{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T12:01:38Z","timestamp":1777982498029,"version":"3.51.4"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T00:00:00Z","timestamp":1771632000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T00:00:00Z","timestamp":1771632000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100011852","name":"Paracelsus Medical University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100011852","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    The implementation of Pediatric Palliative Care (PPC) in hospital settings places considerable demands on nursing staff, particularly during early phases of change. This study explored nurses\u2019 experiences, attitudes, and perceived support needs during the early implementation of a PPC concept at a tertiary pediatric hospital in Austria. A qualitative participatory design was applied. Four moderated focus group discussions were conducted with 18 registered nurses working on two pediatric wards where PPC beds were newly introduced. Data were audio-recorded, transcribed verbatim, and analyzed using Braun and Clarke\u2019s thematic analysis. Four themes were identified: experiences with PPC, PPC as a new model of care, challenges of implementation, and expectations toward PPC. Nurses reported emotional burden, conceptual uncertainty, and limited opportunities for structured training and reflection. Although many participants had prior experience caring for children with life-limiting conditions, these experiences were largely informal and lacked a shared framework. Nurses articulated a strong need for accessible support structures and identified the absence of advanced nursing expertise as a key gap during early PPC implementation.\n                    <jats:italic>Conclusion<\/jats:italic>\n                    : Nurses\u2019 experiences underscore the importance of structured support, conceptual clarity, and emotional resources during early PPC implementation. The articulated need for advanced nursing expertise emerged inductively as a support requirement rather than an evaluation of an existing role and may inform future implementation and role development strategies.\n                    <jats:table-wrap>\n                      <jats:table>\n                        <jats:tbody>\n                          <jats:tr>\n                            <jats:td align=\"left\">\n                              <jats:bold>What is Known:<\/jats:bold>\n                              <jats:italic>\u2022 Pediatric Palliative Care is frequently misunderstood as synonymous with end-of-life care.<\/jats:italic>\n                              <jats:italic>\u2022 Implementing Pediatric Palliative Care in hospital settings requires complex organizational change.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td align=\"left\">\n                              <jats:bold>What is New:<\/jats:bold>\n                              <jats:italic>\u2022 This qualitative study provides in-depth insight into nurses\u2019 experiences during the early implementation of Pediatric Palliative Care in a tertiary pediatric hospital.<\/jats:italic>\n                              <jats:italic>\u2022 Although nurses had prior informal experience caring for children with life-limiting conditions, PPC was perceived as both familiar and novel due to the absence of a shared conceptual framework, leading to emotional burden, conceptual uncertainty, and unmet needs for structured support, including accessible advanced nursing expertise.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                        <\/jats:tbody>\n                      <\/jats:table>\n                    <\/jats:table-wrap>\n                  <\/jats:p>","DOI":"10.1007\/s00431-026-06790-0","type":"journal-article","created":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T08:14:00Z","timestamp":1771661640000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Nurses\u2019 perspectives on implementing pediatric palliative care: a qualitative participatory study on the emerging role of the advanced practice nurse"],"prefix":"10.1007","volume":"185","author":[{"given":"Simone","family":"Saringer-Siegl","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roland","family":"E\u00dfl-Maurer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piret","family":"Paal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,2,21]]},"reference":[{"issue":"4","key":"6790_CR1","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1007\/s00482-008-0690-4","volume":"22","author":"F