What is known about the spirituality in older adults living in residential care facilities? An Integrative review

Confirmatory Factor Analysis of the Spirituality and Spiritual Care Rating Scale: A Cross-Sectional Study in Eight US Nursing Homes

The aim of this study was to test a modified Spirituality and Spiritual Care Rating Scale (SSCRS) and report initial findings, based on a cross-sectional descriptive survey from eight nursing homes in the USA. This study examined the psychometric properties of a modified version of the SSCRS for assessing the perceptions of staff (i.e. nurses, rehabilitation staff, food and nutrition service staff, activities staff, social workers, and administrative staff) who work in nursing homes. The modified version of the SSCRS is measuring respondents' perceptions of spirituality, spiritual care, religiosity, and personalized care. Confirmatory factor analysis showed satisfactory goodness of fit for the original four-factor structure of the SSCRS. The modified version demonstrated good internal consistency and reliability (Cronbach's alpha ranging from 0.71 to 0.90). Initial findings showed statistically significant differences across all four sub-scales. Further research is needed to psychometrically test the modified tool.

Spiritual needs of older adults with cancer: A modified concept analysis

Objective

To clarify the concept of spiritual needs and explain its meaning to older adults with cancer.

Methods

Electronic databases (Web of Science, PubMed, EBSCOASU, CNKI, Wanfang, and VIP) were systematically searched and analyzed using "spiritual needs" as keywords. Rodgers' evolutionary method guided the concept analysis to identify attributes, antecedents, and consequences. Two rounds of Delphi expert consultations ensured accuracy, reliability, and feasibility for implementation.

Results

Spiritual needs express an individual's expectations of comfort and inner peace that satisfy his or her perception of the meaning and purpose of life, the ability to love and be loved, feelings of peace and gratitude, and a sense of belonging and hope. Spiritual needs have four dimensions: personal, communal, environmental, and transcendence or supreme. The attributes of spiritual needs include meaning and purpose of life, love and being loved, peace and gratitude, belonging, and hope. The antecedents include spiritual recognition and events that trigger spiritual needs and spiritual need thresholds. The outcomes of addressing and meeting the spiritual needs of older adults with cancer include promoting their spiritual health and enhancing their quality of life. After two rounds of Delphi experts' consultation, the expert authority coefficients (Cr) were 0.83 and 0.88, respectively. Experts agreed on the concept of spiritual needs.

Conclusions

Exploring antecedents of spiritual needs in older adults with cancer clarifies obstacles to spiritual practice, offering intervention strategies for spiritual care and well-being. Meeting their spiritual needs enhances spiritual health and quality of life, essential in humanistic nursing care.

A qualitative hermeneutical understanding of spiritual care in old age when living in a nursing home: The residents' voices

AIM

To explore and gain a broader understanding of residents' viewpoints and experiences of spiritual care when living in a nursing home.

DESIGN

A qualitative hermeneutical interview study inspired by Gadamer's philosophical hermeneutics.

METHODS

Thirty-eight individual interviews of 14 male and 24 female residents; of these, 24 had a dementia diagnosis. The setting was one large Norwegian nursing home providing long-term care. FACIT-Sp-12 was used as a guide for the interview, in addition to two open-ended questions about thriving and spiritual care.

FINDINGS

The older residents' voices portray a broad and diverse understanding of spiritual care, and four themes emerged: (1) Spiritual at-homeness, (2) Spiritual awareness, (3) Philosophy of life and (4) Interconnectedness.

CONCLUSION

Accepting one's life situation in a nursing home can foster a feeling of belonging, leading to feeling more at-home. Spiritual well-being, including finding purpose, spiritual awareness and beliefs, was found to be interconnected with spiritual at-homeness in the nursing home.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This study provides insights into older nursing home residents' viewpoints on spiritual care, including persons living with dementia.

IMPACT

The study addressed the limited evidence regarding how older residents themselves experience and express spiritual care. Listening to older nursing home residents' voices provides a unique contribution to the research field. As several individuals with dementia contributed to the findings, this study mirrors the current population of residents in nursing homes. The findings may inform healthcare provision and policymakers and impact upon spiritual care in the field of older people nursing and dementia care services.

REPORTING METHOD

The COREQ guideline.

PATIENT OR PUBLIC CONTRIBUTION

Participation through interviews of nursing home residents.

Quality of life and nurse-patient interaction among NH residents: Loneliness is detrimental, while nurse-patient interaction is fundamental

AIMS AND OBJECTIVES

To investigate the association between perceived nurse-patient interaction and quality-of-life among nursing home residents, adjusted for loneliness, anxiety and depression.

