NCT07349563

Brief Summary

Objective Structured Clinical Examinations (OSCEs) are widely used in nursing education to assess clinical skills but are known to induce significant psychological and physiological stress due to performance anxiety, time pressure, and observation. Exam-related stress has been associated with changes in heart rate variability (HRV), particularly increased low-frequency/high-frequency (LF/HF) ratios, reflecting heightened sympathetic activity. Such stress may negatively affect cognitive performance, clinical competence, and professional readiness. Nature-based virtual reality (VR) has emerged as a promising intervention for stress reduction by providing immersive, calming environments that promote relaxation and autonomic regulation. Previous studies suggest that short VR-based nature sessions can effectively reduce anxiety and may be more effective than two-dimensional (2D) nature videos, which represent a more accessible but less immersive alternative. However, evidence regarding the use of VR and 2D nature videos for managing stress during high-stakes clinical examinations such as OSCEs is limited. This randomized controlled study aims to compare the effectiveness of nature-based VR and 2D nature videos in reducing OSCE-related stress among third-year nursing students using physiological (PPG-derived LF/HF ratio) and subjective (STAI and SUD) outcome measures.

Trial Health

87
On Track

Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Enrollment
60

participants targeted

Target at P25-P50 for not_applicable

Timeline
Completed

Started Dec 2025

Shorter than P25 for not_applicable

Geographic Reach
1 country

1 active site

Status
completed

Health score is calculated from publicly available data and should be used for screening purposes only.

Trial Relationships

Click on a node to explore related trials.

Study Timeline

Key milestones and dates

Study Start

First participant enrolled

December 2, 2025

Completed
1 month until next milestone

Primary Completion

Last participant's last visit for primary outcome

January 2, 2026

Completed
Same day until next milestone

Study Completion

Last participant's last visit for all outcomes

January 2, 2026

Completed
11 days until next milestone

First Submitted

Initial submission to the registry

January 13, 2026

Completed
7 days until next milestone

First Posted

Study publicly available on registry

January 20, 2026

Completed
Last Updated

January 20, 2026

Status Verified

January 1, 2026

Enrollment Period

1 month

First QC Date

January 13, 2026

Last Update Submit

January 13, 2026

Conditions

StressVirtual RealityStudentsNursing

Outcome Measures

Primary Outcomes (3)

  • State Anxiety (STAI-State Score)

    Change in state anxiety levels measured using the State-Trait Anxiety Inventory (STAI-State) to evaluate OSCE-related anxiety in nursing students.

    Baseline (pre-intervention, before OSCE) and immediately after the OSCE examination (post-OSCE).

  • Subjective Distress (SUD Score)

    Change in subjective stress levels assessed using the Subjective Units of Distress Scale (SUD).

    Baseline (pre-intervention), immediately after the intervention (post-intervention), and immediately after the OSCE examination (post-OSCE).

  • Physiological Stress Response (LF/HF Ratio)

    Change in physiological stress response assessed by heart rate variability (HRV), expressed as the low-frequency/high-frequency (LF/HF) ratio derived from photoplethysmography (PPG) recordings.

    Baseline (pre-intervention) and immediately after the intervention (post-intervention).

Study Arms (2)

Nature-Based Virtual Reality

EXPERIMENTAL

Participants receive a brief nature-based virtual reality relaxation session prior to the OSCE examination.

Other: Nature-Based Virtual Reality

2D Nature Video

EXPERIMENTAL

Participants watch a two-dimensional nature video for relaxation prior to the OSCE examination.

Other: 2D Nature Video

Interventions

Nature-Based Virtual RealityOTHER

Participants in the intervention group will receive a short nature-based virtual reality relaxation session prior to the OSCE examination. The VR content consists of calming natural environments with gentle visual transitions and ambient sounds designed to promote relaxation and reduce stress. The session is delivered using a head-mounted display and lasts approximately 5-10 minutes.

Nature-Based Virtual Reality
2D Nature VideoOTHER

Participants in the control group will watch a two-dimensional nature video prior to the OSCE examination. The video presents relaxing natural scenes accompanied by ambient sounds and is displayed on a standard screen for approximately 5-10 minutes as a non-immersive relaxation intervention.

2D Nature Video

Eligibility Criteria

Age18 Years - 25 Years
Sexall
Healthy VolunteersYes
Age GroupsAdult (18-64)

You may qualify if:

  • Undergraduate third-year nursing students scheduled to take the final OSCE examination.
  • Aged between 18 and 25 years.
  • Considered healthy, with no known cardiovascular disease or chronic stress-related disorders.
  • Willing to participate in the virtual reality or 2D nature video intervention.
  • Able to understand the study procedures and provide written informed consent.

You may not qualify if:

  • Known sensitivity or intolerance to virtual reality, including symptoms such as dizziness, nausea, headache, or visual discomfort.
  • Medical conditions that may affect photoplethysmography (PPG) measurements, such as cardiac arrhythmias or significant skin sensitivity at the measurement site.
  • Use of medications that may influence heart rate variability, including beta-blockers.
  • Inability to allocate sufficient time to participate in the pre-examination stress management intervention.
  • Pregnancy, acute illness, or current use of psychiatric medications.
  • Refusal to participate or failure to provide informed consent.

