1. Ferrell, Betty PhD, MA, FAAN, FPCN, CHPN, Editor-in-Chief

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A few of us began our careers as hospice nurses or in areas devoted exclusively to palliative care. Most of us have lived a journey of "becoming" palliative care nurses, often on paths that may have been circuitous journeys into this field. Some nurses work in areas such as oncology or critical care with seriously ill patients but realize over time that they are drawn to care of those facing the end of life. I have also spoken to many nurses who describe a critical event in their career, perhaps a special patient whose illness and death provided clarity for their professional commitment. For some, a personal experience such as the loss of a loved one caused us to reflect on what we wanted most to do in our professional lives, and we changed our career paths to palliative care.


"Becoming" a palliative care nurse is an experience that varies greatly among nurses. For many nurses, there is a distinct time when palliative care is the essence of their work-some would even say their calling. What is unique to our profession of palliative nursing care? What is different about an excellent hospice nurse beyond being an excellent nurse? If approached by a nursing student considering a career decision, how would you describe your "becoming" and why do you chose to stay? These are essential questions as we continue to evolve as a specialty, and as we find our place amidst the complex healthcare system of the future.


The articles in this issue of JHPN are an expression of our becoming palliative care nurses. They speak to the commitment of our field to areas of human need such as spiritual care, suffering, interdisciplinary care, and excellent care of symptoms. The article by Codier and colleagues is thoughtful exploration of emotional intelligence, perhaps a concept that will advance our understanding of our profession and the care we provide.


Also of note is the universality of our being palliative care nurses. As I wrote this editorial noting the article by Yong and colleagues from Korea and the article by Martins from Portugal, I actually picked up the world globe sitting next to my home computer. I put one hand on Korea and the other on Portugal and smiled as I realized that, in fact, these articles are precisely from opposite places on the earth. Yet the patient care concerns, nursing education needs, and goals of our care described in both articles share an amazing similarity and remind us that nurses becoming in our field share so much. I also had a recent poignant moment in recognizing the international bond of nurses when in January we hosted an ELNEC course in San Diego, CA. In communicating with the participants registered for the course, we invited the nurses to bring any used palliative care books they could share with nurses we are supporting in Kenya, Africa. I was taken by the generosity of a nurse who arrived from Iceland and had carried with her all the way to San Diego a textbook that will now make its way to the hands of a nurse in Kenya.


One of the essential elements of palliative nursing is dedication to the relief of symptoms common in advanced disease and also known to create immense suffering. The article by Brennan and Mazanec describes the expert care needed in the way of patient assessment, pharmacologic therapies, other supportive care interventions, and patient teaching. This article is also a model of becoming as it is part of our "Research and Practice" series in which Polly Mazanec as a senior author has mentored Caitlin Brennan in writing this article.


Our field of palliative nursing is growing rapidly, and much of this growth is related to extension of the philosophy of care first introduced by hospice into diverse settings of care. The article by Hupcey and colleagues on the needs and experiences of spousal caregivers in heart failure illustrates application of the same goals of hospice care into the world of cardiac care. There is much discussion in the literature now about "patient centered care." What a great stride ahead it would be if all nurses in cardiac care were to also be expert in palliative care.


We also know that "becoming" is not a linear process of consistent growth and a progression to perfection. Becoming means constantly evaluating, holding up a mirror to view our strengths but also our weaknesses, and reevaluating our future. The study by Baldwin and colleagues held up such a mirror to evaluate a basic principle we espouse in our field, interdisciplinary care, by interviewing 145 hospices about their training and functioning as interdisciplinary teams. Their view from this mirror revealed that we don't "become" a team simply by having multiple disciplines working in the same setting, but rather we grow into interdisciplinary care through learning, working together, and intentional effort.


Betty Ferrell, PhD, MA, FAAN, FPCN, CHPN