Anxiety among nursing students during their first human prosection

Death anxiety, sense of meaning in life, and willingness to body donation among nursing students in anatomy course: An explanatory sequential mixed study

BACKGROUND

Anatomy education is a fundamental part of clinical nursing, but anatomy courses may lead to a range of psychological changes, such as death anxiety and sense of meaning in life. Such experiences and changes may influence student's willingness to donate their body. There is insufficient evidence on whether anatomy courses bring about these changes, and the reasons behind experiences are unclear. Focusing on these changes is essential to improve anatomy education in nursing and to promote the mental health of students in the nursing field.

OBJECTIVES

To explore changes and underlying reasons for death anxiety, sense of meaning in life, and the willingness to donate a body before and after anatomy courses.

DESIGN

An explanatory sequential explanatory mixed-methods study.

PARTICIPANTS

A total of 60 students completed quantitative surveys and 16 students from the sub-samples of the quantitative stage were included in the qualitative interviews. All students were from a comprehensive university in Changsha, Hunan Province, China.

METHODS

Data were collected from September 2022 to April 2023, including two rounds of questionnaire surveys and one interview. The questionnaires included sociodemographic data, the Death Anxiety Scale (CT-DAS), the Meaning of Life Scale (MLQ), and a body donation willingness question. Interviews were conducted based on the research objectives. The statistical methods included descriptive statistics, z-tests, and thematic analysis.

RESULTS

Quantitative results showed a decrease in emotional dimension of death anxiety (z = -2.534, P < 0.05) and an increase in body donation willingness (z = -3.183, P < 0.05). Qualitative analysis revealed cognitive experience and value assessment may relate to the changes. Based on the two themes, the reduction of death anxiety in emotional dimension can be further attributed to four factors: demystification, instrumentalization, desensitization, and respect and gratitude towards donors. The increase in willingness to donate bodies can be further attributed to two aspects: increase in knowledge of body donation and the affirmation of the value of donation.

CONCLUSION

The study found that students experience a decrease in death anxiety in the emotional dimension and an increased inclination to donate their bodies after anatomy courses, which may be related to cognitive experience and value assessment. Future nursing anatomy education could delve deeper into these two perspectives and support students to positively cope with death anxiety and rethink body donation through enriching death education activities such as donor memorial ceremonies. These results provide a basis for designing anatomy courses and improving the psychological well-being and professional competence of nursing students.

Comparing the emotional experiences of students in similar dissection- and prosection-based medical gross anatomy courses: A mixed-methods study

The anatomy laboratory can incite strong emotional reactions in students, which can in turn facilitate growth in empathy, care for vulnerable others, and professionalism. Despite this, little is known about the relative emotional impacts of different laboratory modalities. The response to the COVID-19 pandemic created an opportunity to compare the emotional experiences of students in similar courses in which one group of students dissected donors and the other group learned from prosected donors. The courses were otherwise the same in content, length, instructional design, and assessment. Students in the dissection-based (Fall 2019) and prosection-based (Fall 2020) courses completed a previously validated survey that used quantitative and qualitative questions to assess their feelings about the donors and the anatomy laboratory experience. Students in both cohorts reported overall appreciation for having had the experience. Negative themes experienced by both groups included feeling anxiety, worries about depersonalizing donors, and physical discomfort in the laboratory. Students in the dissection course reported stronger connections with the donors and the donors' families but also more frequently felt negative feelings such as disgust, anxiety, and feeling alone. Students in the prosection course reported more consistently positive responses but worried about not using the donors to the fullest extent possible. Regardless of pedagogical design, students have complex emotional experiences in the anatomy laboratory and our results indicate that these feelings may be more intense in the context of dissection. Anatomists should foster educational settings that enable students to learn to process complex or challenging emotions.

Anxiety, emotions, and thoughts of veterinary medicine students during their first visit to the dissection room

The use of cadavers is essential for veterinary anatomy learning. However, facing an animal corpse can be stressful for veterinary students because of their empathy toward animals. The objective of this study was to evaluate veterinary medicine students' emotions, feelings, and anxiety levels related to practicals with dog cadavers. Two questionnaires were administered to 1st year students (n = 168) at CEU Cardenal Herrera University in Valencia (Spain) before and after their first practical session with cadavers. The application of State-Trait Anxiety Inventory questionnaires showed that "state anxiety" decreased significantly (p < 0.05), from a score of 14.8 before the practical to 10.4 after, and that female students showed higher but not significantly different levels than males. Most (64%) of the students were not willing to donate the bodies of their pets, and those students were more stressed before the practical than their peers, although their anxiety levels significantly decreased by the end of the session. The majority of the students answered positively about emotions, such as feeling calm, safe, not nervous, relaxed and not worried before the practical, and this increased significantly to more than 80% by the end of the session. The visualization of educational videos prior to the session was evaluated positively by students. These results agree with those reported in other health science disciplines, showing that students face practical sessions with corpses in a similar way and suggesting that the use of videos can help decrease anxiety and enhance their learning experience.

