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.

Latent profiles of academic resilience in undergraduate nursing students and their association with resilience and self-efficacy

AIM

This study aimed to investigate the heterogeneity of academic resilience among nursing students using latent profile analysis and its associated influencing factors.

BACKGROUND

Nursing students experience higher levels of stress compared to their peers in other professions, and the cultivation of academic resilience plays a pivotal role in their ability to effectively cope with this stress. Academic resilience not only facilitates success in the face of academic adversity but also contributes to the promotion of mental well-being among nursing students. However, the current research on the academic resilience of nursing students has predominantly focused on a scale-centered total score approach, disregarding individual variability, and hindering the development to inform personalized interventions for enhancing academic resilience.

DESIGN

A cross-sectional study.

METHODS

A convenience sampling method was used to collect a total of 644 nursing students from two medical schools in Guangzhou City. The participants were recruited through an online survey conducted from January to March 2023. The questionnaires consisted of a general information form, the Chinese version of the Academic Resilience Scale-30 (C-ARS-30), the 10-item Connor Davidson Resilience Scale (CD-RISC-10), and the General Self-Efficacy Scale (GSES). Latent profile analysis was used to identify distinct categories of academic resilience among nursing students, and influencing factors were examined through ordinal logistic regression analysis.

RESULTS

The academic resilience levels of nursing students can be divided into three potential categories: 'low academic resilience' (13.0%), 'moderate academic resilience' (70.0%), and 'high academic resilience' (17.0%). Level of grade, GPA, self-reported physical health level, resilience and self-efficacy were significantly influenced the different categories of academic resilience of nursing students (P<0.05).

CONCLUSIONS

The majority of undergraduate nursing students were placed in the moderate academic resilience group, however, educational institutions should pay special attention to nursing students demonstrating low levels. Regular assessments of academic resilience are recommended, and personalized interventions should be tailored to address specific academic resilience characteristics across different grades of nursing students. Strategies aimed at enhancing academic resilience among nursing students may include improvements in GPA performance, attention to physical health, and the reinforcement of resilience and self-efficacy.

Test Anxiety Among US Medical Students: A Review of the Current Literature

Purpose

Medical students experience anxiety at higher rates than the general public and many are uniquely affected by additional test anxiety throughout their medical education. Although test anxiety has been studied for decades, little evidence has been published suggesting interventions improve examination performance in medical education. Therefore, we set out to review the current literature to elucidate efforts so far and establish trends in research.

Methods

Databases searched included PubMed, EMBASE, PsychINFO, ERIC, SCOPUS, and CINAHL. English language articles published between 2010 and 2021 were loaded into a reference manager to screen out duplicate articles. During the full-text screen and data extraction phase, reference lists were also inspected to identify additional articles for inclusion in the study.

Results

Of 883 studies identified, 860 were excluded resulting in 22 studies for extraction and analysis. First-year (n = 15) and second-year (n = 12) students were primarily tested. Less than 10 included third- or fourth-year students. Self-help and wellness interventions were employed, though interventions ranged from dog therapy to deep breathing techniques to fish oil supplementation. Test anxiety was evaluated using self-report questionnaires, such as the Westside Test Anxiety Scale, Beck Anxiety Inventory, and State-Trait Anxiety Inventory. None of the studies reported improved examination scores.

Conclusion

This review identifies a variety of measurement tools and interventions attempting to mitigate test anxiety. As far as improving examination performance, none of the interventions reported was successful. Further research addressing test anxiety that results in improved medical student academic performance should be conducted and also use established assessment tools.

Test anxiety and its determinants among health sciences students at Mattu University: a cross-sectional study

Background

Test anxiety is a particular type of anxiety that is marked by physical, cognitive, and behavioural symptoms when taking and performing tests. It is defined as "severe stress" before, during, and after exams and other assessments. Test anxiety could cause poor academic performance and increase dropout rates. This study aimed to determine the levels of test anxiety and its determinants among health sciences students at Mattu University.

Methods

An institution-based cross-sectional study was conducted among 421 selected students from June 1 to June 30, 2021. The study utilized the Westside Test Anxiety, the Oslo Social Support Scale, the Rosenberg Self-esteem Scale, and the Kessler Scale to assess test anxiety, social support, self-esteem, and psychological distress, respectively. The collected data were entered into EpiData version 3.1 and then exported to STATA version 14.0 for analysis. A linear regression model was used to determine factors associated with test anxiety. The multiple regression assumptions were checked for each variable. Statistically significant effects were assumed for a p-value of less than 0.05 at a 95% confidence interval in the multiple linear regression analysis.

