Original Article

Analysis of licensure examination anxiety and its

influencing factors among undergraduate nursing
students
ABSTRACT
Background: Examination anxiety is a concern for educational policymakers because of the impact it can have on the overall outcome of
the performance of the candidates who partake in such examinations.
Aim: The aim of this study is to determine the examination anxiety level of students of Nursing and Midwifery College, Agogo, and Presbyterian
University College and to evaluate the factors affecting them.
Materials and Methods: A total of 160 undergraduate nursing students comprising 80 degree and 80 diploma students were conveniently
sampled for the study. The study was conducted in September 2019 using a descriptive cross‑sectional design. The Westside Test Anxiety Scale
was used to measure examination anxiety among the participants. A researcher‑designed questionnaire in which participants responded to a
three‑point Likert scale was used to assess factors influencing examination anxiety.
Results: The findings of the study showed that test anxiety was higher among the diploma candidates (M = 3.60) than the degree
candidates (M = 2.95) and the difference was statistically significant (P = 0.024). Demographic characteristics such as age (P = 0.009),
sex (P = 0.003), study hours per day (P = 0.001) were found to be significantly associated with test anxiety. The factors found to influence
examination anxiety among students were volume of materials to study (P = 0.044), level of preparation (P = 0.005) perceived difficulty of the
questions (P = 0.033) and myth about examinations (P = 0.000). The perceived importance of the examination (P = 0.057) and schedule of
the exams (P = 0.68) did not influence examination anxiety.
Conclusion: Candidates for the licensure examination organized by the Nursing and Midwifery Council of Ghana should be assessed for
test anxiety and offered the necessary psychological support where necessary.

Keywords: Education, Ghana, licensure, nursing, test anxiety, undergraduate

INTRODUCTION improvement over a specific period, examining strong and

weak points, or classifying students whether they should be
Summative assessment typically includes the evaluation of included or excluded.[5] In nursing and midwifery education,
individuals after which their progress is summarized at a student nurses are challenged with the sine qua non of
specific time within a course or program through feedback
and a grade.[1] Usually, it emphasizes on the outcome of a
Doreen Asantewa ABEASI, Frank Bediako AGYEI
task and seeks to monitor educational outcomes. In higher Department of Nursing and Midwifery, Presbyterian University
education, the most frequently used summative assessment College, Asante‑Akyem, Ghana
methods are examinations and written tests.[2,3] Examinations
are regarded as useful academic exercise,[4] with varying Address for correspondence: Ms. Doreen Asantewa ABEASI,
Department of Nursing and Midwifery, Presbyterian University
purposes. They include; making judgments with regards to College, P. O. Box: 42, Agogo, Asante‑Akyem, Ghana.
the skills or knowledge acquired by an individual, evaluating E‑mail: [email protected]

Submitted: 05‑Jun‑2021 Revised: 28-Jun-2021

Accepted: 08‑Jul‑2021 Published: 28-Sep-2021
Access this article online
Quick Response Code This is an open access journal, and articles are distributed under the terms of the Creative
Website: Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows others to
remix, tweak, and build upon the work non‑commercially, as long as appropriate credit
www.journalin.org is given and the new creations are licensed under the identical terms.

For reprints contact: [email protected]

DOI:
How to cite this article: Abeasi DA, Agyei FB. Analysis of licensure
10.4103/jin.jin_33_21 examination anxiety and its influencing factors among undergraduate
nursing students. J Integr Nurs 2021;3:110-6.

