THE RELATIONSHIP AMONG

TEST ANXIETY, ACADEMIC ACHIEVEMENT, AND AGE

IN ASSOCIATE DEGREE NURSING STUDENTS

A Thesis Presented to the

Division of Nursing
College of Pharmacy and Health Sciences
Drake University

In Partial Fulfillment
of the Requirements for the Degree
Master of Science in Nursing

by
Cynthia C. Eubank
July 1993
 THE RELATIONSHIP AMONG
TEST ANXIETY, ACADEMIC ACHIEVEMENT, AND AGE
IN ASSOCIATE DEGREE NURSING STUDENTS

by
Cynthia C , Eubarik

Approved by Conrmlttee:
 ABSTRACT

à he purpose of this study was to examine the

relationship among test anxiety, academic achievement
and age in Associate Degree Nursing students. To test
~he~relationshlp among the variables, two hypotheses
were posed.
~mployinga descriptive research design, data were
collected through the Test Anxiety Inventory (TAI)
(Spielberger, et al., 1980) and compared to the final
course grades and ages of 107 first term, second year
FDN students. Data were analyzed by the use of
descriptive statistics, the Pearson product moment
correlation coefficient, and the ANOVA. The alpha level
was set at 0.05.
The findings of this study revealed that as test
anxiety increased, academic achievement (course grade)
of the ADN students significantly decreased (r = -0.31,
p < -05). NO significant relationship between age and
test anxiety in the RDN students was found ( p = 0.535).
Recommendations for further research include early
test anxiety assessment with interventions and follow-up
test anxiety testing. Research that targets older
students by specific ages may more clearly address
age-related test anxiety influences.
 TABLE OF CONTENTS

Page
ABSTRACT i

TABLE OF CONTENTS

L I S T OF TABLES

CHAPTER
I . THE PROBLEM
Overview of the Problem
Purpose of the Study
Research Hypotheses
Definition of Terms
Overview of Conceptual Framework and
Literature Review
Significance to Nursing

11. REVIEW OF THE LITERATURE

Conceptual Framework
Review of Relevant Research
Summary
 iii

111. METHODOLOGY
Research Design
Sample and Sampling Plan
Data Collecton Instrument
Data Collection Procedures
Protection of Human Subjects
Summary

IV. ANALYSIS OF DATA

Characteristics of the Sample
Hypothesis One
Hypothesis Two
Incidental Findings
Summary

V. S-Y , DISCUSSION AND RECOMMENDATIONS

Summary
Discussion
Limitations
Recommendations
Implications for Advanced Nursing

REFERENCES

APPENDICES
A . Test Anxiety Inventory
B. Cover Letter and Consent Form
C. Approval Forms
 LIST OF TABLES

Table 1 Characteristics of the Sample 41

Table 2 Analysis of Variance of TAI Scores with

Age Groups of ADN Students 44
Table 3 Analysis of Variance of Course Grade
with Age Groups of ADN Students 46
Table 4 Analysis of Variance of TAI Emotion
Scores with Age Groups of ADN Students 47
Table 5 Analysis of Variance of TAI Worry Scores
with Age Groups of ADM Students 48
 ACKNOWLEDGMENTS

In addition to God, I wish to thank the following

people for their part in helping me through the
completion of my thesis:
To my family, friends, and co-workers who assisted,
encouraged and prayed for me.
To Sandy Sellers, my advisor, for her patience,
persistence, promptness, and preciseness.
To my committee members, Chris Mood and Ev
Anderson, for their willingness to serve on my committee
and their invaluable assistance.
To Elaine Forret, for her time and computer
wizardry in completing final production of the finished
thesis.
To Pat Quinnett, my statistician, for her time and
help in implementing my data analysis.
 CHAPTER ONE

THE PROBLEM

Overview of the Problem

In associate degree nursing (.?~DN) education,
classroom content is complex, the scope is broad, and
the pace is accelerated. Frequent testing of students
is necessary throughout the program for evaluation of
progress in mastering content. Students entering the
second year of an ADN program verbalize and exhibit a
great deal of anxiety regarding course examinations.
Student anxiety is noc limited to examinations, but
test-taking does appear to be the area of greatest
concern. On numerous occasions, this anxiety seems to
negatively affect academic achievement. In addition,
there is speculation among some nurse educators that
anxiety and academic achie-~ementdiffzr among various
age groups. Younger students (19-25 years) seem to
exhibit moderate anxiety, middle-aged students (26-34

years) exhlbit considerably less anxiety, and older

students (greater than 35 years) exhibit the highest
observable anxiety in relation to testing.
Test anxiety can have short and long term effects
on ADN students and their academic achievement may
decline. Academic achievement could be affected to the
point of failure for some students, potentially
eliminating any future for them in nursing. Others who
are able to complete the ADN program may experience
great difficulty with the National Council Licensure
~xamination (NCLEXI. In addition, the graduates also may
be hesitant or resistant to any future continued nursing
education.

Purpose of the Study

The purpose of this study was to examine the
relationship among test anxiety, academic achievement,
and age. Specifically, this study examined the
relationship among test anxiety, academic achievement,
and age in second year, first term ADN students enrolled
in a midwest community college.

Research Hypotheses

Two research hypotheses were posed for this study.

They were ;
1. There will be a significant inverse relationship
between test anxiety and academic achievement in second

year, first term RDN students.

2. There will be no signifisant difference in test
anxiety among second year, first term ADN students
according to age.
The rationale for a directional hypothesis in
hypothesis one was based on previous research that
supports the notion that test anxiety negatively affects
academic achievement. The null hypothesis was used for
hypothesis two because no similar data were available in
the literature to substantiate a directional hypothesis.

Definition of Terms
For the purpose of this study, the terms listed
below were defined as follows:
Test Anxietv: A diffuse feeling of worry or discomfort

accompanied by negative thoughts in relation to a

testing situation as measured by a total score on the
Test Anxiety Inventory (TAI)(Spielberger, Gcnzalez,
Taylor, Ancon, Algaze, Ross, and Westberry, 1980).
~ ~ ~ d Achievement:
~ m i c Final course grade, compuced in

percentages. This percentage was determined by adding

total points obtained on five unlt multiple choice
examinations and one comprehensive multiple choice
examination. The total was weighted for each
examination, divided by the number of points possible,
and rounded to the nearest hundreth.
Age: Chronological self-reported age, in years, of
students.
FDN N u ~ s ~
Students:
~ Q Students enrolled in the second
year, first term of a two year Associate Degree Nursing
program located in a midwest community college.

Overview of Conceptuai Framework and Literature Review

~nxietyserved as the conceptual basis for the
study. S. B. Sarason, Davidson, Lighthall, Waite, and
Ruebush (1960) believed that anxiety had its roots in
early childhood wlth both developmental and
environmental elements. They proposed that these
elements are all linked to perceived feelings of
insecurity and inadequacy that are carried into
adulthood. These feellngs served as Sarason et al.'s
definition of anxiety.
Anxlety as a concept relevant to nursing was
thoroughly developed by nurse theorist Hildegard E.

Pephau (Peplau, 1952). Peplau viewed anxiety as a

frequent consequence of tension resulting from perceived
needs. ~f the need is strong, "all behavior is directed
toward it..." (p. 80). Peplau believed that anxiety

occurs in varying degrees. Mild anxiety frewently

heightens alertness and problem-solving ability. AS
anxiety increases, however, alertness and learning
capability decline, and panic may ensue. Peplau further
stated that "when needs are not met in direct ways, with
subsequent lowering of tension, somatic (physiological)
responses of greater intensity than is usual are
activated. These responses, being more closely related
to emotional and psychosocial needs than to structural
difficulties in the organism itself, are usually called
psychosomatic responses" ( p . 8 3 ) .
Test anxiety as a related concept has been defined
by I. 6 . Sarason (1978). Sarason, an independent
researcher and coauthor with Spielberger, believed that
when characteristics of a person's anxiety are linked to
examination situations, the anxiety could be labeled
test anxiety.
The term "test anxiety" did not appear in the
literature with great frequency until the 1960s and
1970s. Test anxiety, according to Spielberger (1979),

consists of two primary components: worrj and

emotionality. Worry includes personal thoughts
regarding poor test performance and uliimate course or
academic failure. Emotionality includes physiological
components such as fear, panic, tension, and increased
heart and respiration rates. Both of these components
combine to potentially interfere with test performance
in many situations.

