Navigating Spinal Safety: Critical Care Nurses' Experiences of Caring for Patients With Spinal Trauma and Disorders

ABSTRACT

Background

Patients with spinal trauma and disorders admitted to intensive care units (ICUs) require complex care that combines life‐sustaining treatment, spinal precautions, complication prevention and rehabilitation‐related support. Although ICU nurses are central to maintaining patient safety, little is known about their experiences of caring for this patient group.

Aim

To explore ICU nurses' experiences of caring for patients with spinal trauma and disorders.

Study Design

A descriptive qualitative study.

Methods

Fifteen ICU nurses from three tertiary hospitals in Hunan Province, China, were recruited using purposive sampling. Data were collected through one‐to‐one semi‐structured interviews between January and April 2026. Interviews were audio‐recorded, transcribed verbatim and analysed using Braun and Clarke's thematic analysis. The study was reported in accordance with the COREQ checklist.

Findings

Five themes were generated: maintaining spinal safety during ICU care; managing the burden of immobility and high dependency; working under pressure in high‐risk spinal care; making care safer through team support; and building specialist competence within ICU practice. Nurses experienced spinal safety as a continuous concern embedded in routine ICU care, including coordinating high‐risk logrolling and transfer, recognising neurological changes with limited confidence and balancing positioning, orthosis use and pressure‐injury risks. They also described interrelated physiological needs, frequent and precise patient needs, rehabilitation limits, uncertain prognosis, reliance on team support and more vigilant, anticipatory and holistic care.

Conclusions

Caring for patients with spinal trauma and disorders in ICUs requires nurses to balance spinal safety, critical illness management, high dependency care and emotional support. ICU nurses developed anticipatory and holistic approaches, but also experienced uncertainty and pressure when specialist spinal care knowledge was limited.

Relevance to Clinical Practice

ICU teams should develop spinal safety checklists, standardised guidance for logrolling, transfer, positioning and orthosis management and practical training programmes. Strengthening collaboration between ICU teams and spinal specialists may improve nurse competence and patient safety.

Impact Statements

• What is known about this topic

  • ○
    Patients with spinal trauma and disorders may experience neurological impairment, immobility, respiratory complications, pressure‐injury risk and long‐term disability.
  • ○
    ICU nurses play a key role in monitoring, preventing complications and coordinating care, but spinal‐specific nursing challenges in ICU settings remain underexplored.
• What this paper adds

  • ○
    This study shows that ICU nurses experience spinal safety as continuous work embedded in everyday ICU care, rather than as a single technical procedure.
  • ○
    The findings identify key practice needs, including spinal safety checklists, hands‐on training, clearer escalation pathways for neurological changes and stronger multidisciplinary support.

1. Introduction

Spinal trauma and spinal disorders are clinically complex conditions that may lead to neurological impairment, immobility, pain, long‐term disability and psychosocial distress. Spinal cord injury, one of the most serious consequences of spinal pathology, may result from traumatic events such as falls and road traffic injuries, as well as non‐traumatic causes including tumours, degenerative disease, vascular disorders and infection [1]. Recent epidemiological evidence shows that spinal cord injury continues to impose a substantial global burden, with important implications for acute care, rehabilitation and long‐term support [2].

Patients with spinal trauma and disorders admitted to intensive care units (ICUs) often present with multiple risks, including respiratory compromise, haemodynamic instability, postoperative vulnerability, impaired mobility, pressure‐injury risk and potential neurological deterioration. Acute spinal cord injury guidelines emphasise the importance of haemodynamic management to maintain spinal cord perfusion and reduce secondary injury [3]. Respiratory complications and pressure injuries are also well‐recognised challenges in this population and may contribute to prolonged critical care needs and poorer outcomes [4, 5, 6]. These characteristics make spinal safety a central concern in critical care nursing.

2. Background

Critical care nurses play a key role in maintaining physiological stability, preventing complications and coordinating complex care. When caring for patients with spinal trauma and disorders, they must also preserve spinal alignment, support safe positioning and transfer, monitor neurological changes, manage airway and secretion clearance, protect skin integrity and respond to patients' psychological and family‐related needs. However, these responsibilities may be challenging for nurses who have not received systematic training in spinal specialist care.

Previous qualitative studies have explored nurses' experiences of caring for patients with spinal cord injury and have shown that such care can be technically demanding and emotionally complex [7, 8]. However, existing evidence has mainly focused on spinal, rehabilitation or general orthopaedic contexts. Less is known about how critical care nurses experience caring for patients with spinal trauma and disorders in ICUs, where spinal precautions must be balanced with life‐sustaining treatment, rapid clinical changes and high care dependency. Understanding these experiences may help identify gaps in training, clinical pathways, specialist support and interprofessional collaboration and may inform strategies to improve spinal safety in critical care practice.

