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Abstract:This article explores a description of the foodstuffs and daily eating habits of a monastery as recorded in MS Codex 1081 (currently housed at the University of Pennsylvania). The authors provide a translation of the marginal note and examine the choice of terms, concluding it is from the eastern third of the Iberian Peninsula, written in Castilian, but with interference of Aragonese dialect. This note offers a delightful vignette, illuminating the daily routine of fifteenth-century Aragonese religious life: frugal, but not unappetizing fare, generous hospitality to the weary traveler, pleasant evening strolls, and finally a hearty nightcap of fruit and full-bodied wine, as recommended by a generous housekeeper.

Presents a speech by Ruth G. Dean, professor of Simmons College School of Social Work, delivered at the 100th Anniversary of Simmons College in Boston, Massachusetts, on April 21, 2004. Creation of the Allegheny County Emergency Relief Board; Important issues for contemporary social work; Views on violence and globalization; Forms of practice operating outside of the usual funding restrictions that continue the spirit of social work.

Canada’s population is aging, and seniors constitute the fastest growing demographic in the nation. The chronic health conditions, limited social support, functional decline, and cognitive impairment experienced by seniors may necessitate admission to a personal care home (PCH) setting up until the time of their death. The ethical problems that arise in the care of dying patients are numerous and complicated. The care of dying seniors in PCHs, however, is largely provided by frontline workers such as healthcare aides (HCAs), who usually have little training in palliative care or ethics. Research examining the identification and resolution of ethical problems in care of the dying has been conducted from the perspectives of nurses and physicians in various clinical settings, but the voice of HCAs in PCHs is virtually absent from clinical ethics. Given that the inability to satisfactorily resolve ethical issues in clinical practice is associated with feelings of guilt, powerlessness, avoiding contact with patients, failing to provide good physical care, and increased staff turnover, an empirical examination of HCAs’ experiences of ethically challenging situations is warranted.We conducted a phenomenological study to access the lived experience of HCAs (N=12) working in proprietary and nonproprietary care homes as they encountered situations they deemed ethically challenging in providing end-of-life care to dying seniors. The findings reported here explicate: (1) the types of situations that are ethically problematic for HCAs; (2) the meanings they assign to these situations, and (3) the impact such situations have on the provision of end-of-life care.

Assessment and formulation, the gathering of information about a client, and the conceptualization of the client or situation are the essential elements that mark a thoughtful approach to client care. This process has been shaped over time by changes in orientations to knowledge, new theories, new practices, and political and institutional pressures. Currently, there is an intense debate concerning the nature of social work practice, especially the assessment and formulation process. In this context, we review traditional approaches to formulation in light of contemporary understandings and trends. We present a model for formulation that highlights multiple ways of knowing and includes ecological, cross-cultural, psychodynamic, systemic, biological, and spiritual components. Social justice is the value that is foundational to the process.

Humor and laughter are ubiquitous in human interactions. Terminal illness, however, is often accompanied by circumstances of anxiety, fear, and sadness. Hospice/palliative care emphasizes quality of life and the importance of human relationships. In this context, humor finds its place in authentic person-to-person connectedness. This article presents findings from a clinical ethnography that investigated the phenomena of humor and laughter in an inpatient palliative care unit. As a participant observer, the lead author accompanied 6 nurses throughout their day-to-day activities, twice weekly over 12 weeks. In addition to more than 200 hours of fieldwork, informal conversations were held with patients and families and semistructured interviews were conducted with nurses (n11), physicians (n2), a social worker (n1), and a physiotherapist (n1). Humor was pervasive, varied in the setting, and occurred across a range of intensities. Both clients and team members used humor to build relationships, contend with circumstances, and express sensibilities. Humor was affected by differences in people, differing circumstances, ethnicity, gender, and degree of stress. Participants relied on intuition as well as a constellation of other factors in discerning whether or not to use humor. Techniques for assessment included identification of cues such as expression in the eyes and timing as indications of receptivity. Combined with caring and sensitivity, humor is a powerful therapeutic asset in hospice/palliative care. It must neither be taken for granted nor considered trivial.

Our study was an evaluation of a pilot course in palliative nursing care designed to improve practising nurses’ knowledge regarding cancer pain management and attitudes toward care of the dying patient. The course involved 12 weeks (36 hours) of systematic classroom instruction for registered nurses, and a one-day observational experience on a designated palliative care unit. A total of 16 nurses participated in the study. A repeated measures design was used to evaluate the effectiveness of the course. Attitudes toward care of the dying patient and his/her family were also evaluated. Results showed that nurses’ attitudes improved significantly from Time 1 (first day of course) to Time 2 (last day of course) (p=0.0007), and that this improvement was maintained at Time 3 (three months later) (p=0.064). The observational experience on a palliative care unit held in conjunction with the course was reported to be helpful to students in consolidating theoretical instruction.

Nursing research in palliative care has, to date, been limited. As palliative care is increasingly recognized as a nursing specialty area, it requires the scientific foundation that research provides. Palliative care clients are particularly vulnerable because of the intensity of their illnesses and the emotional impact of impending death. This article identifies and discusses ethical and methodological challenges faced by those conducting research with this population. Suggestions for strategies that may help researchers meet these challenges are included.

Cross-cultural competence has become a byword in social work. In a postmodern world in which culture is seen as individually and socially constructed, evolving, emergent, and occurring in language (Laird, 1998), becoming “culturally competent” is a challenging prospect. How do we become competent at something that is continually changing and how do we develop a focus that includes ourselves as having differences, beliefs, and biases that are inevitably active. After considering this and several other contemporary perspectives on cultural competence, the author questions the notion that one can become competent at the culture of another. The author proposes instead a model based on acceptance of one's lack of competence in cross-cultural matters.

This article examines narrative and constructivist approaches to clinical work asking how we decide what makes a “better” story. It explores the educator's role in helping students learn to balance respect for unique and diverse accounts with the profession's commitment to social justice, objectively defined.

Thirty-three nurses from three hospice services in a large Midwestern city participated in this study, which investigated responses to difficult or demanding work-related situations. Three tools (the Self Inventory of Situational Responses-TC questionnaire, the Spielberger State Anxiety Inventory questionnaire and a rank-ordered listing of likely causes of difficult or demanding situations) were used to collect data. Findings indicated that anxiety is an issue for hospice workers but that difficult or demanding situations were viewed as challenges rather than threats. Management of intractable symptoms and communication issues were of primary concern. Administrative concerns were identified as the third-ranking source of difficult situations. Issues related to death and dying were of notably less concern. Strategies for staff support also are identified.