BACKGROUND

Symptoms of anxiety and depression are known to residents of nursing homes along with cognitive impairment, physical inactivity and low quality-of-life. Anxiety, depression and loneliness are found detrimental to NH residents' quality-of-life. The nurse-patient relationship is important for patient's well-being, both in terms of illness and symptom management.

DESIGN

Cross-sectional design.

METHODS

Data were collected in 2017 and 2018 from 188 residents in 27 nursing homes resided in two large urban municipalities in Middle and Western Norway. The inclusion criteria were: (1) local authority's decision of long-term NH care; (2) residential stay 3 months or longer; (3) informed consent competency recognised by responsible doctor and nurse; (4) capable of being interviewed, and (5) aged 65 years or older. This article is executed in accordance with STROBE statement.

RESULTS

Adjusting for age, sex, anxiety, depression and loneliness, perceived nurse-patient interaction was statistically significant to quality-of-life. While anxiety and depression showed insignificant estimates, loneliness demonstrated a significant relation with quality-of-life. Nurse-patient interaction and loneliness explained together 25% of the variation in quality-of-life.

CONCLUSION

This study suggests that loneliness is frequent as well as more detrimental to quality-of-life among nursing home residents compared to anxiety and depression. Furthermore, the present results show that the nurse-patient interaction represents an essential health-promoting resource for Quality-of-life in this population.

RELEVANCE TO CLINICAL PRACTICE

Staff nurses need to exercise their awareness of loneliness to meet residents' needs. Nursing educations should provide knowledge about nurse-patient interaction, and students as well as staff nurses in NHs should be trained, for instance by simulation, to use the nurse-patient interaction as a health-promoting resource. Finally, loneliness represents a bigger challenge than depression and anxiety; accordingly, building nurses that are capable of meeting patients' needs and facilitate care that counteracts loneliness is highly warranted.

Caring behaviours of culturally diverse personal care attendants from the perspective of older people living in residential aged care settings

This study aimed to determine whether older residents perceive differences in the care they receive from personal care attendants (PCAs) of similar cultural backgrounds versus those from other cultural backgrounds. The challenges encountered when receiving care from culturally diverse PCAs were also explored. A directed qualitative content analysis approach was utilised. Results showed that PCAs' personalities were perceived to have a greater impact on all aspects of care delivery than their cultural backgrounds. PCAs from other cultural backgrounds were also perceived to be more observant, pleasant, and sociable than their local counterparts, despite the communication challenges due to their limited English proficiency. This study indicates that migrant PCAs can significantly contribute to addressing workforce shortages in the aged care industry without compromising care quality, but it also highlights the need for long-term strategies to improve meaningful interaction between culturally diverse PCAs and residents and foster a positive work environment.

Promise, Provision, and Potential: A Hopeful Trajectory for Spiritual Care in Long-Term Care

This Canadian study aimed to better understand the provision of spiritual care in long-term care homes, its purpose/importance, the role of a spiritual care provider (SCP)/chaplain, effective practices, and challenges. Online survey responses revealed the need for spiritual care and the robust role of SCPs. Recommendations are made for more consistent employ and integration of SCPs, supported by sector-specific training and a system to connect LTC homes with skilled SCPs.

Making Time and Being Present: Spiritual Care Revisited

The COVID-19 pandemic has placed significant strain on home healthcare clinicians, shifting the focus of care to essential physical care needs. Spiritual care needs have always been present, but the pandemic has heightened recognition of the importance of spiritual care in home care. The goals of spiritual care include promoting physical healing, improving quality of life, and enhancing patient and family wellbeing. The use of a standardized spiritual assessment tool can increase provider awareness and patient expression of spiritual care needs. Spiritual care activities consist of obtaining a spiritual history, compassionate presence, mindful listening, interprofessional collaboration, and the provision of space for spiritual practices. This article provides a conceptual overview and strategies for application of spiritual care competencies.

Transcendence, the Most Important Spiritual Need of Muslim Older Adults: A Content Analysis Study

Healthcare providers agree that promoting spirituality among older adults while caring for them increases their quality of life. However, there is little knowledge about the spiritual needs of the elderly, especially in the Muslim community. This qualitative study attempted to explore the spiritual needs of Muslim older adults. Fifteen non-hospitalized Muslim older adults from Hamadan City, Iran, were interviewed. The semi-structured interviews were analyzed using conventional content analysis. After identifying semantic units from the text, related codes were extracted and placed in subcategories and categories based on their similarities. Once the data were analyzed, one theme was formed. The study's findings showed that the spiritual needs of older adults fell into three main categories: religious needs, the need for transcendence, and the need for connection. Religious needs included subcategories of religious practices and beliefs, and the need for transcendence included the search for meaning and purpose in life, and the need for peace and stability and balance. Also, the need for connection included the need to connect with nature and connect with others. Healthcare professionals and family caregivers should be trained in the specific competence of recognizing older people's unmet spiritual needs and fulfilling them.

