Development and preliminary validation of a composite Spiritual Care-Giving Scale

Perceptions of spirituality and predictors of competence in spiritual care among nursing students in five middle eastern countries: A cross-sectional survey

BACKGROUND

Spiritual Care is integral to holistic nursing; however, it often remains underprovided due to a lack of education.

OBJECTIVE

This study examined perceptions of spirituality and predictors of competence in spiritual care among nursing students in Middle Eastern countries.

DESIGN

A cross-sectional survey was used.

PARTICIPANT/SETTING

Nursing students (n = 785) from five universities in Middle Eastern countries were included.

METHODS

Participants completed the Spiritual Care-Giving Scale-Arabic and Spiritual Care Competency Scale. Multiple linear regression analysis was used to identify the predictors of perceived competence in spiritual care.

RESULTS

Nursing students showed positive attitudes towards spirituality, with a mean score of 5.1 (SD = 0.60) on the Spiritual Care-Giving Scale-Arabic. However, their perceived competence in providing spiritual care was low to moderate with a mean score of 79.0 (SD = 32.0) on the Spiritual Care Competency Scale. The bivariate analysis indicated significant relationships between students' spiritual care competence and gender, previous exposure to spirituality education, willingness to undergo spirituality training, and total spirituality score. Finally, significant predictors of higher competence included regular admission status, prior spiritual education, willingness to undergo spiritual care training, and higher personal spirituality scores.

CONCLUSION

Nursing students in the Middle East have positive attitudes towards spirituality, but low to moderate competence in providing spiritual care. The influence of personal spirituality on competence underscores the importance of fostering a supportive environment for students to reflect on their beliefs. Comprehensive curriculum revisions and training programs, along with the recognition of the impact of personal spirituality, are essential to prepare future nurses for holistic people's care.

Competence and perceptions of spiritual care among clinical nurses: A multicentre cross-sectional study

AIMS

To identify latent profiles of competence and perceptions of spiritual care among clinical nurses and explore the possible influencing factors.

BACKGROUND

Understanding nurses' level of spiritual care competence and their perceptions and acceptance of such care is important, which could help devise nurse training programmes to address such competence in clinical nurses. However, research addressing interindividual variability in competence and perceptions among Chinese nurses is lacking.

DESIGN

Multicentre cross-sectional study.

METHODS

Nurses working in departments with critically ill patients from 12 community, 5 secondary and 10 tertiary hospitals in Shanghai completed a demographic information questionnaire and the Chinese versions of the Spiritual Care Competence Scale, Spiritual Care-Giving Scale and Spiritual Perspectives Scale. The data were analysed using IBM SPSS v26.0 and Mplus version 8.3. Latent profile analysis identified subgroups with different levels of spiritual care competence.

RESULTS

In total, 1277 Chinese nurses were recruited. Four profiles of competence and perceptions of spiritual care were revealed: Low ability (23.8%), High ability (6.4%), High acceptance (34.9%) and Moderate (34.9%). The level of job position, spiritual care-related education, hospital grade and nurses' perceptions and perspectives of spiritual care predicted the probability of profile memberships in their competence.

CONCLUSIONS

There was heterogeneity in the characteristics of spiritual care competence. Nursing managers can implement individualised interventions, including relevant training, according to the influencing factors of different competence profiles to improve the level of such competence among nurses.

RELEVANCE TO CLINICAL PRACTICE

The results provide a new and expanded view of improving nurses' spiritual care competence. Interprofessional collaboration with clinicians, administrators, educators and spiritual leaders can contribute to the development of related education and training.

REPORTING METHOD

EQUATOR guidelines, STROBE checklist: cross-sectional studies.

PATIENT OR PUBLIC CONTRIBUTION

All participants were clinical nurses. Participants were informed they could withdraw from the study at any time.

Vignettes as a novel research tool in spiritual care: A methods paper

AIMS

To discuss the construction and use of vignettes as a novel approach in spiritual care research and education.

DESIGN

Methods paper.

METHODS

In this methods paper, the authors introduce the use of vignettes in spiritual care research and provide insight into the construction of vignettes. The vignette presented was part of a study of neurosurgical nurses' attitudes and responses to the spiritual needs of neuro-oncology patients. The development process, consisting of four steps, is explained in this paper.

RESULTS

Using a vignette to explore nurses' attitudes towards spiritual care is an innovative way to understand what behaviours nurses consider appropriate in situations where the patient is seeking meaning and connection. Transparent description of the development process is crucial to ensure reproducibility.

CONCLUSION

The use of theoretically constructed and validated vignettes in spiritual care research is new. Vignettes used in surveys have the potential to elicit nurses' responses to patients' search for meaning and connectedness.

IMPLICATIONS

In order to investigate nurses' attitudes and behaviours towards patients' spiritual needs, carefully constructed and validated vignettes are valuable research tools.

IMPACT

Vignettes have proven to be a valuable research tool in the social and health sciences. So far, their use as a survey instrument in spiritual care research has not been investigated. Therefore, this method paper introduces vignettes as a novel approach to spiritual care research. Our findings contribute to the further development of vignettes in nursing science, as there are similarities with case development and simulation training in nursing education.

REPORTING METHOD

Reporting guideline is not applicable.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Nurses' perceptions and competencies about spirituality and spiritual care: A systematic review and meta-analysis

OBJECTIVE

To identify and synthesize nurses' perceptions of spirituality and spiritual care and their spiritual care competencies.

DESIGN

A systematic review and meta-analysis of observational studies.

DATA SOURCES

The electronic databases PubMed, EMBASE, Web of Science, CINAHL, ProQuest, Scopus, CNKI, and WANFANG were systematically searched from the inception of each database to April 19, 2023.

