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.

Educational interventions and strategies for spiritual care in nursing and healthcare students and staff: A scoping review.

AIMS AND OBJECTIVES: To map existing evidence about educational interventions or strategies in nursing and allied healthcare concerning students' and staffs' spiritual care provision. BACKGROUND: Spiritual care is an important part of whole person care, but healthcare staff lack competence and awareness of spiritual issues in practice. To rectify this, it is important to identify what educational approaches are most helpful in supporting them to provide spiritual care. DESIGN: A scoping review using the PRISMA-ScR checklist. METHOD: Searches in the databases CINAHL, MEDLINE, ATLA and ERIC were conducted for papers spanning January 2009-May 2020. Search terms were related to spirituality, spiritual care, education and clinical teaching. Appraisal tools were used. RESULTS: From the 2128 potentially relevant papers, 36 were included. The studies were from 15 different countries and involved nurses, physicians and other health-related professions, and both quantitative, qualitative and mixed methods were used. The results are presented in three themes: Understanding of spirituality, Strategies in educational settings, and Strategies in practice settings. The review points to great diversity in the content, lengths and setting of the educational interventions or strategies. CONCLUSIONS: Courses in spiritual care should be implemented in curricula in both undergraduate and postgraduate education, and several studies suggest it should be mandatory. Courses should also be available for healthcare staff to raise awareness and to encourage the integration of spiritual care into their everyday practice. There is a need for greater consensus about how spirituality and spiritual care are described in healthcare settings. RELEVANCE TO CLINICAL PRACTICE: Spiritual care must be included both in monodisciplinary and multidisciplinary educational settings. The main result of spiritual care courses is in building awareness of spiritual issues and self-awareness. To ensure the provision of spiritual care for patients in healthcare practices, continuing and multidisciplinary education is recommended.

Spirituality and caring in old age and the significance of religion - a hermeneutical study from Norway.

Spirituality is an important part of caring for the whole human being. However, there is lack of consensus about the concept parameter, and there is an ongoing discussion in nursing regarding the relation between religion and spirituality. Spirituality and religion is found to support health and well-being in old age, and this article portrays how older Norwegians understand religion and religious support as part of spirituality and caring. The theoretical framework in this study is Eriksson's caritative caring theory, and the research aim is to broaden the understanding of spirituality from a caring science perspective. The methodology is hermeneutical according to Gadamer. The study is based upon qualitative content analysis of 30 interviews with 17 participants above 74 years, six men and 11 women. The findings portray connectedness with a Higher power, including how Christianity has influenced upon the philosophy of life of the participants, wonders about the end of life/afterlife, and the meaning of religious symbols and rituals. The study also portrays how religious support may foster dignity, especially near the end of life, and experiences and opinions regarding support from nursing personnel. The study concludes that religiousness cannot be separated from spirituality, and that nurses should be able to provide spiritual care to a certain extent. Spiritual care including religious support according to patients' desires may foster health and preserve human dignity.

Understanding the Significance of Listening to Older People's Life Stories in Whole Person Care-An Interview Study of Nurses in Gerontology.

Aim: The purpose of this study was to explore the significance of performing a life story interview for gerontological nursing students. Method: The study had a qualitative exploratory design, focusing on hermeneutical understanding using thematic analysis. Seven nurses in older people nursing were interviewed. Findings: Two main themes emerged from the analysis: "Engaging fellowship" and "Understanding the importance of life stories." The participants experienced increased engagement and fellowship with their patients after the life story interview; the change in their perspective was characterized by renewed interest, connection, and recognition of the individual person. The participants also gained a deeper understanding of the significance of listening to an older person's life story narrative, and this was expressed through them gaining an understanding of people's actions, achieving an altered mindset, gaining a greater generational understanding, and integrating a life story focus in their everyday professional life. Conclusion: Knowledge of human life and stories makes older people's situations easier to understand; this insight affects how we as nurses think about others. Seeing each patient as an individual and unique person and being aware of this in daily care is essential for nursing.

Norwegian Nurses' Reflections Upon Experiences of Ethical Challenges in Older People Care: A Qualitative Thematic Analysis.

INTRODUCTION: Internationally, aging populations have increased needs for health care services, and often specialized care is required. However, services for older people tend to be underfunded, resulting in lack of qualified staff and poor quality care. Resource shortages lead to ethical challenges and insufficient nursing care. Therefore, quality in daily care for older people also depends upon the nurses' ability to make complex, ethical decisions in their practice. OBJECTIVES: To explore ethical challenges experienced by nurses caring for older people in clinical practice, and to provide examples of management for the challenges. METHODS: The data collected were written reflection notes by Norwegian continuous education students in advanced gerontology. Forty two of 83 notes were included and a thematic analysis in six steps was utilized. FINDINGS: There are three main themes: (1) meeting vulnerability, discomfort, and suffering, (2) collaboration with relatives, and (3) struggling to perform professional care. CONCLUSION: Nurses strive to "do what is in the patients' best interest", and this is fostered through collaboration, professionalism, care, and presence. Nurses' ethical competencies may develop when reflecting upon their own care performance. Building ethical competencies should be a priority in both nursing education and clinical practice. However, to improve care quality, nurses also need professional knowledge about older people care and ethical awareness should be supported by the workplace.