Craig","year":"2007","unstructured":"Craig F, Huijer A, Benini F, Kuttner L, Wood C, Feraris PC, Zernikow B (2007) IMPaCCT: standards for paediatric palliative care in Europe. Schmerz 22(4):401\u2013408. https:\/\/doi.org\/10.1007\/s00482-008-0690-4","journal-title":"Schmerz"},{"issue":"5","key":"6790_CR2","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1016\/j.jpainsymman.2021.12.031","volume":"63","author":"F Benini","year":"2022","unstructured":"Benini F, Papadatou D, Bernada M, Paravicini E, Pellegatta F, Wolfe J (2022) International standards for pediatric palliative care: from IMPaCCT to GO-PPaCS. J Pain Symptom Manage 63(5):529\u2013543. https:\/\/doi.org\/10.1016\/j.jpainsymman.2021.12.031","journal-title":"J Pain Symptom Manage"},{"issue":"17","key":"6790_CR3","doi-asserted-by":"publisher","first-page":"1752","DOI":"10.1056\/NEJMra030334","volume":"350","author":"BP Himelstein","year":"2004","unstructured":"Himelstein BP, Hilden JM, Boldt AM, Weissman D (2004) Pediatric palliative care. N Engl J Med 350(17):1752\u20131762. https:\/\/doi.org\/10.1056\/NEJMra030334","journal-title":"N Engl J Med"},{"issue":"1","key":"6790_CR4","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1002\/pbc.23100","volume":"15","author":"C Knapp","year":"2011","unstructured":"Knapp C, Woodworth L, Wright M, Downing J, Drake R, Fowler-Kerry S, Hain R, Marston J (2011) Pediatric palliative care provision around the world: a systematic review. Pediatr Blood Cancer 15(1):52\u201360. https:\/\/doi.org\/10.1002\/pbc.23100","journal-title":"Pediatr Blood Cancer"},{"key":"6790_CR5","unstructured":"WHO (1998). Definition des Begriffs Palliative Care. Zugriff am 20.05.2022. Verf\u00fcgbar unter https:\/\/www.who.int\/health-topics\/palliative-care"},{"issue":"23","key":"6790_CR6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12904-018-0274-8","volume":"17","author":"LM Verbene","year":"2018","unstructured":"Verbene LM, Kars MC, Schepers SA, van Schouten- Meeteren AYN, Grootenhuis MA, van Delden JJM (2018) Barriers and facilitators to the implementation of a paediatric palliative care team. BMC Palliat Care 17(23):1\u20138. https:\/\/doi.org\/10.1186\/s12904-018-0274-8","journal-title":"BMC Palliat Care"},{"key":"6790_CR7","doi-asserted-by":"publisher","DOI":"10.1186\/1824-7288-34-4","volume":"34","author":"F Benini","year":"2008","unstructured":"Benini F, Spizzichino M, Trapanotto M, Ferrante A (2008) Pediatric palliative care. Ital J Pediatr 34:4. https:\/\/doi.org\/10.1186\/1824-7288-34-4","journal-title":"Ital J Pediatr"},{"issue":"3","key":"6790_CR8","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1177\/0269216307084608","volume":"14","author":"L Monterosso","year":"2008","unstructured":"Monterosso L, Kristjanson L (2008) Supportive and palliative care needs of families of children with life-threatening illness. Int J Palliat Nurs 14(3):110\u2013117. https:\/\/doi.org\/10.1177\/0269216307084608","journal-title":"Int J Palliat Nurs"},{"key":"6790_CR9","doi-asserted-by":"publisher","unstructured":"De Clerq E, Rost M, Rakic M, Ansari M, Brazzola P, Wangmo T, Elger BS (2019) The conceptual understanding of pediatric palliative care: a Swiss healthcare perspective. BMC Palliative Care 18(55). https:\/\/doi.org\/10.1186\/s12904-019-0438-1","DOI":"10.1186\/s12904-019-0438-1"},{"key":"6790_CR10","doi-asserted-by":"publisher","unstructured":"Winger A, Fr\u00fch EA, Holmen H, Kvarme LG, Lee A, Lorentsen VB, Misvaer N, Riiser K, Steindal S (2022) Making room for life and death at the same time \u2013 a qualitative study of health and social care professionals\u2019 understanding and use of the concept of paediatric palliative care. BMC Palliative Care 21(50). https:\/\/doi.org\/10.1186\/s12904-022-00933-4","DOI":"10.1186\/s12904-022-00933-4"},{"key":"6790_CR11","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1093\/med\/9780190204747.003.0057","volume-title":"Advanced practice palliative Nursing","author":"CA Thaxton","year":"2016","unstructured":"Thaxton CA, Neubauer L (2016) The role of the pediatric palliative advanced practice registered nurse. In: Dahlin C, Coyne P, Ferrel B (eds) Advanced practice palliative Nursing. Oxford University Press, New York, pp 545\u2013551"},{"key":"6790_CR12","unstructured":"Tracy MF, Sendelbach S (2019) The clinical nurse specialist. In: Tracy MF, O\u2019Grady ET (eds) Advanced practice nursing: an integrative approach. Elsevier, St. Louis, Missouri, pp 