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This randomized controlled trial aims to evaluate the effects of two-tier virtual reality-based preoperative education on anxiety, learning knowledge, self-care ability, and cognitive load in patients undergoing urolithiasis surgery. Participants will be randomly assigned to routine education, standard virtual reality education, or two-tier virtual reality education groups. Outcomes will be assessed using anxiety scales, knowledge questionnaires, self-care ability measures, and cognitive load assessments before and after the intervention.
Preoperative anxiety is a common concern among patients undergoing urolithiasis surgery and may adversely affect perioperative experiences, treatment adherence, and postoperative recovery. Conventional preoperative education is often limited by time constraints, variability in information delivery, and insufficient patient engagement.
Virtual reality (VR)-based education has emerged as an innovative educational approach that provides immersive and interactive learning experiences. Previous studies have suggested that VR may improve patient understanding of surgical procedures and reduce anxiety by familiarizing patients with the perioperative environment. However, most existing VR education programs provide information passively and may not adequately identify or correct patient misconceptions.
The present study introduces a two-tier virtual reality educational approach that integrates immersive VR scenarios with structured knowledge assessment and feedback mechanisms. By encouraging participants to actively process information and receive immediate clarification of misunderstandings, the intervention is expected to enhance learning effectiveness and support patient self-management.
This randomized controlled trial aims to examine whether a two-tier VR educational strategy can provide additional benefits beyond standard VR education and routine preoperative instruction for patients undergoing urolithiasis surgery. Findings from this study may contribute to the development of more effective patient-centered educational interventions and provide evidence for the integration of advanced VR technologies into perioperative nursing practice.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Routine Patient Education | No Intervention | Participants receive routine preoperative education provided by clinical nursing staff before urolithiasis surgery. | |
| VR Education | Experimental | Participants receive standard virtual reality-based preoperative education before urolithiasis surgery. |
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| Two-Tier VR Education | Experimental | Participants receive two-tier virtual reality-based preoperative education with integrated interactive questioning and feedback before urolithiasis surgery. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| VR Education | Behavioral | Participants receive standard virtual reality-based preoperative education before urolithiasis surgery. The VR program includes immersive 360-degree educational content covering the preoperative process, operating room environment, postoperative care, and self-care instructions. |
| Measure | Description | Time Frame |
|---|---|---|
| Anxiety Score Measured by the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and Hospital Anxiety and Depression Scale-Anxiety Subscale (HADS-A) | Anxiety will be assessed using the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and the Anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A). The APAIS consists of 6 items scored on a 5-point Likert scale. Total scores range from 6 to 30, with higher scores indicating greater preoperative anxiety and information needs. The HADS-A consists of 7 items scored from 0 to 3. Total scores range from 0 to 21, with higher scores indicating greater anxiety. | Baseline before intervention, 2 hours after intervention, and postoperative day 1 |
| Measure | Description | Time Frame |
|---|---|---|
| Urolithiasis Surgery Knowledge Questionnaire Score | Knowledge regarding perioperative care for urolithiasis surgery will be assessed using a researcher-developed Urolithiasis Surgery Knowledge Questionnaire. The baseline questionnaire consists of 10 multiple-choice items and the post-intervention questionnaire consists of 20 multiple-choice items covering surgical preparation, operating room orientation, perioperative care, urinary catheter care, Double-J stent management, dietary management, hydration, complication recognition, and prevention of stone recurrence. Scores range from 0 to 10 at baseline and from 0 to 20 after intervention. Higher scores indicate better understanding of urolithiasis surgery and postoperative self-care |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| wellin Huang, RN, MSN Student | Contact | +886 953713535 | hwl0111@gmail.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Keelung Chang Gung Memorial Hospital | Keelung | 204 | Taiwan |
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| ID | Term |
|---|---|
| D052878 | Urolithiasis |
| D007669 | Kidney Calculi |
| D001008 | Anxiety Disorders |
| ID | Term |
|---|---|
| D014570 | Urologic Diseases |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
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Participants will be randomly assigned to one of three parallel groups: routine education, standard virtual reality education, or two-tier virtual reality education. Outcomes will be compared across groups before and after the intervention.
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| Two-Tier VR Education | Behavioral | Participants receive two-tier virtual reality-based preoperative education before urolithiasis surgery. The intervention combines immersive 360-degree VR educational content with a two-tier testing mechanism designed to enhance learning comprehension, self-care knowledge, and cognitive engagement. |
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| Baseline before intervention and 2 hours after intervention |
| Postoperative Self-Care Ability Score Measured by the Urolithiasis Self-Care Ability Scale | Postoperative self-care ability will be assessed using the Urolithiasis Postoperative Self-Care Ability Scale developed by Hu et al. (2024). The scale consists of 30 items across five domains, including disease management, diet and fluid intake, psychosocial management, activity and elimination, and disease-related information. Each item is rated on a 5-point Likert scale. Total scores range from 30 to 150. Higher scores indicate better postoperative self-care ability. | Postoperative day 1 |
| Cognitive Load Score Measured by the Cognitive Load Questionnaire | Cognitive load will be assessed using the Cognitive Load Questionnaire developed by Klepsch et al. (2017). The questionnaire contains 8 items assessing intrinsic cognitive load, extraneous cognitive load, and germane cognitive load. Each item is rated on a 5-point Likert scale. Total scores range from 8 to 40. Higher scores indicate greater perceived cognitive load during learning. | 2 hours after intervention |
| D052801 | Male Urogenital Diseases |
| D053040 | Nephrolithiasis |
| D007674 | Kidney Diseases |
| D014545 | Urinary Calculi |
| D002137 | Calculi |
| D020763 | Pathological Conditions, Anatomical |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D001523 | Mental Disorders |