The research article titled "The effect of a stress and anxiety coping program on objective structured clinical examination performance among nursing students in Shiraz, Iran" is published in a credible source which is "BMC Medical Education". The overall rank of this journal is 478 and all the articles which are published here are peer-reviewed. The sources where articles are published should be published in credible sources because it will increase the authenticity of the sources and along with it, also ensures that only current and correct information is presented (Mojarrab et al., 2022).
The study is conducted in primary research, and it is presented in quasi-experimental study form (Mojarrab et al., 2022).
Yes, the title of the study is apt and it clearly defines the topic, participants in the study, and the study design. In addition to it, it also allows the readers to have a clear idea about the study and what it is aiming to achieve. In this study, nursing students are discussed and strategies are discussed which will allow them to take effective action on the coping program. The study is a primary research and about 76 nursing students are interviewed to determine the effect of stress (Mojarrab et al., 2022).
Background
The background section of the article evaluates the several practical and competent skills of nursing students. An Objective Structured Clinical Examination (OSCE), is a highly integral part of the nursing education program. Although, it has also been stated that performance can negatively influence an important level of anxiety and stress which also needs to be discussed. The study which is presented is aimed to evaluate the effectiveness of the anxiety-coping program which is OSCE, on the first-year nursing students in Iran (Mojarrab et al., 2022).
Yes, the background of the research paper also discusses several things which we do not have any idea about. The examination which is talked about OSCE, is highly important in the nursing education program, the readers do not have any idea about this examination, however, after this research, a clear idea will be obtained. This research is highly important because stress and anxiety are an integral part of the nursing profession, hence, it is necessary to control it and take effective measures to eliminate it. It has also been observed that stress has led to a decrease in the performance of nurses and simultaneously patient satisfaction rate has also decreased (Mojarrab et al., 2022).
The primary research which has been conducted in this research is the Quasi-experiment. This type of experiment study primarily aims to evaluate the interventions however, it does not evaluate randomization. This type of research design is aimed to attempt to establish the effect and the causal relationship. The PICO question has been formed in this research and the several components of it are addressed (Miller et al., 2020). The population is nurses, Intervention which is adopted in this research is- Objective Structured Clinical Examination (OSCE). The comparison is done through the other interventions which are adopted to eliminate stress and anxiety, the outcome is aimed towards reducing stress and anxiety.
Method
Study design
It is a quantitative research design
It is an experimental design research.
It is a cross-sectional study design.
The level of evidence that this study follows is level 3 since it is a quasi-experimental study.
The major limitation of this study is all the participants who are present in the study are from a single medical discipline and university. Hence, it limits the generalizability of the study. Another limitation is that the anxiety coping program is performed in a limited period and that there are no follow-ups to determine the state of anxiety among students. After this study, it is highly recommended to include different medical disciplines across several universities. Other than this duration is extended of the interventions which are performed. The number of follow-ups should also be increased. The strength of the study states that the anxiety coping program has been known to reduce the anxiety level among the nursing students and along with it, it also improves the OSCE results. The educational planner also needs to be considered as this offers a curriculum to reduce anxiety and help to improve examination results. This study design is more generalizable and also it provides better external validity than the RCTs. However, the greatest disadvantage of this experimental study is that randomization has not been used. This limits the ability of the study to conclude a causal association between the outcome and intervention (Mojarrab et al., 2022).
Participants and Sampling
The participants who were recruited in the study are nursing students who are enrolled in two consecutive academic calendar years and these are 2017-18 and 2018-19. The sampling method which is adopted is random sampling and in this about 76 nursing students are recruited and divided into two main groups. One group is the control group in which 35 students were recruited, while the other group is the intervention group, and in this about 41 students were recruited (Mojarrab et al., 2022).
The sampling method which is used in the study is random. In a random sampling method, each item that is selected in the population is provided an equal chance of being selected in the sample. Hence, this method is popularly known as the method of chance sampling. There are four types of sampling methods: simple random sampling, systematic sampling, clustered sampling, and stratified sampling. All these sampling methods have their advantages and disadvantages (Elfil & Negida, 2017).
The sample size which is taken for this research paper is 75, this sample size cannot be stated effectively because it is too less. The sample size should be such that it should be big enough so that accurate conclusions can be easily drawn. The sample size should be such that the outcome which is obtained can be applied to a large number of the population, however, the sample size taken for this study is not that effective and hence, the outcome cannot be applied to a large population. A larger sample size also ensures that the chances of errors are also reduced, hence, it needs to be avoided (Mojarrab et al., 2022).
