Test Anxiety and Salivary Cortisol Levels in Nursing Students

Differences in Test Anxiety Scores Among Baccalaureate Nursing Students and Nonnursing Students

BACKGROUND

Test-taking is a prominent cause of anxiety for nursing students. Test anxiety may interfere with academic performance, program completion, and successful transition to practice. Prior research suggests that nursing students are more test-anxious than other students, yet this concept is not well studied.

PURPOSE

This study examined differences between test anxiety in nursing and nonnursing students while comparing current trends related to academic level and gender.

METHODS

Using a cross-sectional design, participants completed the Test Anxiety Inventory as a measure of perceived test anxiety.

RESULTS

Minimal differences in scores based on major and academic level were found. Differences based on gender were noted with females reporting higher levels of test anxiety.

CONCLUSIONS

Findings may help nurse educators better understand test anxiety and guide the implementation of supportive strategies to improve learning outcomes.

Prevalence of test anxiety and its determinants among nursing students in Selangor, Malaysia

The current education system significantly emphasizes tests and evaluations as crucial factors in determining a student's future career path. It has been shown that nursing students have moderate to high levels of Test Anxiety (TA), which results in decreased academic performance, low self-esteem, and an inability to complete the program and pursue a career in nursing successfully. This study aimed to determine nursing students' level of TA and its relationship with demographic characteristics. Four hundred twenty-one nursing students at seven private universities and colleges in Selangor participated in this cross-sectional study. The level of TA was measured using the TA Inventory (TAI). A total of 62.5% of the respondents had mild TA, 25.4% had moderate TA and 2.1% had severe TA. There were significant relationships between TA level and household income (χ2 = 6.70, p = 0.035) and ethnic groups (F (3,417) = 5.20, p = 0.002) where Chinese and Indians are protective from TA compared to the Malays and other ethnic groups and high anxiety was significant in the Ringgit Malaysia (RM 3000) and below group. The study's findings indicate that a significant percentage of nursing students involved in the research had mild to moderate levels of test anxiety (TA) and there is a significant association between TA and demographic characteristics. The results indicate the importance of early identification of TA and the need for interventions to overcome TA to ensure they are emotionally, physically, and academically successful.

Cortisol dynamics in undergraduate nursing students during clinical practice: protocol for an exploratory cross-sectional study

INTRODUCTION

This paper presents a protocol for the Investigation of Cortisol Dynamics in Undergraduate Nursing Students, a funded project aiming to understand the fluctuations in anxiety and salivary cortisol levels due to clinical setting changes and the anxiety associated with clinical practice.

METHODS AND ANALYSIS

This study is an exploratory, cross-sectional, observational study that will be conducted at a health and science school in Portugal. Data collection will involve phycological assessment instruments for personality, anxiety, stress, depression and saliva cortisol levels. The target population consists of undergraduate nursing students enrolled in our institution for the academic year of 2022/2023 (N=272), of whom we aim to recruit 35% (N=96) to the study.

ETHICS AND DISSEMINATION

The project obtained approval from the Institutional Review Board of the Egas Moniz-Cooperativa de Ensino Superior, CRL, on 5 July 2022 (ID: 116/21.22) and ethical approval from the Egas Moniz Ethics Committee on 28 July 2022 (ID:1110.22). Informed consent will be obtained from those who wish to participate, ensuring students' voluntary participation in the project. The results of this study will be disseminated through open-access peer-reviewed publications and presented at scientific events.

Assessing population-level stress through glucocorticoid hormone monitoring in wastewater

Stress is oftentimes overlooked in societies, despite its life-threatening impact. Here, we assessed the feasibility of measuring endogenous stress hormones to estimate population-level stress by wastewater-based epidemiology (WBE). Two primary glucocorticoids, cortisol and cortisone, were monitored in wastewater by liquid chromatography tandem mass spectrometry (LC-MS/MS), to assess changes in these physiological markers of stress in a student population (n = 26,000 ± 7100) on a university campus in the southwestern U.S. Daily composite samples were collected for seven consecutive days each month during the Fall (Autumn) 2017 and Spring 2018 academic semesters (n = 134). Reproducible weekly patterns were seen in stress hormone excretion, with the highest levels occurring on Mondays (124 ± 44 μg d^-1 per person) and Tuesdays (127 ± 54 μg d^-1 per person) and the lowest on Sundays (87 ± 32 μg d^-1 per person). Stress levels on weekdays (defined by class schedules Monday-Thursday) were significantly higher than on weekends (p < 0.05). During both Fall and Spring semesters, per person stress levels of these hormones were significantly higher (p < 0.05) during the first two months of each semester, 162 ± 28 μg d^-1 per person (August), 104 ± 29 μg d^-1 per person (September), 180 ± 14 μg d^-1 per person (January), and 114 ± 54 μg d^-1 per person (February) than in the remaining measured weeks in the semester, including finals week captured in both semesters. Overall Spring semester stress levels (113 ± 45 μg d^-1 per person) were significantly higher than the Fall (94 ± 42 μg d^-1 per person), p < 0.01. This study is the first to demonstrate the utility of endogenous biomarkers, specifically glucocorticoid hormones, to monitor population health status (in this instance community stress) in near real-time by wastewater assessments.

