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. 2023 May 12;2023(5):CD002892. doi: 10.1002/14651858.CD002892.pub6

Dincer 2021.

Study characteristics
Methods Study design: randomised controlled trial
Study grouping: parallel group
Participants Baseline characteristics
Emotional Freedom Techniques
  • Age (mean ± SD): 33.5 ± 9.8

  • Sex (N (% female)): 32 (91%)

  • Sample size: 35

  • Years of experience (mean ± SD): NR


Control (wait list)
  • Age (mean ± SD): 33.4 ± 9.6

  • Sex (N (% female)): 32 (87%)

  • Sample size: 37

  • Years of experience (mean ± SD): NR


Overall
  • Age (mean ± SD): 33.5 ± 9.6

  • Sex (N (% female)): 64 (89%)

  • Sample size: 72

  • Years of experience (mean ± SD): NR


Included criteria: nurses caring for COVID‐19 patients. Inclusion criteria were: a) not having any psychiatric diagnoses, b) not taking any courses about coping with anxiety and stress, and c) volunteering to participate in the study
Excluded criteria: NR
Pretreatment: no statistically significant pre‐intervention differences were found between the groups on demographic variables. The pre‐test stress level, anxiety level and the burn‐out score did not differ significantly between the groups.
Compliance rate: five of the 40 participants did not attend the EFT sessions (13%)
Response rate: 100%
Type of healthcare worker: exclusively nurses caring for COVID‐19 patients
Interventions Intervention characteristics
Emotional Freedom Techniques
  • Type of the intervention: Intervention type 2 ‐ to focus one’s attention away from the experience of stress

  • Description of the intervention: Each 5‐person group began by having the participants complete the pre‐test SUD, the STAI‐I, and the burnout scale via SurveyMonkey. EFT was applied to each group of nurses in a single session of approximately 20 min. At the end of the session, participants again completed the post‐test SUD, the STAI‐I, and the burn‐out scale The EFT session began by presenting the participants with a picture of the acupressure points (Fig. 2) and showing them how to gently tap on them using their index and middle fingers. After this demonstration, the participants followed the basic steps of an EFT session, following the researcher’s example:

  1. Identify an anxiety‐evoking issue and determine the SUD level.

  2. Creating a personal acceptance and reminder statement in the general form of "I accept myself despite this.........."

  3. Tapping seven times on each acupressure point shown in Fig. 2.

  4. After tapping these points, the affirmation/reminder statement is repeated.

  5.  A sequence of physical movements and vocalisations called“The Nine Gamut Procedure” is carried out.

  6. Steps 3 and 4 are repeated.

  7. Another SUD rating is given.

  • The number of sessions: 1

  • Duration of each session on average: 20 min

  • Duration of the entire intervention: 20 min

  • Duration of the entire intervention short vs long: Short

  • Intervention deliverer: First author certified in Emotional Freedom Techniques

  • Intervention form: Online group


Control (wait list)
  • Type of the intervention: control

  • Description of the intervention: participants in the control group were asked to stay comfortable in a calm and tranquil environment for the next 15 min.

  • The number of sessions: 1

  • Duration of each session on average: 15 min

  • Duration of the entire intervention: 15 min

  • Duration of the entire intervention short vs long: short

  • Intervention deliverer: NR

  • Intervention form: NR

Outcomes State Anxiety Scale
  • Outcome type: Continuous Outcome


The Burnout Scale
  • Outcome type: Continuous Outcome


Subjective Units of Distress Scale
  • Outcome type: Continuous Outcome

Identification Sponsorship source: This research was not funded.
Country: Turkey
Setting: A university hospital
Comments: NR
Authors name: Berna Dincer
Institution: Department of Internal Medicine Nursing, Faculty of Health Science, Istanbul Medeniyet University, Istanbul, Turkey
Email: berna.dincer@medeniyet.edu.tr
Address: 38, Tıbbiye Street, Istanbul, Uskudar 34668, Istanbul, Turkey
Time period: 2020
Notes Subjective Units of Distress Scale included in analysis 2.1
STAI included in analysis 2.3
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Eighty nurses who met the inclusion criteria were assigned to groups using an online random number generator.
Allocation concealment (selection bias) Unclear risk Insufficient information to understand whether intervention allocations could have been foreseen in advance of, during, enrolment.
Blinding of participants and personnel (performance bias)
All outcomes High risk Quote: "After completing the Descriptive Characteristics Form online, a time for the meeting was determined in collaboration with the participants in each subgroup. They were also asked to stay comfortable in as calm and tranquil an environment as possible during the session. The EFT treatment was provided by the first author, who was certified in EFT. Each 5‐person group began by having the participants complete the pre‐test SUD, the STAI‐I, and the burnout scale via SurveyMonkey."
Participants were not blinded. Baseline questionnaire filled in after randomisation.
Blinding of outcome assessment (detection bias)
All outcomes High risk Quote: "The analysis was conducted by a researcher who was blind to group assignment."
Participants were not blinded whereas outcomes were self‐reported.
Incomplete outcome data (attrition bias)
All outcomes Low risk 10% lost‐to‐follow‐up however unknown whether this was at random however loss to follow‐up is below our pre‐defined cut‐off point.
Selective reporting (reporting bias) High risk No intention to tread analysis. Participants randomised to the intervention group that did not attend the EFT session (n = 5) were excluded.
Other bias Low risk No indication of other sources of bias