Palliative care is often viewed as a system of calm, comfort, and stability. While those may be accurate attributes, palliative care that truly impacts systems of care must also be vibrant, challenging, active, and aggressive. Most importantly, palliative care is about change.
Most of us in palliative care have devoted our entire careers to changing systems of care in our external environments, such as changing practices to increase hospice referrals or changing care in the ICU to incorporate palliative care consultation. Changing the external environment is perhaps the easiest change because it is "us" versus "them," and we know that the "us" is right. We advocate for external change with great zeal.
But what happens when the change we need is internal? What if we in palliative care need to challenge our own assumptions, beliefs, and decades of practice to deliver our care in different ways? Now that is a difficult change.
The articles in this issue of the journal are about this internal change and rethinking of how we practice our art and our science. The article by Nicoleta Mitrea and Malina Dumitrescu from Romania will bring perspective to every reader who thinks his/her challenges to change practice are overwhelming. These nurses are evolving the practice of palliative care within a country where change requires impacting the culture of a nation. You will note that implementing palliative care in Romania has involved much effort in changing nursing education and practice. We need to change if we are to be effective agents of change.
The article by Lewis on palliative care in a neonatal ICU reminds us that it is not only our neonatal colleagues who need to change their practice, but also we in palliative care will need to be open to changing our palliative care practices to be successful in this intensive care setting.
What changes lie ahead? Increased use of the Internet, blogs, tweets, links, and who knows what's next will be a part of future palliative care. Bereavement support through the Internet? Symptom management through telephone monitoring? What technologies could allow us to improve our care for symptoms such as delirium and anorexia-cachexia described in this issue? Family conferences done by phone or Skype in order to accommodate distant caregivers? Each change will create great angst but ultimately isn't our real commitment to provide the best care possible with the resources we have?
The paper in this issue by Kanacki and colleagues describes "shared presence", a fundamental concept and value in palliative care. What changes in our practice could actually promote the existential aspects of our care. Many organizations are using simulated learning opportunities, skills labs and videotaped communication exercises to enhance the competencies of their staff in listening, presence and communication. Couldn't we all make changes in these areas? The paper by Kristin Gates Cloyes is an innovative approach to studying communication between hospice nurses and family caregivers. This is an excellent approach to understanding improved care at the most fundamental level- the powerful communication of the hospice nurse.
This issue of the Journal of Hospice and Palliative Nursing also launches a change in our journal. The article by Mitrea and Dumitrescu is our first online publication. With each issue of our journal we will now include an online article where the abstract only of the article appears in print and the full article appears on our Web site. This change allows us to include more papers in our journal and to reach the ever-growing population of professionals who rely on electronic means of education and communication. Our journal and HPNA as our organization will increasingly use technology to advance palliative care nursing. I encourage all readers to visit our Web site, http://www.jhpn.org. Read this first online article and become familiar with the many other resources on our Web site and on HPNA's Web site, http://www.hpna.org.
As I write this, my 31/2-year-old granddaughter fearlessly reaches for her father's Kindle and my iPad. Her 8-month-old brother will probably have his own by age 2! So maybe there is hope for all of us to embrace the electronic age. High tech can also be high touch.
Betty Ferrell, PhD, MA, FAAN, FPCN, CHPN
Editor-in-Chief
[email protected]