3. Aim

The aim of this study was to explore critical care nurses' experiences of caring for patients with spinal trauma and disorders in ICUs.

4. Design and Methods

4.1. Design

A descriptive qualitative design was used to explore critical care nurses' experiences of caring for patients with spinal trauma and disorders in ICUs. This design was appropriate because the study aimed to provide a practice‐oriented description of participants' experiences while remaining close to their accounts [9, 10]. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist [11].

4.2. Setting and Participants

The study was conducted in ICUs across three tertiary hospitals in Hunan Province, China, between January and April 2026. Purposive sampling was used to recruit nurses with variation in gender, age, professional title, years of critical care experience and ICU setting. Potential participants were approached through direct contact by the researchers, invitation messages in work‐related WeChat groups and face‐to‐face invitations.

Nurses were eligible if they were registered nurses, worked in an ICU, had experience caring for patients with spinal trauma or spinal disorders and were willing to participate in an audio‐recorded interview. In this study, the term ‘patients with spinal trauma and disorders’ was used to refer to ICU patients whose care involved spinal‐related risks or precautions, including patients with traumatic spinal injury, spinal cord injury, postoperative spinal conditions, severe spinal deformity or other spinal‐related conditions requiring intensive care. The study focused on nurses' experiences of caring for this patient group rather than on patients' diagnoses or outcomes. Nurses who were students, trainees, rotating nurses without independent patient care responsibilities or unable to complete an interview were excluded. Sixteen nurses were approached, and one declined because she considered her experience with this patient group insufficient. Fifteen nurses were included in the final sample.

4.3. Data Collection

Data were collected through one‐to‐one semi‐structured interviews. The interview guide was developed based on a literature review and the study aim, reviewed by one professor in orthopaedic nursing and one professor with expertise in qualitative research and revised after two pilot interviews. The pilot interviews were conducted with two ICU nurses who met the eligibility criteria and had experience caring for patients with spinal trauma or spinal disorders. These two nurses were not included in the formal sample or data analysis. The main interview questions are presented in Table 1.

TABLE 1.

Interview guide.

No.	Interview questions
1	Can you recall your experience of caring for patients with spinal trauma or spinal disorders in ICU nursing practice?
2	What feelings or emotions did caring for these patients bring to you?
3	What difficulties did you encounter when caring for these patients?
4	Compared with other ICU patients you have cared for, what do you think is the main difference in caring for patients with spinal trauma or spinal disorders?
5	What kinds of support have you received when caring for these patients? If support was insufficient, what kinds of help did you need?
6	What suggestions or experiences would you like to share regarding the nursing care of patients with spinal trauma or spinal disorders?
7	Is there anything else about caring for patients with spinal trauma or spinal disorders that we have not discussed but you would like to add?

Note: ICU, intensive care unit. The interview guide was used flexibly. Follow‐up prompts were asked according to participants' responses to encourage further clarification and elaboration.

Two researchers conducted the interviews. One was male and one was female; both held master's degrees, had clinical nursing backgrounds and had received systematic training in qualitative research. At the time of the study, they were nurse researchers involved in critical care and orthopaedic nursing research. They had no direct managerial, supervisory or performance appraisal relationship with the participants. Where prior professional contact existed, it was limited to clinical or academic networks and did not involve authority over participants' work evaluation or employment. To minimise potential influence, the interviewers used open‐ended questions, encouraged participants to describe both positive and difficult experiences, avoided expressing judgement and recorded reflexive memos after interviews.

Interviews were conducted either face to face or via secure online meeting rooms, according to participants' preferences and availability. All interviews were conducted in private settings, and no non‐participants were present. With consent, all interviews were audio‐recorded and lasted approximately 30–60 min. Field notes and reflexive memos were made during and after interviews. Supplementary interviews were conducted when clarification or additional information was needed. Audio recordings were transcribed verbatim, checked against the recordings, anonymised and returned to participants for checking. Data collection and preliminary analysis were conducted concurrently until no substantially new codes or themes were identified.

