Sustaining Compassionate Care in Pediatric and Neonatal Palliative Care: A Qualitative Meta‐Synthesis of Nurses’ Experiences Amid Uncertainty and Loss
Yuan Li, Shiqi Luo, Xia Li, Hanmei Peng, Yanling Hu, Qiong ChenBackground
Nurses provide pediatric and neonatal palliative care amid substantial emotional and relational demands. Qualitative evidence remains fragmented on how nurses sustain compassionate care and how relational and organizational conditions shape these efforts. This systematic review and meta‐synthesis examined these experiences across palliative and end‐of‐life settings.
Methods
PubMed, CINAHL, Embase, PsycINFO, Web of Science, and Scopus were searched from inception to September 2026. Qualitative studies and separately extractable qualitative components of mixed‐methods studies addressing nurses’ experiences of pediatric or neonatal palliative care were eligible. Two reviewers independently screened records, extracted data, and applied the Joanna Briggs Institute qualitative appraisal checklist. Findings were synthesized using Thomas and Harden’s three‐stage thematic synthesis, with confidence assessed using GRADE‐CERQual.
Results
Thirty‐seven studies from 21 countries reported a total of 599 nursing participants. Four analytical themes and 18 descriptive subthemes were generated: (1) finding meaning through care for children and families; (2) managing relational closeness and professional boundaries; (3) responding to grief and loss through coping and meaning‐making; and (4) seeking and using interpersonal and organizational support. Confidence was moderate for Themes 1–3 and high for Theme 4. Valued care, relational involvement, coping, and support coexisted with persistent grief, emotional depletion, and unmet needs.
Conclusions
Nurses’ efforts to sustain compassionate care involve interacting personal, relational, and organizational processes. Meaningful care can coexist with persistent grief and emotional strain, with variation in emotional availability and recovery. These findings highlight the importance of organizational support alongside individual coping.
Implications for Nursing Management
Managers should protect time and resources for relational care and strengthen nursing participation in interdisciplinary decisions. Emotional and clinical support should be accessible and responsive to nurses’ preferences, including opportunities for reflection, supervision, and peer support.