Contact the study team to confirm eligibility.

Sponsors & Collaborators

Study Sites (1)

Acıbadem University

Istanbul, Ataşehir, Turkey (Türkiye)

Location

Related Publications (11)

  • Camara, D., & Hicks, R. E. (2019). Using virtual reality to reduce state anxiety and stress in University students: An experiment. Global Science and Technology Forum (GSTF) Journal of Psychology, 4(1).

    BACKGROUND

  • Shaffer F, Ginsberg JP. An Overview of Heart Rate Variability Metrics and Norms. Front Public Health. 2017 Sep 28;5:258. doi: 10.3389/fpubh.2017.00258. eCollection 2017.

    PMID: 29034226BACKGROUND

  • Namvari M, Lipoth J, Knight S, Jamali AA, Hedayati M, Spiteri RJ, Syed-Abdul S. Photoplethysmography Enabled Wearable Devices and Stress Detection: A Scoping Review. J Pers Med. 2022 Oct 31;12(11):1792. doi: 10.3390/jpm12111792.

    PMID: 36579537BACKGROUND

  • Liu, K. Y., Ponnapalli, P., & Dwivedi, A. K. (2025). Design of a Low-Cost Wearable System for Long-Term Continuous Heart Rate Monitoring. In Advances in Intelligent Systems (pp. 299-311). Apple Academic Press.

    BACKGROUND

  • Puleo, S., Diana, G., Pasta, S., Scardulla, F., & D'Acquisto, L. (2024, September). Sensor-based bioprosthetic valve monitoring: Numerical simulation and experimental design. In International Conference of the Italian Association of Design Methods and Tools for Industrial Engineering (pp. 44-51). Cham: Springer Nature Switzerland.

    BACKGROUND

  • Lundin RM, Yeap Y, Menkes DB. Adverse Effects of Virtual and Augmented Reality Interventions in Psychiatry: Systematic Review. JMIR Ment Health. 2023 May 5;10:e43240. doi: 10.2196/43240.

    PMID: 37145841BACKGROUND

  • Riches S, Azevedo L, Bird L, Pisani S, Valmaggia L. Virtual reality relaxation for the general population: a systematic review. Soc Psychiatry Psychiatr Epidemiol. 2021 Oct;56(10):1707-1727. doi: 10.1007/s00127-021-02110-z. Epub 2021 Jun 13.

    PMID: 34120220BACKGROUND

  • Mazgelyte E, Rekiene V, Dereskeviciute E, Petrenas T, Songailiene J, Utkus A, Chomentauskas G, Karciauskaite D. Effects of Virtual Reality-Based Relaxation Techniques on Psychological, Physiological, and Biochemical Stress Indicators. Healthcare (Basel). 2021 Dec 14;9(12):1729. doi: 10.3390/healthcare9121729.

    PMID: 34946455BACKGROUND

  • Nafee, H. M., Ahmed, A. E. S., & Hussien, A. M. (2019). Objective structured clinical examination versus traditional clinical examination among nursing students: A comparative approach. Journal of Nursing Education and Practice, 9(2), 42-52.

    BACKGROUND

  • Ratanasiripong P, Park JF, Ratanasiripong N, Kathalae D. Stress and Anxiety Management in Nursing Students: Biofeedback and Mindfulness Meditation. J Nurs Educ. 2015 Sep;54(9):520-4. doi: 10.3928/01484834-20150814-07.

    PMID: 26334339BACKGROUND

  • Xu J, Khanotia A, Juni S, Ku J, Sami H, Lin V, Walterson R, Payne E, Jo H, Rahimpoor-Marnani P. Effectiveness of Virtual Reality-Based Well-Being Interventions for Stress Reduction in Young Adults: Systematic Review. JMIR Ment Health. 2024 Mar 29;11:e52186. doi: 10.2196/52186.

    PMID: 38551625BACKGROUND

Study Design

Study Type
interventional
Phase
not applicable
Allocation
RANDOMIZED
Masking
SINGLE
Who Masked
PARTICIPANT
Purpose
OTHER
Intervention Model
PARALLEL
Sponsor Type
OTHER
Responsible Party
PRINCIPAL INVESTIGATOR
PI Title
Lecturer

Study Record Dates

First Submitted

January 13, 2026

First Posted

January 20, 2026

Study Start

December 2, 2025

Primary Completion

January 2, 2026

Study Completion

January 2, 2026

Last Updated

January 20, 2026

Record last verified: 2026-01

Data Sharing

IPD Sharing
Will not share

Individual participant data (IPD) will not be publicly shared due to privacy concerns and the sensitive nature of maternal and infant health information. However, anonymized data may be made available upon reasonable request to the corresponding author after publication of the study results.

Locations

TU(1)