1. Section Editor(s): Ferrell, Betty PhD, MA, FAAN, FPCN, CHPN

Article Content

As I write this editorial, the Supreme Court has just used its ruling in support of Affordable Health Care Act. While there are enormous challenges ahead as the nation determines how healthcare access will be implemented, there is a widespread belief in the palliative care community that this historic event is a step forward in recognition of palliative care as a vital component of quality healthcare. While a segment of our population will receive specific elements of care described within this law such as emergency services or surgery, every person will receive care at the end of life. As a palliative care community, this is our time, our season, to speak up and inform health policy makers, payers, and the public about how palliative care can best be integrated in the design of healthcare for the future. We offer what the nation needs-quality, patient-centered, cost-effective, compassionate care for patients and families.


The articles in this issue of the journal were already selected prior to the Supreme Court decision, but as I look over the contents, I realize that this issue's content is a perfect example of the interface between our field of palliative nursing care and the larger health policy reform. This issue of the journal begins with an article by Fletcher and Panke on opportunities and challenges for palliative care providers in the age of health reform.


As the nation designs and implements plans for healthcare delivery, palliative care will be challenged to also redesign, rethink, and reengineer what we have known and what we do. This is a time where we will be required to hold up a mirror, examine our practices, and be prepared to evolve and reinvent ourselves if we are to truly recognize our full potential. The article on this by Albrecht addresses symptom management in the area of hematology, an area of healthcare with a strong history of cure-focused care and minimal integration of palliative care. Now is the time to incorporate best palliative care in areas that have been resistant to change.


The changes required in this era of healthcare reform are not just about the world waking up to the possibilities of palliative care. There will be a fundamental need for palliative care to awaken to the needs of society. The article by Gibson and colleagues shares the authors' experience of outpatient palliative care, an important extension of our practice. Similarly, the article by Reither and colleagues, "We're hands on[horizontal ellipsis]," will ring true for readers in knowing that the changes needed within our palliative care community will cause distress and angst as we are required to do things differently.


There is a sense of the enormity of healthcare reform-Supreme Court action, national debate and intense party politics, and enormous economic implications as a nation seeks to create the "affordable" within this healthcare act. But within the shadows of this enormous political issue are real people, real lives now facing the end of life, and real professionals trying to maintain the humanity amid the storms ahead. Now is the time for models of care that demonstrate the key role of palliative care as the best of what society should expect at the sacred time of life's end. The article by Wiencek and Webster presents a case study of discontinuing ICD in heart disease. It is fitting that we pause to read this case study-the story of one life and one family-to be reminded that major health policy changes play out in the lives of one family at a time. Our colleagues in the Netherlands share their experiences in the article describing a decision and for choosing a place of death. As US redesigns healthcare, there is much that we can learn from our international colleagues.


The final article in this issue and also our online feature by Walton and Seed addresses "finding our balance" for hospice nurses. Go to the JHPN Web site to read the article and to think about what healthcare reform will mean to the work of nursing. Caring for ourselves will be vital as we participate in this change.


Years from now perhaps many of us will be privileged to explain to our grandchildren or to our young colleagues that yes, we were there in 2012 when the Supreme Court ruled on health reform. And yes, we were there in the years that followed when palliative care became fully integrated into healthcare.



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