Effects of Nature-Based Virtual Reality and 2D Nature Videos on OSCE Exam Stress in Nursing Students

Acibadem University

Status: Completed

Conditions: Students; Nursing; Virtual Reality; Stress

Treatments: Other: 2D Nature Video; Other: Nature-Based Virtual Reality

Study type: Interventional

Funder types: Other

Identifiers

NCT07349563

2025-15/572

Details and patient eligibility

About

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.

Enrollment: 60 patients

Sex: All

Ages: 18 to 25 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• 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.

Exclusion criteria

• 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.

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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60 participants in 2 patient groups

Nature-Based Virtual Reality

Experimental group

Description:

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

Treatment:

Other: Nature-Based Virtual Reality

2D Nature Video

Experimental group

Description:

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

Treatment:

Other: 2D Nature Video