Managing Patient Condition Changes in the <scp>ICU</scp> : Experiences, Challenges and Adaptations of Junior Nurses

BACKGROUND: Junior nurses in the intensive care units (ICU) may feel insufficiently prepared due to limited clinical competencies. They often encounter challenges in perceiving, predicting and responding to changes in patient conditions, which may impact patient safety and the quality of care. AIM: To explore how junior nurses working in the ICU experience and manage changes in patient conditions. STUDY DESIGN: A descriptive qualitative approach was utilised to conduct a study with 15 registered nurses with less than 2 years of experience working in ICU in China. Data were collected through semi-structured interviews and analysed using inductive thematic analysis. FINDINGS: Three core themes emerged: (1) cognition of patient condition changes, (2) anticipation of patient deterioration and (3) recognition and response to patient deterioration. Participants primarily relied on organisational norms and personal experiences rather than the best available evidence in information acquisition, analysis and clinical decision-making. CONCLUSIONS: Our findings indicated that junior nurses may rely on personal experience and organisational norms when managing patient condition changes. They expressed a need for teamwork and collaborative learning, but they reported a lack of confidence in initiating it. These findings highlighted the need to support junior nurses from organisational and cultural perspectives to enhance their capabilities and improve the quality of managing patient condition changes. RELEVANCE TO CLINICAL PRACTICE: This study identified critical competency gaps in patient management among junior ICU nurses, underscoring the need to embed evidence-based protocols into informal learning processes to reduce safety risks and promote context-sensitive clinical decision-making.