4.4. Data Analysis

Data were managed using NVivo and analysed using Braun and Clarke's thematic analysis [12, 13]. The analysis moved iteratively from interview data to initial codes, candidate subthemes and overarching themes. The two researchers repeatedly read the transcripts and field notes, recorded preliminary analytic thoughts and coded meaningful text segments line by line. Initial codes remained close to participants' accounts, such as ‘fear during repositioning’, ‘mental tension about secondary injury’, ‘empathy for young patients with disability’, ‘frustration despite intensive care’ and ‘sense of achievement when deterioration was prevented’. Related codes were compared across transcripts and clustered into candidate subthemes by examining repeated patterns, similarities and differences in nurses' accounts. For example, codes related to fear during turning, concern about secondary injury and continuous mental tension were developed into the subtheme ‘Fear of causing secondary injury’, which contributed to the theme ‘Working under pressure in high‐risk spinal care’. Candidate subthemes and themes were reviewed against the coded extracts and the full dataset to ensure that they reflected nurses' experiences rather than only care activities or procedures. Disagreements were resolved through discussion and by returning to the original transcripts. Themes were refined through repeated team discussion and named to reflect their central meanings. Representative quotations were selected to illustrate each theme and were labelled using participant numbers.

Several strategies were used to enhance trustworthiness [14]. Credibility was supported through purposive sampling, audio‐recorded interviews, verbatim transcription, participant checking of transcripts and use of representative quotations. Dependability and confirmability were enhanced by maintaining an audit trail, including field notes, reflexive memos, coding records and theme development documents. Transferability was supported by providing contextual information about participants, settings and data collection.

4.5. Ethical Considerations

Ethical approval was obtained from the Clinical Medical Ethics Committee of Xiangya Hospital, Central South University on 29 August 2025 (Approval No. 2025091188). Written informed consent was obtained from all participants. Participants were informed that participation was voluntary and that they could withdraw at any time without consequence. Permission to recruit participants was obtained from the nursing departments of the participating institutions. All data were anonymised, stored securely and accessible only to the research team.

5. Findings

Fifteen nurses completed the interviews and were included in the analysis. Their demographic and professional characteristics are presented in Table 2. Five themes were generated from the analysis: maintaining spinal safety during ICU care; managing the burden of immobility and high dependency; working under pressure in high‐risk spinal care; making care safer through team support; and building specialist competence within ICU practice. Together, these themes describe how ICU nurses navigated spinal safety while balancing spinal precautions, life‐sustaining care, care burden, emotional pressure and the need for team‐based support. The themes and subthemes are presented in Table 3.

TABLE 2.

Characteristics of participants.

Participant	Gender	Age, years	Education	Professional title	Nursing/critical care experience, years	ICU setting	Rotating evening/night shifts
N1	Female	24	Bachelor's degree	Nurse	3/3	General ICU	Yes
N2	Male	30	Bachelor's degree	Senior nurse	8/8	Medical ICU	No
N3	Male	28	Master's degree	Senior nurse	7/6	Respiratory ICU	Yes
N4	Female	30	Bachelor's degree	Senior nurse	8/7	Respiratory ICU	Yes
N5	Female	28	Bachelor's degree	Nurse	6/6	General ICU	Yes
N6	Female	32	Bachelor's degree	Senior nurse	11/11	Emergency ICU	Yes
N7	Female	32	Bachelor's degree	Senior nurse	10/8	Neurosurgical ICU	Yes
N8	Female	27	Bachelor's degree	Nurse	5/5	Respiratory ICU	Yes
N9	Female	28	Bachelor's degree	Senior nurse	7/6	Cardiac surgical ICU	Yes
N10	Female	27	Bachelor's degree	Nurse	6/6	Respiratory ICU	Yes
N11	Male	25	College diploma	Nurse	3/1.5	Cardiac surgical ICU	Yes
N12	Female	27	College diploma	Nurse	5/4	Respiratory ICU	Yes
N13	Male	26	Bachelor's degree	Nurse	4/3	Respiratory ICU	Yes
N14	Male	24	Bachelor's degree	Nurse	3/2	Respiratory ICU	Yes
N15	Female	38	Bachelor's degree	Senior nurse	15/12	Neurological ICU	Yes

Note: ICU, intensive care unit. Professional title was grouped according to the Chinese nursing title system for reporting purposes and does not necessarily indicate managerial or shift‐leader roles. Rotating evening/night shifts indicate involvement in evening and/or night shift rotations.

TABLE 3.

Themes and subthemes.