There are many variables that have been identified

as useful in predicting academic achievement (Chacko and
~ u b a ,1991; Howell and Swanson, 1989). Test anxiety
frequently has been investigated as one of these
variables and appears to play a powerful role in
academic achievement.
Spielberger (1966; 1979) was one of the first
researchers to investigate test anxiety in a systematlc
manner. In 1966, Spielberger conducted studies in which
he selected 24 high anxiety students and 24 low anxiety
students enrolled in introductory psychology courses at
Duke University and the University of North Carolma.
Anxiety was determaned using scores on the Taylor
Manifest Anxiety Scale. Spielberger found that in
testing situations, the higher anxlety group
demonstrated overall poorer performance as izask
difficulty increased-
A later study conducted by Spielberger (19793

invest-gated anxiety and over-all grade point average-

participant- were 140 high anxiety and 144 Pow anxiety

students enrolled in introductory psycho log^ classes at

Duke university. ~cholasticaptitude for these students
was determined using the ACE Psychological Examination.
The ACE scores for groups I-V ranged from 62-102,
103-116, 117-126, 127-137, and 138-174 respectively.
Graphic depiction of these results demonstrated a trend
in which the 3 middle scholastic aptitude groups with
high anxiety had lower grade point averages for the
semester than their low anxiety couterparts. In
addition, the ultimate failure/drop-out rate for the
same high anxiety students was 20% compared to 68 of the
same low anxiety students.
The Test .Anxiety Inventory (TAI)(Spielberger et
al., 1980) was developed to specifically analyze test

anxiety components in a research setting. Spielberger

compared TAI scores for 195 male navy recruits and 72
female navy recruits with scores on recruit training
examinations. Negative correlation results of -0.34 and
-0.19 respectively were obtained when recruitment scor2s
and anxiety scores were compared. Spielberger concluded

that test anxiety has a negative effect on academic

achievement.
There are numerous studies supporting Spielbergerls
original research, but in nursing education no research
was discovered that specifically investigated test
anxiety and academic achievement. In addition, two
literature searches have yielded virtually no nursing
education studies specifically targeted at test anxiety,
academic achievement and age, or any combination of
these variables,
Spielberger (1979) and Knowles (1980) suggested
some aspects of aging that may contribute to stress and
anxiety. These include a decline in physical capacity,
decreased self-confidence, decreased job mobility, fewer
opportunities, and approaching age of retirement with
concurrent feelings of limited time to complete an
education.

Significance to Nursing
Nursing education and the students it attracts have

changed significantly. Until a few years ago, career

options for women were limited, and nursing educational
programs had many applicants. Because of this, nurslng
programs could select students with higher aptitudes or
demonstrated abilities. Green (1987) concluded that
interest in nurslng as a major course of study among
first time full-time women enrolled ln 4-year colleges
declined from a high of 8.5% to 3.7% in 1985. Merritt
(1991) believed this change in interest in nursing

mirrors the shift in student preferences away from more

traditional womenis roles.

Todayf more nursing education students fall into

the middle ability category, possibly due in part to
increased career choice options and the emergence of
two-year community college ADN programs. Achievement

scores reflect this middle ability trend. For example,

the ASSET test (an adult academic achievement test)
score means for second year ADN students (1991-921
enrolled in the nursing program used in this study were:
Reading-43.4, Language-43.02, and Numerrcal-39. National
Asset score means (1391-32) were: Reading-40.73,
Language-41.01, and Numerical-39.05. A comparison of
scores from each group indicates similar results
reinforcing the notion that ADN students perform at the
national average. Studies show a greater failure rate
for students in this ability group who exhibit high
levels of test anxiety (Spielberger, 4979).
Green (1987) reported that the average Scholastic

Aptitude Test (SAT) composite score for fall 1985

nursing majors was 217 points lower than the national
average for non-nursing majors. ~mericanCollege Test

(ACT) scores also have declined. Green reported a 1985

National League of ~ursingsurvey that led to data

indicating that over 50% of generic achel lor of science

in ~ursing IBSN) programs have remedial courses
available to students in reading, math, and study

skills.
I. G. Sarason (1972) believed "correlational

explorations of test anxiety can be closely linked to

the process of construct validation" ( p . 382). It was
hoped that test anxiety research within the nursing
education arena would assist in broadening the scope of
understanding the construct of test anxiety and ~ t s
relacionship to academic achlevernent.

The age of nursing education students aiso has

changed significantly with nontraditional students now
outnumbering traditional students. The average age in
1
1991 for students enrolled in the same program used in
this study was 31.07 years. Observation by some nurslng
educators have led to the belief that older students
appear to frequently exhibit high levels of test anxlety
and need some form of Intervention that will assist them
f
in reducing th- anxiety.
It was hoped that findlngs acquired from this
.
research can help nursing educators in their attempts to
understand why many able students fail or exit nursing

programs. I f part of the problem is an inability to

cope with their test anxieties, perhaps methods aimed at
reduction of this anxiety could be implemented with a
follow-up comparison of TAI retest results. Techniques
for assistance with test anxiety have and are being
developed. Test anxiety reduction also may help students
who graduate from nursing educational programs but
suffer continuously with this problem throughout their
education. These students may feel less inclined to
continue advanced education if test anxiety is present.
There are short and long term implications for these
students regarding both future confidence and
performance. Students with hlgh levels of test anxiety
may hesitate to undertake continuing education in both
degree and non-degree educati~nalprograms. It was hoped

that early intervention will beneflt both students and

nursing educational programs. It was also hoped that

nursing education programs would review teaching and

evaluation mecho&logies to maximize student success.
 CHAPTER TWO

REVIEW OF THE LITERATURE

The purpose of this study was to investigate the

relationship among test anxiety, academic achievement,
and age. This chapter is divided into three sections.
The first section presents the conceptual basis for the
study. Research relevant to test anxiety is discussed
in the second section. A brief summary concludes the
chapter.

Conceptual Framework
The conceptual foundation for this research was
based on the concept of anxiety. S. B. Sarason (1960)
believed anxiety has its roots in childhood and is
manifested as a result of a conbination of developmental
and environmental factors. He defined anxiety as a need
for security that remalns unfulfilled. Sarason further

contended that "the passage of time tends not to be

therapeutic and the problem [anxiety] may remain at a

particular level or become worse" ( 2 . 22).

~nxietyas a concept relevant to nursing was
developed by nurse theorist Hildegard E. Peplau (Peplau,
1952). ~eplauviewed anxiety as a frequent consequence
 resulting from perceived needs. ~f the need
is strong, "all behavior is directed toward it...+l
(P- 8 0 ) - Peplau proposed that anxiety occurs in varying
degrees or levels, ranging from mild anxiety to panic.
She postulated that mild anxiety frequently heightens
alertness and problem-solving ability. As anxiety
increases, however, alertness and learning capability
decline, and panic may ensue. Peplau further stated
that "when needs are not met in dlrect ways, with
subsequent lowering of tension, somatic, or physical
responses of greater intensity than is usual are
activated. These responses, being more closely related
to emotional and psychosocial needs than to structural
difficulties in the organism itself, are usually called
psychosomatic responses" ( p . 8 3 1 . ~ h e s etypes of
responses described by Peplau were studied by other
researchers investigating test anxiety. whitley (1992)
acknowledged Peplau as the pioneer in defining anxiety
within nursing. Anxiety continues to be defined as both
a psychological and physiological phenomenon-
~ c c ~ r d i nto
g I. G. Sarason (1978), anxiety is "a
type o f cognitive response marked by self-doubt,
feelings of inadequacy, and self-blame" (P. 195) .
similarly, Lazarus and ~verill (1972) conceptually
defined anxiety as ir'Iv0l~inga "threat to the integrity
of cognitive systemsu (p, 2 7 8 ) .

The term "test anxiety" did not appear in the

literature with any frequency until the 1960s and 1970s.
Test anxiety, as a related concept, was defined

originally as it related to children by S. B. Sarason et

al. (1960). hey believed that "the test anxious child

may have strong hostility toward parents and also strong

guilt" resulting ln self-depreciatory attitudes with
anticipation of test falluse !p. 19). The testing
situation was thought to be an unpleasant experience
that interfered with problem solving. They also
concluded that the passage of time was unlikely to be
therapeutic in reducing test anxiety and at best a
static anxiety level would exist but more likely the
anxiety would become worse.
Spielberger, Anton, and ~edell (1976) defined test
anxiety in terms of personal disposition toward

experiencing both intense personal state anxiety in

testing situations and emission of "negative,
self-centered, worry responses" !P. 341)- The high
level of these responses produce "task-related error
tendencies" and "task-irrele~antW0PI-Y responses," both
of which decrease performance ( P . 324). Test anxiety
 was defined by 1. G . Sarason ( 1 9 7 8 ) . Sarason, an
independent researcher and frequent coauthor with
Spielberger, believed that when characteristics of a
Person's anxiety are linked to examination situations,
the anxiety can be labeled test anxiety.
Initial systematic investigation of test anxiety

was begun in the 1950s ( S . 8. Sarason, Mandler, and

~ r a i g h i l l ,1 9 5 2 ) . Sarason et al. defined anxiety as a
learned drive that operates as a strong stimulus. In
testing situations, this anxiety produces two types of
responses: (1) non-task relevant responses (feelings of
inadequacy and wanting to leave the situation) and (2)
task-relevant responses that allow completion of the
task and reduce anxiety.
I. G. Sarason (1972) clted his earlier research in
which an attempt was made to compare general anxiety
with test anxiety. College students (not defined) were
given a General Anxiety Scale and Test Anxiety S- ale to

complete. They then were asked to complete a serial

learning task of dissyllable words. ~ a l fof the group
was given only neutral instructions necessary to perform
the task. The other half was told that the test was a
measure o f intelligence and the students were urged to
do as well as possible. Although much of the specific
numerical data Were not included, students with high and
low general anxiety Scores performed equally well. When
test- anxiety Scores were compared, students with h i g h
test anxiety scored similarly or becter than those with
low test anxiety only in the neutral instruction group
(69.7 and 63.4 respectively). In the intelligence
achievement instruction group, high test anxiety
students scored 52, while their low test anxiety
counterparts scored 62. Statistical analysis to
determine significance was not Included. Sarason
concluded that general anxiety and test anxiety are
different from one another. He also supported the
notion that test instructions and perceived importance
of tests may alter examination performance in high test
anxious students.
Test anxiety, according to Spielberger (1979),
consists of two primary components: worry and
emotionality. Worry includes personal thoughts
regarding poor test performance and ultimate course or
academic £allure. Emotionality includes physiological
components such as fear, panic, tension, and increased

beart and respiration rates. Both worry and

emotionality combine to potentially interfere with test
performance in many situations.
 ~eichenbaurnand ~utler (19801 supported a similar
conceptualization of test anxiety (worry and

emotionality) and expanded on possible contributing

factors such as the nature of the "~nternaldialogue" in
the test anxious student (p. 159). They proposed that
the internal dialogue in the test anxious person is self-
oriented rather than task-oriented, negative in nature,
and tends to be self-escalating. Additionally, this
negative self-reference is reflective of general,
embedded thoughts about self and the environment.
Meichenbaurn and Butier also acknowledged the importance
of the meaning of the evaluative situation to the
student and the various implications of failure that may
greatly vary in percieved or real magnitude.

