Paediatric palliative care (PPC) is an effective approach to help children and their families deal with life-limiting conditions. PPC encompasses holistic care, including spirituality, yet little is known about how nurses provide spiritual care. This review is to identify, evaluate and synthesise qualitative evidence exploring how nurses provide spiritual care in PPC. A systematic search for qualitative studies conducted during the last 25 years was undertaken in electronic databases. All studies meeting the inclusion criteria were assessed by at least two independent reviewers for methodological quality using a standardised critical appraisal tool from the Joanna Briggs Institute (JBI) Qualitative Assessment and Review Instrument. Data were extracted from the papers using a standardised data extraction tool and findings categorised based on similarity in meaning and then subjected to a meta-synthesis. Fifteen studies were included and three synthesised statements were generated from seven categories of findings. Nurses provided spiritual care by engaging in therapeutic communication with the child and family, strengthening the relationship between the child and family and facilitating religious practices of the child and family. Most studies did not specifically focus on spiritual care, yet the findings were implicit when related to the definition of spiritual care. The findings were dominated by studies conducted during end-of-life care in neonatal and paediatric intensive care settings. These findings inform nurses’ practice in PPC and provide a basis for integration of spirituality concepts into nursing curricula. More research specifically examining nurses’ practice of spiritual care for children is needed.