The God card: spirituality in the nursing home.

Nursing homes were originally developed by Judeo-Christian organizations with a strong focus on providing comfort and spiritual support for the dying.1,2 Spiritual care is a key to the quality of life of nursing home residents. Each individual has his or her own dynamic approach to spirituality, which is a compilation of multiple experiences gained during his or her lifespan.3 These experiences influence the person’s interpretation of a higher power and play an important role in determining the person’s perception of the meaning of life and acceptance of death. Spirituality has been found to be the most significant predictor of hope for persons in long-term care.4 The ability of older nursing home residents to overcome losses in later life is based predominantly on their own beliefs on the meaning of life, integrated with their relationships to others and a higher being.5 In a study in Boston nursing homes, 54% of residents rated religion as very important, whereas only 19% rated religion as not important.6 Persons who perceived religion as important were more likely to have increased psychological wellbeing. Interestingly, families feel residents with dementia are more likely to die peacefully if they reside in a religious-affiliated facility.7 A need for “inner peace” is of high concern among nursing home residents,8 and the concept of “inner peace” has been found to be highly related to religiousness and fatigue. This makes it all the more important for physicians to focus on the treatment of fatigue, which is a key component of the frailty syndrome.9e14 In Germany, nursing home residents identified “being spiritually connected” along with a desire to maintain control and retain physical comfort as key needs for those who had not entered the active dying phase.15 In nursing homes in the Czech Republic, the most frequently used activity for spiritual support during the dying phase was treating the individual with “dignity and respect,” while “praying with the individual” was the least frequently used activity.16 Families rate the quality of care provided in facilities as higher in persons who received spiritual support from facility staff and in those who were assisted with individual devotional activities.17 In general, in faith-based facilities, residents perceive that they receive moderately high levels of spiritual care.18 Examples of spirituality mentioned by residents include arranging visits by religious personnel, kindness, respecting the needs of residents, and listening to the residents. Similarly, nurses expressed spiritual care as