ICU nurses’ experiences with virtual reality technology for work-related stress reduction: A qualitative study

Abstract

Objectives

To explore experiences of ICU nurses with a virtual reality (VR)-based stress reduction intervention and identify the factors influencing its acceptance, guided by the Technology Acceptance Model.

Methods

A qualitative descriptive study was conducted in the ICU of a tertiary hospital in China. Fifteen nurses who had completed a VR intervention were recruited using purposive sampling. Data were collected through in-depth, semi-structured interviews between September and October 2025. The interviews were transcribed verbatim and analyzed using Colaizzi’s phenomenological method.

Results

The analysis yielded five key themes. 1) Perceived usefulness: nurses recognized VR’s effectiveness in reducing stress, primarily through mechanisms of immediate relaxation and psychological detachment from the high-pressure clinical environment. 2) Perceived ease of use: the adoption process was hindered not only by technical issues but, more fundamentally, by a persistent inability to disengage from patient care responsibilities during use mentally. 3) Influence of external variables: a critical barrier identified was the absence of structured organizational support, encompassing protected time, dedicated private spaces, and clear implementation policies. 4) Behavioral intention and usage patterns: despite existing barriers, participants expressed a conditional willingness to adopt VR, integrating it flexibly into their routines for in-shift respite or post-shift recovery. 5) Recommendations for improvement: practical suggestions for optimization focused on three areas, including diversifying VR content, improving hardware ergonomics, and establishing essential institutional enablers.

Conclusions

VR technology has the potential to alleviate stress among ICU nurses. However, its sustainable integration into clinical practice requires a systemic approach that addresses multifaceted barriers, with organizational policy and support being the most critical enabling factor. Future initiatives must extend beyond technological optimization to include protected time, dedicated spaces, and supportive policies to ensure effectiveness and long-term adoption.

What is known?

• •Although ICU nurses experience high levels of occupational stress, many existing stress reduction interventions have limited applicability or effectiveness within the high-workload, time-pressured context of intensive care.
• •Virtual reality (VR) technology is a promising stress management tool due to its immersive nature.
• •Existing research has primarily focused on quantitative validation of efficacy, lacking in-depth qualitative exploration into nurses’ experiences and the factors influencing adoption.

What is new?

• •Based on the Technology Acceptance Model, this study identified five themes related to ICU nurses’ experiences with VR stress reduction: perceived usefulness, perceived ease of use, the influence of external variables, behavioral intention, and usage patterns and recommendations for improvement.
• •The results revealed, under the theme of perceived usefulness, two distinct psychological mechanisms, sensory disengagement and cognitive anchoring, through which nurses experience stress relief.
• •The findings identified a critical lack of organizational support (e.g., protected time, policies), rather than the technology’s perceived usefulness, as the foremost barrier to adoption, thereby shifting the implementation focus from technological optimization to systemic change.

1. Introduction

ICU nurses have a critical responsibility of caring for critically ill patients, which inherently exposes them to intense workloads, frequent night shifts, and sustained psychological pressure [1]. These chronic stressors significantly increase their risk of physical fatigue, sleep disorders, and emotional exhaustion [[2], [3], [4], [5], [6]]. Indeed, approximately 80 % of ICU nurses report moderate-to-severe stress levels [7]. The prolonged state of stress can impair emotional regulation, diminish clinical judgment, and hinder effective communication, ultimately jeopardizing both caregiver wellbeing and patient safety [8]. Further, it contributes to absenteeism, decreased job satisfaction, and high turnover rates, which pose substantial challenges to the stability and quality of healthcare systems worldwide [9,10].

