Nurses play a vital role in the experience of life-threatening illness. The highly visible and dramatic moments leading to the medical diagnosis create vivid memories and recollections of the experience. Nurses are sometimes involved, but are not major players as the reality of the situation dawns. But as the more tedious, life-shaping experiences of coping, learning, shifting to the reality of the illness unfolds, nurses become more central, more involved. Nurses, in this process, have significant opportunities to provide significant influences that can dramatically shape the experiences of living and dying.

Recently, in a doctoral class I taught in Denmark, the members of the class posed the question as to whether I believed there is a universal and fundamental nursing philosophy. There were 4 physicians, 1 occupational therapist, and 6 nurses in the class; therefore, this question held special significance in the group. As we discussed this question, it became quite clear that the fundamental ideas that the nurses brought to the discussion were certainly familiar for those in the class who were not nurses. However, the nurses were consistently able to point to ways in which these ideas shaped their practice in significant ways. The occupational therapist recognized quite clearly how many of these ideas also shaped her practice. The physicians, although familiar with the ideas, expressed a wish that these ideas could have a more central place in their day-to-day practice. Their practice, they recognized, so fully focused on the diagnostic process and medical treatment that they were not able to devote the kind of attention to the experience of the illness itself, which was clearly the focus of the other members of the class.

In her book Surviving and Thriving After a Life-Threatening Diagnosis,1 eminent nurse scholar Beverly Hall draws on her own experience as well as her extensive nursing knowledge of health and healing in the face of life-threatening illness. In her introduction to the second section of the book, she summarizes what I believe to be at the heart of a fundamental nursing philosophy:

Whether you know it or not, you have always had with you two important sources of healing and comfort. The first is derived from the knowledge and expertise that has always been part of your personal, internal being, and that you will always find when you go inside to gain access to it. The second is the wisdom, healing power, and life-lessons that are yours, without charge, taken from the many spiritual practices available to you.1^(p53)

Here, Dr Hall reiterates a fundamental premise set forth by Nightingale-a belief that the human body has innate healing capacity. She also draws on nursing's long traditions that promote, encourage, and facilitate the processes of finding strength and wisdom in a person's capabilities to act on his or her own behalf.

The challenges of surviving and thriving in the face of a life-threatening diagnosis are far greater than the various medical interventions that are used in treatment of the disease. How individuals and families meet these challenges is at the heart of the experience. The experience is shaped by a multitude of factors, and how people respond is not entirely of one's own choosing. In the absence of a strong presence such as that provided by a talented and wise nurse, people can flounder in a hopeless abyss of despair and fear. But the experience can become, as one of the reviewers of Hall's book notes, a wake-up call to live life to the fullest. Nurses have the opportunity each day to bring this possibility to reality.

As you read the articles included in this issue of ANS, you will recognize these fundamental threads that shape the powerful presence of nursing in the challenges surrounding life-threatening illness. It is my hope that you will find ways to bring these possibilities more fully into nursing practice in very real ways.

Peggy L. Chinn, PhD, RN, FAAN, Editor

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