Impact of death education on end-of-life care practice competency among pediatric nurses: A latent profile analysis based on the health ecological model.

PURPOSE: This study identified latent end-of-life care competency classes among pediatric nurses and evaluated influencing factors using a health-ecological framework. DESIGN AND METHODS: This multi-center, cross-sectional survey conveniently sampled 348 pediatric nurses from four Chinese hospitals to evaluate end-of-life care competency. Assessments included a health-ecological general questionnaire and the Palliative Care Self-Reported Practices Scale, focusing on terminal-phase competencies. Latent profile analysis categorized participants, and multinomial logistic regression identified predictors of class membership. RESULTS: Our study identified three latent classes of end-of-life care practice competency among the pediatric nurses: the "Elementary Practice Group" (30.84%, n = 101), the "Developing Practice Group" (41.91%, n = 135), and the "Proficient Practice Group" (27.25%, n = 88). Multinomial logistic regression analysis showed that department type, perception of the importance of death education, physician-nurse collaboration, institutional systems, and community environment perception were significant predictors of class membership (p < 0.05). CONCLUSION: Given pediatric nurses' low competency, multi-dimensional interventions are essential to enhance end-of-life care quality. IMPLICATIONS FOR PRACTICE: With most pediatric nurses at early competency stages, leaders must implement targeted interventions. High-exposure departments should establish tiered, simulation-based death education and institute senior mentorship with debriefings within 48 h post-incident. Transitioning to interprofessional "physician-nurse" teams ensures unified end-of-life care. Finally, collaborating with public health sectors to cultivate community life-education programs will sustain frontline professional self-efficacy.