It has been shown that ICU nurses employ various strategies to relieve stress, such as meditation, recreational activities, socializing with friends, and religious practices [11]. Healthcare institutions and nursing researchers have explored various interventions, including group psychological counseling, flexible leave policies, dedicated rest areas [12], aromatherapy [13,14], resilience training [15], mindfulness-based stress reduction programs [16], and mobile health-enabled micro-learning courses [17]. However, the effectiveness of such interventions is often limited within the specific context of ICU nursing management. Namely, high-workload workflows hinder participation in lengthy, fixed-format programs, while standard respite measures frequently fail to facilitate meaningful psychological disengagement from the high-stakes environment. Further, sustainable organizational support is often curtailed by institutional resource constraints. These limitations underscore an urgent need for innovative, feasible, and practical solutions that can be seamlessly integrated into the demanding reality of ICU nursing.

Virtual reality (VR) technology, which creates immersive, simulated environments that perceptually replace the physical world [[18], [19], [20]], presents a promising alternative for stress management in nursing. It has been shown that VR reduces acute stress [21,22] and aids in biomechanics training [23] among ICU nurses. It has also been demonstrated in broader populations that VR can enhance mindfulness [24]. Its value for ICU nursing management derives from several key advantages. VR promotes rapid psychological detachment by creating an immersive virtual space shielded from clinical distractions. This function is particularly vital for ICU nurses, as it enables effective decompression during short breaks. This flexibility allows VR to seamlessly integrate into unpredictable clinical schedules, overcoming a critical limitation of fixed-format interventions. VR also offers standardization, ensuring consistent intervention quality and facilitating its potential scalability across healthcare systems.

Despite its promise, research on VR as a wellbeing tool for nurses remains nascent. Previous studies [21,22,25] have predominantly used quantitative methodologies, focusing on efficacy outcomes while offering limited insight into nurses’ lived experiences and the multifaceted contextual factors influencing the adoption of VR in real-world clinical workflows. Although there are some descriptive qualitative reports [26], they often lack a robust theoretical framework for systematically analyzing the acceptance process.

Given this limitation, a qualitative investigation grounded in a theoretical framework is essential. The Technology Acceptance Model (TAM), which posits that technology adoption is primarily determined by its perceived usefulness and ease of use [27,28], provides a structured analytical lens. The use of the TAM framework moves the inquiry beyond anecdotal feedback, allowing for a systematic examination of the determinants of successful implementation from the user’s perspective.

Therefore, we conducted a qualitative study using the TAM as a guiding framework to explore ICU nurses’ experiences with a VR-based stress-reduction intervention. The study aimed to elucidate the factors shaping ICU nurses’ acceptance of VR, including perceived benefits, barriers to use, and critical conditions for its successful integration into the ICU environment. Our study was expected to generate nuanced, evidence-based insights to inform the development of effective, acceptable, and sustainable VR initiatives to support the mental well-being of the critical care nursing workforce and enhance nursing management quality.

2. Methods

2.1. Study design

We conducted a qualitative descriptive study to explore ICU nurses’ in-depth experiences and perceptions of VR use for stress reduction. This design was chosen as it is particularly suitable for obtaining direct, rich descriptions of a phenomenon in the participants’ own words, without being overly interpretive or theoretical [29]. The study is reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist [30].

2.2. Study participants

This study was conducted in the ICU of a tertiary comprehensive hospital in Xiamen City, Fujian Province, China. A purposive sampling method was employed, with a maximum variation sampling strategy intentionally applied to ensure diversity across the key dimensions relevant to the study context. During September to October 2025, we recruited participants with diverse professional titles, years of work experience, and ages, aiming to capture a wide range of perspectives on technology adoption and stress-reduction needs. The inclusion criteria were as follows: 1) at least one year of nursing experience in critical care; 2) current provision of direct patient care; and 3) a completed three-week, hospital-organized VR-based stress reduction program. Nurses on extended leave or in administrative roles were excluded. The sample size was determined based on data saturation, which was deemed achieved when no new themes or concepts emerged from three consecutive interviews.

This three-week VR-based stress-reduction program was jointly implemented by the hospital’s nursing department and the ICU. Utilizing Pico four all-in-one VR headsets, the program provided immersive relaxation experiences in the ICU staff break room. The participants engaged in the VR-based intervention twice per week. Each session followed a standardized 30-min protocol comprising three sequential components, namely, a 5-min guided breathing regulation module, a 10-min mindfulness meditation session, and a 15-min immersive relaxation segment. The program was available daily from 08:00 to 18:00, allowing flexible participation based on individual shift schedules. A trained research assistant provided technical support during equipment setup without intervening in the experience itself. The content sequence remained consistent for all of the participants throughout the study period.

