Experiences and challenges of pediatric intensive care unit nurses in Iran: a qualitative content analysis study

Pediatric intensive care units (PICUs) are demanding places to work. Nurses there provide complex, continuous care to critically ill children and support distressed families, often with too few staff and limited resources. In Iran, little is known about how PICU nurses experience these pressures. This study explored their experiences and considered how these challenges may affect nurses' well-being and the quality and safety of care.

We used conventional content analysis, following Graneheim and Lundman. Fifteen nurses were recruited by purposive maximum variation sampling from four PICUs in three tertiary pediatric referral hospitals in Iran. Between February and December 2025, we conducted 17 in-depth, semi-structured interviews and non-participant observations. Recordings were transcribed verbatim and analyzed inductively. Trustworthiness was supported by member checking, peer debriefing, reflexive field notes, and the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

We identified 213 initial codes, grouped into 15 subcategories and five interrelated categories: working under structural constraints; professional role complexity; interactional challenges in critical situations; limited professional empowerment and organizational support; and emotional challenges. Nurses spoke about staffing shortages, limited equipment, heavy workload, difficult communication with parents and conscious children, insufficient structured education, and repeated exposure to child suffering, death, and moral distress. These stressors interacted and threatened their well-being and sense of professional effectiveness.

PICU nurses in Iran face interrelated structural, professional, interactional, and emotional challenges. Responding to them requires coordinated organizational, educational, ethical, and psychological strategies, including better staffing and resources, PICU-specific professional development, support for family-centered communication, and structured emotional and ethical support.