Although it is widely accepted that spirituality is an important aspect of health and healing in long term care, its meaning and day-to-day implications remain poorly understood. This study explored the meaning of spiritual care from the perspectives of patients living with moderate to severe dementia, their families and their care providers. Using a hermeneutic phenomenological approach, open-ended interviews were conducted in a dementia care unit with 29 participants, including patients, families, RNs, LPNs, and hospital chaplains. Interviewees were asked to share their stories and insights about spiritual care in dementia. Using hermeneutic analysis, the central theme of ‘little things’ was identified. Recognition and attendance to ‘little things’ promoted patients’ sense of personhood and connectedness to self and others. Barriers to spiritual care in dementia were also identified. These findings inform our understanding about effective relational approaches in spiritual care with this unique population.

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Agitation in individuals with severe cognitive impairment is a significant problem that affects care and overall quality of life. Building on research conducted by Goddaer and Abraham (1994), this quasi-experimental study proposed that relaxing music played during meals would exert a calming effect and decrease agitated behaviors among nursing home residents with dementia. Thirty residents residing in a Special Care Unit participated in the 4-week study. The Cohen-Mansfield Agitation Inventory (Cohen-Mansfield, Marx, & Rosenthal, 1989) was used to gather data. Baseline data was obtained in Week 1 (no music). Music was introduced in Week 2, removed in Week 3, and reintroduced in Week 4. At the end of the 4-week study, overall reductions in the cumulative incidence of total agitated behaviors were observed. Reductions in absolute numbers of agitated behaviors were achieved during the weeks with music and a distinct pattern was observed.

Today, the complexities in the health care system are challenging nurses to be skillful and knowledgeable critical thinkers and decision makers. To adequately prepare future nurses to meet the challenges, nurse educators must nurture and facilitate critical thinking. One strategy believed to promote critical thinking in nursing education is concept maps. The purpose of this pilot study was to determine the level of critical thinking in the clinical concept maps developed by second year baccalaureate nursing students. Students enrolled in a five-week clinical practicum course were asked to submit their final concept map and participate in a focus group. The data for the study included eighteen concept maps, 1 student focus group and 1 instructor focus group. The Holistic Critical Thinking Scoring Rubric (Facione & Facione, 1994) was used to measure levels of critical thinking, and content analysis was used to analyze focus group data. Results from this study indicated that developing concept maps in the clinical setting fostered critical thinking and improved clinical preparedness.

Agitation in individuals with dementia living in the nursing home environment affects care and quality of life. Relaxation techniques such as music and massage are showing promise to decrease agitation and improve quality of life in individuals with dementia. Using an experimental 3 ϫ 3 repeated measures design, 41 residents with mild to moderate dementia participated in a study to test the effectiveness of favorite music (FM) and hand massage (HM) in reducing agitated behaviors. Agitated residents were randomly assigned to either the treatment or control groups. Residents in the treatment group received each of three treatments, HM, FM, and HMFM, with each treatment lasting 10 minutes. Residents in the control group received no treatment. Agitation was measured using the Cohen-Mansfield Agitation Inventory (CMAI) at three different intervals. The results suggest that FM and HM individually and combined are effective in significantly decreasing agitation immediately following the intervention and also one hour post intervention.Agitation and disruptive behaviors in individuals with dementia living in the nursing home environment is a widespread concern affecting the care of patients, staff satisfaction and the ability of staff to cope with providing care to these individuals (Brodaty, Draper, & Low, 2003;Souder & O'Sullivan, 2003). Agitation is not a diagnosis but a broad descriptive term connoting a group of behavioral symptoms. Cohen-Mansfield and de men tia d e m e n t i a http://dem.sagepub.com vol 7(1) 95-108