Virtual Reality for Managing Procedural Pain in Children: A Concept Analysis with Walker and Avant Approach

Procedural pain and anxiety are common among children undergoing medical procedures. Traditional pharmacologic and behavioural interventions may not fully alleviate pain and distress in young children. Virtual Reality (VR) has emerged as a promising nonpharmacologic approach, yet conceptual ambiguity persists regarding its defining characteristics within paediatric nursing practice.

To clarify the concept of Virtual Reality for the management of procedural pain in children by delineating its defining attributes, antecedents, consequences, and empirical referents utilizing the Walker and Avant framework.

Walker and Avant's eight-step concept analysis framework was employed. Literature published between 2005 and 2025 was systematically identified from PubMed, Scopus, CINAHL, and Web of Science. Twenty-eight eligible studies were synthesized through iterative comparison and conceptual coding to identify defining attributes, antecedents, consequences, and empirical referents of Virtual Reality for managing procedural pain in children.

Three defining attributes were identified: (1) immersion and presence, referring to a sense of being within a three-dimensional simulated environment; (2) distraction and cognitive engagement, involving active redirection of attention away from pain stimuli; and (3) emotional regulation and anxiety reduction, promoting calmness and procedural cooperation. Antecedents include the presence of a painful procedure, availability of VR technology, trained providers, and child readiness. Consequences include reduced pain and anxiety, improved procedural cooperation, and increased satisfaction among children, parents, and healthcare providers. Empirical referents include pain intensity measure, fear and anxiety assessments, and presence related instruments.

Virtual reality represents an immersive, interactive, and emotion-focused nursing intervention for managing procedural pain and anxiety in children. Clarifying this concept supports its integration into evidence-based, child-centred, atraumatic nursing care.