Results

A total of 416 (99%) participants were completed out of the 420 questionnaires administered. The mean score of test anxiety among participants was 25.3 (SD: ±5.51). Tobacco use (β: 1.028; 95% CI: 0.709-1.347), khat chewing (β: 0.115; 95% CI: 0.038-0.192), self-esteem (β: -0.049; 95% CI: -0.062-(-0.036)), psychological distress (β: 0.022; 95% CI: 0.017-0.027), and physical activity (β: -0.162; 95% CI: -0.224-(-0.099)) were shown to have a significant association with test anxiety.

Conclusion

Test anxiety was common in the study area. Current substance use (tobacco use and khat chewing) and psychological distress were discovered to be factors that exacerbated test anxiety, whereas self-esteem and physical activity were discovered to be factors that alleviated test anxiety. Therefore, students and stakeholders need to work to discourage those factors that increase test anxiety while promoting factors that alleviate it.

Reducing Medication Math Anxiety of Prelicensure Nursing Students Using Social Media Tutorials: A Feasibility Study

BACKGROUND

First-semester prelicensure nursing students commonly report experiencing math anxiety that negatively affects academic performance and triggers fear of causing patient harm. Students often turn to social media platforms to supplement their learning experience.

PURPOSE

To explore the feasibility of using Instagram tutorials to reduce math anxiety of first-semester prelicensure nursing students.

METHODS

A quasi-experimental descriptive survey design was used to evaluate the utility of posting supplemental math tutorials on Instagram and examined the effect of tutorials on math anxiety levels. A convenience sample of 20 students used the tutorials. Math anxiety levels were evaluated using the Single-Item Math Anxiety Scale.

RESULTS

A statistically significant inverse relationship was observed between math anxiety levels and tutorial use. The Instagram platform was familiar to students and simple to access. Brief tutorials appealed to audio-visual learners.

CONCLUSIONS

Using Instagram-based tutorials is feasible and appears effective in reducing medication math anxiety.

Medication administration competency for clinical preparedness: Comparing testing modalities and test anxiety in undergraduate nursing students

BACKGROUND

Adverse drug events, which occur at various stages of the medication preparation and administration process, cause over half a million injuries or deaths yearly. Upon graduation, prelicensure nursing students lack the skill and competency required for safe medication administration. Therefore, it is essential to ascertain their medication administration proficiency throughout their curriculum prior to participation in clinical experiences. Historically, this has been a deeply embedded process of high-stakes testing. Aligned is cognitive test anxiety which can severely limit a student's performance. Thus, nursing student competency and control appraisal in medication administration can be linked to the Control Value Theory framework.

OBJECTIVES

The purpose of the research was to determine whether an e-simulated high-stakes medication administration test was associated with less anxiety than a standard high-stakes medication math assessment within and between two nursing tracks over three semesters to capture sequencing of medical-surgical clinical courses.

DESIGN

The prospective, quantitative, longitudinal study received Institutional Review Board approval.

PARTICIPANTS/SETTING

Students were recruited from a traditional BSN track and an online LPN-to-BSN track per course level over three semesters.

METHODS

Participants completed the State-Trait Anxiety Inventory prior to their course level high-stakes assessment modality.

RESULTS

For both tracks, testing anxiety remained a factor with no significant difference in the anxiety level between assessment modalities. There was a trend for anxiety scores to slightly decrease over time with each testing modality, but results were non-significant. There was a trend for traditional BSN students (n = 435) to have slightly lower anxiety scores than the LPN-to-BSN (n = 246) students.

CONCLUSIONS

Researchers must continue investigating teaching, learning, and testing modalities in medication calculation/administration that maintain rigor, enhance student self-efficacy, and provide accurate assessment. These can be aligned with research regarding study skills training and cognitive-behavioral interventions to help mitigate the challenge of cognitive test anxiety.

Cultivating Student Success After Repeated Failure

ABSTRACT

Everyone experiences failure. This reality contrasts with human desire and societal culture to succeed. Students experiencing academic failure can struggle to learn from failure, find hope, build resilience, and create self-efficacy. Insights and strategies of learning and applying Scripture and practicing positive affirmations in a mentoring atmosphere with Christian faculty can lead students to understand and accept God's orchestration of failure for good.

