Virtual Reality to Reduce Stress Among Nursing Students Before Final Exams

Virtual Reality-Based Relaxation to Reduce Stress Among Nursing Students Before Final Exams: A Randomized Controlled Trial

The goal of this clinical trial is to evaluate whether a brief virtual reality (VR) relaxation session can reduce pre-exam stress levels among undergraduate nursing students enrolled in nursing courses.

The participant population includes male and female nursing students, aged 20-26 years, who are preparing to take their final practical exam.

The main questions it aims to answer are:

1. Does a 10-minute, self-selected VR relaxation session significantly reduce stress levels immediately before a high-stakes clinical exam?
2. Are certain types of virtual environments (e.g., beach, island, space, ocean) more effective than others in promoting relaxation?

Researchers will compare pre- and post-intervention stress scores to see if the VR experience results in a statistically significant reduction in perceived stress.

Participants will:

• Complete a brief pre-intervention stress survey (e.g., using a validated scale such as the State-Trait Anxiety Inventory).
• Explore several calming VR environments (e.g., tropical beaches, islands, deep ocean, space, savanna, and tourist destinations).
• Choose one preferred scene based on personal relaxation preference.
• Engage in a 10-minute immersive VR relaxation session.
• Complete a post-intervention stress survey to assess any changes.

Study Overview

• Status: Completed
• Conditions: Virtual Reality; Anxiety and Fear; Stress (Psychology); Relaxation Therapy; Education Nursing; Student Nursing
• Intervention / Treatment: Device: Self-Selected Virtual Reality Relaxation Session

Detailed Description

High-stakes clinical assessments, such as final practical examinations, represent a critical component of nursing education but are frequently associated with elevated stress levels among students. Excessive stress during such assessments has been linked to impaired cognitive processing, reduced psychomotor performance, and diminished clinical decision-making, potentially affecting both educational outcomes and student well-being. Despite this, interventions aimed at mitigating acute pre-exam stress in authentic educational contexts remain limited.

Immersive virtual reality (VR) has emerged as a promising modality for emotional regulation due to its ability to create engaging, multisensory environments that facilitate attentional distraction and psychological detachment from stressors. Unlike traditional relaxation techniques, VR allows users to experience a heightened sense of presence, which may enhance emotional engagement and promote rapid stress reduction within short exposure periods. Prior studies in healthcare education and clinical populations suggest that even brief VR-based relaxation sessions can yield meaningful reductions in perceived stress and anxiety.

A key methodological consideration in stress-reduction interventions is individual variability in emotional response to relaxation stimuli. Allowing participants to self-select preferred virtual environments may enhance engagement, perceived control, and emotional resonance, thereby maximizing intervention effectiveness. This preference-based approach also reflects real-world feasibility and scalability in educational settings, where time and resources are often constrained.

The present study embeds a brief, self-selected VR relaxation intervention within a real examination context, immediately prior to a final practical assessment in a Critical Care Nursing course. By situating the intervention at a moment of peak stress, the study seeks to capture ecologically valid changes in perceived stress that are directly relevant to educational performance and student experience. In addition to evaluating stress reduction, the study examines feasibility and acceptability of VR as an adjunctive support strategy in nurse education, contributing to the growing body of methodological work addressing the complexity of demonstrating meaningful educational outcomes.

• Study Type: Interventional
• Enrollment (Actual): 50
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Saudi Arabia
  • Riyadh, Saudi Arabia, 61922
    • University of Bisha

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Undergraduate nursing students enrolled in the Critical Care Nursing course at the University of Bisha.
• Both male and female students aged 20 and above.
• Scheduled to take the final practical exam during the study period.
• Able and willing to provide informed consent.