2.3. Data collection

The research team comprised the following members: one ICU nurse (X. Hong) who was responsible for program coordination and interviews; another ICU nurse (Y. Cai) responsible solely for the technical setup and operation of the VR equipment; two nursing researchers (X. Chen and F. Chen) involved in optimizing the study design and conducting data analysis; and the director of ICU head nurse (Y. Liang), who provided resource coordination and administrative support. All of the members had prior experience in qualitative research. This structure ensured a critical separation of functions. Namely, the interviewer and analyst (X. Hong and X. Chen) had no roles in the hands-on delivery of the intervention. In contrast, the equipment operator (Y. Cai) had no involvement in data collection or analysis, thereby safeguarding objectivity.

The initial interview guide was developed based on a comprehensive literature review, the TAM, and team discussions. It covered core domains such as the perceived usefulness and ease of the VR intervention, users’ attitudes and behavioral intentions toward VR, and influencing factors and feedback. To ensure content validity, the guide was reviewed by two clinical nursing experts and piloted in two preliminary interviews (data not included in the final analysis). The final interview guide is provided in Appendix A.

Before each interview, the interviewer (X. Hong) thoroughly explained the study’s purpose and procedures to the participants. The interviews were conducted individually in a private, quiet room to ensure confidentiality and minimize interruptions. Using a semi-structured approach, all sessions were audio-recorded with participants’ consent. In addition, the interviewer maintained field notes to document nonverbal cues, such as body language, emotional expressions, and significant pauses, to provide contextual support for subsequent analysis. Each interview lasted approximately 20 to 30 min.

2.4. Data analysis

Following the interviews, the audio recordings were transcribed verbatim using an intelligent transcription feature and were cross-checked against the original recordings by two researchers within 24 h to ensure accuracy. Subsequently, to enhance trustworthiness through member checking, preliminary codes and themes were shared with five participants whose interviews were particularly rich in information. They confirmed that the interpretations accurately reflected their experiences, and minor clarifications were incorporated.

Data were analyzed using Colaizzi’s seven-step phenomenological analysis method [31], assisted by NVivo 14.0 software for textual management and coding. To implement the principle of bracketing, the research team adopted the following measures before analysis to consciously set aside preconceptions: 1) all of the researchers involved in data analysis maintained reflective memos documenting their personal views and assumptions regarding VR interventions and nurse stress; 2) regular team meetings were held to compare these reflective memos with the textual data, identifying and discussing subjective tendencies that might influence interpretation; and 3) during the coding process, researchers consistently referred back to the original transcripts to verify the accuracy of their interpretations. The analytical process included reading the texts, extracting significant statements, coding, and clustering meanings into themes. Any discrepancies in coding were resolved through team discussion until consensus was reached.

2.5. Ethical considerations

Participation in the study was entirely voluntary. The study protocol was approved by the hospital’s ethics committee [2025(071)], and the study was conducted in accordance with the principles outlined in the Declaration of Helsinki. Written informed consent was obtained from all of the participants before their inclusion in the study. The following ethics principles were adopted: 1) the right to withdraw from the study at any stage without penalty; 2) strict confidentiality of personal data, with all of the published findings presented in anonymized form; and 3) transparency regarding potential benefits, such as insights that may inform future support strategies for ICU nursing practice.

3. Results

3.1. Participants’ characteristics

Fifteen ICU nurses were enrolled in this qualitative study. The majority of nurses were female (73.3 %), and most (86.7 %) held a bachelor’s degree. The mean age was 30.7 ± 4.6 years, and the mean ICU work experience was 6.5 ± 5.6 years. Participants had varied professional backgrounds and levels of experience, bringing extensive, firsthand ICU nursing experience to the study and enriching the data with diverse and in-depth perspectives. Further details are presented in Appendix B.