Theme	Subthemes
Theme 1. Maintaining spinal safety during ICU care	Coordinating high‐risk logrolling and transfer; Recognising neurological changes with limited confidence; Balancing positioning, orthoses and pressure‐injury risks
Theme 2. Managing the burden of immobility and high dependency	Addressing interrelated respiratory, skin, bowel and pain‐related needs; Responding to frequent and precise patient needs; Facing rehabilitation limits and uncertain prognosis
Theme 3. Working under pressure in high‐risk spinal care	Fear of causing secondary injury; Empathy for disability and young patients; Emotional fluctuation between distress and reward
Theme 4. Making care safer through team support	Receiving support from senior nurses and peers; Relying on multidisciplinary collaboration; Seeking protocols and hands‐on training
Theme 5. Building specialist competence within ICU practice	Becoming more vigilant and anticipatory; Recognising psychological and family support as part of care; Self‐protection and professional growth

Note: ICU, intensive care unit.

5.1. Theme 1: Maintaining Spinal Safety During ICU Care

This theme describes how ICU nurses experienced spinal safety as a continuous concern in everyday ICU care. Spinal safety involved not only maintaining alignment during logrolling, transfer and transport, but also recognising neurological changes and balancing positioning, orthosis use, comfort and pressure‐injury prevention.

5.1.1. Coordinating High‐Risk Logrolling and Transfer

Participants described logrolling, a turning technique used to maintain spinal alignment and transfer, as high‐risk procedures that required technical accuracy and team coordination. One nurse explained that logrolling was difficult because the whole body had to be moved as a unit:

Logrolling is common, but it is difficult to do it in a standardised way. It requires several people to work together, and we have to make sure the head, neck and body, the whole spine, turn in one straight line. (N1)

Another participant emphasised that moving patients between beds could not be performed in the same way as for other ICU patients:

When moving the patient between beds, we need to use tools such as transfer boards. We cannot lift them in the usual way. (N15)

These accounts show that routine turning and transfer became high‐risk coordinated work when spinal stability had to be maintained.

5.1.2. Recognising Neurological Changes With Limited Confidence

Nurses also reported uncertainty in assessing neurological changes. Some participants compared their practice with that of spinal specialist nurses and felt that their assessment and documentation were less specific:

We do not assess the injured segment by using a cotton swab to test sensation like spinal surgery nurses do, and we do not have professional records for this. This may be a potential risk for disputes. (N3)

For others, this uncertainty was experienced as a clear gap in their ICU nursing practice:

We do not know how to assess changes in sensation or whether neurological deterioration has occurred. I feel this is a blind spot in my nursing care. (N15)

This uncertainty suggests that spinal safety was not only a matter of physical immobilisation, but also depended on nurses' ability to recognise subtle neurological changes.

5.1.3. Balancing Positioning, Orthoses and Pressure‐Injury Risks

Positioning and orthosis management were another source of concern. Nurses had to balance spinal precautions, patient comfort, pressure‐injury prevention and ICU devices such as ventilators and tubes. One participant described how severe spinal deformity made routine positioning difficult:

Positioning is very difficult. For example, patients with severe spinal deformity cannot lie flat, and their bodies are always curled up. (N10)

Orthoses also created uncertainty, particularly when nurses were unsure about correct application or removal:

What is the correct way to wear this kind of cervical collar? The collars brought in by patients often have different sizes and wearing methods. (N5)

These experiences indicate that maintaining spinal safety during ICU care required nurses to make continuous adjustments between immobilisation, comfort and prevention of device‐related complications.

5.2. Theme 2: Managing the Burden of Immobility and High Dependency

This theme describes the intensified care burden that ICU nurses experienced when caring for patients with spinal trauma and disorders. Participants reported that immobility, sensory disturbance, impaired self‐care ability and multiple complications made care more demanding than routine ICU nursing. Nurses had to manage physiological risks while also responding to frequent, highly specific bodily needs.

5.2.1. Addressing Interrelated Respiratory, Skin, Bowel and Pain‐Related Needs

Participants described respiratory, skin, bowel and pain‐related needs as recurrent and interrelated challenges. For some nurses, airway clearance required constant vigilance because deterioration could occur rapidly.

One nurse described the need for more intensive airway management than usual:

These patients have a lot of sputum, probably because they are bedridden for a long time and have poor lung function. We must suction more frequently than for ordinary patients, otherwise their oxygen saturation drops very quickly. (N1)

Other nurses emphasised that immobility and impaired sensation increased the risk of bowel problems and skin injury. One participant explained how incontinence could quickly lead to skin complications:

Paralysed patients often have constipation or diarrhoea, and the risk of incontinence‐associated dermatitis is very high. (N5)

These accounts suggest that caring for such patients required nurses to manage several interrelated complications at the same time, rather than addressing isolated nursing problems.

