共找到 20 条结果
暂无摘要（点击查看详情）
暂无摘要（点击查看详情）
Parental involvement in a child's self-monitoring and treatment, including challenges encountered during treatment, influences the life satisfaction of caregivers of children with type 1 diabetes mellitus (T1DM). This study aimed to assess the level of life satisfaction among parents of children with T1DM and to examine the impact of selected sociodemographic and medical factors on life satisfaction. The study was conducted between September 1st, 2024, and March 1st, 2025, using a questionnaire designed by the author and the standardized Satisfaction with Life Scale (SWLS). Participants were parents of children aged 2 to 18 with a diagnosis of T1DM for more than one year, who were receiving care at four Diabetes Centers in the Mazovian, Pomeranian, and Warmian-Masurian voivodeships in Poland. A total of 327 parents of children with T1DM participated in the study. The mean ages of mothers and fathers were 41.5 ± 6.6 years and 44.1 ± 7.1 years, respectively, and the average age of the children was 11.8 ± 3.9 years. The mean duration of diabetes was 5.47 ± 3.62 years. The median SWLS sten score was 6.0 (4.0÷7.0). Higher life satisfaction was observed among professionally active fathers, parents living in nuclear families, and parents reporting a very good financial situation. Parents of children with T1DM who consulted a psychologist, psychotherapist, or psychiatrist reported lower life satisfaction. The life satisfaction of parents of children with T1DM was average. The parents of children with T1DM who have lower life satisfaction more likely to seek psychological support. The study demonstrated the influence of the roles of family members (mother vs. father), the father's employment status, family structure, and the family's financial status on life satisfaction. Independent sociodemographic factors were parent/caregiver and family financial status. Given the complexity of T1DM management, multidisciplinary support is essential for both children and their families. Efforts should be made to protect the mental health of children with T1DM and their parents. Facilitated access to specialist care should be prioritized. Nurses should develop family-centered care plans and work to reduce factors that negatively affect the life satisfaction of children and their families. The current parental life satisfaction score is important in providing daily care for children with T1DM. If the parental life satisfaction is low, the family should be provided with psychological support. Nurses should actively cooperate with psychologists, psychotherapists, and social workers in caring for children with T1DM, and should also inform caregivers on the current methods of support for families of children with chronic diseases. Up-to-date parental life satisfaction should be assessed during follow-up visits with educational nurses (diabetes educators) at the Diabetes Clinic. The development and implementation of a screening questionnaire would be a valuable component of nursing care planning for children with T1DM and their parents, as it would enable the rapid identification of the needs of both children and their parents (e.g., regarding education, emotional support, and caregiving). This would facilitate comprehensive, family-centered, and personalized care, while helping to prevent caregiver burnout, and improve the quality of family functioning in their home environment. These measures would support the individualization of care plans, enable early crisis intervention, and improve communication between parents and healthcare professionals. Healthcare professionals play a key role in identifying parental difficulties and ensuring specialized care for those most in need. A holistic and systemic approach that addresses both physical and mental health is crucial for improving the outcomes, self-monitoring results, and treatment of T1DM in children and adolescents, as well as for improving the quality of life of children and their parents.
Pediatric nurses carry heavy emotional and clinical demands that leave them vulnerable to burnout. Trauma-Informed Care (TIC) has helped ease burnout in the workplace, but psychological factors like Impostor Syndrome (IS) may weaken these benefits. Whether IS mediates the TIC-burnout link has not been well studied. To examine the mediating effect of impostor syndrome on the association of trauma-informed care with burnout in pediatric nurses. A descriptive cross-sectional study was conducted in six hospitals of Mansoura City, Egypt, between October 2024 and January 2025, with a sample size of 251 pediatric critical care nurses (96.5% response rate). Instruments included Trauma-Informed Care Scale, Maslach Burnout Inventory, and Clance Impostor Syndrome Scale. Data were analyzed by means of Pearson correlation, multiple linear regression, and mediation analysis through PROCESS macro with 5000 bootstrap samples. Impostor syndrome was the strongest predictor of burnout (β = 0.383, p < .001), followed by attitude toward TIC (β = 0.234, p = .047). Female nurses reported lower burnout, though only IS acted as a mediator. IS partially mediated the association of TIC with burnout (indirect effect = 0.15, 95% CI (0.06, 0.24)), with the model explaining 50.3% of burnout variance. Impostor syndrome has the potential to alter the work requirements of TIC into further vulnerability to burnout. Comprehensive support for pediatric nurses should incorporate trauma-informed practices alongside programs and strategies to ameliorate the experience of self-doubt, thus improving well-being and care quality.