Review of Relevant Research

There are many variables chat nave been identifled
as useful in predicting academic achievement (Chacko and
Huba, 1991; Howell and Swanson, 1989; Watson, 1988).

Test anxiety has been frequently researched as one of

these variables and appears to play a powerful role r n
academic achievement.
An early investigation conducted by S. B. Sarason
(1960) focused on children and test anxiety. He
surmised that the test anxious child may have a severe

sense of guilt along with hostility toward parents. In

testing situations, the child manifests
self-depreciatory attitudes, anticipates test failure,
and experiences the situation as unpleasant with
resultant interference with problem solving. These
feelings are thought to persist into adulthood. Sarason
developed both test and general anxiety scales for
children. His research studies yielded a variety of
results, but overall conclusions indicated that a time
criterion and no additional trials had detrimental
effects on high anxiety students.
Similar research was conducted by I. G. Sarason
(1978). He compiled the examination scores of 34
undergraduate students enrolled in a personality class.
Using a Test Anxiety Scale developed by Sarason, high

and low anxiety students were identified and their

examination scores compared. Average scores were 32.06
and 3 0 . 9 3 respectively. He then informed all students
that they would be given a second examination over the
same material and if they got a higher score, it would
be entered in the grade book, but they would not be
penalized if the score was lower. second test results
for high and low anxiety students Were 42 and 3 3 - 7 3
respectively - These results were statisitically
significant at the 0.05 level, although specific 7rnlues
were not identified. "There was a marked facilitative
effect of the no-risk condition for students relatively
high in anxiety" (I. G. Sarason, 1978, p . 2 1 3 ) .
~pielberger (1966; 1979) also investigated adult
test anxiety in a systematic manner. In 1966,
~pielbergerconducted studies in which he selected 24
high anxiety students and 24 low anxiety students
enrolled in introductory psychology courses at Duke
University and the University of North Carolina.
Anxiety was determined using scores on the Taylor
Manifest Anxiety Scale. Spielberger discovered that in
testing situations, the hlgh anxiety group demonstrated
overall poorer performance as task difficulty increased.
Spielbesger et al. (1976) applied their premise of
a worry and emotionality component in test anxiety.
~ l t h o u g hspecific data were not included, they related

research results that suggested that worry about tests

remains constant in high anxiety students, but
emotionality increases immediately prlor to the testing
situation. This finding was supported by ~ ef enbacher
f
( 1 9 8 0 ) who cited five studies involving college students

(N = 77-87). In each study, worry correlations were

significantly inversely related to performance ( -.26 to

-.361 while emotionality correlations were

P= -01--001),

not always significant i - . 0 7 to - . 2 6 , p= .10-.01).

Deffenbacher believed the timing of emotionality
measurements is a critical factor. Emotionality may peak
just prior to an examination and decrease during the
examination as greater attenclon is focused on the
examination. He therefore supported the notion that the
worry component of test anxlety acts as a more pervasive
factor with performance than emotionality.
A later study conducted by Spielberger ( 1 9 7 9 !

investigated anxiety and overall semester grade polnt

average. Participants were 140 high anxiety and 1 4 4 low
anxiety students enrolled in introductory psycholow
classes at Duke Unversity. scholastic aptitude for
these students was determined using the ACE
Psychological Examrnation. Students were then placed in
groups depending on their scholastic aptitude. he ACE

scores for groups I-V ranged from 6 2 - 1 0 2 , 1 0 3 - 1 1 6 ,

117-1215, 127-137, and 1 3 8 - 1 ? 4 respectively. Graphic
depiction of these results demonstrated a trend in which
the 3 middle scholastic aptitude groups with high
anxiety had lower grade point averages for the semester

t h a n their low anxiety counterparts. Statistical

significance was not reported. In addition, the ultimate
failure/drop-out rate for the same high anxiety students
was 20% as compared to 6% for the same low anxiety
students.
Kirkland and Hollandsworth (1980) reported
statistically significant correlations between test
anxiety and GPA ir= - . 3 7 , p > .001) and ACT scores
r - 3 p > 0 0 The subjects consisted of 305
undergraduate students enrolled in introductory
psychology and sociology courses at a Southeastern
university.
The literature related to test anxiety also
contained numerous studies that have invest-gated
specific factors that may contribute to test anxiety.
These include cognitive interference, study skills, test
taking skills, types of testing i~s~ructions,
and
previous academic success. Bruch, Pearl, and Giordano
(1986) investigated the effects of several variables of
test anxiety on academic performance. These included
information-processing strategies. degree of belief in
negative self-statements, type A behavior, test-taking
skills, and unrealistic expectations. The sample
consisted of 58 undergraduates at an unnamed
institution. The ages of the students ranged from 18 to
25 years. MRNOVA findings included statistically
significant effects of Lest anxiety (F = 3.03, p -05)
on performance (F = 8.27, p < .001). Also, ANOVA results
for test-taking skills were statistically significant
for performance iF = 35.27, p < .001) regardless of
anxiety levels. Bruch et a l . concluded that deficits in

academic skills, particularly test-taking skills, m a y be

more important determinants of performance than worry or
emotionality.
Similar results were reported by Brown and Nelson
(1983). Their research involved 72 undergraduate
students enrolled in an Introduction to Applied
Psychology class at a large midwestern state university.
The high performers in this group reported greater
cognitive control ( F = 12.97, p = ,001) regardless of
anxiety levels. Thus they supported focuslng on
cognitive control as one mechanism to improve
performance .
I. G. Sarason and Stoops (1978) proposed that test

anxiety is affected by cognitive interference

(preoccupation) that then affects performance. Their
sub~ectsincluded 96 psychology students from the
University of Washington. All students were given the
Test Anxiety Scale to determine level of test anxiety.
One half of the group was given achievement-oriented
instructions. The other half was given neutral
instructions. All students were then asked to complete

a digit symbol task. An ANOVA revealed a statistically

significant interaction among test anxiety, conditions
(type of instruction) (F = 3.73, p < .10) and
performance (F = 4.07, p <.05). ~ighlytest anxious

students performed more poorly when given

achievement-oriented instructions.
Naveh-Benjamin and Lin (1987) proposed that it is

the testing situation, rather than study habits, that

has a more profound effect on performance. The subjects
included 86 students enrolled in a research methodology
course at Ben-Gurion University. Proficient study
skills for high anxiety students were reported to have a
beneficial effect in non-evaluative situations, but no

significant benefit in evaiuatlve (examination)

situations. Poor study skills for high anxiety students
produced poor performance results for both situations
( F = 4.3, p c - 0 5 ) . Naveh- enj jam in and Lin proposed

that there are two types of test anxious students. O n e

group requires assistance in the testing situation only.

and the other requires assistance in both study and
test-taking skills
 In an anecdotal artlcle, Casanova (1988) suggested
that faculty members also should identify their own test
anxiety. She identified that the demands for better
test results may contribute to faculty anxiety that is
subsequently transrnltted to students.

Hunsley (19851 investigated the correlations of

several variables of test anxiety over the course of a
semester. The subjects consisted of 62 undergraduate
students enrolled in a statistics course whose test
anxiety was measured during each of 4 examinations that
were administered throughout t h e semester. Variables
were most strongly correlated with test anxiety at the
beginning of the term. For example, positive cognitions
were -.21 ( p < .95), and negative cognitions were - 4 8

Ip < -01). This compares to - .04 and .19 respectively

at the end of the term. Self-efficacy and predicted
grade (not defined) were strongly correlated with test
anxiety at both the beginning and end of the semester
(--26, -.31, p < .05 and - . 3 5 , -.26, p < -05
respectively). All correlations were weaker during the
middle of the semester except for actual performance.
These were significant for examinations 1, 3 , and 4

(r = - - 2 9 , -.30, - . 3 3 , p < . 0 5 ) . The authors reported

that there are situational differences at different
times of the term. For example, the first examination
may be percieved with greater uncertainty of content.