110 © 2021 Journal of Integrative Nursing | Published by Wolters Kluwer ‑ Medknow

 Abeasi and Agyei: Licensure examination anxiety

successfully finishing various forms of assessment of which examinations were internal examinations organized by the
includes examinations if they are to achieve their goals institutions. Few studies have looked at test anxiety among
personally and professionally.[5] nursing students.[26,27] Some studies have also examined
academic anxiety but not necessarily test anxiety.[28] A study
In Ghana, the Nursing and Midwifery Council (NMC), has that compared two groups, looked at undergraduate and
the mission to ensure the highest standards of not only postgraduate students’ levels of test anxiety.[22] Few studies
training but also the practice of nursing and midwifery. have reported on examination anxiety of nursing students
The mandate of the NMC is from the Health Professions in Ghana.[27] This study, therefore, seeks to take another
Regulatory Bodies Act (Act 857).[6] As part of their mission, look at the determinants of examination anxiety among
the NMC thus organizes licensure examinations for student nursing students in Ghana. If anxiety is a key factor behind
nurses at the end of their training. The assessment procedure the failure of the candidates in Ghana,[8] it may have effect on
is most at times regarded as one of the crucial aspects of a the health care system of the country since there would be
student nurse’s course as it measures students’ competency the inadequate number of practicing nurses in the country.[7]
to practise.[5] This implies that the practice of an individual Thus, the higher the pass rate, the better would it be for the
who has completed the training of nursing would be deemed country. Consequently, identifying the sources of such anxiety
illegal if the person has not satisfied all the requirements is critical for Ghana.
of the NMC.[1] Thus, such a person may face the full rigor of
the law. Success in the licensure examination is therefore The current study makes three key contributions to literature.
the only legal requirement to practice as a nurse in Ghana.[7] It is the first study to evaluate examination anxiety among
It is, therefore, not surprising that most students after their candidates preparing to write their licensure examinations in
stipulated period of training attach so much importance to Ghana. In addition to the above, the study tries to examine
the licensure examinations.[7] However, a report by the NMC the prevalence of examination anxiety of two groups of
undergraduate students, such evidence which is missing in
has revealed that a large number of students who sit for
the Ghanaian context. Such comparison is necessary to find
the exams fail in their first attempt[7,8] which is attributed
out if the duration of the training program has any effect on
to a myriad of factors. One of the main factors that have
the candidates’ examination anxiety. Finally, the current study
been linked to such unfortunate outcomes is examination
seeks to assess factors influencing examination anxiety among
anxiety.[9‑13] Examination anxiety is also referred to as test
nursing students sitting for an external examination as most
anxiety.
studies in literature have focused on examination anxiety
among nursing students sitting for internal examinations
It is normal to have some form of anxiety during examinations
and not external examinations. The study, therefore, seeks to
as such anxiety may not be entirely bad. Some studies
examine the level of examination anxiety and its influencing
have reported positive impact of moderate anxiety during
factors among degree students of Presbyterian University
examinations.[14,15] Kumari and Jain[15] reported that anxiety
College, Ghana (PUCG) and diploma students of the Nursing
can compel the student to focus on a given task. On the other
and Midwifery Training College (NMTC), Agogo.
hand, too much stress and anxiety during the examination
can be distressing to the student and may affect him/her in
MATERIALS AND METHODS
multifaceted ways including physically, emotionally, socially,
and cognitively.[16] Some studies have reported that high test Study design and setting
anxiety is likely to lead to poor performance.[10,17] This makes To examine the prevalence of examination anxiety among
it necessary to identify the factors behind such anxiety to undergraduate and diploma nursing students as well as the
offer the needed guidelines for students when preparing for influencing factors, a cross‑sectional design was used for the
or writing such examinations. Some factors that have been study. The study was conducted at the PUCG and the NMTC,
associated with examination anxiety are fear of failure,[18] Agogo. The former has a department of nursing which trains
inappropriate style of learning,[19] negative and irrational nursing students for 4 years for the award of Degree while
thinking about exams,[18] inadequate rest, examination the later trains for 3 years for the award of a Diploma.
schedule,[20] excessive course load,[18] gender,[20] previous
exams experience,[21] and lack of preparation.[22] Sampling technique and sample size
The convenience sampling method was used to select
A review of the literature reveals most studies have reported participants of the study. The population consisted of 274
high prevalence of test anxiety among undergraduate candidates preparing to write their licensure examination.
students[17,19,23] and high school students,[21,24,25] but those Using the Krejcie and Morgan sample size estimation
Journal of Integrative Nursing / Volume 3 / Issue 3 / July‑September 2021 111
 Abeasi and Agyei: Licensure examination anxiety

