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Biofeedback Assisted Relaxation Training Program to Decrease Test Anxiety in Nursing Students

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Biofeedback Assisted Relaxation Training Program to Decrease Test Anxiety in Nursing Students UNLV Theses, Dissertations, Professional Papers, and Capstones 2009 Biofeedback assisted relaxation training program to decrease test anxiety in nursing students Catherine Andrea Prato University of Nevada, Las Vegas Follow this and additional works at: https://digitalscholarship.unlv.edu/thesesdissertations Part of the Counseling Psychology Commons, and the Nursing Commons Repository Citation Prato, Catherine Andrea, "Biofeedback assisted relaxation training program to decrease test anxiety in nursing students" (2009). UNLV Theses, Dissertations, Professional Papers, and Capstones. 81. http://dx.doi.org/10.34917/1377261 This Dissertation is protected by copyright and/or related rights. It has been brought to you by Digital Scholarship@UNLV with permission from the rights-holder(s). You are free to use this Dissertation in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s) directly, unless additional rights are indicated by a Creative Commons license in the record and/or on the work itself. This Dissertation has been accepted for inclusion in UNLV Theses, Dissertations, Professional Papers, and Capstones by an authorized administrator of Digital Scholarship@UNLV. For more information, please contact [email protected]. BIOFEEDBACK ASSISTED RELAXATION TRAINING PROGRAM TO DECREASE TEST ANXIETY IN NURSING STUDENTS by Catherine Andrea Prato Bachelor of Arts University of Nevada, Las Vegas 2001 Bachelor of Science in Nursing University of Nevada, Las Vegas 2002 Masters of Science in Nursing University of Nevada, Las Vegas 2007 A dissertation in partial fulfillment of the requirements for the Doctor of Philosophy in Nursing School of Nursing Division of Health Sciences Graduate College University of Nevada, Las Vegas December 2009 THE GRADUATE COLLEGE We recommend that the dissertation prepared under our supervision by Catherine Andrea Prato entitled Biofeedback Assisted Relaxation Training Program to Decrease Test Anxiety in Nursing Student be accepted in partial fulfillment of the requirements for the degree of Doctor of Philosophy Nursing Carolyn Yucha, Committee Chair Susan Kowalski, Committee Member Nancy York, Committee Member Chad Cross, Graduate Faculty Representative Ronald Smith, Ph. D., Vice President for Research and Graduate Studies and Dean of the Graduate College December 2009 ii ABSTRACT Biofeedback Assisted Relaxation Training Program to Decrease Test Anxiety in Nursing Students by Catherine Prato Dr. Carolyn Yucha, Dissertation Committee Chair Dean and Professor of the School of Nursing University of Nevada, Las Vegas Nursing programs have been cited as being among the most stressful undergraduate programs. Students’ knowledge and skills are consistently tested and monitored, and students may fail a course or be dropped from their nursing program if scores are not above a certain standard. Anxiety reactions are common to situations perceived as threatening; however, excessive anxiety may paralyze an individual and interfere with effective learning, functioning, and testing. Numerous studies have found increased anxiety causes physiological changes including increased respirations and heart rate, and decreased peripheral skin temperature. The purpose of this study was two fold. First test anxiety was measured across the four semesters of a nursing program to determine if test anxiety differed by semester. Second, a biofeedback assisted relaxation training program was tested as a means to reduce test anxiety in undergraduate nursing students who self reported test anxiety. Anxiety was measured subjectively using Spielberger’s Test Anxiety Inventory (TAI) and objectively by monitoring peripheral skin temperature, pulse rates, and respiration rates during the biofeedback assisted relaxation training program. iii There were no statistically significant differences in test anxiety across the four semesters. However, third semester nursing students reported the highest test anxiety scores (47.5±16.5). Fourteen students from this semester participated in phase two of the study. During this phase, the students were introduced to three relaxation techniques including diaphragmatic breathing, progressive muscle relaxation, and autogenics training. They were asked to practice the relaxation techniques they were taught during the following week for fifteen minutes a day and record their respiratory rates, peripheral skin temperatures, and pulse rates. Findings showed statistically significant changes in respiratory rates and skin temperatures during the diaphragmatic breathing session; changes in respiratory rates and peripheral skin temperatures were statistically significant during the progressive muscle relaxation training session, and statistically significant changes in respiratory rates, peripheral skin temperatures, and pulse rates were found during the autogenic training sessions. There was no statistically significant difference between the first Spielberger Test Anxiety Inventory (TAI) and the second TAI. For further analysis, the students were divided into two groups, those who were able to learn the techniques, as evidence by a change in all three physiological variables; and those who were unable to learn the techniques. The pre and post TAI scores were compared between these two groups and there was no statistical significance between the difference scores. The researcher then artificially divided the participants into two groups, according to their score on the first TAI. Group one was comprised of those scoring above the TAI 1 mean; and group two was comprised of those scoring below the TAI 1 mean. The researcher compared TAI scores after the relaxation training using an unpaired t test. iv There was no statistical significance between the high and low scoring students on the second TAI 1. This suggests that the lack of effect of training on test anxiety was not related to the initial test anxiety level. In conclusion, the subjective test anxiety scores of the students did not decrease by the end of the biofeedback assisted relaxation training program. The students were able to learn how to control their respiratory rate, and as a result peripheral skin temperatures increased significantly during each training session. The training strategy that resulted in the greatest change in physiological measures, and presented the most significant findings was the autogenic training session. The students reported this training to be effective and useful, and 100% reported they would use this training in the future to reduce their physiological reactions associated with anxiety. v ACKNOWLEDGEMENTS I would first and foremost like to thank Dr. Carolyn Yucha for her continued support throughout this endeavor. I appreciate all of the time you have taken to ensure I was adequately prepared for each step of this process. Thank you for using your weekends to read my submissions and spending hours revising and making suggestions. Thank you for listening to me when I wanted to quit and keeping me under your wing as we went through this process together. I can never thank you enough for all you have done for me. Next, I would like to thank my entire committee. Dr. Nancy York, thank you for challenging me to think about my initial conceptual framework as you encouraged me to find a better fit for my study. Dr. Chad Cross, thank you for the endless hours you worked with me on all of the statistics for this study. Dr. Susan Kowlaski, your kind words of encouragement resonate in my mind and I thank you for being one of the best educators I have had throughout nursing school. To my husband, Todd, thank you for supporting me through this challenging time. I am sure you are as happy as I am to know this chapter in our lives is coming to a close, but I do appreciate you sticking with me through these past few years! vi TABLE OF CONTENTS ABSTRACT ....................................................................................................................... iii ACKNOWLEDGEMENTS ............................................................................................... vi LIST OF TABLES ............................................................................................................. ix CHAPTER 1 INTRODUCTION ........................................................................................ 1 Problem Statement ....................................................................................................... 2 Background and Significance to Nursing .................................................................... 3 Purpose of Study .......................................................................................................... 7 CHAPTER 2 REVIEW OF RELATED LITERATURE .................................................... 8 Anxiety ......................................................................................................................... 8 Test Anxiety ................................................................................................................. 8 Test Anxiety and DSM IV ......................................................................................... 14 Test Anxiety and Gender ........................................................................................... 16 Test Anxiety and Culture ........................................................................................... 18 Physiological Measures Related to Test
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