By the last examination, poorer performance has been

confirmed for many test-anxious students, validating a

reason for these students to question their ability.
The Test Anxiety Inventory (TAI)(~pielbergeret
al., 1980) was developed to specifically analyze test
anxiety components in a research setting. Spielberger
compared TAX scores for 195 male navy recruits and 72
female navy recruits with scores on recruit training
examinations. Negative correlation results of - 0 . 3 4 and
-0.19 respectively were obtained between TAI scores and
examination results. Spielberger concluded that test
anxiety has a negative effect on academic achievement.
There are numerous studies supporting Spielberger's
original research, but in nursing education no research
was discovered that specifically investigated tesL
anxiety and academic achievement. A related study by
Poorman and Martin (1991) included test anxiety as one
possible variable predictive of success on the NCLEX.
Participants were 102 female, second semester,

senior-level baccalaureate nursing students, who were 25

years old or less, and eligible to sit for the NCLEX on
graduation. Each participant completed the TAI prior to
taking the NCLEX. Application of a PearsonBsproduct
moment correlation coefficient demonstrated a
statistically significant inverse relationship between
the passing score on W L E X and test anxiety (r= -0.31).
Application of a t test revealed a slgniflcant
difference in TAI scores (t= 3.55, p < 0.05) between
the group thac passed the NCLEX ( N = 9 2 ) and the group

that failed che NCLEX (N=10).

Beck and Srivastava i1991) conducted a descriptive

study to investigate perceived level and sources of
stress in 94 Bachelor of Science in Nursing ( 3 . S . N )
students enrolled at the University a f Newfoundland.
Stress of taking examinations ranked second 185%) only
to long hours of study ( 9 2 8 ) .
Two literature searches yielded no nursing
educational studies specifically targeted at test
anxiety, academic performance, and age, or any
combination of these variables. Some research studies on
test anxiety and academic performance occasionally
mentioned age but did so incidentally and did not
lnclude age as a variable. I c was interesting to note,
however, that the rna~orityof studies that did mention
age researched students in their early twenties.
Research by Highfield (1988) investigated learning
styles of baccalaureate nursing students and included
age as a variable. No statistically significant
differences, however, were found between learning styles
and age of students.
Mattson (1990) investigated coping strategies of
138 B . S . N . students at a Southern California state

university. Ages of the students ranged from 23 to 62

years. Coping effectiveness in the nursing program was
found to be statistically significantly related to
previous successful coping (t = 3.281, p = 0.05) and
developmental maturity (t = 2.560, p = 0.05) There was
no statistically significant relationship between age of
student and coping efficiency. The author supported the
contention that people mature at different rates
throughout adulthood.
A study by Lindop i1990) provided data on nursing

students in age categories closely paralleling the age

groups utilized for this research. Lindop's subjects
consisted of 324 nursing students (no level given)
enrolled in the North Staffordshire College of Nursing
and Midwifery in the United Klngdorn. Using a

self-developed questionnaire, Lindop in parL evaluated

student attitudes about various aspects of the nursing
program among different age groups. One finding was
that the students frequently reported feelings of
pressure. Students with ages ranging from 17-25 and
26-35 expressed the strongest feelings of general
pressure, and students with ages ranging from 36-45, the
least (there was an older group) ( F = 5.1, p = 0.00).
Within the educational environment, students with ages
ranging from 17-25 and 36-45 expressed the greatest
stress, with examinations cited as a stressful situation
(no data listed). A sense of determination was greatest
for students aged 36-45, then 26-35, and weakest for
students aged 17-25 (F = 3.7, p = 0.01). Similar
results were obtained for "the need to carry on" and
"the need to finish something I started" (Lindop, 1990,
p. 114). Results, therefore, supported a significantly
greater perceived need for effort on the part of older
students.
Spielberger (19791 suggested some aspects of aging
that may contribute to stress and anxiety. These
include a decline in physical capacity, decreased job
mobility, fever opportunities, and approaching age of
retirement.
The literature on adult education provided
information that may support the notion that older
students experience hi~heranxiety. Knowles (1980)
integrated the ideas of several theorists in
interpreting adult needs and their relationship to
education- Overall, he proposed that the need for
self-fulfillment and a sense of worth comprise
significant motivation for adults to continue their
education. Education recelved in their youth may have
been inadequate or obsolete for current utilization in
the job market. "-An educational need, therefore, is the
discrepency between what individuals . . . .want themselves
to be and what they are; the dlstance between an
application and a reality" !p. 8 8 ) . Older adults may
believe that time to fulflll educational needs is
limited and perceive greater pressure to fulfill them
quickly and successfully. Knowles also concluded that a
time does come when some adults believe that thelr time
for these aspirations is over.
Age and learning ability also have been a focus in
adult education literature. Lumsden 11985) identified
that there is evldence that there may be learning
deficits that occur gradually as learners get older. He
cited declines in paired associate and serial learning
task performance, b u ~was not specific with regard to
the age at which these deficits begin to appear-
Knowles ( 1 9 8 0 ) also supported a decline in learning
capacity and concluded this decline to be approximately

one percent a year after age twenty, but proposed that

the decline is related to speed of learning and not
intellectual power. Knowles also cited several other
factors that if present could impede adult learning.
These included adults who have not been involved in
systematic education for a long period of time and lack

confidence or situations in which physiological decline

is occurring.

Summary
mxiety served as the conceptual basis for this
study. ~nxietyis a feeling of insecurity, inadequacy,
and the result of unmet needs. When these feelings
exist in examination situations, test anxiety is
present.
The literature overwhelmingly supports an inverse
relationship between test anxiety and academic
achievement, but this research has been investigated
infrequently in nursing education. In all educational

arenas, there is a great deal of contradictory or

inconclusive evidence with regard to which variables
contribute to test anxiety and to what degree they do
so. No research could be found to support that age may
be a contributing variable, although related data
indicated possible increases in perceived stress as a
person ages. There is a need, therefore, for nurse
educators to investigate the relationship among test
anxiety, academic achievement, and age in nursing
students.
 CHAPTER THREE

METHODOLOGY

The purpose of this study was to investigate the

relationship among test anxiety, academic achievement,
and age in ADN students. This chapter focuses on the

research methodology used for the study and includes the

following sections: the research design, sample and
sampling plan, the data collection instrument, data
collection procedures, and the protection of human
subjects.

Research Design
he design of thls study was descriptive in nature
with the intent to answer the following question: IS

there a relationship among test anxlety, academic

achievement, and age? Specifically, the relationship
between academic achievement and test anxiety in nursing
students was investigated and described. In a d d i t i o ~ ,
this study examlned a possible relationship between test
anxiety and age. A descriptive approach examines
phenomena as they occur. It 1 s the initial data about a
topic that are gathered, analyzed and forms the basls

for further research. Test anxlety and academic

achievement, although widely studied, have not been
investigated in nursing education. Studies exploring
test anxiety and age were not evident in the literature.
Therefore, studies that describe relationships among
these three variables are needed.

Sample and Sampling Plan

The sample consisted of 107 second year, first
Semester full-time j!J)N students. These students were
all enrolled in the same midwest nursing program, but

located on two campuses, one rural and one predominantly

urban. Forty-six scudents were from the rural campus and
sixty-one students were from the urban campus.
A convenience sampling plan was utilized during

regular nursing class hours on each campus. This is the

next to last nursing course prior to completion of the
program, and consists of medical-surgical, obstetric,
and mental health content. Students on both campuses
attend identical nursing classes. All students had

taken nursing classes previously wlthin the same nursing

program but they were not all in the same classes or the
Same campus. A total of 107 students enrolled in the
mibest nursing program and in attendance at the above
classes were invited to participate in the study. ~ l l
attending students agreed to participate.

Daca Collection Instrument

The Test .Anxiety Inventory (TAI) (Spielberger et
al., 19801, a tool that measures individual differences

in test anxiety, was used to measure cest anxiety

(~ppendixA ) . The TAI is a 20-item paper and pencil test
that takes 5-10 minutes to administer and measures two

major components of test anxiety: worry and

emotionality. The tool requires participants to report
how frequently they experience specific anxiety symptoms
in test-taking situations. Each item on the tool has a
possible score of one (least anxious) to four (most
anxious). An example of a statement on the TAI is
"During examinations I get so nervous that I forget
facts I really know." The scores for the items are
combined for a total composite score ranging from 20
(lowest test anxiety) to 80 (highest test anxiety).
Within the TAI total score, worry or emotionality
subscores also can be compiled. Eight statemencs
comprise the worry component with scores ranging from a
minimum total of 8 to a maximum of 32 for each. An

example of a worry statement from the T A I is "Thinking

about my grade in a course interferes with my work on
tests." ~ i g h tstatements comprise the emotionality
component, with scores ranging from a minimum total of 8
to a maximum of 32 for each. An example of an
emotionality statement from the TAI is "While taking
examinations I have an uneasy, upset feeling."
The validity of the TAI was established using
correlations with six other anxiety measures and 4
measures of personality (Spielberger et al., 1980). The

anxiety measures used were the Test Anxiety Scale, the

Worry and Emotionalicy Questionnaire, the State-Trait

Anxiety Inventory (Anxiety Trait and Anxiety state
scales), and the Exam m i e t y Scale. The personality
measures used were The Scate-Trait m i e t y ~nventory

(Anxiety Trait), the State-Trait Curiosity Inventory

(Curiosity Trait), the Locus of Control Scale, and the
Irrational Personality Tralt Inventory. The validity
correlations were highest with the anxiety measures
(0.34 - 0.86). The Test Anxiety Scale produced
correlations of 0.82 and 0.83 for males and females
respectively and the Exam A-State had correlations of
0.86 and 0 . 7 7 for males and females respectively. "The

high correlations of the TAI total scale with the scores

from the administration of the STAI A-State...

demonstrate the construct validity of the TAI ~ o t a las a

measure of individual differences in anxiety proneness
in test situationsu (pp. 5-61. Personality test
correlations were lower and ranged from -0.23 to 0.58.
TAI test-retest reliability for college students
a£ter three weeks was .80 (Spielberger et al., 1980) .
The alpha coefficients for five normative samples ranged
from -92 to . 9 6 . In the community college setting, the
alpha coefficients were - 9 3 and -96 for males and
females respectively.

