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.

Although nurses of the past and present recognize the importance of spiritual care to health and healing, in practice and education, spiritual care dwells on the periphery of the profession. The purpose of this study was to gain a better understanding of the reasons behind this contradiction. Using the phenomenological approach, open-ended interviews were conducted with 29 individuals, including oncology nurses, patients and their families, chaplains, and hospital administrators. Their accounts reveal examples of how attitudes, beliefs, and practices of the larger organizational culture can shape the everyday lived experience of bedside nursing. Specifically, these influences tend to create a lived space that is uncaring, and a lived time that is "too tight." Moreover, lived body is experienced as an object for technical intervention, and lived other is experienced from a distance rather than "up close and personal." It was argued that, together, these existential experiences of lived time, space, body, and other create formidable barriers to spiritual nursing care.

Although the importance of spiritual care is widely recognized in nursing theory, recent research suggests that it is rarely attended to in nursing practice. One explanation for this contradiction is the conceptual confusion that exists regarding the meaning of spiritual nursing care. To help unravel this confusion, in-depth open-ended interviews were conducted in an oncology care setting with 29 individuals representing the multiple perspectives of nurses, patients, family, and others. Phenomenological analysis of these interviews reveals that spiritual nursing care involves a complexity of social processes, of which developing caring relationships is core. For these social processes to work and for spiritual nursing care to be realized, the nurse must embody four essential human qualities: receptivity, humanity, competency, and positivity. Participants' descriptions of these processes and qualities not only offer clarity and understanding but also capture the diffuse and amorphous nature of spiritual nursing care.

In this paper, we draw on the authors' collective experiences as qualitative researchers undergoing research ethics reviews. We highlight specific areas within our standard national guidelines that support qualitative research. Using case examples, we illustrate how diverse interpretations of these guidelines can be inconsistent and problematic for qualitative researchers. We outline recommendations for transparency, reciprocity, and streamlining of the review process. It is our hope that adoption of these recommendations will lead to a more collegial evaluative process, thereby contributing to the advancement of knowledge.

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