{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T04:22:51Z","timestamp":1793074971949,"version":"4.5.0"},"reference-count":93,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Canadian Department of National Defense"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["DIGITAL HEALTH"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Nurses face high levels of stress, particularly in high-pressure environments, such as hospitals. Digital interventions, including virtual reality (VR), offer promising avenues for educating frontline workers, monitoring momentary distress, and delivering evidence-based stress-reduction programs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study examined: (1) the tolerability, realism, and utility of a VR simulation for eliciting and monitoring stress among nurses; (2) within- (repeated measures) and between- (demographics) participant differences in stress and moral distress responses throughout the VR simulation and across runs; (3) knowledge retention of psychoeducation content; and (4) perceived success and helpfulness of stress-reduction strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Nursing professionals (\n                      <jats:italic toggle=\"yes\">N<\/jats:italic>\n                      = 99) completed two runs of a hospital-based VR simulation interspersed with an 8-minute psychoeducation video regarding moral distress and stress-reduction techniques. Stress and moral distress were assessed in real-time during the simulation, alongside post-VR questionnaires assessing presence and cybersickness, and two interviews (debriefing and exit), analyzed using a qualitative coding schema. The STROBE checklist guided results reporting.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The VR simulation elicited distinct non-linear trajectories of acute stress and moral distress across simulation checkpoints and runs. The intervention was well-tolerated with low cybersickness (VRSQ:\n                      <jats:italic toggle=\"yes\">M<\/jats:italic>\n                      = 13.29), high general presence (IPQ:\n                      <jats:italic toggle=\"yes\">Mdn<\/jats:italic>\n                      = 5.00), and moderate spatial presence and realism (IPQ:\n                      <jats:italic toggle=\"yes\">Mdn<\/jats:italic>\n                      = 3.00). Most participants recalled at least two of the three stress-reduction techniques with high ratings of perceived understanding and helpfulness. However, objective assessments revealed overestimations of conceptual understanding, highlighting gaps in knowledge retention and indicating that tailored, multi-modal psychoeducation may be necessary to ensure consistent uptake and effectiveness across the nursing workforce.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our hospital-based immersive VR simulation is a feasible and ethically sound method for inducing and monitoring stress and moral distress in nurses. Findings underscore the importance of triangulating self-report and objective measures to assess intervention effectiveness and inform future digital health education strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20552076261484009","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T13:44:07Z","timestamp":1788183847000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Working under pressure: How virtual reality and psychoeducation shape stress and moral distress responses in nurses"],"prefix":"10.1177","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5886-0228","authenticated-orcid":false,"given":"Karisa","family":"Parkington","sequence":"first","affiliation":[{"name":"Unity Health Toronto"},{"name":"Department of Psychiatry, Temerty School of Medicine, University of Toronto, Toronto, ON, 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