StressNCT07349563
Effects of Nature-Based Virtual Reality and 2D Nature Videos on OSCE Exam Stress in Nursing Students
A study testing Nature-Based Virtual Reality and 2D Nature Video in people with Stress and Virtual Reality, run by Acibadem University at 1 site in Turkey (Türkiye).
Trial 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. Read more about this study
- Who is it for?
- Ages 18 to 25 yearsHealthy volunteers can take part
- Conditions the study is for
- Stress, Virtual Reality, Students
- What is being tested?
- Nature-Based Virtual Reality and 2D Nature Video
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 60 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 2 Dec 2025to 2 Jan 2026
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 25 years
- All sexes
- Healthy volunteers accepted
- Adult
Who may be able to join
- 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.
Who cannot join
- 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 locations and contacts
1 site in 1 country.
About this study
Official title: Effect of Nature-Based Virtual Reality and Two-Dimensional Nature Videos on OSCE-Related Exam Stress in Nursing Students: A Randomized Controlled Trial
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.
- Conditions
- Stress, Virtual Reality, Students, Nursing
- Being tested
- Nature-Based Virtual Reality, 2D Nature Video
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
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.
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.
| Study group | Role | What they receive |
|---|---|---|
| Nature-Based Virtual Reality | Experimental | Participants receive a brief nature-based virtual reality relaxation session prior to the OSCE examination. Receives: Other: Nature-Based Virtual Reality |
| 2D Nature Video | Experimental | Participants watch a two-dimensional nature video for relaxation prior to the OSCE examination. Receives: Other: 2D Nature Video |
What is being measured
The primary outcome is the main question the study is designed to answer.
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.
Measured: 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).
Measured: 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.
Measured: Baseline (pre-intervention) and immediately after the intervention (post-intervention).
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted20 Jan 2026
- Study start2 Dec 2025
- Primary completion2 Jan 2026
- Study completion2 Jan 2026
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (11)Papers the sponsor has linked to this study.
- Other trials for StressStudies of the same condition, open and under way.
- More trials run by Acibadem UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 60 participants (actual)
Sponsor and investigators
- Lead sponsor
- Acibadem University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Güzin Ünlü Suvari, Acibadem University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07349563
- Sponsor's protocol ID
- 2025-15/572
- Status last verified
- Jan 2026
- First submitted
- 13 Jan 2026
- Last updated
- 20 Jan 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: 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.
Publications
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).
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.
PubMed 29034226Namvari 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.
PubMed 36579537Liu, 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.
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.
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.
PubMed 37145841Riches 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.
PubMed 34120220Mazgelyte 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.
PubMed 34946455Nafee, 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.
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.
PubMed 26334339Xu 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.
PubMed 38551625
Study at a glance
From the registry record, last updated by the sponsor on 20 Jan 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effect of Nature-Based Virtual Reality and Two-Dimensional Nature Videos on OSCE-Related Exam Stress in Nursing Students: A Randomized Controlled Trial
- ClinicalTrials.gov ID
- NCT07349563
- Acronym / sponsor ID
- 2025-15/572
- Conditions
- Stress, Virtual Reality, Students, Nursing
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 60 participants (actual)
- Lead sponsor
- Acibadem UniversityUniversity, hospital or other
- Study start
- 2 Dec 2025 (actual)
- Primary completion
- 2 Jan 2026 (actual)
- Study completion
- 2 Jan 2026 (actual)
- First posted
- 20 Jan 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Study design
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (participant)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Nature-Based Virtual Reality | Experimental | Other: Nature-Based Virtual RealityParticipants receive a brief nature-based virtual reality relaxation session prior to the OSCE examination. |
| 2D Nature Video | Experimental | Other: 2D Nature VideoParticipants watch a two-dimensional nature video for relaxation prior to the OSCE examination. |
Who may qualify
- Ages
- 18 to 25 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult
Key inclusion criteria (5 listed)
- 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.
Key exclusion criteria (6 listed)
- 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.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Nature-Based Virtual RealityParticipants 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. | Other | Nature-Based Virtual Reality |
| 2D Nature VideoParticipants 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. | Other | 2D Nature Video |
Primary outcome
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.
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).
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.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 20 Jan 2026.
- BackgroundCamara, 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: PubMed 29034226Shaffer 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.
- Background: PubMed 36579537Namvari 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.
- BackgroundLiu, 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.
- BackgroundPuleo, 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: PubMed 37145841Lundin 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.
- Background: PubMed 34120220Riches 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.
- Background: PubMed 34946455Mazgelyte 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.
- BackgroundNafee, 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: PubMed 26334339Ratanasiripong 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.
- Background: PubMed 38551625Xu 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.
- Individual participant dataSharing planned: No. 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.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Nature-Based Virtual Reality and 2D Nature Video in people with Stress and Virtual Reality, run by Acibadem University at 1 site in Turkey (Türkiye).
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 20 Jan 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
State Anxiety (STAI-State Score) (time frame: Baseline (pre-intervention, before OSCE) and immediately after the OSCE examination (post-OSCE).). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07349563, which also lists 11 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 Jan 2026.