A modified Delphi study identifying design priorities, barriers, and implementation requirements for virtual reality–based resilience training for nurses

Nurses face persistent stress, burnout, and psychological strain, highlighting the need for scalable resilience-support interventions. Extended reality (XR) and virtual reality (VR) may enable immersive, skills-oriented stress-management training, but their integration into nursing contexts requires clearer design and implementation guidance. Within the Horizon Europe project XR2ESILIENCE, we conducted a consortium-internal modified Delphi study to identify requirements, barriers, and design principles for VR-based resilience training for nurses.

An interdisciplinary expert panel (N = 21) completed an online ranking of 29 statements across six domains. Consensus was assessed using z-standardized dispersion and Kendall’s W. Items with medium or low consensus were further discussed in six mixed-disciplinary groups during an in-person co-design workshop.

Results showed moderate consensus for incentives and implementation challenges, and emerging consensus in the remaining domains. Experts emphasized that VR resilience training should demonstrate transfer to everyday work, focus on clinically relevant coping skills, and be supported by protected time, usability-by-design, adequate infrastructure, privacy safeguards, and fair delivery models. The findings provide consortium-informed preliminary design guardrails and should be interpreted as internal prioritization signals for subsequent co-design, feasibility testing, and external validation.

Consolidated framework for implementation research This research was funded by the European Union through the Horizon Europe project XR2ESILIENCE (Grant agreement ID: 101137237). The funding body had no role in the study design; collection, analysis, and interpretation of data; writing of the manuscript; or the decision to submit the article for publication. A list of authors and their affiliations appears at the end of the paper.

Center for Digital Health & Social Innovation, University of Applied Sciences St. Pölten, Austria Martin Ernst, Yvonne Prinzellner & Eva Turk Department of Neuropsychology and Psychological Resilience Research, Central Institute of Mental Health, Mannheim, Germany Department of Health Psychology, School of Sustainability, Leuphana University of Lüneburg, Lüneburg, Germany M. Wanner Medical University of Graz, Graz, Austria N.

Wessa SERMAS, Madrilenian Health Service, Madrid, Spain M.J.Almodovar Carretón, C.Báez León, J.Briongos Pastor, J.Cabrerizo Fernández, D.R.Díaz Rodríguez, M.A.Dominguez Conde, M. Hammel, C.Noguera Quijada, P.G.Peñaranda Beltrán, M.P.Ruiz Romera & A.Sanchís Ruiz Health School, University of Évora, CHRC – Comprehensive Health Research Centre, Évora, Portugal; Instituto Politécnico de Viana do Castelo, Viana do Castelo, Portugal E. Fonseca, L.Guedes de Pinho, M.A.Sanchez Uriz & M.