“It’s not just our nurses’ responsibility”—The assessment dilemmas of ICU nurses for acute skin failure: A qualitative study

The intensive care unit (ICU) is a special medical unit that integrates human and technical resources to conduct advanced monitoring and intervention for patients with critical illness, unstable vital signs, or risk of multiple organ failure. Acute skin failure (ASF) is a skin problem that ICU nurses need to focus on, and accurate assessment is key to preventing skin damage from occurring. Due to the nascent status of research on ASF, ICU nurses may encounter numerous obstacles in the assessment and management of this condition. This study aimed to elucidate the challenges faced by ICU nurses in evaluating ASF and to offer a foundation for enhancing management protocols and assessment instruments for this condition. A descriptive qualitative research approach was used to gain insight into the dilemmas of ICU nurses when assessing patients with ASF. A purposive sampling method was employed to select ICU nurses from a tertiary grade A hospital in Nanjing for semi-structured interviews conducted between December 2024 and January 2025. The Colaizzi 7-step analysis method was used to analyze the data, which includes familiarizing with the material, extracting statements, constructing meanings, clustering themes, describing the phenomenon, verifying the essence, and respondents' feedback. Twelve ICU nurses participated in this study. A total of 3 themes and 9 subthemes were distilled. The themes identified included insufficient theoretical knowledge and practical experience related to ASF (insufficient ASF training experience, lack of autonomous learning awareness, and insufficient capacity for dynamic assessment), dilemma of resource allocation (lack of specific assessment tools, inevitable assessment delays under high workloads, and lack of advanced assessment equipment for ASF), and deficiencies in the ASF management system (poor medical electronic information recording module, lack of ASF specific quality control indicators, ambiguity of responsibility and collaborative inertia). ICU nurses encounter numerous dilemmas and challenges when assessing ASF. Improving the process of assessment and management of ASF and the development of appropriate tools are future research priorities.