Although it is widely accepted that spirituality is an important aspect of health and healing in long term care, its meaning and day-to-day implications remain poorly understood. This study explored the meaning of spiritual care from the perspectives of patients living with moderate to severe dementia, their families and their care providers. Using a hermeneutic phenomenological approach, open-ended interviews were conducted in a dementia care unit with 29 participants, including patients, families, RNs, LPNs, and hospital chaplains. Interviewees were asked to share their stories and insights about spiritual care in dementia. Using hermeneutic analysis, the central theme of ‘little things’ was identified. Recognition and attendance to ‘little things’ promoted patients’ sense of personhood and connectedness to self and others. Barriers to spiritual care in dementia were also identified. These findings inform our understanding about effective relational approaches in spiritual care with this unique population.
Aggarwal, N., Vass, A.A., Minardi, H.A., Ward, R., Garfield, C., & Cybyk, B. ( 2003). People with dementia and their relative: Personal experiences of Alzheimer’s and of the provision of care. Journal of Psychiatric and Mental Health Nursing, 10, 187-197.
2.
Ambert, A.M., & Adler, P.A. ( 1995). Understanding and evaluating qualitative research. Journal of Marriage and Family, 57(4), 879-894.
3.
Appelin, G., & Bertero, C. ( 2004). Patients’ experiences of palliative care in the home: A phenomenological study of a Swedish sample. Cancer Nursing, 27(1), 65-70.
4.
Bell, V., & Troxel, D. ( 2001). Spirituality and the person with dementia - a view from the field. Alzheimer’s Care Quarterly, 2(2), 31-45.
5.
Boero, M.E., Caviglia, M.L., Monteverdi, R., Braida, V., Fabello, M., & Zorzella, L.M. (2005). Spirituality of health workers: A descriptive study. International Journal of Nursing Studies, 42(8), 915-921.
6.
Carroll, B. ( 2001). A phenomenological exploration of the nature of spirituality and spiritual care. Mortality, 6(1), 81-98.
7.
Carr, T. ( 2003). The spirit of Nursing: Ghost of our past or force for our future? In M. R. McIntyre &, & E. H. Thomlinson (Eds.), Realities of Canadian nursing: Professional, practice and power issues (pp. 470-492). Philadelphia, PE: Lippincott, Williams & Wilkins .
8.
Carr, T. ( 2008). Mapping the processes and qualities of spiritual nursing care. Qualitative Health Research, 18(5), 686-700.
9.
Como, J.M. ( 2007). Spiritual practice: A literature review related to spiritual health and health outcomes. Holistic Nursing Practice, 21(5), 224-236.
10.
Daaleman, T.P., Kuckelman Cobb, A., & Frey, B.B. ( 2001). Spirituality and well-being: An exploratory study of the patient perspective. Social Science and Medicine, 53 1503-1511.
11.
Demerath, N.J. ( 2000). Varieties of sacred experience: Finding the sacred in a secular grove. Journal for the Scientific Study of Religion , 39(1), 1-11.
12.
Dunn, D. ( 2004). Hearing the story: Spiritual challenges for the ageing in an acute mental health unit. In Jewell Albert (Ed.), Ageing, Spirituality and Well-Being (pp. 153-160). London: Jessica Kingsley.
13.
Farran, C.J., Paun, O., & Elliott, M.H. ( 2003). Spirituality in multicultural caregivers of persons with dementia. Dementia, 2(3), 353-37.
14.
Faver, C.A. ( 2001). Rights, responsibility, and relationship: Motivations for women’s social activism. Affilia: Journal of Women & Social Work, 16(3), 314-336.
15.
Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). Mini-mental state: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189-198.
16.
Gilligan, C. ( 1982). In a different voice: Psychological theory and women’s development. Cambridge, MA: Harvard University Press.
17.
Goodley, D. ( 1996). Tales of hidden lives: A critical examination of life history research with people who have learning difficulties. Disability & Society, 11(3), 333-348.
18.
Grant, D. ( 2004). Spiritual interventions: How, when, and why nurses use them. Holistic Nursing Practice, 18(1), 36-41.
19.
