A Multi-Modal Approach to Address Test Anxiety in Students in an Accelerated Nursing Program

Saturday, 21 July 2018

Dafina A. Naydenova, MSN, RN-BC, AGPCNP-BC1
Carleen Graham, MSN, RN, NY-SAFE1
Nicole Davis, BSN, RN2
Vivian Lien, BSN, RN3
Joana Velasquez, MS, RN, CNOR1
(1)Phillips School of Nursing at Mount Sinai Beth Israel, New York, NY, USA
(2)Medical-Surgical/Oncology Unit, St. Luke's University Health Network, Easton, PA, USA
(3)School of Nursing, Phillips School of Nursing at Mount Sinai Beth Israel, New York, NY, USA


The aim of this project is to reduce test anxiety and improve scores of nursing exams and NCLEX-RN pass rates through the use of multiple interventions including aromatherapy, cognitive based therapy, and peer mentoring. The program’s overarching goal is to promote academic success and emotional well-being for our nursing students through the identification and reduction of test anxiety in our nursing students.


All the accelerated nursing students who will be attending the spring (Spr), summer (S), and fall (F) semesters of 2018 at Phillips School of Nursing at Mount Sinai Beth Israel will be participants in the study. Approval from the institutional review board will be obtained. Participation in all activities will be voluntary. Students will be screened for contraindications to essential oils and written informed consent will be obtained at the beginning of the study.

Aroma therapy, cognitive behavioral therapy (CBT) and peer mentoring will be offered to students as test anxiety lowering interventions. The students will be given a choice to participate in one or more of the provided strategies. Pre and posttest questionnaires will be administered to all the students. The initial questionnaire will include a question for the students to indicate whether students had participated in the intervention(s) or not. In addition, the exam grades and the NCLEX results will be monitored for improvement.

In previous studies the essential oils were diffused in the classrooms (Johnson, 2014). However, that method will not be available to the students when they are to take the NCLEX exam. The essential oil could be applied to the student’s wrists, under their noses, or the students could be provided with a paper strip (FLORMOON Fragrance Test Strips) impregnated with essential oils for direct delivering the fragrance to the nose (Schneider, 2015). After the initial questionnaires are completed, the participants will be prompted to inhale the fragrance immediately before and throughout the exam.

The CBT will be offered by two faculty members who will be trained by expert consultants. Written materials will be provided to the participants with related topics. The therapy will be implemented via small group sessions and individual sessions throughout the semesters based on the individual needs of students. The group sessions will provide lectures and exercises introducing the students to CBT and emotion regulating strategies. The individual session will be focused on the “application of cognitive and behavioral strategies such as cognitive restructuring, assertive communication, and stress management” (Chand et al., 2017).

The peer mentoring activity will provide students with peer-led stress prevention seminars throughout the semesters. The mentors will be selected via volunteer process and trained. The selection will be based on the applicant’s GPA and professional conduct in the school. The Phillips Fellows will be also involved as mentors. The seminar sessions will include teaching of the basic knowledge of stress, stress reduction, coping techniques, and time management. Discussions among the participants will be encouraged and small group activities will be implemented to enhance the process (Bugaj et al., 2016). Each seminar will be evaluated with a questionnaire.


A needs assessment was performed on the nursing school on the need for a crisis management program. This needs assessment was intended to identify the psychosocial needs of current and future nursing students, program responsibilities for meeting those needs, and faculty knowledge gaps.

Gaps identified in the assessment included: (a) the need for implementing policies on addressing crisis intervention on the campus and clinical setting; (b) addressing the needs of a widely diverse student body; (c) addressing student interest in onsite counseling, crisis intervention, and accessibility of program services; and (d) faculty training in recognizing, identifying, and intervening with individuals in distress. It was also identified that students report a significant amount of test anxiety. A great deal of this anxiety can also be attributed to personal stressors and mental health related issues experienced by students.

Success of the project will be determined by evaluation of student and staff feedback. Specific information on student report of decreased anxiety post interventions, student report of satisfaction with the interventions, student performance on exams, and student overall success in the nursing program and NCLEX pass-rates will be collected. Depending on periodic evaluation results, the project will be amended; and if the program is successful, the school will continue the program.


The proposed program responds to challenges in the teaching and learning environment that are inherent in today’s nursing classrooms. One of the rising concerns in nursing students that could negatively impact their navigation through a nursing program is the presence of test anxiety. Test anxiety has been shown to negatively impact a student’s academic performance and has become one of the most debilitating stressors in nursing students. In spite of these challenges, schools of nursing present great opportunities for the identification, management, and improvement in the prevention of test anxiety in nursing students.

The literature revealed that utilizing strategies such as biofeedback-assisted relaxation alone was not enough to have a significant impact on students’ test anxiety. It was discovered, however, that incorporating multiple strategies such as aromatherapy, cognitive based therapy, and/or peer mentoring may help to reduce test-anxiety in nursing students. Additionally, the proposed project supports PSON’s mission to improve student learning in higher education by piloting a crisis management program that will promote academic success and emotional well-being for nursing students. The proposed project will enable faculty to develop a policy of interventions that effectively deal with students who experience test-anxiety in the classroom and in the clinical setting. Anticipated benefits include a reduction in test anxiety, improved academic performance, and improved NCLEX pass-rates.