Before the intervention, eligible midwifery students who agreed to participate were informed verbally and in writing, and completed the Informed Consent Form, The Participant Information Form, Perceived Stress Scale, and Scale of Attitudes Towards Learning (pre-test). Forms were distributed by a department assistant not involved in the study.

During the first two weeks, students in the intervention group received individual 45-minute etamine (cross-stitch) training in the clinical skills laboratory, including introduction to materials and basic techniques, followed by practice of simple patterns.

Students continued etamine practice for six weeks (12 sessions, 45 minutes each). Six weeks later, all students received episiotomy education (2-hour theory by the researcher and 6-hour practical training by two independent instructors). Students practiced suturing on a model and were evaluated

Control group students completed the Informed Consent Form, The Participant Information Form, Perceived Stress Scale, and Scale of Attitudes Towards Learning (pre-test) distributed by a department assistant not involved in the study, while the researcher was absent. Students did not receive etamine training. Six weeks later, all students received 2-hour theory and 6-hour practical episiotomy training by the researcher and two independent instructors. Groups of ~20 students received 1-hour suturing training, then practiced and were assessed in separate rooms by blinded instructors using the Episiotomy Repair Skill Form (post-test). Final evaluations included the Perceived Stress Scale and Scale of Attitudes Towards Learning (post-test). After the study, etamine training was optionally offered to ensure equal skill opportunities.

Before the intervention, eligible midwifery students who agreed to participate were informed verbally and in writing, and completed the Informed Consent Form, The Participant Information Form, Perceived Stress Scale, and Scale of Attitudes Towards Learning (pre-test). Forms were distributed by a department assistant not involved in the study. During the first two weeks, students in the intervention group received individual 45-minute etamine (cross-stitch) training in the clinical skills laboratory, including introduction to materials and basic techniques, followed by practice of simple patterns. Students continued etamine practice for six weeks (12 sessions, 45 minutes each). Six weeks later, all students received episiotomy education (2-hour theory by the researcher and 6-hour practical training by two independent instructors). Students practiced suturing on a model and were evaluated

The form, which was developed by the researcher by scanning the literature and obtaining expert opinions, consists of 16 questions. It will be evaluated under four headings. It consists of "Selection and use of suture material (3 questions)", "Suture Technique and Application (8 questions)", "Equal and Proper Placement of Sutures (2 questions)", "Aesthetic and Functional Results (3 questions)". The steps in the skill form were examined by midwifery faculty members who are experts in the field and finalized. The evaluation form includes the following options: "1. Needs improvement: The step is not applied at all, applied incorrectly or not applied in order, 2. Sufficient: The step is applied correctly and in order, but there are deficiencies and/or the help of the trainer is needed, 3. Mastered: The step is applied correctly and in order without pausing and needing help." High scores obtained from the form indicate good skill.

The Perceived Stress Scale (PSS-10), developed by Cohen et al. (1983) and adapted to Turkish by Kaya et al. (2019), consists of 10 items rated on a five-point Likert scale (0-4). Items 4, 5, 7, and 8 are reverse-scored. Scores of 0-13 indicate low, 14-26 moderate, and 27-40 high stress. Cronbach's alpha for self-efficacy and helplessness subscales were 0.68 and 0.85, respectively. The scale was used to assess how stress in the lab setting affects students' skill performance and reflects clinical stress. The lab is a preparatory stage for clinical practice, making stress measurement here significant. Literature shows that lab stress can impact students' skills (Duffy et al., 2021), and tasks requiring fine motor skills like etamine may also influence stress in competitive environments (Ferrara, 2022). Therefore, the PSS will evaluate both lab stress and etamine's impact, contributing valuable insights into skill performance and preparedness.

The scale was developed by Kara (2010) to measure students' attitudes towards learning. It includes 40 items and four sub-dimensions: Nature of Learning (7 items), Anxiety About Learning (13 items), Expectations About Learning (9 items), and Openness to Learning (11 items). It uses a 5-point Likert scale: 1 (Strongly Disagree) to 5 (Strongly Agree). Subscale score ranges are: Nature of Learning (7-35), Anxiety (13-65), Expectations (9-45), and Openness (11-55). The scale provides insights into how students perceive and approach learning. Cronbach's alpha was calculated as 0.73, indicating acceptable reliability (Kara, 2010). It is suitable for assessing both positive and negative attitudes related to the learning process in educational research.

The Perceived Stress Scale (PSS-10), developed by Cohen et al. (1983) and adapted to Turkish by Kaya et al. (2019), consists of 10 items rated on a five-point Likert scale (0-4). Items 4, 5, 7, and 8 are reverse-scored. Scores of 0-13 indicate low, 14-26 moderate, and 27-40 high stress. Cronbach's alpha for self-efficacy and helplessness subscales were 0.68 and 0.85, respectively. The scale was used to assess how stress in the lab setting affects students' skill performance and reflects clinical stress. The lab is a preparatory stage for clinical practice, making stress measurement here significant. Literature shows that lab stress can impact students' skills (Duffy et al., 2021), and tasks requiring fine motor skills like etamine may also influence stress in competitive environments (Ferrara, 2022). Therefore, the PSS will evaluate both lab stress and etamine's impact, contributing valuable insights into skill performance and preparedness.