Proposal for Distraction in Pediatric Nursing Using
Two-Screen Projection Method to Support Children
Receiving Medical Care and Their Families
Hiroyuki Ogihara

Erika Okada

Hiromasa Oku

Ashikaga university / Gunma University
Ashikaga, Tochigi, Japan / Maebashi, Gunma, Japanogihara.hiroyuki@g.ashikaga.ac.jp

Gunma University
Maebashi, Gunma, Japant231d017@gunma-u.ac.jp

Gunma University
Maebashi, Gunma, Japanh.oku@gunma-u.ac.jp

Abstract—Our proposed two-screen projection is a costeffective solution that creates the feeling that children withmedical complexity and their families experiencing long-term
hospitalization or behavioral limitations are outside the hospitalor facility and can easily share their experience with others.
Index Terms—Projection, distraction, pediatric nursing

Two-screen projection entails the utilization of two projectors, one projecting onto the wall and the other onto thefloor, as depicted in Figure 2, thereby enabling an immersive
experience within the hospital room.

I. I NTRODUCTION
Children with medical complexity (CMC) and their families
often experience stress due to the numerous restrictions andinterventions that are a part of their daily lives. Distractiontechniques [1] have been recognized in pediatric nursing as away to alleviate stress in children receiving medical care, andthe value of promoting ingenuity in nursing practice has beenemphasized [2].
Our group has focused on immersion, which promotes positive factors such as empathy, extraversion, and willingness toparticipate [3], and we predicted that the immersive experience
provided by two-way communication would be an effective
distraction in pediatric nursing. Therefore, we experimentallytested the hypothesis that an immersive experience with twoscreen projection using a simple and cost-effective projection
method may have a stress-reducing distraction effect, andobtained evidence that it could be implemented in society as
an ideal form of nursing support.

Fig. 1. Wall and floor screen settings according to viewing angle.

II. PROPOSED METHOD
To enhance immersion in a virtual reality (VR) experience,the projection arrangement proposed in this study requires
a wall screen that takes into account the horizontal field ofview and the vertical field of view and a floor screen in thelower area, which together provide strong visual stimulation,
as shown in Figure 1. Since the human binocular field ofvision widens downward [4], visual information from below
is particularly important for maintaining an upright posture,and the feet should be included in the image presentation area
to enhance the immersive experience.
This work was supported in part by JSPS Grants-in-Aid for Scientific
Research under Grant 23K18473, Grant 21H03458, Grant 20K20626 andGrant 24K15843; and in part by the Gunma University Grant-in-Aid for
Academic Research Promotion.

Fig. 2. Two-screen projection limited by equipment installation space.

The wall and floor projectors were placed within a projection space of 3000 mm by 2000 mm, positioned at anangle that minimized the reflection of a person’s shadow being
projected. The resulting two-screen projection system, shownin Figure 3, provided an immersive VR experience within thelimited space available.

two-screen projection compared to before the projection (p <0.05).

Fig. 4. Two-screen projection arrangement in a hospital room.

Fig. 3. Two-screen projection arrangement in a hospital room.

The necessary equipment and materials required for executing two-screen projection are commercially available, easily
accessible, and appropriate for use in mobile settings. The
process itself is uncomplicated, and it takes around 15 minutes
from the preparation stage to the projection stage.The projection method used in this study presents a challenge in that theshape of the projected image does not align with the surface ofthe object being projected, owing to the projector’s placement
at an angle to the projection surface. To address this issue,
an image transformation technique known as homographytransformation was applied to the projected image.
Each experiment was conducted with the approval of theEthical Review Board for Medical Research Involving Human
Subjects of Gunma University (HS2021-112) (HS2022-095).
III. EXPERIMENTS AND RESULTS
A. Experiment 1
Subjects consisted of 30 healthy adult students and faculty
members enrolled at University A who agreed to participate
in the experiment between November 2021 and April 2022.
Measurement of salivary α-amylase activity, a reliable noninvasive biomarker known to be increased by acute psychological stress, showed that the two-screen projection method
significantly reduced subjects’ stress levels compared to theone-screen projection method (p < 0.05).
B. Experiment 2
Subjects consisted of 24 people: 9 CMCs, 3 parents, and 12
staff members who used a multifunctional day care facility andagreed to participate in the experiment from December 2022 toApril 2023. The experimental setting is illustrated in Figure
4. The KOKORO Scale, a mood measurement system thatquantifies changes in human emotions and feelings, showedthat the CMC’s stress levels significantly decreased after theIV. RELATED STUDIES AND DISCUSSIONS
There are two main types of interfaces for visually recreating immersive digital spaces. One is head-mounted displays,
which are typically used as immersive displays, but they areinappropriate for use with CMCs because they are a physicalburden and tend to inhibit interactive communication. Thereis another type of virtual environment called Cave Automatic
Virtual Environment (CAVE) that uses the surrounding space
as a display, but it requires a large space and multiple
screens, projectors, and cameras, and is not suitable for mobile
applications that can be set up in hospitals [5]. To overcome
these issues, in this study we proposed a cost-effective solution
for interactive communication: two-screen projection. This
represents a crucial form of nursing support sought after bychildren receiving medical care and their families, and it holds
significant potential for implementation as a creative approachto distraction in pediatric nursing.
ACKNOWLEDGMENT
The authors would like to thank all the students, faculty,
and staff who contributed to this study, to the children receiving medical care, and their parents, and to Kazue Noguchi,
President of Plus N Inc.
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