Changes in parameters of biochemical and oxidative stress in university students during and after examinations

The study aimed to evaluate the parameters of lipid peroxidation and antioxidant protection, biochemical parameters, and cortisol and adrenaline content in the blood of students depending on the effect of exam stress. A total of 135 healthy students (72 female (53.3%) and 63 male (46.7%)) aged from 19 to 21 years (mean age 20.16 ± 0.42 years) of the experimental group underwent detailed medical screening and examination before the inclusion in the study. The control group consisted of 30 healthy students (17 female (56.7%) and 13 male (43.3%)) of corresponding age (mean age 20.23 ± 0.54 years), whose medical examination was performed during breaks in the absence of any stress factors. The blood parameters of the experimental group were investigated 1 h before, 1 h after, and 24 h after the exam. The cortisol content in the blood of experimental group students significantly increased 1.37 times (p < 0.05) an hour before the exam and 1.32 times (p < 0.05) an hour after; adrenalin content in blood increased 1.76 times (p < 0.05) and 1.49 times (p < 0.05), respectively. Compared to the control group, intensification of lipid peroxidation processes with a 1.51-fold (p < 0.05) increase in erythrocyte malonic aldehyde content in blood 1 h before and 1.42-fold (p < 0.05) increase an hour after the exam was observed in students due to the effect of exam stress.. Changes in hormonal homeostasis, activation of lipoperoxidation processes with the development of oxidative stress, and the disintegration of antioxidant protection factors are typical for academic stress in students.

Salivary cortisol concentrations in hematogy/oncology nurses on working days and days off

OBJECTIVE

to assess salivary cortisol concentrations in hematology/oncology nurses on working days and days off.

METHODS

a cross-sectional study carried out with 28 nurses from a university hospital. A sociodemographic, employment and health profile questionnaire was applied. For saliva collection, Salivette® tubes were used. Descriptive and analytical analysis was used.

RESULTS

there was no significant difference in cortisol concentrations between working days and days off (p>0.05). The high cortisol concentration was associated with not having children (0.621±0.340; p=0.046), not using medication (0.623±0.133; p=0.017) and birth control pills (0.556 ± 0.228; p=0.047) and intention to leave work (0.951±0.154; p=0.001). A positive correlation was identified between cortisol and absence from work due to health issues (0.72; p=0.05) and weight gain (0.935; p=0.02).

CONCLUSION

in general, cortisol concentration is within the reference parameters, with no significant difference in its secretion on working days and days off.

Perceived stress, physiological stress reactivity, and exit exam performance in a prelicensure Bachelor of Science nursing program

Objectives High-stakes exams are a source of chronic stress that may adversely affect nursing students' thinking, behavior, and overall health. The purpose of this study was to explore the relationships of perceived stress, physiological stress reactivity, and exit exam performance. Methods A within-subjects design allowed measurement of perceived stress, salivary cortisol, and salivary alpha amylase in pre-licensure nursing students under two different conditions: a high-stakes exit exam and a low-stakes homework assignment. Results Perceived stress and salivary alpha amylase were significantly higher after the high-stakes exam compared to the homework condition. Perceived stress after the exam was correlated with lower exam score. Conclusion Study findings suggest that in response to a high-stakes exam, prelicensure nursing students experience high levels of perceived stress coupled with sympathetic activation but not activation of the hypothalamic-pituitary adrenal axis.

Distraction-focused interventions on examination stress in nursing students: Effects on psychological stress and biomarker levels. A randomized controlled trial

BACKGROUND

Nursing students all over the world experience high levels of stress with negative impacts on their health, emotional state and performance.

AIM

This study aimed to investigate the effects of distraction-focused interventions on examination stress and anxiety in nursing students.

METHODS

A randomized controlled, parallel trial design was conducted from January to June 2016. After baseline measurement, 72 participants were randomized to one of the following groups (n = 18 each): (i) animal-assisted therapy; (ii) music therapy; (iii) mandala painting; (iv) control group. Outcomes of all groups in terms of stress-reduction were compared by measuring self-reported perceived stress (STAI-State and visual analogue stress scale) and salivary biomarker levels (Cortisol and Immunoglobulin A).

RESULTS

Fifty-seven complete data sets (n = 12-16 for each group) were analysed. All distraction-focused interventions showed stress and anxiety reduction in everyday school situations. By contrast, on days with examinations, stress reductions did not reach statistical significance in regard to self-reported psychological stress. At the same time, interventions resulted in significantly decreased levels of stress biomarkers (P < .001).

CONCLUSIONS

Our preliminary findings suggest positive but situation-dependent effects of distraction-focused interventions in academic settings. Further research should investigate the complex relationship between physiological and psychological stress parameters.

Guided Imagery as a Resource to Decrease Test Anxiety

A pre-exam guided imagery intervention was implemented with 49 senior baccalaureate nursing students to address test anxiety. The intervention consisted of listening to a 10-minute recorded audio guided imagery exercise. Self-reported anxiety levels were measured using a Likert scale pre- and post-guided imagery. Most students demonstrated a reduction in test anxiety postintervention.

Examination Stress Results in Attentional Bias and Altered Neural Reactivity in Test-Anxious Individuals

Examination stress occurs so frequently in the lives of students. The neural mechanisms of attentional bias induced by examination stress in test-anxious individuals remain unclear. Accordingly, we investigated the attentional bias toward test-related threatening words in selected high and low test-anxious participants under the stress of final examinations by using an event-related potential (ERP) technique. A classic dot-probe paradigm was adopted with a test-related/test-unrelated threatening word and a neutral word pair as cues. Results showed attention bias and enhanced N200 amplitude toward test-related threat in high test-anxious individuals, whereas avoidance of test-related threat and decreased N200 amplitude were shown in low test-anxious individuals. Additionally, ERP data revealed the relatively enhanced LPP amplitude in low test-anxious participants compared with that in high test-anxious participants. No attentional bias toward test-unrelated threat was found. In conclusion, examination stress resulted in attentional bias and functional perturbations of a brain circuitry that reacted rapidly to test-related threat in high test-anxious individuals.