"This study compared staff and resident knowledge, attitudes and practices related to religious expression in long-term care settings. Staff and residents from 13 facilities and organizations providing services to long-term care staff completed a survey related to religion and spirituality in long-term care" (Walker et al. August 1998).
- Data File
- Cases: 592
Weight Variable: None
Variables ITEM11 - ITEM43 and AITEM11 - AITEM43 report responses given on items that vary by the module administered (variables ITEM1-10 and AITEM1-10 are the same for all modules). The module items and their variable descriptions by module number are reported at the end of this document.
Variable JOBTITLE reports the qualitative answers to codes found in the data file. The codes follow the module and item descriptions at the end of this document.
- Data Collection
- Date Collected: March to September 1998
- Funded By
- National Institute on Aging
- Collection Procedures
- Self-administered surveys featuring sets of the eight forms of the Knowledge, Attitudes and Practices related to Spirituality and Religion (KAPS-R) were sent to the participating facilities and completed between March and June 1998. All participants were instructed to read the statements and circle either Agree, Disagree, or Don't Know. Average time to complete the survey was 15 minutes.
- Sampling Procedures
- Staff (N=299) and residents (N=266) from long-term care facilities completed one of eight forms. Facilities included skilled nursing facilities, continuing-care residential communities (CCRCs), retirement apartment complexes and assisted living facilities located in California, Florida, Maryland, Michigan, Oklahoma, Utah and Virginia. Some facilities had affiliations with Protestants, Catholic and Jewish groups, and some were unaffiliated. About half of the participants lived or worked in a facility that had a full-time chaplain.
Coordinators at each site estimated the number of staff and residents available to complete a survey. Each site received a set of surveys with equal numbers of the eight KAPS-R forms along with copies of a letter explaining the project. Approximately half of the surveys were completed.
- Principal Investigators
- Bonnie L. Walker
- Related Publications
- Walker, Bonnie L., Ephross, Paul H., Koenig, Harold G., Moberg, David O., Nye, William P., Osgood, Nancy J., & Richardson, James P. Staff and resident knowledge and attitudes toward religion and spirituality in long-term care. Submitted to The Gerontologist February 1999.
Walker, Bonnie L. Religious attitudes, beliefs, and practices of residents in two continuing care residential communities. Under review by the Journal of Applied Gerontology, October 1998.
- For each of eight topics related to religious expression and spirituality in long-term care, modules were given assessing general program objectives (ITEM01-ITEM10) and 33 separate items assessing one of the eight topics. Responses reported in the data file vary by MODULENU (module number)
Variable Descriptions for variables (ITEM11-ITEM43)in Modules 1-8 are reported below, along with the topic description of the module.
Variables AITEM11-AITEM43 are also variable by module. They are based on the modules' ITEM11-ITEM43, but have been coded as either "correct" or "wrong." "For each of the eight topics, the team developed training objectives and constructed items to assess related knowledge, attitudes and staff practices. Knowledge items were validated by consulting appropriate references; attitudes were considered correct if they reflected religious tolerance; practices were considered correct if they were proactive staff behaviors that would promote opportunities for religious expression and spirituality in long-term care" (Walker et al. 1998).
- FOR ALL MODULES:
Staff should help residents so they can participate in the religious activities of their choice.
People with Alzheimer's disease no longer have religious and spiritual needs.
Being religious and being spiritual are the same thing.
There is more to religion and spirituality than going to religious services.
People who participate in religious activities tend to be more satisfied with their lives.
People with religious faith handle problems more easily than nonreligious people.
Staff who are religious or spiritual enjoy their work more than those who are not.
Staff have a responsibility to help the residents to express their religious beliefs.
The staff needs to know the religious and spiritual needs of each resident.
All religious beliefs deserve equal respect.
VARIABLES FOR ITEM11-43 and AITEM11-43
MODULE 1 - Religious Expression in Long-Term Care
This module will help staff and other caregivers understand the role religion plays in later life, especially for older people living in various types of long-term care facilities, including assisted living, adult homes, congregate living, retirement communities, adult day care, or the community at large.
Religion is more important to older people than to younger adults.
Religion is not important to most young people.
Religious services comfort many people with dementia.
Many older people like to say grace before a meal.
Long-term care facilities should provide time for people to say grace before meals.
God created each person with free will.
