1. Raudonis, Barbara M. PhD, APRN, BC

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One evening during dinner, my husband shared an interesting story from his day at work. Periodically, he would hear some chimes come over the hospital paging system. He finally figured out that the tune was a lullaby. Sometimes the chimes could be heard 3 or 4 times a day, yet on other days, nothing at all. As a new employee, he was still learning about the hospital and its policies, so he had no idea what it all meant. The next time the chimes rang he was meeting with the head of his department. He asked, "What is that?" The answer was that every time a baby is born the lullaby is played. I smiled and immediately said, "Why don't they do something similar when someone dies?" First, we chuckled together and hummed a few bars of a funeral dirge. Then I became serious. Why couldn't a simple but elegant bell toll 3 times over the paging system? Why can't we honor the passing of a fellow human being in the same way we honor new life born into our world? However, reality quickly returned when my husband reminded me that my dream wouldn't come true in the context of our current healthcare system. He voiced the "party line": people are not supposed to die. Death is still considered by many to be a failure of our healthcare system. My response was that things must change! We need to think outside the box!


At a recent end-of-life conference in our city, Dr Ira Byock challenged the audience of hospice, palliative care, and other healthcare providers to be creative in developing solutions to improve end-of-life care in our country. As the baby-boomers age and die, he encouraged us to "think outside of the box." What will hospice and palliative care look like for the baby-boomer generation and those to follow?


Building on Dr Byock's charge, I would like to offer the thought that health promotion is needed at the end of life. Palliative care is health promotion at the end of life. As hospice and palliative care nurses, you treat, prevent, and promote the needs of your patients and families. 1 Using an interdisciplinary approach, palliative care strives to return a balance that includes quality of life for patients and their families. To some, this may be a new concept-but is it?


The Navajo philosophy of healing includes a concept called "Walking in Beauty." Beauty means living in balance and harmony with your self, your environment, and the world. Everything is connected in life and death. Illness occurs when there is an imbalance. Removing the imbalance is the focus of a healer's interventions. 2


In our work promoting health at the end of life, we can envision our role as helping patients and families "walk in beauty." I think of the words of Itzhak Perlman: "Sometimes it is the artist's task to find out how much music you can still make with what you have left." When death occurs, we can shamelessly acknowledge the event. We can "think outside the box." I know hospice and palliative care nurses can do this. Let's help our colleagues throughout the healthcare system do the same. At least we can try.




1. National Hospice and Palliative Care Organization. A pathway for patients and families facing terminal illness. Arlington, VA: Author; 1997. [Context Link]


2. Alvord LA, Van Pelt EC. The scalpel and the silver bear: the first Navajo woman surgeon combines western medicine and traditional healing. New York: Bantam Books; 1999. [Context Link]

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Guest Editorial