Article Critique: Stress and Coping Responses to
Proficiency Testing in School-Age Children
Brea Brewer
Indiana University

Since the inception of the “No Child Left Behind” Act, proficiency testing of school children has increased greatly. This type of testing helps determine educational outcomes in students, evaluate teachers’ performance, as well as rate schools’ performance. Due to an increased pressure to achieve a certain academic level, students often exhibit stress-related biophysical symptoms especially when their coping strategies are inadequate.
The article, Stress and Coping Responses to Proficiency Testing in School-Age Children by Theresa Skybo and Jacalyn Buck, assesses 53 forth grade students’ appraisals of their specific proficiency tests and concurrent stressors, as well as their stress symptoms and coping strategies used. Nurses frequently encounter school-age children both in the school setting as well as the clinical setting. Therefore, knowledge obtained from this study, could be used to help nurses educate parents and teachers how to identify students with test anxiety, and how to help them improve their coping strategies. The purpose of this study was very well defined, easily identifiable, and also met.
When trying to decide the type of research leveling, I first looked for the type of design. This study falls within the quasi-experimental design description, and more specifically the time-series design. Since this study was conducted over several months time, i.e. October, February, March, and April, it is a classic example of a time-series or longitudinal design study. In studies such as these, there is no control group, and the participants are not randomized. Therefore, going by this analysis, the research leveling for this particular study is level three according to the Hierarchy of levels of evidence.

Population is defined as the entire set of elements that meet specified criteria. In this article, the target population turned out to be fourth grade students that were required to complete specified proficiency testing. More specifically, the accessible population was one elementary school district in Southwestern Ohio that housed students from both rural and suburban areas. This particular school district has a mandate to improve the scores of their students. In order to determine the sample size for this study, a power analysis for repeated measures was used. By using a power of .80, a moderate effect size of 35, and an alpha of .05, it was concluded that minimally, 27 students were necessary in order to even conduct the study. This would produce the ability to detect a moderate sized change over the course of the school year, in the student’s stressors, symptoms, as well as their coping strategies.
A convenience sample of 55 students was enlisted, but of those 55, one student withdrew based on personal reasons, and one returned to the third grade. This ultimately left a sample size of 53 students, but all forth grade students that were enrolled and would be participating in the proficiency testing were invited to participate in the study. Exclusions from this study included those students that were not participating in proficiency testing for one reason or another, as well as any student not enrolled in the forth grade. Data collection for this study was by means of assessment questionnaires. There were four different assessments in which the students answered questions. The Proficiency Test Stress Visual Analog Scale (VAS) ranked each students level of stress associated with the proficiency testing from 0 (not stressful) to 10 (most stressful). The Children’s Source of Stress Scale (CS) identified sources of both acute and chronic stress for the students. They were either 0 (not a stressor) or 1 (stressor). The Children’s Stress Symptom Scale (CSSS) measured the

student’s experience with stress-related symptoms. These were scored as 0 (not present) or 1 (present); 0 (once in a while), 1 (a lot) or 2 (most of the time); 0 (not bad), 1 (pretty bad), or 2 (terrible). Only the occurrence scores in the CSSS assessment were analyzed for reliability. Lastly, the Schoolager’s Coping Strategies Inventory (SCSI) assessed the coping strategies of the students. The frequency scoring for this assessment was 0 (never), 1 (once in a while), 2 (a lot), or 3 (most of the time); coping effectiveness went 0 (never do it), 1 (does not help), 2 (helps a little) to 3 (helps a lot).
There were two researchers and three trained research assistants collecting the data. The purpose of the study and directions for completing the questionnaires were reviewed prior to the start of the session, and each data collection session lasted 10-15 minutes. The assessments were completed in the same order VAS, CS, CSS and SCSI for each student at each time point.
This study is an example of quantitative research. This is the most commonly used research design. This type of research is often associated with objective data collection that is done in an organized, systematic, and controlled manner. This allows the data findings to be generalized to other situations/populations. Quantitative design can be experimental, non-experimental, or quasi-experimental. This study fits the quasi-experimental design and is more specifically, a time-series design. With time-series design, there is no control group, nor are the participants of the study randomized.
The study in this article was conducted in the 2003-2004 school year, which was not long after the enactment of the “No Child Left Behind” Act. President George W. Bush signed this Act into law on January 8, 2002. Since that time, more and more emphasis has been placed on the proficiency of students, teachers and schools. This becomes relevant in today’s society by

evidence of more and more students using stimulants to keep them awake to study longer, in order to achieve a better score on an exam. Even though this study was conducted on forth grade students, the ideation is present among all grade levels. Nursing practice is becoming even more education driven so to help prevent issues before they evidence. If nurses are able to help educated parents about test-anxiety and coping measures at well child visits, then quite possibly there may be a decline in students with treatable symptoms as a result of that teaching. There are certain clinical problems seen today that are directly related to stress and poor coping skills. I certainly feel that this article, even though skimming the surface of the issue, clearly addresses this fact and gives plausible solutions to an ongoing problem.
A limitation within this study is the fact that the convenience sample was lacking racial diversity, which allows for generalization. The fact that there was geographic diversity is a positive notion, but it still allows for general assumptions to be made. The fact that students and parents that are most stressed by proficiency testing could opt out, makes for another limitation. By only assessing the forth grade class in this study, the research is limited to that grade. There are several grades in which proficiency testing is completed, and there could be many other stress symptoms, coping methods and outcomes to be evaluated. It would be interesting to review a study on nurses that work, have families, and are returning to school to further their degree. One could only fathom the stress symptoms and coping skills among that grade level!

References

Skybo, T. and Buck, J. (2007). Stress and coping responses to proficiency testing in school-aged children. Pediatric Nursing 33(5), 410-418.