Staff should not make judgments about another person's spirituality.
All people have the right to practice their religion in their own way.
Religious people make good caregivers.
Religious people deal with personal problems better than non-religious people.
Religious people tend to be healthier than non-religious people.
Religious people usually like to attend worship services regularly.
Prayer can have a positive effect on someone's health.
When I am sick, I want people to pray for me.
I often pray for other people.
Religious people get along better in long-term care than non-religious people.
Most residents would like to attend a religious service once a week.
Long-term care facilities should arrange transportation for residents so they can attend religious events in the community.
Staff needs to know the religious beliefs and interests of the residents.
It would be helpful if the facility residents worshipped together each week.
People who enter long-term care need to find new ways to express their religious faith.
Staff should pray with residents.
Many people appreciate having someone pray with them.
Staff should find volunteers to sing hymns with residents if they ask.
Staff and pastors from community churches should work together with the residents to plan religious activities.
Many residents want their pastors to visit them.
Many of the clergy receive training in pastoral counseling.
A chaplain is an important person in a long-term care facility.
Chaplains help the staff as well as the residents with spiritual problems.
I have witnessed conflict related to religious expression in my facility.
Families and residents often disagree about religious issues.
The facility administration and staff often disagree with each other about religious issues.
Most of the time there is no problem related to religious expression in our facility.
MODULE 2 - The Spiritual Needs of People with Dementia
This module will help staff understand the spiritual and religious needs and capabilities of people with dementia. It will explain how religious and spiritual expression can be beneficial.
In my opinion, people with dementia have the same needs as the other residents.
It is important for staff to understand the spiritual needs of each resident.
Signs of dementia appear suddenly in most people.
Most people with dementia keep their long-term memory in early stages of disease.
It is not easy to know whether a person has dementia.
A religious resident with dementia probably won't want to receive communion.
People with dementia continue to have religious and spiritual needs.
Spirituality is not important to people with dementia.
I think that attending religious services is important for people with dementia.
A Jewish resident with dementia will not care about having kosher meals.
Residents with dementia are not able to pray.
People with Alzheimer's can sometimes remember the words to religious hymns.
People with dementia can often remember the words to prayers.
Putting a crucifix in the room of a Catholic resident with dementia may be comforting.
Some dementia residents respond positively to music that has a spiritual content.
Religious activities can improve the quality of life of people with dementia.
People with dementia do not care about religious activities.
Receiving communion seems comforting to religious people with dementia.
Taking a person with dementia to a religious service often calms down the person.
Participating in religious services helps people with dementia get used to their surroundings.
Staff should help people with dementia attend religious activities in the facility.
Reading scriptures to a resident with dementia can improve communication between staff and the resident.
It is useful for staff to find out the religious preferences of patients with dementia.
Staff can ask residents if they would like them to read scriptures to them.
Working with residents with dementia is a satisfying job.
Having a strong religious faith helps staff who work with residents with dementia.
Staff can help people with dementia find religious programming on TV or radio if they seem to enjoy it.
It is part of the staff's job to take residents with dementia to religious services in the facility.
The spiritual needs of a resident with dementia should be part of the care plan.
I think that staff should pray with religious residents who have dementia.
Staff can communicate with residents with dementia through religious activities.
People with dementia should worship separately because they might disturb the service.
It is helpful for staff to sing religious songs to religious residents with dementia.
MODULE 3 - End-of-Life Issues (Dealing with Death and Dying)
This module helps staff understand end-of-life issues, especially those related to death and dying, the role of spirituality and religious expression, and respond appropriately.
Staff should help residents with end-of-life issues.
Often a staff member is the only person there to help a resident at the end-of-life.
Hearing is the last sense to go when a person is dying.
Staff should recognize behaviors normal for someone in pain.
It is part of the staff's job to offer emotional support to other residents when someone dies at the facility.
It is best if staff doesn't get emotionally involved with a dying resident.
Staff should distance themselves from dying residents.
It is not a good idea to talk with a resident about death and dying.
Staff shouldn't encourage a resident to talk about his feelings about death.
The staff should be willing to talk about death when a resident brings up the topic.
Staff should listen patiently if a dying resident talks about doubts about heaven, fears about death or anger.
Spiritual beliefs are helpful to people who are dying.
Prayer is often comforting to someone close to death.