REVIEW METHODS

Two reviewers independently completed the selection of included studies and data extraction. The Agency for Healthcare Research and Quality (AHRQ) checklist was used to assess the methodological quality of the included studies. The study outcomes were meta-analyzed using STATA 15 software. Predefined subgroup analyses were conducted to explore differences in spiritual care competencies among nurses across religious affiliation and education levels.

RESULTS

Thirty-five cross-sectional studies conducted in 11 countries and territories met the inclusion criteria, with 17,786 participants. The meta-analysis revealed that the pooled mean scores for spirituality and spiritual care perceptions and spiritual care competencies were 3.62 (95 % CI: 3.41-3.83) and 3.46 (95 % CI: 3.28-3.63), respectively. Nurses with no religious affiliation had inferior spiritual care competencies (3.24) than nurses with religious affiliation (3.31); nurses with a master's degree or above had the greatest spiritual care competencies (3.59), while nurses with an associate's degree had the least (3.31).

CONCLUSION

Nurses' perceptions and competencies about spirituality and spiritual care were moderate, and both needed to be improved, especially among nurses with no religious affiliation and low education levels. Nursing educators and leaders need to emphasize both theory education in the spiritual dimension and dedication to training in spiritual care practice, as well as provide nurses with targeted teaching and training to improve their competency in addressing the spiritual needs of their patients.

Does the nursing students' perceived level of compassion correlate with affect their perception of spiritual care?

BACKGROUND

It is an important competence for nurses to develop compassion emotions during their education. Studies emphasize compassion as one of the most important components of spiritual care, suggesting that spiritual care begins with compassionate relationships. However, there is no study about the relationship between these two concepts in nursing students.

OBJECTIVE

To determine the level of perceived compassion and perceived spiritual care in nursing students and to reveal the effect of compassion on perceived spiritual care.

DESIGN

Cross-sectional study.

SETTING

The faculty of health sciences of a state university in Turkey.

PARTICIPANTS

Nursing students at the faculty where the study was conducted in the fall academic semester of the 2022-2023 academic year.

METHODS

The population of the study consisted of 1st, 2nd, 3rd, and 4th grade nursing students at the faculty of health sciences of a state university in the fall academic year of the 2022-2023 academic year (N = 720). The study was completed with a total of 440 nursing students. Data were collected online using a sociodemographic information form, the Compassion Scale and the Spiritual Care-Giving Scale between October 10 and November 20, 2022 via Google Forms.

RESULTS

The students scored 98.72 ± 12.16 (high) on the Compassion Scale and 146.47 ± 28.92 (high) on the Spiritual Care Giving Scale. There was a significant positive correlation between their perceived compassion and spiritual care giving mean scores (r = 0.440; p < 0.01). The explanatory power of the regression model was 0.292, suggesting that 29.2 % of the variance of spiritual care-giving can be explained by compassion.

CONCLUSION

The students reported high levels of perceived compassion and perceived spiritual care. Compassion is an important component in the formation of perceived spiritual care in nursing students. Further studies in diverse populations will be useful for the comparisons of relevant results.

Translation and psychometric evaluation of the reflective capacity scale in Iranian medical education

BACKGROUND

Examining the reflective capacity in medical students is a principal step for the development of effective educational strategies to improve it. Reflection scales available in Iran are inadequate due to the lack of focus on students' willingness and tendency to participate in reflection. This study aimed at translation and psychometric evaluation of "Reflective Capacity Scale" in Iranian medical education.

METHODS

This methodological research was completed in two parts: translation and psychometric evaluation. After getting permission from the main developer of the tool, the translation process was done based on Polit and Yang model in Persian language. Then, face validity and content validity of the tool were established using a qualitative method. Construct validity was surveyed with exploratory and confirmatory factor analysis via completing the questionnaire by 320 medical students, who were selected using convenience sampling. The reliability of the tool was also checked with two methods of internal consistency and stability. The gleaned data were analyzed with SPSS20 and AMOS.

RESULTS

"Reflective Capacity Scale" includes 16 items that were retained after cross-cultural translation. Face validity and content validity were acceptable. By performing exploratory factor analysis, four factors were identified that accounted for 63.79% of the total variance. In the confirmatory factor analysis, the values of the fit indices confirmed the appropriate fit of the model. The internal consistency reliability of the whole tool was equal to 0.83 and the intra-class correlation coefficient was equal to 0.98.

CONCLUSION

The translated and validated "Reflective Capacity Scale" provides a robust tool for assessing reflective capacity among Iranian medical students. Its validity and reliability underscore its potential for measuring the reflective capacity of medical students.

Spirituality and Spiritual Care in Nursing: Validity of the Spirituality and Spiritual Care Rating Scale in an Indian Context

This study was undertaken to test the validity of the Spirituality and Spiritual Care Rating Scale (SSCRS) by McSherry et al. (IJNS 39:723-734, 2002) in an Indian context. The study was conducted in a tertiary care teaching hospital with a convenience sample of 200 nurses. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were completed to assess the reliability and validity of the tool. The results of the present study were similar to but differed from the McSherry et al's (IJNS 39:723-734, 2002) study which identified 17 items on the scale. Only 15 items loaded on three factors.

Frequency of nurse-provided spiritual care: An international comparison

AIMS AND OBJECTIVES

To compare the frequency of nurse-provided spiritual care across diverse cultures.

BACKGROUND

Given an ethical imperative to respect patient spirituality and religiosity, nurses are increasingly taught and expected to provide spiritual care. Although nurses report positive attitudes toward spiritual care, they typically self-report providing it infrequently. Evidence about the reported frequency of spiritual care is constrained by substantial variation in its measurement.