The Meaning and Role of Spirituality for Older Adults: A Qualitative Study

This study is designed to identify the meaning and effects perceived by a person concerning religion and spirituality as that person grows old. A total of nineteen adults aged 65-88, five of whom were male and fourteen of whom were female, participated in semistructured interviews. As per the results of the thematic analysis, four main themes emerged: the meaning of spirituality, spiritual practices, the effect of spirituality and the meaning of growing old for the person. The results indicate that the participants view the entrance into old-age adulthood as a process that enhances interactions with others and intensifies help and compassion. The results also indicate that spirituality may play a crucial role in guiding older adults' lives and can help them clarify the meaning of their lives and cope with negative circumstances. Supporting older adults spiritually could also assist them to have positive emotions and help them to cope with stress. The organization of regular education programs to raise health professionals' awareness of spiritual needs is recommended.

Understanding Spiritual Care—Perspectives from Healthcare Professionals in a Norwegian Nursing Home

Nursing home professionals have reported that spiritual care is an unclear concept, and research suggests that healthcare professionals have a limited understanding of this dimension of care. The provision of spiritual care is well-investigated internationally, but research is sparse within Norway’s secularized society. This study investigated healthcare professionals’ understanding of spiritual care in one nursing home. Methods: Data were collected from individual interviews (N = 8) and one focus group (N = 5) of nursing home personnel; the study used qualitative content analysis and a hermeneutic methodology. Results: One central question emerged during the data analysis: what is spiritual care versus good care? This starting point resulted in four themes (1) caring for the whole person, (2) having a personal touch, (3) seeing the person behind the diagnosis, and (4) more than religiousness. Some healthcare professionals had not heard of spiritual care, and many were not aware of this in their daily work with older patients. Nevertheless, they facilitated and cared for the patient’s spiritual needs, but they did not address it as spiritual care. Other participants were familiar with the concept and understood spiritual care as an essential part of daily care. Conclusion: healthcare professionals’ understanding of spiritual care is broad and varied, including practical and non-verbal aspects. The results indicated a need for an open dialogue about spiritual needs and resources in clinical practice and the teaching of personnel about how to facilitate older people’s spirituality. Moreover, there is a need for more research into spiritual care and how it differs from the concept of good fundamental care.

Spiritual Care in Ontario Long-Term Care: Current Staffing Realities and Recommendations

How are spiritual needs addressed in long-term care? This quantitative study explored the level of spiritual care offered and qualifications of spiritual care providers in 177 LTC homes in Ontario. Data showed 49% of homes employ Spiritual Care Providers (SCPs), with more positions in urban and not-for-profit homes. Findings revealed SCPs bring a substantial skill set, attending to needs of residents, families and team members. More consistent staffing for spiritual care provision across the sector is recommended.

Seeking and maintaining connections: A grounded theory study of maintaining spirituality in residential aged care facilities

BACKGROUND

Moving to a residential aged care facility involves living far from family and a familiar environment, and leaving behind the social support system of relatives, friends, and society. The pressure to find and develop new and meaningful connections in a residential aged care facility can be significant for older adults.

OBJECTIVE

To provide a theoretical explanation of how older adults seek and maintain connections in a residential aged care facility.

METHODS

A grounded theory study was conducted. A total of 17 residents were recruited from two Nepalese residential aged care facilities using theoretical sampling. Face to face in-depth, semi-structured interviews and observation within interviews were conducted. Data analysis included the process of open, axial, selective coding, and constant comparative analysis as per Corbin and Strauss' variant of grounded theory.

RESULTS

This study identified that the process of seeking connections in a residential aged care facility was forward-moving, and involved "identifying sources," "developing connections," and "appraising responses." By seeking connections, residents built new connections. Similarly, the study found that maintaining connections was a continuous process of "sustaining connections with co-residents," "preserving connections with nurses/caregivers," and "continuing connections with inner-self and higher being/s." Maintaining connections led residents to balance shifting connections. Furthermore, it was found that the process of seeking and maintaining connections was conditional on facility arrangement i.e. the way residents were placed, rules, regulations, co-residents' language, gender, religious affiliation, attitudes, the attitudes and practices of nurses/caregivers, decreasing physical abilities of residents, increasing illness of residents, illness or death of co-residents, and retirement or resignation of nurses/caregivers.

CONCLUSION

The current study provides unique insights into the process of seeking and maintaining connections in a residential aged care facility. Facility arrangement, rules, regulations, and caregiving practices should resonate with residents' socio-cultural expectations and spiritual belief system to support their process of seeking and maintaining connections.

