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

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As a nursing student, I had sufficient preparation in pharmacology, physiology, physical assessment, and all the areas I thought would prepare me to be a nurse. Over the 40 years since my graduation, I have a list of the topics for which I received no formal training and yet I have come to realize these topics are essential skills for nursing practice in palliative care. At the top of that list is advocacy - the ability to speak for the most vulnerable and champion their needs. As Arundhati Roy in the 2004 Sydney Peace Prize Lecture said: "There's really no such thing as the 'voiceless'. There are only the deliberately silenced, or the preferably unheard".


Advocacy is defined in many terms including supporting, pleading for, and recommending. Many professions are known for serving as advocates but nurses have a very unique role as they are in intimate relationships with patients, directly caring for their needs, being present at this sacred time of life and often being the person closest to the patient and family. Nurses face challenging systems, other providers, payors and many forces in order to insure quality care at life's end.


This issue of the journal is a testament to the role of palliative care nurses as advocates. The first article is the Ethics Series paper by Paice and Coyne on "Justice in America: Ethical Issues in Pain Control". Many of us have spent decades of our professional lives advocating for pain relief and now we face the greatest challenge of all - continuing to advocate for the relief of pain amidst what now has been deemed the opioid epidemic.


The paper by Lowers addresses care of LGBT individuals. Many nurses were strong advocates who cared for patients at the onset of the AIDS crisis and we now play a vital role in advocating for respectful and quality care for all our LGBT patients.


The paper by Kunte describes efforts to improve the care of long-term residents. There is no greater form of advocacy than that of our nursing colleagues who serve the elderly in the community and in long-term care. Nurses are often the voice and the presence in these settings to honor the dignity of the oldest in our society who are most vulnerable.


Each paper in this issue is a lesson in nursing advocacy, addressing areas of pediatrics, American Indians, and LGBT communities. In the outstanding papers by Sayaka Takenouchi and colleagues, and Minjeong Jo and colleagues, we hear of the amazing work in Japan and Korea in which they describe palliative care education as empowering nurses. The papers by Alt-Gehrman and Glover remind us of the role of nursing faculty to prepare our future nurses to become strong advocates.


As I reflect on this topic of Advocacy, I am so reminded of how little preparation I had to do this work. I am also reminded of how deeply grateful I am for the opportunity to do this work. As Gary Haugen, CEO and founder of the International Justice Mission, reminds us: "When our grandchildren ask us where we were when the voiceless and the vulnerable in our era needed leaders of compassion and purpose, I hope we can say that we showed up, and that we showed up on time".



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