We are undoubtedly in 2014 living in the era of "quality." Policy makers, accountable care organizations, insurers, and accrediting bodies speak with an ever rising voice to insist that all health care organizations, including hospices and palliative care programs, demonstrate quality. Measures of quality are often reduced to objective outcomes linked to financial costs such as avoidance of hospital admissions or urgent care visits.

There is an abundant literature that has defined "quality" for the field of palliative care including documents from the National Consensus Project, the National Quality Forum, and The Joint Commission. As I do my work as a researcher in palliative care, I am often asked what I believe is the best definition for quality palliative care. Here is my answer:

Quality palliative care is the kind of care you would want if you or someone you love were seriously ill or dying.

That is it. More elaborate definitions exist, definitions that are "evidence" based, but this one is the best. It is heart based.

For all professionals engaged in developing palliative care programs or evaluating their effectiveness, pausing to ask this question, "if it were me," is a return to patient-centered outcomes. I challenge you to ask this question of your colleagues and then compare the results to your current institutional goals and quality assurance plan.

Important work is being done including that by HPNA and AAHPM in their project on "Measuring What Matters." Hospice and palliative care programs are working diligently to create measurement tools to assess key indicators of quality in our field where usual health system outcomes mean little. What matters when someone you love is dying is that their symptoms are controlled; their enormous psychosocial and spiritual needs, as well as yours, are met; and that you as a family are supported in the most difficult journey of your life.

The articles in this issue of JHPN speak to quality in our field. They document gaps in quality, and they lift up models of true quality care. They also bring the voice of nursing into the conversations about quality. The article by Niki Koesel and Maureen Link questions the ability of aggressive care to coexist with a good death. Two of the articles in this issue share models of nursing education for palliative care, reminding us that quality palliative care will never be achieved until we have a nursing workforce well prepared to deliver that care. Two additional articles share programs designed to meet the needs of children, the first by Punziano and colleagues on losing a parent and the second by Heller and coauthors on supporting children with life-threatening illnesses in schools. I realize I am a biased source, but I believe that nurses are especially good at asking the "if it were me" questions as they are the professionals most often present at life's end.

As you read these pages and as we all work to implement quality assurance programs, keep focused on the true north of quality care, the kind of care we would seek for our own. You will know it when you feel it.

Betty Ferrell PhD, MA, FAAN, FPCN, CHPN

Editor-in-Chief

[email protected]