3.2. Nurses’ experiences using virtual reality technology for stress reduction

Guided by the TAM, the analysis revealed a thematic structure encompassing the model’s core components. Five overarching themes and 16 sub-themes were identified, and illustrated the factors that influenced ICU nurses’ acceptance of VR for stress reduction. The findings are presented using direct quotations from participants, which were translated into English by the authors. Quotations are annotated with the respective nurse identifier (N).

3.2.1. Perceived usefulness

This theme encompasses the benefits that nurses attributed to the VR intervention, which shaped their perception of its usefulness. Their experiences primarily manifested as immediate physical and emotional relaxation and effective psychological detachment.

3.2.1.1. Immediate physical and emotional relaxation

Physical and emotional relaxation was commonly reported. It manifested in two patterns: using VR after work to improve sleep at home (n = 2) and experiencing such deep relaxation during the session that it directly promoted sleep onset (n = 8).

“During my last night shift, our team admitted five patients—I felt my head was about to explode… Using the VR headset before going home genuinely reduced my anxiety and helped me sleep more soundly afterward.” (N7)

“Sometimes, after just a few min of listening to the guidance, I’d close my eyes and feel sleepy. Watching the VR content made it much easier to fall asleep.” (N5)

3.2.1.2. Effective psychological detachment from high-pressure environments

Four nurses described two primary mechanisms through which VR’s immersive quality enabled a temporary mental distance from the ICU environment.

First, the strong sense of presence helped cognitively transport them away, as one nurse described:

“The sense of immersion with these goggles was very strong; it really felt like you’re there, which helped me detach from that intense work environment.” (N6)

Second, the technology provided auditory isolation from typical clinical stressors, creating a soothing contrast, as noted by another nurse:

“There were so many machine noises in the ICU… Auditorily, it made everything feel very quiet, separating me from the work scene—it was very soothing.” (N9)

3.2.1.3. Positive spillover effects on work and family life

For four nurses, the relaxing effects of the VR intervention were reported to spill over into both work and family life. Some examples of the nurses’ impressions follow:

“Taking a break at noon…, improved my work performance later.” (N7)

“This left me more energetic after work so that I could handle household chores and childcare with greater patience.” (N9)

3.2.2. Perceived ease of use

This theme captures the various barriers—technical, contextual, and individual—that influenced how easy or difficult the ICU nurses found the VR technology to use.

3.2.2.1. Technical and content barriers

Eight nurses reported that challenges with hardware comfort, content appeal, and feature design hindered ease of use with VR. Some examples of the nurses’ impressions follow:

“The headset caused discomfort to my eyes…, it felt like it was sliding down, so I had to lie back to use it.” (N3)

“The graphics felt dated and not very realistic. Plus, all our content was natural landscapes—it was so monotonous.” (N11)

“I couldn’t keep up with the breathing exercise rhythm at all… Instead of relaxing me, the breathing exercises made me feel more stressed.” (N15)

3.2.2.2. Work-related concerns as a central psychological barrier

For the majority of nurses (n = 12), immersion was significantly hindered by an inability to disengage from work, characterized by persistent worries about patient welfare, time constraints, and ultimate responsibility. Some examples of the nurses’ impressions follow:

“During the VR session, I still worried about my patients… I was also afraid I might fall asleep and oversleep, so I always set an alarm.” (N8)

“Even though I had asked someone else to watch my patients, I still worried: how are they doing? If anything happens, the responsibility is still mine. These distracting thoughts were always there.” (N11)

3.2.2.3. Individual barriers

Four nurses described individual physiological reactions and psychological predispositions that limited the effectiveness of the intervention. Some examples of the nurses’ experiences follow:

“I experienced some motion sickness with 3D visuals. After about 20 min of viewing floral scenes, I started feeling dizzy.” (N2)

“My way of dealing with stress is to solve the problem directly. VR was not very effective for me because I’m not well-suited to such a slow-paced relaxation approach…” (N15)

