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

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In September 2014, the Institute of Medicine (IOM) issued a new report on the status of end-of-life care in America. This valuable report provides a snapshot of the current status of care for the seriously ill and dying. It provides a current perspective building on the first IOM report issued in 1998 on "Approaching Death" as well as the 2002 report on "When Children Die" ( The 2014 report comes at a critical time in health care. The time period of the first report in 1998 to the present, 2014, has seen enormous change. While the first report focused on documenting the deficiencies in end-of-life care, this updated report moves to a very urgent demand to reform systems of care. I encourage all nurses to read the report and use it in their work to advocate for system changes as we work to build better care across settings, early in the course of disease. This issue of JHPN includes a summary of the IOM report written by our nursing colleague, Dr Pam Hinds, who served on the IOM Committee. The full report can be accessed on the IOM Web site. http://www.iom.ed/Reports/2014/Dying-in-America-Improving-Quality-and-Honoring


This is the final issue of the journal for 2014. We are extremely grateful to the journal reviewers and authors who have contributed this year to JHPN. As I interact with nurses around the country, I constantly think about the many "best kept secrets"-the amazing palliative care nurses whose work should be shared with others through publication. Make a New Year's resolution to expand your professional horizon in 2015 by writing.


As we reflect on another year ending, I am reminded that for many nurses, 2014 has probably been a challenging year-perhaps one of those years many people are ready to see end! The demands of changing health care systems, mergers, cutbacks, and ever increasing populations in need are overwhelming. But as we reflect on the year soon to end, I encourage you to also take the time to be grateful for this year. I was reminded on this need to cultivate a sense of gratitude as I sat in the back row of our ELNEC course for advanced practice registered nurses (APRNs) held in Portland, Oregon. The course had been going on for 2 days, filled with critical areas for APRNs ranging from clinical topics such as advanced pain management, to APRN roles and operational issues. The participants had shared their struggles with role clarity, interdisciplinary teams, self-care and compassion fatigue, reimbursement issues, and scope of practice. I was thinking how the nurses sitting in the many rows in front of me were true pioneers in the field of palliative care. In the final session, the speaker somewhat abruptly shifted the focus from these clinical and operational topics by reminding the nurses how fortunate we are to be doing this work. I looked up to see the audience response, wondering if this group of generally overwhelmed and overworked palliative care APRNs would see themselves as fortunate. What I observed was 80 nurses nodding their heads, glancing at each other and affirming that "Yes, yes! We are indeed fortunate."


The pages of every issue of this journal this year, and every year, tell the story of palliative nursing. This year, authors have addressed topics including "a good death," end-stage heart disease, supporting seriously ill children in their schools, adolescents losing parents, suffering in people with dementia, care of the poorest people in safety net hospitals, music therapy at the end of life, palliative care of prisoners, and many other topics of incredible importance. We are indeed very fortunate to embrace meaningful work that matters greatly to the people we serve and to society.


So as 2014 ends, if you are holding this journal in your hands (or holding it on your Ipad!), then it is likely that you are a palliative care nurse. And that means you are doing some of the most important and sacred work in the world.


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