The effect of the clinical oriented reasoning examination on anxiety and perceived stress levels in nursing students: A quasi-experimental study

Abstract Background The clinical oriented reasoning examination is a structured assessment developed to evaluate students' clinical decision-making rather than their recall of factual knowledge. Because such examinations require students to reason under time pressure and to justify their decisions, they may be experienced as more demanding than conventional written assessment, and their affective consequences for students are not well understood. Anxiety and stress can influence both examination performance and student wellbeing, yet the relationship between this form of assessment and students' anxiety and stress has not previously been examined. This study aimed to examine the effect of the clinical oriented reasoning examination on state anxiety, trait anxiety and perceived stress in nursing students. Methods A quasi-experimental, single-group pretest–posttest study was conducted in a nursing faculty in the Mediterranean region of Türkiye. A total of 131 first-year nursing students who sat the clinical oriented reasoning examination and met the inclusion criteria participated. Data were collected using a student information form, the State–Trait Anxiety Inventory and the Perceived Stress Scale, administered immediately before and after the examination. Differences between measurements were analysed using paired comparisons, and the relationship between examination performance and the psychological measures was examined using correlation analysis. Results State anxiety decreased significantly after the examination, whereas trait anxiety and perceived stress did not change. Examination score was weakly and negatively correlated with post-examination state anxiety and with perceived stress. Conclusions State anxiety declined following the clinical oriented reasoning examination, while trait anxiety and perceived stress remained unchanged, consistent with the distinction between transient and dispositional components of anxiety. Examination performance was largely independent of anxiety and stress, suggesting that this form of assessment does not disadvantage students with higher baseline anxiety. As the study used a single-group design without a comparison examination, the decline in state anxiety cannot be attributed to the examination format itself and may reflect the natural resolution of anticipatory anxiety once an examination has ended. Controlled designs comparing assessment formats are needed.