Broadening End-of-Life Comfort to Improve Palliative Care Practices in Long Term Care.

This study aimed to (1) explore how palliative care in long-term care (LTC) addresses the tensions associated with caring for the living and dying within one care community, and (2) to inform how palliative care practices may be improved to better address the needs of all residents living and dying in LTC as well as those of the families and support staff. This article reports findings from 19 focus groups and 117 participants. Study findings reveal that LTC home staff, resident, and family perspectives of end-of-life comfort applied to those who were actively dying and to their families. Our findings further suggest that eliciting residents' perceptions of end-of-life comfort, sharing information about a fellow resident's death more personally, and ensuring that residents, families, and staff can constructively participate in providing comfort care to dying residents could extend the purview of end-of-life comfort and support expanded integration of palliative principles within LTC.

It takes a whole community: the contribution of rural hospice volunteers to whole-person palliative care.

Although volunteers are widely acknowledged as important members of the palliative care team, their unique contribution to whole-person care has not been well documented or theorized, especially in rural communities. We conducted a focused ethnography in a small rural community, asking key community informants about their understanding of the role of hospice volunteers with dying people and their families. Our results show that these volunteers inhabit a unique third culture of care that fuses elements of formal care with the informal visiting of friends and neighbours. Their role is shaped to a community context where dying is not a private medical event, but rather a whole-person-in-community event, and where care is offered as a natural expression of the interdependence and reciprocity that characterizes rural community life. Our results are a reminder that it takes an entire community to care for the dying, and that hospice volunteers are a crucial link in the network of care that allows people to die with dignity and quality of life.

So no one dies alone: a study of hospice volunteering with rural seniors.

This paper summarizes the results of a qualitative study of hospice volunteering in the rural communities of northwestern Ontario. In this region, there are 13 independent and active hospice volunteer programs serving communities ranging in population from 1,000 to 15,000. The 13 volunteer coordinators in these communities participated in a phone interview in which they described the role of hospice volunteers in their community and the kinds of clients they serve. The results indicate that the hospice volunteers in this rural region spend a large part of their time visiting medically frail and lonely seniors who are at risk of dying alone or without adequate care and companionship at the end of life. Long-term visiting to build relationships of trust and genuine caring are considered the ideal in these communities. Implications for end-of-life care for rural seniors are discussed.

Transformational leadership and psychological well-being: the mediating role of meaningful work.

Two studies investigated the relationship between transformational leadership, the meaning that individuals ascribe to their work, and their psychological well-being. In Study 1, the perceptions of meaningful work partially mediated the relationship between transformational leadership and positive affective well-being in a sample of Canadian health care workers (N=319). In Study 2, the meaning that a separate sample of service workers (N=146) ascribed to their work fully mediated the relationship between transformational leadership and psychological well-being, after controlling for humanistic work beliefs. Overall, these results support and add to the range of positive mental health effects associated with transformational leadership and are suggestive of interventions that organizations can make to improve well-being of workers.

Excavating our frames of mind: the key to dialogue and collaboration.

Conversations between colleagues who hold divergent views of a case or practice situation often take the form of a win-lose debate in which contenders, arguing from within their respective frameworks, find they are unable to reach mutual understanding. The resulting impasse makes mutual understanding and collaboration difficult. Our typical way of resolving the impasse is to invoke the evidence for our own position, hoping that the facts somehow speak for themselves. Strangely, this may only exacerbate the impasse and worsen our view of our colleagues, whom we presume to be ignoring the facts. This article attempts to show that reflecting on the frame--not debating the facts--might be a more helpful way to approach such impasses and to reach mutual understanding.