To report on the experience of developing a care protocol for pediatric patients fixation for the transflight in rotary-wing aircrafts. Professional experience report. The protocol was developed within the aeromedical urgency and emergency service of Santa Catarina, guided by the Guide for the Construction of Care Protocols of Coren/São Paulo. The theoretical framework was based on an integrative review and consultation of documents from national and international official agencies, as well as the Brazilian Federal Nursing Council. Internal validation was carried out with eight flight nurses from the service. The protocol structured the care for securing the pediatric patient into three care phases: preflight, transflight, and postflight, supporting clinical decision-making and safety during transport. The developed protocol standardized the practices for pediatric patients fixation in aeromedical services, promoting safety and supporting clinical decision-making during transflight, minimizing the risk of complications during transport, and strengthening professional practice in the field of aeromedical services. Relatar a experiência de elaboração de um protocolo de cuidados para a fixação do paciente pediátrico durante o transvoo em aeronave de asa rotativa. Relato de experiência profissional. O protocolo foi elaborado no serviço aeromédico de urgência e emergência de Santa Catarina, orientado pelo Guia para a Construção de Protocolos Assistenciais do Coren/São Paulo. A fundamentação teórica baseou-se em revisão integrativa e consulta a documentos de órgãos oficiais nacionais e internacionais, bem como do Conselho Federal de Enfermagem. Realizou-se validação interna com oito enfermeiros de voo do serviço. O protocolo estruturou os cuidados de fixação do paciente pediátrico em três momentos assistenciais: pré-voo, transvoo e pós-voo, apoiando a tomada de decisão clínica e a segurança durante o transporte. O protocolo desenvolvido padronizou as práticas de fixação do paciente pediátrico no serviço aeromédico, promovendo a segurança e o suporte à tomada de decisão clínica durante o transvoo, minimizando o risco de agravos durante o transporte e fortalecendo a prática profissional no âmbito do atendimento aeromédico. Relatar la experiencia de elaboración de un protocolo de cuidados para la inmovilización del paciente pediátrico durante el vuelo en aeronaves de ala giratoria. Relato de experiencia profesional. El protocolo fue elaborado en el servicio aeromédico de urgencias y emergencias de Santa Catarina, orientado por la Guía para la Elaboración de Protocolos de Atención de Coren/São Paulo. La fundamentación teórica se basó en una revisión integrativa y en la consulta de documentos de organismos oficiales nacionales e internacionales, así como del Consejo Federal de Enfermería. Se llevó a cabo una validación interna con ocho enfermeros de vuelo del servicio. El protocolo estructuró los cuidados de inmovilización del paciente pediátrico en tres momentos asistenciales: pre-vuelo, durante el vuelo y post-vuelo, apoyando la toma de decisiones clínicas y la seguridad durante el transporte. El protocolo desarrollado estandarizó las prácticas de inmovilización del paciente pediátrico en el servicio aeromédico, promoviendo la seguridad y el apoyo a la toma de decisiones clínicas durante el vuelo, minimizando el riesgo de complicaciones durante el transporte y fortaleciendo la práctica profesional en el ámbito de la atención aeromédica.
