Introduction Spiritual Care is an abstract concept relating to the art of nursing and is often neglected or infrequently provided even though it is an essential component of palliative care. It is becoming increasingly common to live and die in nursing homes with spiritual needs being one of the most important dimensions of an older adults’ health.

Aims The purpose of this discussion paper is to explore the facilitators and barriers to delivering spiritual care, providing suggestions as to how spiritual needs can be addressed as part of end of life care practice within nursing homes.

Methods A literature search was carried out using Medline (ProQuest), Science Direct and EBSCOhost databases with the following keywords for filtering: spiritual care, spirituality, spiritual/existential distress, spiritual needs, spiritual transcendence, end-of-life care, palliative care, nursing homes, older adults and aged care. Peer reviewed articles which met the inclusion criteria were manually reviewed using a critical appraisal skills programme tool for relevance. Common themes were drawn from the literature.

Results Spiritual care was most commonly described as the act of being with, or in the presence of the older adult. Barriers identified to providing spiritual care were high workload, lack of resources and time including funding, lack of privacy and staff continuity, task orientated so missing the opportunities to meet spiritual needs, lack of confidence/competence in delivering spiritual care, complexities in assessing and documenting spirituality/spiritual distress, and lack of training. Facilitators to providing spiritual care were effective staff-patient communication, multi-disciplinary teamwork and collaboration, having clear definitions of spirituality, self-awareness of spirituality, and a willingness to provide spirituality as part of advanced care planning. There are available tools such as HOPE and FICA that can be used to assess spirituality.

Conclusions The literature reviewed has demonstrated the importance of spiritual care in improving patient outcomes at the end of life, enhancing quality of life and is an essential component to delivering good quality palliative care. However, further research is needed specifically within nursing homes to address if the spiritual needs of people are being assessed as part of palliative care practice and how some of the challenges identified can be overcome.

Impact Compassion is a fundamental nursing principle vital for effective spiritual care provision. Through compassion, nurses are enabled and motivated to observe and alleviate spiritual distress and engage with residents. Despite several studies suggesting a lack of understanding and competence, reports of a willingness to provide such care exist. Therefore, there is a need for focused training both on an individual level and in clinical practice to improve spiritual care.