Data Collection Procedures

Data collection procedures were completed by the
researcher. During the eighth week of a four~eenweek
semester, the consent forms and TAI were distributed.
~ l t h o u g ha 5 to 10 minute time frame was recommended, 20
minutes were allotted for completion and collection of
the TAI at the end of a regular nursing class. The tool
was administered on two consecutive days, one on each
campus, and was completed by the student part~cipants

seven days prior to the fourth out of six scheduled unlt

examinations for the rural campus group and six days
prior to the fourth scheduled unit examination for the
urban campus group. This time frame was used to minimize

any unintentional effects of the TAI on course

examination performance. The researcher verbally
explained the study to the students, invited each
student eligible to participate in the study, and
requested that students who desired to participate sign
a consent form (Appendix B). The consent form cover
letter explained participation, confidentiality, risks,
benefits, and how each participant could obtain results
of the study. The student participants were asked to
complete the TAI, write their age in years on the
consent form, and release their final course grade to
the researcher. The slgned consent forms were collected
by the researcher.
Immediately after collecting the signed consent
forms, the TXI was administered. No time limit for
completion was imposed and all participants completed
the TAI before the end of the scheduled class (within 15
minutes). These results were retained by the researcher

and kept in a locked file until data collection was

completed. At the end of the semester, student final
course grades were obtained from a faculty member and
listed wlth the T A I results and age for each
participant. When course grades were matched with
anxiety scores and ages. rhe list of names associated
with each set of scores was destroyed to protect student
confidentiality.

Protection of Human Subjects

Special consideration was given to the protection
of the rights of the student subjects. Permission to

conduct the study was obtained from the Human Subjects

~ e s e a r c h~ e v i e wCommittee (HSRRC) at Drake University
(~ppendixC ) . Agency approval for the study and

permission to collect data during regular class time

then was obtained from the Program Director of Nursing
and the Dean for the program (Appendix C) . Students were
informed that their participation was entirely
voluntary, A cover letter was developed that explained
to the students participation, confidentiality, risks,
benefits, and how each participant could obtain results
of the study (Appendix B ) . Informed consent also was
obtained (Appendix 3 ) . The TXI was administered 6 or 7

days prior to the nexc scheduled examination in an

attempt to minimize any effect on exarninatron scores.

Summalry

To investigate the relationship among test anxiety,

academic achievement and age, the TAI was administered

to 107 second year, first term ADN students, and TAI

scores were compared with final course grades and ages.
The results of the data are presented and analyzed in

Chapter Four.
 CHAPTER FOUR
ANALYSIS OF DATA

The purpose of this study was to investigate the

relationship among test anxiety, academic achievement,
and age. This chapter is divided into five sections.
Descriptive data related to sample characteristics are
presented in the first section. The second and third
sections discuss and analyze data related to the two
research hypotheses. The fourth section presents
incidental findings related to the study. A summary
concludes the chapter.

Characteristics of the Sample

The sample consisted of i07 first Eerm, second year

ADN students. Forty-six of the students were enrolled
at the rural campus of the community college, and
sixty-one of the students were enrolled at the urban
campus. The sample was predominantly female, with 88
percent female and 12 percent male. As indicated in
Table 1, the ages of participants ranged from 19 to 54
years and were divided into three age groups. Group one

included participants age 19 to 25 years (20 % ) . Group

two included participants age 26 to 34 years (49 %), and

group three included participants age 35 years and older
(31 % I .

Table 1

Characteristics of the S a m ~ l e

Trait Urban Campus Rural Campus Total

Female N = 52 (85%) N = 42 (91%) N = 94 (88%)

Male N = 9 (15%) N = 4 (9%) N = 13 (12%)

Total* N = 61 (57%) N = 46 (43%) N = 107 (100%)

Group 1 N = 12 (20%) N = 9 (19%) N = 21 (20%)

119-25)
Group 2 N = 26 (42%) N = 27 (59%) N = 53 (49%)
(26-34)
Group 3 N = 23 (38%) N = 10 (22%) N = 33 (31%)
(35 &

Total* N = 61 (57%) N = 46 ( 4 3 % )

* Represents component of total sample

Hypothesis One

The first research hypothesis was: There will be a

significant inverse relationship between test anxiecy

and academic achievement I n second year, first term ADN
students. The TAI was administered to determine test
anxiety levels for each participant. As indicated
previously, TAI scores can range from a low of 20 (low
test anxiety) to a high of 80 (high test anxiety). The
TAI scores for the total sample ranged from 20 to 75

with a mean average of 42.748 and a standard deviation

of 14.999. Age group 1 (19 to 25 years) had a mean TAI
average of 40.476, with a standard deviation of 15.686.

Age group 2 (26 to 34 years) had a mean TAI average of

43.887, with a standard deviation of 14.257. Age group

3 (35 years and older) had a mean TAI average of 42.364,

with a standard deviation of 15.994.
Course total grades ln percentages also were
obtained for each participant. Course grades ranged from
44.72% to 97.04%. with a mean average course grade of
81.26% and a standard deviation of 0.070. Age group 1
(19 to 25 years) had a mean course grade average of
78.94%, with a standard deviation of 0.064. Age group 2
(26 to 34 years) had a mean course grade average of
81.78%, with a standard deviation of 0.055. Age group 3

(35 years and older) had a mean course grade average of

~ 1 . 9 2 %with
~ a standard deviation of 0.016.
A pearSon product moment correlation coefficient
was applied to measure hypothesis one. The alpha level
was set at 0.05. A significant inverse relationship was
found Ir = -0.306). Hypothesis one was supported. As
test anxiety increased, students' academlc performance
decreased.

Hypothesis Two
The second research hypothesis for the study was:
There will be no significant difference in test anxiety
among second year, first term ADN stl~dentsaccording to
age. he total student sample was divided Into three age
groups. Group one consisted of participants whose ages
ranged from 19 to 25 years. Group two consisted of
participants 26 to 34 years, and group three consisted
of participants 35 years and older. TAI scores for each
age group were reported in the previous section. An
Analysis of Variance comparing the three age groups with
their TAI scores was applied (Table 2). he degree of
significance was ser at 0.05. 'The F ratio was
calculated and compared with variance points to
determine significance of values (F (2, 1 0 4 ) = 0.400).
Table 2

Analvsis of Variance of TAL scores with Aoe G r ~ u n sof

ADN Nursinc? Student%

Source of Sum of mean E R

variance df squares scuare Ratio level

Within
groups 2 181.992 90.995 0.400 0.571

Between
groups 104 23566.195 227.560

When the Analysis of Variance was applied, there

was no statistically significant difference in test
anxiety among the three age groups of students
(p = .671). ~ h u s ,the hypothesis of no significant
difference in test anxiety in ADN students according to

age was supported.

Incidental Findings

Other data were analyzed to provide additional

information related to the study. Although the data were
not directly related to the purpose of this study, they
may provide insight for future research studles.
Within the total TAI score, worry or emotionality
subscores also can be compiled. Eight statements
comprise the worry component and each has a possible
value of 1 to 4 points. Total worry scores can range
from 8 (low worry) to 32 (high worryj. Eight statements
comprise the emotionality component and each has a
possible value of 1 to 4 points. Total emotionality

scores Can range from 8 (low emotionality) to 3 2 (high

emotionality). Worry scores of the student sample ranged
from 8 to 30, with a mean average score of 15-16 and a
standard deviation of 5.7339, Emotionality scores of

the student sample ranged from 8 to 32, with a mean

average score of 18.2804 and a standard deviation of
6.6797.
A Pearson product moment correlation coefficient
was applied to compare (1) worry components of the TAI
score with course grades; (2) emotion components of the
TAI score with course grades; and ( 3 ) worry T A I scores

with emotion TAI scores. When the Pearson r was applied,

the total TAI worry scores and course grades were found
to have an inverse relationship (r = -0.3871).
indicating that as the worry component of test anxiety
increased in students, academic achievement decreased.
The total TAI emotionality Scores and course grades were
found to have a weaker inverse relationship
(r = -0.1890), indicating that as the worry component of
test anxiety increased, academic achievement decreased.
he total TAI worry and TAI emotion scores were found to

have a strong positive correlation with each other

(r = 0.7921). As the worry component of test anxiety
increased, the emotion component of test anxiety also
increased in the students.
~n Analysis of Variance was applied to measure the
differences among (1) age groups and course grade; (2)
age groups and TAI worry scores; and ( 3 ) age groups and
TAI emotion scores ip = 0.05). Tables 3 , 4, and 5 list

statisical data for the Anaiysls of Variance of each.