3.2.2.4. Environmental interference

The shared break-room environment was a commonly reported barrier, with many nurses (n = 11) citing a disruptive lack of privacy and quietness that prevented relaxation. Some examples of the nurses’ impressions follow:

“In a shared break room, people inevitably came in to look for things, eat, or rest. There was noise from people searching for items, taking phone calls…, I always ended up feeling disturbed.” (N1)

“I was more concerned about privacy…, I needed a quiet and somewhat private environment for sleep. If someone came in at that moment…, it felt like an intrusion on my privacy. It felt like a burden.” (N13)

3.2.3. The influence of external variables

Nurses identified key contextual factors outside the technology itself that significantly shaped their willingness to adopt and use it. These factors primarily pertained to organizational support and social-hygienic concerns.

3.2.3.1. Social apprehensions and hygiene safety concerns

Nurses raised concerns about social discomfort and infection risks associated with the shared VR equipment. Two nurses were concerned about the potential awkwardness of using the device in public, while hygiene was a prominent issue for five nurses. Some examples of the nurses’ impressions follow:

“When I wore the headset, although what I saw is immersive, I felt like others watching me would think I look silly waving my arms around. Don’t be foolish.” (N2)

“After all, it makes direct contact with your eyes…, I worried that inadequate disinfection could lead to infection.” (N4)

3.2.3.2. Lack of organizational support and policy frameworks

There was strong consensus among nurses (n = 13) on the critical need for structured organizational support, including protected time, dedicated space, and formal policy frameworks, to enable sustainable VR use. Some examples of the nurses’ comments follow:

“We need compensated time, scheduling support, or some reward and incentive policies… Schedules shouldn’t be overly packed, and encouraging policies should be in place.” (N3)

“The department could schedule fixed time slots…, during which we shouldn’t be assigned nursing tasks…, so we wouldn’t worry about being called away right after putting on the equipment.” (N9)

3.2.4. Behavioral intention to use and usage patterns

The nurses reported their willingness to use VR. They described the usage patterns they adopted or preferred, reflecting their assessment of the technology’s usefulness, ease of use, and the influence of external variables.

3.2.4.1. Positive attitudes rooted in recognized value

The majority of nurses (n = 12) expressed willingness to use the VR intervention, citing its perceived value as an innovative tool and its practical convenience. Some examples of the nurses’ comments follow:

“I was willing to use it and hope it can be available long-term… After using it, I felt my work pressure was somewhat relieved …” (N3)

“Because it’s quite an innovative approach, it felt like it would be useful.” (N6)

“It was very convenient to use—the decompression videos are all pre-installed, so you didn’t have to search for resources yourself.” (N7)

3.2.4.2. Usage patterns adapted to work schedules

The nurses described three patterns of using VR: during short breaks for immediate relief (n = 6), after shifts to decompress before going home (n = 6), or before night shifts to prepare (n = 3) mentally. Some examples of the nurses’ comments follow:

“I hoped to come during work hours. The work pressure builds up right then and there—I wanted to get rid of it on the spot during my lunch break or downtime so that I can focus better afterward.” (N5)

“I was willing to come after my shift, adjust myself, and then go home.” (N12)

“I wanted to do this before a night shift. Night shifts really drain my energy, and I usually feel exhausted. Doing the intervention beforehand helped put me in a good state for work.” (N15)

3.2.4.3. Preferences in mode of engagement

Beyond the timing of use, the nurses’ preferences also diverged in how they engaged with the content, forming two distinct patterns. One group (n = 3) valued structured guidance, finding that the audio narration helped quiet work-related intrusive thoughts by directing their attention (e.g.: “When I tried to relax on my own, my mind often wandered… But with guided narration…, the words helped direct my attention, making it harder for my thoughts to drift. The relaxation effect felt stronger” (N1).

In contrast, another group (n = 5) preferred self-directed immersion, perceiving guided instructions as a cognitive task that impeded proper mental rest (e.g.: “I preferred being given pleasant scenery and music to immerse myself independently. When I followed guided relaxation instructions…, my brain didn’t really rest—it was still concentrating on a task” (N10).