Fever is one of the most common symptoms in children and a leading cause of their hospitalisation. Nurses, as primary caregivers in paediatric wards, play a pivotal role in the assessment and management of children with fever. However, nurses' perceptions and experiences of fever management are influenced by cultural contexts, psychological and social factors, as well as prevailing health system policies. The aim of the study was to explore nurses' perceptions influencing their management of childhood fever, including barriers and facilitators to evidence-based practice. A qualitative descriptive design using a conventional content analysis approach. Nineteen nurses working in paediatric wards participated in individual semi-structured interviews conducted between March 20, 2024 and May 20, 2025. Purposive sampling was used to recruit participants with direct experience in managing fever in children. Data were audio-recorded, transcribed verbatim and analysed inductively using qualitative content analysis as described by Graneheim and Lundman. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Data analysis resulted in the extraction of one main theme titled 'Navigating Uncertainty and Psychological Strain in Pediatric Fever Management' and five main categories. Nurses described challenges related to the absence of locally adapted clinical guidelines, lack of continuous education, hierarchical dependence on physicians, fever phobia and misconceptions, which led to non-evidence-based decision-making and unnecessary interventions. The findings underscore the need for developing culturally appropriate local clinical guidelines, implementing evidence-based continuous educational programmes, enhancing nurses' professional autonomy and providing effective family education. These interventions can improve care quality, reduce nurses' occupational anxiety and ultimately enhance child health outcomes. Understanding nurses' experiences and challenges may inform the development of educational interventions, localised clinical guidelines and organisational strategies to improve the quality and consistency of fever management in children. What problem did the study address? ◦The study addressed the gap between evidence-based fever management guidelines and actual nursing practice in paediatric settings. What were the main findings? ◦Nurses' clinical decision-making was influenced by fear of complications, parental expectations, organisational factors and contextual factors. Where and on whom will the research have an impact on? ◦The findings may impact paediatric nurses, healthcare administrators and policymakers by informing strategies to support evidence-based fever management in hospital settings. This study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. No patient or public contribution: Patients or members of the public were not involved in the design, conduct, reporting or dissemination plans of this research, as the study focused on nurses' professional experiences.
There is an increasing population of children who are surviving with chronic critical illnesses, some of whom are dependent on technology to sustain life. Long-term ventilation (LTV) is frequently initiated in the paediatric intensive care unit (PICU) due to acute or acute-on-chronic events. Most published literature exploring the initiation of LTV focuses on physicians' perspectives. Nurses with a constant presence at the bedside are well positioned to offer a unique insight into the initiation of LTV in a PICU and the care needs of the child and family at this time in care delivery. Research into nursing perspectives in the PICU is limited, most frequently focused on caring for children at the end of life. Little is known about the voice of the nurse when life-changing decisions are made about children's care in the PICU such as the initiation of LTV. The aim of this study was to explore the nursing voice at the point of initiation of LTV for a child in a PICU. This study used hermeneutic phenomenology, guided by van Manen, to understand the meaning nurses give to their voices during the initiation of LTV in a PICU. Semistructured interviews were conducted with 13 nurses in Australia who had experience caring for a child during the initiation of LTV. The analysis identified three themes: "Initiating Long-term Ventilation", "Complexity of Being a PICU Nurse", and "Information Provision". The findings from this study offer further insights into the voice of the nurse in both the formal setting in meetings and at the bedside during the initiation of LTV. They highlighted that while formal meetings were the predominant setting for discussions and information provision, they were intrinsically linked to care and discussions at the bedside. Although there is an increasing incidence of LTV, little remains known about the specific role of the voice of the nurse during this time. The findings expanded on previous research, highlighting that while nurses are silent, they are not silenced. These findings suggest platforms, including prehuddles, for nurses to have increased involvement in discussions and decision-making.
