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For test anxiety:

Step 4 (6-8 attributes or characteristics)

· When the concept is occurring, what does it look like? How do you know it is happening?

Step 5 (Identify 5-8 antecedents & 5-8 consequences)

· What must happen before the concept occurs?

· What happens as a result of the concept occurring?

Step 6 (Model case development)

· Create a 250-300 word model case that shows how the concept appears in real-life for a person. Mention:

· Antecedents, attributes/characteristics, & consequences


Step 7 (Contrary case development)

· Create a 250-300 word contrary case that shows how the opposite of the concept appears in real-life

· Same situation but this person
has the opposite experience
as model case

· Antecedents, attributes/characteristics, & consequences

Step 8: Define at least one empirical referents (how we can measure/identify that the concept exists). Identify others if available. (approx 100-125 words, will vary)

· Do review of whole assignment

Below is an example that was done for Nursing Burn out, need same for Nursing Test anxiety for above questions answered:

4. Determine the defining attributes or characteristics (6-8): The key attributes that define burnout are

a. Emotional exhaustion

i. physical, mental, and emotional depletion caused by work stressors

i. low energy, fatigue, depression, hopelessness, and helplessness.

1. Cynicism/depersonalization

ii. employee develops an indifference towards their job

ii. negative attitudes, negative behaviors towards patients, irritability, and withdrawal 

1. Inefficacy/low personal accomplishment

iii. the state of negative self-perception

iii. views self as incompetent and inadequate

iii. results in reduced levels of contribution to their work

5. Identify 5-8 antecedents (what happens before) and 5-8 consequences (what happens after) the concept occuring

1. Antecedents of burnout 

iv. high workload paired with understaffing

iv. 12-hour work shifts, ‘forced’ overtime, and working night shift or rotating shifts

iv.  a dysfunctional workplace with poor communication, lack of collaboration and teamwork

iv. low control when it comes to decision-making

iv. difficult workplace relationships and bullying with physicians, managers, and other nurses

iv. lack of support at home, multiple demands (caregiving, financial stress, relationships)

iv. neglected self-care (dietary choices, lack of exercise, inconsitent sleeping habits, lacking stress-relief or spritiual grounding)

1. Consequences of burnout

v. cardiovascular disease, high cholesterol, a high body mass index

v. insomnia, depression, anxiety

v. PTSD, suicide

v. Detachment from work, devaluing work

v. For the organizations high turnover rates due to job dissatisfaction & toxic work environments, leading to dysfunction and monetary losses

v. For patients burnout increases missed care and general care errors, and HAI. Nurses are less likely to report these adverse events and near misses 

6. Create a model case that shows how the concept appears in real-life (250-300 words)

1. Auri is a 24 year-old new graduate nurse who began her career in a cardiothoracic unit. She was super ecstatic to have this position and relocated to NYC for it in January 2020. When the Covid-19 pandemic hit, her unit converted to care for these patients. She already felt incompetent and had little clinical guidance as the workload increased with critically ill patients, who died at a terrible rate. Safety for the nurses seemed second to patient care with limited PPE and unreasonable assignments. She picked up extra shifts as peers became sick and an older nurse on the unit died of Covid-19. Without family to help with care and isolation, patients were receiving little attention and Auri often went into the supply room and cried. She expressed her concerns to her manager but there was no time or energy to attend to her needs. On her days off she stayed in bed, nearly paralyzed from sadness and guilt. Her distraction and being overwhelmed led to a medication error. The patient seemed unharmed so she did not tell anyone. She felt like a zombie at work, unable to empathize anymore. She began calling out sick from work, which led to a disciplinary meeting because she was still in her orientation stage, although not getting any mentoring or support. Her anxiety was overwhelming and one day she could not enter the hospital. She put in her resignation and moved back home with her parents. This case demonstrates how Auri experienced burnout with symptoms of exhaustion, depersonalization, and inefficacy within a six month period.

7. Create a contrary case that shows how the opposite of the concept appears in real-life (250-300 words)

1. Chester is a 35 year-old nurse who has been working on a surgical unit in NYC for seven five years. As a single mother with two children, 12 and 14 years old, she lives with her parents and sister who help  at home. She works 12-hour night shifts, sleeps during the day when the kids are at school, and walks to school each afternoon to pick them up. The family eats a relatively healthy dinner together each night. Chester maintains a good sleeping schedule, sets limits when asked to pick up shifts, and communicates her concerns quickly and clearly. When Covid-19 hit, her unit was quickly converted to a Covid-19 unit. Her experience and strong history of work-life balance somewhat prepared her for what happened. Her manager and nursing staff pulled together to conserve PPE, support each other, and accept their limitations in providing patient care. The staff mourned together, even if briefly, for the daily deaths on their unit, assuring each other they had done all they could in the circumstance. Even with the high death rates, patients did recover and they celebrated together with that patient at each discharge. Chester’s supportive family stepped in to oversee the kid’s remote learning so she could sleep during the day as usual. This pace continued for three months. As the crush of the early pandemic wave subsided, she was able to take time off to rest and recuperate. She took her kids on outdoor day trips and signed up for a yoga class in the park. Although some of the nurses on the unit left for travel positions, and one colleague died, the staff remained close and committed with the help of their manager and supportive hospital leaders. This case demonstrates how Chester avoided exhaustion, depersonalization, and loss of accomplishment so did not experience burnout.

8. Define at least ONE empirical referents/measurement tool for the concept

1. One of the main instruments to measure burnout is the Maslach Burnout Inventory (Maslach & Leiter, 2016). 

1. The Inventory explores the frequency in which people experienced different feelings from a scale of zero to six in three dimensions: 

ix. Emotional exhaustion consists of nine items and focuses on how people feel about work, whether frustrated or fatigued. 

ix. Depersonalization consists of five items that focus on the relationships we build with our patients and others. 

ix. Personal accomplishment has eight items that highlight job satisfaction and personal efficacy. 

ix. High scores on the emotional exhaustion and depersonalization dimensions with a low score in the personal achievement dimension indicate a person experiencing burnout. 

1. Burnout can also be measured with the Bergen Burnout Inventory (BBI), the Oldenburg Burnout Inventory (OLBI), the Shirom‐Melamed Burnout Measure (SMBM), and the Copenhagen Burnout Inventory (CBI) (Maslach & Leiter, 2016).

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