DESIGN

This cross-sectional, descriptive study involved secondary analysis of data collected in multiple sites globally using one quantitative instrument.

METHODS

Data were collected from practicing nurses using the Nurse Spiritual Care Therapeutics Scale and analysed using descriptive statistics and a meta-analysis procedure with random-effect modelling. Datasets from 16 studies completed in Indonesia, Iran, Malaysia, Philippines, Portugal, Taiwan, Turkey and the United States contributed to a pooled sample (n = 4062). STROBE guidelines for cross-sectional observational studies were observed.

RESULTS

Spiritual care varied between countries and within countries. It was slightly more frequent within Islamic cultures compared with predominantly Christian cultures. Likewise, frequency of spiritual care differed between nurses in palliative care, predominantly hospital/inpatient settings, and skilled nursing homes. Overall, "Remaining present…" was the most frequent therapeutic, whereas documenting spiritual care and making arrangements for the patient's clergy or a chaplain to visit were among the most infrequent therapeutics.

CONCLUSIONS

In widely varying degrees of frequency, nurses around the world provide care that is cognisant of the spiritual and religious responses to living with health challenges. Future research should be designed to adjust for the multiple factors that may contribute to nurses providing spiritual care.

RELEVANCE TO CLINICAL PRACTICE

Findings offer a benchmark and begin to inform nurse leaders about what may be normative in practice. They also encourage nurses providing direct patient care that they are not alone and inform educators about what instruction future nurses require.

Analysis of the current status of community nurses' spiritual care competencies and the factors: A descriptive cross-sectional analysis

AIM

To examine and analyze the level of spiritual care competency among community nurses.

DESIGN

The study employed a cross-sectional design.

METHODS

From May to July 2022, 442 nurses from community health clinics were chosen as survey respondents using the convenience sample method. The General Information Questionnaire, the version in Chinese of the Nurses' Spiritual Caregiving Awareness Scale and the Chinese version of the Spiritual Caregiving Competence Scale were used in the survey. There were 442 questionnaires distributed, 422 were collected, and the response rate was 95.4%.

RESULTS

The amount of spiritual care competencies of community nurses was positively correlated with the level of spiritual awareness. Simultaneously, their level of education, religious beliefs, marital status and the degree of knowledge of spirituality were all influenced.

Spirituality and Religious Diversity in Nursing: A Scoping Review

Spirituality is a common theme in the field of healthcare research. This study aimed to examine nurses’ perceptions of spirituality in the context of the religious diversity of patients in pluri-religious settings. We performed a scoping review following the methodology on studies conducted between 2010 and 2020. We searched the following databases: CINAHL Plus, PubMed, and PsycINFO. For the identification of grey literature, the OpenGrey database was used. In total, 789 articles were reviewed. Of these, 16 met predetermined inclusion criteria. Two main overarching themes emerged from our inductive analysis: (a) the intertwining of spirituality and spiritual care in diverse religious landscapes and (b) obstacles impeding the inclusion of spiritual care in pluri-religious settings. According to our results, nurses consider that spirituality is interconnected with spiritual care for individuals from different religious backgrounds. Interpretations of spirituality in nursing practice vary widely, with spirituality and religiosity often shaped and influenced by culture and the experience of the professionals. Nurses attribute various meanings to spiritual care, most of which center on respecting personal, interpersonal, and relational aspects of religious and cultural beliefs and practices. Lack of education and specific skills, insufficient time, role ambiguity, and different religious beliefs were identified as hurdles to spiritual care. A poor work environment, a lack of patient privacy, including personal space, and a lack of compassion were also reported as deterrents to spiritual healing. More knowledge and training on different religions and spirituality are required to meet patients’ spiritual needs to better overcome these hurdles.

Spiritual care perceptions and empathy of Chinese nursing students: The mediating roles of spiritual well-being

OBJECTIVE

To investigate spiritual care perceptions, spiritual well-being, and empathy, examine the correlations among spiritual care perceptions, spiritual well-being, and empathy, and explore the mediating role of spiritual well-being between other two variables of Chinese nursing students.

METHODS

A cross-sectional design was implemented, and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist was used to ensure quality reporting of the study. A cluster sample of 2,718 nursing students was selected from 7 universities and colleges in China. The demographic characteristics questionnaire, the Chinese Version of the Spiritual Care-Giving Scale (C-SCGS), the Spiritual Health Scale Short Form (SHS-SF), and the Jefferson Scale of Physician Empathy-Nursing Student (JSPE-NS) were used. Descriptive statistics, correlation, and process plug-in mediation effect analyses were used to analyze the data.

RESULTS

The total score of spiritual care perceptions, spiritual well-being, and empathy were 173.83 ± 25.62, 98.74 ± 12.87, and 105.04 ± 21.34, respectively. Spiritual care perceptions were positively correlated with spiritual well-being (r = 0.617, p < 0.01) and empathy (r = 0.528, p < 0.01). And spiritual well-being played a partial mediating role between the other two variables (accounting for 28.1%).

SIGNIFICANCE OF RESULTS

Spiritual care perceptions, spiritual well-being, and empathy were quite moderate, which need in improving. It is suggested that nursing educators pay attention to the spiritual care education of nursing students, perfect the spiritual care education system, and take targeted measures according to nursing students' individual personality traits and differences, improve their spiritual well-being and empathy in multiple ways, so as to improve their spiritual care perceptions and competence.