Understanding and Fostering Mental Health and Well-Being among University Faculty: A Narrative Review

In recent years, there has been increasing recognition of mental health concerns in academia, with stress, burnout, anxiety, and depression being reported among faculty members. The demanding work environment, the need to balance personal and professional duties, and the constant pressure of productivity while navigating multiple tasks of teaching, research, mentorship, professional development, and service all impact the mental health and overall well-being of faculty. Higher education institutions have structurally changed as has the research landscape. These changes as well as faculty-specific and student-specific factors coupled to the effect of the COVID-19 pandemic have led to profound effects on the mental health of academics. This paper is a narrative review of the pertinent literature describing faculty mental health and well-being. It summarizes the available evidence on factors influencing faculty mental health and shows the prevalence of anxiety, depression, stress, and burnout among faculty from various academic fields and along the whole academic ladder. Using a suggested framework that collates the efforts of leaders and faculty, the paper concludes by exploring strategies that promote work-life balance among academics and suggesting effective interventions to improve their mental health outcomes.

Association between COVID-19-related Stress and Self-Directed Learning Ability among Korean Nursing Students

Purpose

Traditional face-to-face classes for nursing students due to the COVID (Coronavirus Disease)-19 pandemic around the world made it inevitable to operate education delivery method using remote/hybrid fashion. This study was aimed to validate the Korean version of the Student Stress Inventory-Stress Manifestations (SSI-SM) and assess the association between COVID-19 pandemic related stress level and self-directed learning ability competence in nursing students.

Design

This research was a cross-sectional study design.

Methods

The study was conducted from December 2020 to January 2021, with a convenience sample of 172 nursing students in the 3rd and 4th grades in South Korea. The Korean version of SSI-SM(K-SSI-SM) was translated and adapted according to standard guideline, and tested construct validity and reliability. In addition, a multiple linear regression analysis was used to examine the associations between the COVID-19 related stress level and the self-directed learning ability.

Results

An exploratory analysis showed that K-SSI-SM composed of 13-item in three factors (uncertainty, non-sociability, and somatization) accounted for 68.73% of the total variance after it was modified. The internal consistency was good with 0.91. Multiple linear regression analysis revealed that higher self-directed learning ability was associated with lower stress levels (β=-0.19, p=0.008), positive toward online learning (β=0.41, p=0.003) and scored higher in theory (β=0.30, p<0.001) in nursing students.

Conclusion

The K-SSI-SM is an acceptable instrument for assessing stress levels in Korean-nursing students. And nursing faculties need to pay attention to related factors of self-directed learning ability, in order to achieve the course's self-directed learning goal in students attending online classes.

Influence of COVID-19 on the next generation of nurses in the United States

AIMS/OBJECTIVES

Examine the affective state (anxiety, depression), life satisfaction, stress and worry, media consumption and perceptions of pursuing a career in nursing amidst the COVID-19 pandemic.

BACKGROUND

Nursing students worldwide have reported increased stress, fear and anxiety amidst challenges and risks associated with COVID-19. It remains unclear what impact COVID-19 will have on nursing students in the United States (US) as they prepare to enter the workforce.

DESIGN

Cross-sectional study of undergraduate nursing students at one university in the Northeastern United States.

METHODS

Students (N = 161) completed an online survey (July 2020) about health and life satisfaction, affective state (depression, anxiety), stress and interest in pursuing nursing. Descriptive statistical analysis described sample and quantitative data. Linear regression was used to examine whether media consumption, stress, affective states predicted interest in pursuing a nursing career. Qualitative thematic analysis was applied to the open-ended question, 'How has COVID-19 influenced your interest in pursuing a nursing career?'. The Standards for Reporting Qualitative Research (SRQR) checklist was used to evaluate methodological quality.

RESULTS

Mean stress score was 56.6 (range 0-100), 55.6% of respondents felt unsettled about the future, and 68.2% reported feeling overwhelmed. 18.7% of students reported moderate to severe anxiety, 19.8% reported moderate to severe depression and 54.4% reported that COVID-19 influenced their interest in nursing. Six themes emerged from qualitative analysis: no change, reaffirming/confirmatory, importance of nursing, reality check, positive influence and negative influence.

