tu re 3 lrticle

Spirituality and the Elderly:
Nursing Implications with Nursing Home Residents
T.J. Hicks, Jr., MS, R N

Abstract-" Spiritual care is integral to quality nursing care for nursing home residents.

Spirituality can be defined as dynamic principles developed throughout the lifespan that
guide a person's view of the world; influence his or her interpretation of a higher power,
hope, morals, loss, faith, love, and trust; and provide structure and meaning to everyday activities. Spiritually focused nursing interventions include silent witnessing, serving as a liaison, and active listening. Nursing interventions for spiritual care can be divided into four
dynamic phases: self-comfort, assessment, intervention, and evaluation. Spiritual wellbeing helps residents' total well-being and inner peace.
(Geriatr Nurs 1999;20:144-6)

Pirituality is ingrained in
every aspect of a person's
life, influencing the meaning of each moment. As
such, nurses interact with a
person's spiritual aspects when providing care. This article focuses
specifically on the nursing home population and provides nurses working
in that setting with an overview of
spirituality, a discussion of spirituality
and the aged, and nursing interventions for spiritual care with the nursing home resident.

S

DEFINITIONS OF SPIRITUALITY
Spirituality is defined as the dynamic principles developed throughout the lifespan that guide a person's
view of the world; influence his or her

144

interpretation of a higher power,
hope, morals, loss, faith, love, and
trust; and provide structure and meaning to everyday activities. Spirituality
is a rich tapestry intricately interwoven throughout life events. Other definitions of spirituality include a search
for meaning, a driving force, and a
realm larger than complete understanding. 1-7
The terms religion and spirituality often are used interchangeably in
common conversation, but they have
distinct characteristics. Spirituality is a
realm of an individual's being that encompasses much more than religious
beliefs. Religion is a behavioral manifestation of an individual's spirituality
and a framework from which he or she
expresses that spirituality. The current

Geriatric Nursing Volume 20, Number 3

cohort of elderly adults tends to express its spirituality
through religion. 4 Although objective religious practices
may appear identical, each individual's spirituality is
unique.
Spirituality can be a resource for well-being among
the elderly.l,;,4,5, s-l° Sickness, loss, and aging sometimes
are considered obstacles to optimal functioning and
total well-being, but spirituality may become especially
more salient as frail elders adapt in nursing homes.
Furthermore, spirituality is necessary to develop harmonious i n t e r c o n n e c t e d n e s s a m o n g the elderly. 8 H a r monious interconnectedness is the melding of an
individual's past, present, and future; the environment;
and a higher power. Hungelmann et al. 8 found that elders with a strong belief in a power greater than themselves had a high level of total well-being.

ASSISTING ELDERS IN THE SPIRITUAL JOURNEY
Illness and suffering are spiritual experiences as
much as they are physical and emotional encounters.
The increasingly holistic focus of health care has
brought back an attention to spirituality. The nurse's
role is to accompany individuals along their spiritual
journey. The nurse also is on a personal spiritual journey
and gleans meaningful moments from spiritual encounters with residents. 1~-~3The process of spiritual nursing
care can be divided into four phases:
• Achieve a state of personal comfort
• Assess resident's spirituality
• Provide spiritual intervention
• Evaluate spiritual care outcomes
PHASE ONE:
ACHIEVE A STATE OF PERSONAL COMFORT
The nurse should be attuned to his or her own spirituality before participating in spiritual care with a residentJ 2,14-.6 Nurses can determine their connection with
and understanding of their own spirituality by asking
themselves such questions as, " H o w do I define the
meaning of life? .... What is my relationship with a higher
power?" and " H o w are my spiritual beliefs incorporated
into my nursing practice?" Nurses who discover they are
not comfortable with their own spirituality should not
attempt to provide spiritual care for residents. Such
nurses should make arrangements for another nurse to
provide the spiritual care and consult books and valued
people to understand, develop, and find comfort with
their own spirituality. A n understanding of their own
spirituality will enable these nurses to focus their attention on residents during spiritual care.
PHASE TWO:
ASSESS RESIDENT'S SPIRITUALITY
Social isolation, questions on the meaning of existence, depression, or a search for spiritual assistance are
possible indications that residents need or warrant spir-

Geriatric Nursing Volume 20, Number 3

itual attention? A survey of the resident's r o o m for religiously oriented items, such as books and statues, can
be further indicators or manifestations of a resident's
spirituality.
Several instruments for assessing spirituality
among older adults have been developed.14,17-2° In general, these measures assess spirituality by asking such
questions as, " W h a t is your source of h o p e and
strength?" and "What is your understanding of G o d ? "
Table 1 outlines some of these approaches.

