Distraction‐focused interventions on examination stress in nursing students: Effects on psychological stress and biomarker levels. A randomized controlled trial

Background Nursing students all over the world experience high levels of stress with negative impacts on their health, emotional state and performance. Aim This study aimed to investigate the effects of distraction‐focused interventions on examination stress and anxiety in nursing students. Methods A randomized controlled, parallel trial design was conducted from January to June 2016. After baseline measurement, 72 participants were randomized to one of the following groups (n = 18 each): (i) animal‐assisted therapy; (ii) music therapy; (iii) mandala painting; (iv) control group. Outcomes of all groups in terms of stress‐reduction were compared by measuring self‐reported perceived stress (STAI‐State and visual analogue stress scale) and salivary biomarker levels (Cortisol and Immunoglobulin A). Results Fifty‐seven complete data sets (n = 12‐16 for each group) were analysed. All distraction‐focused interventions showed stress and anxiety reduction in everyday school situations. By contrast, on days with examinations, stress reductions did not reach statistical significance in regard to self‐reported psychological stress. At the same time, interventions resulted in significantly decreased levels of stress biomarkers (P < .001). Conclusions Our preliminary findings suggest positive but situation‐dependent effects of distraction‐focused interventions in academic settings. Further research should investigate the complex relationship between physiological and psychological stress parameters.