1. Schoenly, Lorry

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The end of life. Most of us don't think much about it. And when we do, we are likely to think unrealistically. A 1996 Gallop Poll indicated that 9 out of 10 of us prefer to die at home. However, currently 80% of deaths occur in institutions. Summer 2002 brought me face-to-face with the issue of the end of life. NAON was invited to participate in the June End-of-Life Nursing Education Consortium (ELNEC) Curriculum presented by the American Association of Colleges of Nursing and the City of Hope National Medical Center Nursing Research and Education. I attended on behalf of the association. Later that summer I joined NAON Executive Board Director, Margaret McWilliams, for the week-long Nursing Leadership Academy for End-of-Life Care, sponsored by the Institute for Johns Hopkins Nursing. My eyes were opened to the reality of the current state of practice in caring for individuals at the end of life. There are great challenges ahead.


You might not think that the end of life is an issue for orthopaedic nurses, but think again. Palliative and end-of-life care encompass patients of all ages who suffer from not only terminal conditions but also those that limit life. In fact, the alleviation of suffering is a major principle of palliative care. A challenging misconception is that this care need only take place in the final stages of illness. However, this summer I discovered that palliative care principles are important concepts to inform our nursing practice throughout the lifespan, whatever the patient condition.


Palliative care "affirms life and regards dying as a natural process that is a profound personal experience for the individual and family" (Last Acts Taskforce, 1997). Goals of this care include relief of suffering, control of symptoms, and restoration of functional capacity. This is accomplished while remaining sensitive to personal, cultural, and religious values, beliefs, and practices.


Communication is a large part of nursing practice at the end of life. Orthopaedic nurses can fill an important role by facilitating family and caregiver communication and conflict resolution during an often emotion-laden time. With this in mind, an extended session at NAON's 2003 Congress will focus on "Patient and Family Communication at the End of Life." I encourage you to register for this session taught by Kathy Egan, MA, BSN, CHPN, Vice President of the Hospice Institute of Florida Suncoast. NAON is committed to incorporating the major elements of the ELNEC curriculum into the Annual Congress Program during the next several years.


NAON will also create a task force within the Gerontology Special Interest Group to address the incorporation of palliative care principles into orthopaedic nursing practice. News of this group's activities will be forthcoming. If you have suggestions for activities or would like to volunteer to assist with task force goals, please contact Gerontology SIG Facilitator, Dana Pansa, at


Do you have a story about helping an orthopaedic patient at the end of life? NAON is collecting true stories about members involved in end-of-life and palliative nursing care. Send your real-life experience to me at




1. Last Acts Task Force. (1997). Precepts of palliative care. Princeton, NJ: Robert Wood Johnson Foundation. [Context Link]

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Guest Editorial