Nursing is a stressful occupation. While children's palliative care nurses encounter many of the stressors in common with other nurses, this unique context of care generates specific aspects of stress that warrant further examination. This qualitative study explores the experiences of stress in nurses providing children's palliative care in one region of the UK. In total, four focus groups took place with children's hospice nurses, community children's nurses and children's nurse specialists based in the regional children's hospital. The focus groups were taped, transcribed and analysed through the application of Newell and Burnard's thematic content analysis methodology. Four core themes emerged: work demands; relationships, maintaining control, and support and roles. Of particular note were stressors associated with the sub-themes of relationships, emotional demands and ethical conflicts. Conclusions illustrating how individuals and organizations may reduce the impact of stress in nurses contributing to the palliative care of children and their families are made.

Background Palliative care is recognised as a public health issue with the need for earlier integration in the wider healthcare system. However, research indicates that it continues to be accessed late in the course of an illness, public understanding of palliative care is limited, and common misconceptions prevail. Strategies to address this are needed in order to reduce barriers to palliative care delivery and improve access. Methods An explanatory sequential mixed methods study, comprising a cross-sectional survey and interviews was undertaken. Sociodemographic characteristics, public awareness, knowledge and perceptions of palliative care were examined and strategies to raise awareness and overcome barriers within a public health framework were identified. Survey data were analysed using SPSS v25 with factor analysis and non-parametric statistics and qualitative data were analysed using thematic analysis. Results A total of 1201 participants completed the survey (58.3% female, mean age 61 years) and 25 took part in interviews. A fifth of participants (20.1%) had previously heard about palliative care and had an accurate understanding of the term. Being female, higher educated, married, and older, increased respondents’ levels of awareness. The three most commonly held misconceptions included: Palliative care is exclusively for people who are in the last 6 months of life (55.4% answered incorrectly); A goal of palliative care is to address any psychological issues brought up by serious illness (42.2% answered incorrectly); and a goal of palliative care is to improve a person’s ability to participate in daily activities (39.6% answered incorrectly). Talking about palliative and end of life care was advocated but societal taboos restricted this occurring with exposure limited to personal experience. Conclusions Current knowledge gaps and misconceptions derived from limited ad hoc personal experiences and fear of engaging in taboo conversations may deter people from accessing integrated palliative care services early in a disease trajectory. The results indicate the need for public education programmes that move beyond merely raising awareness but provide key messages within a public health approach, which may change attitudes to palliative care thus ultimately improving end of life outcomes.

The study highlights a number of crucial benefits to the child and family both in the immediate and longer terms. The collective perspectives therefore endorse hospice as a potential viable choice for these children and their families during the always difficult, usually protracted transition from hospital to home.

Successful symptom management in the palliative and terminal care of patients frequently involves the use of syringe drivers. A wealth of literature exists to support their use in the care of adult patients both within specialist palliative care inpatient units and in the community setting. However, little has been written regarding their use in the paediatric population. The purpose of this article is to examine specific issues concerning the use of syringe drivers when caring for children and young people in the terminal phase of illness.

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