Exploring Virtual Reality in Clinical Care - Impacts on Patient Distress, Parental Anxiety and Nurse Satisfaction

Retrospective Observational Study Analyzing De-identified Data Originally Collected as Part of a Quality Improvement (QI) Initiative.

Prior experience with virtual reality (VR) in clinical care has demonstrated its potential to reduce patient anxiety and distress, particularly in pediatric settings. VR has been shown to effectively decrease preoperative anxiety in children undergoing various medical procedures, including IV catheter replacement, blood draws, and improve their compliance with anesthesia and overall procedural experiences. Limited evidence exists regarding the impact of VR on the broader care environment, including parental anxiety and nursing satisfaction in pediatric settings.

Study Overview

• Status: Completed
• Conditions: Anxiety
• Intervention / Treatment: Other: Virtual Reality; Behavioral: Survey Responses/Parent Caregivers; Behavioral: Survey Responses/Nurses

Detailed Description

This retrospective study analyzes de-identified data from a nine-month quality improvement initiative to evaluate the impact of a custom VR intervention on pediatric preoperative anxiety, parental anxiety, and nurse satisfaction in a real clinical setting. The findings offer preliminary, practice-relevant evidence that VR can be a feasible, acceptable, and clinically meaningful non-pharmacologic tool in pediatric preoperative care, and they provide actionable insights to guide future implementation efforts and rigorous trials aimed at improving the hospital experience for children, families, and providers.

• Study Type: Observational
• Enrollment (Actual): 168

Contacts and Locations

Study Locations

• United States
  • Virginia
    • Richmond, Virginia, United States, 23298
      • Virginia Commonwealth University

Participation Criteria

Eligibility Criteria

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

• Sampling Method: Non-Probability Sample

Study Population

The study involved pediatric patients who received VR intervention as part of the original QI initiative. Data protection and de-identification procedures were rigorously applied throughout the study

Description

Pediatric Subjects

Inclusion Criteria:

• pediatric patients who received VR intervention as part of the original QI initiative.
• pediatric patients who were eligible and received VR during the QI initiative aged 6-15 years.

Exclusion Criteria:

• Patients with developmental delays, head injuries, or seizures were excluded from the study.
• Only those pediatric patients who met the inclusion criteria and did not exhibit the specified exclusion conditions were included. Data protection and de-identification procedures were rigorously applied throughout the study

Caregivers/Parents

Inclusion Criteria:

- pediatric patients who were eligible and received VR during the QI initiative, aged 6-15 years

Exclusion Criteria:

- N/A

Nurses

Inclusion Criteria:

• nurses of pediatric patients who were eligible and received VR during the QI initiative, aged 6-15 years

Exclusion Criteria:

• N/A

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Pediatric Patients; Pediatric patients receiving VR interventions (6-15 years)	Other: Virtual Reality; Administered as part of a QI initiative aimed at reducing anxiety in pediatric patients during clinical care. The intervention involved using a VR system to provide a distraction and relaxation tool during routine procedures. This approach is consistent with recent research showing that VR can be an effective tool for reducing pain and anxiety in pediatric patients undergoing medical procedures. Retrospective data collection.
Parent Caregivers; Parents of Pediatric patients receiving VR interventions (6-15 years)	Behavioral: Survey Responses/Parent Caregivers; Survey responses from parents regarding anxiety and satisfaction.
Nurses; The nursing staff are involved in the care process of the Pediatric patients receiving VR interventions (6-15 years)	Behavioral: Survey Responses/Nurses; Survey responses from nurses regarding anxiety and satisfaction.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in patient anxiety levels, as measured by heart rate	Change in patient anxiety levels, as measured by heart rate, before and after VR intervention. Baseline heart rate will be compared to the heart rate after the intervention.	Before and after VR intervention, one visit only
Change in patient anxiety levels, as measured by blood pressure	Change in patient anxiety levels, as measured by blood pressure, before and after VR intervention. Baseline blood pressure will be compared to the blood pressure after the intervention.	Before and after VR intervention, one visit only
Change in patient anxiety levels, as measured by distress/fear scores	Change in patient anxiety levels, as measured by distress/fear scores before and after VR intervention Baseline distress/fear scores will be compared to the distress/fear scores after the intervention. Using the Children's Fear Scale (CFS) (0-4): 0 = no fear (good); 4 = very high fear (bad) . Higher scores indicate worse anxiety. Anxiety levels were measured immediately before and immediately after the VR intervention).	Before and after VR intervention, one visit only

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Parental anxiety levels	Change in parental anxiety levels, measured by pre- and post-intervention State-Trait Anxiety Inventory (STAI) scores. The State-Trait Anxiety Inventory (STAI) scoring involves summing the scores from the 40 items, each rated on a 4-point Likert scale, to assess state and trait anxiety. The higher the score, the higher the level of anxiety.; = Not at all; = Somewhat; = Moderately so; = Very much so	Before and after VR intervention, one visit only
Nurse satisfaction ratings	Nurse satisfaction ratings with the VR intervention, measured via survey responses. Nurse satisfaction with the VR intervention was measured using a brief, Likert-scale survey developed for this quality improvement project. Survey Format: A 5-point Likert scale was used for all items: 1 = Very Dissatisfied / Very Difficult (bad); 2 = Dissatisfied; 3 = Neutral; 4 = Satisfied; 5 = Very Satisfied / Very Easy to Use (good) Higher scores indicate better satisfaction and more straightforward implementation.	Before and after VR intervention, one visit only

Collaborators and Investigators

• Sponsor: Virginia Commonwealth University
• Investigators: Principal Investigator: Dayanjan Wijesinghe, Virginia Commonwealth University

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2023
• Primary Completion (Actual): June 30, 2024
• Study Completion (Actual): June 30, 2024

Study Registration Dates

• First Submitted: December 1, 2025
• First Submitted That Met QC Criteria: December 1, 2025
• First Posted (Actual): December 12, 2025

Study Record Updates

• Last Update Posted (Actual): December 12, 2025
• Last Update Submitted That Met QC Criteria: December 1, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: Virtual Reality; Blood Pressure; Quality Improvement; Heart Rate; State-Trait Anxiety Inventory; Protected Health Information
• Additional Relevant MeSH Terms: Mental Disorders; Anxiety Disorders; Health Care Facilities Workforce and Services; Health Personnel; Nurses
• Other Study ID Numbers: HM20032312

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No