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The Effect of Virtual Reality-Based (VR) Training on Knowledge and Clinical Performance of Cardiopulmonary Resuscitation among Nursing Students: A Randomized Controlled Trial

Protocol summary

Study aim
To determine the effect of virtual reality based training on knowledge and clinical performance of cardiopulmonary resuscitation (CPR) among nursing students
Design
Two arm parallel-group randomized controlled trial on 38 sixth-semester nursing students (census sampling), 1:1 allocation, block randomization (block sizes 4 and 6) using Sealed Envelope Ltd.
Settings and conduct
This study will be conducted at the Clinical Skills Center of Shahid Beheshti Nursing and Midwifery School, Rasht. Participants will be randomly allocated to traditional and virtual reality training groups. Pre-test assesses knowledge (questionnaire) and performance (checklist on manikin). Four weeks post-intervention, post-test will be administered by the researcher using the same instruments.
Participants/Inclusion and exclusion criteria
Sixth-semester students who provide informed consent to participate in the study, No previous participation in virtual reality-based CPR training before the study; Students who have previously taken this course with an incomplete grade
Intervention groups
In the control group, traditional CPR training based on 2025 American Heart Association guidelines, including PowerPoint lectures and hands-on manikin practice over two 2-hour sessions and 90-minute supervised practice session. In the intervention group, VR-based training using headset, motion sensors, manikin, and four simulated environments (street, classroom, mall, mosque) with cardiac arrest scenarios (smoking, electrocution, unknown cause) and environmental stressors. Each student will use the system for 12 minutes per session and will participate twice in the intervention, resulting in a total intervention time of 8 hours across four 2-hour sessions.
Main outcome variables
Knowledge of CPR Clinical performance of CPR

General information

Reason for update
Acronym
IRCT registration information
IRCT registration number: IRCT20260602069618N1
Registration date: 2026-06-14, 1405/03/24
Registration timing: prospective

Last update: 2026-06-14, 1405/03/24
Update count: 0
Registration date
2026-06-14, 1405/03/24
Registrant information
Name
Saba Jahani
Name of organization / entity
Country
Iran (Islamic Republic of)
Phone
+98 11 3525 1319
Email address
sabajahani70@gmail.com
Recruitment status
Recruitment complete
Funding source
Expected recruitment start date
2026-06-23, 1405/04/02
Expected recruitment end date
2026-06-29, 1405/04/08
Actual recruitment start date
empty
Actual recruitment end date
empty
Trial completion date
empty
Scientific title
The Effect of Virtual Reality-Based (VR) Training on Knowledge and Clinical Performance of Cardiopulmonary Resuscitation among Nursing Students: A Randomized Controlled Trial
Public title
Effect of Virtual Reality-Based (VR) Training on Knowledge and Clinical Performance of Cardiopulmonary Resuscitation
Purpose
Education/Guidance
Inclusion/Exclusion criteria
Inclusion criteria:
Sixth-semester students who provide informed consent to participate in the study. No previous participation in virtual reality-based cardiopulmonary resuscitation (CPR) training before the study.
Exclusion criteria:
Students who have previously taken this course with an incomplete grade.
Age
No age limit
Gender
Both
Phase
N/A
Groups that have been masked
No information
Sample size
Target sample size: 38
Randomization (investigator's opinion)
Randomized
Randomization description
All eligible nursing students will be allocated equally (1:1 ratio) to the traditional and virtual reality-based training groups using block randomization with block sizes of 4 and 6. The randomization sequence will be generated using the online randomization service Sealed Envelope Ltd. The students will be unaware of their group allocation.
Blinding (investigator's opinion)
Not blinded
Blinding description
Placebo
Not used
Assignment
Parallel
Other design features
A Randomized Controlled Trial

Secondary Ids

empty

Ethics committees

1

Ethics committee
Name of ethics committee
Ethics committee of Gilan University of Medical Sciences
Street address
Shahid Beheshti School of Nursing and Midwifery, Daneshjoo St., Shahid Beheshti Blvd.
City
Rasht
Province
Guilan
Postal code
41469-39814
Approval date
2026-05-13, 1405/02/23
Ethics committee reference number
IR.GUMS.REC.1405.071

Health conditions studied

1

Description of health condition studied
Knowledge and clinical performance of cardiopulmonary resuscitation among nursing students
ICD-10 code
ICD-10 code description

Primary outcomes

1

Description
knowledge score of cardiopulmonary resuscitation
Timepoint
before the intervention and 4 weeks after the intervention
Method of measurement
G. Spinelli's cardiopulmonary resuscitation knowledge questionnaire.

2

Description
Clinical performance score of cardiopulmonary resuscitation
Timepoint
before the intervention and 4 weeks after the intervention
Method of measurement
Observational checklist for cardiopulmonary resuscitation performance

Secondary outcomes

empty

Intervention groups

1

Description
Control group: Cardiopulmonary resuscitation (CPR) training based on the 2025 American Heart Association guidelines will be delivered using the traditional method, including lectures with PowerPoint presentations and hands-on demonstrations on a manikin. The training will be conducted over two 2-hour sessions, followed by one 90-minute supervised practical practice session in which students perform CPR procedures on a manikin under instructor supervision.
Category
Other