Measurement of Study
The data for the study is collected using several instruments and these instruments mainly include demographic characteristics form along with State-Trait Anxiety Inventory (STAI) questionnaire. The STAI questionnaire which was collected was filled in before and after the OSCE. The results which are obtained are then compared with the control group. Collected data is then analyzed using the SPSS software and it was statistically significant. Informed consent has been obtained from the research design and adequate steps need to be taken for it (Mojarrab et al., 2022).
The two measures which are adopted while collecting data are: socio-demographic information and State-trait anxiety inventory (STAI). The first measure takes care of the demographic characteristics of the participants and this includes age, sex, year, and city. It is a subjective measure. On the other hand, STAI questionnaires have S and T scales, and these scales are used to measure anxiety levels. There are 20 items on which the participants need to be evaluated. It is an objective measure (Mojarrab et al., 2022).
Both the measures which are adopted are reliable and valid, the socio-demographic information is necessary because it will allow getting an idea about the participants, their way of living, and the kind of accommodation they are in. It also helps to understand the curriculum of the students. The second measure is STAI, which is a questionnaire, and it will cover all the important aspects which are required. The intensity of the participants is studied and effective steps are then taken.
The primary research which has been adopted is Quasi-experiment, and although these experiments have lower internal validity when compared to true experiments. However, they have high external validity as they can be used in real-world interventions instead of any artificial setting in the laboratory. This experiment design mimics the experiment and along with it, it also provides some high level of evidence without any randomization. The research question which has been identified is how the OSCE intervention will help to overcome the stress and anxiety that the nurse faces. It is then compared to the other interventions which are present and the effectiveness of both these measures is identified. The research question which is present answers all the questions that are present and hence, it is an effective way (Mojarrab et al., 2022).
Ethical Consideration
Yes, the present study presented has received ethical approval from the Ethics Committee of Shiraz University of Medical Sciences, Shiraz, Iran. Approval from every department has been obtained and this has helped sort out all the ethical concerns. Other than this, all the participants were informed about the research procedures and goals. The confidentiality of the participants has also been maintained. All the participants in the study have been presented with written informed consent from the participants (Mojarrab et al., 2022).
Two ethical considerations which the ethics review board will likely consider are the voluntary participation of the participants and the presence of informed consent. The voluntary participation of the participants is an important point to consider because it ensures that the participants are under no pressure or obligation to participate in the research. Other than this when the researcher is working with a vulnerable group of people, it also provides them the freedom to stop the study whenever they want to. The participants have the freedom to decline whenever they want. Informed consent in the research is highly important as it ensures that the individual has an informed choice if the participant would like to participate in the study or not. It will help to protect the welfare of the participants and this ensures that the participants are informed and voluntary. It also promotes positive feelings before and after completing the study (Mojarrab et al., 2022).
Statistics
The statistics which are used in the research paper are not alternate and null hypotheses. The data which is collected is analyzed through different software such as SPSS software. This software uses descriptive and inferential statistics. Several measures are used for the statistical analysis of the study and these are the chi-square test, t-test, t- dependent and independent test. All these tests which are performed are highly useful and should be used effectively (Mojarrab et al., 2022).
In the research paper, both dependent and independent variables are used, both these variables have their importance, hence, it needs to be used carefully. The t-score variable is used as the dependent variable. The chi-square test which is used is the independent variable, the t-test is the independent variable and hence, is used effectively. All these variables are highly effective when it is used to study primary study. It helps to increase the authenticity of the research paper (Mojarrab et al., 2022).
All the dependent and independent variables which are identified above need to be categorized into continuous and categorical variables. The chi-square test which is used is a categorical variable, along with it, the t-test is also a categorical variable. A categorical variable is also known as a qualitative or discrete variable, it can be future classified as dichotomous, nominal, or ordinal. While on the other hand continuous variable is more of a theoretical variable and it can be maximum and minimum (Mojarrab et al., 2022).
Two tests have been used and these are: The chi-square test and independent t-test.
Results
A significant fraction of the participants scored well on the national entrance exam for universities. Based on the overall number of applicants to universities, this extremely competitive exam is rated; those with a lower ranking have a stronger chance of being accepted. The intervention had a positive impact, as seen by the anxiety levels before and after the exam. The results showed that the control group's anxiety level increased (8.31 units) following the OSCE. The pre-and post-exam scores of the control group differed significantly (P 0.001) according to the results of the paired t-test (Mojarrab et al., 2022).
Discussion
Yes, the author has related the study results back to the research question, and the effectiveness of the research question has been identified. The findings of the present study indicate that the anxiety coping program which has been implemented on the nursing students has been shown to improve the OSCE results. Educational planners can think about including a curriculum to ease pupils' nervousness and aid in improving their test scores. Future studies should be conducted over a longer period, with updates on the academic performance of the participants. The average anxiety score of nursing students improved as a result of the anxiety-coping program.