Staff should tell a resident who is angry about dying that God loves him or her.
You can comfort a dying person by holding his hand.
Staff should encourage all residents who are close to death to fight back.
Staff members must be careful not to "preach" to residents or try to convert them, even if they are dying.
If a resident asks, it is acceptable for a staff member to pray with them.
Staff should arrange for a visit from a clergy if the resident requests it.
It is important for staff to know the religious affiliations of residents in their care.
Hospice is an important resource for staff when residents are dying.
Suicide is an appropriate choice for older people who are very ill.
Many people want to say good-bye to their friends and family when they believe they are dying.
Staff should help people say good-bye to their friends if asked.
It's normal for dying people to see visions of family and friends who have died.
Dying people frequently report seeing visions of family members and friends who have died.
All religions believe in life after death.
It is important to practicing Catholics for a priest to give them the last rites before they die.
Some Protestants will want a clergy to anoint them if they are near death.
Orthodox Jews must be buried with 24 hours of death.
Some religious faiths do not permit cremation.
When a resident asks why God allows them to suffer, staff should call a pastor or rabbi.
Memorial services are healing events for family, staff, and other residents.
MODULE 4 - Bereavement and End-of-life Losses
This module will help long-term care staff better understand and respond to end-of-life losses and resident bereavement.
Staff members do not need to understand the spiritual needs of the residents.
Most staff do not need special training to help people who are grieving.
Most people enter long-term care because of a major, recent loss.
Moving to a nursing home results in a loss of privacy and personal freedom.
Moving is an extremely stressful event for people at any age.
Nearly everyone is depressed when they first move into long-term care.
I think that strong religious faith helps people deal with their losses.
Religious activities play a major role in the lives of the majority of older people.
Leaving a familiar church or synagogue is difficult for religious people when they move to a long-term care facility.
People in long-term care continue to experience new losses.
Religious people handle difficult situations better than non-religious people.
Prayer can help residents overcome their problems.
It is pleasant to be around religious people.
Having religious symbols in the room is comforting to religious people.
Staff need to help residents create a space that is entirely theirs and reflects their personalities.
Staff should encourage residents to show their family photos and talk about family members.
Staff should encourage residents to talk about their own religious beliefs.
It is a waste of time to develop a relationship with people who have a short time to live.
It is helpful for residents to discuss feelings about their lives with staff.
Talking about the past often helps people deal with the present.
Grieving after a loss is normal.
Religious people do not need to grieve.
Brief periods of depression are normal when people experience losses.
Staff should call a trained professional to treat a person with severe depression.
Chaplains are trained to help people deal with sadness and loss.
Grieving for an important loss often requires one or two years.
Thinking about suicide is a common response to a major loss.
Listening to music is spiritually uplifting to many people.
I often turn on the TV when I come into a room.
Staff should encourage a depressed person to become involved in religious activities.
Staff can encourage residents to pray for them.
Older people can remain useful and loving to others through spiritual activities and religious expression.
Residents should be allowed to make their own choices whenever possible.
MODULE 5 - Knowledge of Faiths and Their Expression
This module expands staff knowledge of the differences in expression of religious faith and spirituality among the major religious faiths with the goal of increasing tolerance towards diversity.
People of all religious beliefs live in long-term care.
People can learn a lot by talking about their religious beliefs with each other.
Long-term care residents have very different ideas about religion.
Religion is very important to the majority of people in long-term care.
Some people are spiritual even though they aren't religious.
All long-term care facilities should allow residents to worship God the way they choose or not to worship at all.
Long-term care facilities should be sure that all residents can practice the religious faith of their choice.
All religions believe that people have free will.
Each person has free will to decide what to believe about God.
God gave each person the choice of whether to believe in him or not.
God loves all people the same.
In my opinion, all religions worship the same God.
Facilities should help Christians celebrate the birth of Christ.
Some Christian services do not include hymn singing.
Facilities should provide a Sabbath service for Jewish residents.
The Bible is the only book that was divinely inspired.
The Torah is the holy book of the Jews.
Facilities should have a chapel without religious symbols if they have members of many faiths.
Hindus believe in daily meditation.
Moslems stop each day at the same time to pray no matter where they are.
Staff should call a priest to administer last rites for Catholic residents who are dying.
Hindus believe in reincarnation.