The Relationship Between Nursing Students' Perceptions of Spirituality and Spiritual Care and their Personal Values

This study involved a descriptive and correlational study to determine how nursing students at one university in Turkey perceive spiritual care. The data were collected through a personal information form, the Spiritual Care-Giving Scale and the Portrait Values Questionnaire. The data were analyzed using Pearson's Correlation Analysis and hierarchical regression analysis. There was a correlation between perceptions of personal values and spiritual care. It was observed that the values that predicted perception of spiritual care were the values of hedonism and tradition. Therefore, it is recommended to plan value-based training, especially on subjective concepts such as spiritual care and plan simulation-based training where students can measure the results of their behaviors and reactions in given scenarios.

Competencies of nursing students in the provision of spiritual care and the factors affecting spiritual caregiving

PURPOSE

Nursing care is a holistic practice that contains biological, psychological, sociological, and spiritual elements. Spiritual care is also one of the core aspects of a holistic care approach, The provision of optimal spiritual care requires a good understanding of the issue by nurses. The present study determines the competencies of nursing students in spiritual care and the status of spiritual caregiving.

DESIGN AND METHODS

The study has a descriptive, cross-sectional, and qualitative research method of answers to follow-up questions. The study was conducted with 468 nursing students who are 1-4 years in a BSN program in Turkey. Personal information form, semi-structured interview form, Spiritual Caregiving Scale, and Spiritual Care Competence Scale were used for the collection of data.

FINDINGS

The average scores recorded by the participants in the Spiritual Caregiving and Spiritual Care Competence Scales were 145.60 ± 20.63 (the perception of spirituality and spiritual care is moderate-high) and 102.92 ± 15.67 (the competence of the nurse in spiritual care is moderate-high), respectively. It was found that nearly half of the respondent students had never heard of the concept of spiritual care, nor did they have any knowledge of such care, and almost none had undergone training in this subject.

PRACTICE IMPLICATIONS

Important to add spiritual care to the nursing curriculum as a separate course or subject, and to raise awareness of students through applied teaching methods.

Correlations among spiritual care competence, spiritual care perceptions and spiritual health of Chinese nurses: A cross-sectional correlational study

BACKGROUND

The significance of spiritual care competence among nurses has been emphasized across countries and cultures in many studies. However, there were few studies on correlations among spiritual care competence, spiritual care perceptions, and spiritual health of nurses in China.

OBJECTIVE

To investigate spiritual care competence, spiritual care perceptions, and spiritual health, and examine the correlations among spiritual care competence, spiritual care perceptions and spiritual health, and the mediating role of spiritual health between other two variables of Chinese nurses.

METHODS

A cross-sectional and correlational design was implemented, and the STROBE Checklist was used to report the study. A convenience sample of 2,181 nurses were selected from 17 hospitals in 3 provinces, China. Participants provided data on sociodemographic by completing the Chinese Version of the Spiritual Care Competence Scale, the Chinese Version of the Spiritual Care-Giving Scale, and the Spiritual Health Scale Short Form. Descriptive statistics, univariate, multiple linear regression, and Pearson correlation analysis were used to analyze data.

RESULTS

The total scores of spiritual care competence, spiritual care perceptions, and spiritual health were 58.25 ± 16.21, 144.49 ± 16.87, and 84.88 ± 10.57, respectively, which both were moderate. Spiritual care competence was positively correlated with spiritual care perceptions (r = 0.653, p < 0.01) and spiritual health (r = 0.587, p < 0.01). And spiritual health played a mediating role between the other two variables (accounting for 35.6%).

SIGNIFICANCE OF RESULTS

The spiritual care competence, spiritual care perceptions, and spiritual health of Chinese nurses need to be improved. It is recommended that nursing managers should pay attention to spiritual care education of nurses, and improve spiritual care perceptions and spiritual health in multiple ways, so as to improve their spiritual care competence and to maximize the satisfy spiritual care needs of patients in China.

Validity and reliability of the spiritual care competency scale for oncology nurses in Taiwan

Background

Nurses must have spiritual competence to provide holistic patient care. Therefore, the designed instrument to assess nurses’ competence could be a practical guide for health care professionals. This study aimed to evaluate the validity and reliability of the spiritual care competency scale (SCCS) for oncology nurses in Taiwan.

Methods

This study used a convenience sample from a regional teaching hospital in Taiwan from November 2017 to February 2019, who were asked to complete the SCCS. We employed scale-content validity index (S-CVI). Exploratory Factor Analysis (EFA) was also used to evaluate the structural factor of SCCS. Confirmatory Factor Analysis (CFA) verified the construct validity of SCCS scale for oncology nurses in Taiwan. Test–retest reliability were also measured in this study at 2-week interval.

Results

The average S-CVI of SCCS was 0.96. The EFA produced four factors of 27 items, such as professionalization, improving the quality of spiritual care, personal support, patient counseling and referral, attitude towards patient spirituality and communication, assessment, implementation providing and evaluation of spiritual care. Fitting the 27 items yielded an acceptable model fit; X²/df = 2.41, RMSEA = 0.08, GFI = 0.80, AGFI = 0.80, CFI = 0.92, IFI = 0.92, NFI = 0.90, RFI = 0.90, TLI = 0.91, SRMR = 0.06. Cronbach’s alpha values were between 0.93 and 0.95, and the total Cronbach’s alpha was 0.96. The intraclass correlation coefficient (ICC) scores were between 0.43 and 0.88.

Conclusions

The result of this study demonstrated satisfactory validity and reliability for the SCCS in the nursing field in Taiwan. Implications for practice in this study serves as a reference for effectively evaluating nursing competency in spiritual care.

Nursing students' spiritual caregiving status: Comparison of Western and Central Anatolia regions of Turkey

PURPOSE

The aim of this study was to determine the status of spiritual caregiving education in nursing students belonging to two different state universities in Turkey.