IMPLICATIONS FOR PRACTICE

The findings can be beneficial for managers, nurses, caregivers, and spiritual advisors in developing interventions that promote the development of meaningful connections in a residential aged care facility.

Making meaning of the new identity-as-resident: A grounded theory study

Residential living has the potential to threaten older adults' established identity. This study utilized grounded theory methodology to explore how older adults make meaning of the new identity-as-resident in a residential aged care facility. Using theoretical sampling, in-depth semi-structured interviews and observation within interviews were conducted with 17 residents from two Nepalese residential aged care facilities. Data analysis involved the process of open, axial, selective coding, and constant comparative analysis as specified by grounded theory methodology. The process that older adults experience in making meaning of their new identity-as-resident involved phases of isolating, exploring, evaluating, and compromising, which led in consequence to internalization of the new identity. Furthermore, it was found that this process depends on the facility structure, rules and regulations, and the attitudes and practices of nurses/caregivers. A focus on these facilitators is crucial for managers and nurses/caregivers working in residential aged care to assist residents in constructing a positive identity-as-resident. The findings can potentially be beneficial for raising awareness, educating nurses/caregivers, developing policies for promoting a positive identity-as-resident in residential aged care facilities worldwide.

Despite Symptom Severity, do Nursing Home Residents Experience Joy-of-Life? The Associations Between Joy-of-Life and Symptom Severity in Norwegian Nursing Home Residents

Background: Finding new approaches to increase health and well-being among nursing home (NH) residents is highly warranted. From a holistic perspective, several Norwegian municipalities have implemented the certification scheme framed "Joy-of-Life Nursing Home" Aims: In a holistic perspective on NH care, this study investigated if NH residents despite potential symptom severity experience joy-of-life (JoL). Therefore, we examined the frequency of common symptoms and the association between common symptoms and JoL in cognitively intact NH residents. Methods: A cross-sectional design was employed. Using the QLQ-C15-PAL quality-of-life questionnaire, hospital anxiety and depression scale, and JoL scale, a total of 188 cognitively intact NH residents participated. Results: Symptom severity was high; 54% reported fatigue, 52% reported constipation, 45% reported pain, 43% reported dyspnea, 32% reported insomnia, 22% reported appetite loss, and 20% reported nausea, while 20% reported anxiety and 23% reported depressive symptoms. Nevertheless, 59% of the NH residents reported high JoL, which was significantly positively related to the quality of life and negatively associated with anxiety and depression.

Exploring the Process of Spiritual Health of the Elderly Living in Nursing Homes: A Grounded Theory Study

BACKGROUND

Spiritual health is one of the important dimensions of the elderly's health, which plays an important role in other dimensions of their health. This study aimed to explain the process of spiritual health of the elderly living in nursing homes.

METHODS

This grounded theory study was conducted in 4 nursing homes in the city of Arak Iran between October 2019 and September 2020. The participants were 24 elderly people living in nursing homes, two health care providers, one nurse and one family member, first selected through purposive sampling and then, through theoretical sampling. The data were collected through semi-structured interviews and field notes. All the interviews were transcribed verbatim and analyzed based on Strauss and Corbin approach (2008).

RESULTS

Six main categories were identified, including helplessness, inefficient supportive environment, spiritual distress, seeking support, relative improvement of spiritual health and factors affecting spiritual health, each of which explains a part of the whole process of spiritual health of the elderly living in nursing homes.

CONCLUSION

Supporting the elderly living in nursing homes is necessary in order to meet their spiritual needs and preserve and promote their spiritual health.

Spiritual Needs of Older Adults during Hospitalization: An Integrative Review

A hospital admission presents various challenges for a patient which often result in high or intense spiritual needs. To provide the best possible care for older adults during hospitalization, it is essential to assess patients’ spiritual needs. However, little research has been done into the spiritual needs of geriatric patients. This article seeks insight into what is known in the literature on the spiritual needs of geriatric patients. This integrative review presents a summary of the articles on this topic. To select eligible studies, the PRISMA Flow Diagram was used. This resulted in ten articles that have been reviewed. Results show (1) a wide interest in researching spiritual needs, using different research designs. In addition, (2) four subcategories of spiritual needs can be distinguished: (a) the need to be connected with others or with God/the transcendent/the divine, (b) religious needs, (c) the need to find meaning in life, and (d) the need to maintain one’s identity. Moreover, results show that (3) assessing spiritual needs is required to provide the best possible spiritual care, and that (4) there are four reasons for unmet spiritual needs. Further research is needed on the definition of spiritual needs and to investigate older patients’ spiritual needs and the relation with their well-being, mental health and religious coping mechanisms, in order to provide the best spiritual care.