Effects of Virtual Reality and Nature Sounds on Pain and Anxiety in Women Having Cesarean Section

Effects of Virtual Reality and Nature Sounds on Pain and Anxiety After Cesarean Section: A Randomized Controlled Trial

This study was conducted to determine the effects of virtual reality application on pain and anxiety in women who gave birth by caesarean section. It was applied to women who had given birth by caesarean section at a public hospital in northern Turkey, voluntarily agreed to participate in the study, and were randomly assigned to the intervention (n=40) and control (n=40) groups. Women in the intervention group were taught how to use virtual reality goggles. After the first mobilisation, women were shown a nature landscape video through virtual reality goggles (VRG) accompanied by nature sounds for an average of 20 minutes. The aim of this application was to enable women to view nature images more effectively accompanied by nature sounds, thereby helping them to focus on the images and sounds, distract their attention, relax, and escape the tension of their surroundings. The application was carried out with the women in a semi-reclining position and without sleeping. The same application was applied to each woman, and the glasses were disinfected with Dermosept surface disinfectant, which provides cold sterilisation, before the application. No application was made to the women in the control group; only the hospital's routine care was applied. The data were collected by the researcher through face-to-face interviews based on the statements of women after caesarean section.

Study Overview

• Status: Completed
• Conditions: Pain; Caesarean Section; Anxiety; Nursing; Obstetrics and Gynaecology
• Intervention / Treatment: Device: Virtual Reality Glasses

• Study Type: Interventional
• Enrollment (Actual): 80
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Samsun, Turkey, 55
    • Gynecology and Obstetrics Department affiliated to the Gynecology and Obstetrics Department of Samsun Education and Research Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Volunteering to participate in the study
• Being over 18 years of ageBeing able to read and write in Turkish
• Giving birth at term, having a single, live and healthy baby
• The baby being with the mother
• Having a healthy/risk-free pregnancy
• Having had spinal anesthesia.

Exclusion Criteria:

• Having a diagnosed psychiatric disease,
• Having a mental disability and communication problem,
• Having a vision or hearing problem,
• Developing complications during or after a cesarean section,
• Having any obstacles to postpartum mobilization.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control Group with Standard Care; Participants in the control group did not undergo any intervention other than routine post-caesarean care (verbal information about the procedure and brief written information about the procedure are planned to be provided).
Experimental: Control Group Using Virtual Reality Glasses; The researcher informed the women in the intervention group about the study, introduced them to the virtual reality glasses after obtaining written consent, and taught them how to use the glasses. Subsequently, the data collection form, State Anxiety Scale, and visual analogue scale rating scale for pain were administered face-to-face to both groups. After the first mobilisation, postpartum women were shown a nature landscape video through virtual reality glasses (VRG) accompanied by nature sounds for an average of 20 minutes. Each woman watched the same video. Pain and anxiety were reassessed after the application. The same application was performed for each woman, and the goggles were disinfected with Dermosept surface disinfectant, which provides cold sterilisation, prior to the application.	Device: Virtual Reality Glasses; Pharmacological and non-pharmacological methods are applied in the management of pain and anxiety after cesarean section (Tetik & Tekinemre, 2017). In addition to medical treatment during the post-cesarean care process, complementary and supportive non-pharmacological approaches can be used to address the woman holistically and provide multi-faceted contributions to the health of the mother and baby (Ali, 2022; Bayraktar, 2023). One of the non-pharmacological approaches, virtual reality glasses, is a device that provides two or three-dimensional environments to stimulate our senses by creating illusions of images (Appel et al., 2021). SGG creates a therapeutic effect by diverting attention, provides relaxation, and can thus be used in the management of pain and anxiety (Ayed et al., 2019). It has been determined that virtual reality glasses are an effective method in the management of pain and anxiety in the field of nursing (Akıncı & Aydın Özkan, 2024).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
State Anxiety Level	State anxiety level will be measured with Spielberger State Anxiety Scale. The Turkish reliability and validity study of the scale, which was developed by Spielberger and his colleagues to measure an individual's state and trait anxiety levels, was conducted by Öner and Le Compte in 1983. The scale examines anxiety in two sub-dimensions: State Anxiety measures an individual's feelings under a certain moment and condition, while Trait Anxiety expresses the individual's general anxiety level. Each statement in the scale is a 4-point Likert-type scale. There are 20 items in both types in the Spielberger State-Trait Anxiety Scale. The total score obtained from the scale varies between 20 and 80, with high scores indicating a high level of anxiety. The scale does not have any cut-off value. Cronbach's alpha coefficient was found to be 0.83 for State Anxiety.	Anxiety levels were assessed before and after the intervention.
Pain Level	Pain level will be measured with Visual Analog Scale. The use of the scale, developed by Price et al. in 1983, is achieved by measuring pain based on the statements of the people participating in the research. It is a one-dimensional, easy-to-administer scale and is widely used. It is a scale that the individual evaluates by making marks on a horizontal or vertical line of 10 cm or 100 mm, indicating that one end is very good and the other end is very poor. In our study, the scale starts with "mild pain" and ends with "very severe pain". A higher score from the scale indicates increased pain intensity.	Pain levels were assessed before and after the intervention.

Collaborators and Investigators

• Sponsor: Ondokuz Mayıs University
• Investigators: Study Director: Nazlı Baltacı, Assoc. Prof., phD, baltacinazli@gmail.com; Principal Investigator: Gizem Türkmen, MSc Student, gizemturkkmen19@gmail.com

Study record dates

Study Major Dates

• Study Start (Actual): December 24, 2024
• Primary Completion (Actual): March 17, 2025
• Study Completion (Actual): June 15, 2025

Study Registration Dates

• First Submitted: October 30, 2024
• First Submitted That Met QC Criteria: October 30, 2024
• First Posted (Actual): October 31, 2024

Study Record Updates

• Last Update Posted (Actual): August 1, 2025
• Last Update Submitted That Met QC Criteria: July 29, 2025
• Last Verified: July 1, 2025

More Information

Terms related to this study

• Keywords: Nurse; Pain; Anxiety; Virtual Reality; Caesarean Section; Nature Sounds
• Additional Relevant MeSH Terms: Mental Disorders; Anxiety Disorders
• Other Study ID Numbers: OMU-TURKMEN-2024/367

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: You are undertaking that your answers to the questions will be kept confidential and will not be shared with anyone.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No