CONCLUSIONS

Universities/colleges and nursing faculty should prioritise universal mental health assessment for nursing students and enhance mental health services to support and monitor this population.

RELEVANCE TO CLINICAL PRACTICE

Mental health services to support nursing students are warranted in the wake of the COVID-19 pandemic. Reduction in nursing workforce may have significant impacts on staffing ratios, patient outcomes, nurse burn-out and other aspects of clinical care.

Interventional Strategies to Reduce Test Anxiety among Nursing Students: A Systematic Review

Nursing students are reported to have moderate to high test anxiety, leading to reduced academic performance, poor self-esteem, and failure to complete the program and practice nursing. This review aims to examine the interventions for test anxiety reduction in nursing students. Following the PRISMA guidelines, peer-reviewed experimental studies published in English between 2016 and 2021 from four databases, EBSCOhost, PubMed, Science Direct, and Scopus, were systematically searched. The findings were presented in tabular and narrative form. Among the 722 studies retrieved, 14 selected studies were critically appraised, guided by the Joanna Briggs checklist for Randomized Controlled Trials and the checklist for Quasi-Experimental Studies, resulting in 11 studies for inclusion in the systematic review. Test anxiety was assessed by different scales. Aromatherapy hand massage, aromatherapy using a diffuser in combination with music therapy, confidence training for test relaxation, coping program, music therapy, emotional freedom technique, animal-assisted intervention, and guided imagery were all found to be effective in reducing test anxiety. In conclusion, while numerous interventions to reduce test anxiety in nursing students were found to be effective, the quality of the studies investigating these interventions was varied with generally small sample sizes and limited follow-up. Future research should be conducted, and the same interventions should be carried out using a larger sample size to strengthen the body of evidence.

Aromatherapy with inhalation effectively alleviates the test anxiety of college students: A meta-analysis

Objective

Test anxiety is one of the common psychological and behavioral problems of college students, which can result in poor academic performance and even academic failure. Aromatherapy has been proposed as a promising method to reduce test anxiety in college students, but its precise efficacy has not been fully confirmed. This meta-analysis evaluated the effects of aromatherapy on the symptoms of test anxiety in college students to serve as a reference for future research and provide more scientific and exact evidence.

Methods

PubMed, The Cochrane Library, Web of Science, Embase, CINAHL, Science Direct, Chinese National Knowledge Infrastructure (CNKI), Chinese Science and Technology Journal Full-Text Database (VIP), and Wanfang Data were electronically searched from inception to June 2022 to identify randomized controlled trials (RCTs) on aromatherapy for treating students' test anxiety. The Cochrane Risk of Bias Assessment Tool for RCTs was used by two reviewers to critically and independently assess the methodological quality of the included studies. Review Manager 5.4 was used for the meta-analysis. Stata 17.0 was used for sensitivity analysis and Egger's test.

Results

Seven RCTs included 425 patients, with a moderate risk of bias in the included studies. The meta-analysis found that aromatherapy effectively reduced test anxiety in college students (SMD = -0.67, p < 0.01), with high heterogeneity of results (I 2 = 72%). The different types of essential oil devices used in the study are the source of inter-study heterogeneity. Subgroup analysis suggested that most effective methods were aromatherapy with compound essential oils (SMD = -0.91, p < 0.01), and using cloths or pads as the essential oil devices (SMD = -1.03, p < 0.01). There was no difference between aromatherapy and placebo control groups (SMD = -0.65, p = 0.25).

Conclusion

Aromatherapy with inhalation can help relieve test anxiety in college students, but more and higher-quality studies are needed. This study provides a reference for future research designs in terms of the selection of essential oil types and devices and the design of research groups.

Systematic review registration

[https://www.crd.york.ac.uk/prospero/], identifier [CRD42022345767].

Factors to predict the knowledge, attitude and practice of nursing interruptions among nurses: A nationwide cross-sectional survey

AIM

To identify the knowledge, attitude and practice of nursing interruptions and related factors among nurses in China.

BACKGROUND

Nursing interruptions are extremely common and have introduced major security risks and harm to hospitalized patients. However, nursing interruptions' factors are not well known.

DESIGN

A nationwide cross-sectional descriptive survey.

