Palliative care has long been framed as a specialist discipline reserved for hospices and oncology wards, but a growing body of evidence insists it belongs everywhere people approach the end of life, including nursing homes, where a large share of deaths in ageing societies now occur. A new qualitative study from Sweden, published in BMC Nursing, offers an unusually candid look at what happens inside care teams after they receive structured palliative care education, and the central finding is striking: training changes how staff think, but thinking alone does not change care. The researchers, Camilla Ekeblom, Carina Lundh Hagelin and Jane Österlind of Marie Cederschiöld University in Stockholm, found that the value of an educational intervention depends on an intricate alignment between individual emotions, relational dynamics and organisational realities, and that when any one of these dimensions falls out of step, the benefits of education can quietly dissolve.

The study set out to explore how nursing home staff reason about providing palliative care after participating in an interprofessional educational intervention, abbreviated in the literature as IPEI. Rather than measuring outcomes with questionnaires, the team chose a descriptive qualitative design, interviewing eighteen staff members drawn from five Swedish nursing homes. The participants represented the full spectrum of people who actually deliver and manage care: registered nurses, assistant nurses, a physician, first-line managers and designated palliative care champions. This breadth matters, because palliative care in nursing homes is not delivered by any single profession; it emerges, or fails to emerge, from the daily interplay of people with different training levels, responsibilities and emotional exposures to dying residents.

Data were collected through semi-structured individual interviews conducted between March and April 2024, and analysed using inductive qualitative content analysis, a method that allows themes to rise from the material itself rather than being forced into pre-existing theoretical boxes. From this analysis, three main categories emerged, and together they map the terrain on which palliative care is actually practised. The first concerns managing one’s own emotions, thoughts and attitudes. The second addresses the significance of relationships, communication and interactions in care. The third captures how staff navigate norms, assumptions and organisational structures in everyday palliative care. The categories correspond, respectively, to the individual, relational and organisational dimensions of the work, and the authors argue that it is the interplay among all three, not any single factor, that determines whether good palliative care becomes possible.

The individual dimension is perhaps the most human part of the findings. Staff described the ongoing internal work of confronting their own feelings about death, ageing and suffering, and of examining assumptions they carried about what palliative care even means. A recurring tension in the literature, echoed here, is the tendency to equate palliative care narrowly with end-of-life care, the final days and hours, rather than understanding it as an approach that can and should be integrated into everyday care over a longer trajectory. The interviews suggested that the educational intervention gave participants opportunities for personal as well as professional development, creating space to reflect on attitudes that had previously gone unexamined. In this sense, education functioned less like a knowledge transfer and more like a mirror, prompting staff to notice how their own emotional responses shaped their clinical decisions.

The relational dimension proved equally consequential. Palliative care in a nursing home is saturated with communication: conversations with residents about what matters to them, exchanges with distressed relatives, coordination between assistant nurses who know the residents intimately and nurses and physicians who carry clinical responsibility. The participants’ reasoning placed relationships and interactions at the heart of care provision, indicating that no amount of theoretical knowledge substitutes for the ability to build trust, listen and communicate across professional boundaries. This is where the interprofessional design of the intervention appears to have paid off. By bringing different professions into a shared educational space, the programme created a common language and, implicitly, a shared understanding of what the team was trying to achieve together, something that fragmented, profession-specific training often fails to produce.

The third dimension, the organisational, is where the study’s message becomes most uncomfortable for policymakers and care home leadership. Staff described navigating norms and assumptions embedded in their workplaces, along with structural conditions that could either support or obstruct a palliative approach. Staffing levels, routines, leadership priorities and workplace culture all shape what is practically possible on a shift where residents are dying, families are anxious and time is scarce. The authors’ conclusion is explicit on this point: providing palliative care was not solely a matter of enhancing staff knowledge. Knowledge and the conditions for care are shaped through the interplay between staff attitudes, their reasoning about care, relational dynamics and organisational conditions. When these dimensions align and mutually reinforce one another, favourable conditions for palliative care may be supported; when they do not, even well-trained staff may find their intentions frustrated.

Why does this matter on a societal scale? Nursing homes accommodate older people with complex needs and account for a large proportion of deaths, which makes palliative care a central component of care in these settings rather than an occasional emergency. Yet access to palliative care remains unequal, particularly for older people, and staff in long-term care often lack sufficient training. The demographic arithmetic is unforgiving: as populations age, the number of people who will die in nursing homes rises, and the quality of their final months depends heavily on the competence and confidence of the workforce that cares for them. Studies like this one move the conversation beyond the simplistic assumption that a training course fixes the problem, and toward a systems view in which education is necessary but insufficient on its own.