Nursing Education: Students' Narratives of Moral Distress in Clinical Practice.

BACKGROUND: Research indicates that newly graduated nurses are often unprepared for meeting challenging situations in clinical practice. This phenomenon is referred to as a "reality shock". This gap in preparedness may lead to moral distress. The aim of this article is to provide knowledge of moral distress in clinical nursing practice. METHODS: Bachelor and further education nursing students were invited to write a story about challenging situations from their own clinical practice, resulting in 36 stories. Analysis was based on hermeneutical reading inspired by a narrative method; therefore, six stories were selected to represent the findings. RESULTS: A finding across the stories is that the students knew the right thing to do but ended up doing nothing. Four themes were related to moral distress: (a) undermining of professional judgement, (b) disagreement concerning treatment and care, (c) undignified care by supervisors, and (d) colliding values and priorities of care. CONCLUSION: Nursing education should emphasize to a greater extent ethical competency and training for the challenging situations students will encounter in clinical practice.

[Improved hand hygiene through simple interventions]. / Enkle tiltak gir bedre håndhygiene.

BACKGROUND: On the basis of new National Guidelines for Hand Hygiene, a project was started in 2004 in a medical ward at Haukeland University Hospital. The aims were to improve the personnel's compliance with hand hygiene guidelines and to transfer from soap hand wash to a disinfectant alcohol-based hand rub. MATERIAL AND METHODS: Two interventions were implemented: information about hand hygiene and increased availability of alcohol-based hand rub. The personnel's hand hygiene performance was recorded through 3 questionnaire-based interviews. The effect was assessed with a paired t-test, by comparing scores 2 and 9 months after the interventions with those before the interventions. Effect was also measured as changes in expenditure on alcohol-based hand rub compared with those for hand soap. RESULTS: Significant improvements were found for hand hygiene before (p = 0.02) and after (p = 0.01) direct contact with patients, after contact with objects near the patient (p = 0.002), before medicine distribution (p = 0.007) and for two subscores when evaluated after 2 months. The 9-month evaluation maintained most of these results, and for some questions the results improved. The expenditure on hand soap decreased, while the expenditure on alcohol-based hand rub increased significantly from 16 to 26 L/1000 treatment days (p = 0.02). There was little change in the total consumption of hand soap and alcohol-based hand rub. INTERPRETATION: Information about hand hygiene and increased availability of alcohol-based hand rub led to improved hand hygiene at all levels of staff.

[Oral care in the last stages of life]. / Munnstell når livet er på hell.

BACKGROUND: It is the responsibility of the nursing homes to provide residents with adequate oral hygiene. This article describes a new approach to improve the oral hygiene standards of the elderly in long-term care. MATERIAL AND METHODS: The method was based on 1) the production of individual, pictorial oral care plans for each resident; 2) the patients receiving first-class dental care equipment (electric toothbrush, interdental brushes, prosthesis brushes etc.; 3) nursing staff receiving information on oral hygiene methods; 4) the introduction of a number of fixed routines at the nursing home. To assess the oral care in the group of elderly, the mucosal-plaque index was used. RESULTS AND INTERPRETATION: The evaluation was made before commencement of the study and again after 15 months. The evaluation showed that the introduction of this method significantly improved oral hygiene in 40 out of the 63 patients.

Intercountry adoption and nursing care.

AIMS AND OBJECTIVES: This paper is based on a Norwegian study that addressed the importance of nurses understanding adoptive families' particular needs. The study aimed to provide a diverse picture of adoptive families' challenges and resources. It addressed adoptive families' experiences with welfare professions, particularly public health nurse services, and explored their need for support before and after adoption. This paper focuses particularly on challenges confronting 'transracial' families. PARTICIPANTS AND METHOD: The qualitative research interview was used as the methodological approach. Nine couples of adoptive parents, four adoptive mothers, three public health nurses and four adult adoptees were interviewed. The analysis process was an ad hoc generation of meaning, and the data were systematically reviewed and categorized through an intuitive analysis style. RESULTS: The study indicates that adoptive families manage their 'most common' challenges on their own, but the informants also spoke about a need for professional support and assistance in many cases. Recurring themes in the study were challenges linked to 'attachment difficulties', 'external categorization', 'grief' and 'the meaning of biological heritage and roots'. Findings indicate that there is a substantial demand for increased knowledge of adoptive families' special needs, not least in the public health nurse services; there is also limited knowledge within other welfare professions. Nurses particularly need to strengthen their understanding on how external categorization affects transracial adoptive families. CONCLUSIONS: The study recommendations call for improved follow-up after adoptions. This can be met by establishing a special programme for adoptive families at maternity and child health centres. In addition, public health nurses can support adoptees in their teenage years through individual consultations.