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

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.