METHODS

A multistratified random sampling method was used to obtain nurses from five provinces in China. We collected data by online questionnaires (the Knowledge, Attitude and Practice Questionnaire of Nursing Interruptions, the Chinese Revised Safety Attitude Questionnaire and the Coping Adaptation Processing Scale). We used the Mann-Whitney test, the Kruskal-Wallis test, Spearman's linear correlation analysis and multiple linear stepwise regression to analyze the data. A STROBE checklist was used to report the results.

RESULTS

Of the 14500 questionnaires distributed, 14302 (98.6 %) were returned. The mean score was 79.69 (SD 17.73) and the level was medium. Having attended nursing interruptions training and attended nursing safety training, safety attitude, coping ability and position were positive factors, while age and marital status were negative factors (F=1068.226, p < 0.001, R² =0.374, adjusted R² =0.373).

CONCLUSIONS

Chinese nurses expressed a moderate level of knowledge, attitude and practice of nursing interruptions. Safety attitude, having attended nursing interruptions training, coping ability, having attended nursing safety training, position, age and marital status were predictors.

RELEVANCE TO CLINICAL PRACTICE

Nursing managers should pay attention to the influencing factors of clinical nurses' knowledge, attitude and practice of nursing interruptions and take effective individualized training for clinical nurses with different ages, positions and marital status to improve their coping ability, so as to ensure nursing safety and improve nursing quality.

The experience of anxiety among Chinese undergraduate nursing students in the later period of their internships: findings from a qualitative study

Background

Clinical internships are a critical transition period for nursing students to develop into nursing professionals and are essential for the solidification of their professional attitudes. Undergraduate nursing students face multiple sources of severe anxiety that affect their nursing career development during this period. This study aimed to understand the anxiety experienced by undergraduate nursing students in the later period of their internship periods in a Chinese educational context.

Methods

A descriptive qualitative study was conducted. A purposive sample of 17 undergraduate nursing interns with experiences of anxiety was selected from three teaching hospitals in Hunan Province, China. Data were collected through semi-structured interviews and analyzed using the Colaizzi seven-step method for data analysis.

Results

Three themes emerged: the sources of perceived anxiety, the psychological journey of coping with anxiety, and suggestions for nursing management and education. The sub-themes for the first theme included career decision dilemmas, competitive pressures for employment, worries about progress of the graduation projects, challenges of the nursing licensure examination, and low self-confidence in clinical competence. The second theme consisted of two sub-themes: negative avoidance and retreat, and positive preparation and response. The third theme consisted of policy support to create more employment opportunities, comprehensive guidance from nursing schools and hospitals, and psychological assistance and counseling.

Conclusions

This study revealed that undergraduate nursing students were prone to anxiety during the later period of their clinical internships. Specific sources of anxiety encompassed career decision-making, job pursuit, graduation, and licensure examination. Undergraduate nursing students adopted both positive and negative approaches in coping with anxiety during the later period of their clinical internships. Nursing educators and administrators should develop appropriate instructions and support systems to reduce anxiety among undergraduate nursing students.

Relationships between Nursing Students’ Skill Mastery, Test Anxiety, Self-Efficacy, and Facial Expressions: A Preliminary Observational Study

Test anxiety and self-efficacy significantly influence the mastery of nursing skills. Facial expression recognition tools are central components to recognising these elements. This study investigated the frequent facial expressions conveyed by nursing students and examined the relationships between nursing skill mastery, test anxiety, self-efficacy, and facial expressions in a test-taking situation. Thirty-three second-year nursing students who were attending a university in a Korean metropolitan city participated. Test anxiety, self-efficacy, and facial expressions were collected while the students inserted indwelling catheters. Using Microsoft Azure software, the researchers examined the students’ facial expressions. Negative facial expressions, such as anger, disgust, sadness, and surprise, were more common during the test-taking situation than the practice trial. Fear was positively correlated with anxiety. None of the facial expressions had significant relationships with self-efficacy; however, disgust was positively associated with nursing skill mastery. The facial expressions during the practice and test-taking situations were similar; however, fear and disgust may have been indicators of test anxiety and skill mastery. To create a screening tool for detecting and caring for students’ emotions, further studies should explore students’ facial expressions that were not evaluated in this study.

