Objective To systematically evaluate and integrate qualitative research on moral distress of nurses in Pediatric Intensive Care Unit (PICU), and to providea reference for nursing managers to develop interventions to alleviate moral distress of PICU nurses. Methods Relevant Chinese and English databases were systematically searched for qualitative studies on moral distress of PICU nurses.The search frame was from inception of databases to April 2024. The literature was evaluated using JBI Critical Appraisal Tool for qualitative studies, and the aggregative integration method was applied to integrate theresults. Results A total of 9 studies were included, and 28 pieces of research results were extracted, which were organized into 12 categories, resulting in 3 integrated findings: causes of moral distress of PICU nurses, effects of moral distress of PICU nurses, and coping strategies for moral distress of PICU nurses. Conclusion Moral distress of PICU nurses is a complex phenomenon with multiple negative effects. Nursing managers should be attentive to the moral distress of PICU nurses and promote their effective coping, improve their physical and mental health,and optimize the development of nursing profession.