Spiritual care in dementia nursing - A qualitative, exploratory study

Abstract

Background: Spiritual care is included in nurses’ holistic care. Descriptions of spirituality in research highlight humans search for the sacred, experiences of self-transcendence and connectedness (to self, to others and to God/a deity), with the end-point being the human experience of meaning. Nurses report spiritual care as being difficult to carry out, and that they lack knowledge in relation to what a spiritual dimension to nursing means and implies, and how to practise spiritual care in real terms. For people with dementia spiritual care is in general explored very little in research, and research on spiritual care for people living in nursing homes who have dementia is particularly sparse. Aim: The main purpose of this doctoral thesis is to explore how nurses (registered nurses [RNs]) and care workers (licensed practical nurses [LPNs], auxiliary nurses, health workers, assistant nurses) carry out spiritual care in nursing homes, by focusing on their experiences and perspectives of the spiritual needs of people with dementia. The aim in studies I, II, III and IV were: I. To synthesize research that investigated how patients and caregivers view spiritual care, come to understand the spiritual needs of people with dementia and how caregivers provide care congruent with peoples’ needs. II. To investigate nurses’ and care workers’ experience of spiritual needs among residents with dementia in nursing homes. III. To investigate how nurses and care workers carry out spiritual care for people with dementia in nursing homes. IV. To investigate nurses’ attitudes towards and accommodation of patients’ expressions of religiosity and faith in dementia care in nursing homes. Methods and design: This doctoral project was of a qualitative exploratory design informed by phenomenological and hermeneutic methodology. Study I comprised a metasynthesis of eight qualitatively empirical primary studies based on the perspectives of patients and caregivers providers. Studies II, III and IV were based on eight focus-group interviews (4x2), conducted in four different nursing homes in eastern Norway. Both nurses and care workers participated in the empirical study; 16 were nurses and 15 were care workers. Just one man attended. Main findings: In the meta-synthesis, the first level of synthesis revealed that spiritual care included caregivers helping patients with religious rituals to provide a sense of comfort; coming to know a person with dementia provides an opportunity to understand that person’s meaning and purpose. Attending to basic needs provides an opportunity to appreciate others vulnerability and humanness in the lives of people with dementia (Study I). Nurses’ experience of the spiritual needs of people in nursing homes who have dementia was described as the need for serenity and inner peace, the need for confirmation, and the need to express faith and beliefs (Study II). The nurses provided spiritual care by integrating spiritual care into general care, creating togetherness and providing meaningful activities for the patients (Study III). Nurses’ attitudes towards and accommodation of patients’ expressions of religiosity and faith were described as a movement between two extremes, such as embarrassment versus comfort, unknown religious practices versus known religious practices, and death versus life (Study IV). Conclusions: The spiritual care of nurses was considered to be tacit, intuitive and altruistic, and a part of general care. The nurses’ understanding of the meaning of spiritual care was to meet patients’ spiritual need for calmness and serenity, self-transcendence, inner peace, wellbeing and connectedness in relation to self, other people and God/a deity. Such relationships promoted a patient’s sense of belonging and togetherness. Nurses facilitated activities that promoted patients’ experiences of significance and meaning in everyday life, but their understanding of the meaning of this care for people with dementia seemed to be blurred. Nurses emphasized taking care of patients’ expressions of faith and beliefs, although they did not have a clear understanding of the significance of religiosity in patients’ lives. Nurses shared their patients’ religious beliefs and faith to a limited extent, which affected their practice of caring. Some nurses experienced challenges and personal barriers by feeling embarrassed, ashamed and alienated in relation to the religious practice in nursing homes. It seemed as if the nurses favoured general spiritual care through subjective knowledge, but had less focus on particular religious spiritual care. Furthermore, nurses felt that they lacked knowledge and expertise to provide spiritual care. It was not common to talk about or incorporate spiritual care into dementia care in nursing homes, because the culture was not open to discussion of spiritual and religious concerns.