formula,[29] a sample size of 159 was arrived at. A total of used to describe the basic features of the data in the study
160 licensure candidates comprising 80 each from the two including the age and sex of participants. One-way analysis of
the institutions were recruited for the study. variance (ANOVA) was used to determine differences between
Degree and Diploma students on test anxiety. Regression
Inclusion criteria analysis was done to identify factors which could predict test
The inclusion criteria were as follows: (1) The student anxiety. A P-value was considered to be statistically significant
should be in the final year preparing for the licensure if it was less than 0.05.
examination; (2) The student should be a registered candidate
for the Registered General Nursing examinations; (3) The Ethical considerations
student should provide consent to take part in the study. The participants were informed of the research objectives and
were given the opportunity to ask questions for clarification.
Exclusion criteria
They were assured of the confidentiality of the collected
The exclusion criteria were students who were not in their
information and also of anonymity. They were informed
final year and refused to wilfully participate or offer consent.
of the freedom to withdraw from the study whenever they
Data collection and instrument wanted without facing any negative consequences. Informed
The participants responded to a questionnaire divided into consent was obtained from all the subjects by signing the
three sections. The first section examined the demographic consent form.
information of the participants. The second section
assessed examination anxiety using the Westside Test RESULTS
Anxiety Scale (WTAS) and the last, factors likely to influence
examination anxiety. Demographic data of respondents
The results from Table 1 showed that majority of the candidates
Demographic questionnaire were between 20 and 25 years for both NMTC (diploma) and
The questionnaire included items on the demographic and PUCG (degree) students. Females comprised the majority of
social variables of the participants including their age, gender, respondents in both groups. Majority of respondents had CGPA
academic institution, Cumulative Grade Point Average (CGPA). between 3.0 and 3.59. Most of the candidates studied between
2 and 4 hours in both groups. A combination of personal studies
Westside Test Anxiety Scale and group discussion was the preferred mode of study in both
WTAS is a 10‑item self‑reporting instrument used to groups.
measure test anxiety among students. The scale is brief
and takes about 8–10 min to administer. It consists of Table 1: Demographic data of respondents
a five‑point scale response ranging from always true to Variables Frequency, n (%)
never true. The highest score is 50 and the least being Degree students Diploma
10. The higher the score, the higher the level of test (n=80) students (n=80)
anxiety and vice versa. To determine the level of test Age (years)
20‑25 61 (76.25) 57 (71.25)
anxiety, the score is divided by 10. The score ranges and
26‑30 16 (20.00) 20 (25.00)
interpretations are as follows: 1.0–1.9 (comfortably low),
31‑35 3 (3.75) 3 (3.75)
2.0–2.4 (normal), 2.5–2.9 (high normal), 3.0–3.4 (moderately Sex
high), 3.5–3.9 (high), and 4.0–5.0 (extremely high).[30,31] It is Male 39 (48.75) 36 (45.00)
a reliable and valid instrument for the measure of anxiety Female 41 (51.25) 44 (55.00)
impairment. A Cronbach's alpha coefficient of 0.78 and CGPA
split‑half reliability of 0.77 as well as concurrent validity of 3.6‑4.0 8 (10.0) 4 (5.00)
0.51 have been reported.[32] 3.0‑3.59 30 (37.50) 28 (35.00)
2.5‑2.99 27 (33.75) 27 (33.75)
2.0‑2.49 13 (16.25) 19 (23.75)
Predictors of examination anxiety questionnaire
1.0‑1.99 2 (2.50) 2 (2.50)
The participants were required to respond to a three‑point
Study hours per day
Likert scale with the options as agree, neutral, and disagree. 2‑4 41 (51.25) 40 (50.00)
5‑7 27 (33.75) 30 (37.50)
Statistical analysis 8‑10 9 (11.25) 8 (10.00)
IBM SPSS Statistics for Windows, version 24.0 (Arrmonk, NY: >10 3 (3.75) 2 (2.50)
IBM) was used to analyze data. Descriptive statistics were CGPA: Cumulative grade point average

