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

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An article in this issue of the journal by Donna Corr, a pioneer in our field, revisits the groundbreaking work of Elizabeth Kubler Ross, "On Death and Dying." This article reflects on the progress made since that book was published over 50 years ago. The remaining articles in this issue are examples of that progress, as they cover topics such as palliative care education, legacy interventions, and extending palliative care into diverse communities. None of these articles would have been written without the first step that Dr Elizabeth Kubler Ross took to shatter the silence surrounding death and to suggest that we do the unthinkable: talk to patients about death.


This issue prompts me to think about the idea of progress. What is progress? How do we make progress? My first reflection is that progress is very messy. Fredrick Douglas is often quoted as saying, "If there is no struggle, there is no progress." The work of palliative care is a messy business, and this issue reports on the work of palliative care, which is always challenged to break down enormous cultural, financial, and organizational barriers in order to improve care. Reading this issue and seeing the many obstacles to quality palliative care in 2019 and beyond also make me think about what "On Death and Dying" did over 50 years ago. But as Fredrick Wilcox addressed, "Progress always involves risk. You cannot steal second base and keep your foot still on first base."


Progress in palliative care comes from vision: the ability to look beyond the very real obstacles around us and to see what "better" can look like. Deborah Helsal and colleagues do this in their article in this issue, "Their Last Breath: Death and Dying in a Hmong American Community." Rather than be overwhelmed by challenges in more resource-rich communities, why not have a vision about better care in one of the least studied and most challenging communities? Dr Elizabeth Kubler Ross would be proud.


The Hospice and Palliative Nursing Association has a bold vision that quality palliative care can be provided to all people with serious illness. This vision will be made possible by a workforce that includes, at its core, the profession of nursing. Nurses have and will do the messy work of changing systems and advocating for the most vulnerable. We do that work by strengthening ourselves through nursing education, certification, and ensuring that nurses are leading the change.


This issue of Journal of Hospice & Palliative Nursing is a statement on progress: the bold act of breaking the silence surrounding death and responding to all the noise that follows the chaos of change, but also always being attentive to the often weak and depleted voices of patients and families who remain our best guides to progress.


My hope is that this issue of Journal of Hospice & Palliative Nursing is a reminder of our past progress, our present struggles, and also the vision ahead. As the great "philosopher" and rock star Alice Cooper wrote, "You have to believe your best work is ahead of you. If I believed my best song had already been written, I would not keep writing."


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