Stress is a complex phenomenon that has significant effects on students which may disturb their physiological, psychological, and spiritual health and well-being. Nursing students have been identified to be at high risk for stress during their training. Crary (2013) reported that course examinations and clinical practice have been identified as 2 of the most perceived stressors in nursing programs. The demands of nursing programs with substantial course loads and rigorous examinations all within a competitive environment can lead to unattainable levels of stress for students. Most nursing programs administer a standardized predictor exam to assess preparedness for the NCLEX. A study was completed at a Midwestern, Liberal Arts College that introduced a stress intervention prior to nursing seniors taking their predictor exam.
Methods:
Data was collected for three consecutive years. The Stetler Model was utilized as a foundational framework to guide this study. All senior nursing students were invited to participate in the study. A total of 87 students participated over the 3 years (2017-2019). The project paperwork included a stress questionnaire and post intervention self-report of usefulness survey. The stress intervention took place on the predictor exam dates. The stress intervention began once students entered the examination room. An ocean waves soundtrack was playing with the lights dimmed in the room. Once all students had entered the examination room and logged into their exam accounts, students were then led through 90 seconds of light stretching followed by 1 minute of deep breathing exercises. The ocean waves soundtrack continued to play in the background. At the end of the deep breathing, the soundtrack was stopped, the lights turned on and students returned to their seats ready to begin the exam. At the end of the exam, students were provided with a short post intervention of usefulness survey and stress questionnaire.
Results: Data from the study was exceptionally positive and noted that 97.7% of all students studied over 3 years reported they would use the stress intervention techniques implemented in the study to reduce stress in the future. Data from the 2017 cohort reported that 91.9% of students stated the stress intervention helped decrease their testing anxiety with 96% reporting decreased testing anxiety in the 2018 cohort and 83.3% with decreased testing anxiety in the 2019 cohort. Data from the 2017 and 2018 cohorts both reported 100% of students felt the stress intervention was helpful with 80% of students in 2019 reporting the intervention as being helpful.
Conclusion: Implications for future practice have been validated by the results of this study. Based on the positive results of this study, the integration of pre examination stress interventions in undergraduate nursing curricula should be considered to reduce pre exam stress among nursing students.