The Effect of Visualization Techniques on Students of Occupational Therapy during the First Visit to the Dissection Room

Background: Part of the basic teaching of human anatomy are prosection sessions with a human corpse, which may generate stress or anxiety among students. The objective of this work was to study how, through the visualization technique (a coping technique), these levels could be reduced before starting prosection classes. Methods: A cross-sectional pilot study was conducted involving first-year students who had never participated in screening sessions. Prior to the visit, occupational therapy students underwent a viewing session (visualization technique). On the day of the visit, before and after the screening session, an anonymous questionnaire was distributed to find out about aspects of the students’ experiences, such as their feelings and perceptions. The State−Trait Anxiety Inventory was used to assess anxiety. Results: The baseline levels of anxiety measured remained stable (from 18.5 to 18.2 points), with no differences being found (p > 0.05). The levels of emotional anxiety measured fell from 15.2 to 12.6 points (p < 0.05). Before starting the class, there were six students (17.1%) with anxiety criteria, and this figure was doubled at the end of the session (33.3%) (p < 0.05). Conclusions: Sessions in a dissection room can cause stressful experiences and change the emotional balances of some students. The results obtained and published here showed no significant differences after the visualization technique. We found that the students believed that the prosection sessions were very useful for teaching anatomy.

Validation of General Anxiety Disorder (GAD-7) questionnaire in Spanish nursing students

Background

Nursing students are at risk of anxiety during their university education.

Objective

To determine the psychometric characteristics of the General Anxiety Disorder (GAD-7) questionnaire in a population of university nursing students.

Methods

A cross-sectional study was carried out with 170 students at the University of Jaen (Spain) in 2022. An online questionnaire was administered that included sociodemographic and student profile variables, the GAD-7 questionnaire, and the Goldberg anxiety subscale. An exploratory factor analysis (EFA), validation with convergence, and reliability analysis using Cronbach's α were performed.

Results

The EFA identified a single component that explained 63.50% of the variance. It was positively correlated with the Goldberg anxiety subscale (r = 0.653; p < 0.001). A statistically significant association was observed with academic year, gender, and having experienced an anxiety crisis (p < 0.005). Internal consistency with Cronbach's α was 0.903.

Conclusion

The GAD-7 presents appropriate psychometric characteristics for use in a university population of nursing students. It is capable of detecting symptoms and generalized anxiety disorder, making it a useful and simple tool for detecting anxiety-related problems in this population.

Nursing students' experiences and perceptions of an anatomy laboratory session: Mixed methods study

Many nursing curricula do not offer anatomy laboratories and exposure to cadaveric material. In this mixed methods study, nursing students' perceptions and experiences from an anatomy laboratory session were examined. Students from two academic nursing programs (a four-year general baccalaureate nursing program and a two-year accelerated nursing program for non-nursing baccalaureate graduates) took part in an anatomy laboratory session (N = 223). Participants' learning experiences, emotional experiences, and satisfaction with the anatomy laboratory session were assessed by their responses to closed-ended questionnaires. Participants' reasons for participation and suggestions for improvement were examined by open-ended questions. A mixed methods analysis of the data revealed a high level of satisfaction with the anatomy laboratory experience. Positive attitudes and learning experiences correlated with a sense of identification with the nursing profession. Satisfaction was positively associated with a perceived quality of learning and negatively associated with a negative emotional experience. Curiosity and self-challenge, as well as the quest for tangible, in-depth learning, were major motivators involved in the students' desire to participate in the session. Both qualitative and quantitative analyses indicated that the educational experience was significant. Therefore, it is recommended to integrate anatomy laboratory sessions into anatomy courses for nursing students. This will help to illustrate and assimilate classroom material and strengthen nursing students' sense of identification with their profession.

To Touch or Not to Touch: Evaluating Student Laboratory Outcomes of Hands-On versus Visual Examination of Prosected Cadavers

We utilized the physical manipulation of cadaveric donors by students to evaluate learning outcomes in two undergraduate anatomy courses. Students (n = 176) were assigned as those whom ‘manipulated’ (n = 100) or ‘did not manipulate’ (n = 76) donors, and data were compared to performance on laboratory assessments. A Fisher’s exact test was conducted within individual and combined course populations to assess if the relationship between physical touch and receiving a passing grade is more than expected by chance. BIO 201 ‘manipulating’ students received a ‘C’ or better (n = 58) vs. 6 D, F, or Withdraw grades (DFW) on lab practicals as compared to those who did not manipulate (n = 33 DFW vs. 18 C or better) (p < 0.0001). BIO 221 ‘manipulating’ students (n = 34) received a ‘C’ or better vs. DFW grades (n = 2), while ‘non-manipulating’ students were able to earn outcomes of ‘C’ or better (n = 13 vs. 12 DFW). However, students involved in donor manipulation were more likely to receive a ‘C or better’ (p = 0.0002). Analysis of the data as a single cohort indicates non-manipulating students are 7.24 times more likely to earn a ‘DFW’ on lab practicals, demonstrating that students are better prepared for laboratory assessments when encouraged to manipulate anatomical structures.