112 Journal of Integrative Nursing / Volume 3 / Issue 3 / July‑September 2021

 Abeasi and Agyei: Licensure examination anxiety

Test anxiety among diploma and degree students Table 2: Test anxiety among diploma and degree students
The results from Table 2 showed that majority of the Diploma Test anxiety Frequency, n (%)
students (58.75%) reported high test anxiety scoring between Diploma Degree students
3.0 and 5.0 on the test anxiety scale. Only a few, 11 (13.75%), students (n=80) (n=80)
16 (20.00%), and 6 (7.50%) reported low, normal, or high 1.0‑1.9 (comfortably low) 11 (13.75) 29 (36.25)
2.0‑2.4 (normal) 16 (20.00) 13 (16.25)
normal test anxiety respectively. On the other hand, only
2.5‑2.9 (high normal) 6 (7.50) 8 (10.00)
30 (37.5%) of the Degree students reported moderate to
3.0‑3.4 (moderately high) 20 (25.00) 6 (7.50)
extremely high test anxiety with majority (62.5%) reporting 3.5‑3.9 (high) 15 (18.75) 11 (13.75)
low, normal, or high normal test anxiety. 4.0‑5.0 (extremely high) 12 (15.00) 13 (16.25)

Further analysis was done to find out if the differences

between the two groups on test anxiety will be significant Table 3: Examination anxiety difference among diploma and
degree students
using one‑way ANOVA [Table 3]. The findings showed
that participants who offered diploma scored higher Groups n Mean SD F‑stat P
Diploma students 80 3.60 1.66 5.185 0.024
mean (M = 3.60) for test anxiety than those who offered
Degree students 80 2.95 1.93
degree (M = 2.95). The difference was significant (P = 0.024).
SD: Standard deviation

Association between selected demographic variables and

test anxiety Table 4: Association between demographic variables and
examination anxiety for both degree and diploma candidates
Using a univariate analysis, results showed that females
(n=160)
had a higher mean score (M = 4.03) to high test anxiety
Variables Test anxiety P
than males (M = 3.34), thus females experience high test
Mean SD
anxiety than males (P = 0.009). Furthermore, respondents
Sex
with older ages recorded lower mean score (M = 3.33) for Male 3.34 1.73 0.009
test anxiety than those with younger ages, 20–25 years Female 4.03 1.53
(M = 3.86) and 26–30 years (M = 3.50). The difference Age (years)
observed among the age groups was statistically significant 31‑35 3.33 1.44 0.003
(0.003). On CGPA, respondents with higher CGPA recorded 26‑30 3.50 1.62
lower mean score for test anxiety than those with lower 20‑25 3.86 1.74
CGPA even though this was not significant (P = 0.075). CGPA
3.6‑4.0 2.58 2.15 0.075
Furthermore, respondents with longer or more than 10-hour
3.0‑3.59 3.62 1.51
study recorded lower mean score (M = 2.60) than those
2.5‑2.99 3.61 1.66
with 5–7 (M = 3.53), 8–10 (M = 3.53) and 2–4 (M = 3.85) 2.0‑2.49 4.00 1.73
respectively. Thus, respondents with longer study hours 1.0‑1.99 4.18 1.67
experience lower or less test anxiety than those with shorter Personal study hours per day
study hours (P = 0.001) [Table 4]. 2‑4 3.85 1.63 0.001
8‑10 3.53 1.67
Factors influencing licensure examination anxiety 5‑7 3.53 1.91
The myth about the licensure examination (P = 0.000), >10 2.60 1.34
SD: Standard deviation, CGPA: Cumulative grade point average
inadequate preparation (P = 0.005), volume of materials to
study (P = 0.044), and perceived difficulty of questions (P =
0.033) were found to predict test anxiety as shown in Table Table 5: Factors predicting examination anxiety
5. The perceived importance of the examination (P = 0.057) Factors Unstandardized Standardized
and the schedule of the exams (P = 0.680) did not predict coefficients coefficients
test anxiety. B SE B P
Constant 2.637 0.455 0.000
Myth about the exams 0.656 0.172 0.336 0.000
DISCUSSION
Inadequate preparation 0.147 0.137 0.085 0.005
Volume of materials to study 0.483 0.186 0.233 0.044
The findings of the current study revealed that examination Perceived difficulty of questions 0.122 0.165 0.059 0.033
anxiety was significantly high among diploma students than Schedule for exams −0.035 0.174 −0.016 0.680
degree students. The above differences could be due to Perceived importance of exams 0.389 0.150 0.209 0.057
several factors. First and foremost, degree students of PUCG SE: Standard error

