This randomized clinical trial aimed to evaluate the effectiveness of Twin Heart Meditation in reducing exam anxiety among undergraduate nursing students. The study focused on whether regular practice of this meditation technique could significantly reduce state anxiety before examinations. The main research questions were:

Does Twin Heart Meditation reduce exam-related anxiety among nursing students? Can this complementary and non-invasive method be considered a viable approach for managing academic stress? Participants were randomly assigned to either the intervention group, which practiced Twin Heart Meditation, or the control group, which followed routine academic activities. Pre- and post-intervention anxiety levels were measured using the State-Trait Anxiety Inventory (STAI).

Study Title:

The Effect of Twin Heart Meditation on Exam Anxiety of Nursing Students

Study Purpose:

The aim of this study was to investigate the efficacy of Twin Heart Meditation a mind-body relaxation technique rooted in complementary and alternative medicine in reducing exam anxiety among undergraduate nursing students. The intervention was designed in accordance with holistic nursing principles and implemented in a controlled, double-blind randomized trial setting.Sample Size Determination:

The statistical population of this study included seventh-semester nursing students enrolled in the English-language program at Near East University. Out of 120 available students, 100 who met the eligibility criteria were selected to participate.

After obtaining informed consent, the students were randomly divided into the experimental and control groups. A simple randomization technique was used: numbered cards (1 to 100) were placed in a glass container, and the numbers were drawn and assigned alternately to the two groups. This method ensured equal allocation and reduced selection bias.

Based on the findings of a similar study and the mean comparison formula, with a Type I error of 0.05 and a power of 80%, the required sample size was 48 per group. To account for a potential 5% dropout rate, 50 participants were included in each group.

To minimize bias, a double-blind design was employed. The researcher who collected the data was unaware of group assignments. Similarly, the statistician who analyzed the data was blinded to the group allocations and treated the data as variables x₁ and x₂.

Tools of Data Collection:

To address the research objectives, data were collected using the following tools:

A) Demographic questionnaire:

Collected background information including age, gender, marital status, and academic history.

B) State-Trait Anxiety Inventory (STAI):

A 40-item self-report tool measuring both state and trait anxiety, with 20 items in each subscale. Items were scored on a 4-point Likert scale. Higher scores indicated greater anxiety. The STAI has demonstrated high validity and reliability in student populations.

C) Pre- and post-intervention anxiety scoring sheet:

Completed by students in both groups one week and two hours before their final exam.

Intervention:

Experimental Group:

Participants received both theoretical and practical training in Twin Heart Meditation from a certified researcher. They practiced meditation for 30 minutes per session, at least three times over a one-week period. Sessions were guided using MP3 audio recordings and conducted under the supervision of the researcher.

The intervention included:

Physical warm-up exercises (5 minutes) Heart chakra activation Crown chakra activation Blessing the Earth with loving-kindness Silent concentration on "Amen" Gratitude expression Closing exercises (5 minutes)

Control Group:

Participants received routine academic preparation without any additional intervention.

Implementation Phase:

The study was conducted in the Nursing Department of Near East University. After explaining the study procedures, written informed consent was obtained from all participants. Students were randomly assigned to either the intervention or control group. Meditation sessions were held in a quiet room. All participants completed the STAI questionnaire before and after the intervention period.

Ethical Considerations:

The study received approval from the Near East University Ethics Review Board under the approval number NUE/2023/114-1736. It adhered to the principles of the Declaration of Helsinki (1964). Participants were informed of their right to withdraw at any time without penalty. All participants provided written informed consent. Data confidentiality was strictly maintained throughout the study.

Statistical Analysis:

All data are analyzed using SPSS version 26. Descriptive statistics (mean, standard deviation, and frequencies) are used to summarize the data. Inferential statistical methods include:

Kolmogorov-Smirnov test to assess normality Paired t-test to evaluate pre- and post-intervention changes within each group Independent t-test to compare differences between the two groups Chi-square test or Fisher's exact test for analysis of categorical variables A significance level of P < 0.05 is considered statistically significant for all analyses.

Inclusion criteria:

1. All seventh-semester undergraduate nursing students, both female and male, enrolled in the English-language program at the Department of Nursing, Near East University.
2. Students not using any other stress reduction methods, such as progressive muscle relaxation, pharmacological therapy, or similar techniques, to manage exam-related anxiety.
3. Students who voluntarily agreed to participate in the study and provided informed consent.

Exclusion criteria:

1. Doing meditation less than 3 times a week
2. Unwilling to continue cooperation in the project,
3. Using any psycho medicines (anti-depressants ...), mental health
4. Mourning, especially the death of loved ones or relatives in the 1st phase.

There is no plan to make IPD available to other researchers

Double-Blind (Investigator, Outcomes Assessor):

To minimize bias, a double-blind approach is employed. The data are collected by the researcher, who remains unaware of group assignments, and the statistician performing the analysis is also blinded to the allocation. The data are analyzed as anonymous variables (x₁ and x₂) to preserve objectivity.