Write to heal: the impact of an expressive writing intervention on stress in first-year nursing students

Background: First-year nursing students often face high stress and challenges in adjusting to academic and social demands, which can negatively affect their psychological well-being and academic performance. Expressive writing, a brief therapeutic approach encouraging reflection on personal thoughts and emotions, has shown promise in reducing stress and enhancing college adjustment. Aim: To evaluate the effectiveness of an expressive writing intervention in reducing stress and improving college adjustment among first-year nursing students in a multicultural higher education setting. Methods: A quasi-experimental, controlled pre-test–post-test design was conducted at the College of Nursing, Ras Al Khaimah Medical and Health Sciences University, UAE, during the 2023–2024 academic year. Sixty first-year nursing students were recruited via purposive sampling and assigned to an intervention group (n = 30) or control group (n = 30). The intervention group participated in four consecutive daily 15-minute expressive writing sessions addressing academic stress, exams, expectations, and college life. Stress and college adjustment were assessed at baseline, immediately post-intervention, and at one- and three-month follow-ups using a modified Student Stress Inventory and adjustment to college scale. The control group received no intervention. Results: Both groups were comparable at baseline (overall stress: intervention 92.1 ± 13.7 vs. control 91.5 ± 12.9, p > 0.05). Post-intervention, the intervention group showed significant reductions in overall stress at immediate (100.96 ± 17.31 vs. 137.46 ± 7.11), one-month (90.06 ± 15.93 vs. 144.96 ± 7.57), and three-month follow-ups (82.70 ± 20.22 vs. 143.06 ± 8.64; all p < 0.001) compared to the control group. College adjustment scores significantly improved in the intervention group at immediate (2.93 ± 0.52 vs. 1.90 ± 0.71), one-month (3.03 ± 0.61 vs. 1.56 ± 0.67), and three-month assessments (3.16 ± 0.53 vs. 1.83 ± 0.69; all p < 0.001). Conclusion: Expressive writing is a simple, low-cost strategy that can meaningfully reduce stress and help first-year nursing students adjust to college life. Beyond measurable outcomes, it offers students a safe space to reflect on personal challenges, promoting self-awareness, emotional resilience, and a more positive academic experience. Incorporating expressive writing into orientation programs or student wellness initiatives may empower students to navigate stress more effectively while fostering a supportive educational environment. Clinical trial number: Not applicable.