Journal of Integrative Nursing / Volume 3 / Issue 3 / July‑September 2021 113

 Abeasi and Agyei: Licensure examination anxiety

go through 4 years of nursing education whilst diploma the current study may view CGPA as a cumulative record of
students of NMTC use 3 years. This means that the degree internal examinations which may not have direct bearing
students have an extra year as an added advantage to cover on an external examination like the licensure examinations.
extensively the curriculum. Also, because a Bachelor’s Similarly, Dawood et al.[13] did not find any significant
degree is awarded at the end of the 4 years of training, it relationship between the test anxiety and GPA. On the
appears most of the students do not feel pressured as several contrary, Bashir et al.[21] and Onyeizugbo[32] found that those
opportunities exist for them in other sectors apart from the with high grades were less likely to have high test anxiety.
clinical environment.
In the current study, age was found to influence test anxiety
The finding is consistent with a study conducted by Li et al.[33] which is consistent with other studies.[14] Similarly, a study
who examined anxiety and influencing factors of nursing reported that younger people are more likely to develop
students in different levels before the National Council anxiety that older people.[36] Several studies did not find any
Licensure Examination for Registered Nurses (NCLEX‑RN). significant relationship between age and test anxiety.[21,35,37,38]
Their study reported that among the 1527 nursing students, The results also showed that students who studied for
154 had mild anxiety, 688 with moderate anxiety, and 685 few hours presented with high levels of test anxiety. The
with severe anxiety. The same study also reported that number of study hours is somewhat directly related to the
anxiety levels were severe among the lower educational level of preparation. Adequate preparation is likely to boost
levels as compared to higher educational levels. The a student’s self‑esteem and self‑confidence in taking an
percentage of severe anxiety for the various levels was examination. Thus, regardless of the likely questions and level
46.80%, 44.83%, and 27.59% for the diploma, advanced of difficulty the candidate can be rest assured that he/she will
diploma, and baccalaureate degree, respectively. Atindanbila not be clueless. The finding is consistent with other studies
et al.[27] also found that students pursuing Health Assistant which have cited inadequate preparation as a contributing
Clinical which is a certificate program reported more test factor to higher test anxiety.[21,22] It is, therefore, not surprising
anxiety than those pursuing diploma, though their study that the schedule of the exams did not predict test anxiety.
was not in relation to licensure examination. The current If a student is adequately prepared, the student may not be
finding is worrying because high test anxiety scores have so much worried about the schedule of the exams.
been linked to low academic performance on the test.[11,12]
Considering this reported impact of high test anxiety, The findings indicated that the myth surrounding the
then it means high test anxiety can negatively affect the examination is a factor influencing licensure examination
performance of the candidates in the licensure examination. anxiety. The licensure examination is surrounded by a lot
of myths. Some of these myths come from candidates who
The study sought to find out demographic factors which have gone through the exams previously. The fact that the
influenced test anxiety among licensure candidates. The examination is being organized by an external body creates
current study found that gender influenced test anxiety. a certain impression in the minds of the students. There is a
Females reported high test anxiety than males. Females have myth that yearly, the NMC has a quota in terms of the number
been found to be more uncomfortable and self‑conscious of students they expect to pass the licensure examinations.
in testing situations than males. From the cultural point of These myths are usually accepted by the students which
view, males are socialized not to overtly express how they affect them psychologically and lead to examination anxiety.
feel as that is seen as a sign of weakness. Again, males may Although the NMC has a requirement where examiners meet
feel they have a huge social responsibility of making it thus candidates a day before the examinations, these meetings
no need to entertain any form of anxiety. In consistent with may not have a significant impact on the candidates for
the current study, other studies have reported that females several reasons. First, the examination anxiety may have
had high test anxiety than males.[34] On the contrary, Bashir developed already. Second, the focus of such meetings is to
et al.[21] mentioned in their study that females were less likely provide the candidates’ information on the dos and don’ts
to develop test anxiety as compared to males. In that study, and not necessarily aimed at demystifying the negative
males had 2.501 times higher odds of having test anxiety. perceptions on the licensure examinations. The study by
Other studies did not find a significant relationship between Johnson[39] corroborates the current findings as he also found
test anxiety and gender.[27,35] that myths about NCLEX exams led to anxiety.

