Restricted accessResearch articleFirst published online 2026
Effect of Virtual Reality and Jacobson’s Progressive Muscle Relaxation on Occupational Fatigue in Intensive Care Unit Nurses: A Factorial Randomized Controlled Trial
Fatigue is a prevalent occupational problem among intensive care nurses. Relaxation approaches such as virtual reality (VR) and Jacobson’s progressive muscle relaxation (JPMR) are promising strategies to reduce work-related fatigue. The aim of this study was to assess and compare the effects of VR, JPMR, and their combined application on occupational fatigue among intensive care unit (ICU) nurses. The study was a four-arm factorial randomized controlled trial conducted across nine intensive care units and involving 132 nurses in Baghdad. Twelve weeks after the initiation of the intervention, those who received the active intervention showed a significant reduction in fatigue compared with the control group (p < 0.001). The conclusion of the study is that both VR and JPMR, separately and together, effectively reduced occupational fatigue among ICU nurses.
AjilZ. W.MajeedH. M.Al-RedaJ. J. A. (2024). Critical care nurses’ knowledge and perceived barriers regarding pressure injury prevention among critically ill patients at Baghdad teaching hospitals: A cross-sectional survey. International Journal of Critical Illness and Injury Science, 14(4), 215-220.
2.
AlameriR. A.AlmullaH. A.Al SwyanA. H.HammadS. S. (2024). Sleep quality and fatigue among nurses working in high-acuity clinical settings in Saudi Arabia: A cross-sectional study. BMC Nursing, 23(1), 51.
3.
AlhanbaliS.AljasserA.AboudiO.AlaqrabawiW. AMunroK. J. (2023). Establishing the reliability and the validity of the Arabic translated versions of the Effort Assessment Scale and the Fatigue Assessment Scale. International Journal of Audiology, 62(9), 853-858. doi:10.1080/14992027.2023.2181072
4.
AşkarS. E.OvayoluÖ.OvayoluN. (2024). The effect of progressive relaxation exercise on fatigue level of intensive care nurses: A randomized controlled trial. Australian Critical Care, 37(6), 601-609. doi:10.1016/j.aucc.2024.01.011
5.
BellT.SprajcerM.FlenadyT.SahayA. (2023). Fatigue in nurses and medication administration errors: A scoping review. Journal of clinical nursing, 32(17-18), 5445–5460. https://doi.org/10.1111/jocn.16620
6.
Bodet-ContentinL.LetourneurM.EhrmannS. (2023). Virtual reality during work breaks to reduce fatigue of intensive-care unit caregivers: A crossover, pilot randomized trial. Australian Critical Care, 36(3), 345-349. doi:10.1016/j.aucc.2022.01.009
7.
de CordovaP. B.ReillyL. L.Pogorzelska-MaziarzM.GerolamoA. M.GrafovaI.VasquezA.JohansenM. L. (2024). A theoretical framework for Acute Care Nurse Stress Appraisal: Application of the transactional model of stress and coping. Journal of Advanced Nursing, 80(9), 3835-3845.
8.
FaulF.ErdfelderE.LangA-G.BuchnerA., & G*Power 3. (2007). A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavioral Research Methods, 39(2), 175-191.
9.
HendriksC.DrentM.ElfferichM.de VriesJ. (2018). The Fatigue Assessment Scale: Quality and availability in sarcoidosis and other diseases. Current Opinion Pulmonary Medicine, 24(5), 495-503. doi:10.1097/MCP.0000000000000496
10.
HsuC.LeeF.HungM.ChenL.YenM.ChiangY.ChowH.FetzerS. J.MuF. (2023). Effectiveness of individual-based strategies to reduce nurse burnout: AnUmbrella Review. Journal of Nursing Management, 1, 8544725. https://doi.org/10.1155/2024/8544725
11.
KadhimA. J.MohammadiN.HezbiyanZ.AbbasiniaM.NorouzadehR.TaghadosiM.AghaieB. (2024).The effects of a mindfulness training intervention on fatigue and job satisfaction among emergency nurses: A quasi-experimental study. Nursing Midwifery Studies, 13(1), 9-17.
12.
KavehM. H.MehrazinF.CousinsR.MokaramiH. (2023). Effectiveness of a transactional model-based education programme for enhancing stress-coping skills in industrial workers: A randomized controlled trial. Scientific Reports, 13(1), 5076. https://doi.org/10.1038/s41598-023-32230-2
13.
LazarusR. S.FolkmanS. (1984). Stress, appraisal, and coping. New York: Springer.
14.
MajeedH. M.HassanA. F.JasimA. H.Al-GanmiA. H. (2023). Protective health behaviors among critical care nurses concerning pressure ulcer prevention for hospitalized patients at Baghdad teaching hospitals. Al-Rafidain Journal of Medical Science, 5, 205-210. doi:10.54133/ajms.v5i.211
15.
PapazianL.HraiechS.LoundouA.HerridgeM. S.BoyerL. (2023). High-level burnout in physicians and nurses working in adult ICUs: A systematic review and meta-analysis. Intensive Care Medicine, 49(4), 387-400. https://doi.org/10.1007/s00134-023-07025-8
RossA.Geiger-BrownJ.YangL.FlynnS.CoxR.WehrlenL.LeeL. J. (2021). Acute and chronic fatigue in nurses providing direct patient care and in non-direct care roles: A cross-sectional analysis. Nursing & Health Sciences, 23(3), 628-638. https://doi.org/10.1111/nhs.12862
18.
SchulzK. F.AltmanD. G.MoherD., & CONSORT Group. (2010). CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials. BMJ (Clinical Research Ed.), 340, c332. https://doi.org/10.1136/bmj.c332
19.
TangC.ChenX.GongG.GuanC.LiuC. (2022). Self-reported work-related accumulative fatigue of nurses: A cross-sectional study in public hospitals in China. Frontiers of Public Health, 10, 1019092. doi:10.3389/fpubh.2022.1019092
20.
ToniniE.CrouseJ. J.ShinM.CarpenterJ. S.LloydA. R.HindmarshG.McKennaS.NichlesA.ZmicerevskaN.ScottJ.IorfinoF.PantelisC.NelsonB.McGorryP. D.WoodS. J.YungA. R.PurcellR.HickieI. B. (2025). Multidimensional outcomes associated with chronic fatigue over 12 months in youth with emerging mood disorders. Journal of Psychosomatic Research, 193, 112141. https://doi.org/10.1016/j.jpsychores.2025.112141
21.
YildirimN.YesilbasH.KantekF. (2023). Interventions to reduce nurses’ burnout: A systematic review and meta-analysis. Japan Journal of Nursing Science, 20(4), e12542. https://doi.org/10.1111/jjns.12542
22.
YousifS. Y.Al-FayyadhS. (2025). Burnout among nurses practicing in critical care units: Predicting the contributing factors. Journal of Educational Health Promotion, 14(1), 38.
23.
ZhongX.ZengY.PengL.LiX.JiaY.PanC.WangB. (2025). Levels and related factors of occupational stress among nurses: Hospital-based evidence from China, 2023. Frontiers in Psychology, 15, 1471640. https://doi.org/10.3389/fpsyg.2024.1471640
