Author ORCID Identifier
0009-0009-4983-0383
Defense Date
2025
Document Type
Dissertation
Degree Name
Doctor of Philosophy
Department
Pharmaceutical Sciences
First Advisor
Dayanjan Wijesinghe
Abstract
Abstract
EXPLORING VIRTUAL REALITY IN PREOPERATIVE CLINICAL CARE: IMPACTS ON PATIENT ANXIETY, PARENTAL ANXIETY, AND NURSE SATISFACTION
By Walaa Abu Rukbah, Ph.D.
A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University.
Virginia Commonwealth University, 2025
Major Director: Dayanjan S Wijesinghe, Ph.D.
Associate Professor, Department of Pharmacotherapy and Outcomes Sciences
Director, Laboratory of Pharmacometabolomic and Companion Diagnostics
Introduction: Preoperative anxiety affects up to 65% of pediatric surgical patients, leading to increased stress responses, difficult anesthesia induction, and adverse postoperative outcomes. While pharmacological premedication remains standard practice, non-pharmacological alternatives like virtual reality (VR) show promise for anxiety reduction. This study evaluated the effectiveness and implementation feasibility of a custom-designed VR intervention for managing preoperative anxiety in pediatric patients, while assessing impacts on parental anxiety and healthcare provider satisfaction.
Methods: A retrospective analysis was conducted using data from a nine-month quality improvement initiative (October 2023-June 2024) at VCU Children's Hospital. Eighty pediatric patients (ages 6-15 years) undergoing elective surgery received a custom VR intervention during preoperative waiting. Primary outcomes included changes in patient-reported distress (0-10 numerical rating scale) and fear (Children's Fear Scale 0-4) measured pre- and post-VR intervention. Secondary outcomes included physiological measures (heart rate, systolic blood pressure), parental anxiety (STAI-6), and stakeholder satisfaction ratings from patients, parents (n=65), and nurses (n=29). Logistic regression models identified predictors of clinically significant anxiety reduction (≥30% and ≥50% thresholds). Thematic analysis examined qualitative parent feedback to understand intervention mechanisms and stakeholder perspectives.
Results: VR intervention demonstrated significant reductions in both patient distress (median change: -2.0 points, 95% CI [-2.00, -1.00], p< 0.001) and fear (median change: -1.0 point, 95% CI [-1.00, 0.00], p< 0.001). A majority of patients achieved a clinically significant reduction (≥30%) in both distress (66.2%) and fear (52.5%). Physiological measures showed significant decreases in heart rate (-5.8 bpm, p<0.001) and systolic blood pressure (-4.1 mmHg, p< 0.0001). Baseline anxiety severity emerged as the strongest predictor of clinical response, with higher initial fear scores associated with increased odds of achieving ≥50% reduction (OR=1.80, 95% CI [1.11, 2.92], p<0.017). Stakeholder satisfaction was exceptionally high: 95.4% of parents would recommend VR to other families, 91.2% of children expressed willingness to use VR again, and 100% of nurses recommended VR for pediatric procedures. Parental anxiety significantly decreased following their child's VR intervention (P<0.0015), with 53.8% of parents experiencing improved anxiety levels. Qualitative analysis revealed predominant themes of engagement/distraction (52.4% of responses), emotional impact (34.9%), and clinical utility recognition (31.7%). Implementation was feasible with minimal workflow disruption (6.9% of nurses reported interference).
Conclusion: Custom-designed VR interventions can be successfully integrated into pediatric preoperative care with significant clinical benefits and stakeholder acceptance. The intervention achieved meaningful anxiety reduction across multiple measures while demonstrating implementation feasibility in a busy clinical environment. Children with higher baseline anxiety levels experienced the greatest benefits, providing data-informed recommendations for targeted implementation strategies. The consistent of positive outcomes across patients, families, and healthcare providers, combined with minimal adverse effects (3.8%), supports VR integration as a valuable non-pharmacological approach to pediatric preoperative anxiety management. These findings add to the growing support for digital therapeutics in pediatric care and provide real-world guidance for healthcare systems considering VR implementation.
Keywords: Virtual reality, pediatric anxiety, preoperative care, implementation science, non-pharmacological intervention, digital therapeutics
Rights
© Walaa S. Abu Rukbah 2011 All Rights Reserved
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
11-10-2025