Test anxiety is a form of performance anxiety that affects a student's ability to prepare for and take an examination (Poorman, Mastorovich, Molcan, & Liberto, 2011). Prior research suggests that nursing students experience higher levels of test anxiety than students in other fields (Driscoll, Evans, Ramsey, & Wheeler, 2009; Edelman & Ficorelli, 2005). On many occasions, avoidance behaviors are often used as a coping mechanism to combat anxious feelings. Thus, nursing students with test anxiety may procrastinate in preparing for examinations, which may result in poor test results, poor self-esteem, failure of nursing courses or failure to complete the nursing program, and possible failure on the NCLEX-RN(R) (Gibson, 2014).
The purpose of this study was to: 1) determine the relationship between test anxiety and academic procrastination among prelicensure nursing students, 2) identify differences in test anxiety and academic procrastination among prelicensure nursing program types, 3) identify factors that affect the incidence of academic procrastination, and 4) determine the tasks most frequently procrastinated upon by prelicensure nursing students.
The cognitive avoidance theory of worry (Borkovec, Alcaine, & Behar, 2004) was selected as the conceptual framework for this research. This theory suggests that cognitive avoidance is a coping mechanism to perceived actions that may cause anxiety or fear. The theory suggests that worry is a predominantly thought activity that a) focuses on attempts to avoid the experience of future catastrophe regarding a particular situation and b) functions as a cognitive avoidance maneuver in response to perceived threats.
METHOD
A quantitative descriptive correlational design was used for this study. Participants from diploma, associate (AD), and baccalaureate degree (BSN) nursing education programs in a small geographic region of western Pennsylvania were obtained by convenience sampling. A power analysis was used to calculate the sample size for a three-group analysis of variance (ANOVA) to achieve .80 power with a medium effect size ([eta]2 = .06) and a significance level ([alpha]) of .05. The calculated sample size needed was 53 participants in each group, for a total sample size of 159 participants. The total number of participants obtained for this study was 202. Institutional review board approval was obtained prior to data collection.
Survey Instruments
The researcher performed face-to-face data collection at the end of nursing theory courses. Each participant was given a paper-pencil survey packet that included demographic questions, the Test Anxiety Inventory (TAI), and the Procrastination Assessment Scale for Students (PASS). The TAI measures test anxiety before, during, and after examinations and yields a total score and Worry and Emotionality subscale scores (Spielberger, 1980). The TAI Total ([alpha] = .95), the TAI Worry subscale ([alpha] = .89), and the TAI Emotionality subscale ([alpha] = .92) displayed high reliability in this study.
The PASS yields a total score as well as two indices of academic procrastination: Fear of Failure and Task Aversiveness (Solomon & Rothblum, 1984). In this study, the PASS Total ([alpha] = .84) and the PASS Fear of Failure displayed high reliability; however, reliability for the PASS Task Aversiveness subscale was moderate ([alpha] = .64).
RESULTS
Paper-pencil surveys were administered by the researcher to 203 students from diploma, AD, and BSN education programs; 202 surveys were returned for a response rate of 99.5 percent.
Sample
Of the 202 participants, 73 were from a diploma program, 68 from an AD program, and 61 from a BSN program. Of all participants, 83.2 percent were female and 16.8 percent were male. Participants ranged in age from 19 to 53 years (M = 23.9, SD = 6.2). The majority of the sample identified themselves as Caucasian (95.5 percent).
Of the participants, 7.4 percent were repeating a nursing course in the current semester; 27 percent identified having repeated a nursing course in a prior semester. The demographics are consistent among the program types regarding gender and ethnicity, with the majority of the students in all program types being primarily female and Caucasian.
Statistical Analysis
Pearson product-moment correlation yielded small positive relationship between test anxiety and academic procrastination (r = .23, p = .002). Moderate statistically significant correlations were also noted between the total TAI and the PASS Fear of Failure subscale (r = .40, p < .01) and between the TAI Worry and the PASS Fear of Failure subscales (r = .38, p <.01), suggesting that students who were afraid of failure exhibited more worry.
One-way ANOVA was used to examine differences in test anxiety among groups. A statistically significant difference in the total TAI mean score between the groups was found, F(2, 192) = 6.77, p < .01. The most notable difference was found in the mean scores of the diploma group (M = 44.64, SD = 13.1) and the AD group (M = 53.2, SD = 14.9). A one-way between-group ANOVA was also conducted to determine the differences in academic procrastination among the three groups. No statistically significant results were found, F(2, 195) = 1.96, p = .14.
The variables of gender, age, ethnicity, employment, first-generation college student, and grade point average (GPA) were entered into a standard multiple regression equation. The results did not reveal a statistically significant regression model, F(6, 189) = 2.10, p = 0.55, R2 = .06. Self-reported GPA was the sole variable that had a significant negative influence ([beta] = -.24, p < .01) on predicting prelicensure nursing students' academic procrastination, suggesting that students with higher GPAs procrastinated less.
Descriptive statistics were used to assess the frequency of various academic tasks in which students often procrastinate. The majority of the sample (71.2 percent) always or nearly always procrastinated in keeping up with weekly reading assignments, 41.6 percent always or nearly always procrastinated when writing a term paper, and 29.2 percent always or nearly always procrastinated when studying for exams.
DISCUSSION
In this study, the AD group reported significantly higher levels of test anxiety than those in the diploma group; however, no significant difference in test anxiety was found between the AD group and the BSN group. It should be noted that self-reported GPA was the only variable that had a significant influence on predicting prelicensure nursing students' academic procrastination. These results propose that as GPA increases, academic procrastination decreases among prelicensure nursing students. One possible explanation for this association may be that nursing students with higher GPAs might be more intrinsically motivated and self-efficacious, have higher levels of self-esteem, and thus procrastinate less on academic tasks.
Although more nursing students reported procrastination in completing weekly reading than studying for exams, a higher percentage reported wanting or definitely wanting to decrease procrastinating in studying for exams than completing weekly readings. One explanation may be that the nursing students in this study did not view weekly reading as helping them study for exams. Another reason may be the difficult nature of the weekly readings, an academic task that may be viewed by prelicensure students as aversive.
The study findings support an assumption of the cognitive avoidance theory of worry, indicating that prelicensure nursing students with test anxiety tend to worry and procrastinate more. Additional research using the cognitive avoidance theory of worry to explain test anxiety and academic procrastination is warranted.
Limitations
There were several limitations of this study. Use of convenience sampling from a small geographic region and lack of ethnic diversity limit generalizability of the findings. Although the study compared prelicensure nursing education program types (diploma, associate, and baccalaureate), only one program from each type was included. The use of self-reported surveys also acts as study limitation. In addition, although the PASS has been used in higher education, primarily in general psychology courses, it has not been used in the nursing student population.
CONCLUSION
Nurse educators should consider assessing students' test anxiety at several points during the program and use cognitive behavioral approaches and test-taking workshops, while also making appropriate campus referrals. Clear expectations and deadlines, time management workshops, and assignment reminders may help students who procrastinate. This study's results add to the state of the science on test anxiety in nursing education.
Although it has been speculated that a relationship between test anxiety and academic procrastination may exist, this is the first study to observe this finding in the prelicensure nursing student population. This study's results identify the need for nurse educators to begin to address test anxiety and academic procrastination in prelicensure students.
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