343\u2013373"},{"key":"6790_CR13","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1016\/j.pedhc.2022.01.005","volume":"36","author":"CL Cormack","year":"2022","unstructured":"Cormack CL, Dahlin C (2022) The pediatric palliative APRN: leading the future. J Pediatr Health Care 36:381\u2013387. https:\/\/doi.org\/10.1016\/j.pedhc.2022.01.005","journal-title":"J Pediatr Health Care"},{"key":"6790_CR14","volume-title":"Advanced nursing practice (APN)","author":"M Schober","year":"2008","unstructured":"Schober M, Affara F (2008) Advanced nursing practice (APN). Huber, Bern"},{"key":"6790_CR15","doi-asserted-by":"publisher","DOI":"10.1016\/j.pedhc.2008.02.006","author":"RA Hubble","year":"2009","unstructured":"Hubble RA, Ward-Smith P, Christenson K, Hutto CJ, Korphage RM, Hubble CL (2009) Implementation of a palliative care team in a pediatric hospital. J Pediatr Health Care. https:\/\/doi.org\/10.1016\/j.pedhc.2008.02.006","journal-title":"J Pediatr Health Care"},{"issue":"0","key":"6790_CR16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/13674935221076214","volume":"0","author":"D Rawling","year":"2022","unstructured":"Rawling D, Winsall M, Yin H, Devery K (2022) Holding back my own emotions\u201d: evaluation of an online education module in pediatric end-of-life care. J Child Health Care 0(0):1\u201316. https:\/\/doi.org\/10.1177\/13674935221076214","journal-title":"J Child Health Care"},{"key":"6790_CR17","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1136\/archdischild-2021-321802","volume":"107","author":"S Mitchell","year":"2021","unstructured":"Mitchell S, Slowther A-M, Coad J, Bertraud S, Dale J (2021) Facilitators and barriers to the delivery of palliative care to children with life-limiting and life-threatening conditions: a qualitative study of the experiences and perceptions of healthcare professionals. Arch Dis Child 107:59\u201364. https:\/\/doi.org\/10.1136\/archdischild-2021-321802","journal-title":"Arch Dis Child"},{"key":"6790_CR18","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1007\/s00431-012-1880-8","volume":"172","author":"E Bergstr\u00e4sser","year":"2012","unstructured":"Bergstr\u00e4sser E, Inglin S, Abbruzzese R, Marfurt-Russenberger K, Hosek M, Hornung R (2012) The needs of professionals in the palliative care of children and adolescents. Eur J Pediatr 172:111\u2013118. https:\/\/doi.org\/10.1007\/s00431-012-1880-8","journal-title":"Eur J Pediatr"},{"issue":"1","key":"6790_CR19","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1177\/1367493512468363","volume":"18","author":"K Twamley","year":"2014","unstructured":"Twamley K, Craig F, Kelly P, Hollowell DR, Mendoza P, Bluebond-Langner M (2014) Underlying barriers to referral to paediatric palliative care services: knowledge and attitudes of health care professionals in a paediatric tertiary care centre in the United Kingdom. J Child Health Care 18(1):19\u201330. https:\/\/doi.org\/10.1177\/1367493512468363","journal-title":"J Child Health Care"},{"issue":"1","key":"6790_CR20","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1186\/s12904-017-0254-4","volume":"16","author":"J Taylor","year":"2017","unstructured":"Taylor J, Aldridge J (2017) Exploring the rewards and challenges of paediatric palliative care work \u2013 a qualitative study of a multi-disciplinary children`s hospice care team. BMC Palliat Care 16:73. https:\/\/doi.org\/10.1186\/s12904-017-0254-4","journal-title":"BMC Palliat Care"},{"issue":"5","key":"6790_CR21","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1111\/j.1365-2648.2004.03235.x","volume":"48","author":"D Bryant-Lukosius","year":"2004","unstructured":"Bryant-Lukosius D, DiCenso A (2004) A framework for the introduction and evaluation of advanced practice nursing roles. J Adv Nurs 48(5):530\u2013540. https:\/\/doi.org\/10.1111\/j.1365-2648.2004.03235.x","journal-title":"J Adv Nurs"},{"issue":"2","key":"6790_CR22","doi-asserted-by":"publisher","first-page":"165","DOI":"10.6004\/jadpro.2021.12.2.4","volume":"12","author":"B Ferrell","year":"2021","unstructured":"Ferrell B, Virani R, Han E, Mazanec P (2021) Integration of palliative care in the role of the oncology advanced practice nurse. J Adv Pract Oncol 12(2):165\u2013172. https:\/\/doi.org\/10.6004\/jadpro.2021.12.2.4","journal-title":"J Adv Pract Oncol"},{"issue":"1","key":"6790_CR23","doi-asserted-by":"publisher","first-page":"39","DOI":"10.21037\/apm.201","volume":"8","author":"TF Akard","year":"2019","unstructured":"Akard TF, Hendricks-Ferguson V, Gilmer MJ (2019) Pediatric palliative