Exploring Stakeholders' Perspectives on Required Nursing Competencies in Paediatric End‐of‐Life Care: A Qualitative Study
Latif Panahi, Zahra Taheri‐Ezbarami, Maryam Rassouli, Somaye PouyABSTRACT
Aim
To explore stakeholder perspectives (including nurses, nursing supervisors, educators and parents) on the competencies perceived as important for providing paediatric end‐of‐life care.
Design
A qualitative design using semi‐structured interviews and a conventional content analysis approach was employed.
Review Methods
Data were collected through individual, in‐depth, semi‐structured face‐to‐face interviews. Multi‐stakeholder purposive sampling with maximum variation was utilized. Audio‐recorded interviews were transcribed verbatim and analysed using conventional qualitative content analysis following Graneheim and Lundman's approach. Data collection and iterative analysis proceeded until code saturation was achieved within the healthcare professional cohort.
Data Sources
Primary qualitative data were collected between 1 April and 30 June 2025, across paediatric healthcare settings in the North of Iran (Rasht, Guilan). Data sources comprised 17 participants: 15 healthcare professionals (10 clinical paediatric nurses, 2 nursing supervisors and 3 nursing faculty members) and 2 bereaved parents whose children had received end‐of‐life palliative care.
Results
Data analysis revealed one overarching theme, ‘Providing comprehensive and ethically oriented care for the child and family at the end of life’, encompassing six stakeholder‐identified competencies (main categories) and 17 subcategories. The six proposed categories were: (1) competencies in ethical and empathetic communication; (2) competencies in comprehensive physical care focused on the child's quality of life; (3) competencies in psychological care and bereavement support; (4) competencies in cultural and spiritual care; (5) ethical and advanced clinical decision‐making competencies; and (6) competencies in interdisciplinary and team‐based collaboration.
Conclusion
From the perspective of key stakeholders, competent paediatric end‐of‐life nursing care extends beyond routine clinical skills, requiring comprehensive, ethically grounded and context‐sensitive capabilities for supporting both the dying child and their family. These preliminary, stakeholder‐informed competencies highlight the need for strengthening specialized educational curricula and supportive institutional infrastructure to enhance the quality of paediatric end‐of‐life care.
Implications for Nursing Practice
Culturally responsive care
: Highlights the need to incorporate cultural and spiritual coping strategies—such as faith in divine providence—into paediatric palliative care competencies, extending beyond Western‐oriented frameworks.
Navigating ethical tensions
: Equips nurses to effectively navigate complex ethical dilemmas and facilitate family‐centred decision‐making in healthcare settings characterized by limited resources and prominent religious frameworks.
Educational framework
: Offers an evidence‐based foundation for developing specialized undergraduate curricula, continuous professional development programs and clinical protocols for general nurses providing end‐of‐life care.
Impact
This study addresses the lack of context‐specific evidence on paediatric end‐of‐life nursing competencies in Iran. The findings clarify the professional competencies required to support dignified, high‐quality end‐of‐life care, preserve children's dignity and empower families during decision‐making and bereavement. These results are anticipated to inform nurses, educators and healthcare policymakers involved in paediatric palliative care.
Reporting Method
This study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.
Patient or Public Contribution
Bereaved parents whose children passed away in paediatric units participated as key interviewees, contributing directly to qualitative data generation by sharing their lived experiences and expectations regarding nursing competencies during their child's end‐of‐life trajectory.