Feasibility, Usability, and Acceptability of a Nurse-Facilitated, Phase-Matched Virtual Reality Intervention After ICU Extubation: A Mixed-Methods Study

Abstract Objectives To evaluate the feasibility, usability, tolerability, acceptability and exploratory psychological effects of an investigator-developed multicomponent virtual reality (VR) intervention after ICU extubation. Methods A preference-based, non-randomised controlled mixed-methods feasibility study was conducted in a general ICU in China. Adults who had received invasive mechanical ventilation for more than 48 h selected VR plus usual care or usual care alone. The phase-matched intervention combined ICU environmental familiarisation, treatment education, relaxation and mindfulness, and personalised videos from family members and clinicians. Feasibility, usability and tolerability were assessed through recruitment, VR uptake and completion, session delivery, staff assistance, the System Usability Scale and adverse-event monitoring. Anxiety, depressive and post-traumatic stress symptoms were assessed at baseline, ICU discharge and 1 month. Semistructured interviews explored acceptability. Results Of 70 eligible patients, 54 enrolled (77.1%); 31 initiated VR and 23 received usual care alone. Thirty completed the VR intervention (96.8%) and undertook 185 sessions (mean 6.17 per participant; 7.08 min per session). Twenty-four used the system with minimal assistance and six required continued staff support. The mean System Usability Scale score was 79.42 (SD 7.09). One participant discontinued during the initial session because of mild transient dizziness and nausea; no serious VR-related adverse events or technical failures occurred. One usual-care participant died before 1-month follow-up. Adjusted exploratory analyses showed lower psychological symptom scores in the VR group at ICU discharge and 1 month. Interviews indicated that acceptability depended on recovery phase, physical capacity, ease of operation and bedside support. Conclusions The nurse-facilitated, phase-matched VR intervention was deliverable and generally acceptable among selected postextubation ICU patients. Successful implementation required bedside assessment, flexible content selection, operational assistance, and monitoring for discomfort. Psychological findings were exploratory and should not be interpreted as evidence of effectiveness because of preference-based allocation, baseline imbalance, and the small sample.