FEATURES Effects of Virtual Reality in Patients Undergoing Dialysis Study Protocol ■ Francesco Burrai, PhD, RN ■ Shokri Othman, MSN ■ Elena Brioni, MSN, RN ■ Valentina Micheluzzi, MSN, RN ■ Marco Luppi, PhD ■ Luigi Apuzzo, MSC, RN ■ Giulia Bruna Delli Zotti, PsyD ■ Gaetano La Manna, PhD, MD Dialysis is often considered slow, repetitive, and with programmed intervals. Patients often perceive it as time taken from their lives with a sense of ineluctability and emptiness, engendering a negative emotional and cognitive perception of the world and one’s place in it. Today, it is possible to improve the quality of life of patients during hemodialysis using virtual reality (VR). This creation of a true multisensory experience may absorb the patient’s perceptions during hemodialysis, improving his/her quality of life. An Italian multicenter, longitudinal experimental study will be conducted with a randomized, pre-post test design, with balanced allocation 1:1, in parallel groups with a control group in the standard care of patients diagnosed with chronic renal failure who are, undergoing hemodialysis treatment. A sample of 186 patients calculated with sample size (power = 80%, β = 0.2, α = 0.05) will be randomized into an experimental group exposed to VR, and a control group in standard care. The 2 groups will be studied over a period of 1 month, with 12 applications of VR and with measurements of the following outcomes: anxiety, fatigue, pruritus, arterial pressure, heart rate, respiration rate, and duration of the session at each hemodialysis session. This is the first international experimental protocol that examines the application of VR in patients undergoing hemodialysis. If the results show statistically and clinically significant differences, the VR could be an additional holistic intervention, which is evidence based, linked to the humanization of chronic, repetitive interventions, complementary to and synergistic with standard of care. KEY WORDS: dialysis, framework, holistic care, virtual reality Holist Nurs Pract 2019;33(6):327–337 INTRODUCTION This study has considerable importance in the context of scientific development because it identifies an innovative, low-cost, intervention designed to improve the quality of life for patients with chronic kidney disease undergoing dialysis treatments. This study proposes to investigate the effects of virtual reality Author Affiliations: Education, Research and Organizational Change, ATS Sardegna, Sassari, Italy (Dr Burrai); Imperial College London, United King- dom (Mr Othman); San Raffaele Hospital, Milan, Italy (Ms Brioni); Univer- sity of Sassari, Telti (SS), Italy (Ms Micheluzzi); Departments of Biomedi- cal and Neuromotor Sciences (Dr Luppi) and Experimental, Diagnostic and Specialty Medicine (Dr La Manna), University of Bologna, Italy; SIAN Research Center, Bologna, Italy (Mr Apuzzo); and IRCCS San Raffaele Hospital, Milan, Italy (Dr Delli Zotti). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Correspondence: Francesco Burrai, PhD, RN, Education, Research and Organizational Change, ATS Sardegna, Via San Camillo 07100, Sassari, Italy (francesco.burrai@atssardegna.it). DOI: 10.1097/HNP.0000000000000330 (VR) on key clinical outcomes related to hemodialysis sessions. The patient undergoing hemodialysis faces continuous immersion in emotions such as anxiety and fear, with a cognitive world formed of many negative thoughts and worries. Anxiety and fear can also compromise adherence to hemodialysis treatments. The discomfort, the psychological suffering, and the stress of the continuous and repetitive sessions of hemodialysis can lead to conditions of psychological instability, anxiety, and anguish that influence the duration of dialysis sessions, mortality, morbidity, and the amount of anxiolytic drugs prescribed. The anxiety related to hemodialysis treatment is often measured not only in psychological terms, but also with corresponding physiological correlates, such as blood pressure, heart rate, respiratory rate, pain, and pruritus. The time spent in dialysis is a time of repetitiveness, programmed cadences and slowness, leading to a sense of emptiness and loss of valuable time. Many patients do not know how, or do not want, to fill that time. Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. 327