The goal of this doctoral research training program is to understand how pediatric intensive care unit (PICU) nurses care for dying children and their families. The specific aims are: 1) to describe PICU nurses'perceptions, beliefs, and attitudes toward palliative care in the intensive care unit;2) to describe PICU nurses'competence and comfort in delivering palliative care;3) to investigate the resources and support available to PICU nurses in providing care for dying children and their families;and 4) to describe how palliative nursing care is delivered in the PICU. Grounded theory research methods will be used to achieve these aims. Open-ended interviews and participant observation during clinical practice will be conducted with nurses from a single PICU, allowing for in-depth analysis of the roles that both individual and environmental factors play in the delivery of end-of-life care to children and families in the PICU. Audio- recordings of the interviews and field notes from observations will allow for analysis of themes and the development of a theoretical model that describes PICU nurses'work with dying children and their families. PUBLIC HEALTH RELEVANCE: The majority of children who die each year do so in the hospital and in an intensive care unit. Pediatric intensive care unit nurses have a central, front-line role in the delivery of care to critically ill children and their families and are therefore frequently present at or near the time of a child's death. They are uniquely positioned to identify the existing supports and barriers to the implementation of palliative care in the intensive care unit (ICU) setting. This research proposal will explore PICU nurses'role in the delivery of palliative care and identify the supports of and barriers to providing palliative care in the pediatric ICU. The information obtained from this study will contribute to efforts aimed at improving pediatric palliative care and supporting the healthcare providers who care for dying children and their families.