3.2.4.4. Conditional willingness to recommend

When discussing whether they would recommend VR to colleagues, the nurses often emphasized the importance of personal choice and individual fit. Their approach was typically unimposing. Some examples of the nurses’ comments follow:

“I would recommend it…, but I would share my own experience and let them decide for themselves whether to try it. Willing is fine, unwilling is also fine—I didn’t want my colleagues to feel pressured.” (N8)

“I thought I might suggest it to colleagues who don’t sleep well or appear particularly tired. It’s important to identify the right people first.” (N14)

3.2.5. Recommendations for improvement

Based on their experiences, the participants provided concrete suggestions for enhancing the VR technology, its supporting processes, and the organizational conditions for its use.

3.2.5.1. Content and software enhancements

Nine nurses offered specific suggestions for enhancing the VR content and software, primarily focusing on greater diversity, personalization, and adaptability. Some examples of the nurses’ suggestions follow:

“More themes would be good…, add some animal world content…, include both natural landscapes and cityscapes, ideally with different weather conditions…, incorporate more tranquil scenes.” (N4)

“Let us choose different content according to our preferences. It would be great if we could select and combine modules ourselves.” (N14)

“It would be better if the speech speed in breathing exercises could be adjustable, like offering fast, medium, or slow options.” (N5)

3.2.5.2. Hardware and management protocols

Seven nurses proposed improvements targeting hardware comfort, device management, and hygiene protocols to facilitate routine use.

“The equipment could be designed to be lighter… Wearing it for 30 min makes my nose bridge and ears ache from the pressure.” (N15)

“Dedicated staff should be assigned to manage the equipment and regularly check the battery levels and cleanliness… Perhaps we could also have a booking system. Otherwise, if everyone comes to use them at once, there won’t be enough devices.” (N6)

“Could we be provided with disposable eye masks? This would allow for individual use and reduce infection concerns. Also, we should be supplied with disinfectant wipes or alcohol swabs.” (N13)

3.2.5.3. Institutional support and policy frameworks

The nurses emphasized that enabling routine use required foundational institutional support, centering on two key areas.

“It would be best to provide us with massage chairs…, and create a very comfortable environment for sleep…perhaps allocate a smaller room or set up a partitioned space with curtains.” (N1)

“We need compensatory time, scheduling support, or some reward and incentive policies… Schedules should not be overly tight, and encouraging policies must be established.” (N11)

4. Discussion

This qualitative study, grounded in the TAM, provided an in-depth exploration of ICU nurses’ acceptance of a VR-based stress-reduction intervention. The findings revealed that while VR is perceived as highly useful for alleviating stress and improving sleep, its integration into practice is critically hindered by perceived ease of use and external organizational and contextual barriers. This finding suggests a critical refinement to the TAM within the high-stakes ICU context, where contextual feasibility may precede and fundamentally shape technology acceptance.

Our findings on the efficacy of VR are consistent with prior research involving ICU nurses [21] and broader nursing populations [25]. The intervention’s effectiveness can be understood through two complementary psychological pathways that also elucidate the interplay among core TAM constructs. The ICU environment is characterized by high noise levels, fast-paced workflows, and significant mental strain on nurses [32]. VR addresses these issues by constructing an undisturbed virtual natural space, offering a period of rest and recovery for overstimulated minds [33,34]. Such sensory disengagement provides a low-effort pathway to relaxation through an immersive sanctuary, thereby directly enhancing perceived ease of use. In contrast, cognitive anchoring through guided mindfulness requires more active cognitive engagement but facilitates a deeper, more structured restorative experience, thereby enhancing the technology’s perceived usefulness [35,36]. This synergy, supported by Attention Restoration Theory, demonstrates how VR’s design can cater to diverse user preferences, ultimately boosting overall acceptance [37,38].