care nursing. Ann Palliat Med 8(1):39\u201348. https:\/\/doi.org\/10.21037\/apm.201","journal-title":"Ann Palliat Med"},{"key":"6790_CR24","volume-title":"Qualitative Sozialforschung: eine Einf\u00fchrung","author":"U Flick","year":"2019","unstructured":"Flick U (2019) Qualitative Sozialforschung: eine Einf\u00fchrung, 9. Aufl. Rowohlt, Reinbeck","edition":"9. Aufl"},{"key":"6790_CR25","volume-title":"Qualitative Sozialforschung","author":"S Lamnek","year":"2016","unstructured":"Lamnek S, Krell C (2016) Qualitative Sozialforschung, 6. \u00fcberarb. Aufl. Beltz, Weinheim","edition":"6. \u00fcberarb. Auf"},{"key":"6790_CR26","volume-title":"Thematic analysis. A practical guide","author":"V Braun","year":"2022","unstructured":"Braun V, Clarke V (2022) Thematic analysis. A practical guide. Sage Publications, London"},{"key":"6790_CR27","doi-asserted-by":"publisher","unstructured":"Snamann JM, Torres C, Duffy B, Levine DR, Gibson DV, Baker JN (2016) Parental perspectives of communication at the end of life at a pediatric oncology institution. J Palliative Med 19(3). https:\/\/doi.org\/10.1089\/jpm.2015.0253","DOI":"10.1089\/jpm.2015.0253"},{"issue":"8","key":"6790_CR28","doi-asserted-by":"publisher","first-page":"1940","DOI":"10.1111\/jan.12650","volume":"71","author":"E Bergstr\u00e4sser","year":"2015","unstructured":"Bergstr\u00e4sser E, Zimmermann K, Eskola K, Luck P, Remelet AS, Cignacco E (2015) Paediatric end-of-life care needs in Switzerland: current practices, and perspectives from parents and professionals. A study protocol. J Adv Nurs 71(8):1940\u20131947. https:\/\/doi.org\/10.1111\/jan.12650","journal-title":"J Adv Nurs"},{"issue":"1","key":"6790_CR29","doi-asserted-by":"publisher","first-page":"111","DOI":"10.4037\/aacnacc2016275","volume":"27","author":"CH Rushton","year":"2016","unstructured":"Rushton CH (2016) Moral resilience: a capacity for navigating moral distress in critical care. AACN Adv Crit Care 27(1):111\u2013119. https:\/\/doi.org\/10.4037\/aacnacc2016275","journal-title":"AACN Adv Crit Care"},{"key":"6790_CR30","doi-asserted-by":"publisher","unstructured":"Paal P, Helo Y, Frick E (2015) Spiritual care training provided to healthcare professionals: a systematic review. J Pastoral Care Couns 19(1). https:\/\/doi.org\/10.1177\/1542305015572955","DOI":"10.1177\/1542305015572955"},{"key":"6790_CR31","doi-asserted-by":"publisher","DOI":"10.1007\/s00431-025-05979-z","author":"A Wiljen","year":"2025","unstructured":"Wiljen A, Chaplin J, Nilsson S, Karlsson K, \u00d6hlen J, Schwarz A (2025) Validity and reliability of the Swedish version of the Visual CARE measure for assessing children\u2019s perceptions of nurses\u2018 empathy. Eur J Pediatr. https:\/\/doi.org\/10.1007\/s00431-025-05979-z","journal-title":"Eur J Pediatr"},{"key":"6790_CR32","doi-asserted-by":"publisher","unstructured":"Fojer M, Spek B, de Vos MA, Verhagen AA, Aris-Meijer JL (2025) Development and validation of the PACPN: Parents\u2018 attitudes towards crying pediatricians and pediatric nurses questionnaire. Eur J Pediatr 17(3). https:\/\/doi.org\/10.1007\/s00431-025-06030-x","DOI":"10.1007\/s00431-025-06030-x"}],"container-title":["European Journal of Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-026-06790-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00431-026-06790-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-026-06790-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T07:41:15Z","timestamp":1776930075000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00431-026-06790-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,21]]},"references-count":32,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["6790"],"URL":"https:\/\/doi.org\/10.1007\/s00431-026-06790-0","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-7102048\/v1","asserted-by":"object"}]},"ISSN":["1432-1076"],"issn-type":[{"value":"1432-1076","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,21]]},"assertion":[{"value":"11 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 January 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 February 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 February 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethical approval was obtained from the institutional ethics committee of the Paracelsus Medical University (SS22-0046\u20130046).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Written informed consent was obtained from all individual participants.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"143"}}