Animal-Assisted Interventions for the Improvement of Mental Health Outcomes in Higher Education Students: A Systematic Review of Randomised Controlled Trials

BACKGROUND

The aim of this systematic review was to evaluate the effectiveness of Animal-Assisted Interventions (AAIs), particularly Animal-Assisted Therapy (AAT) and Animal-Assisted Activity (AAA), in improving mental health outcomes for students in higher education. The number of students in higher education reporting mental health problems and seeking support from universities' student support services has risen over recent years. Therefore, providing engaging interventions, such as AAIs, that are accessible to large groups of students are attractive.

METHODS

MEDLINE, PsycINFO, Embase and Cochrane Library were searched from relative inception to end of April 2020. Additionally, a grey literature search was undertaken. Independent screening, data extraction and risk of bias assessment were completed, with varying percentages, by two reviewers.

RESULTS

After de-duplication, 6248 articles were identified of which 11 studies were included in the narrative synthesis. The evidence from randomised controlled trials suggests that AAIs could provide short-term beneficial results for anxiety in students attending higher education but with limited evidence for stress, and inconclusive evidence for depression, well-being and mood. For the non-statistically significant results, the studies either did not include a power calculation or were under-powered.

CONCLUSIONS

Potential emerging evidence for the short-term benefits of AAI for anxiety, and possibly stress, for students in higher education was found.

Impact of COVID-19 on public health nursing student learning outcomes

BACKGROUND

The COVID-19 pandemic has highlighted the importance of a strong, effective public health nursing workforce while also requiring public health nursing faculty to adapt teaching strategies as courses transitioned online. It is essential to understand how the pandemic-enforced transition from face-to-face to remote learning impacts student outcomes. The purpose of this paper is to compare student learning outcomes in a pre-licensure public health nursing course before, during, and after the transition to remote learning.

METHODS

Descriptive statistics were computed for assignments, exams, and final course grades for three terms (Fall 2019, Spring 2020 and Fall 2020).

RESULTS

Analysis showed statistically significant differences between terms for assignments and exams but not the final course grade. However, these differences were driven by small standard deviations rather than differences between mean scores demonstrating that there was actual little difference in student learning outcomes across terms.

CONCLUSIONS

Authors suggest strategies to support consistent academic outcomes and future research needed understand student learning outcomes during the pandemic; ultimately building the public health nursing workforce necessary to address the current and future public health crises.

Medication math dosage assessment anxiety in undergraduate nursing students: A systematic review

BACKGROUND

Medication calculation assessment is commonplace in undergraduate nursing programs. A test is routinely used to assist in the determination of safe medication administration practice in a clinical setting. Multiple factors negatively impact student performance.

AIM

The aim of this article is to analyze current literature related to medication calculation assessment and undergraduate nursing student anxiety.

METHOD

A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Articles included were peer-reviewed publications focused on undergraduate nursing student anxiety related to medication dosage calculation.

FINDINGS

Anxiety related to medication calculation assessments can stem from students' personal lives and previous math experiences. Interventions related to increasing self-efficacy can impact student performance on assessments.

CONCLUSION

A variety of interventions to assist undergraduate nursing students increase performance on assessments were indicated in the literature. Advances in educational technologies allow for more assessment options to facilitate safe medication practices.

Academic and Nonacademic Predictors of BSN Student Success on the HESI Exit Exam

First-time success rate on the NCLEX-RN examination has significant implications for BSN students, faculty, and schools of nursing. Many nursing programs utilize standardized examinations such as the HESI Exit Exam to quantify student success on knowledge of nursing concepts and to prepare students for success on the NCLEX-RN. Nursing faculty must be able to identify predictors of student success early in the nursing program in order to offer appropriate support and remediation. The purpose of this retrospective, correlational study was to determine predictive variables of BSN student success on the HESI Exit Exam in a southeastern university. Students who reported higher test anxiety scored significantly lower on the HESI Exit Exam. Higher medical-surgical I HESI examination scores, higher medical-surgical II HESI examination scores, higher obstetrics HESI examination scores, and higher final grade point average were significant predictors of students' HESI Exit Exam scores and accounted for 39% of the variance in the scores. Results from this study suggest implementing remediation based on HESI Specialty Exam scores and interventions aimed at reducing test anxiety.

The effect of animal-assisted therapy on nursing student anxiety: A randomized control study

BACKGROUND AND OBJECTIVE

Nursing student stress has a major impact on academic performance and testing anxiety is one prominent source. This study evaluated the influence of dogs in decreasing student anxiety at a nursing program prior to a medication dosage calculation exam.

