Test Anxiety And Undergraduate Nursing Students

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This literature review will analyze the study of whether test anxiety interfered with how well students performed on the exam. This literature review will examine the different aspects of the study and how well it answered the question related to the study, also this review will breakdown the results within each area of the study to determine whether it worked. Finally, this literature review will dive into test anxiety to determine the background on it and how a student might feel anxious. The review will also determine whether different aspects in a student’s life contribute to further anxiety during an exam.

Test Anxiety and Academic Achievement among Undergraduate Nursing Students: A literature review

In 2016 there was a study conducted on the relationship between test anxiety and academic achievement among undergraduate nursing students. The researchers wanted to explore the study more when it was realized that “most nursing students experience high levels of test anxiety during final exam even though their marks are good throughout the semester” (Dawood et al., 2016). The study consisted of taking 277 nursing students from different levels in nursing school, the students were asked to do a questionnaire that included “participant’s demographic background such as age, GPA, academic level, history or medical and mental illnesses and Test Anxiety Inventory (Dawood et al., 2016) (Spielberger, 1980). The students were asked “20 statements to find out how often the participants experience the feeling described in each statement” (Dawood et al., 2016), this was done to determine how each student felt during certain high-stress situations. The purpose of this literature review is to determine if there is a relationship between test anxiety and academic achievement among undergraduate nursing students, by “identifying the level of test anxiety and second to explore the relationship between anxiety and academic achievement among undergraduate nursing students” (Dawood et al., 2016).

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Test Anxiety

There is evidence that anxiety is a “universal cause of poor academic performance among students worldwide (Dawood et al., 2016). There is support for this theory when Asadullapoor, Fati, and Gharaee, 2010, state “anxiety was defined by as feeling that undesirable and unclear like when a person predicts a danger situation” (Asadullapoor, Fati, and Gharaee, 2010). On the other hand, other sources suggested there was no relationship between emotional aspects of performing that correlates with performing poorly on an exam, this is evidenced by Cassady (2001) stating “The prime view of the association between these two factors suggests the cognitive component that directly influences the performance of students in exams, while the emotionality component is associated but does not directly persuade test performance” (Cassady, 2001). Both sides evidence the standing of the argument that anxiety can have an impact on test performance, but there is also no correlation between a student doing poorly on an exam due to anxiety. Other researchers believed that having test anxiety was important for the student to do better in school, but other researchers disagreed and stated 'Mounting up so much of anxiety will not help the student to perform rather it will influence the academic performance negatively (Coon & Mitterer, 2009).

Relationship Between Nursing students & Test Anxiety

There was also evidence that stated nursing school in general causes the student to feel anxiety because 'Nursing programs can be viewed as highly stressful settings. Nursing students are under pressure for taking various tests throughout their college and professional lives (Dawood et al., 2016), this idea is supported when Beggs, Shields & Goodin 2011 state 'Nursing students experience higher levels of test anxiety than others, especially because of struggle to balance multiple works, career adjustment and family responsibilities with long study hours that are required for success. Over time these stressors may put the student in chronic stress' (Beggs, Shields & Goodin 2011). The downside to the study for nursing students and the relationship between performing negatively on an exam was the fact that the study did not take into account other students from different parts of the world to determine whether there was anxiety while taking an exam during nursing school, given this problem the study was conducted in Saudi Arabi and there was little evidence to support the nursing students there, but rather more so the nursing students in western cultures, this is evidenced when “Most of the studies that assessed anxiety and stress among nursing students were carried out in western population. However, there are limited researches on test anxiety among nursing students in the Saudi population” (Dawood et al, 2016), this is concerning considering the researchers wanted to make the connection of test anxiety to nursing students in this area.


The study was conducted with 277 nursing students, some from different levels within school, using the Test Anxiety Inventory by (Spielberger, 1980) “which was used as a measure of the primary outcome variable of the current study, test anxiety among undergraduate nursing students. The TAI consists of 20 statements, and the participants indicate on a four-point Likert- type scale how often they experience the feeling described in each statement” (Dawood et al, 2016). The average age of the participant was between 19-23, the researchers considered whether the participant was married, as well as if the student had a medical diagnosis. When the study was evaluated it was determined that the students felt more anxious during an exam stating “during examinations I get so nervous that I forget facts I really know. Thinking about my grade in the course interferes with my work on tests” (Dawood et al, 2016) these were the statements that were ranked highest for students. The least ranked questions were those that showed the student as being confident during the exam, the statements were “I feel confident and relax while taking test” and “I find myself thinking about whether ill ever ger through school” (Dawood et al, 2016). When comparing the test anxiety inventory score there is a clear increase in the number of students who did not feel comfortable while taking an exam and the feeling of anxiety present “participants were distributed to four different levels of test anxiety according to their test anxiety inventory scores” (Dawood et al, 2016) “scores between 20 and 35 no anxiety, 36 – 50 mild anxiety, 51 – 65 moderate anxiety and 66 – 80 severe anxiety. Based on this classification, only 6.5% experienced no anxiety, more than one quarter of the participants experienced mild anxiety, half of the participants (50.9%) classified as having moderate anxiety while 14.4% demonstrated severe anxiety” (Dawood et al, 2016). Based on the findings above more students ranked with mild anxiety during an exam in nursing school. The study also presented that students with a high academic level had a decrease in anxiety while taking an exam. It was also learned that although different aspects like marriage, age, and children were taken into consideration neither had much of an impact on whether or not the student did well on the exam.


The purpose of this study was done to determine whether nursing students had test anxiety that interfered with academic achievement. During this study several things were taken into consideration when determining whether it had to do with a students performance on an exam, it was determined that age did not affect whether a student performed poorly on an exam, this is supported by “With regard to relationship between test anxiety and undergraduate nursing students age the present study showed no significant relationship; also indicate that test anxiety scores decreased with participant’s age. These findings agree to the work done by (Ebrahimi & Khoshsima 2014) that age does not play a significant role in the relationship between learners Test Anxiety” (Dawood et al,2016). It was also determined that test anxiety although most students admitted to it there is no correlation on the student's test scores decreasing because of the anxiety felt while taking an exam. It was also suggested that the study needed to take into account more information to support what could potentially cause the student to have anxiety, the study could be re done and new questions could have been asked to students to see if there is a relationship to how well they prepared for an upcoming exam and whether or not It had caused the student anxiety for feeling underprepared for an exam. The study did suggest that students had 'mild anxiety' there was no set factor that determined the patient was going to perform poorly on the test, but rather the student was anxious because nursing school is hard work. The study was done to “(a) identifying the level of test anxiety and (b) to explore the relationship between anxiety and academic achievement among undergraduate nursing students” (Dawood et al., 2016). The reviewed study determined that although most nursing students felt anxious during an exam, it did not correlate with the students performing poorly during the exam.


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