ON BECOMING "ESSENTIAL"

Jeanne Quint Benoliel, PhD, RN, FAAN, began her nursing career in 1941 serving in the US Army Nurse Corps in World War II. She observed death early on, caring for soldiers dying in battle or dying of malaria and typhus. In the 1950s, Dr Benoliel experienced death in her own family as her sister died of breast cancer. She described the "conspiracy of silence" as doctors and nurses avoided any communication with her sister or the family about the seriousness of her illness or death. In the 1960s, Dr Benoliel and colleagues conducted research that broke that silence, as they provided strong evidence of the avoidance of death by clinicians and the consequences of the silence. Among the studies were profound findings that nurses took longer to answer the call bells of patients who were expected to die and that patients with the poorest prognoses were routinely assigned to rooms farthest away from the nurses' station. Dr Benoliel's research started the conversation about the quality of care of the dying.

In 1974, building on the work of Dr Benoliel and the growing worldwide recognition of the needs of the seriously ill and dying, Florence Wald, PhD, RN, FAAN, took action-she started the first hospice in the United States. Dr Wald led these early years of hospice development, which included highlighting nurses as central to providing holistic, interdisciplinary care.

The efforts of Dr Jeanne Quint Benoliel, Dr Florence Wald, and the many other nurse pioneers have resulted in amazing progress, the extension of hospice care to palliative care, and the development of palliative nursing as a specialty. In 1997, when my colleagues and I (Ferrell) began to make the case for nursing education in palliative care, we began our partnership with the American Association of Colleges of Nursing (AACN). Our first needs assessment study examined 50 of the leading textbooks used in schools of nursing, and the results documented that less than 2% of the content in these leading texts had any relationship to any topic in palliative care.

We (Ferrell and colleagues) then began the End-of-Life Nursing Education Consortium (ELNEC) project as a partnership with AACN. The first ELNEC course was held in the year 2001, which has led to 1.4 million nurses and other clinicians trained in all 50 states and 100 countries.1 The breadth of this educational impact is in large part due to the partnership of AACN. Fast forward 20 years, in 2021 AACN released its updated Essentials document,2 which outlines 4 spheres of care: (1) Promotion of Health and Well-being/Disease Prevention, (2) Chronic Disease Care, (3) Regenerative or Restorative Care, and (4) Hospice/Palliative/Supportive Care.

Having the field of palliative care recognized as an essential sphere of nursing practice is a monumental step forward. It is the realization of the vision of Dr Jeanne Quint Benoliel, Dr Florence Wald, and the many other pioneers of our field.

And with progress comes responsibility. Now that hospice and palliative care are recognized as an essential sphere of nursing practice, we, as leaders in this field, need to do our part in supporting schools of nursing. We need to provide lectures, serve as preceptors and clinical sites, and share our clinical expertise to build on nursing schools' palliative care educational efforts. Palliative care nurses are valuable colleagues for nursing school faculty, as educators revise their curricula to integrate these essentials into courses and clinical rotations.

There has never been a time in our history when palliative care was needed more. These times of pandemics, serious chronic illness in adults and children, an aging population, and a burdened health care system need the support palliative care can provide.

Supporting our schools of nursing is Essential.

Betty Ferrell, PhD, RN, CHPN, FAAN, FPCN

Andra Davis, PhD, MN, RN

Megan Lippe, PhD, MSN, RN

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