PURPOSE: This study was designed to examine the relationships between maternal perceptions of an acutely ill child, nurse caregivers and contextual factors in a pediatric critical care unit. METHODS: Subjects were mothers of 20 children who had had their first bone marrow transplant and the primary nurse of each child. The study was conducted on a bone marrow transplant unit. Variables included the acuity of the child, maternal satisfaction with nursing care, maternal vigilance as measured by the time spent at the child's bedside, nurses' attitudes toward family involvement with care, nursing experience and bone marrow transplant unit variables (census, unit acuity and staffing deficit). RESULTS: Positive associations were observed between the child's acuity and maternal satisfaction with nursing care, and between maternal vigilance and staffing deficit. There was an inverse relationship between maternal vigilance and length of nursing experience of the primary nurse and between positive attitudes of nurses toward family participation and years of nursing experience. CONCLUSION: These results show the complex nature of parental perceptions and involvement in the hospitalized child's care. They suggest that maternal attitudes about caregiving are associated with the child's acuity and that maternal vigilance is related to nursing and environmental factors, principally critical care experience of the primary nurse.