Enrollment
80
The Connection-Enhancement Program is a 4-week intervention for newly employed Generation Z nurses, delivered by trained research personnel in weekly 50-60-minute sessions. The programme uses presentations, multimedia materials, guided exercises, and brief discussions. Week 1 addresses workplace adaptation, stress awareness, role transition, and psychological safety; Week 2 focuses on resilience, relaxation techniques, and self-care; Week 3 addresses emotional awareness, emotion regulation, and mindfulness-based breathing; and Week 4 focuses on self-compassion, resilience, coping strategies, support resources, and active listening skills. Workplace-based scenarios and experiences shared by experienced nurses are integrated throughout the program to strengthen participants' understanding of workplace stress and practical coping strategies.
Participants in the control group will receive conventional orientation education for newly employed nurses provided by the hospital. They will not receive the Connection-Enhancement Program during the study intervention period.
Change in Resilience
Resilience will be assessed using the 29-item Chinese version of the Resilience Scale, which comprises five domains: personal strength, family cohesion, social resources, social competence, and structured style. Total scores range from 0 to 203, with higher scores indicating greater resilience.
Time frame: At baseline (before intervention) and immediately after the 4-week intervention.
Change in Perceived Stress
Perceived stress will be assessed using the 14-item Perceived Stress Scale (PSS). Each item is rated on a 5-point Likert scale ranging from 0 (never) to 4 (always), with selected items reverse-scored. Total scores range from 0 to 56, with higher scores indicating greater perceived stress.
Time frame: At baseline (before intervention) and immediately after the 4-week intervention.
Change in Burnout
Burnout will be assessed using the 19-item Taiwanese Nurse Burnout Scale (TNBS), which comprises five domains: workload, workplace support, family relationships, work ability, and nursing identity. Items are rated on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree), with higher scores indicating greater burnout.
Time frame: At baseline (before intervention) and immediately after the 4-week intervention.
Change in Intention to Stay
Intention to stay will be assessed using the 19-item Nurses' Professional Commitment Scale, which comprises three domains: professional identity, professional involvement, and professional withdrawal. Items are rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree), with higher scores indicating greater professional commitment.
Time frame: At baseline (before intervention) and immediately after the 4-week intervention.
Change in Self-Compassion
Self-compassion will be assessed using the 26-item Taiwanese version of the Self-Compassion Scale (SCS), comprising six domains: self-kindness, common humanity, mindfulness, self-judgment, isolation, and over-identification. Items are rated on a 5-point Likert scale ranging from 1 (almost never) to 5 (almost always). Negative domains are reverse-scored, and the total score is calculated as the mean of all items. Higher scores indicate greater self-compassion.
Time frame: At baseline (before intervention) and immediately after the 4-week intervention.
Change in Self-Efficacy
General self-efficacy will be assessed using the 10-item Chinese version of the General Self-Efficacy Scale (GSES). Each item is rated on a 4-point Likert scale ranging from 1 (not at all true) to 4 (exactly true). Total scores range from 10 to 40, with higher scores indicating greater general self-efficacy.
Time frame: At baseline (before intervention) and immediately after the 4-week intervention.
Change in Salivary Cortisol Level
Salivary cortisol will be assessed as a physiological indicator of stress using a noninvasive point-of-care salivary analysis device. The measurement range is 1.25-40 nM, with higher cortisol levels indicating greater physiological stress. Saliva samples will be collected between 8:00 AM and 10:00 AM to account for diurnal variation in cortisol levels.
Time frame: At baseline (before intervention) and immediately after the 4-week intervention.
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