Table 3

~ a 'l s v ri n with A rou f

ADN Students

Source of Sum of mean F

- E
variance & squares square Ratio level

within
groups 2
Between
groups 104
 No significant difference was found in the course
grades of the students according to age ( p = 0.2365) .

Table 4

f ei f v i r ith
GrouDs of ADN Students

Source of Sum of mean L?

A Q
variance df squares square Ratio level

within
groups 2

Between
groups 104 3480.3316 33.4647

No significant difference was found in the TAI

emotion scores of the students according to age
(p = 0.9331).
 Table 5

s A* I i £ r'n res with A

of ADN Students

Source of Sum of mean P. P

variance iaf squares square Ratio level

Within
groups 2 59 -5494 29.7747 0.6631 0.5174
Between
groups 104 4670.0394 44.9042

No significant difference was found in the TAI

worry scores of the students according to age
( p = 0.5174).

Summary
TO investigate the relationship among test anxiety,
academic achievement and age in first term, second year
A D S students, two hypotheses were tested. A significant
inverse relationship ir = -0.306) was found between tesc
anxiety and academic achievement ( p < 0 - 05) . No

significant difference, however, was found between test

anxiety and age of students ( F = 0.400, p = 0.671).
Incidental findings revealed an inverse
relationship between course grade and TAI worry scores
(r = -0.3871) and course grade and TAI emotion scores
(r = -0.1890) among the ADN students. TAI worry scores
and TAI emotion scores had a positive relationship

(r = .79211. No significant differences were found among

age groups and course grade, age groups and TAI emotion
scores, o r age groups and TAI worry scores among the ADN
students.
 CHAPTER FIVE
S-Y, DISCUSSION AND RECOMMENDATIONS

Summary
The Purpose of this study was to examine the
relationship among test anxiety, academic achievement
and age in ~ssociateDegree Nursing students. To test
the relationship among the variables, two hypotheses

were posed. Employing a descriptive research design,

data were collected through the TAT (Spielberger, et
al., 1980) and compared to the final course grades and
ages of 107 first term, second year ADN students.
Data were analyzed by the use of descriptive
statistics, the Pearson product moment correlation
coefficient, and the .ANOVA. The alpha level was set at
0.05. The results revealed that as test anxiety

increased, academic achievement (course grade) of the

ADN students significantly decreased (r = -0.31,
< -05). NO significant relationship hetween age and

test amiety in the ADN students was found (p = 0 - 6 3 5 ) .

Discussion

The first hypothesis stated that there would be an

inverse relationship between test anxiety and academic
achievement. The findings of this study supported this
hypothesis that as test anxiety increased, ADN students'
academic performance (course grade) decreased. This
finding supports Peplau's (19523 proposition that
increased anxiety leads to decreased alertness and
learning capability. This study also corroborates the
previous research conducted by Kirkland and
Hollandsworth, 1980; Naveh-Benjamin and Lin, 1987;
I. G . Sarason, 1972; Spielberger, 1966; 1979. In each of
these studies, as anxiety increased, academic
performance significantly decreased.
A combination of influences may have affected the

results of this study. S. B. Sarason (1960) proposed

that a time criterion or no additional trials in testing
situations had a detrimental effect on highly test
anxious students. The students used in this study were
enrolled in a program in which both a Elme criterion and
no additional trials are in effect for examination
situations. Students are alloted one hour to answer
approximately 60 examination questions. Students also
are not permitted to retake any examinations. These
factors may have influenced the findings of this study
by producing higher test anxiety in the students. The
TAI, however, was given prior to the fourth exam (out of
six), near midterm of the semester. Hunsley (1985)
found weaker correlations of test anxiety and academic
performance during this approximate period. He proposed
that test anxiety is lower at thls time because students
have already experienced an examination situation, and
final course grading is not imminent. ~drninisteringthe
TAI for this study near midterm may have lowered

correlational results because both timing situations

were present.
The second hypothesis proposed that no relationship
between age of students and l e v e l of test anxiety would
be found. ANOVA results indicated that the age of
students was not related to the level of test anxiety
( p = 0.671) in this study. Lindop (199C) reported that

some older students verbalize more feelings of pressure

and stress than younger students. This lent support to
this researcher's notion that older students would
manifest higher test anxiety levels. It is possible,
however, that age groupings for the students I n thls
study were too broad. Lindop used a fourth, older group
of students for her research and reported that the older
group did not verbalize significantly higher levels of
pressure and stress. Other possible explanations for the
lack of significant findings regarding age and test
anxiety in the nursing students could be the result of
the tool used for this research. The TAI may not be
sensitive to age. Older students may face stressors that
are not adequately assessed and measured in the TAI, but
contribute to test anxiety. Finally, it is possible
that older students are more verbal about test anxiety
but do not actually experience higher anxiety levels
than younger students.
Additional findings of the study included the

finding that the .DN students experienced stronger TAI

worry components than the TAI emotionality components
when compared wlth academic achievement. The TAI was
given 6 and 7 days prior to the next scheduled course
examination. Deffenbacher ( 1 9 7 2 ) proposed that the
Worry component of test anxiety rernalns relatively
scable while the emotionality component is strongest
near the tine of an examination. m this study, the

emotionalicy coefficient obtained several days prior to

the next scheduled examination was lower than the worry
coefficient, and therefore supports ~effenbacher's
notion of lower emotionality when an examination is not
imminent. The scores may have been higher it the TRI

had been administered just prior to an examination.

 Liaitations
There are limitations of any study that explores
complex variables among human beings. Several of these

are discussed as they pertain to this study.

The first major limitation of t h e study was related
to the sample. The sample was not large, not randomly
selected, and not necessarily representative of ADN
students, or any other nursing student. Therefore, the
generalizability of the flndings from the study are
extremely limited. All students were enrolled in the
same c l a s s with the same educational curriculum. There
was a different group of faculty at each of the urban
and rural campuses, but all components of the
educational program were the same. if other ADN programs
had been used, results may have been differsnt for
reasons such as curriculum design. In addition, because
registered nurse preparation nay be accomplished by 3
different educational programs (.MINI Baccalaureate, and
Diploma), research that includes n~rsingstudents from

each of these settings may provlde more comprehensive

and accurate findings regarding test anxiety in nursing
students .
A second major Limitation was the timing of the

administration of the TAI. Because the T.41 was given 6

and 7 days prior to the fourth unit examination, total
TAI scores may have been lower. According to
oeffenbacher I1972), emotionality increases only at the

time of an examination. At the time the TAI was given

for this study, TAI emotionality scores may have been
decreased from their expected peak nearer to an
examination. Also, the T A I was given during the last 15
minutes of a scheduled class. Participants knew they
could leave as soon as they finished. Although no time
limit for completion of the TAI was imposed and the
manual states that 5 to 10 minutes is sufficient for

completion, students may have hurried to finish and

given less thought to accuracy. Therefore, TAI results
for this study might not reflect accurately the
students' perceptions of test anxiety.
A third major limitation of this study was the age
grouping techniques used to compare the level of test
anxiety with age. ~ l l
students were combined into only
three age groups. The age groups of the two groups of

younger students was 7 and 9 years respectively, buc the

older groupts age had a range of 19 years. specific

comparison of these older students or even a fourth

older group might have yielded different findings in

levels of test anxiety.

 Other factors also may have threatened the validity
of this study. The TAI may not accurately reflect test
anxiety for older students. Validity and reliability
testing completed by Spielberger (Spielberger et al.,

1980) used scores primarily obtained from participants

who were young adults. Scores from older participants
may have yielded different results. ~pielbergeret al.
also did not test the T A I with a female population drawn
from a large sample. Navy recruits were used for this
purpose, and traditionally the male population is
significantly higher. Validity and reliability results
for the TAI might have been different if the sample of
female par~icipantshad been larger. I n addition, as
reported previously, when the TAI was compared with the
Exam A-State for sralidlty, the correlation coef f iclent
was lower for female participants than male participants
(0.77 and 0.86) respectively. In this study 88% of the
nursing student participants were female.
Flnally, the Hawthorne effect may have been a
limitation in this study for several reasons. Students
knew the TAI was measuring test anxiety and may have
marked statements lower in an attempt to conceal their
test anxiety and present themselves in what they
believed to be a more favorable position. The students
also knew that the researcher was a faculty member of
the program in which they were enrolled. They may have
scored some statements higher in an attempt to please
the researcher or to demonstrate an area of perceived
need higher than its actual levels. In addition, the
students' knowledge of involvement in a study may have
influenced their responses.

Although this study has contributed to the body of

knowledge regarding the rela~lonshlgamong test anxiety,
academic achievement and age in nursing students, many
questions remain unanswered. The following
recommendations for future research are based on the
findings of this study.
This study needs to be replicated with larger,
randomly selected samples of nursing students from
different programs ( B S N , Diploma, ADN). In addition,

the study should be replicated with different age groups

of nursing students or each age should be evaluated
specifically. Hypotheses regarding an age relationship
with test amiety may then be directed more specifically

toward older nursing students ln their forties and

fifties.
 Test anxiety and academic performance among
nursing education programs that grade by examinination
only should be compared with nursing education programs
that assess academic performance with other evaluation
methods such as clinical performance, written
assignments, projects, formal papers, group projects
care plans, and class presentations. A hypothesis such
as students with only examination scores for grading
purposes will manifest higher test anxiety than students
graded by a variety of evaluation methods could be
researched.
Research should be conducted in which the TAI is
administered closer to an examination and earlier in the
semester. Hunsley (1985) reported higher levels of test
arxiety at the beginning of a course than during the
middle of the same course. Cef fenbacher (1972) obtained
higher emotionality scores at the time of an
examination. This change in the timing of administration
of the TAI may help to explore peak levels of test
anxiety.
Another research study might consider comparing
test anxiety scores with aptitude scores of nursing
students. Spielberger (1979) reported higher levels of
test anxiety for students with average aptitude scores
than those with high aptitude scores.

