The effect of cross-stitch (Etamin) processing practice on midwifery students' episiotomy repair application skills, perceived stress and learning attitude: a randomized controlled study

Background: Episiotomy repair training in midwifery education requires fine motor skills, yet evidence on artistic pre-interventions remains limited. Aim: This randomized controlled trial was conducted to evaluate the effect of cross-stitch (etamin) on midwifery students' episiotomy repair skills, perceived stress, and attitudes toward learning. Methods: Data were collected from 110 third-year midwifery students at a state university (intervention = 58; control = 52). The Participant Information Form, Episiotomy Repair Skill Form, Perceived Stress Scale, and Scale of Attitudes Toward Learning were used. The intervention group completed 12 cross-stitch sessions over six weeks, while no intervention was applied to the control group. In week seven, both groups received theoretical and practical training on episiotomy. Data were analyzed using chi-square and independent t-tests. Findings: The mean age of the students was 20.86±1.24. Compared with the control group, the intervention group demonstrated significantly higher episiotomy repair skill scores, lower perceived stress, greater stress-related self-efficacy, and lower feelings of helplessness (p<.001). In addition, total scores and the Nature of Learning, Expectation, and Openness subscales of the Scale of Attitudes Toward Learning were significantly higher in the intervention group (p<.001). Discussion: There is limited evidence in the literature on the use of artistic, fine motor skill–enhancing pre-interventions to support the acquisition of episiotomy repair skills in midwifery education. Conclusions: Cross-stitch (etamin) improved midwifery students’ episiotomy repair skills, reduced perceived stress, and positively influenced learning attitudes. It is recommended to incorporate hand-skill-based arts into clinical training programs.