This study was a true experiment study using a post-test-only control group design.

This study involved 66 children aged 6‐12 years, with urgent and non-urgent triage, compos mentis (conscious), no respiratory or circulatory emergencies, no disturbance in the head and face area, and being able to communicate. The sample size was calculated using the sample size formula for hypothesis testing of the means of two independent populations based on literature [11]. The effect size was 3,4 based on previous research [12]. Samples were selected using simple random sampling by applying one drawing for each day of admission.

The instruments used were the demographic questionnaire, the short form of the Chinese version of the State Anxiety Scale for Children (CSAS-C) [13] to measure children’s anxiety, and the State Anxiety Inventory (SAI) [14] to measure caregivers’ anxiety.

After passing the triage assessment, respondents in the intervention group received a VR intervention for 10 minutes. They watched an animated video of Pororo the Little Penguin about the situation in the emergency room. The tool used was entry-level, low-immersive VR (smartphone and headset Sinecon VR Box).

Data collection for this study was conducted between February until May 2023. After passing the triage assessment, the researcher assessed which respondents matched the inclusion and exclusion criteria. The researcher explained the purpose and benefits of the research as well as the procedures that will be passed by the prospective respondent and ask for their consent. The child’s anxiety was measured immediately after the intervention. Meanwhile, the companion’s anxiety was measured after the child completed the procedure in the emergency room.

The data were analysed using IBM SPSS Statistics 20, with a significance level of 0.05. Univariate analysis was performed using distribution of frequencies and percentages and mean-standard deviation for categorical and numerical data, respectively. The analysis of the children’s anxiety differences between the intervention and control groups used the independent t test.

Ethical approval was obtained from the hospital where the study was conducted (Ethical approval number: 017/EC/KEPK-KANDOU/II/2023). Consent was obtained from the accompanying persons and from the children, when possible. No names were provided by the respondents. Following completing the questionnaire, all respondents received a gift of US $2 from the researcher.

The use of VR could reduce anxiety in school-age children treated in the emergency room (P<.001). This result coincides with the study involving children undergoing surgery, which found a difference in preoperative anxiety between children who received VR intervention and those who did not (P<.05) [7].

VR is a diversion method where the child is given tools resembling glasses and headsets to view virtual images from a computer [5]. In the era of digital technology, VR can support nurses in implementing nursing care for patients [12]. These findings show significant differences in anxiety between the control and intervention groups. The mean score of the intervention group was lower than that of the control group. The children who received the VR intervention focused on the video they were watching [5]. Watching video using VR involves more than one sense, namely, vision and hearing. This made the use of VR more attractive to the children’s attention compared to distraction techniques that only involved one sense, such as music (hearing) or picture books (vision) [8]. The children enjoyed the video presented using VR; therefore, their anxiety was reduced.

There was a moderate relationship between caregivers’anxiety and school-age children’s anxiety (r=.532, P<.001). The presence of parents can be a source of motivation and strengthen children [9]. Parents’ anxiety is related to children’s anxiety [10]. When the child’s anxiety decreased, the parent’s anxiety also decreased.

This study did not measure the anxiety score before the intervention due to permission granted from the research location. The anxiety measurement before the intervention would delay the treatment that the patient would receive. Apart from that, the intervention was only given for 10 minutes, so the researchers were concerned that giving questionnaires twice, both for children and caregivers, in a short time interval could cause discomfort.

The findings of this study show that the use of VR could reduce anxiety in school-age children treated in the emergency room. Therefore, the authors recommend that hospital management establish a policy related to the use of VR in managing children’s anxiety.