Navigating Uncertainty in Pediatric Chronic Illness Care: A Hermeneutic Phenomenological Study of Nurses in Saudi...

Background/Objectives: Children with complex chronic conditions (CCCs) present profound clinical uncertainty for pediatric nurses, who must navigate unpredictable disease trajectories, ambiguous symptom presentations, and emotionally demanding care situations. This study explored the lived experiences of pediatric nurses caring for children with CCCs, with a specific focus on how they perceive, navigate, and manage clinical and emotional uncertainty in daily practice. Methods: A Gadamerian hermeneutic phenomenological study was conducted in pediatric units within tertiary hospitals in Riyadh, Saudi Arabia, using purposive, maximum-variation sampling. Fifteen pediatric nurses participated in semi-structured interviews conducted in English. Data were analysed using hermeneutic phenomenological analysis informed by the framework of Alsaigh and Coyne. Reporting followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Results: Three themes emerged: navigating the unknown, reflecting nurses' encounters with diagnostic ambiguity and unpredictable illness trajectories; the emotional weight of not knowing, capturing the psychological burden of sustained uncertainty; and finding footing in uncertainty, describing adaptive strategies including relational anchoring, peer support, and meaning-making through caregiving. Conclusions: Clinical uncertainty is an inherent and pervasive feature of pediatric chronic illness care. Pediatric nurses develop relational and meaning-making strategies, alongside more limited cognitive appraisal strategies, to manage uncertainty, yet require greater institutional recognition and support. Targeted interventions addressing uncertainty tolerance, reflective practice, and structured peer support are proposed as potential approaches, warranting future evaluation, to strengthen nursing resilience and support care quality for children with CCCs.