"Barefoot and bleeding": Emergency nurses' experiences caring for Palestinian working children presenting to emergency departments in the West Bank-A qualitative descriptive study.

INTRODUCTION: Hazardous child labor is an important cause of preventable injury requiring emergency care. In the occupied West Bank, children as young as 11 work in agricultural settlements under hazardous conditions beyond Palestinian labor law enforcement. Emergency nurses are often the first healthcare professionals to assess these injuries, identify safeguarding concerns, and initiate care, yet their experiences remain absent from the literature.

METHODS: This qualitative descriptive study employed semi-structured interviews with 19 emergency nurses purposively recruited from six hospitals across three West Bank regions between March and August 2025. Data were analyzed using Braun and Clarke's reflexive thematic analysis with NVivo support.

RESULTS: Four interconnected themes described nurses' experiences: severe occupational injuries requiring emergency care; hidden psychological suffering beyond physical wounds; navigating system barriers within emergency care; and the emotional burden of emergency nursing for working children.

DISCUSSION: Emergency nurses witness repeated, preventable occupational injuries among working children while navigating resource constraints, absent referral pathways, and jurisdictional barriers. The emotional burden is significant, yet nurses demonstrate resilience through faith, peer support, and advocacy.

CONCLUSION: Findings suggest that emergency departments should develop protocols for screening child labor, trauma-informed care, safeguarding referral pathways, and psychological support for nursing staff. Emergency nurses are uniquely positioned to identify, treat, and advocate for working children, but require institutional support to fulfill this role.