This study aimed to explore pediatric intensive care unit (PICU) nurses' practices, experiences, and decision-making processes related to the preservation of skin integrity in pediatric patients. An inductive qualitative study using thematic analysis was conducted. Data were collected between February and August 2025 through semi-structured, in-depth, face-to-face interviews with 22 nurses working in PICUs. Interviews were audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis in accordance with Braun and Clarke's framework. Methodological rigor was ensured through data saturation, inter-coder agreement, member checking, and adherence to the COREQ reporting guideline. Five main themes emerged: (1) Nursing practices for skin care, (2) Materials and technological devices used to preserve skin integrity, (3) Multidimensional effects of skin protection practices, (4) Factors shaping nurses' clinical decisions, and (5) Nurses' needs related to pediatric skin care practices. Nurses actively managed skin integrity through hygienic and therapeutic interventions, mechanical pressure and equipment management, moisture control, environmental regulation, and interprofessional collaboration. Nurses perceived that skin care practices may contribute to clinical recovery, hemodynamic stability, comfort, sleep quality, and hospitalization experiences. Clinical decision-making was shaped by patient characteristics, clinical experience, team-based communication, institutional resources, and access to evidence-based knowledge. Pediatric skin care in intensive care settings extends beyond technical interventions and represents a holistic domain of nursing care with physiological, psychosocial, and organizational implications. Strengthening evidence-based, standardized, and interdisciplinary skin care approaches, alongside targeted nurse education and supportive institutional policies, is essential to sustain high-quality pediatric intensive care.
Digital technology has brought many advantages to healthcare, but it has also given rise to a new form of worker abuse called "cyberbullying." This type of bullying can happen anytime and can greatly harm workers' mental health. Since "professional quality of life" is vital for how well the healthcare system functions and there is not much research on how this connects to online bullying in Iranian nursing, it is important to look closer at this relationship. This study aimed to assess the association between cyberbullying and professional quality of life among nurses in Southeast Iran. This research utilized a descriptive cross-sectional design and recruited 335 nurses from Kerman University of Medical Sciences affiliated hospitals during 2025. Subjects were enrolled using a convenience sampling approach, and data were collected using the Menesini Cyberbullying Questionnaire and the Professional Quality of Life Scale (ProQOL). Data were analyzed using SPSS Version 24 and descriptive statistics, independent t-tests, analysis of variance, spearman correlation coefficients, and stepwise multivariate regression, with a significance level of less than 0.05. Data analysis indicated a low prevalence of cyberbullying among nurses. The mean scores of compassion satisfaction, burnout, and secondary traumatic stress were 34.71 ± 5.47, 16.03 ± 3.92, and 31.63 ± 4.90, respectively, all of which fell within the moderate range. Inferential findings indicated a significant positive correlation between cyberbullying and compassion fatigue, burnout, and secondary traumatic stress. Furthermore, cyberbullying emerged as a significant positive predictor across all three dimensions of professional quality of life in regression analyses. Additionally, key demographic and occupational factors including educational degree, shift type, employment status, gender, and marital status emerged as significant predictors within their respective models. The findings indicated that cyberbullying was generally low and showed significant statistical associations with compassion fatigue in the analyses. Targeted interventions to enhance nurses' professional quality of life should be prioritized in healthcare settings. Furthermore, longitudinal and interventional studies are needed to better elucidate the temporal and causal relationships among these variables. Nurse administrators should adopt preventive strategies addressing workplace cyberbullying and compassion fatigue to enhance nurses' professional quality of life.
