Biofeedback assisted relaxation training program to decrease test anxiety in nursing students

Nursing programs have been cited as being among the most stressful undergraduate programs. Students\u27 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\u27s Test Anxiety Inventory (TAI) and objectively by monitoring peripheral skin temperature, pulse rates, and respiration rates during the biofeedback assisted relaxation training program. 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. 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