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An important measurement of a resident's spirituality c a n b e c o n d u c t e d d u r i n g t h e a d m i s s i o n p r o c e s s to
t h e l o n g - t e r m c a r e f a c i l i t y by saying, " T e l l m e a b o u t
y o u r s p i r i t u a l n e e d s . " I n c o r p o r a t i n g a s p i r i t u a l assessm e n t i n t o p e r i o d i c r e s i d e n t e v a l u a t i o n e n c o u r a g e s staff
m e m b e r s to e m p h a s i z e this f a c e t of life. T h i s q u e s t i o n
m a y f u r t h e r t h e i n d i v i d u a l o n his o r h e r s p i r i t u a l j o u r n e y
or indicate possible areas for spiritual interventions.
PHASE THREE:
P R O V I D E S P I R I T U A L INTERVENTION
T h e life c o u r s e c a n b e s e e n as a j o u r n e y o r a
process. T h e n u r s e ' s r o l e in s p i r i t u a l c a r e is to a c c o m pany that individual for part of the journey. This care
c a n b e o f f e r e d in t h r e e ways: s i l e n t w i t n e s s i n g , a l i a i s o n
role, a n d a c t i v e listening. T a b l e 2 f e a t u r e s s e v e r a l spirit u a l n u r s i n g i n t e r v e n t i o n s b a s e d o n t h e s e t h r e e actions.
Silent witnessing, which occurs when the nurse
s e r v e s as a " s o u n d i n g b o a r d " f o r t h e e l d e r l y r e s i d e n t ,
can be a highly effective nursing interventionY t The
n u r s e d o e s n o t o f f e r a d v i c e o r o p i n i o n s b u t is w i l l i n g to
l i s t e n a n d d e m o n s t r a t e t h a t s o m e o n e c a r e s a b o u t this
f a c e t o f t h e r e s i d e n t ' s life.
T h e n u r s e also c a n s e r v e as a l i a i s o n f o r t h e resid e n t by c o o r d i n a t i n g t h e s e r v i c e s t h e r e s i d e n t f e e l s a r e
n e c e s s a r y f o r s p i r i t u a l e x p r e s s i o n . E n c o u r a g i n g clergy,
family, a n d f r i e n d s to e n g a g e in s p i r i t u a l a c t i v i t i e s w i t h
t h e r e s i d e n t , as w e l l as i n f o r m i n g t h e staff o f t h e resid e n t ' s s p i r i t u a l n e e d s a n d beliefs, c a n fulfill this role. T h e
n u r s e c a n e n s u r e t h e r e s i d e n t is t a k e n to d e s i r e d relig i o u s activities, such as B i b l e s t u d y a n d w o r s h i p c e r e m o n i e s . T h e n u r s e also c a n i n t e r v e n e by o b t a i n i n g
r e q u e s t e d s p i r i t u a l l y r e l a t e d i t e m s , s u c h as b o o k s ,
r o s a r i e s , o r statues. T h e r e s i d e n t ' s n e e d s a n d d e s i r e s will
g u i d e t h e n u r s i n g activities.
A c t i v e listening, t h e t h i r d n u r s i n g i n t e r v e n t i o n , is
d i f f e r e n t f r o m s i l e n t w i t n e s s i n g in t h a t t h e n u r s e is v e r bally engaged with the resident. Spending a few moments discussing spiritual topics constitutes one aspect
o f a c t i v e listening. T h e r e s i d e n t s h o u l d b e a l l o w e d to
guide the conversation. Discussing their own spiritual
b e l i e f s is a c c e p t a b l e for t h e n u r s e a n d o t h e r s t a f f so l o n g
as s u c h a c o n v e r s a t i o n is i n i t i a t e d a n d l e d by t h e resid e n t . S p i r i t u a l b e l i e f s m u s t n o t b e i m p o s e d o n t h e resid e n t ; t h e n u r s e s h o u l d b e c a r e f u l to a v o i d u s i n g his o r
h e r o w n b e l i e f s to i n f l u e n c e o r j u d g e t h e r e s i d e n t ' s decisions a b o u t t r e a t m e n t .
T h e r e s i d e n t ' s o b s e r v e d l e v e l of c o m f o r t ( e y e c o n tact, r e s t l e s s n e s s , b o d y p o s i t i o n ) a n d d i s e n g a g e m e n t
f r o m c o n v e r s a t i o n a r e c u e s t h a t h e o r she w a n t s to e n d
t h e d i s c u s s i o n . S u m m a r i z i n g t h e t h e m e s of t h e c o n v e r s a tion helps the resident reach a better understanding of
s e l f a n d g r e a t e r w e l l - b e i n g a n d e n s u r e s t h e n u r s e has an
a c c u r a t e i n t e r p r e t a t i o n of t h e i n t e r a c t i o n .

146

PHASE FOUR:
EVALUATE S P I R I T U A L C A R E O U T C O M E S
E v a l u a t i o n o f s p i r i t u a l n e e d s , l i k e a s s e s s m e n t , is
highly individualized. An appropriate evaluation would
b e to ask q u e s t i o n s like, " H o w d o y o u f e e l s p i r i t u a l l y ? "
a n d "Is t h e r e a n y t h i n g w e c a n d o to assist y o u w i t h y o u r
spirituality?" Evaluation should be incorporated into
r o u t i n e , r e g u l a r a s s e s s m e n t s a n d d o c u m e n t e d in t h e resident's chart.
CONCLUSION
T h e p r o c e s s Of p r o v i d i n g s p i r i t u a l n u r s i n g c a r e has
f o u r d y n a m i c phases. T i m e l y i n t e r v e n t i o n s c a n h e l p resi d e n t s a t t a i n a h i g h e r l e v e l of s p i r i t u a l h e a l t h . N u r s e s
w h o k e e p an o p e n m i n d a n d s p e n d t i m e w i t h e l d e r l y resi d e n t s c a n h e l p t h e m a c h i e v e t h e i r d e s i r e d l e v e l o f wellbeing and inner peace.
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T.J. HICKS, JR., MS, RN, is a doctoral student at Wayne State
University in Michigan and director of the dementia program for the
Botsford Continuing Care Corp.
Copyright © 1999 by Mosby, Inc.
0197-4572/99/$8.00 + 0

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