METHOD

This study uses a convenience sample randomly assigned to a control and intervention group with a pre-pre, pre, post and post-post-test using the Spielberger State-Trait Anxiety Inventory. The intervention group experienced a therapy dog intervention prior to the medication dosage calculation exam.

RESULTS

Using a repeated measures one-way MANOVA, there was a statistically significance difference between intervention and control groups Wilk's ∧ = 0.761, F(8, 79) = 3.103, p < 0.01.

CONCLUSION

A brief interaction with therapy dogs prior to a medication calculation exam decreased anxiety in a convenience sample of nursing students. This study adds empirical knowledge to the field of animal-assisted therapy and nursing student anxiety-coping methods.

Nursing graduates' lived experiences of anxiety during their final year at University: a phenomenological study

BACKGROUND

Nursing students voiced that they were stressed or anxious during their final year at university. Further, they articulated that their anxiety affected their academic performance as well as their motivation to work on their clinical placement.

OBJECTIVES

This study was designed to describe nursing graduates' perceptions of their lived experiences of anxiety during their final year.

DESIGN

Phenomenology was chosen.

SETTINGS

Three universities in Taiwan.

PARTICIPANTS

A purposive sample of 18 nursing graduates with experiences of anxiety.

METHODS

Data were collected using a semi-structured interview and analyzed utilizing Colaizzi's seven-step method.

RESULTS

Four themes emerged from the findings. The first was: uncertainty about future employment. This included negative clinical practicum experiences impacted on future career choices and uncertainty about future workplace choices. The second theme was: emotional relationships and life experiences becoming chaotic. This included anxiety about the loss of established relationships and financial insecurities. The third theme was: three phases of anxiety experienced in preparation for the national examination. They comprised: feeling anxiety but not taking action to study; increasing anxiety and beginning to study and, exacerbated anxiety and cramming for the national examination. The fourth theme was: adjustment strategies. They involved; looking for support to release emotional stress; changing the situation and fine-tuning the stress; positive thinking and self-affirmations and also, self-reflecting and consolidating learning.

CONCLUSIONS

Finding could inform nursing teachers on nurses' lived experiences of anxiety during their final year, especially that related to the national examination before registration. Further, findings could be used as a map to facilitate nursing teachers in the provision of suitable teaching and counselling for final year students to alleviate their anxiety.

Stress and Coping Strategies Among Malawian Undergraduate Nursing Students

PURPOSE

Stress among nursing students has been widely investigated across the globe, and evidence suggests that nursing programs are stressful. Students from resource constrained contexts, such as Malawi, often find it difficult and over stressing to be socialized into the nursing profession. However, this area has not been adequately investigated in Malawi. The aim of the study was to investigate stress and its coping strategies among nursing students in Malawi.

METHODS

This was a quantitative study which used a descriptive cross-sectional design that included 102 students in years 2, 3 and 4. Data were collected using the adapted standard tools (Perceived Stress Scale and Adaptive Version of the Nurse Stress Scale) to comprehensively measure levels of stress categorised as clinical, academic and external. The brief Cope was used to measure common coping strategies. Independent samples t test and ANOVA were run at 5% level of significance to analyze the data.

RESULTS

Moderate levels of stress were perceived by this sample. Academic category contributed to more stress than clinical and external sources. Lecturers, clinical teachers and nursing staff were the major contributors of stress among students. Similarly, high levels of stress were found among year 2 and self-sponsored students. In terms of coping strategies, active coping and planning were the common coping strategies. However, substance use was also recorded as a coping strategy.

CONCLUSION

The study revealed that although nursing students face various challenges in under-resourced environments, teachers and clinical staff highly contribute towards stress. It was then established that stress among nursing students' can be contained by initiating stress reduction interventions. There is also need to further investigate the extent of substance use as it suggests that some students have not been able to cope with current stress levels hence resorting to use of substances.