Exclusion Criteria:

• History of severe motion sickness, vertigo, or epilepsy triggered by visual stimuli.
• Current diagnosis of severe psychiatric disorders (e.g., psychosis, major depressive disorder) that could interfere with participation.
• Visual, auditory, or cognitive impairments that prevent effective use of VR equipment.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: VR Relaxation Intervention for Exam Stress Reduction in Nursing Students; In this arm, participants will explore a range of immersive virtual environments-including beaches, islands, deep ocean, savanna, space, and popular tourist destinations-using a VR headset. After previewing the scenes, each participant will select the environment they find most relaxing and engage in a 10-minute guided VR session prior to their final practical exam in the Critical Care Nursing course. The intervention is designed to promote relaxation, reduce stress, and support emotional well-being immediately before high-stakes assessment.	Device: Self-Selected Virtual Reality Relaxation Session; This intervention is distinguished by allowing participants to preview and personally select from multiple immersive virtual environments tailored to promote relaxation, followed by a standardized 10-minute VR session conducted immediately before a high-stakes clinical exam, specifically targeting stress reduction in nursing students preparing for their final practical assessment in Critical Care Nursing.; Other Names: virtual reality
No Intervention: Control Group - No VR Intervention; Participants in this arm will not receive any virtual reality intervention prior to the final practical exam in the Critical Care Nursing course. They will follow the standard pre-exam routine without exposure to VR or other structured relaxation methods. Pre- and post-intervention surveys will still be administered to assess baseline and post-exam stress levels for comparison with the intervention group.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Perceived Stress	Perceived stress will be assessed using the Perceived Stress Scale-10 (PSS-10), a validated 10-item self-report questionnaire assessing the degree to which situations in one's life are appraised as stressful. Total scores range from 0 to 40, with higher scores indicating greater perceived stress. The outcome will be evaluated immediately before and immediately after the 10-minute virtual reality relaxation session on the day of the final practical exam.	Immediately before and immediately after the 10-minute VR session on the day of the final practical exam.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Test Anxiety Measured by the Test Anxiety Inventory (TAI)	Test anxiety will be measured using the Test Anxiety Inventory (TAI), a standardized self-report questionnaire assessing anxiety related to examinations. Scores range from 20 to 80, with higher scores indicating greater test anxiety. Measurement will occur immediately before and after the 10-minute VR relaxation session.	Immediately before and immediately after the VR session on the day of the final practical exam.
Participant Satisfaction with the VR Relaxation Intervention Measured by a Structured Questionnaire	Participant satisfaction with the VR relaxation intervention will be assessed using a brief structured self-administered questionnaire, evaluating comfort, enjoyment, immersion, and perceived usefulness. Each item is rated on a 5-point Likert scale ranging from 1 (very dissatisfied) to 5 (very satisfied), with higher scores indicating greater satisfaction.	Immediately after completion of the VR session.

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
VR Tolerability Assessed by the Virtual Reality Sickness Questionnaire (VRSQ)	Tolerability of the VR intervention will be assessed using the Virtual Reality Sickness Questionnaire (VRSQ), a validated tool measuring symptoms such as nausea, dizziness, and discomfort during VR exposure. Higher scores indicate greater cybersickness.	Immediately after completion of the VR session.

Collaborators and Investigators

• Sponsor: University of Bisha

Study record dates

Study Major Dates

• Study Start (Actual): July 25, 2025
• Primary Completion (Actual): September 15, 2025
• Study Completion (Actual): January 15, 2026

Study Registration Dates

• First Submitted: July 31, 2025
• First Submitted That Met QC Criteria: May 3, 2026
• First Posted (Actual): May 7, 2026

Study Record Updates

• Last Update Posted (Actual): May 7, 2026
• Last Update Submitted That Met QC Criteria: May 3, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Virtual Reality; Stress Reduction; Nursing Education; Nursing Students; Exam Anxiety; Technology in Education
• Additional Relevant MeSH Terms: Mental Disorders; Anxiety Disorders
• Other Study ID Numbers: UBisha

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Due to the sensitive nature of the data collected, including personal stress and psychological measures from nursing students, maintaining participant confidentiality and privacy is a priority. Additionally, data sharing may be restricted by institutional policies and ethical approvals that limit dissemination of individual-level information. Therefore, IPD will not be shared beyond the research team to ensure compliance with these protections.

Drug and device information, study documents

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