The researcher did not find any significant relationship The volume of materials to study for the examination was
between test anxiety and students’ CGPA. Candidates in identified to affect anxiety. The end‑of‑semester examinations

114 Journal of Integrative Nursing / Volume 3 / Issue 3 / July‑September 2021

 Abeasi and Agyei: Licensure examination anxiety

in the various institutions usually cover the content that was learning as compared to surface learning since the later does
studied for that particular semester. However, with regards to not emphasize on synthesis and application of information
the licensure examinations, they cover everything that was which is crucial for success in the licensure examination. (4)
learnt throughout training. This appears quite burdensome Future studies should explore the role of psychological factors
for the students. The perceived burdensomeness of the like self‑esteem in examination anxiety.
volume of materials to study might also be due to the fact
that students are not prepared adequately and may wait Acknowledgement
when the examinations is so close before they start to learn. The researchers would like to express their profound
Other studies have reported that too much course load was appreciation to licensure candidates of NMTC, Agogo, and
a factor influencing test anxiety.[40] Regardless of the volume PUCG who wholeheartedly and willingly participated in the
of materials to study, adequate preparation can mitigate its study. Dr. Paul Adjei Kwakwa is also acknowledged for his time
impact on test anxiety. in reading through the manuscript and offering meaningful
as well as constructive criticisms.
In addition, the perceived difficulty of the licensure examination
was identified as a factor contributing to examination anxiety. Financial support and sponsorship
This is consistent with the findings by von der Embse et al.[41] Nil.
When students perceive that the examination is difficult it
means they anticipate there are a lot of expectations from them. Conflicts of interest
These expectations may create stress on these students and There are no conflicts of interest.
lead to anxiety. The perceived importance of the examination
REFERENCES
and the schedule of the exams were not identified as predictors
of examination anxiety. Possibly participants in the current study
1. McCarthy J. Evaluating written, audio and video feedback in higher
did not consider the examination to be a to do-or-die affair education summative assessment tasks. Issues Educ Res 2015;25:153‑69.
as the NMC gives opportunity to candidates who are referred 2. Pereira D, Flores MA. Percepcões dos estudantes universitários
in the first attempt to re‑sit. Furthermore, students were not sobre a avaliacao das aprendizagens: Um estudo exploratório.
Avaliação (Campinas) 2012;17:529‑56.
anxious about writing a paper every day for 3 days. This means 3. Pereira D, Flores MA, Niklasson L. Assessment revisited: A review of
