Overcoming evaluation anxiety

Chapter 18


Overcoming evaluation anxiety



Objectives



1. Define evaluation anxiety


2. Describe characteristics of evaluation anxiety


3. Identify strategies to handle job performance appraisals assertively


4. Discuss techniques to decrease test anxiety


5. Identify benefits of criticism


6. Identify assertive strategies to handle difficult situations in student performance evaluations


7. Participate in exercises to overcome evaluation anxiety





Defining evaluation anxiety


Pause for a moment and take a deep breath. Reflect on the old saying, “To err is human.” Yes, it applies to all of us. We know this and yet we still think we have to be perfect. In our competitive culture we idolize excellence in personal performance, products, and services. Advertisements about “better” or “improved” products bombard us from billboards, radio, and TV. We spend years in an educational system that makes judgments about our physical and psychological abilities through a variety of examinations and elaborate grading systems. Emphasis on standardized achievement testing in American school systems has increased with the passage in 2001 of House Resolution 1, the No Child Left Behind Act, and has made for high stakes in test taking. Making mistakes is the antithesis of our cultural standard for excellence. Because of our preoccupation with perfection, it is difficult to believe that making mistakes is a normal part of human endeavor. We face these unrealistic expectations whenever we are in a situation in which our knowledge, skills, and behavior must be evaluated. In this chapter you will learn how to approach evaluations, test taking, and criticism in more positive ways so you can learn from them. These approaches will help you as a student and throughout your career as a nurse.


Evaluation anxiety occurs when we are upset about having our performance judged and are intimidated by the evaluation process. We cannot directly control others’ responses to our work, and overvaluing the responses of others creates a kind of anxiety that interferes with performing at our best. One form of evaluation anxiety is test anxiety, which has negative effects on academic performance (Bowie, 2010; Black et al, 2008). For nursing students, test anxiety can be evident in both written examinations and evaluations of clinical proficiency. Instead of focusing on relevant parts of a task, students with high test anxiety worry about how they are performing and how well others are doing and ruminate about alternatives (Meichenbaum, 1972). High test anxiety is associated with intrusion of irrelevant thoughts such as preoccupation with feelings of inadequacy, anticipation of punishment, and loss of status and esteem.


Accompanying these cognitive aspects of test anxiety are emotionality, the autonomic arousal aspect of anxiety, and a variety of physical symptoms including increased heart rate, increased muscular tension, gastrointestinal changes, changes in breathing, and dietary and sleep pattern disturbances (Meichenbaum, 1972). These physiological symptoms are distressing and must be alleviated just as much as negative thought processes. Learning to relax and decrease unpleasant symptoms helps diminish their negative effects.


One of the most significant and recurring problems experienced by health professionals is a fear of making a mistake and being evaluated negatively. Clinicians in practice have revealed fears about committing errors in diagnosis or treatment. Nursing students and nurses, too, fear making mistakes.


Examples of other nursing situations that engender anxiety in students are the initial clinical experience on a unit, nursing procedures, hospital equipment, patient simulators, evaluation by faculty, observation by instructors, tardiness, and conversations with physicians (Kaplan and Ura, 2010; Moscaritolo, 2010).


The two major factors underlying our evaluation anxiety as nurses are concern for client safety and concern for our own security.



WIT&Wisdom






Concern for our own security


Clients are becoming more knowledgeable and critical about healthcare and its cost. No longer content to passively submit to treatment, consumers of healthcare are demanding to know the rationale for regimens and to have access to a second opinion. In extreme cases clients are suing physicians and other healthcare professionals, including nurses, for ineffective healthcare. This potential threat from clients represents a powerful source of disapproval, with implications for career advancement and public embarrassment. The loss of your job and financial assets could also result from unsafe care. Today, nurses are aware of their accountability for the nursing care provided and their vulnerability to investigations of these actions through the legal process.


Evaluation anxiety is an unpleasant, ever-lurking phenomenon that threatens nurses and other health professionals. As nurses, we are committed to making a positive difference for our clients, yet today’s work environments are loaded with potential deterrents to this goal: inadequate staffing, the more acute health conditions of clients, technological complexity, information overload, and the uncertainty of healthcare reform. In its mildest form, evaluation anxiety can detract from enjoyment in the workplace; when strong, it can be overwhelming and interfere with our ability to perform competently as nurses.


As nursing students, or as practicing registered nurses, we need to develop ways to minimize evaluation anxiety so that we can confidently handle clinical or written examinations, job performance appraisals, and everyday criticisms—all naturally recurring events in the professional life of nurses.



Characteristics of evaluation anxiety


People who suffer from evaluation anxiety exhibit ways of thinking that make them feel uneasy and interfere with their ability to perform in adaptive ways. Those experiencing evaluation anxiety have been reported in the literature to have the following characteristics (Dweck and Wortman, 1982; Wine, 1982):



• Self-focus versus task focus. Some people spend more time thinking about their performance than they do completing the actual task. Attention to their performance detracts from the necessary attention needed to do the task adequately. Self-focused thoughts are negative and self-devaluing, and they lead to self-doubt. Not only does a focus on self versus task detract from task performance, but the focus on negative aspects of one’s performance engenders feelings of anxiety.


• Self-blame. Some people with evaluation anxiety tend to blame themselves for their poor performance more than they blame circumstances or other external factors.


