الفهرس 
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Abstract
Graduate students are faced with multiple stressors, they often experience high levels of stress during their study .This may result in psychological or emotional impairment ultimately affecting the quality of patient care and their role as graduate students. Moreover, graduate students need to cope with the psychosocial changes associated with the development of an autonomous personal life and the academic and social demands encountered in graduate study.
Researchers found that prolonged stress causes various problems including burnout. Burnout is characterized by emotional exhaustion, depersonalization and reduced personal achievement. Thus burnout is a serious psychological syndrome that can affect not only the individual’s well-being, but also the functioning of the whole organizations.
Energy medicine or energy therapies are among the techniques that can be used to decrease burnout. Energy therapies are sometimes referred to as biofield therapies or meridian based therapies because of the belief that they affect energy fields that surround and intersect the human body. They include a number of therapies as Reiki, Healing Touch, Therapeutic Touch, Qigong and most recently Emotional Freedom Technique (EFT). EFT is a novel treatment that combines exposure, cognitive reprocessing and somatic stimulation. It is a form of psychological acupuncture that uses light tapping with the individual fingertips instead of inserting needles to stimulate traditional Chinese acupuncture points. The tapping on these designated points on the face and body is combined with verbalizing the identified problem (or target) followed by a general affirmation phrase. These result in balancing the energy system and relieving psychological stress and physiological painii. Restoring the balance of the energy system allows the body and mind to resume their natural healing abilities. EFT is safe, easy to apply, non-invasive and an inexpensive technique.
The aim of this study
This study aims to determine the effect of using Emotional Freedom Technique on graduate nursing students’ burnout.
Research hypothesis
Graduate nursing students who apply Emotional Freedom Technique exhibit less burnout level than those who don’t.
Research design:
Quasi-experimental research design was used.
Setting:
This study was conducted at the Faculty of Nursing, Alexandria University.
Subjects:
The total number of graduate students at the Faculty of Nursing, Alexandria University amounted to 160 students during their first, second and third semester of the academic year 2016-2017. Only 140 students accepted to participate in the study.
Maslach Burnout Inventory was used to determine those with moderate or high level of burnout. They were 137 students from these students using epidemiological information; effect size for intervention = 0.8 using alpha error = 0.05 and 10% DROP out rate, providing a study with a power of 80% accordingly the required number of students for the study amounted to seventy students . These were selected and assigned randomly into two equal groups (study and control), 35 students each.
Tools:
Three tools were used for data collection.
Tool I: Maslach Burnout Inventory (MBI)
The MBI was developed by Maslach et al. (1996) . This tool was adopted by Mohamed (2011) to measure graduate nursing students’ levels of burnout. It consists of 22 statements measured on six point rating scale ranging from never (0) to every day (6).
Tool II: Factors Affecting Burnout Questionnaire
This questionnaire was originally developed by Mohamed (2011). It was modified by the researcher to determine the factors affecting burnout among graduate nursing students as personal, academic, organizational and work related factors. It consists of 45 statements. In addition to, burnout signs and symptoms of burnout among graduate students.
Tool III: Emotional Freedom Technique Effectiveness Questionnaire (EFTEQ).
This tool was developed by the researcher to identify the graduate students’ opinions about the effectiveness of EFT.
In addition, a sheet including socio-demographic and academic data such as: age, gender, marital status, years of experience, current employment status, number of studying hours and work related data as place of work and number of working hours.
Tool II and Tool III were tested for content validity by nine experts from Faculty of Nursing; Alexandria University.
Tool II and tool III were tested for internal consistency using Cronbach’s Alpha test. They were reliable and their coefficient values were 0.944 and 0.928 respectively.
A pilot study was carried out on sixteen graduate students to test the clarity and applicability of the tools. These students were excluded from the study.
Data were collected over a period of three months from October to December 2016.