Harmer, B., & Orrell, M. ( 2008). What is meaningful activity for people with dementia living in care homes? A comparison of the views of older people with dementia, staff and family carers. Aging and Mental Health, 12(5), 548-558.
20.
Hicks-Moore, S.L. ( 2005). Relaxing music at mealtime in nursing homes: Effects on agitated patients with dementia. Journal of Gerontological Nursing, 31(12) 26-32.
21.
Hicks-Moore, S.L., & Robinson, B.A. (2008). Favorite music and hand massage: Two interventions to decrease agitation in residents with dementia . Dementia, 7(1), 95-108.
22.
Jonas-Simpson, C., Mitchell, G.J., Fisher, A., Jones, G., & Linscott, J. ( 2006). The experience of being listened to: A qualitative study of older adults in long-term care settings. Journal of Gerontological Nursing, 32(1), 46-53.
23.
Katsuno, T. ( 2003). Personal spirituality of persons with early-stage dementia: Is it related to perceived quality of life. Dementia, 2(3), 315-335.
24.
Keller, J. ( 1996). Care ethics as a health care ethic. Contexts: A Forum for the Medical Humanities, 4(4). Retrieved October 27, 2008 from : http://www.uhmc.sunysb.edu/prevmed/mns/imcs/contexts/care/carejean.html.
25.
Kirsh, B., Dawson, D., Antolikova, S., & Reynolds, L. ( 2001). Developing awareness of spirituality in occupational therapy students: Are our curricula up to the task? Occupational Therapy International, 8(2), 119-125http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=2001091151&site=ehost-liv.
26.
Kitwood, T. ( 1997). Dementia reconsidered: The person comes first. Philadelpia, PA: Open UNiversity Press.
27.
Kociszewski, C. ( 2003). A phenomenological pilot study of the nurses’ experience providing spiritual care. Journal of Holistic Nursing, 21(2), 131-148.
28.
Lengermann, P.M., & Niebrugge-Brantley, J. (1998). The women founders: Sociology and social theory, 1830-1930. New York, NY: McGraw-Hill.
29.
Locke, L.F., Spirduso, W.W., & Silverman, S.J. (2000). Proposals that work: A guide for planning dissertations and grant proposals4th edition. Thousand Oaks, CA: Sage Publication.
30.
Lofland, J., & Lofland, L.H. ( 1995). Analyzing social settings: A guide to qualitative observation and analysis. Belmont, CA: Wadsworth Publishing Company.
31.
Logsdon, R.G., Gibbons, L.E., McCurry, S.M., & Teri, L. ( 2002). Assessing quality of life in older adults with cognitive impairment. Psychosomatic Medicine, 64, 510-519.
32.
Mclean, A.P. ( 2007). Dementia care as a moral enterprise: A call for a return to the sanctity of lived time. Alzheimer’s Care Today , 8(4), 360-372.
33.
Moberg, D.O. ( 2001). Aging and spirituality: Spiritual dimensions of aging theory, research, practice, and policy. New York, NY: The Haworth Pastoral Press.
34.
Narayanasamy, A., Clissett, P., Parumal, L., Thompson, D., Annasamy, S., & Edge, R. ( 2004). Responses to the spiritual needs of older people. Journal of Advanced Nursing, 48(1), 6-16.
35.
Narayanasamy, A., & Owens, J. ( 2001). A critical incident study of nurses’ responses to the spiritual needs of their patients. Journal of Advanced Nursing, 33(4), 446-455.
36.
Neely, D., & Minford, E.J. ( 2008). Current status of teaching on spirituality in UK medical schools. Medical Education, 42(2), 176-182http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=2009771258&site=ehost-liv.
37.
Noddings, N. ( 1984). Caring: A feminine approach to ethics and moral education . Berkeley, CA: University of California Press.
38.
O’Brien, M.E. ( 1999). Spirituality in nursing: Standing on holy ground. Toronto, ON: Jones and Bartlett Publishers.
39.
O’Connor, D., Phinney, A., Smith, A., Small, J., Purves, B., Perry, J., Drance, E., Donnelly, M., Chaudhury, H., & Beattie, L. ( 2007). Personhood in dementia care: Developing a research agenda for broadening the vision. Dementia, 6(1), 121-142.