Increasing student success through in-class resilience education

Student performance can be affected by internal and external stressors, so we explored the effects of an experiential psychiatric/mental health nursing class designed to present methods of stress reduction. Mixed methods to assess the effects of experiential learning about self-care in a baccalaureate psychiatric nursing class were used with 113 nursing students. Students were exposed in class each week to one of 6 techniques: deep breathing, progressive muscle relaxation, mindfulness & exercise, aromatherapy, guided imagery, and yoga. Students used the method at home and journaled about the experience weekly. Journals and free-text responses from a post-intervention assessment were examined with qualitative content analysis. The Beck Anxiety Inventory, the Ten-Item Personality Inventory, and the Skovholt Practitioner Professional Resiliency and Self-Care inventory were used. Moderate to strong negative correlations between emotional stability (Ten-Item) and anxiety scores (Beck) was seen. Themes included physical/emotional effects of stress, lack of control during nursing school, and fears about communicating with psychiatric patients. Preferred coping methods were easy to perform, portable, and low cost; students used them to alleviate anxiety and promote relaxation before sleep. Family/friend support and self-care promoted professional vitality. Lack of time for self-care, sleep problems, and financial problems were negatives for students.

The COVID-19 Pandemic and Its Impact on Homebound Nursing Students

University students are predisposed to stress, which could be even higher in Nursing students since they are directly related to the COVID-19 pandemic given their health training and area of knowledge. Our purpose was to assess the stress levels of Nursing students before and during lockdown due to the COVID-19 pandemic in Murcia (Spain), its influence on taking an online exam and how it was affected by physical exercise. This was an observational and prospective study including Nursing students from the second year of the Nursing Degree from 3 February to 23 April 2020. Three measurements were performed: one before lockdown and two during lockdown. Stress increased substantially during lockdown. Financial, family or emotional problems, as well as physical exercise, also increased. Indeed, at 40 days of lockdown, those students with financial, family or emotional problems, and less physical exercise reported significantly higher stress levels. In addition, those who passed the online exam had lower stress levels compared to those who failed. In conclusion, during lockdown, stress in Nursing students increased. This could be triggered by students' personal problems, and physical exercise may be used as a way to reduce stress. Academic performance was better in those students reporting less stress.

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.

Effectiveness of music therapy and progressive muscle relaxation in reducing stress before exams and improving academic performance in Nursing students: A randomized trial

BACKGROUND

Nursing students experiencing high stress levels before exams could suffer worse academic performance.

OBJECTIVE

We evaluated an intervention combining Progressive Muscle Relaxation (PMR) and music therapy on the decrease of before exams stress and the improvement of academic results.

DESIGN AND METHODS

Randomized controlled trial including students from the Nursing Degree during the first semester of the 2017-2018 academic year. All participants were randomized to the control (CG) or the experimental group (EG). The CG took the exam as usual whereas in the EG, PMR and music therapy were performed before exams. Blood samples were drawn to investigate variations in biochemical parameters. The academic performance was assessed by the score obtained in the "Clinical Nursing" exam.

RESULTS

We included 112 students (75% females, mean age 24.3 ± 6.2 years, 56 students in every group). There were no differences in any parameter during the first measurement. Regarding the second measurement, we observed a reduction in heart rate for the EG and an increase in blood pressure, heart rate, and cortisol for the CG. Indeed, these parameters were significantly higher compared to the EG. The EG had a mean score of 5.07 ± 1.59 in the Clinical Nursing exam, which was significantly higher compared to the CG (4.42 ± 1.58, p = 0.033). The proportion of fails in the CG was also higher (62.5% vs. 42.9%, p = 0.037).

CONCLUSION

In this study including students from the Nursing degree, the combination of PMR and music therapy was effective for the control and decrease of stress before exams, and also demonstrated improvements in academic results.

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.

Stress and Coping Among Nursing Students During Clinical Training: An Integrative Review

BACKGROUND

Nursing students perceive stress during clinical trainings and use various coping strategies to manage it. This integrative review critically appraises previous literature on stress and coping strategies among undergraduate nursing students during clinical training.

METHOD

An integrative review procedure was followed. Five electronic databases were searched with various search terms. A total of 1,170 publications were screened, 13 of which were included in the review.

RESULTS

Most studies applied a cross-sectional, descriptive approach. Students perceived moderate to high levels of stress during their clinical trainings, with problem solving and transference the most common coping techniques. Teachers and nursing staff were a strong stressor because students felt they were constantly being observed and evaluated.

CONCLUSION

The findings may provide guidance for how nursing staff can mentor students during clinical practice and establish a more supportive clinical environment. [J Nurs Educ. 2019;58(5):266-272.].

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.