Nurses’ Understanding of Spirituality and the Spirituality of Older People with Dementia in the Continuing Care Setting

Abstract

This research paper was presented at the Third International Spirituality in Healthcare Conference 2017-'Creating Space for Spirituality in Healthcare' at Trinity College Dublin, The University of Dublin. 22 June 2017. The number of older people living with dementia in Ireland is rising. Dementia is prevalent among those residing in the continuing care setting. Nurses have a professional obligation to provide person centred, holistic care, to which spiritual care is a core element, yet often do not. As there are no guidelines in Ireland for spiritual care provision it is open to personal interpretation and application. This study was the first in Ireland to explore how spiritual care is understood by nurses in the context of older people living with dementia in a public, rural, continuing care setting. A qualitative descriptive design was utilized. Following purposive sampling, eight semi structured interviews were conducted in a rural Irish community hospital among registered nurses caring for older people living with dementia. A conceptual framework developed from the findings of a literature review, as well as this research study's aim and objectives framed the interview schedule and data analysis. Data analysis utilized Newell and Burnard (2011) Thematic Content Analysis. Ethical approval was granted by the Health Service Executive (HSE) and the University of Dublin, Trinity College Dublin (TCD). Six key themes emerged from the study-1. Understandings of Spirituality, 2. Assessing spiritual need, 3. Providing spiritual care, 4. The impact of spirituality on quality of life, 5. Barriers to spiritual care and how these are addressed, and finally 6. The needs of staff. This paper presents and discusses the findings of the first theme 'Understandings of Spirituality' and its two sub-themes, 1. 'The nurse's own understanding of spirituality' and 2. 'The nurses' understanding of spirituality and older people living with dementia.' It is evident from the findings that there exists a variety of responses with regards to the nurses' own understanding of the concept spirituality and spirituality for older people living with dementia. Participants placed emphasis on person-centred approaches to understanding and providing for the needs of care recipients' in this area of care. Most participants acknowledged the positive impact of spiritual care on quality of life for older people living with dementia. Indications for practice suggest the need to develop suitable evidence based professional, person-centred frameworks, guidelines and educational standards for nurses which better equip them to understand spirituality and how this area of need can be properly assessed in partnership with the recipient of nursing practice in the continuing care setting to ensure comprehensive holistic, person-centred practice.

Spiritual Care in Advanced Dementia from the Perspective of Health Providers: A Qualitative Systematic Review

“…Care home staff report that people with advanced dementia prefer to die in familiar settings, such as nursing homes [39], although these settings are often viewed negatively due to the lack of professional training [3,9,23,41]. In matters of spirituality, professionals also display a lack of confidence [10,14], due to a lack of adequate training in spiritual approaches [11].…”

“…Perception of spirituality (i) Spirituality [14,41] (ii) Spirituality in end stage of dementia [14,41] (iii) Unsuccessful spiritual approach [3,7,9] Spiritual needs of people with advanced dementia (i) Spiritual care plan record [9,39,40] (ii) Familiar environment [6,39] (iii) Need for person-centered care [3,23] (iv) Interactions [6,25,41] Spiritual needs of health care professionals (i) Additional training [3,9,23,41] (ii) Fear of death [3,39] Spiritual care (i) Conversations [3,39] (ii) Music [12,25,41] (iii) Religion [3,12,41] (iv) Meaningful occupations [4,9] (v) Private space [4,23] (vi) Namaste Care effects [4,23,25] (vii) Other approaches [9,12] 7 Occupational Therapy International doing nothing, at least they are in a safe place … a safe and comfortable place" [4]. Moreover, this was seen as a source of respect: "…when you, sort of, just allocate a particular room and it's just, it's somehow given more respect" [23].…”

“…The connection that takes place between the person and the environment, or with his or her inner self, allows for a spiritual experience. The connections that have been highlighted in relation to spirituality include a link with a superior being, with oneself, with others, with nature [ 10 ], or with comfort [ 14 ]. Each culture or society also has an influence on an individual's sense of connectedness, which in turn it is related to the interconnection between the person, their environment, and their occupation [ 13 ].…”

“…However, there are barriers among health professionals [ 10 ] that influence their ability to integrate spirituality during care, such as lack of safety, and self-efficacy [ 11 ]. In addition, professionals believe that it is difficult to apply spirituality in people with dementia [ 10 ], or even that people in the last stage of dementia have no spiritual needs [ 11 , 14 ].…”

Spiritual care for people suffering from dementia disorders – selected issues

“…The nurse's understanding and acceptance of the patient's spiritual needs avoids disregard for the patient and creates a space necessary to carefully listen to the individual's spiritual perspective, observe, and draw attention to circumstances that provide spiritual, inner peace. According to some professionals, the best way to understand spirituality is to know a person's religion and spiritual practices [45].…”