Nurses' perceptions of end-of-life care in neonatal and pediatric intensive care units in Korea: a qualitative descriptive study using thematic analysis.

PURPOSE: To explore nurses' perceptions of end-of-life care in neonatal and pediatric intensive care units, focusing on the components, facilitators, and challenges of such care in daily practice.

METHODS: A qualitative descriptive study was conducted. Data were collected from June to October 2023 through semi-structured individual interviews with 17 nurses from the neonatal and pediatric intensive care units of four tertiary general hospitals in a metropolitan area of South Korea, and were analyzed using thematic analysis techniques.

RESULTS: We identified three themes and nine subthemes: (1) supporting families' emotional and relational closure, (2) perceiving relational and systemic support as enabling end-of-life care, and (3) feeling constrained by systemic and practical challenges. Participants perceived fostering an emotional connection with the child, ensuring opportunities for meaningful farewell, and supporting emotional acceptance of death as ways to support families' emotional and relational closure with their child. Although relational and systemic support, such as collaborative teamwork, clear communication, shared planning, and structured tools, enabled compassionate care, participants also felt unprepared, burdened by heavy workloads, and hindered by environmental barriers.

CONCLUSION: The findings highlight that delivering quality end-of-life care in neonatal and pediatric intensive care units requires supporting families' emotional needs, strengthening relational and systemic support, and addressing practical challenges. Further research is needed to develop and test practical strategies (e.g., specialized education in compassionate communication, standardized protocols, and supportive care environments) that can improve the quality of end-of-life care for neonatal and pediatric patients and their families.