Children's Resilience in Crisis Settings: Experiences of Mothers and Paediatric Intensive Care Nurses

Children exposed to armed violence and crisis-related paediatric intensive care unit (PICU) admission may experience psychological distress, yet many also show resilient recovery. Existing literature has often focused on post-traumatic stress symptoms and risk of poor outcomes, with less attention to how resilience is supported through family, clinical and community relationships.

To explore and compare mothers' and PICU nurses' experiences of supporting children's psychological recovery following exposure to regional armed violence and to develop an empirically grounded model of resilience in crisis-affected paediatric intensive care contexts.

A conventional qualitative content analysis study was conducted with 20 mothers and 15 PICU nurses recruited from a tertiary paediatric hospital and affiliated follow-up networks after a 12-day regional crisis. Semi-structured, in-depth interviews were audio-recorded, transcribed verbatim and analysed iteratively using MAXQDA software. Trustworthiness was supported through triangulation of mothers' and nurses' perspectives, member checking, prolonged engagement, reflexive memoing, peer review of coding and adherence to COREQ and SRQR reporting guidance.

Analysis generated the model Resilience as Negotiated Co-Regulation, comprising three interrelated domains: (1) intrafamilial negotiation, including relational emotion regulation, narrative reframing and child agency; (2) immediate clinical and social transactions, including caregiver mental health, support and monitoring practices and spiritual/narrative scaffolding; and (3) extended socio-cultural ecology, including school routines, community networks and future orientation. A cross-cutting theme showed differences and alignments between nurses' clinical focus on safety, symptom monitoring and referral, and mothers' emphasis on faith, family routines, patience, hope and return to ordinary life.

Children's resilience after crisis-related PICU admission was experienced as a dynamic process shaped through child-caregiver co-regulation, nurse-family communication, culturally meaningful coping and community support. Interventions should strengthen caregiver capacity, support trauma-informed PICU communication, preserve child agency and integrate safe family, spiritual and community resources.

PICU nurses can promote children's recovery by providing trauma-informed communication, coaching parents in emotional regulation and warning signs, involving children in developmentally appropriate choices and linking families with post-discharge psychosocial, school and community support. Culturally respectful care may improve trust, acceptability and continuity of recovery support.