Aim: This study was conducted to evaluate the effect of Emotional Freedom Technique (EFT) on the state exam anxiety levels of nursing students.

Background: Exam anxiety is a common problem among nursing students. EFT has emerged as a complementary method to reduce exam anxiety. However, experimental studies on this subject are limited in the literature.

Design: Randomized controlled trial design.

Methods: This study was carried out with second-year students enrolled in the Surgical Nursing course at the Faculty of Nursing of a state university. Participants were assigned to intervention and control groups using simple random sampling. One hour before the exam, all students were present in the exam hall. While the intervention group received EFT, the control group was given free time. Data were collected using the State Test Anxiety Scale (STAS) and the Subjective Units of Distress Scale (SUD). Descriptive statistics, normality tests (Shapiro-Wilk/Kolmogorov-Smirnov), independent and paired samples t-test, Mann-Whitney U test, Wilcoxon test, and two-way mixed ANOVA were used for data analysis. The significance level was set at p<0.05.

Outcomes: There were no significant differences between the groups in the pre-test STAS total and subscale scores or SUD scores. However, post-test results revealed statistically significant differences between the intervention and control groups in all measurements (p<0.05), with effect sizes ranging from medium to large. The time and group-time interaction effects for STAS total and subscale scores and SUD scores were also significant (p<0.05), and the effect size of the change over time was determined to be large (η² > 0.14).

Conclusion: This study demonstrated that EFT is effective in reducing exam anxiety among nursing students. EFT should be considered a complementary intervention in managing exam anxiety. It is recommended that EFT be integrated into the support services provided to students prior to examinations.

Test anxiety is a set of phenomenological, physiological, and behavioral responses that accompany anxiety about possible negative outcomes or failure in an exam or assessment situation. Test anxiety is a form of situational anxiety and is an important factor affecting students' health and academic performance throughout their educational journey. It is stated in the literature that students' past experiences and beliefs, family attitudes, perceptions about course load, and time management skills can have an impact on test anxiety.

It is emphasized that low levels of anxiety support creativity and development in students, while high levels of anxiety can cause emotional and physiological arousal, leading to significant limiting behaviors such as excessive restlessness and anxiety.

It is stated that anxious students are easily distracted during exams and have difficulty understanding instructions. The severity of exam anxiety in students can reach clinical dimensions and negatively affect daily life, the educational process and career advancement . In the literature, it is stated that exam anxiety is associated with a number of negative variables such as increased risk of anxiety and depression in later life, difficulties in participating in teaching content, lack of attention, shorter concentration periods, decreased learning problems, low exam performance and decrease in academic achievement. Studies specifically link test anxiety to academic success and show that high test anxiety leads to a decrease in academic success. Nursing students also encounter various stressful situations throughout their academic journey.

Nursing education includes both theoretical and practical teaching processes, and this curriculum includes intense course loads, rigorous exams, and pressure to achieve a high GPA in a competitive environment. Clinical education, in which skill development is especially assessed, stands out as one of the first steps in acquiring professional skills and creates a significant source of stress and anxiety in nursing students, becoming a situation that needs to be managed. In the literature, it is stated that the test anxiety experienced by nursing students worldwide is one of the most important problems that prevent the acquisition of professional skills, and it is reported that 50% to 100% of nursing students experience test anxiety at least once during their undergraduate education. Therefore, there is a need for effective therapeutic interventions using complementary methods to reduce the negative effects of exam anxiety among nursing students. When the studies are examined, it is seen that many methods such as hand massage, music therapy, aromatherapy, auriculotherapy, gum chewing, trust training, coping program, animal-assisted intervention, guided imagery, expressive writing, mindfulness exercises, relaxation with cognitive behavioral methods are used to reduce exam anxietyç. It is known that another method used in the management of exam anxiety is the Emotional Freedom Technique (EFT).

EFT is an evidence-based therapeutic method that combines cognitive reframing and exposure therapies with light tapping on acupuncture points (acupressure) to induce relaxation. This method, which involves touching specific acupressure points while focusing on emotional concerns, stimulates the body's energy meridians to promote relaxation. EFT, which has a mechanism of action that alters emotional responses through limbic pathways by reactivating disturbing memories or triggers and allows the release of intense emotional experiences, is used to improve an individual's negative emotions and manage associated emotional and physical disorders. In the literature, EFT has been shown to be effective on depression, phobias, post-traumatic stress disorder, pain, insomnia, autoimmune diseases, professional performance, sports performance, anxiety, and exam anxiety. EFT studies on students show that this technique has a very therapeutic effect in overcoming anxiety and student motivation problems. Many other studies have also found that EFT significantly reduces exam anxiety in nursing students who receive clinical and theoretical training with an intensive curriculum.

As a self-help tool, EFT is easy to learn and apply, provides effective results in a short time and has been proven to reduce exam anxiety. EFT and exam anxiety have been studied limitedly internationally and two studies on this subject have been found at the national level. In this direction, this study aims to contribute to the literature by evaluating the effect of EFT on exam anxiety in nursing students. Surgical Diseases Nursing course is one of the basic courses given in the second year of nursing education, including theoretical and clinical components. The academic success of students in this course is decisive in terms of the quality of nursing education. Therefore, as a surgical nursing instructor, it is thought that reducing exam anxiety will positively affect student success. This study also aims to increase student success through anxiety management.

Inclusion Criteria:

• Volunteers to participate in the study • Qualified to take the final exam of the Surgical Diseases Nursing course

Exclusion Criteria:

• Refusing to participate in the study
• Receiving psychiatric treatment/receiving psychological support
• Failing the Surgical Diseases Nursing course application

Removal criteria

• A student who did not take the course exam due to illness, delay, or similar reasons
• Someone who wishes to withdraw from the study during the implementation phase after having agreed to participate.

Participants' personal information will not be shared. Demographic data and scale scores included in the statistical analysis are being considered for sharing.

2 years from the article publication

In case of a request for research purposes, the researcher will be directed to the drive link provided by SF.

To prevent assignment bias in the study, blocks will be created by a statistician. The letters representing the experimental and control groups (A and B) will be determined by drawing lots. Because the researcher must have students administer the EFT one-on-one, blinding will not be possible during the application. After determining the students who meet the inclusion criteria and provide informed consent for assignment to groups (assignment blinding), researcher MK, who will be administering the EFT, will be notified by researcher SF. Students will not be informed of their group placement. After data collection, the groups will be coded as A and B in the dataset created by the researcher, and the codes will not be disclosed to the statistician conducting the analyses before reporting (blind technique).