5.2.2. Responding to Frequent and Precise Patient Needs

Participants also described patients' needs as frequent, detailed and difficult to fully meet within the busy ICU environment. This was particularly evident among conscious patients with paralysis, sensory disturbance or discomfort from prolonged immobility.

One nurse described how patients repeatedly requested small adjustments:

He would ask for water from time to time, ask to be turned from time to time, and as long as he felt a little itch on his back, he would ask to be turned. (N1)

Another participant emphasised how precise these requests could be:

I could only keep communicating with him and help him move his position. His need for position adjustment was very detailed; sometimes he only asked me to move him two centimetres to the right. (N7)

These accounts show that patients' high dependency created continuous demands for ICU nurses. Nurses not only had to provide basic care, but also needed to respond repeatedly to small changes in comfort, position and bodily sensations.

5.2.3. Facing Rehabilitation Limits and Uncertain Prognosis

Nurses also described facing limits in rehabilitation support and uncertainty around prognosis. Although participants recognised the importance of early rehabilitation, they felt that ICU care represented only one stage in a much longer recovery trajectory, which limited their ability to answer patients' and families' questions.

One nurse described rehabilitation as a broad concept but felt that available ICU interventions were limited:

Rehabilitation is a comprehensive concept, including early removal of tubes, limb exercise, nutrition and so on, but the rehabilitation measures we can provide are very limited. (N2)

Another participant described difficulty responding to patients' and families' concerns about long‐term outcomes:

Patients and families are very confused about what the later treatment effect will be, but because our emergency ICU is only one part of the whole treatment and rehabilitation process, I cannot answer them. We have not followed up the prognosis of these patients. (N6)

These accounts reflect the tension between ICU care and long‐term recovery needs. Nurses were expected to support early recovery but often faced limited rehabilitation capacity and lacked the continuity of information needed to explain prognosis or rehabilitation outcomes.

5.3. Theme 3: Working Under Pressure in High‐Risk Spinal Care

This theme captures the emotional pressure experienced by ICU nurses when caring for patients with spinal trauma and disorders. Participants described feeling tense, fearful and emotionally affected because small omissions or improper movements could lead to serious consequences. At the same time, they also experienced empathy, reflection and professional reward when patients stabilised or improved.

5.3.1. Fear of Causing Secondary Injury

Fear of causing secondary injury was a prominent experience. Nurses described spinal care as requiring constant caution, especially during turning, transfer and positioning.

One nurse directly expressed fear during repositioning:

I am afraid that turning the patient may cause secondary injury. (N1)

Another participant described this fear as a state of continuous tension:

I feel mentally tense all the time, thinking that I must not cause secondary injury to the patient. (N14)

These statements show that spinal safety was emotionally demanding. Nurses were not only performing technical procedures but also carrying the psychological weight of preventing irreversible harm.

5.3.2. Empathy for Disability and Young Patients

Participants were also deeply affected by the age, disability and potential long‐term dependence of some patients. Young patients with traumatic injuries appeared to evoke particularly strong emotional responses.

One nurse described feeling regret when caring for young patients with multiple injuries:

I feel a little sorry for them, because many patients admitted with multiple trauma are still very young. (N1)

Another participant reflected on the life‐changing consequences of spinal cord injury:

Such a young patient may be paralysed in the lower body and may have urinary and faecal incontinence for the rest of his life. (N6)

These responses suggest that nurses' emotional pressure was shaped not only by clinical risk but also by their awareness of patients' future disability and disrupted life trajectories.

5.3.3. Emotional Fluctuation Between Distress and Reward

Participants described emotional fluctuation between distress and reward. They felt frustrated or guilty when complications occurred despite intensive care, but they also gained a sense of achievement when patients remained stable, avoided further harm or transferred out of ICU.

One nurse described frustration when skin injury could not be fully prevented despite frequent repositioning:

Even though I turned the patient every hour, some patients still could not avoid pressure injuries. I felt that I had tried my best but could not improve the outcome, and I felt frustrated. (N9)

However, nurses also described professional reward when their care contributed to patient safety and recovery:

Through logrolling and skin protection, we prevented the patient's pressure injury from worsening and helped the patient get through the safe period. That gave me a sense of achievement. (N9)

This fluctuation between distress and reward shows that high‐risk spinal care was emotionally complex. Nurses experienced pressure and self‐questioning, but successful prevention of deterioration also reinforced their professional value.