The study also carries a methodological lesson for how we evaluate educational interventions in care settings. Much of the existing research measures knowledge gains or self-reported confidence before and after training. Those metrics are useful, but they cannot reveal how staff actually reason about applying what they have learned in the messy reality of daily care. By using inductive content analysis of interviews, the Swedish team surfaced the texture of that reasoning: the hesitations, the emotional labour, the negotiations with colleagues and managers, the quiet adjustments between ideal practice and what the shift allows. The findings suggest that interprofessional educational initiatives work best when they combine theoretical knowledge with opportunities for reflection and practical application, allowing staff to translate concepts into their own working context rather than leaving translation to chance.

There are limits worth noting. The study involved eighteen participants in five Swedish nursing homes, interviewed at a single point in time after the intervention, and qualitative findings are not designed to be statistically generalised. The researchers themselves submitted the work for ethical review, receiving approval from the Swedish Ethical Review Authority, and obtained written informed consent from all participants, but the transferability of the results to other health systems will depend on how similar those systems’ nursing homes and educational programmes are to the Swedish context. Still, the three-dimensional framework that emerged, individual, relational and organisational, offers a portable lens that other teams can use to examine their own settings, and it aligns with a broader international consensus that palliative care competence must be built at every level of an organisation simultaneously.

The most durable insight from this research may be its refusal to locate the solution in any single place. Staff who completed the intervention perceived it as an opportunity for growth, and their reasoning showed genuine movement in how they understood palliative care as an ongoing approach rather than a final act. But their accounts also made clear that attitudes, relationships and structures must pull in the same direction for that understanding to reach residents’ bedsides. For nursing homes everywhere, the implication is a practical checklist of a different kind: train your staff together, give them room to reflect, examine the norms your workplace quietly enforces, and make sure the organisation’s daily conditions match what the education teaches. Where those elements align, palliative care stops being an aspiration and becomes, simply, the way care is done.

Subject of Research: Nursing home staff's reasoning about providing palliative care after an interprofessional educational intervention

Article Title: “Nursing home staff’s reasoning about providing palliative care following an educational intervention – a qualitative interview study”

Article References: Ekeblom, C., Lundh Hagelin, C., & Österlind, J. (2026). “Nursing home staff’s reasoning about providing palliative care following an educational intervention – a qualitative interview study”. BMC Nursing, 25(1), Article 956. https://doi.org/10.1186/s12912-026-05480-4

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05480-4

Keywords: palliative care, nursing homes, older people, interprofessional education, qualitative research, nursing education, end-of-life care, care staff attitudes, organisational conditions, Sweden, BMC Nursing, healthcare workforce

Where is the line between firm discipline and child abuse? For millions of families in the United States, the answer depends on where they grew up, what their parents did, and how their culture defines good parenting. A new study published in the Journal of Child and Family Studies tackles this thorny question with an ambitious goal: building a scientific instrument that can measure how people from different backgrounds judge parenting practices that are accepted in some communities but condemned in others. The Parenting Practices and Discipline Scale, or PPDS, developed by Kevin Ortiz Diaz, Maureen C. Kenny, and Helia Baez at Florida International University, is one of the first tools designed specifically to capture culturally situated discipline practices that existing measures simply ignore.

The stakes are enormous. Child abuse is recognized as a global health issue, and in the United States it occurs at what researchers describe as epidemic proportions. Federal data show 546,159 victims of child abuse and neglect in 2023 alone, and the vast majority of these cases, roughly 89 percent, are committed by one or both parents. Children from minority groups are often the most affected, with Black or African American children among the most likely to experience abuse, second only to American Indian or Alaska Native children. Yet the definitions of what constitutes abuse vary dramatically across countries and cultures, creating a legal and ethical minefield for immigrant families who may not realize that practices considered normal at home are illegal in their new country.

The problem is particularly acute for Hispanic families, who make up 19 percent of the American population and represent the largest share of recent immigrants. Hispanic culture is far from monolithic, encompassing communities from South and Central America and the Caribbean with distinct traditions, but certain common threads run through the research. The concept of familismo, a cultural orientation and sense of obligation to family, has been linked to greater parental warmth in some studies. At the same time, physical violence as a disciplinary method remains common in many Hispanic cultures, and the chances that such behaviors are carried over by families immigrating to the United States are high. The result is a potential collision between generations of cultural practice and a legal system, anchored by the Child Abuse Prevention and Treatment Act of 1974, that defines abuse in terms of serious physical or emotional harm.

What makes the new study distinctive is its grounding in intersectionality theory, a framework rooted in feminist scholarship that examines how multiple categories of identity, such as race, ethnicity, gender, and nativity, interact to shape experience. Rather than treating demographic characteristics as independent variables, the researchers designed their analyses to test whether these dimensions jointly predict how individuals classify discipline practices as culturally acceptable or abusive. The framework has practical urgency: racial and ethnic disparities exist in both the reporting and substantiation of child maltreatment, and current child protection policies can disproportionately affect women of color who use social services and face heightened surveillance and risk of reports to child protective services.

The scale itself emerged from a careful two-stage piloting process. First, four experienced mental health clinicians specializing in child abuse, with 10 to 20 years of experience each, reviewed a draft pool of 54 items describing parenting behaviors and case vignettes. Then ten first-generation Hispanic immigrants from a range of nationalities, including Puerto Rican, Cuban, Colombian, Mexican, Dominican, and Nicaraguan participants, examined the refined items and identified which behaviors they would associate with parents in their own cultures and whether they would label those behaviors abusive or acceptable. Consensus required agreement from at least 70 percent of the pilot group. Eighteen items survived, ten identified as culturally acceptable behaviors such as yelling, using the chancla, the slipper famously wielded in many Latino households, or letting a child sleep with parents, and eight identified as abusive behaviors such as spanking, leaving a child alone in a car, or forcing a child to bathe with an adult.

The main study recruited 1,477 undergraduates at a large Hispanic-Serving Institution in Miami, ultimately yielding an analytic sample of 1,089 participants after exclusions for failed attention checks, missing data, and groups too small for meaningful analysis. The final sample was 72.2 percent Hispanic, 16.3 percent non-Hispanic Black, and 11.6 percent non-Hispanic White, nearly 70 percent U.S.-born, and predominantly female at 88.8 percent. Participants rated each of the 18 behaviors on a three-point scale: not abusive, inappropriate but not abusive, or abusive. The choice of a college population was deliberate, since emerging adults are on the cusp of parenthood, attitudes at this life stage predict later parenting intentions, and parenting practices tend to be transmitted intergenerationally.

Psychometrically, the study unfolded in two parts. Study 1 established the scale’s initial properties using exploratory factor analysis with principal axis factoring and oblique rotation on a polychoric correlation matrix, an approach suited to the ordinal, non-normally distributed responses. The analysis supported a two-factor structure: Factor 1 captured discipline and psychological aggression, including spanking, yelling, the chancla, cursing, ignoring, comparing, fighting, and religion, while Factor 2 reflected neglect and physical endangerment, such as using drugs in front of a child, refusing treatment for illness, and allowing smoking. The two factors accounted for 29.5 percent of the variance and were moderately correlated. Internal consistency for the full 18-item measure was acceptable at a Cronbach’s alpha of 0.71, though the abusive subscale showed weaker reliability, a limitation the authors acknowledge candidly.

Study 2 then deployed regression models to test how demographic identities shaped perceptions, and the results were revealing. Gender and parental status emerged as the strongest and most consistent predictors: women and parents were significantly more likely to classify culturally acceptable practices as abusive. Among Hispanic participants, those not born in the United States were more likely than U.S.-born Hispanics to view behaviors like spanking as abusive, a finding that ran counter to the researchers’ hypothesis and suggests that acculturation may shift parenting beliefs toward American child protection norms. Across racial and ethnic groups, Hispanic participants were more likely than Black participants to classify culturally acceptable practices as abusive. Notably, for the more overtly harmful behaviors in Factor 2, parental status was the only significant predictor, suggesting broad agreement that neglecting a sick child or encouraging substance use transcends cultural and gendered expectations.

The effect sizes were small, with the models explaining roughly 1 to 6 percent of the variance, a reminder that unmeasured cultural and contextual factors account for most of the variation in how people judge discipline. Still, the patterns carry real implications for prevention. The authors suggest that father-focused education programs may be valuable, since men were less likely to identify physical discipline as harmful and may therefore be at greater risk of normalizing such practices. Culturally adapted interventions have already shown promise, from brief summer parent training programs benefiting Hispanic children to the multinational Triple P Positive Parenting Program, and the PPDS could help practitioners identify which disciplinary practices are perceived as acceptable within specific communities, allowing messaging to be tailored rather than uniform.

The researchers are careful to frame their findings as preliminary. The sample was heavily female and drawn from a single Miami institution in a minority-majority city, socioeconomic status was not assessed, and social desirability bias may have influenced responses to questions about parenting. The abusive subscale needs refinement, and future work should apply confirmatory factor analysis and measurement invariance testing across cultural groups. Yet the core contribution stands: a novel measure that captures culturally situated discipline practices invisible to existing tools like the Alabama Parenting Questionnaire or the Child Abuse Potential Inventory. As parenting practices pass from generation to generation and families cross borders into legal systems with different rules, understanding exactly how culture shapes perceptions of abuse may be the first step toward protecting children without criminalizing the traditions their parents brought with them.

Subject of Research: Development and validation of a scale measuring cultural perceptions of parenting and discipline practices

Article Title: Development and Validation of the Parenting Practices and Discipline Scale in an Ethnically Diverse Sample

Article References: Ortiz Diaz, K., Kenny, M. C., & Baez, H. (2026). Development and Validation of the Parenting Practices and Discipline Scale in an Ethnically Diverse Sample. Journal of Child and Family Studies. https://doi.org/10.1007/s10826-026-03370-6

Image Credits: AI Generated

DOI: 10.1007/s10826-026-03370-6

Keywords: child abuse, parenting practices, discipline, Hispanic families, intersectionality, psychometrics, scale development, cultural perceptions, child welfare, corporal punishment, acculturation, exploratory factor analysis