Workaholism is an important occupational risk that may impair nurses' quality of life. Psychological resilience may buffer these negative effects and mediate the relationship between workaholism and quality of life. To examine the relationships among workaholism, psychological resilience, and quality of life among pediatric nurses in Türkiye and to determine the mediating role of psychological resilience. This cross-sectional study included 258 pediatric nurses working across Türkiye. Data were collected using the Demographic Information Form, Dutch Work Addiction Scale, Brief Resilience Scale, and Quality of Life Scale for Nurses. Mediation was examined using bootstrap analysis. Psychological resilience was negatively associated with workaholism (B = -0.519, t = -7.921, p < 0.001), whereas workaholism was negatively associated with physical quality of life (B = -0.130, t = -3.120, p = 0.002). The indirect effect was significant (Effect = 0.068, 95% CI [0.016, 0.125]). Psychological resilience also had a significant direct effect on physical quality of life after controlling for workaholism (B = 0.406, t = 8.310, p < 0 0.001), indicating partial mediation. Psychological resilience protects against the adverse effects of workaholism on pediatric nurses' physical quality of life. Interventions that strengthen resilience and reduce workaholic behaviors may improve nurses' well-being. Healthcare organizations should promote resilience and reduce excessive work demands through supportive workplace strategies to improve pediatric nurses' physical quality of life.
Compassion fatigue, a form of emotional exhaustion resulting from repeated exposure to patients' suffering and trauma, is prevalent among nurses in pediatric intensive care units (PICUs). It damages nurses' health and reduces care safety and quality. This study aims to investigate the prevalence and associated factors of compassion fatigue among PICU nurses in China. A cross-sectional study was conducted among 186 PICU nurses from seven hospitals in Chengdu, China, using convenience sampling. Data were collected using the Professional Quality of Life Scale (Pro-QOL) and the Social Support Rating Scale, along with assessments of sociodemographic characteristics, work-related information, and self-perceived health status. According to the Pro-QOL Manual, compassion fatigue comprises two distinct subdimensions: burnout and secondary traumatic stress. The study found that 74.7% of PICU nurses reported moderate to high secondary traumatic stress, and 79.6% reported moderate to high burnout. In contrast, 24.7% reported high compassion satisfaction. Multiple linear regression identified several significant factors associated with the subdimensions of professional quality of life. Higher social support was significantly associated with higher compassion satisfaction (β = 0.375, p < 0.001) and lower burnout (β = -0.224, p < 0.001). Poorer self-perceived health, worse sleep quality, more frequent end-of-life care experiences, and less frequent gratitude from patients/families were also significantly linked to higher burnout or secondary traumatic stress (all p < 0.05). The high prevalence of burnout and secondary traumatic stress among PICU nurses underscores the need for targeted interventions. Interventions should prioritize strengthening social support systems, improving sleep quality, and providing additional support for nurses frequently engaged in end-of-life care.
As direct and continuous providers of patient care, nurses are more susceptible to various forms of psychological stress within the healthcare environment compared to other healthcare professionals. Nurses in paediatric wards, who maintain constant contact with children and their families, are particularly vulnerable to moral distress. This study aimed to explore the perceptions and experiences of Iranian nurses regarding moral distress in paediatric settings. This qualitative study employed inductive content analysis, conducted between 2023 and 2024. Data were collected through semi-structured individual interviews and analysed following Graneheim and Lundman's approach. Twelve participants experiencing moral distress were selected via purposive sampling from the Babol and Tehran Universities of Medical Sciences. The findings identified four primary categories and eight subcategories: moral distress related to colleagues (doctors and nursing colleagues); moral distress related to parents (conflict with children's rights and distrust of nurses); moral distress related to organizational factors (understaffing and workload undermining holistic care and professional ethics; and inadequate equipment and resources compromising care and fostering dishonesty); and psychological tensions following moral distress (mental conflict involving the cognitive and emotional burden of moral compromise; and helplessness and despair in the face of systemic failure). Rather than representing isolated individual experiences, these findings illustrate that moral distress in paediatric nursing is deeply rooted in the structural and relational conditions of healthcare settings. The results highlight that repeated exposure to ethical conflicts can erode professional values, impede the delivery of holistic care, and intensify emotional suffering. Consequently, this study contributes to a deeper understanding of moral distress as a systemic phenomenon requiring organizational intervention rather than merely an individual coping response. The findings underscore the necessity for healthcare managers and policymakers to implement systemic mechanisms, such as specialized educational programmes and workshops, to mitigate moral distress among nurses. Furthermore, identifying the inherent stressors in paediatric nursing and reducing nurses' exposure to moral dilemmas are essential steps toward safeguarding ethical practice and enhancing care quality. This study contributes by shifting the focus from merely describing moral distress as a set of themes toward understanding it as a critical indicator of organizational strain and ethical vulnerability in paediatric nursing.
