Centre for Health Research and Innovation, NIHR Lancashire Clinical Research Facility, Chorley, UK.
Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, University of Central Lancashire, Preston, UK.
Nurs Crit Care. 2024 Mar;29(2):313-324. doi: 10.1111/nicc.12868. Epub 2022 Dec 2.
Virtual reality (VR) as a digital technology has developed rapidly, becoming more realistic, portable, sensory and easier to navigate. Although studies have found VR to be effective for many clinical applications, patients and clinicians have described several barriers to the successful implementation of this technology. To remove barriers for implementation of VR in health care, a greater understanding is needed of how VR can integrate into clinical environments, particularly complex settings such as an intensive care unit.
This study aimed to explore the perceived barriers and facilitators for the implementation of VR exposure therapy for intensive care patients and clinical staff.
A qualitative study using an Interpretative Description approach was undertaken. Semi-structured focus groups were conducted with 13 participants: nine patients and four health care professionals. Focus groups explored barriers and facilitators of using virtual reality (VR) exposure therapy in intensive care. Thematic analysis was employed to produce codes and themes.
In total, eight themes describing the perceived barriers and facilitators to implementing VR exposure therapy were identified. Four themes related to the perceived barriers of implementing VR exposure therapy in intensive care were identified: psychological, sensory, environmental and staff competency and confidence. There were a further four themes related to the perceived facilitators to the implementation of VR exposure therapy: staff training, patient capacity, orientation to technology and support during the intervention.
This study identified novel barriers and facilitators that could be expected when implementing VR exposure therapy for patients' post-intensive care unit stay. The findings suggest that psychological barriers of fear and apprehension were expected to provoke patient avoidance of exposure therapy. Perceived barriers for staff focused on preparedness to deliver the VR exposure therapy and a lack of technological competence. Both patients and staff stated that a comprehensive induction, orientation and training could facilitate VR exposure therapy, improving engagement.
This study has identified that with appropriate staff training, resources, and integration into current patient care pathways, VR exposure therapy may be a valuable intervention to support patient recovery following critical illness. Prior to undertaking VR exposure therapy, patients often need reassurance that side-effects can be managed, and that they can easily control their virtual exposure experience.
虚拟现实（VR）作为一种数字技术发展迅速，变得更加逼真、便携、感性和易于操作。尽管研究发现 VR 对许多临床应用都很有效，但患者和临床医生描述了该技术成功实施的几个障碍。为了消除 VR 在医疗保健中的实施障碍，需要更多地了解 VR 如何融入临床环境，特别是在 ICU 等复杂环境中。
本研究旨在探讨 ICU 患者和临床医护人员对 VR 暴露疗法实施的感知障碍和促进因素。
采用解释性描述方法进行定性研究。对 13 名参与者（9 名患者和 4 名医护人员）进行了半结构式焦点小组讨论，探讨了在 ICU 使用虚拟现实（VR）暴露疗法的障碍和促进因素。采用主题分析法产生代码和主题。
共确定了 8 个主题，描述了在 ICU 实施 VR 暴露疗法的感知障碍和促进因素。确定了 4 个与在 ICU 实施 VR 暴露疗法的感知障碍相关的主题：心理、感官、环境和员工能力和信心。还有另外 4 个与实施 VR 暴露疗法的感知促进因素相关的主题：员工培训、患者能力、对技术的适应和干预期间的支持。
本研究确定了在 ICU 后患者实施 VR 暴露疗法时可能出现的新障碍和促进因素。研究结果表明，患者对暴露疗法的恐惧和忧虑可能会导致他们回避治疗。员工关注的是准备实施 VR 暴露疗法和缺乏技术能力。患者和员工都表示，全面的入职培训、指导和培训可以促进 VR 暴露疗法，提高参与度。
本研究表明，通过适当的员工培训、资源和整合到当前的患者护理途径中，VR 暴露疗法可能是支持患者从重病中康复的有价值的干预措施。在进行 VR 暴露疗法之前，患者通常需要得到保证，即可以控制副作用，并且可以轻松控制他们的虚拟暴露体验。
