The goal of this quasi-experimental clinical trial is to evaluate the effect of a culturally adapted, six-week resilience-building programme on psychological well-being and clinical performance in emergency nurses working in Palestinian hospitals. The main questions it aims to answer are:

Does the six-week resilience-building programme improve the psychological well-being of emergency nurses? Does the intervention enhance their Advanced Life Support (ALS) performance during a simulation-based assessment? Researchers will compare the intervention group receiving the resilience-building programme to a non-equivalent control group to see if the intervention leads to significant improvements in adaptive coping, mental health, and simulated clinical performance.

Participants will:

Participate in a six-week resilience-building programme integrating cognitive-behavioural techniques, mindfulness, stress inoculation training, and mental rehearsal (intervention group only).

Complete validated questionnaires to measure psychological well-being and resilience before and after the study period.

Complete a standardized, high-fidelity simulated scenario to assess their Advanced Life Support (ALS) clinical performance.

Emergency nurses in Palestine operate under severe clinical and contextual stressors, including prolonged political conflict, acute resource shortages, and high patient acuity. Chronic exposure to these multifaceted stressors often leads to elevated psychological distress, which not only impacts the nurses' mental health but also has the potential to impair their clinical performance in high-stakes, life-saving situations. Addressing both psychological well-being and clinical competence is critical in this high-pressure environment.

Guided by Roy's Adaptation Model, this research addresses a critical gap in the literature by evaluating a dual-outcome intervention. The study hypothesizes that by enhancing adaptive coping mechanisms, nurses will not only improve their personal psychological resilience but also maintain or improve their objective clinical performance under stress.

To achieve this, the study utilizes a quasi-experimental, non-equivalent control group pre-test/post-test design. To prevent treatment contamination between groups, allocation to either the intervention or control group is conducted at the hospital level.

The intervention consists of a culturally adapted, six-week resilience-building programme. It is specifically designed for the Palestinian context and integrates elements of cognitive-behavioural techniques, mindfulness, stress inoculation training, and mental rehearsal. The study will evaluate the programme's effectiveness by assessing changes in psychological well-being and objective clinical performance (specifically, Advanced Life Support [ALS] skills) before and after the study period. By utilizing high-fidelity simulated scenarios alongside validated psychometric tools, this study aims to provide robust, evidence-based recommendations for integrating psychological resilience training into clinical performance frameworks and nursing education.

Inclusion Criteria:

Registered nurses currently employed in the Emergency Department of the selected Palestinian hospitals.

Nurses working full-time Willingness to commit to the 6-week intervention program and complete all simulation-based assessments.

Provided written informed consent to participate in the study.

Exclusion Criteria:

• Nurses who have participated in formal resilience or stress management training programs within the past year.

Nurses currently receiving medical or psychological treatment for diagnosed mental health conditions.

Nurses with physical or medical conditions that prohibit them from performing Advanced Life Support (ALS) chest compressions during the simulation assessment.