Perspectives of intensive care professionals on psychological stressors, support strategies, and the potential of virtual reality in critical care

Abstract Background Psychological distress is common among intensive care unit (ICU) patients, yet current pharmacological approaches carry risks. Objectives The aim of this study was to survey ICU clinicians' perceptions of psychological stressors affecting patients, their coping strategies, and the perceived feasibility, benefits, and challenges of implementing virtual reality (VR) interventions in ICU settings. Methods A dual-method cross-sectional survey was distributed to ICU clinicians in Australia and New Zealand between March and May 2025. The survey comprised 5-point Likert-scale and open-ended questions exploring three domains: (i) perceived psychological stressors in ICU patients; (ii) current practices and perceived effectiveness of psychological support interventions, including VR; and (iii) perceived barriers and design recommendations for VR implementation in the ICU. Quantitative data were analysed descriptively; qualitative responses underwent thematic analysis using the NVivo software. Results Among 143 valid respondents (125 completed), 56.6% were female; 48.3 % were nurses, 46.9% doctors, and 4.8% allied health professionals. Lack of sleep (median: 5 [4–5]), isolation (median: 4 [3–4]), temporal disorientation (median: 4 [3.5–4]), and sensory overload (median: 4 [4–5]) were rated as key stressors. Pharmacological, family communication, and maintaining a calm environment were the most implemented and effective interventions (median: 4 [4–4]). Engagement activities were infrequent, but structured communication with family was rated important (median: 4 [4–5]). The interventions listening to music, watching family videos, and viewing nature scenes (median: 4 [3–4.5]) closely followed. VR was seen as moderately familiar (median: 3 [2–3]) and moderately beneficial (median: 3 [3–4]) but difficult to implement (median: 3 [3–4]). ICU clinicians recommended that the VR content should be personalised, simple, safe, and supporting both patients' emotional needs and ICU workflow integration. Conclusions ICU clinicians acknowledge the perceived psychological burden of ICU environments and engagement activities were infrequent in ICU patients. They express cautious optimism towards VR as a supportive tool. However, successful implementation requires addressing significant logistical, clinical, and educational barriers.