Routine, timely postoperative ambulation reduces complications, speeds up recovery, and shortens length of stay, yet little is known about how interdisciplinary staff perceive factors influencing ambulation for pediatric patients on surgical units. This gap limits the design of effective interventions in pediatric postoperative care. To explore interdisciplinary staff perceptions of facilitators, barriers, and experiences related to promoting ambulation among pediatric patients recovering from surgery on a pediatric surgical unit. This descriptive qualitative study used semi-structured interviews with registered nurses, patient care technicians, advanced practice providers, and physical therapists (n = 16). Data were analyzed using manual thematic analysis, and member checking was conducted to enhance credibility and validate the findings. Three overarching themes emerged: (a) staff readiness, roles, and safety; (b) patient and family engagement; and (c) interdisciplinary knowledge and coordination. Subthemes were identified as facilitators or barriers toward patient ambulation. For example, patient and family engagement demonstrated that parental involvement, visual goals, and reminders facilitate patient ambulation, while poor understanding of ambulation, low motivation, pain, and anticipatory fear limit engagement and hinder ambulation. Registered nurses, as frontline coordinators of pediatric postoperative care, collaborate closely with interdisciplinary team members, patients, and families to promote timely ambulation. Their central role uniquely positions them to lead interventions that leverage facilitators and barriers to improve ambulation consistency. Nurses can improve patient ambulation by integrating standardized pediatric postoperative protocols into workflows, delivering consistent perioperative education, strengthening orientation and competency development for new nurses, and optimizing ambulation-related orders.
This case report details the perioperative management of a 5-year-old girl with biliary atresia (BA) and Alagille syndrome (ALGS) undergoing liver transplantation. Our transplant center emphasizes preoperative optimization, targeted management of high-risk complications, and family-centered support throughout the care process. This report was prepared in strict accordance with the Case Report (CARE) Guidelines, an official clinical reporting guideline endorsed by the EQUATOR Network, to ensure standardized and transparent case reporting. This case report details the perioperative management of a 5-year-old girl with BA and ALGS undergoing liver transplantation. The clinical strategy highlights preoperative optimization, targeted intervention for high-risk complications, and family-centered care throughout the treatment course. The patient underwent orthotopic liver transplantation on the second hospital day. Postoperative complications included chylous ascites and biliary anastomotic stricture. The total length of hospital stay was 78 days. During 3 months of remote follow-up, her graft function remained stable. The percutaneous transhepatic cholangiography (PTCD) catheter was temporarily clamped at 1 month postoperatively, and anxiety in the patient's caregiver was significantly alleviated. This case report presents a novel integrated strategy encompassing multidisciplinary team evaluation, stepwise nutritional optimization, and remote digital follow-up.This approach effectively supported postoperative recovery in this case study, consistently maintained the function of the allograft, and facilitated a successful transition to home care. Nursing care for complex pediatric liver transplantation should incorporate a multidisciplinary team (MDT)-led, stepwise nutritional protocol for the management of lymphatic complications, standardized symptom assessment instruments, and a patient empowerment model integrated with digital telemedicine to support safe and effective transition to home care.
Pediatric feeding disorder is a prevalent, impactful diagnosis for children and their families. This diagnosis is heterogenous in presentation and requires the care of a multidisciplinary team of providers. Existing research suggests providers are underprepared to assess and treat pediatric feeding disorder, therefore more information on training and clinical practice is needed. This study conducted focus groups to describe the training journey of providers across all four pediatric feeding disorder domains (medical, nutrition, feeding skill, psychosocial). Seven focus groups (total of 25 providers) were conducted and analyzed using thematic analysis. Four themes were identified: differences in academic preparation, workplace infrastructure and access, desire for comprehensiveness and feasibility, and value of the family perspective. Overall, results point to opportunities to improve provider training and therefore patient care including academic exposure to pediatric feeding disorder and multi-disciplinary collaboration practices, increased access to mentorship, training, and evidenced-based resources, and enrichment of the research to practice pipeline with a focus on family-centered care.
