DEVELOPING EVIDENCE-BASED NURSING PROTOCOLS IN PALLIATIVE CARE ASSISTED BY VIRTUAL REALITY TECHNOLOGY
Indonesia 
Pakistan Pakistan 
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Palliative Care, Protocol Development, Symptom Management
Abstract
Palliative care requires evidence-based, person-centered interventions capable of addressing multidimensional symptoms while preserving comfort, dignity, and safety. This study aimed to develop and preliminarily evaluate an evidence-based nursing protocol for integrating virtual reality technology into palliative care. A methodological development design was employed through three sequential phases: evidence synthesis, modified Delphi expert validation, and clinical feasibility testing involving 30 palliative-care patients and 10 nurses. The final protocol achieved strong expert agreement, with a scale-level content validity index of 0.96, and demonstrated a 93.3% patient completion rate. Significant short-term reductions were observed in pain, anxiety, distress, and overall well-being burden, while fatigue showed a smaller and non-significant change. Patient willingness to repeat virtual reality exposure was high, although two sessions were discontinued because of dizziness or increasing fatigue. The findings indicate that virtual reality is most clinically useful when embedded within structured nursing assessment, individualized content selection, continuous safety monitoring, and post-intervention reassessment. The study concludes that virtual reality should be implemented as an adjunctive, nurse-governed intervention rather than a stand-alone technology, with larger controlled trials required to confirm effectiveness, sustainability, and applicability across diverse palliative-care settings, and to determine optimal intervention duration, frequency, personalization, and implementation requirements in routine practice.
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