2

Description
Intervention group: Cardiopulmonary resuscitation (CPR) training will be delivered using virtual reality (VR) technology. The educational program provides an interactive and intelligent simulation of the key steps of CPR, including scene safety assessment, evaluation of the patient's level of consciousness, activation of emergency medical services, assessment of pulse and breathing, identification of the correct chest compression site, evaluation of compression rate, depth (shallow, adequate, or excessive), rhythm, and chest recoil, airway opening using the Head Tilt–Chin Lift maneuver, performance of five cycles of 30:2 compressions-to-ventilations, and training in the use of an automated external defibrillator (AED).Participants will use equipment developed by Aras Mixed Reality, a knowledge-based company, including a virtual reality headset, VR-compatible computers, motion-tracking sensors, a CPR training manikin, and microcontroller-based processing units. The system consists of two components: training and assessment. For the assessment phase, four different simulated environments (street, classroom, shopping mall, and mosque) have been designed to enable participants to practice and evaluate their skills under a variety of environmental and psychological conditions, including situational stress. In each environment, a distinct cardiac arrest scenario is presented. For example, one scenario involves cardiac arrest following cigarette smoking, another following electrocution, and a third with no apparent cause. Participants are required to perform CPR according to the 2025 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. This VR simulator incorporates several advanced technologies, including alignment of the physical manikin with its virtual counterpart through augmented reality technology, detection of hand, finger, and pulse assessment movements using image-processing techniques, and the ability to palpate the chest, assess pulse, and perceive breathing through mixed reality technology. During chest compressions, the extent of chest depression is visually displayed, allowing participants to practice achieving the recommended compression depth of 5–6 cm accurately. In addition, environmental stressors are simulated through virtual characters exhibiting behaviors such as shouting, crying, and creating panic, thereby enabling participants to develop the skills necessary to perform CPR effectively in realistic and stressful situations. Each participant will use the VR system for a total of 12 minutes per session, including both training and assessment. Based on the sample size, completion of one full training round requires approximately 4 hours. Each participant will undergo the training process twice; therefore, the total intervention time for the intervention group will be approximately 8 hours. The intervention will be implemented in four sessions, each lasting 2 hours.
Category
Other

Recruitment centers

1

Recruitment center
Name of recruitment center
Shahid Beheshti School of Nursing and Midwifery, Rasht
Full name of responsible person
Marzieh Jahani
Street address
Shahid Beheshti School of Nursing and Midwifery, Daneshjoo St., Shahid Beheshti Highway.
City
Rasht
Province
Guilan
Postal code
41469-39814
Phone
+98 13 3255 3202
Fax
Email
marziyeh_jahani@gums.ac.ir

Sponsors / Funding sources

1

Sponsor
Name of organization / entity
Rasht University of Medical Sciences
Full name of responsible person
Marzieh Jahani
Street address
Shahid Beheshti School of Nursing and Midwifery, Daneshjoo St., Shahid Beheshti Highway.
City
Rasht
Province
Guilan
Postal code
41469-39814
Phone
+98 13 3255 3202
Email
marziyeh_jahani@gums.ac.ir
Grant name
Grant code / Reference number
Is the source of funding the same sponsor organization/entity?
Yes
Title of funding source
Rasht University of Medical Sciences
Proportion provided by this source
100
Public or private sector
Public
Domestic or foreign origin
Domestic
Category of foreign source of funding
empty
Country of origin
Type of organization providing the funding
Academic

Person responsible for general inquiries

Contact
Name of organization / entity
Rasht University of Medical Sciences
Full name of responsible person
Saba Jahani
Position
Master’s Student of Medical-Surgical Nursing
Latest degree
Bachelor
Other areas of specialty/work
Nursery
Street address
Saba Apartment, Corner of Ghasabian 22/1 Alley, Shahid Ghasabian St.
City
Babolsar
Province
Mazandaran
Postal code
4741755096
Phone
+98 11 3525 1319
Email
sabajahani70@gmail.com

Person responsible for scientific inquiries

Contact
Name of organization / entity
Rasht University of Medical Sciences
Full name of responsible person
Marzieh Jahani
Position
Associate professor
Latest degree
Ph.D.
Other areas of specialty/work
Nursery
Street address
Shahid Beheshti School of Nursing and Midwifery, Daneshjoo St., Shahid Beheshti Highway.
City
Rasht
Province
Guilan
Postal code
41469-39814
Phone
+98 13 3255 3202
Email
marziyeh_jahani@gums.ac.ir

Person responsible for updating data

Contact
Name of organization / entity
Rasht University of Medical Sciences
Full name of responsible person
Saba Jahani
Position
Master’s Student of Medical-Surgical Nursing
Latest degree
Bachelor
Other areas of specialty/work
Nursery
Street address
Saba Apartment, Corner of Ghasabian 22/1 Alley, Shahid Ghasabian St.
City
Babolsar
Province
Mazandaran
Postal code
4741755096
Phone
+98 11 3525 1319
Email
sabajahani70@gmail.com

Sharing plan

Deidentified Individual Participant Data Set (IPD)
Undecided - It is not yet known if there will be a plan to make this available
Study Protocol
Undecided - It is not yet known if there will be a plan to make this available
Statistical Analysis Plan
Undecided - It is not yet known if there will be a plan to make this available
Informed Consent Form
Undecided - It is not yet known if there will be a plan to make this available
Clinical Study Report
Undecided - It is not yet known if there will be a plan to make this available
Analytic Code
Not applicable
Data Dictionary
Undecided - It is not yet known if there will be a plan to make this available
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