This study aimed to explore parents' help-seeking behaviors in pediatric palliative care and the role of nurses in this process. This descriptive qualitative study included 15 parents of children hospitalized in a pediatric palliative care unit. Data were collected through semi-structured interviews and evaluated using thematic analysis. Thematic analysis identified six themes: emotional experiences of palliative care, caregiver burden, coping strategies, support networks, the role of nursing support, and help-seeking dynamics. Nurses strengthened parents' confidence and self-efficacy through empathetic communication, guidance, and education, facilitating parents' help-seeking behaviors. Parents experience substantial emotional and social burdens during pediatric palliative care. Nursing support and family resources play a critical role in facilitating parents' adjustment and coping during this process. Pediatric nurses should develop care approaches that facilitate parents' help-seeking behaviors by holistically assessing parents' emotional burden, coping needs and support networks.
Atypical hemolytic uremic syndrome (aHUS) is a rare and potentially life-threatening disease in children, and skin complications such as spontaneous bullous rupture with dystrophic wound calcification are uncommon and challenging to manage. e report the case of an 8-month-old male infant diagnosed with aHUS who developed spontaneous skin bullae rupture and subsequent dystrophic wound calcification after approximately one month of treatment, while his systemic condition was gradually improving. A nurse-led multidisciplinary care approach was implemented, focusing on close monitoring of renal function, fluid balance, electrolytes, and vital signs; individualized hemodialysis support; infection prevention and medication-related observation; staged wound assessment, debridement, dressing changes, and calcification management based on moist wound healing principles; nutritional support adjusted to balance renal function and wound healing needs; pain assessment and comfort care; and continuous family education and psychological support for caregivers. With these coordinated nursing interventions, the patient's wound gradually healed, renal function recovered, and internal homeostasis stabilized. During the 3-month post-discharge follow-up, no recurrence of aHUS was observed, and the wound condition remained satisfactory. This case highlights the importance of integrating systemic disease management with local wound care in pediatric aHUS complicated by rare wound complications and may provide practical guidance for the nursing care of similar complex pediatric cases.
To examine how healthcare provider communication shapes referral, acceptance and ongoing integration of specialist pediatric palliative care (SPPC). A qualitative study was conducted across four pediatric cancer centers in Canada. Sixty-six healthcare providers working in oncology and palliative care settings participated in in-depth interviews. Participants included physicians, nurses, psycho-social clinicians and other members of the interprofessional health team. Transcripts were analyzed using iterative, inductive coding based on the Grounded Theory method. Communication barriers to referral and acceptance included inadequate explanations for SPPC involvement, incomplete or misleading descriptions of services, and framing SPPC solely as end-of-life care. Oncologist discomfort, avoidance, and use of ambiguous "coded" language further hindered referral conversations. Facilitators included strong communication skills, clear and comprehensive explanations of SPPC, and age-appropriate engagement with patients. For ongoing integration of SPPC, poor interprofessional communication and unclear role and responsibilities among team members created risks for fragmented care. In contrast, structured collaboration such as joint meetings, shared care planning, and proactive information exchange, supported effective integration of SPPC and consistent messaging to patients and families. Communication is central to successful SPPC referral, acceptance, and integration in pediatric oncology settings. Both clinician-family and interprofessional communication practices directly shaped understanding and engagement with SPPC services. Interventions should prioritize communication training, clearer framing of SPPC, and enhanced collaboration between teams. Early involvement of the psychosocial provider along with an SPPC specialist may further improve communication and uptake, ultimately strengthening care for children with serious illness and their families.