No, the author's recommendations and conclusions are not just solely based on the result of the research. However, it is based on overall study results. There are several recommendations for future studies and these are: it is important to study the effect of anxiety-coping programs on paramedical students, other than this, it is also necessary to study the effect of anxiety-coping programs on educational motivation. In addition to it, the effect of mock OSCE tests on examination and anxiety needs to be studied. There are several identifications of anxiety factors among the nursing students, these need to be studied (Mojarrab et al., 2022).
Generalisability
This study has certain limitations, however, in this section, two limitations will be discussed and these are mentioned below. The first limitation is that all of the participants in the study come from the same medical school and discipline. As a result, it restricts how broadly the findings may be applied. If the sample size is too restricted then the likelihood of Type 2 error increases. In addition to it, the power of the study is also decreased. If the sample size is too small then the results that are obtained cannot be applied to a larger population. Hence, it is essential to control the sample size. The second limitation is that the anxiety coping program is implemented for a brief period, and no follow-ups are conducted to assess pupils' levels of anxiety. Follow-up is keeping track of a patient's health after therapy. This entails monitoring the health of participants in clinical studies or clinical trials for an extended period, both during and after the study ends. To effectively measure over-diagnosis, even after screening is finished, long-term follow-up is required. Additionally, additional steps and subsequent side effects need to be tracked and studied (Mojarrab et al., 2022).
Section- B Grade Recommendation
The research paper which is presented is of high quality, there are several qualities of a good research paper and these are mentioned below. An excellent research question clearly states the objectives of the study and limits its scope. Researchers may make sure they stay on track during their study by developing a solid research question. Most of the time, the research question affects all of the other actions a researcher does when doing their study. Another characteristic of successful research is a sound research approach. It describes the methodical steps or strategies a researcher employs to guarantee that his study yields accurate, trustworthy data. Research methodologies are frequently divided into three categories: mixed-methods research, qualitative research, and quantitative research. The collecting of empirical data is only the first step in doing good research; the data must also be appropriately analyzed. The best data analysis technique to adopt is primarily determined by the type of data that was obtained.When analyzing quantitative data, for instance, descriptive or inferential statistics are typically used. Some of the most crucial aspects of research are replication, reproducibility, and transparency. A research study's capacity to be replicated is crucial because it enables other researchers to examine its findings. Research ethics guide the conduct of good research. The World Health Organisation claims that standards for academic research are provided through research ethics. These guidelines assist in safeguarding the rights and dignity of study subjects while ensuring that researchers uphold principles like impartiality, honesty, integrity, and accountability in their work. These recommendations for additional research frequently result from the study's shortcomings. Along with the study's findings and conclusions, researchers must present the study's constraints and potential weaknesses (Mojarrab et al., 2022).
The GRADE recommendation strength for this article to be strong is that it covers almost all the aspects which are required for research to be authentic and correct.
Several recommendations can be made for future studies and can be communicated to other interested parties who may be thinking about making modifications in light of the findings of this article. Several other programs need to be identified and worked upon. The impact of an anxiety management program on paramedical students' anxiety levels and OSCE exam outcomes. This will help to study the level of anxiety which is present and how to control it. The impact of an anxiety management program on nursing students' motivation for learning, contentment with their learning, and academic achievement following an OSCE. When a nursing student goes through stress and anxiety it will also affect their performance, hence, it needs to be controlled. The impact of practicing OSCE exams on nursing students' test anxiety and performance. Identification of nursing students' risk factors for anxiety. In a research paper, cost plays an important role because it determines the quality of the research. The major factor which plays an important role in determining the cost of the research is the sample size, however, in this study the sample size is low hence the cost of the whole research will be reduced. A small sample size requires fewer resources to be spent and effective work is done using fewer resources. More research requires more resources while conducting research it is necessary to use all these resources effectively (Mojarrab et al., 2022).
References
Elfil, M., & Negida, A. (2017). Sampling methods in clinical research; An educational review. Emergency (Tehran, Iran), 5(1), e52.
Miller, C.J., Smith, S.N., & Pugatch, M. (2020). Experimental and quasi-experimental designs in implementation research. Psychiatry Research, 283, 112452. https://doi.org/10.1016/j.psychres.2019.06.027
Mojarrab, S., Bazrafkan, L., & Jaberi, A. (2020). The effect of a stress and anxiety coping program on objective structured clinical examination performance among nursing students in shiraz, Iran. BMC Medical Education, 20, 1-7.
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