• Worry and concern about evaluation. People with high evaluation anxiety tend to place great emphasis on how they are doing in comparison to others and how the examiner is evaluating them.


Those with low evaluation anxiety react to performance evaluation with an external, situational, task-oriented focus. For those with high evaluation anxiety, failure signifies a lack of ability. Those with low evaluation anxiety generate thoughts about the task or situation that encourage solutions or completion of the task, whereas those with high evaluation anxiety give up and see themselves as the main reason for failure.


High-anxiety individuals do not fully explore options such as trying different strategies or looking for an external causative factor, which leaves them with feelings of failure and uneasiness. Mistakes are interpreted as failures, not as stepping stones in the process of discovering the best solution. People with high performance anxiety tend to attribute success to factors other than their own ability, yet they readily assume that failure is their own doing. This view leads to feelings of pressure in every new achievement situation (Dweck and Wortman, 1982; Wine, 1982). Consider, too, the effect of past negative experiences on the evaluation process. Students and nurses with previous work experience who have had a traumatic incident in performance appraisal may have so much anxiety that the process is highly emotionally charged (Marquis and Huston, 1998). It is useful to spend some time reflecting on your fears and worries to determine how realistic they are.


In our culture it is easy to berate ourselves when we make a mistake. In addition to our self-chastisement we sometimes invent disapproval or exaggerate the disapproval of others. How we internally evaluate ourselves can be constructive or destructive.


Examples of constructive and destructive thoughts in relation to being evaluated are given in Table 18-1.




Gaining control over your evaluation anxiety


Knight (2011), on the management faculty in the graduate program at the University of Pennsylvania, observes that students who are afraid of evaluation are rendered incapable of engaging with a topic of learning and seeing it from multiple perspectives due to their fear of being wrong.


Because evaluation anxiety affects cognitive, affective, and psychomotor dimensions, a multifaceted approach is needed to help overcome it.



• You can use positive self-talk (see Chapter 22) to overcome your self-defeating internal dialogue. Making sure that your inner voice is reassuring comforts you in your day-to-day activities and during those times when you are having an examination or a performance appraisal.


• Relaxation (see Chapter 20) helps you focus on the task and act more efficiently. You feel more at ease and overcome the negative physiological effects of evaluation anxiety when you relax.


• Imagery (see Chapter 21) helps you picture yourself performing in a way that makes you feel good about yourself. Your positive visualizations keep you focused on performing your best and engender positive feelings that overpower the uneasiness generated by your anxiety.


• Learning how to make use of feedback from others (see Chapter 19) helps you prepare yourself for situations in which your performance is evaluated. Practice sessions with helpful colleagues can boost your confidence.


In addition to these four approaches, avoiding errors requires thinking before acting. Using the nursing process on a consistent basis helps to ensure that your nursing actions are safe, ethical, and helpful.



Handling job performance appraisals assertively


At many points in our nursing careers we receive both formal and informal evaluations of our performance. For us, the purpose of these evaluations is to learn what we are doing well (so that we can continue to do it) and where we need to improve our work performance. For the employer, evaluations serve as a check on whether employees are fulfilling the expectations of the work contract.


Evaluations are helpful to both parties and should occur regularly. As the employee, you can take an assertive approach to evaluations, which will help ease your anxiety. The following sections describe several assertive steps you can take to prepare for an evaluation. The example given is for a nurse employed in service.


As a student nurse, apply the same preparatory procedures for evaluations at your school of nursing. It is helpful early in your course or clinical experience to carefully read the guidelines for successful completion and clarify anything you do not understand. Review clinical competencies, procedures, and behaviors expected for this clinical rotation. Keep your own documentation of the completion of specific requirements in a clinical rotation and bring this to an evaluation meeting. Pay attention to the details of assignments on course syllabi.



Before your evaluation




1. Find out the schedule for evaluations in your agency. Many agencies offer an evaluation for new employees after 3 to 6 months of probationary employment and yearly thereafter.


2. Find out in advance the criteria by which your employer will be evaluating you. Having this information gives you the chance to make notes about how you think you have met the standards expected of someone in your position.


3. If your employer does not have a set of standard criteria for evaluation, suggest that one be developed soon. Request that your job description or the standards of nursing care prepared by your professional nursing association be used as the reference for determining your performance level.


4. Review what you and your colleagues in similar nursing positions actually do in the workplace. Compare this time and task allotment with what your job description outlines. At your evaluation, point out any discrepancies to your employer. If job descriptions are not updated, you may find that a significant part of your daily work is not being acknowledged.


5. Prepare your own evaluation of your work performance before meeting with your employer. Go to your appointment armed with specific examples of how you have met the requirements of your job description. Be aware of where you need to improve and what support you will need from your head nurse to make the necessary changes.


6. Develop goals toward which you would like to work. Be as clear, realistic, and specific as possible in the preparation of these work objectives so that you can articulate them clearly in your performance evaluation.


7. If the date at which your evaluation should have occurred passes, request an evaluation from your employer. Evaluations protect you by providing guidelines for maintaining or changing your professional behavior. You need feedback to know if your nursing care is within the legal and qualitative expectations of your agency.


8. Prepare mentally for your evaluation interview by ensuring that your self-talk is encouraging and visualize yourself looking and feeling calm and confident during your interview.

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Oct 26, 2016 | Posted by in NURSING | Comments Off on Overcoming evaluation anxiety

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