Some Christians believe that any use of alcohol is a sin.
Most Seventh Day Adventists do not eat meat.
Facilities should not serve pork to Moslems and Orthodox Jews.
Christian Scientists generally will not accept medical treatment.
Facilities should not serve caffeine beverages to people whose religions prohibit using them.
Unitarians do not believe that Jesus Christ was the son of God.
I believe that people can be healed through prayer.
Some religious people like to attend religious services, others don't.
Some religious faiths don't permit cremation.
Staff should arrange for someone to come to the facility to serve communion to Christians at least once a month.
Staff should allow time for residents to pray before meals.
MODULE 6 - Creating a Spiritual Environment
This module helps staff understand the need for a spiritually enhanced environment and what they can do to create and maintain it.
The place where you live has a lot to do with your quality of life.
Staff have a responsibility to create a pleasant environment for the residents.
Staff should care for the residents' spirits as well as their bodies.
It is possible to have a good quality of life while living in a nursing home.
Everyone enjoys beauty in their environment.
The temperature in the room should be comfortable for the resident, not the staff.
Staff should pick up any trash they see in the facility.
A clean room is the most important thing to almost everyone.
Smoking is forbidden in most long-term care facilities.
Many people are allergic to perfume and deodorants.
When possible, staff should put a chair beside the window so the resident can look out.
Residents of long-term care should be allowed to have pets.
Staff should put bird feeders outside residents' windows and maintain them.
Residents often find arranging flowers to be a spiritually fulfilling activity.
Staff should help residents take care of their plants, if help is needed.
Residents need to communicate with nature whenever possible.
Everyone needs a quiet place to go.
Spiritual people must have opportunities for meditation.
All facilities should have a place where residents and staff can pray.
Staff should help residents find a quiet place when they ask.
Loneliness causes more pain to residents than physical illness.
Staff should greet residents by name when they pass them in the hall.
Staff should smile at residents as often as possible.
Most residents in my facility enjoy interaction with children.
Staff should ask residents before turning on the TV.
For many residents, the staff are the most important people in their lives.
Staff should talk softly (or not at all) if a resident is sleeping.
Listening to soft, pleasant music adds to a resident's quality of life.
Many residents enjoy singing religious music.
A good facility offers the residents freedom of choice whenever possible.
Residents should be allowed to choose their roommates.
Residents should be encouraged to be independent as long as possible.
People who feel as though they are in control are not as likely to be depressed as people who feel out of control.
MODULE 7 - The Need for Continuity in LTC
Continuity is an important need for people moving to LTC. This module helps staff see the need for continuity and ways they can help this happen.
People continue to grow and change throughout their lives.
Most older adults are capable of adapting to changes in their environment.
The religious beliefs of older adults can change just like those of younger adults.
Older people living in long-term care facilities continue to use their life experiences to make choices.
People who do not learn from their experiences do not adapt well to new experiences when they are old.
Many older people would rather attend religious activities at the facility where they live than to attend services in the community.
Older people pray, meditate and read scriptures more than they did when they were younger.
Older people tend to be more spiritual than younger people.
Staff should ask residents for advice when appropriate.
Moving into long-term care is a major life change for most residents.
People who were unhappy when they were young are usually unhappy when they are old.
Life in a nursing home offers the residents opportunities for growth and change.
Each resident values his sexual identity (being a man or a woman) as much as they ever did.
Residents often miss attending religious services at their former house of [worship,] church or synagogue.
A person's physical appearance is not a good measure of what that person is really like.
I think that a person can be in poor health and still be happy.
People who have been religious all their lives find religious activities important in old age.
Residents may want to attend religious services to meet friends and sing songs and familiar hymns.
After a religious service, residents may like to have refreshments and talk to their friends.
Staff need to ask residents about their religious beliefs.
Helping people express their religious beliefs should be a part of the care plan.
Most older people want to continue their religious activities when they move to a long-term care facility.
Staff has a responsibility to provide opportunities for people to attend religious services.
Staff can help residents cope with changes in their lives by listening sympathetically to their concerns.
Our lives have meaning that continues after we die.
Staff should reassure residents that their lives have meaning.
The value of a person does not depend on his past.
Staff should tell the residents that they are important.
Staff should help residents find opportunities to do things for others.
I enjoy sharing personal experiences with other people.
