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Completed

NCT Number: NCT07349563

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

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.

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Key information

Conditions

Stress Nursing Students Virtual Reality

Age range

18 year–25 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Acıbadem University

Istanbul, Ataşehir, Turkey (Türkiye)

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

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.

Treatment and study plan

Nature-Based Virtual Reality

Other

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.

2D Nature Video

Other

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.

Primary outcomes

  1. State Anxiety (STAI-State Score)

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

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

  2. Subjective Distress (SUD Score)

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

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

  3. Physiological Stress Response (LF/HF Ratio)

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

    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.

Sponsors and collaborators

Lead sponsor

Acibadem University

Other

Registry information

Official study title

Effect of Nature-Based Virtual Reality and Two-Dimensional Nature Videos on OSCE-Related Exam Stress in Nursing Students: A Randomized Controlled Trial

Important dates

Study start
2025
Primary completion
2026
Study completion
2026
First posted
Jan 20, 2026
Registry last updated
Jan 20, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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