DESIGN AND METHODS

The descriptive, cross-sectional study was completed with 326 students.

FINDINGS

Turkey's western regions in mean scale scores of students (147.27 ± 19.40) in central Anatolia (140.83 ± 18.82) was higher than the students and the difference was statistically significant. A statistically significant difference was found between the total score averages of the Spiritual Caregiving Scale and their year of study, self-perception of spirituality, and relating their profession to spirituality (p < 0.05).

PRACTICE IMPLICATIONS

It is recommended to include spiritual care issues and principles in the nursing education curriculum.

Spiritual care, compassion and associated factors of midwives working in delivery rooms

AIM

This study aimed to determine the level of spiritual care and compassion among midwives working in delivery rooms and associated factors.

METHODS

A descriptive design was utilized to collect data using self-report questionnaires from 181 midwives working in delivery rooms in Turkey. Data were collected between 1 February 2020 and 20 March 2020.

RESULTS

The mean Spiritual Care-Giving Scale (SCGS) (min: 25- max: 175) and Compassion Scale (CS) (min: 24- max: 120) scores were 147.88 ± 17.84 and 96.37 ± 12.84. It was determined that there was a significant difference between the SCGS and CS scores of the midwives based on age, working year, work schedule, job satisfaction and traumatic birth experiences. Furthermore, there were positive correlations between scores on certain SCGS and CS subdimensions.

CONCLUSION

Midwifery is a continuously evolving profession based on helping others. However, long working hours and their exposure to traumatic birth events negatively affect both spiritual caregiving and compassion levels of midwives. Working conditions of midwives need to improve and this would contribute to the quality of maternal healthcare. Also, studies should be conducted in different contexts, societies and cultures to identify barriers to compassionate and spiritual care during childbirth.

Research progress in the definition, assessment tools, and practice of spiritual care

To promote the development of nursing spiritual care and humanistic care, this article introduces the current status of the definition, assessment tools, and practice of spiritual care at home and abroad.

Spiritual Care Perceptions of Baccalaureate Nursing Students

Purpose: The purpose of this study was to examine baccalaureate nursing (BSN) students' perception of spirituality and spiritual care as a component of holistic nursing practice. Aim: The specific aim of this study was to determine the perception levels of spiritual care, religiosity, and spirituality in first- and last-semester BSN students. Method: This descriptive cross-sectional study used a convenience sample of BSN students. Participants (n = 150) completed demographics with self-reflected levels of religiosity and spirituality, the Spiritual Care-Giving Scale (SCGS), and the Spirituality and Spiritual Care Rating Scale (SSCRS). Findings: First-semester and last-semester BSN students were predominately single, female, Caucasian, and Christian. First-semester BSN students completed the SCGS and SSCRS upon entrance and exit in the first semester of the nursing program with no significant differences found. However, the last-semester BSN students scored significantly higher than the first-semester BSN students on the SCGS and the SSCRS. Conclusion: Over the course of the nursing program, the last-semester BSN students gained insight into spiritual care placing a higher emphasis on spirituality and less on religiosity. This supports the threading of spiritual nursing care throughout the nursing curriculum. Further study validation is needed.

Barriers to the Provision of Spiritual Care by Nurses for Hospitalized Patients in Jordan

BACKGROUND AND PURPOSE

Spiritual care is an essential part of holistic patient care but is provided infrequently in practice. There is a paucity of research investigating the barriers to the provision of spiritual care among Jordanian nurses. The main purpose of this cross-sectional, correlational study was to identify these barriers and to explore the associations with nurses' personal and professional characteristics. A secondary purpose was to examine the psychometric properties of a newlydeveloped spiritual care barriers instrument.

METHODS

We surveyed a convenience sample of Jordanian nurses (N = 282). Participants completed both the Spiritual Well-Being Scale (SWBS) and the Spiritual Care Barriers Scale (SCBS). We conducted an exploratory factor analysis to examine the internal structure of the SCBS, and internal consistency was assessed by Cronbach's alpha.

RESULTS

The most common perceived barriers were lack of private places (82.3%), absence of an imam (79.8%), insufficient time (78.8%), inadequate skills and competencies (73.7%), lack ofreligious and spiritual facilities and resources in the hospital (71.3%), and insufficient knowledge (71.3%). Nurses' personal spiritual and existential well-being were negatively associated with spiritual care barriers. Head nurses and supervisors reported lower mean scores on perceived barriers than did associate nurses. The SCBS exhibited acceptable evidence of internal consistency and validity.

IMPLICATIONS FOR PRACTICE

The findings help Jordanian nurse decision makers in practice and education to overcome barriers to the provision of spiritual care to better meet the spiritual needs of Muslim patients.

How Nurses Understand Spirituality and Spiritual Care: A Critical Synthesis

Aims: To discover how nurses understand spirituality and spiritual care and what affects nurses' understanding of these terms. Method: A literature search was conducted in CINAHL Plus, MEDLINE, and Google Scholar for research articles dated between 2010 and 2018 that were published in English. Using the Critical Appraisal Skills Program checklist for systematic reviews, nine articles met the inclusion criteria for this review. Most of these articles reported quantitative studies. Results: Although nurses recognize the importance of spirituality and spiritual care in nursing and have ascribed a diversity of meanings, there remains some confusion about what these terms mean. Several influences have been identified as shaping nurses understanding of spirituality and spiritual care, including education, nurses' own spirituality or religious beliefs, age, years of clinical experience, and place of employment. Conclusions: This review identifies the need for further studies using qualitative approaches to investigate how nurses' construct their understanding of spirituality and spiritual care and the dominant discourses nurses draw from to inform their understanding using qualitative approaches. Relevance to Clinical Practice: The insights gained by this review may be of value to nurse educators, managers, and policy makers in nursing education and the development of policies and practice guidelines.