However, realizing this potential is constrained by a complex interplay of factors. Our findings significantly extend the application of TAM by elucidating how external variables directly moderate its core constructs. Our study showed that the most critical barrier was not technological but contextual. Namely, the nurses’ persistent double awareness of patient care responsibilities and the lack of private space not only directly hindered usage but also fundamentally undermined both perceived ease of use and perceived usefulness, as full engagement was impossible. This phenomenon is echoed in studies of rural nurses [26], highlighting a universal challenge in healthcare. At the technological level, hardware discomfort and content monotony directly impaired the ease of use [25,39]. At the individual level, a mismatch between proactive coping styles and VR’s passive nature reduced its perceived usefulness. At the same time, negative experiences, such as motion sickness, further diminished willingness to use it [40,41]. These multilayered barriers illustrate that in healthcare settings, technology acceptance is inherently more complex than in consumer environments.

Based on our findings, we propose integrated recommendations to support the sustainable implementation of VR in the ICU context. As for organizational policy [42], it is essential to move beyond vague suggestions to concrete action by formally integrating protected VR time into shift schedules as 20–30-min wellbeing breaks, backed by clear patient handover protocols managed by a charge nurse, with endorsement from hospital administration as a legitimate component of nurse wellness. In terms of environmental adaptation, low-cost, high-impact modifications should be prioritized, such as installing curtains or partitions in existing break rooms to create privacy and reduce disruptions quickly. Technologically, iteration should remain user-driven, focusing on developing lighter hardware, diversifying content, and incorporating features such as session save and resume to accommodate fragmented workflows [43]. Finally, to foster a supportive unit culture, peer-led promotion should be encouraged, with nurses who have positive experiences voluntarily sharing their insights [44]. This approach helps normalize usage and positions VR as a professional self-care tool, thereby reducing stigma more effectively than top-down mandates.

5. Limitations

This study has several limitations. First, the sample was recruited from a single tertiary hospital in China, which may limit the generalizability of the findings to other healthcare systems or cultural contexts. Second, the fixed, twice-weekly intervention schedule may not reflect the flexible, on-demand usage patterns of real-world practice, potentially limiting insights into natural adoption. In addition, the lack of systematic baseline stress assessment means the sample included nurses with varying stress levels and coping styles, which could have affected the interpretation of their experiences. Finally, the findings reflect immediate post-intervention perceptions; longitudinal research is needed to understand the evolution of acceptance and usage patterns over time.

6. Conclusions

In conclusion, successfully implementing VR in the ICU requires a systemic approach that transcends technological optimization. Future efforts must concurrently address the identified barriers at the organizational, environmental, and individual levels. The ultimate success of VR hinges on the institution’s commitment to creating a supportive infrastructure, thus affirming that in the demanding ICU environment, organizational support is not merely a facilitator but a fundamental prerequisite for sustainable adoption.

Data availability statement

The datasets generated during and/or analyzed during the current study are not publicly available due to privacy or ethical restrictions but are available from the corresponding author upon reasonable request.

CRediT authorship contribution statement

Yufeng Liang: Conceptualization, Methodology, Validation, Resources, Data curation, Writing - original draft, Writing - review & editing, Supervision, Project administration. Xuepei Hong: Conceptualization, Methodology, Validation, Interview, Data curation, Writing - review & editing, Project administration. Yihong Cai: Conceptualization, Methodology, Validation, Resources, Data curation, Writing - review & editing. Xiuwan Chen: Conceptualization, Methodology, Validation, Formal analysis, Writing - review & editing, Funding acquisition, Supervision, Project administration. Fuhong Chen: Conceptualization, Methodology, Validation, Formal analysis, Resources, Writing - review & editing.

Funding

This study was supported by grants from the funding sources: Chinese Nursing Association (ZHKY202415). The funding organizations had no role in the design of the study, in the collection, analysis, or interpretation of data, nor in the writing of the manuscript or the decision to publish its results.

Declaration of competing interest

The authors have declared no conflict of interest.

Appendices. Supplementary data

The following are the Supplementary data to this article: