The Evolution of a Specialty

As members of the specialty of palliative nursing, we are defining the specialty of our field and the nature of our work. Palliative care nurses care for patients and families across clinical areas of oncology, geriatrics, pediatrics, critical care, and many other areas, yet the nature of our work is distinct.

In the year 2011, only months away, the Hospice and Palliative Nurses Association will celebrate its 25th anniversary. History will note that those of us who have been fortunate to practice during these years have participated in the evolution of this very complex specialty occurring at a time when society desperately needs our care.

While I was a graduate student, one of the most eloquent and scholarly works in nursing was written by Patricia Benner, PhD, RN,1 entitled From Novice to Expert. Benner1 described the progression of the individual nurse as he/she masters the role of expert nurse. These expert nurses display tremendous intuition, wisdom, and insight into the depth of the relationship between nurse and patient.

I often think of Benner's writing as I witness expert palliative care nurses. These nurses skillfully guide patients and families in end-of-life decision making, prepare families' for the moment of death, intricately manage symptoms, and offer their presence to the bereaved. These palliative care nurses embody Benner's description of the expert.

The articles in this issue exemplify the mastery of our field. The article by Hersh on "Never Events" illustrates the tremendous opportunity for nurses to address the difficult choices for patients with dementia. The article by Campbell, as an expert nurse, addresses the needs of decision making by African Americans.

The article by Patrick Coyne provides valuable clinical advice for patients and families related to artificial nutrition. The article by Nochomovitz addresses palliative care needs in long-term care, a very critical setting for our future care.

These expert nurses are extending the reach of palliative care and changing the paradigm of what quality care can mean in these diseases. The evolution of palliative nursing has been advanced through insightful qualitative research that has helped us understand the meaning and implications of our work. The article by Meeker on "Staying Oneself" is a superb example of qualitative research to advance our understanding of the world of family caregivers. The family caregiving experience can be compared to the findings by Lobb and colleagues in recognizing "Frontline Grief."

The pages of this journal offer an opportunity for nurses to tell our story. From the earliest years of nurses launching hospice programs to the current incredible extension of palliative care across all diseases and settings of care, we have an important story to be shared.

Betty Ferrell, PhD, MA, FAAN, FPCN

Editor-in-Chief

[email protected]

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