that other factors might be contributing to examination anxiety research in assessment and evaluation in higher education. Assess Eval
than the perceived level of importance and the schedule of High Educ 2016;41:1008‑32.
examination. 4. Joughin G. The hidden curriculum revisited: A critical review of research
into the influence of summative assessment on learning. Assess Eval
High Educ 2010;35:335‑45.
CONCLUSION 5. Whelan A, Brown J. Does the seen examination promote or constrain
student learning? Pract Res High Educ 2011;5:48‑54.
Anxiety has a significant impact on the performance in an 6. Health Professions Regulatory Bodies Act; c2013. Available
from: https://www.bcp.gov.gh/acc/registry/docs/HEALTH%20
examination, hence, the current study sought to examine PROFESSIONS%20 REGULATORY%20BODIES%20ACT,%20
the level of examination anxiety among two undergraduate 2013%20(ACT%20 857)%20(6).pdf. [Last accessed on 2020 Nov 20].
nursing student groups and also to find out factors 7. Amankwaa I, Agyemang‑Dankwah A, Boateng D. Previous Education,
influencing it. The study found that examination anxiety was Sociodemographic Characteristics, and Nursing Cumulative Grade Point
Average as Predictors of Success in Nursing Licensure Examinations.
high among diploma nursing students as compared to degree Nurs Res Pract 2015;2015:682479.
nursing students. Age, gender, number of study hours were 8. Nursing and Midwifery Council. Research Report, 2013. Accra: NMC;
demographic factors found to influence test anxiety. Based 2014.
9. Rana R, Mahmood N. The relationship between test anxiety and
on the findings, the following recommendations are made: (1)
academic achievement. Bull Educ Res 2010;32:63‑74.
The NMC of Ghana should collaborate with the training 10. Vitasari P, Wahab MN, Othman A, et al. The relationship between
institutions, to hold seminars for students concerning the study anxiety and academic performance among engineering students.
licensure examinations. This should not be done only before Procedia Soc Behav Sci 2010;8:490‑7.
11. Barrows J, Dunn S, Lloyd, CA. Anxiety, self‑Efficacy, and college exam
the exams but can begin when the students enter their final
grades. Univers J Educ Res 2013;1:204‑8.
year.(2) Candidates should be assessed by psychologists 12. Duty SM, Christian L, Loftus J, et al. Is cognitive test‑taking anxiety
before the licensure examinations. Students who are found associated with academic performance among nursing students? Nurse
with high levels of anxiety should be offered psychological Educ 2016;41:70‑4.
13. Dawood E, Ghadeer H, Mitsu R, et al. Relationship between test anxiety
support before they begin the exams. (3) The various health
and academic achievement among undergraduate nursing students.
training institutions should teach candidates how to prepare J Educ Pract 2016;7:57‑65.
adequately for examinations with more emphasis on deep 14. Dordinejad F, Hakimi H, Ashouri M, et al. On the relationship between

