The goal of this clinical trial is to evaluate whether a brief virtual reality (VR) relaxation session can reduce pre-exam stress levels among undergraduate nursing students enrolled in nursing courses.

The participant population includes male and female nursing students, aged 20-26 years, who are preparing to take their final practical exam.

The main questions it aims to answer are:

1. Does a 10-minute, self-selected VR relaxation session significantly reduce stress levels immediately before a high-stakes clinical exam?
2. Are certain types of virtual environments (e.g., beach, island, space, ocean) more effective than others in promoting relaxation?

Researchers will compare pre- and post-intervention stress scores to see if the VR experience results in a statistically significant reduction in perceived stress.

Participants will:

• Complete a brief pre-intervention stress survey (e.g., using a validated scale such as the State-Trait Anxiety Inventory).
• Explore several calming VR environments (e.g., tropical beaches, islands, deep ocean, space, savanna, and tourist destinations).
• Choose one preferred scene based on personal relaxation preference.
• Engage in a 10-minute immersive VR relaxation session.
• Complete a post-intervention stress survey to assess any changes.

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.

Inclusion Criteria:

• Undergraduate nursing students enrolled in the Critical Care Nursing course at the University of Bisha.
• Both male and female students aged 20 and above.
• Scheduled to take the final practical exam during the study period.
• Able and willing to provide informed consent.

Exclusion Criteria:

• History of severe motion sickness, vertigo, or epilepsy triggered by visual stimuli.
• Current diagnosis of severe psychiatric disorders (e.g., psychosis, major depressive disorder) that could interfere with participation.
• Visual, auditory, or cognitive impairments that prevent effective use of VR equipment.

Due to the sensitive nature of the data collected, including personal stress and psychological measures from nursing students, maintaining participant confidentiality and privacy is a priority. Additionally, data sharing may be restricted by institutional policies and ethical approvals that limit dissemination of individual-level information. Therefore, IPD will not be shared beyond the research team to ensure compliance with these protections.

the study employed a single-blind design in which the research assistants responsible for administering pre- and post-intervention questionnaires and data entry were blinded to group allocation. In addition, all datasets were coded prior to analysis, and the data analyst was blinded to group assignment.