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Aim This paper reports on parent and professional perspectives of step down care in assisting the transition from hospital to home, within one children's hospice in a constituent country of the United Kingdom. Background In recent years increasing numbers of children dependent on long term assisted ventilation have been noted. Meeting the complex physical, emotional and social needs of the child and family is challenging. Many of these children spend extended periods in hospital even when medically stable. Design This was a qualitative study using an inductive, semantic analytic approach within a realist epistemology. Methods Data collection was carried out in 2013. Interviews took place with parents (n=5) and focus groups with professionals (n=26) who had experience of step down care. Results/Findings Multiple benefits of step down in the hospice were clear. Both sets of accounts suggested that for children and families life was ‘on hold’ in hospital. Hospice was considered a home-like environment where the child and family could ‘live again’. Parents reflected that, in hospice they were ‘living, not existing’ while professionals highlighted hospice as nurturing and empowering the whole family, promoting the child's development while safely meeting their clinical needs. Conclusion and implications for practice 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. This article is protected by copyright. All rights reserved.

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.

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.