Spirituality in Selected Nepalese Residential Care Facilities: A Process of Connecting
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Background: Moving to a Residential Care Facility (RCF) is recognised as being a significant life event for older adults that has potential to negatively impact their spirituality. Although much is known about the process of adjusting to residential life, little is known about how older adults maintain their spirituality in a RCF. Aim: The study sought to provide a theoretical explanation of how older adults maintain spirituality in RCFs in Nepal. The specific objective was to explore how nurses/caregivers perceive and respond to residents’ spiritual needs. Methods: A total of 24 participants (17 residents, 3 nurses, and 4 caregivers) were recruited from two RCFs in Nepal using theoretical sampling. Semi-structured interviews in Nepali language, and observation during interviews, were undertaken. Using Corbin and Strauss’ variant of grounded theory, data were analysed until the point of theoretical saturation was achieved. Findings: This study identified that maintaining spirituality in a RCF involves a process of connecting, which is complicated, ongoing, and dynamic. The process of connecting comprised of three main categories or sub-processes; namely, making sense, seeking connections, and maintaining connections. Making sense explained how residents made meaning of their new identities-as-residents before seeking and maintaining connections in the RCF. Making sense comprised phases of isolating, exploring, evaluating, and compromising, which eventually led to the consequence—internalisation of the new identity. When residents internalised their new identity as a person lacking connection, they started seeking connections in the RCF. Seeking connections described how residents pursued different sources of connections before deciding whether or not to maintain those connections in the RCF. Seeking connections included the strategies of identifying sources, developing connections, and appraising responses, which eventually led residents to build new connections in the RCF. After building new connections, residents started employing strategies to maintain those newly built connections; namely, sustaining connections with co-residents, preserving connections with nurses/caregivers, and continuing connections with inner-self and higher being/s. Each of these process were operated by different conditions, such as facility structure, arrangement, rules, regulations, co-residents’ language, gender, religious affiliation and attitudes, attitudes and practices of nurses/caregivers, decreasing physical abilities or increasing illness of residents, illness or death of co-residents, and retirement or resignation of nurses/caregivers. The process of connecting was ongoing, involving continually choosing particular strategies—making sense, seeking connections, or maintaining connections—in response to the shifting conditions in the RCF. In addition, this study identified that nurses/caregivers were aware of most of the spiritual needs of residents; yet, only a few were involved in providing spiritual care. Therefore, most spiritual needs of residents remained unattended. The process of spiritual care provision included strategies such as preparing internally, interacting with residents, integrating care, and being involved in spiritual practices of residents. Furthermore, this study revealed that the increased gap between spiritual needs and spiritual care leads to spiritual distress in residents. Conclusion: In the future, the focus of care for residents in RCFs must expand beyond the physical dimensions of their health and consider spiritual needs as well.