Impact of a 360-degree Nature Film in Virtual Reality on Pain During Arteriovenous Fistula Punctur enous Fistula Puncture in Patients under atients undergoing Hemodialysis: A Pr going Hemodialysis: A Pre- and Post-Test Design Abstract Abstract Hemodialysis patients suffer from pain during arteriovenous fistula punctures. By distracting patients with immersive virtual reality (VR), this discomfort can be lessened. The aim of this study was to evaluate the perception of pain by patients undergoing arteriovenous fistula cannulation during hemodialysis in response to a 360-degree nature film that is viewed through virtual reality headsets. Material and Methods: A pre-test-post-test clinical investigation was conducted with 100 hemodialysis patients. During arteriovenous fistula cannulation, patients were placed in a virtual natural setting using the Oculus Quest 2 headset. To calm patients and visually block them from the cannulation process, the 360-degree VR film included a relaxing natural scene and tranquil background music. Results: There was a statistically significant difference in the mean pain score between the first and second sessions (Mean = 4.79 vs. 2.65, p = 0.000). In the second session (n = 24, 24%), the proportion of patients experiencing moderate pain decreased significantly (p = 0.027) compared with the first session (n = 53, 53%). In both sessions, a somewhat positive association was observed between age and pain (Kendall's tau = 0.221, p = 0.016 in the first session, and 0.273, p = 0.004 in the second). In the initial session, a moderate connection (Eta = 0.317) was observed between occupation and pain. Conclusion: Patients on hemodialysis who used VR reported feeling less pain, which supports the technology's incorporation into routine hemodialysis care procedures. This emphasizes the ability of VR to improve hemodialysis patient care by encouraging a patient-centered approach to pain treatment. Keywords: Hemodialysis, cannulation, pain, arteriovenous fistula, virtual reality, and 360-degree video Keywords Hemodialysis, cannulation, pain, arteriovenous fistula, virtual reality, and 360-degree video.