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

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Brene Brown, PhD, LMSW, is a social worker and social scientist whose work I believe has profound messages for palliative nursing. Her writing (including books The Gift of Imperfection, Rising Strong, and Daring Greatly) and her website ( address concepts such as vulnerability, shame, and worthiness that are critical emotions in our own personal and professional lives as well as in the people for whom we care as nurses.


Brene defines vulnerability as "the willingness to show up and be seen with no guarantee of outcome." To me, this defines palliative nursing-we tread in the waters of vulnerability as we navigate complex health systems in our desperation to get care for our patients' needs. We breathe in the courage to answer questions such as "Am I dying?" when so many others have avoided the conversation. We call upon every ounce of patience we can grasp as we sit with the angry son or listen to parents of the dying child anguish-as once again, they tell the story of how they should have listened sooner to their son's complaints of a headache, now a brain tumor, that will soon end his 10-year-old life. Showing up for these moments as a palliative care nurse-that is vulnerability.


Brene Brown has also written eloquently about human emotion. Her list of core emotions includes "anger, anxiety, belonging, blame, disappointment, empathy, fear, frustration, gratitude, grief, guilt, joy, loneliness, overwhelm, regret, sadness, shame, worry", and several others. How many of those emotions did you witness yesterday as a palliative care nurse in yourself or your patients? Case closed! Palliative nursing is a model of vulnerability.


Author Madeline L'Engle wrote: "When we were children, we used to think that when we were grown up we would no longer be vulnerable. But to grow up is to accept vulnerability." I think of these words as I reflect on my 42 years as a nurse. I began as a 21-year-old, very vulnerable nurse-terrified to assume my role as a registered nurse on an oncology unit. As I stumbled through those early years, I imagined the day when I would finally feel confident, certain, competent, and very wise. Twenty years into my career, I might have said that I did feel those things. But 40 years into a career dedicated to palliative care, I feel quite vulnerable. And it is the vulnerability that Brene Brown speaks of-recognizing that to fully embrace palliative care means to live in the deep valleys of unknowing, uncertainty, and, most days, recognizing I know very little. I accept that showing up is all I can give.


The authors of the articles in this issue chose to be vulnerable. They asked difficult questions and launched studies and projects fraught with challenges. They have written articles that address the many gaps that continue in our care despite our best intent. They have written articles uncertain whether they would be published, responded to reviewers' critiques, and put forward their ideas knowing they were opening themselves to possible criticism. But they wrote anyway. Their vulnerability is our gift.