YouTube-based course orientation videos delivered prior to matriculation fail to alleviate medical student anxiety about anatomy

Gross anatomy is a source of anxiety for matriculating medical students due to the large volume of information presented in a truncated timeline, and because it may be their first exposure to human cadavers. This study aimed to assess if video-based resources would affect matriculating medical students' anatomy state anxiety levels. Videos were designed to be short, YouTube-based units that served to provide orientation information about the anatomy course, dissection facilities, and available study resources to dispel anxiety around beginning their anatomy studies. To evaluate the impact of the videos, students in two consecutive matriculating years (2018 and 2019) completed the validated State-Trait Anxiety Inventory and a demographic questionnaire. The 2019 cohort (n = 118) served as the experimental group with access to the videos; while the 2018 cohort (n = 120) without video access served as a historical control. Analyses revealed that the groups were equivalent in terms of trait anxiety (P = 0.854) and anatomy state anxiety even when student video exposure was controlled (P = 0.495). Anatomy state anxiety was only significantly lower in students with prior formal anatomy exposure (P = 0.006). Further inquiry into students' prior anatomy experience identified that individuals with post-secondary dissection experience were significantly less anxious than those without formal anatomical experience (P = 0.023). These results may serve as a cautionary tale to educators; while preference for video-based instructional materials is prevalent in the literature, videos delivered on public social media platforms fail to prepare students for the psychological impact of studying human anatomy.

Anticipatory Feelings About Dissection: An Exercise for the First Day of a Gross Anatomy Course

Studies have demonstrated that students experience a variety of intense emotions in anticipation of human anatomical dissection, including enthusiasm, gratitude, responsibility, apprehension, detachment, anxiety, and spiritual or moral reflection. The exercise described here provides an opportunity to start a conversation about the complexity of students' emotional reactions to the anatomy experience. The intention of this exercise is to normalize the variety of emotions that anatomy students experience, both to demonstrate to students that their emotions are normal and to encourage the empathy for others' reactions which may differ from their own. In the lecture hall setting before the first day of dissection, students are asked to draw how they feel about the dissection experience and are provided an opportunity to discuss their drawings with their peers. The course director then provides a slide show demonstration of drawings from previous years, and experienced anatomy faculty facilitate a large group discussion in which students react to the drawing exercise and slide show and ask questions which are addressed by the faculty. This exercise provides an opportunity for students to practice appropriately communicating about emotionally complex experiences in a professional setting. The exercise is straightforward to implement and is easily modifiable for different class sizes and curricular structures.

What emotions do physical therapy students feel during their first visit to the dissection room?

Dissections are a fundamental practical methodology for teaching human anatomy. However, this experience can be stressful, generating anxiety situations among students. This study tries to understand the attitudes, reactions, fears and anxiety state among students earning a physiotherapy degree when facing their first prosection. A cross-sectional before-and-after study was carried out with students who were provided with an anonymous "ad hoc" questionnaire and the State-Trait Anxiety Inventory (STAI).The values obtained from the total STAI questionnaire remained stable and unchanged during the prosection (p > 0.05). The levels of trait anxiety (TA) and state anxiety (SA) remained stable except in female students, who showed higher TA and SA scores, with a significance of p < 0.05 before and after the prosection. Although 100% of the students were satisfied with the dissection practices, the experience can provoke stressful responses and should be addressed using coping mechanisms, especially among female students.

Exploring Nursing Students' Experiences in the Anatomy Laboratory to Optimize Their Learning

BACKGROUND

In medicine, dissecting human cadavers is vital for learning anatomy, developing professional skills, and fostering a relationship with the body. This opportunity has received little pedagogical attention in nursing. The purpose of this study was to understand the experiences of nursing students in the human anatomy laboratory to inform strategies that may be implemented to optimize learning.

METHOD

A qualitative descriptive study was conducted to analyze reflective assignments completed by undergraduate and graduate nursing students following participation in a required session in the human cadaver anatomy laboratory.

RESULTS

Overall, 168 assignments were included in the analysis. Three themes were identified: Coping With the Initial Shock, Reflecting on the Salience of Death and Dying, and Acknowledging Impacts on Future Practice.

CONCLUSION

The students' reflections support the integration of a human anatomy laboratory session into the nursing curriculum and inform strategies to foster learning and development. [J Nurs Educ. 2021;60(4):221-224.].