INTRODUCTION:

Children are the heart of every family and the hope of every nation. They bring light, laughter, and a sense of wonder into the world with their boundless energy and pure, innocent joy. Their natural curiosity drives them to explore, ask questions, and learn with enthusiasm, making every day an adventure filled with discovery.

Pain and anxiety during paediatric procedures remain key concerns in nursing, and textbooks emphasize the need for effective comfort measures in children¹.

Evidence shows VR significantly decreases procedural pain and anxiety in children², and reviews further support its effectiveness as a distraction tool during paediatric procedures³. Additional studies confirm VR’s role in reducing pain during various clinical interventions⁴, and meta-analytic findings highlight its benefit in lowering pain and fear during needle-related procedures⁵. VR exposure before surgery has also been shown to reduce preoperative anxiety and pain in children⁶.

Children often experience pain, fear, and anxiety during medical and needle-related procedures, and distraction techniques have been shown to reduce this distress⁷. Virtual reality (VR) has came up as an effective, immersive method for managing such procedural discomfort. Proofs shows VR significantly reduces pain and distress during needle procedures⁸ and dental treatments in young children⁹. VR has also shows safety and benefit for both acute and chronic pain management ¹⁰, with active VR improving chronic primary pain¹¹.

Systematic reviews confirm VR’s efficacy in reducing pain, anxiety, and fear during paediatric needle-related procedures¹², and VR hypnosis performs comparably to standard care in managing procedural distress¹². Nursing literature supports the value of therapeutic interventions that minimize anxiety and support coping¹³. Additional reviews show VR exposure therapy benefits broader pain management settings¹⁴, while VR education helps decrease venipuncture-related pain and anxiety by improving procedural preparedness¹⁵.

STATEMENT OF THE PROBLEM:

A study to assess the effectiveness of virtual reality on pain and anxiety during intravenous injections among children at paediatric department of Little Lourdes Mission Hospital, Kidangoor

OBJECTIVES:

· To assess the effectiveness of virtual reality on Pain during intravenous injection among children at paediatric department of Little Lourdes Mission Hospital Kidangoor.

· To evaluate the impact of virtual reality on anxiety level during intravenous injection among children at paediatric department of Little Lourdes Mission Hospital Kidangoor.

OPERATIONAL DEFINITION:

· Effectiveness: In this study, it is defined as the degree to which virtual reality reduce perceived pain and anxiety in children during intravenous injection

· Virtual Reality: In this study, it is defined as the use of computer generated, immersive, three-dimensional environment delivered through head mounted display among children for 3-6 minutes during intravenous injection.

· Pain: In this study, it is defined as sensory and emotional feelings experienced by children during intravenous injection and is assessed using Wong Bakers pain scale.

· Anxiety: In this study it is defined as the state of heightened emotional distress experienced by the children during intravenous injection which is assessed using visual analogue anxiety scale.

· Intravenous injection: In this study, it is defined as administration of fluid or medication to the children through intravenous route and blood withdrawal.

· Children: In this study it refers to paediatric population between 3 to 6 years admitted in ward, casualty and out patient department of Little Lourdes Mission Hospital, Kidangoor.

· Paediatric department: In this study, it refers to the ward, laboratory and out patient unit that provide care and treatment to children between the age group of 3 to 6 years.

HYPOTHESIS:

· H₀₁: There is no relationship between virtual reality and pain during intravenous injection among children at paediatric department of Little Lourdes Mission Hospital, Kidangoor

· H₀₂: there is no relationship between virtual reality and anxiety during intravenous injection among children at paediatric department of little Lourdes Mission Hospital, kidangoor.

RESEARCH METHODOLOGY:

Quantitative research approach with experimental post test design was used for this study. The study was conducted in Little Lourdes Mission Hospital, Kidangoor, Kottayam. The sample size was 30 children among the age group 3-6 years who fulfilled the inclusion criteria. The samples were selected using systematic random sampling technique.

The tool used for the study was organised as two sections. Section-A consisted of Demographic Variables. Section-B consisted of Wong Baker Pain Scale Score to assess pain during intravenous injection. Section-C consisted of Visual Analog Anxiety Scale to assess anxiety during intravenous injection. The researchers obtained formal permission from the Director of Little Lourdes Mission Hospital Kidangoor. The samples were divided into experimental and control groups, after which informed consent were obtained. The experimental group received a virtual reality (VR) intervention for 3 to 5 minutes during the intravenous injection. Following the intervention, the researcher collected data from the experimental group using the Wong-Baker Faces Pain Scale and the Visual Analogue Anxiety Scale.

Research Design:

The research design of the present study is Experimental design.

Settings of the Study:

Setting of the study is Little Lourdes Mission Hospital, Kidangoor.

Population:

In the present study, population includes all children in Kerala

Sample:

In this study sample is the children of age group 3-6 years.

Sample size:

In this study sample consist of 30 children

Sampling Technique:

In present study, sampling technique initially used is purposive random sampling from which simple random sampling technique is done.

Criteria for sample selection:

Inclusion criteria:

Inclusion criteria are the key features of the target population that a researcher will used to answer their research.

In the present study, inclusion criteria is,

· Children who are undergoing intravenous treatment.

· Children who are medical stable.

Exclusion Criteria:

It is defined as a set of pre defined characteristics that enables the researcher to identify the

particular subject who cannot be included in the Research problem.

In present, study exclusion criteria is,

· Children with severe visual impairment.

· Children came for non - invasive procedure.

· Children who are critically ill or undergoing any surgical procedure in head or eye.

Method of Data Collection:

Tools of data collection

The tool used in the present study consist of

Sections A: Demographic data containing name, age, gender, education, level of education of parent, occupation of parent, reason for admission/ hospital visit.