Psychometric properties of the Chinese mainland version of the Palliative Care Spiritual Care Competency Scale (PCSCCS-M) in nursing: a cross-sectional study

BACKGROUND

Spiritual care competencies are among the primary professional skills that enable best practices in nursing. Assessing these competencies and identifying those that are insufficient are important tasks. The traditional Chinese version of the Palliative Care Spiritual Care Competency Scale (PCSCCS) used in Taiwan is a well-validated tool to measure palliative caregivers' competencies in providing spiritual care. However, whether this scale is valid and reliable for use with nurses in other health-care contexts is unknown. The purpose of this study is to determine this version's validity and reliability for use with nurses in mainland China.

METHODS

The PCSCCS was first converted into a simplified Chinese version (PCSCCS-M) from the traditional Chinese version used in Taiwan such that mainland nurses could read and understand it easily. Then, the validity and reliability of the PCSCCS-M was evaluated with 400 Chinese nurses recruited using convenience sampling from three university-affiliated comprehensive hospitals, two cancer hospitals, one psychiatric hospital, two traditional Chinese medicine hospitals, one marital and child service care center, and one community health service center. Concurrent validity was assessed using Pearson's correlation coefficients of the PCSCCS-M and the Chinese version of the Spiritual Care-Giving Scale (C-SCGS). Exploratory factor analysis (EFA) was performed to determine the construct validity. Confirmatory factor analysis (CFA) was conducted using another sample of 351 nurses to verify the quality of the factor structures of the PCSCCS-M. An internal consistency test based on Cronbach's alpha coefficient and a stability test based on the Guttman split-half coefficient were also conducted.

RESULTS

Useful data were obtained from 356 participants (response rate: 89%). EFA confirmed a three-dimensional structure of the scale after one item was deleted, and the three factors explained 63.839% of the total variance. Cronbach's alpha coefficients of the three subscales were 0.811, 0.889 and 0.896, and the Guttman split-half coefficient for the PCSCCS-M was 0.862. Modified CFA indicated a well-fitting model. The correlation between the PCSCCS-M and C-SCGS was 0.340 (p < 0.01).

CONCLUSIONS

The PCSCCS-M is a brief, easy-to-understand, and psychometrically sound measurement tool to evaluate spiritual care competencies in nurses from mainland China.

Psychometric properties of the Chinese version of the spiritual care-giving scale (C-SCGS) in nursing practice

Background

Spiritual care is defined as recognizing and responding to the needs of the human spirit when the individual is facing trauma, illness, or sadness. Providing spiritual care is one of the core aspects of holistic care, as it is significantly associated with patients’ quality of life. The provision of optimal spiritual care requires good understanding by the nurses. Therefore, it is important to assess this understanding by using a proven, well-validated instrument. The Spiritual Care-Giving Scale (SCGS) is designed to measure nurses’ perceptions of spirituality and spiritual care in Singapore. However, it is unknown whether this scale is valid and reliable for use with nurses in the context of Chinese culture. The purpose of this study is to determine this version’s validity and reliability for use with nurses in China.

Methods

In this quantitative, descriptive, cross-sectional study, after translating the English version of the SCGS into Chinese and making adjustments for culture and values, we assessed the performance of this instrument by administering the C-SCGS to a convenience sample of 400 nurses. The participants also completed the Chinese version of the Spiritual Care Competency Scale (C-SCCS) to assess the concurrent validity of the C-SCGS. The internal consistency and homogeneity of the C-SCGS were also tested, and a factorial analysis was performed.

Results

Completed questionnaires were obtained from 355 participants (response rate: 88.75%). Four factors were confirmed by an exploratory factor analysis (EFA) using Promax with the Kaiser normalization rotation method after the 35-item SCGS was reduced to 34 items, and these factors explained 53.116% of the total variance. The adjusted item–total correlation ranged from 0.527 to 0.760. The Cronbach’s alpha of the factors ranged from 0.836 to 0.941, and the Guttman split-half coefficient was between 0.759 and 0.902. The concurrent validity of the C-SCGS and C-SCCS (r = 0.534, p < 0.01) showed a significant correlation. Nurses’ education showed a significant association with the scores of the C-SCGS.

Conclusion

The C-SCGS was found to be a psychometrically sound measurement to evaluate Chinese-speaking nurses’ perceptions of spirituality and spiritual care.

Electronic supplementary material

The online version of this article (10.1186/s12874-019-0662-7) contains supplementary material, which is available to authorized users.

“Enablement”—Spirituality Engagement in Pre-Registration Nurse Education and Practice: A Grounded Theory Investigation

Historically, spirituality in nursing was considered a fundamental dimension, contributing to patients’ wellbeing. Accordingly, nurses are expected to attend to the spiritual needs of patients as a part of holistic nursing care, and pre-registration nurse education (that is undergraduate nurse education) has a responsibility to equip them to fulfil this aspect of their role. However, the content of spirituality in nurse education programmes lack structure and consistency, hence further investigation into the value of such education and its transferability in clinical practice is needed. Data collection was by individual interviews with 13 pre-registration participants undertaking adult nursing between March 2012 and May 2014. Each interview was digitally recorded and transcribed verbatim. Through theoretical sampling, data collection and analysis occurred in a cyclical manner until theoretical saturation/sufficiency was reached. The participants’ main concerns were: explaining spirituality, remembering spirituality education and content, and uncertainties about facilitating patients’ spiritual needs; these combine to form ‘having sufficient spirituality education to facilitate patients’ spiritual needs’. The substantive theory of ‘Enablement’ (make possible) was constructed to explain how the participants resolved their main concern. This investigation reveals how the participants acquire and translate spirituality education to practice, so realising holistic care.

