When images speak care: Nurses' visual accounts of paediatric practice

Background Paediatric nursing is widely described as relational and holistic, yet much of its everyday practice remains tacit and materially embedded. While the Fundamentals of Care and Family-Centred Care frameworks emphasise relational partnership, they offer limited insight into how nurses enact these principles in practice. Visual methods can illuminate embodied and sensory dimensions of care that often remain unspoken in interview-based research. Aim To explore how paediatric nurses understand and conceptualise nursing care in their practice. Methods Twenty-seven paediatric nurses submitted 131 anonymised photographs with written descriptive accounts. Data were analysed inductively using reflexive thematic analysis informed by a phenomenological–hermeneutic orientation, attending to both manifest and latent meanings. Analytic insights Paediatric nursing emerged as an ecology of interdependent practices. Nurses depicted care as a weaving together of multimodal communication, embodied relational presence, material scaffolding, and collaborative knowledge work. The visual accounts illuminated tacit forms of judgement, attunement, and emotional labour shaping how nurses understand and enact paediatric care. Conclusions The study extends conceptualisations of paediatric nursing by showing how relational, material, and collaborative orientations operate as mutually reinforcing elements of practice. Visual methods proved valuable for accessing dimensions of care that are difficult to verbalise. Implications for practice Multimodal communication resources may enhance children's understanding and coping. Their use requires organisational conditions that support relational engagement and documentation tools that promote shared understanding without diminishing clinical judgement or the child's voice. Family teaching and peer learning may further strengthen collective competence in paediatric care.