Maintaining skin integrity in pediatric patients in pediatric intensive care units: Qualitative study of nursing practices and clinical decision-making.

BACKGROUND

This study aimed to explore pediatric intensive care unit (PICU) nurses' practices, experiences, and decision-making processes related to the preservation of skin integrity in pediatric patients.

METHODS

An inductive qualitative study using thematic analysis was conducted. Data were collected between February and August 2025 through semi-structured, in-depth, face-to-face interviews with 22 nurses working in PICUs. Interviews were audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis in accordance with Braun and Clarke's framework. Methodological rigor was ensured through data saturation, inter-coder agreement, member checking, and adherence to the COREQ reporting guideline.

RESULTS

Five main themes emerged: (1) Nursing practices for skin care, (2) Materials and technological devices used to preserve skin integrity, (3) Multidimensional effects of skin protection practices, (4) Factors shaping nurses' clinical decisions, and (5) Nurses' needs related to pediatric skin care practices. Nurses actively managed skin integrity through hygienic and therapeutic interventions, mechanical pressure and equipment management, moisture control, environmental regulation, and interprofessional collaboration. Nurses perceived that skin care practices may contribute to clinical recovery, hemodynamic stability, comfort, sleep quality, and hospitalization experiences. Clinical decision-making was shaped by patient characteristics, clinical experience, team-based communication, institutional resources, and access to evidence-based knowledge.

CONCLUSIONS

Pediatric skin care in intensive care settings extends beyond technical interventions and represents a holistic domain of nursing care with physiological, psychosocial, and organizational implications. Strengthening evidence-based, standardized, and interdisciplinary skin care approaches, alongside targeted nurse education and supportive institutional policies, is essential to sustain high-quality pediatric intensive care.