Spirituality and the care of patients at the end-of-life: an essential component of care

Spirituality is an essential component of the care of patients with serious illness and those that are dying. Dame Cicely Saunders developed the hospice movement based on the biopsychosocialspiritual model of care, in which all four dimensions are important in the care of patients. Of all the models of care, hospice and palliative care recognize the importance of spiritual issues in the care of patients and their families. The National Consensus Project Guidelines for Quality Palliative Care, in the United States, provides specific recommendations about all domains of care including the spiritual domain, which is recognized as a critical component of care (The National Consensus Project for Quality Palliative Care www.nationalconsensusproject.org). Studies indicate that the majority of patients would like their spiritual issues addressed, yet find that their spiritual needs are not being met by the current system of care. Interestingly, spirituality is the one dimension that seems to get slightly less emphasis than the biopsychosocial dimensions of care. Some reasons may include the difficulty with definitions of spirituality for clinical and research purposes, the time constraints and financial burdens in the current healthcare system in the United States, and the lack of uniform training for all healthcare professionals. Yet, there are theoretical and ethical frameworks that support spiritual care as well as some educational models in spirituality and health that have been successful in medical education in the United States. Spirituality can be seen as the essential part of the humanity of all people. It is at its root, relational and thus forms the basis of the altruistic care healthcare professionals are committed to. Spirituality has to do with respecting the inherent value and dignity of all persons, regardless of their health status. It is the part of humans that seeks healing, particularly in the midst of suffering. Spiritual care models are based on an intrinsic aspect that calls for compassionate presence to patients as well as an extrinsic component where healthcare professionals address spiritual issues with patients and their loved ones. Currently in the healthcare system, evidence-base models are the criteria for practice recommendations. Yet, spirituality may not be amenable entirely to strict evidence-base criteria. As hospice and palliative care continues to develop as a field, healthcare professionals are challenged to think of ways to advocate for and include the spiritual dimension of care.     

Risk Communication in The Netherlands: The Monitored Introduction of the EC "Post-Seveso" Directive

Implementation of article 8.1 of the EC-"Seveso" Directive (82/501/EC) is now under way in many countries in Europe. In The Netherlands, the implementation of the Directive started with a carefully monitored introduction of active information provision at two sites (Dordrecht and Elst). This introduction was supported by a multidisciplinary research group. This group helped to develop the risk communication program and also played a role in the evaluation of the program. This paper describes these processes and their evaluation. We will focus on the design of the risk communication programs and the effects of the programs on knowledge and attitudes of the local target groups. This effort and its results clearly started an institutional learning process involving governmental bodies at several organizational levels (local, regional, and national), and industrial organizations (individual firms and organizations of industries). Monitoring the design, the implementation, and the effects of active information provision proves an effective means to gain experience with the implementation of the Seveso Directive and could help to facilitate further implementation.     

Innovation in education: Technological economics

Technological change and innovation are vital parts of the economy. This paper concerns one particular attempt to study both the process of innovation itself and possible means of increasing its effectiveness: Technological Economics. Barriers to innovation, intellectual and organizational, are described from the experience at the University of Stirling.     

Credit at the Corner Store: An Analysis of Resource Exchange among Detroit‐Area Urban Poor

This ethnographic study examines how and why Detroit‐area credit‐constrained members of the urban poor relied on owners/employees of corner convenience stores, known as “party stores,” for accessing short‐term, interest‐free informal credit services. Findings indicate that informal credit at party stores functioned as a low‐ or no‐cost alternative to formal credit and high‐cost fringe banking services such as payday loans, both of which were inaccessible and/or cost prohibitive for informants. These data contribute empirically to a growing body of research on “credit invisibility” by exploring these populations' use of informal credit mechanisms. Findings also make a theoretical contribution by highlighting the importance of resource exchange networks through which members of the urban poor build strong yet disposable social ties in order to respond to economic shocks, combat food insufficiency, and survive economic destitution.