Nurses' perspective on spiritual leadership: A qualitative study based on Fry's spiritual leadership model

Background

Spiritual leadership and spirituality in organizations have the capacity to develop individual and organizational outcomes. This concept, as a newly established paradigm, has many ambiguities and definitions highly affected by cultural contexts.

Objective

This study aimed at determining the concept of spiritual leadership from nurses’ perspective and recognizing aspects of spiritual leadership model in the Iranian nurses’ sociocultural context, to achieve a common and comprehensive understanding of the concept under study.

Methods

This qualitative study used a directed content analysis method. The participants of this study were 14 managers and nurses employed at different wards of hospitals affiliated to medical universities of Tehran, and were selected using purposive sampling method on the basis of inclusion criteria. The data were collected via individual, deep, and semi-structured interviews from October 2015 to March 2016.

Results

In this study, 14 participants were interviewed, 11 females and three males aged between 26 and 52 years old with a mean working experience of 13 years. After data analysis, 33 subcategories were distilled which fell into nine categories and three main categories including “spiritual leadership”, “spiritual well-being”, and “organizational consequences”. The findings indicated that spiritual leadership can, through application of intrinsic motivation, help develop individual and organizational outcomes by the use of elements of extrinsic motivation in organizational learning.

Conclusion

Nursing managers and nurses expunged upon various dimensions of spiritual leadership. The elements of extrinsic motivation and organizational learning have the potential to develop spiritual leadership. The nursing leaders can use this potential to foster the outcomes of nursing services.

Reliability and Validity of the Spiritual Care-Giving Scale in a Turkish Population

This study aimed to adapt an English version of the survey tool Spiritual Care-Giving Scale for Turkish students and to evaluate its psychometric properties. Spiritual care is a central element of holistic nursing, but is not often made explicit in the theoretical and practical components of preregistration nursing programs. A composite scale will assist in identifying students' perceptions and issues to be addressed in curricula and practice settings in Turkey. The scale was composed of 35 items and five subscales. Cronbach's α reliability coefficient was .96, and item-total point correlations were between .37 and .77. In addition, split-half reliability coefficient was .88. The Spiritual Care-Giving Scale was found to be a valid and reliable instrument for measuring the multifaceted perspectives of spirituality and spiritual care in practice by students. Further testing of this scale is required with other student populations and clinicians.

Spirituality and spiritual care perspectives among baccalaureate nursing students in Saudi Arabia: A cross-sectional study

BACKGROUND

No study has been undertaken to understand how spirituality and spiritual care is perceived and implemented by Saudi nursing students undergoing training for their future professional roles as nurses.

OBJECTIVES

This study was conducted to investigate the perception of Baccalaureate nursing students toward spirituality and spiritual care.

DESIGN

A descriptive, cross-sectional design was employed.

SETTINGS AND PARTICIPANTS

A convenience sample of 338 baccalaureate nursing students in two government-run universities in Saudi Arabia was included in this study.

METHODS

A self-administered questionnaire, consisting of a demographic and spiritual care background information sheet and the Spiritual Care-Giving Scale Arabic version (SCGS-A), was used for data collection. A multivariate multiple regression analysis and multiple linear regression analyses were performed accordingly.

RESULTS

The mean value on the SCGS-A was 3.84±1.26. Spiritual perspective received the highest mean (4.14±1.45), followed by attribute for spiritual care (3.96±1.48), spiritual care attitude (3.81±1.47), defining spiritual care (3.71±1.51) and spiritual care values (3.57±1.47). Gender, academic level and learning spiritual care from classroom or clinical discussions showed a statistically significant multivariate effect on the five factors of SCGS-A.

CONCLUSIONS

Efforts should be done to formally integrate holistic concept including all the facets of spirituality and spiritual care in the nursing curriculum. The current findings can be used to inform the development and testing of holistic nursing conceptual framework in nursing education in Saudi Arabia and other Arab Muslim countries.

A critical analysis of scales to measure the attitude of nurses toward spiritual care and the frequency of spiritual nursing care activities

Quantitative studies have assessed nurses' attitudes toward and frequency of spiritual care [SC] and which factors are of influence on this attitude and frequency. However, we had doubts about the construct validity of the scales used in these studies. Our objective was to evaluate scales measuring nursing SC. Articles about the development and psychometric evaluation of SC scales have been identified, using, Web of Science, and CINAHL, and evaluated with respect to the psychometric properties and item content of the scales. Item content was evaluated by each of the five authors with respect to the following questions: Does the item (1) reflect a general opinion about SC instead of a personal willingness to offer SC; (2) reflect general psychosocial care instead of specific SC; (3) focus solely on religious care; (4) contain the words 'spiritual' (care/needs/health/strengths, etc.); and (5) contain multiple propositions, or have an unclear meaning? We found eight scales. Psychometric analysis of these scales was often meager and the items of all but one scale suffered from two or more of the five problems described above. This leads us to conclude that many quantitative results in this area are based on findings with questionable scales. Suggestions for improvements are provided.

Development of the Arabic Spiritual Care Intervention-Provision Scale

AIMS AND OBJECTIVES

This study develops a new instrument, the Spiritual Care Intervention-Provision Scale, and assesses its psychometric properties in an Arab Muslim nurse sample. The Spiritual Care Intervention-Provision Scale was developed to measure the frequency with which nurses provided aspects of spiritual care.

