Spirituality During Lockdown: In-Person (Rare) Interviews with Nursing Home Residents
Cindy Schmidt, PhD, Director of Scholarly Activity and Faculty Development, Associate Professor, Kansas City University; Don Smith, MD, Family Medicine Residency Program, Reid Health; Loes Nauta, MSEd, BTE, CHSE, Standardized Patient Program Consultant; and Tom Huth, MD, Family Medicine Residency Program, Reid Health
Residents of long-term care facilities arguably fared worse than most other populations in the U.S. during the early stages of the COVID-19 pandemic. The lockdown precautions implemented to reduce the spread of the virus also isolated them from most of the people and activities providing spiritual connection and care. How did this profound loss affect their spirituality?
A physician talked individually with his patients living in two Midwestern long-term care facilities in November 2020 (i.e., during lockdown). Only those residents demonstrating strong cognitive abilities were invited for interviews. To make this determination, we used the most recent cognitive screening score from their electronic medical record (Brief Interview for Mental Status, BIMS). We applied a more conservative cutoff of 13+ (out of 15) on the BIMS to identify eligible participants. Of the 27 residents eligible to participate, two declined the invitation outright, and one resident consented initially but the physician/researcher deemed their current mental status as likely below our cutoff, so their interview was abbreviated and not used. The 24 participants were 54% female, 96% Caucasian, and they had a mean age of 74.9 years.
Using a structured interview protocol, the physician researcher asked participants about how their experience with COVID-19 and the lockdown impacted their spirituality and their engagement with spiritual or religious activities. He wrote down their responses. We selected this method instead of recording the interviews because this was the first research experience with these facilities, and we did not want to raise concerns with family members about having recorded the residents.
Using a constructivist perspective, we qualitatively analyzed residents’ responses. Two researchers independently coded the data, then met for discussion and negotiation, using an iterative process to categorize themes.
Participants described a variety of responses to the COVID-19 lockdown. Some participants talked about the experience strengthening their spirituality, while others felt no impact or found it more difficult to be spiritual. Reflecting more deeply, some participants talked about the profound loss from not being allowed to touch others. Other themes centered around supernatural or providential oversight; feeling resigned to the rule of natural law; reliance on their faith; and religious and spiritual activities during lockdown, such as prayer, watching televangelists, and religious songs.
This study is one of the few in-person research studies conducting during the first year of the pandemic (2020), with so many studies placed on hold during lockdown. The results help us to understand how the lockdown experience impacted long-term care residents’ spirituality. Without access to chaplaincy and organized religious activities, these participants describe the gap/opportunity for physicians and the rest of the health care team to respond to patients’ spiritual needs.
Our data have limitations due to manually recording interviewee responses rather than using a process of audio recording and transcription. Another limitation is potential bias from the participants’ personal physician coding their interview responses, as well as other possible biases from the interpretation and analytic processes of conducting qualitative research.
A physician talked individually with his patients living in two Midwestern long-term care facilities in November 2020 (i.e., during lockdown). Only those residents demonstrating strong cognitive abilities were invited for interviews. To make this determination, we used the most recent cognitive screening score from their electronic medical record (Brief Interview for Mental Status, BIMS). We applied a more conservative cutoff of 13+ (out of 15) on the BIMS to identify eligible participants. Of the 27 residents eligible to participate, two declined the invitation outright, and one resident consented initially but the physician/researcher deemed their current mental status as likely below our cutoff, so their interview was abbreviated and not used. The 24 participants were 54% female, 96% Caucasian, and they had a mean age of 74.9 years.
Using a structured interview protocol, the physician researcher asked participants about how their experience with COVID-19 and the lockdown impacted their spirituality and their engagement with spiritual or religious activities. He wrote down their responses. We selected this method instead of recording the interviews because this was the first research experience with these facilities, and we did not want to raise concerns with family members about having recorded the residents.
Using a constructivist perspective, we qualitatively analyzed residents’ responses. Two researchers independently coded the data, then met for discussion and negotiation, using an iterative process to categorize themes.
Participants described a variety of responses to the COVID-19 lockdown. Some participants talked about the experience strengthening their spirituality, while others felt no impact or found it more difficult to be spiritual. Reflecting more deeply, some participants talked about the profound loss from not being allowed to touch others. Other themes centered around supernatural or providential oversight; feeling resigned to the rule of natural law; reliance on their faith; and religious and spiritual activities during lockdown, such as prayer, watching televangelists, and religious songs.
This study is one of the few in-person research studies conducting during the first year of the pandemic (2020), with so many studies placed on hold during lockdown. The results help us to understand how the lockdown experience impacted long-term care residents’ spirituality. Without access to chaplaincy and organized religious activities, these participants describe the gap/opportunity for physicians and the rest of the health care team to respond to patients’ spiritual needs.
Our data have limitations due to manually recording interviewee responses rather than using a process of audio recording and transcription. Another limitation is potential bias from the participants’ personal physician coding their interview responses, as well as other possible biases from the interpretation and analytic processes of conducting qualitative research.