# Integrating the spiritual dimension in long-term care: a mixed methods evaluation of a multicomponent intervention for nursing home teams

## TL;DR

This study evaluates a training program to help nursing home staff better address residents' spiritual needs, showing improved self-reported skills and practical application.

## Contribution

A novel multicomponent intervention combining training, coaching, and team discussions to enhance spiritual care competencies in nursing home professionals.

## Key findings

- Healthcare professionals showed significant improvements in self-reported spiritual care competencies after the intervention.
- Training and on-the-job coaching increased awareness of the spiritual dimension in daily interactions with residents.
- Practical application of spiritual skills was observed in areas like aligning, connecting, and deepening resident care.

## Abstract

Moving to a nursing home has a major existential impact on the lives of residents and their relatives. Healthcare professionals who have daily contact with residents have many opportunities to pay attention to existential and spiritual issues. To support them, the Dutch multidisciplinary guideline on existential and spiritual aspects of palliative care was developed. However, many healthcare professionals report a perceived lack of competence in this domain and it remains unclear what they need to effectively translate the theory and tools from the guideline into daily practice. The multicomponent intervention ‘Insight into meaning’ (Zicht op zingeving) was developed, to facilitate the integration of the spiritual dimension into the daily practice of healthcare professionals. It consisted of structured training sessions, individualized on-the-job coaching and team intervision meetings. This study aimed to examine the effects of the intervention by exploring how healthcare professionals assess their spiritual competencies before and after the intervention, the focus of their coaching questions and learning outcomes during individual on-the-job coaching, and how they apply spiritual skills in daily practice.

A mixed method experimental design was used to examine the effects of a multicomponent intervention on two wards of a Dutch nursing home. The study included 44 healthcare professionals: primarily certified nurse assistants and client support workers. Participants were recruited via non-probability volunteer sampling and completed the Spiritual Care Competency Scale (SCCS) before and after the intervention. Quantitative data were analyzed using paired samples t-tests. Qualitative data were collected via coach registration forms and analyzed using thematic and deductive content analysis to explore participants’ coaching questions, learning outcomes, and observed spiritual competencies.

SCCS total and subscale scores showed statically significant improvements for pre- to post intervention (n=19; Δ0.50). Participants foremost frequently sought coaching to strengthen their role in addressing the spiritual dimension in interactions with residents. An increased awareness of their personal role in such encounters was commonly reported. Moreover, participants who did not articulate specific coaching questions appreciated the individual feedback. The observations provided valuable insight into the practical application of spiritual competency: particularly in the areas of aligning, connecting and deepening. A variety of responsive actions were noted, when healthcare professionals pay attention to what matters most to residents

The multicomponent intervention led to improvements in self-reported spiritual competencies among healthcare professionals. Both the training sessions and individualized on-the-job coaching contributed to heightened awareness of the spiritual dimension in daily practice. The study provided valuable insight into how theoretical frameworks and practical tools related to the spiritual dimension can be effectively integrated into the daily practice of healthcare professionals working in a nursing home setting.