5.4. Theme 4: Making Care Safer Through Team Support

This theme describes how nurses relied on team‐based support to make spinal care safer in the ICU. Participants did not experience spinal safety as an individual responsibility alone. Instead, they described learning from senior nurses, seeking help from colleagues and drawing on multidisciplinary input to reduce uncertainty and improve care.

5.4.1. Receiving Support From Senior Nurses and Peers

Participants commonly described senior nurses and peers as important sources of practical knowledge. For some, learning occurred through everyday work rather than formal training. One nurse explained how experience was passed on informally:

Most of my nursing experience came from senior nurses and the head nurse. I gradually learned how to care for these patients through their guidance. (N1)

Peer support was also important during high‐risk procedures such as turning and positioning. One participant described how the team shared experience and adjusted care plans within the unit:

Our whole department shares nursing experience in the WeChat group. The department also makes nursing plans for patients, and handovers between colleagues are more detailed. (N8)

These accounts show that peer learning and team communication helped nurses compensate for limited formal spinal specialist training.

5.4.2. Relying on Multidisciplinary Collaboration

Participants also described multidisciplinary collaboration as essential to managing complex spinal patients in the ICU. Nurses drew on input from spinal surgeons, rehabilitation therapists, respiratory therapists and nutrition teams to manage problems beyond their own expertise.

One nurse described how rehabilitation input was integrated into care:

We work with rehabilitation therapists to provide rehabilitation training and use a multidisciplinary collaborative model. (N8)

Another participant emphasised the role of respiratory therapists in managing respiratory risks:

Respiratory therapists dynamically adjust ventilator parameters and help develop sputum clearance plans. (N12)

These examples indicate that nurses viewed spinal care in the ICU as a shared process. Multidisciplinary collaboration helped them manage the overlap between critical illness, spinal precautions and rehabilitation needs.

5.4.3. Seeking Protocols and Hands‐On Training

Despite team support, participants still expressed a need for clearer protocols and more practical training. They wanted guidance that could be directly applied to ICU work, rather than lengthy theoretical teaching.

One nurse suggested that standardised tools could help reduce uncertainty:

I suggest establishing a standardised nursing checklist for ICU patients with spinal conditions. (N14)

Several participants preferred short, practical and experience‐based training. One nurse described a hands‐on approach to learning about orthoses:

For orthosis use, I think nurses could wear the devices themselves and experience how they feel, like a simulated patient experience workshop. (N5)

These views suggest that nurses needed structured, practical support to translate spinal specialist knowledge into ICU routines.

5.5. Theme 5: Building Specialist Competence Within ICU Practice

This theme describes how nurses developed their own approaches to caring for patients with spinal trauma and disorders within ICU practice. Participants described becoming more observant, more anticipatory and more aware of patients' psychological and family needs. They also reflected on the importance of asking for help and protecting themselves during physically demanding care.

5.5.1. Becoming More Vigilant and Anticipatory

Participants emphasised that patients with spinal trauma and disorders required careful observation because deterioration could be subtle or rapid. One nurse described the need for more detailed surveillance:

These patients' conditions can be hidden, so more careful observation is needed. (N1)

Nurses also described taking anticipatory action to prevent complications or safety events. One participant explained how nurses needed to prepare for agitation when sedation was reduced:

When the patient changes from a sedated state to being awake, they may become agitated. We need to take anticipatory measures, such as better limb restraint, to prevent large movements causing secondary injury or accidental tube removal. (N3)

These accounts suggest that specialist competence was built not only through technical procedures, but also through ICU surveillance and early risk anticipation.

5.5.2. Recognising Psychological and Family Support as Part of Care

Participants recognised that caring for conscious patients with paralysis or long‐term immobility involved psychological and family‐related support, not only physical protection. Nurses described emotional care as part of their responsibility, particularly when patients appeared distressed or hopeless.

One nurse described the emotional needs observed at the bedside:

From his eyes, I could feel that he had lost hope in life. We need to talk with him at the bedside. (N7)

Family involvement was also viewed as a way to support patients emotionally and improve cooperation. One participant described using family contact to help with psychological care:

Letting family members have regular video calls or visit the ICU allows them to participate in the patient's psychological support. (N6)

These accounts show that nurses understood spinal care as more than physical protection. Psychological support and family connection were recognised as important parts of caring for patients whose mobility, independence and future recovery were uncertain.