40.
Olson, J.K., Paul, P., Douglas, L., Clark, M.B., Simington, J., & Goddard, N. ( 2003). Addressing the spiritual dimension in Canadian Undergraduate nursing education. Canadian. Journal of Nursing Research, 34(3), 94-107.
41.
Orrell, M., Hancock, G.A., Galboda Liyanage, K.C., Woods, B., Challis, D., & Hoe, J. ( 2008). The needs of people with dementia in care homes: The perspectives of users, staff and family caregivers. International Psychogeriatrics, 20(5), 941-951.
42.
Patton, M.Q. ( 2002). Qualitative research and evaluation methods3rd edn. Thousand Oaks, CA: Sage Publications.
43.
Pesut, B. ( 2008). A conversation on diverse perspectives of spirituality in nursing literature. Nursing Philosophy, 9(2), 98-109.
44.
Priest, H. ( 2002). Issues in research: An approach to the phenomenological analysis of data. Nurse Researcher, 10(2), 50-63.
Ross, L.A. ( 2006). Spiritual care in nursing: An overview of the research to date. Journal of Clinical Nursing, 15(7), 852-862.
47.
Rothman, J. ( 2009). Spirituality: What we can teach and how we can teach it. Journal of Religion & Spirituality in Social Work , 28(1-2), 161-184http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=2010257441&site=ehost-liv .
48.
Savage, J. ( 2000). Participative observation: Standing in the shoes of others ? Qualitative Health Research, 10(3), 324-340.
49.
Smith, S.D.M. ( 2005). Dementia palliative care needs assessment: A focus on spiritual care. Scottish Journal of Healthcare Chaplaincy , 8(1), 13-19.
50.
Stuckey, G. ( 2003). Dementia, religion, and spirituality. Dementia, 2(3), 291-297.
51.
Stuckey, J.C., Post, S.G., Ollerton, S., FallCreek, S.J., & Whitehouse, P.J. (2002). Alzheimer’s disease, religion, and the ethics of respect for spirituality: A community dialogue . Alzheimer’s Care Quarterly, 3(3), 199-207.
52.
Sumner, J. ( 2008). Is caring in nursing an impossible ideal for today’s practicing nurse. Nursing Administration Quarterly, 32(2), 92-101.
53.
Tanyi, R.A. ( 2002). Toward clarification of the meaning of spirituality. Journal of Advanced Nursing, 39(5), 500-509.
54.
Toma, J.D. ( 2006). Approaching rigor in applied qualitative research. In F. Conrad, & R. C. Serlin (Eds.), The Sage handbook for research in education: Engaging ideas and enriching inquiry (pp. 405-423). Thousand Oaks, CA: Sage Publications.
55.
Touhy, T.A. ( 2001). Nurturing hope and spirituality in the nursing home. Holistic Nursing Practice, 15(4), 45-5.
56.
Tuck, I., McCain, N.L., & Elswick, R.K. ( 2001). Spirituality and psychosocial factors in persons living with HIV. Journal of Advanced Nursing, 33, 776-783.
57.
van Manen, M. ( 1997). Hermeneutic Phenomenological reflection. In M. van Manen (Ed.), Researching lived experience (2nd edn. pp. 77-109). London, ON: The Althouse Press.
58.
van Manen, M. ( 2003). Writing in the Dark. Phenomenological Studies in Interpretive Inquiry. London, ON: The Althouse Press.
59.
Vickrey, B.G., Strickland, T.L., Fitten, L.J., Adams, G.R., Ortiz, F., & Hays, R.D. ( 2007). Ethnic variations in dementia caregiving from focus groups . Journal of Human Behavior in the Social Environment, 15(2-3) 233-249.
60.
Walters, D. ( 2007). The effect of multi-sensory ministry on the affect and engagement of women with dementia. Dementia, 6(2), 233-243.
61.
Walton, J. ( 1999). Spirituality of patients recovering from an acute myocardial infarction. Journal of Holistic Nursing, 17(1), 334-353.
