Spiritual care in dementia nursing - A qualitative, exploratory study

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