Journal of Integrative Nursing / Volume 3 / Issue 3 / July‑September 2021 115

 Abeasi and Agyei: Licensure examination anxiety

test anxiety and academic performance. Procedia Soc Behav Sci Appl Psychol 2014;3:21‑6.
2011:15:3774‑8. 28. Shahrouri EA. Sources of academic anxiety among undergraduate
15. Kumari A, Jain J. Examination stress and anxiety: A study of college students. J Emerg Trends Educ Res Policy Stud 2016;7:118‑24.
students. Glob J Multidiscip Stud 2014;4:31‑40. 29. Krejcie RV, Morgan DW. Determining sample size for research activities.
16. Lowe PA, Lee SW, Witteborg KM, et al. The test anxiety inventory for Educ Psychol Meas 1970;30:607‑10.
children and adolescents (TAICA): Examination of the psychometric 30. Driscoll R. Westside Test Anxiety Scale Validation. Education Resources
properties of a new multidimensional measure of test anxiety among Information Centre; 2007. Available from: http://www.amtaa.org/res/
elementary and secondary school students. J Psycheducational Assess svtxt.html. [Last accessed on 2020 Apr 29].
2008;26:215‑30. 31. Rajiah K, Saravanan C. The effectiveness of psychoeducation and
17. Balogun AG, Balogun SK, Onyencho CV. Test anxiety and academic systematic desensitization to reduce test anxiety among first‑year
performance among undergraduates: The moderating role of achievement pharmacy students. Am J Pharm Educ 2014;78:163.
motivation. Span J Psychol 2017;20:E14. 32. Onyeizugbo EU. Self‑efficacy and test anxiety as correlates of academic
18. Al‑Sahman LA, Al‑Sahman RA, Joseph B, et al. Major factors causing performance. J Educ Res 2010;1:477‑48.
examination anxiety in undergraduate dental students – A questionnaire 33. Li N, Li B, Dou J, et al. The anxiety and influence factor of the nurse
based cross‑sectional study. Ann Med Health Sci Res 2019:691‑4. students in different levels before the NCLEX‑RN. Iran J Public Health
19. Sansgiry SS, Bhosle M, Dutta AP. Predictors of test anxiety in doctor 2015;44:588‑9.
of pharmacy students: An empirical study. Pharm Educ 2005;5:1‑9. 34. Akanbi ST. Comparisons of test anxiety level of senior secondary
20. Patil S, Aithala M. Exam anxiety: Its prevalence and causative factors school students across gender, year of study, school type and parental
among Indian medical students. Natl J Physiol Pharm Pharmacol educational background. IFE Psychol 2013;21:40‑54.
2017;7:1323‑8. 35. Al Khatib H. Exam anxiety among nursing students at Al‑Ahliyya
21. Bashir MB, Albadawy IM, Cumber SN. Predictors and correlates of Amman University and its relationship with some variables. Int J Appl
examination anxiety and depression among high school students taking Psychol 2019;9:110‑6.
the Sudanese national board examination in Khartoum state, Sudan: 36. Flint AJ, Peasley-Miklus C, Papademetriou E, et al. Effect of age on
A cross‑sectional study. Pan Afr Med J 2019;33:69. the frequency of anxiety disorders in major depression with psychotic
22. Duraku ZH. Factors influencing test anxiety among university students. features. Am J Geriatr Psychiatry. 2010;18:404-412.
Eur J Soc Behav Sci 2017;18:2325‑34. 37. Ebrahimi M, Khoshsima H. On the association (s) between test anxiety
23. Kurt AS, Balci S, Kose D. Test anxiety levels and related factors: Students and emotional intelligence, considering demographic information; A
preparing for university exams. J Pak Med Assoc 2014;64:1235‑9. case of Iranian EFL University Students. Int J Stud English Lang Lit
24. Adewuyi TO, Taiwo OK, Olley BO. Influence of examination anxiety 2014;2:147‑57.
and self‑efficacy on academic performance among secondary school 38. Oladipo SE, Ogungba A. Demographic predictors of test anxiety among
students. IFE Psychol 2012;20:60‑8. undergraduate students. Int J Learn Dev 2013;3:62‑6.
25. Akanbi ST. Test anxiety as a correlate of academic achievement among 39. Johnson SH. Dispelling myths about the new NCLEX exam. Recruit
Senior Secondary School in Ogbomoso area of Oyo State. Afr J Educ Retent Restruct Rep 1996;9:6‑7.
Res 2010;14:89‑97. 40. Simran G, Sangeeta N, Lily W. Evaluation of examination anxiety status
26. Qutishat MG, Cayaban AR, Leocadio ML. Extent of test anxiety among and its associated factors among first professional medical (MBBS)
nursing students in Oman and impact on academic performance. J Health students. Int J Interdiscip Multidiscip Stud 2015;2:1‑11.
Sci Nurs 2018;3:11‑25. 41. von der Embse N, Jester D, Roy DJ. Post Test anxiety effects, predictors,
27. Atindanbila S, Abasimi E, Nyarko K, et al. The occurrence of test and correlates: A 30‑year meta‑analytic review. J Affect Disord
anxiety in student nurses in selected nursing schools in Ghana. Am J 2018;227:483‑93.

116 Journal of Integrative Nursing / Volume 3 / Issue 3 / July‑September 2021