Nurse educators also might administer the TAI in a

test-retest situation after test anxiety reduction
interventions such as relaxation or test-taking skills
courses have been implemented with students. The TAI
also could be administered in a test-retest situation
after £acuity education in test construction, test
anxiety self-awareness or other staff development
programs to address faculty's influence on student test
anxiety
Finally, nurse educators need to further
investigate the types of variables that contribute to
test anxiety in nursing students and the degree to which
they do so. These variables could include study skills,
coping mechanisms, or internal cognitions.

Implications for Advanced Nursing

This study investigated a possible relationship
among test anxiety, academic achievement and age in PDN
students. I. G. Sarason (1972) believed that

correlational studies are necessary for construct

validation. Because no research exploring test anxiety.

academic achievement and age was evident in the nursing

education literature, this study was implemented. It has
added to the body of knowledge regarding test anxiety in
nursing education by implicating test anxiety as a

factor that may impede academic achievement of nursing

students. Many capable nursing students may perform
poorly because of its influence. Some nursing students
may fail or exit nursing education. Others may hesitate
to continue their education because of the effect of
test anxiety.
Several implications are evident regarding test
anxiety assessment and reduction in nursing education.
First, nursing programs should assess for test anxiety
early in the first course of a nursing program and
preferably at times when anxiety is likely to be at its
highest such as at the start of a course and near an
examination time. The TAI used for this study is neither
lengthy nor time consuming to administer and could
easily be administered by nurslng faculty members,
counselors, or other qualified person~el.
After test anxiety levels for each student are
determined, several test anxiety reduction methods
should be investigated by nursing educators or
counselors who meec with students individually, assist
them in determining their needs, and refer them for
assistance if needed. Many institutions now offer
programs which could assist some students in test

anxiety reduction. These programs are usually directed

at study and test taking skills acquisition. Acquisition
of relaxation techniques is another approach and this
could be learned through reading literature or perhaps
audio tapes available at the library.
As indicated above, several methods of test anxiety
reduction have been thoroughly developed and could be
used by nursing educators or counselors in reducing the

test anxiety of nursing students. One of the most

frequently utilized strategies for reducing test anxiety
is test-taking skills acquisition (Kirkland and
Hollandsworth, 1980). In their research, this method
was found to be superior to anxiety reduction

techniques, another frequently used approach.

Test-taking skills emphasize methods of reading all
aspects of examination questions carefully to improve
the selection of the correct answer. Tryon (1983) and
Dendato and Diener (1986) reported that a combination of
relaxation and study skills training was more effective
than either technique used alone in reducing test
anxiety. Other methods focus on educators' use of

examination strategies and test construction methods to

improve student performance (Barges, 1983; Fulkerson and

 art in, i981; Plake. Ansorge. Parker, and Lowry. 1982).
These methods include simple strategies from
organization of examination contenc to more complex
endeavors such as reliability and validity testing and
item analysis.
More complex methods of test anxiety reduction have
and are currently being researched. while these methods
may not b e readily accessible to nursing educators, they
may be available, through referral, to nursing students

with more complex test anxiety needs. Tryon (1983)

found that mechods directed at the worry components of
test anxiety had a more beneficial effect on performance

than treatment of emotionality components, ~h~ most

effective single worry reduction method used by Tryon
was cognitive procedures. This method teaches the
student how to focus on the task at hand (the
examination) rather than focusing on interfering

Self-oriented negative thoughts. Newer test anxiety

reduction methods include modeling approaches
(Rosenthal, 1980) and self -control approaches (Denney,
1980). I n modeling approaches, the student observes,

through live or video demonstration, the desired actions

and responses during examination situations.
Self-control approaches c a r q treatment beyond
relaxation techniques into rehearsal of examination
situations and recognition of cues to promote
relaxation.
Students who complete one or more of the basic test
anxiety reduction programs should have test anxiety
reassessed to evaluate improvement. I£ improvement is
not evident, the student may have more complex needs
which could possibly be met through referral to student
assistance counseling programs or other resources
outside of the institution.
Nursing educators employed in any setting such as
formal nursing education programs, hospital-based
certification programs, staff development programs, or
continuing education workshops could assist students in
reducing test anxiety by analyzing their o m test
anxiety. Educators may feel pressure for their students
to perform well and meet the outcome criteria for which
they are responsible. They also may experience personal
test anxiety. Transmission of this anxiety to students

can only serve to heighten that of students.

Nursing educators can participate in test
construction workshops to ensure that examinations are
valid, reliable, and organized effectively. his will

help minimize student failure that is the result of Poor

examination construction and also may reduce student
test anxiety.
A critical implication for this study involves
re-evaluating the extensive use of exaainations in
assessing student achievement in nursing education.
~ e p l a u ( 1 9 5 2 ) , a recognized nursing theorist, has
postulated that high anxiety has a negative influence on
learning. Nursing educators are leaning toward a more
humanistic, caring learning environment. If examinations
are recognized as a major source of anxiety for nursing
students, perhaps using them as the only basis for
assessment of student achievement is neither caring nor
humanistic. Other evaluation methods may be used in
combination for grading purposes. Students who
experience difficulty with one method can still be
academically successful if they can demonstrate academic
achievement with other methods. when examinations are
given, the time for completion could be lengthened, or
an option to retake a similar examination could be
offered. ~ 0 t hof these provisions were found to decrease

test anxiety (s. B. Sarason, 1960).

Nursing needs more practitioners who Possess

advanced nursing degrees. Nursing's credibility, image,

influence and growth is largely dependent on the
advanced practice of its members. The recognition and
treatment of test anxiety may be one method of retaining
capable contributing nurses.
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Bruch, M. A., Pearl, L.. & Giordano, S. (1986).
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Casanova, U. (1988). HOW do we balance test anxiety and

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Chackof S . B. & Hubat M. E. (1991). Academic achievement

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Education, U, 267-273.
Deffenbacher, J. L. (1980). Worry and emotionality in
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anxietv: Thearv, research, and a~~lications.

Hillsdale, New Jersey: Lawrence ~rlbaum~ssociates,
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Dendata, K. M., & Diener, D. (1986). Effectiveness of

cognitive/relaxation therapy and study-skills
training in reducing self-reported anxiety and
improving the academic performance of test-anxious
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Denney, D. R. (1980). Self-control approaches to the
treatment of test anxiety. In Sarason, I. G. (~d.1,

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Hillsdale, New Jersey: Lawrence Erlbaum Associates.

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Fulkerson, F. E. & Martin, G. (1981). Effects of exam
frequency onstudent performance, evaluations of
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Psvcholoav, 8, 90-91.
Green, K. C. (1987). The educational "pipeline" in
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Highfield, M. E. (1988). Learning styles. Nurse

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Howell, C. C., & Swanson, S. C. (1989). The relative
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in baccalaureate nursing students. Journal of
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Hunsley , J. (1985). Test anxiety, academic performance,
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Psvcholocr~,-
77, 678-682.
Kirkland, K., & Hollandsworth, J. G. (1979). Test

anxiety, study skills, and academic performance.

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test taking skills-acquisition Versus amiety-
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~ n o w l e s ,M. S. (1980). The modern ~racticeof adult
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Lazarus, R. S . , & Averill, J. R. (1972). Emotion and

cognition. In Spielberger, C. D. (Ed.),Anxietv:
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Lindop. E. (1991). Individual stress among nurses in
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Mattson, S. (1990). Coping and developmental maturity of

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Meichenbaum. L. B. , & Butler, L. (1980).Toward a
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A S S O C ~ ~ ~ ~ S ,
Merritt~ S - L. (1991). The abilities and aptitudes of

students must be considered in program design.

N u r s i n ~and ~ e a l t hcare, 2 , 240-242.

~aveh-Benjamin.M. Lin, Y. G. (1987). TWO types of

test-anxious students: Support for and information

processing model. Journal of Educational
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w q . New York: G. P. Putnam's Sons.

plake, B. S . , Ansorge, C. J., Parker, C. S., & Lowry, S.

R. (1982). Effects of item arrangement, knowledge

of arrangement test anxiety and sex on test

performance. Journal of Educational MeasuremenL,

u14 9 - 5 7 .
Poorman, S. G., & Martin, E. J. (1991). The role of
nonacademic variables in passing the National
Council Licensure Examination. Journal of

Professional Nursinq, 1, 25-32.