The study was conducted through the following phases:
1- Pre-study phase:
During this phase the researcher prepared herself and the handout
2- Study phase
The researcher introduced herself to graduate students and explained the purpose and steps of the study, then assured them that their responses on the questionnaires will be confidential. All students were given the same instructions and were asked to read questions carefully before giving their responses. They were asked to take their time and give their responses as best as they can, because honest and trustful answers are necessary to get accurate findings.
The study group:
Study group was divided into seven subgroups of five students each to attend Emotional Freedom Technique sessions.
At the beginning session, the Emotional Freedom Technique handout was distributed to students in the study group. The researcher explained EFT advantages, uses, tapping points and how to perform the tapping exercise. Every student applied EFT tapping on him /her self. The researcher guided and directed their performance until they became able to perform it independently and correctly. Students were allowed to ask questions and all questions were answered.
Each student was then interviewed individually for six sessions, two sessions weekly to perform EFT in front of the researcher.
The control group did not receive any intervention.
3- Evaluation phase:
At the fourth week, the burnout level was re-assessed for both the study and control groups using Tool I (MBI) as a post measurement of burnout level.
Emotional Freedom Technique Feedback Questionnaire (EFTFQ) was applied for the study group to determine their opinions about using EFT.
Results
The following are the main results yielded by the present study
It was found that a minority of graduate students in the study group had low emotional exhaustion before applying EFT increased to be three quarters after applying the technique with a high statistical significant difference between them (p <0.001) . While in the control group, none of the student had low emotional exhaustion before intervention increased slightly to be 5.7% after intervention with no statistical significant difference between them (p=0.131).
It was found that a minority of students in the study group had low depersonalization before applying EFT increased to be more than two third after applying the technique with a high statistical significant difference between them (p <0.001) . While in the control group , the same percent of the students (2.9%) had low depersonalization before applying EFT and remained the same after applying it with no statistical significant difference between them (p=0.442).
It was found that only 5.7% of students in the study group had high personal achievement before applying EFT increased to be 54.3% after applying the technique with a high statistical significant difference between them (p <0.001) . While in the
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control group, 14.3% of the student had high personal achievement before intervention increased slightly to be only 17.1 % after applying it with no statistical significant difference between them (p=0.545).
It was found that none of the students in the study group had low total burnout levels before applying EFT increased to be 60% after applying technique with a high statistical significant difference between them (p <0.001). While in the control group, none of the students had low total burnout levels before and after applying EFT with no statistical significant difference between them (p=0.980).
Almost all graduate students reported that applying EFT was highly effective in decreasing their burnout, getting rid of all of their negative emotions .On the other hand the majority of them reported that there is no drawback o EFT.
Conclusion
The current study demote that graduate nursing students suffer from high burnout level and that intervention technique can help in reducing burnout. Moreover, study proved that Emotional Freedom Technique is a valuable and effective tool for managing burnout. It was perceived by graduate students as highly effective and helps overcoming negative emotions. Moreover, EFT helped in feeling comfortable and in reducing stress and anxiety. In addition, EFT enhances self-confidence, problem solving abilities and academic performance.
Based on the current results, the following recommendations are offered:
Recommendations related to nursing education
Conduct educational workshops to nurse educators, undergraduate students and graduates students to raise their awareness about using stress reduction technique as Emotional Freedom Technique.
Disseminate Emotional Freedom Technique handout to nurse educators, undergraduate students and graduates students at the faculty of nursing, Alexandria University to guide them in using this technique.
Conduct orientation session to explain polices rules and regulations for graduate study for graduate students.
Carrying out regular meeting between graduate students and their academic supervisors to overcome any academic problem they suffer.
Study leave should be offered for graduate students.
Recommendations for further studies
Study the effect of Emotional Freedom Technique on anxiety level and clinical performance of graduate students.
Study the effect of Emotional Freedom Technique on nurse educators’ burnout.
Replicate the effect of Emotional Freedom Technique on undergraduate students’ burnout.
Conduct a qualitative study to determine the effect of Emotional Freedom Technique on graduate students’ burnout.