Section B: Wong Baker pain scale is a visual scale that uses six cartoon faces to depict in increasing degree of pain ranging from no hurt to worst hurt.

Section C: Visual Analogue Anxiety Scale

Visual analog scale is used to measure the level of anxiety experienced

Procedure for Data Collection:

Formal written permission was obtained from the concerned authorities prior to the study. Samples were selected using inclusion criteria and then divided into experimental and control groups. Informed consent from parents and assent from children were obtained before data collection. The experimental group received a virtual reality intervention for 3–6 minutes during the intravenous injection. After the intervention, the researcher collected data from the experimental group using the Wong-Baker Faces Pain Scale and the Visual Analogue Anxiety Scale. Data were analyzed using descriptive and inferential statistics.

Analysis:

Demographic variables

Frequency and percentage distribution of demographic variables revealed that the highest proportion 33.3% being 6 years old, followed by 26.7% aged 3 years, 23.3% aged 4 years, and 16.7% aged 5 years, indicating that most participants were in the older age group. Gender distribution showed 53.3% male and 46.7% female, reflecting an almost equal representation of boys and girls. Regarding education, 53.3% of the children were schoolers, while 46.7% were preschoolers, indicating that a slightly higher number of children were attending school. Most parents 80% were degree holders, with smaller percentages having HSE 10%, diploma 6.7%, and UG 3.3% qualifications, showing that the majority of parents were well-educated. In terms of occupation, a large proportion of parents 93.3% were private employees, while 3.3% were daily wagers and another 3.3% were government employees, indicating that most families in the study belonged to a middle-income, working-class background. This demographic profile suggests that the study sample included older, school-going children from educated families with stable employment, which may contribute to better cooperation and awareness during the implementation of virtual reality for pain management in children.

The first objective was to assess the effectiveness of virtual reality on pain during intravenous injection among children at paediatric department of Little Lourdes Mission Hospital, Kidangoor.

Figure1: Percentage distribution of sample according to the age.

Figure 2: Percentage distribution of sample according the gender

Table 1 showed that there is a statistically significant difference in pain scores between the control and experimental groups. The experimental group (mean = 2.0) had much lower pain scores compared to the control group (mean = 8.13). Since the calculated t-value (10.25) is greater than the critical value (2.048) at df = 28, we reject the null hypothesis (H₀). This suggests that the treatment or intervention in the experimental group was effective in reducing pain.

The second objective was to evaluate the impact of virtual reality on anxiety level during intravenous injection among children at paediatric department of Little Lourdes Mission Hospital Kidangoor

Table 2: Comparison of virtual reality on anxiety during intravenous injection among children at paediatric department.

N=30

Group	Mean	S. D	T value	df	Decision
Control	8.67	1.23	12.26	28	Reject H₀₂
Experimental	1.87	1.92			Significant

*t value for df 28=2.048

Table 2 showed that there is a significant difference in pain scores between the control and experimental groups. The experimental group (mean = 1.87) reported much lower pain than the control group (mean = 8.67). The calculated t-value (12.26) is much higher than the critical value (2.048) at df = 28, so we reject the null hypothesis (H₀₂). This indicates that the intervention in the experimental group was highly effective in reducing pain.

The above study was supported by randomised controlled study was conducted by Gulum Ozalp Gerceker. It uses parallel trial design which is CONSORT design checklist. The sample of (n = 42) was allocated to VR group (n =21) and control group (n = 21). Wong Baker Faces Pain Rating Scale was used. The self-reported pain scale score of patient in the VR and control group were 2.4±1.8 and 6.3±1.8 Hence study proved that use if virtual reality in intravenous injection reduces pain.

CONCLUSION:

The aim of the study was to assess the effectiveness of virtual reality on pain and anxiety during intravenous injection among children of age 3-6 years. The following conclusions was drawn from the findings of the study

· Among 30 children, majority of sample were 6 years old (33.3%) and minority of sample were 5 years old (16.7%).

· Out of 30 children, 53.3% were male and 46.7% were female.

· In the study, 53.3% were schoolers and 46.7% preschooler.

· Majority of parents 80% were degree holders while a minority were SSLC and below with 0%.

· The majority of parents were employed in private employee (93.3%), while aminority were self employee with 0%.

· Experimental group has less pain (score 2.0) compared to control group (score 8.13).

· The t value for pain scale in both group shows 10.25.

· Experimental group has lower anxiety level (score1.87) compared to control group (score 8.67).

· The t value for anxiety scale in both group shows 12.26.

Virtual Reality (VR) has emerged as a promising, non-invasive tool in the field of pain management. By offering immersive distraction and engaging sensory environments, VR helps reduce the perception of pain in both acute and chronic conditions. Its application in clinical settings shows significant benefits, including decreased use of analgesics, improved patient satisfaction, and enhanced overall treatment experience. As technology continues to advance, integrating VR into standard pain management protocols holds great potential for improving patient outcomes and transforming traditional care approaches.

LIMITATION:

· The study is limited to children of 3-6 years

· The study is limited to small number of samples.

· Sample selection limited to only one hospital.

· Time was limited for shorter period

RECOMMENDATION:

· A similar study can be conducted in larger sample so that the finding can be generalised.

· The similar studies can be conducted in older children and adults.

· Study can be conducted to train nurses and health workers in implementing virtual reality in clinical setting.

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Received on 26.08.2025 Revised on 18.11.2025

Accepted on 01.01.2026 Published on 30.07.2026

Available online from August 05, 2026

Int. J. Nursing Education and Research. 2026;14(3):215-219.

DOI: 10.52711/2454-2660.2026.00043

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.

Group	Mean	S.D	T value	df	decision
Control	8.13	1.59	10.25	28	Reject H₀₁
Experimental	2.0	1.69			Significant