In my early career in about 1980, I read an editorial by Dame Cicely Saunders, founder of the modern hospice movement. Dame Cicely acknowledged the growing recognition that hospice professionals were known for their passion, expert psychosocial skills, and empathy. But she strongly proclaimed that "Our patients need not only our compassion, they also need our competence." In retrospect, I believe that with those words, Dame Cicely Saunders not only began the modern hospice movement, but she also sparked the current movement toward quality assurance, evidence-based practice, and outcomes research in palliative care.
In the year 2012, as we face a national crisis in healthcare spending and a burgeoning demand for palliative care services, the demand for competence in our field is essential. Our public desperately needs compassionate professionals offering expert psychosocial and spiritual support as well as symptom management and attention to the needs of family caregivers.
Nurses, as the primary providers of hospice and palliative care, should be especially attentive to the call for both compassion and competence. The articles in this issue of the journal should inspire us all to reach for greater compassion and competence.
The article by Groninger and Phillips on "Gross Hematuria: Assessment and Management at the End of Life" is part of our new Symptom series, which was created to advance evidence-based practice in symptom management. My prediction is that every reader of this article will advance his/her knowledge through this article and competence in practice. This article emphasizes expert nursing assessment, interdisciplinary collaboration, and evidence-based management.
A major response to Dame Cicely Saunders' challenge to improve our competence and compassion has been the development of professional certification in palliative nursing. The article by Schmal and Derrevere on "The Vital Role of Professional Certification" addresses certification as one of the most important professional opportunities we have. Make 2012 the year that you become certified in palliative nursing as your personal commitment to competence in practice!
While Dame Cicely's words and life inspire our practice, role models can contribute greatly to achieving quality in our individual practice and in our work settings. Two articles in this issue provide such models to guide us. Wildner and Ferri in Italy focused on a very basic element of our practice, the communication of nurses in change-of-shift reporting. They tested a model of bedside handover with the patient included, and their results suggest elements of improved competence and compassion. What other basic, everyday practices in your setting should be evaluated?
On a larger systems level, Quade and Yoder present their article on "The Impact of Palliative Medicine on Franciscan Alliance, St Francis Health." Initiated in 2004 for 13 patients, this program served 1200 patients in 2010 with a model of care that has reduced costs and improved quality. Dame Cicely would be proud!
The final four articles in this issue certainly address competence in practice, but they are also excellent contributions to advancing compassion in practice. Munck and colleagues from Sweden apply a phenomenological approach to understanding patient perceptions of medical technology used in the home. Their study reminds us that listening to the patient and seeking to understand their lived experience are the first step toward compassion.
The articles by Karikari-Martin, Upchurch, and Watkins and each of their respective colleagues help us advance our compassion and competence in care of patients with dementia and their family caregivers. These articles demonstrate that one of the greatest demands of our future will be meeting the needs of this ever-growing, complex patient population. Successful models of care will require an understanding of the unique needs of these patients and families and better ways of communicating with referring physicians and designing services for this care. Progress in our field will begin with addressing the issues raised in the articles in this issue.
Excellence at the national and international level for our field begins with excellence by the individual provider. Those of you who are reading this issue of the journal are the individuals who commit to excellence that collectively will advance the larger collective of compassionate competence.
In addition to the words of Dame Cicely Saunders, I am also reminded of another principle I learned early in my practice in palliative nursing. That is, we need to build the kind of systems that we would seek to care for someone we love if he/she was terminally ill. At the center of that system is a competent and compassionate palliative care nurse.
Betty Ferrell, PhD, MA, FAAN, FPCN, CHPN
Editor-in-Chief
[email protected]