Child maltreatment refers to abuse and neglect experienced by individuals under the age of 18. It encompasses physical and/or emotional abuse, sexual abuse, neglect, negligence, and commercial or other forms of exploitation that cause, or may potentially cause, harm to a child's health, survival, development, or dignity within relationships involving responsibility, trust, or power (World Health Organization, 2024). In Taiwan, the number of child maltreatment cases showed an increasing trend from 2021 to 2023. According to data on the types of child maltreatment in 2024, out of the total of 10,810 children, approximately 52% experienced physical abuse, 32% experienced sexual abuse, 10% experienced neglect, and 5% experienced emotional abuse; the remaining 1% included cases of abandonment, substance abuse, and witnessing domestic violence (Ministry of Health and Welfare, 2025). Regardless of the form of maltreatment neglect or abuse can lead to serious health problems in children, necessitating medical care (Ministry of Health and Welfare, 2016).

Hospitals and medical institutions become important venues for the discovery of potential child abuse when children and adolescents are admitted because of maltreatment. Within these settings, nurses are at the forefront of caring for maltreated pediatric patients. As these patients often experience physical and mental abuse, nurses require sophisticated skills to handle the complexity of such patients. This includes facing ethical conflicts during care and grappling with feelings of powerlessness in improving the circumstances of child maltreatment (Karakachian, Colbert, Hupp, & Berger, 2021).

This is particularly evident when the child's condition deteriorates, leading to their transfer to the pediatric intensive care unit (PICU). During critical care, PICU nurses are responsible for the care of acutely ill children and their families, which increases their work pressure (Kellogg, Knight, Dowling, & Crawford, 2018; Vicente, Shadvar, Lepage, & Rennick, 2016). They often encounter moral dilemmas, including parental medical decision-making, treatment refusal by family members, and obtaining informed consent, thereby amplifying the challenges faced by PICU nurses (Gagnon & Kunyk, 2022). Additionally, some studies indicate that pediatric nurses struggle to disentangle themselves from negative emotions during patient care. They may feel empathy for their patients, lack sufficient time to process emotions due to their demanding clinical workload, or fail to receive adequate support from their superiors. Consequently, they often experience significant work stress, which may lead to secondary trauma and impairment of their ability to fulfill their professional duties, potentially compromising patient safety (Kleis & Kellogg, 2020).