Rosenthal, T. L. (1980). Modeling approaches to test

anxiety and related performance problems. In

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, publishers.
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Sarason, 1. G. (1972). Experimental approaches to test
anxiety: Attention and the uses of information. In

Spielberger, C. D. (Ed.),paxietv: Current trends

in theorv and research. New York: ~cademicPress.
Sarason, I. G. (1978). The test anxiety scale: Concept
and research. In Spielberger, C. D., & Sarason, I.
G. (Eds.), Stress and anxietv (Vol. 5). New York:
John Wiley & Sons.
Sarason, I. G., & Stoops, R. (1978). Test anxiety and
the passage of time. journal of Consultina and
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Clinical Psycholoc~~,

Sarason, S. B., Mandler, G., & Craighill, P. G. (1952).

The effect of differential instructions on anxiety
and learning. ,Journal of Abnormal and Social
Psvcholocrv, 47, 561-565.
.
Sarason, S. B . , Davidson, K. S. ~ighthall,F. F.
Waite, R. R.. & Ruebush. 8. K. (1960). Anxietv in

elementam school children. New York: John W i l e ~&

Sons, Inc.

Spielberber, C. D. (1966). Anxietv and behavior. New

York: ~cademicPress.
S~ielbergert C. D., Anton, W. D., & Bedell, J. (1976).
The nature and treatment of test anxiety. In
~uckerman,M., & Spielberger, C. D. (Eds.),
motions and anxietv: New concepts, methods and
a ~ l i c a t i o n s .Hillsdale, New Jersey: Lawrence
Erlbaum Associates. Publishers
spielberger, C. D. (1979). Understandina stress and
anxietv. New York: Harper and Row, publishers.
Spielberger, C. D., Gonzales, H. P., Taylor, C. J.,
Anton, W. D . , Algaze, B., Ross, G. R., & Westberry,
L. G. (1980). Test anxietv inventorv. (Available

from Consulting Psychologists Press, Inc., 3803 E.

Bayshore Road, Palo Alto, CA 94303).
Tryon, G. S. (1980). The measurement and treatment of
test anxiety. Review of Educational ~esearch,X,
343-372.
Whitley, G. G. (1992). Concept analysis of anxiety.

Nursina Diaanosis, 3, 107-116.

Wine, J. D. (1980). Cognitive-attentional theory of test
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 APPENDIX A
Test Anxiety Inventory
 m collaborat~onw ~ t h 74
H P Gonzalez, C J T a y l o r , G R Ro& a n d W D Anton

?j&%I E
DATE SEX M F
DIRECTIONS: A number of statements which people have
used t o describe themselves are given below. Read each state- T W E --
ment and then blacken in the appropriate circle to the right of
-5 -'c
the statement t o indicate how yougenerally feel. There are no -4~ bQe3
right o r wrong answers. Do not spend too much time on any 7% '%
one statement but give the answer which seems to describe % "?;;..: Ij* ?cr,
how y o u generally feel. 6% %+ "+ 7%
I 1 . 1 feel confident and relaxed while taking tests . . . . . . . . . . . . . . . . . . . . . . . . .

!
2 . While taking examinations I have an uneasy, upset feeling . . . . . . . . . . . . . . . . T ; i ~ ' i .

! 3. Thinking a b o u t my grade in a course interferes with my work on tests. . . . . . . ? -

'I 'i
I ,

4. I freeze u p o n important exams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,-

=7 5 4
5. During exams I find myself thinking about whether I'll ever get
throughschool ................................................. -
L ?
-
?

6 . T h e harder I work ar: taking a test, the more confused I get ............... -
i ! .- / i x

'I
7. Thoughts o f doing poorly interfere with my concentration on tests . . . . . . . . . ,
7 - 3 4
f
8. I feel very jittery when taking an important t e a . . . . . . . . . . . . . . . . . . . . . . . 7 5 4
-
t

I P - -
9. Even when I'm well prepared f o r a test, I feel very nervous about i t . . . . . . . . . 1. 3 a

-:
10. I start feeling very uneasy just before getting a test paper back . . . . . . . . . . . . ' i :

11. During tests I feel very tense . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -L i

-
l t

12. I wish examinations did not bother me so much . . . . . . . . . . . . . . . . . . . . . . . j

?

: I 4

-
13. During important tests I aiti so tense that my stomach gets upset . . . . . . . . . . I 3 7 ;

?
14.1 seem t o defeat myself while working on important tests . . . . . . . . . . . . . . . . . i 3 r

1 5 . I feel very panicky when I take an important test . . . . . . . . . . . . . . . . . . . . . . 2 7 T T

16. 1 worry a great deal before taking an important examination . . . . . . . . . . . . . 7 I 5 1

1 7 . During tests I find myself thinking about the consequences of failing . . . . . . . : I a

-
18. I feel my heart beating very fast during important tests . . . . . . . . . . . . . . . . . .
?
7 I I d

19.After an exam is over I try t o stop worrying about it, but 1 just can't. . . . . . .
' < i i '

20. During examinations I get so nervous that I forget facts I reallv know . . . . . . .
i : c

Q Consulting Psychologists Press, Inc.

3803 E. Bayshore Road, Palo Alto. CA 94303

Copyright @ 1 9 7 7 by Charles D. Spielberger. Reproduction of this test or u n y portion

thereof b y process wilhovt written permission ot' the Publisher IS prohibited.
 APPENDIX B

Cover Letter and Consent Form

 Cover Letter
You are invited to participate in a study of test
anxiety. The purpose of this study is to investigate
whether test anxiety is related to grades, the age of

students, or both. This research is being conducted by

cynthia Eubank as a requirement for the Master of
Science Degree in Nursing at Drake University.
Because you are a full time second year ADN student
at Des Moines Area Community College, you are invited to
participate. It is hoped that data from this research
will provide useful information about test anxiety that

may benefit future nursing students.

Your participation will involve:
1. Completion of an inventory which asks you to

race your thoughts and feelings when taking

course exams. The inventory will take
approximately 10 minutes to complete and will be
given during your regular class time.
2. YOU are asked to list your age in years.
3. You are asked to release your final course grade
for ASDN 264 at the end of the semester to the
researcher.
The information you provide to the researcher will

remain completely confidential and will be secured in a

locked file. Only the researcher will have access to
this information. Your name will be kept on file until
grade scores can be added to your inventory score and
age. At that time the list of names will be destroyed.
participa~ionin this study is totally voluntary
and in no way related to enrollment in ASDN 2 6 4 , your
grade in ASDN 2 6 4 , or your enrollment at DMACC. You are
at virtually no risk to participate in the study. YOU

are assured that no prejudice will result from your

decision to participate or not. If you agree to
participate you may withdraw at any time prior to
completion of ASDN 2 6 4 .
If you have any questions please ask me. If you
would like a copy of the results of this study please
include your address with your signature. Your
signature on the attached form indicates that you
understand the information presented here and agree to
participate.

Sincerely,

Cynthia Eubank
 Consent Form
I understand the information presented in the cover
letter regarding my participation in the study
described. My signature below indicates my agreement to
participate in this study.

Signature of Participant Age Date

Address (if you would like a copy of results)

 APPENDIX C
Approval Forms
To be completed by the Invcrngaoc

the Relationshi
R o p n l Tltle: Anxiety, Academic
Students
IrrvcrUgatar: C y n t h i a Eubank
-

FoculCy n w u t h 8bvlrrr: Ifor atudcnl rrsearhl: Sandra Sellers

R.- ul Sandra Sellers. Division of Nursing, Drake Univerkitg
H-a
422 Olin Hall
8 t . r &i&ua or k p u r OH-
Des Moines, Iowa
C l q . $Lab, a p K o u w p U 8

To be completed by the H u n m Subjects Research R e v i m bmmlllee ChaOperroc

Date Rtet~vcd:/ 0,/2/

Approval. no rts k
/
V
' minimal dsk
~pptova.~,
Approval. subjecb at risk but benefits
outPrelgh rlllu
No appmvtl. Subjecu at rlsk or propasll
docs not adequately address rlslu, benefits
and pmadura.
Rcasns for Dlsappmvtl:

L0/5/90 Form
Final No{~fica~ion
 Memorandum ,,
3C Des blotnes .%es Cornmunip College

From: S u s a n Wager, D i r e c t o r Nursing Education

E x t e n s i o n 6316

i Re: Research Request - 0 1=12 f=6,,1 c f c,, /?d-j-

'
,, f l 5 - W b ' L I
iZ/-,/

We have r e c e i v e d a r e s e a r c h r e q u e s t on
.gox t? hy- G n - t / 3 5 ~ & ' 976d 00u/la q I & & 5
*o_
be ji h L W r / 7 . j />,.,
I
JC,.i~~cn &OP. i g z 7 ~ r
J '
7
The t a r g e t a u d i e n c e i s FL,// X / n e ,CzrcndL ! ? f i r i v 1-10,~
2 . / ? n k d n ~ j.+ ,43-00~~ +
//
, 1
I am i n s u p p o r t o f t h i s p r o j e c t :
w i t h no m o d i f i c a t i o n s i n t h e p r o p o s a l o r tools.

4 p r o v i d i n g t h e f o l l o w i n g m o d i f i c a t i o n s a r e made:

, 5A;dj,,+ / n ; h L r c i ,rm ~ h c tr fiiicJI [/ cn+/- (54 r - p acj

P l e a s e i n d i c a t e y o u r a p p r o v a l / d i s a p p r o v a l below and r e t u r n t o me by

Thanks.

I Disapprove
I Date
1