5.5.3. Self‐Protection and Professional Growth

Participants also reflected on their own professional behaviour and physical safety. Some nurses emphasised that uncertainty should prompt help‐seeking rather than independent judgement without support. One participant stated:

If you do not understand something, you must ask more questions and cannot take it for granted. (N2)

Self‐protection was especially important during physically demanding care such as lifting, turning and transfer. One nurse reflected on personal injury and the need to protect both patient and nurse:

I developed lumbar disc herniation in my third year of work because of lifting patients. We should think about how to save effort and protect ourselves while protecting the patient. (N15)

These reflections suggest that professional growth involved both clinical learning and self‐awareness. Nurses became more conscious of asking for support, working safely and developing the patience, caution and responsibility required for spinal care in the ICU.

6. Discussion

This study explored ICU nurses' experiences of caring for patients with spinal trauma and disorders. The findings show that caring for this patient group required nurses to navigate spinal safety within complex ICU environments. Participants described protecting spinal alignment, managing immobility‐related complications, responding to high levels of dependency, coping with emotional pressure and seeking support from colleagues and multidisciplinary teams. These experiences suggest that spinal care in the ICU is not limited to specialist procedures such as logrolling or orthosis management, but involves continuous surveillance, coordinated teamwork and anticipatory decision‐making.

6.1. Spinal Safety as Continuous ICU Safety Work

A key finding of this study is that spinal safety was experienced as a continuous form of ICU safety work rather than a single technical procedure. Participants described logrolling, transfer, positioning, orthosis management and neurological observation as routine but high‐risk elements of care. This finding extends current acute spinal cord injury guidance, which emphasises haemodynamic management, maintenance of spinal cord perfusion and prevention of secondary neurological injury [3]. At the bedside, however, nurses' accounts suggest that secondary injury prevention also depends on the accurate performance of daily care procedures, adequate staff coordination and timely recognition of neurological deterioration.

The uncertainty expressed by nurses in neurological assessment is particularly important. The International Standards for Neurological Classification of Spinal Cord Injury provide a structured approach to assessing motor and sensory function after spinal cord injury [15, 16], and autonomic function after spinal cord injury can also be systematically documented using international standards [17]. However, several participants felt that such assessments were mainly conducted by doctors, rehabilitation professionals or spinal specialists, leaving ICU nurses less confident in identifying subtle neurological or autonomic changes. This gap suggests that spinal safety requires not only immobilisation and careful handling, but also enhanced nursing surveillance and clearer escalation pathways when changes are identified.

6.2. The Hidden Care Burden of Immobility and High Dependency

A second important finding was the intensified care burden associated with immobility and high dependency. Participants described respiratory care, skin protection, bowel management, pain control and frequent position‐related requests as continuous demands. This is consistent with evidence that spinal cord injury can impair respiratory mechanics, cough effectiveness and secretion clearance, increasing the risk of respiratory failure, pneumonia and prolonged ventilatory support [4]. In this study, nurses' accounts of frequent suctioning and rapid oxygen desaturation show how these risks were experienced as real‐time vigilance and workload in ICU practice.

Skin and bowel care also contributed substantially to perceived burden. People with spinal cord injury are at high risk of pressure injury because of immobility, sensory loss and multiple secondary physiological impairments [18, 19]. A systematic review and meta‐analysis also reported a high global burden of pressure ulcers among patients with spinal cord injury [6]. Similarly, neurogenic bowel dysfunction may involve constipation, faecal incontinence and altered gastrointestinal motility, requiring structured and ongoing management [20]. Our findings add that these complications are not experienced by ICU nurses as separate nursing problems. Rather, they interact in practice: immobility, incontinence, pain and positioning difficulties can reinforce each other and create cumulative care demands. Conscious patients with paralysis or sensory disturbance may also require repeated communication and small position adjustments, which are easily overlooked in guidelines but strongly shape nurses' workload.

6.3. Bridging the Gap Between ICU Competence and Spinal Specialist Competence

This study highlights a practical competence gap between general ICU nursing expertise and spinal specialist care. ICU nurses are skilled in monitoring, life support, airway management and rapid response, but participants reported uncertainty in spinal‐specific areas such as neurological assessment, orthosis application, positioning restrictions, rehabilitation timing and prognosis explanation. Previous qualitative studies conducted in an Australian spinal unit and in a Taiwanese nursing context have shown that nurses caring for patients with spinal cord injury experience care as technically demanding and emotionally complex [7, 8]. Our findings extend this evidence by locating these challenges specifically within ICU practice, where spinal precautions must be balanced with ventilation, invasive devices, sedation, transport and acute deterioration.