Spiritually alert residents can serve others through their attitudes, words and prayers.
Staff work is easier when residents participate in their own care.
Long-term care administrators should consider the spiritual needs of both staff and residents.
MODULE 8 - Resident Rights Issues
This module discusses resident rights issues, such as freedom of religion (to be religious or not to be), freedom to be proactive in their faith in the manner that they choose (including the right to attend services of the denomination of their choice), obligations and limitations of the facility to provide transportation to religious opportunities and problems related to pragmatic limitations.
Most people living in long-term care are able to attend the church or synagogue of their choice.
Residents in nursing homes should have the same rights and responsibilities as people living in the community.
Residents of long-term care facilities have all of their rights as citizens.
People living in long-term care facilities have the right to vote.
In the U.S., Christianity is the official religion.
Each person is free to decide what to believe about God.
People living in long-term care have the right to go to the church or synagogue of their choice.
The U.S. Constitution guarantees freedom of religion.
The Bible guarantees freedom of religion.
Residents in long-term care have the legal right to demand transportation to the church or synagogue of their choice.
People with dementia should be allowed to attend religious services.
If a person is judged to be incompetent, someone must be appointed to act on that person's behalf.
Staff should take dementia patients to religious services even if they seem to object.
It is morally wrong to deny someone the opportunity to attend religious services.
It is wrong to see that someone has violated a resident's rights and not try to restore them.
Staff should not make non-believers attend religious activities.
I think people have the right to die if that is their choice.
Christian Scientists do not believe in medical treatment.
Residents have the right to make decisions about their religious expression.
It is good for residents to attend religious services.
Staff should always ask permission before turning on a TV or radio.
In a long-term care facility, the residents make the rules for their rooms.
Staff and visitors should knock before entering a resident's room even if the door is open.
The resident can make rules about staff behavior in his room.
Staff should respect a person's choice not to eat certain foods.
Staff should tell the resident if they disagree with the resident's religious beliefs.
It is okay for a staff to try to convert a non-believer to their religious faith.
Everyone has a right to their own religious beliefs.
When residents talk about their own religious beliefs, they violate the rights of the staff.
Facilities should find transportation so that residents can attend the church or synagogue of their choice.
Staff should make sure that all residents know about any religious activity or event at the facility.
Staff should welcome volunteers to help residents with religious needs.
Staff should contact the resident's church or synagogue if that person is no longer able to attend services.
- Codes for JOBTITLE
- 4 Academic
6 Acting Administrator
8 Activity Aide
9 Activity Assistant
10 Activity Coordinator
11 Activity Director
12 Activity Fitness
14 Administrative Assistant
19 Admissions Assistant
23 Army Budget
24 Art Historian
26 Assistant Coordinator
27 Assistant Director
29 Bank Clerk
36 Business Development
39 Cancer Biologist
43 Case Manager
46 Certified Nurse
47 Charge Nurse
49 Chemical Engineer
51 Civil Engineer
62 Community Living
63 Community Skills
64 Computer Science
65 Construction Engineer
73 Dietary Aide
74 Dietetic Tech
76 Dining Service
77 Direct Care Supervisor
78 Direct Care Worker
83 Earth Science
90 Executive Director
94 Floor Aide
95 Floor Assistant
96 Floral Arranger
99 Food Service
100 Foreign Service
101 Geriatric Nurse
106 Hotel Manager
107 House Supervisor
108 House Tech
113 Human Resources
114 IBM Operator
123 Line Server
125 LPN Charge Nurse
126 LPN Rehab
127 LPN Student
136 Medicine Aide
139 Mill Work
141 Meeting Planner
143 Music Education
144 Naval Architect
145 Navy, Aerospace
147 Nurse Manager
148 Nurse Supervisor
149 Nursing Assistant
151 Office Coordinator
152 Office Manager
153 Optical Engineer
154 Occupational Therapy
157 Packing House
162 Personal Assistant
163 Pharmacy Assistant
164 Physical Therapy
166 Piano Teacher
167 Postal Clerk
170 Program Manager
171 Project Manager
174 Public Relations
177 RCA and MAT
178 Real Estate
181 Resident Service
183 Restaurant Owner
188 Senior Activities
189 Social Activities
190 Social Worker
191 Staff Development
202 Training Coordinator
204 Unit Manager
205 Van Driver