Background <p>Less sedation has become the standard regimen in patients admitted to an intensive care unit. Consequently, conscious patients experience discomfort and anxiety during their admission. Virtual reality is used in other hospital settings to distract patients and reduce discomfort and anxiety; however, its acceptability in intensive care has yet to be explored. This study aimed to identify and adapt a virtual reality intervention for relaxation and distraction to meet the specific needs of patients admitted to an intensive care unit, focusing on patients’ and nurses’ acceptability of the intervention.</p> Methods <p>This exploratory study was guided by the Medical Research Council’s framework for developing or identifying, evaluating and implementing complex interventions. In the initial phase, combined knowledge from existing literature and experts in virtual reality for healthcare guided the preliminary identification process. Findings from think-aloud interviews with stakeholders guided the final adaptations. The data was analysed using the framework method.</p> Results <p>The combined findings from the literature, stakeholder audit trails and interviews showed consensus that nature films with auditory stimuli were acceptable for inducing relaxation and distraction in critically ill patients, with few or no adverse effects. A key uncertainty regarding virtual reality’s effect on delirium or its potential role in delirium development affected nurses’ acceptability of virtual reality, highlighting a need to consider this risk.</p> Conclusions <p>This intervention identification, adaptation, acceptability and feasibility study concludes that virtual reality for relaxation and distraction is an acceptable intervention in the intensive care unit setting. The identified and adapted virtual reality software intervention was a 10-min 360-degree natural beach film combined with nature sounds and calming music. The identified hardware intervention was a headset connected to a tablet, enabling nurses to control the software. A subsequent study should examine the preliminary short effectiveness and adapt the intervention according to the further findings.</p> Trial registration <p>Retrospectively registered in Open Science Framework 14 Feb 2024. Registration DOI <a href="https://doi.org/10.17605/OSF.IO/BYZ42">https://doi.org/10.17605/OSF.IO/BYZ42</a> .</p>