The findings suggest that this gap should not be interpreted simply as an individual deficit in nurses' knowledge. Rather, it reflects a mismatch between the complexity of ICU spinal care and the availability of specialist support, protocols and training. Similarly, qualitative studies of trauma and critical care nursing conducted in Swedish ICU and trauma‐team contexts, together with an exploratory multiple case study of ICU trauma education in Saudi Arabia, have shown that nurses value preparation, practical education and clearer support for managing complex trauma patients [21, 22, 23]. In our study, nurses preferred short, practical and case‐based training rather than lengthy theoretical sessions. Therefore, spinal safety education in the ICU should include simulation‐based practice [24] for logrolling and transfer, bedside checklists for neurological observation and orthosis care and clear pathways for consultation with spinal surgeons, rehabilitation therapists and specialist nurses.

6.4. Emotional Pressure, Team Support and Professional Growth

Participants' accounts also show that high‐risk spinal care carried a significant emotional burden. Nurses feared causing secondary injury, felt empathy for young patients facing disability and described frustration or guilt when complications occurred despite intensive care. Previous research has found that nurses caring for patients with spinal cord injury may confront emotional difficulty, uncertainty and profound awareness of patients' life changes [7, 8]. In trauma care, critical care nurses have also described the need to prepare for unexpected situations and to manage the emotional impact of caring for severely injured patients [22]. Our findings are consistent with this literature, but further show that emotional pressure in ICU spinal care is closely linked to nurses' perception that ordinary care activities could have irreversible consequences.

At the same time, participants described professional reward when patients stabilised, avoided further deterioration or transferred out of the ICU. This fluctuation between distress and reward suggests that emotional support for nurses should not be separated from clinical safety systems. Team support, senior nurse guidance, multidisciplinary collaboration and reflective discussion may help nurses manage uncertainty and sustain professional confidence [25, 26, 27]. The need for multidisciplinary collaboration is especially relevant because spinal trauma and disorders involve respiratory, neurological, rehabilitation, nutritional and psychosocial needs. Interprofessional education and communication training in spinal cord injury/disorder care may support clearer role understanding and more coordinated care [28]. In this sense, building specialist competence within ICU practice requires both technical training and a supportive team culture that recognises the emotional work of spinal safety.

6.5. Limitations

This study has several limitations. First, participants were recruited from three tertiary hospitals in one province in China, which may limit the transferability of the findings to other regions, healthcare systems or ICU settings. Second, the study relied on nurses' retrospective accounts, which may be influenced by recall bias or social desirability. Third, although participants were recruited from different types of ICUs, the perspectives of patients, family members, spinal surgeons, rehabilitation professionals and specialist spinal nurses were not included. Future studies could adopt a multi‐perspective or multi‐centre design to obtain a more comprehensive understanding of spinal safety in ICU care.

6.6. Implications for Practice and Further Research

The findings suggest that ICU care for patients with spinal trauma and disorders requires structured support beyond individual nurses' experience. ICU teams should consider developing spinal safety checklists, standardised procedures for logrolling and transfer, guidance for orthosis and positioning management and clear escalation pathways for neurological changes. Practical, case‐based and simulation‐based training may help ICU nurses translate spinal specialist knowledge into bedside practice. Multidisciplinary collaboration among ICU nurses, spinal surgeons, rehabilitation therapists, respiratory therapists and specialist nurses should be strengthened to support safer and more coordinated care. Future research could evaluate the effectiveness of spinal safety training programmes, checklist‐based interventions and multidisciplinary care pathways in improving nurse competence, patient safety and recovery outcomes.

7. Conclusion

This study provides insight into ICU nurses' experiences of caring for patients with spinal trauma and disorders. The findings show that spinal safety in ICU care involves more than preventing movement‐related secondary injury. It requires continuous surveillance, careful positioning and transfer, management of immobility‐related complications, emotional support and coordinated multidisciplinary care. Nurses experienced uncertainty in spinal‐specific assessment and care but also developed anticipatory, holistic and self‐protective practices through team support and experiential learning. These findings highlight the need for structured spinal safety training, practical bedside tools and stronger collaboration between ICU teams and spinal specialists. Supporting ICU nurses in developing spinal specialist competence may improve patient safety and quality of care for this complex patient group.

Funding

This work was supported by the Natural Science Foundation of Hunan Province, China (Grant No. 2026JJ81269).

Ethics Statement

This study was approved by the Clinical Medical Ethics Committee of Xiangya Hospital, Central South University on 29 August 2025 (Approval No. 2025091188).

Consent

Written informed consent was obtained from all participants before data collection.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The data that support the findings of this study are not publicly available due to privacy and confidentiality considerations. De‐identified data may be available from the corresponding author upon reasonable request.