BACKGROUND

Most of the available spiritual care instruments were developed in the West and reflect a predominantly Christian tradition. A review of the literature on spiritual care in nursing revealed that no instrument exists for measuring spiritual care interventions provided by nurses to Arab Muslim patients.

DESIGN

A cross-sectional descriptive and correlational design.

METHODS

Following an extensive literature search, review by an expert panel and a pilot study which included patients' views regarding aspects of spiritual care provided by nurses, the final version of the Spiritual Care Intervention-Provision Scale was tested in a convenience sample of 360 Jordanian Arab Muslim nurses. Correlational and factor analysis were used.

RESULTS

The internal consistency of the Spiritual Care Intervention-Provision Scale was high, with α coefficient of 0·85. The exploratory factor analysis supported a two-factor structure for the Spiritual Care Intervention-Provision Scale as hypothesised. A significant positive correlation between the Spiritual Care Intervention-Provision Scale and religiosity was in the expected direction though small in magnitude.

CONCLUSIONS

This study initiates the development of an instrument for the provision of spiritual care intervention by nurses that balances the religious and existential dimensions of spirituality. The Spiritual Care Intervention-Provision Scale exhibited acceptable evidence of internal consistency and validity among Jordanian Arab Muslim nurses. Further work was suggested to firmly establish all aspects of this new scale.

RELEVANCE TO CLINICAL PRACTICE

This culturally specific instrument contributes to the evaluation of the provision of spiritual care by Jordanian Muslim nurses to their patients, to guide them in providing a comprehensive and appropriate spiritual care interventions and to examine the effect of spiritual care on various aspects of patient's quality of life.

Psychometric Properties of the Spiritual Care-Giving Scale-Arabic Version in Saudi Nursing Students

AIM

To evaluate the psychometric properties of an Arabic version of the Spiritual Care-Giving Scale (SCGS) in a sample of Saudi nursing students.

METHOD

A convenience sample of 202 Saudi nursing students was included in this descriptive cross-sectional study. The 35-item Arabic version of the SCGS (SCGS-A) was tested for internal consistency, stability reliability, content validity, and construct validity.

FINDINGS

The SCGS-A manifested acceptable internal consistency and stability reliability with computed Cronbach's alpha ranges from .84 to .94, and an intraclass correlation coefficient of .97. The item-level content validity index ranged from .83 to 1, and the scale-level content validity index (average) was .98. The principal component analysis revealed five dominant components with eigenvalues greater than 1, and a cumulative contribution rate of 62.0%. The five factors were moderately to strongly correlated ( r = .29-.56; p < .001) with each other and with the overall SCGS-A score ( r = .57-.77; p < .001).

CONCLUSION

The SCGS-A manifested an acceptable reliability and validity in Saudi nursing students, which supports its sound psychometric properties. With the establishment of this valid and reliable tool, timely and accurate assessment of student nurses' perceptions about spirituality and spiritual care can be facilitated.

Spiritual development in Iranian nurses

BACKGROUND

Spiritual development is one of the most important aspects of socialization that has attracted the attention of researchers. It is needed to train nursing student and novice nurses to provide high-quality care for patients. There is ambiguity in the definition of spiritual development and its relations, especially in the eastern countries.

RESEARCH OBJECTIVES

To explore the concept of spiritual development in Iranian nurses.

RESEARCH DESIGN

Qualitative content analysis approach. Data were gathered from semi-structured interviews. Participants and research context: The participants were 17 Iranian Muslim nurses selected using a purposeful sampling. The place of interviews was on their choice. Ethical considerations: Based on the principles of the Helsinki declaration, the focus was on preserving the participants' autonomy, confidentiality, and anonymity. The participants were told the study purposes and trends, and their rights were emphasized; they were then asked to sign written consent forms. Formal research approval was obtained from Kerman University of Medical Sciences. Ethical approval was granted by the University Ethics Committee before the study was conducted (K/92 etc).

FINDINGS

Three themes for spiritual development were defined: obligation to religion, commitment to ethics, and commitment to law. From the results, factors such as connection to the limitless divine power, personal and society-oriented ethical codes, and commitment to the law are proposed.

DISCUSSION

There are some differences between these findings and previous study, especially in the relation of the spirituality, religion, and law. Some studies, mostly Iranian, support these findings partially.

CONCLUSION

The results suggest that it is better to teach nursing education based on humanistic principles, ethics, and law to the new generation of nurses to improve community health and development. More studies are needed to examine the relation between these themes.

Nurses' Perceptions of Spirituality and Spiritual Care Giving: A Comparison Study Among All Health Care Sectors in Jordan

AIMS

This study aimed to describe nurses' perceptions of spirituality and spiritual care in Jordan, and to investigate the relationship between their perceptions and their demographic variables.

METHODS

The study used a cross-sectional descriptive design and recruited a convenience sample of 408 Jordanian registered nurses to complete the spiritual care giving scale.

RESULTS

The findings of the study demonstrated that most of the participating nurses had a high level of spirituality and spiritual care perception. Significant differences were found between male and female nurses' perceptions of spirituality and spiritual care (P < 0.05); previous attendance of courses on spiritual care also made a significant difference to perceptions (P < 0.05).

CONCLUSIONS

The research findings suggest that, Jordanian nurses' gender made a difference in their perceptions of spirituality and spiritual care. They had satisfactory levels of perception of spirituality and spiritual care. Moreover, spiritual care courses appeared to have a positive impact on their perception of spirituality and spiritual care. Enhancing nursing care by integrating standardized spiritual care into the current nursing care, training, and education should also be emphasized.

Spirituality in pre-registration nurse education and practice: A review of the literature

Spirituality is known to be an integral part of holistic care, yet research shows that it is not well valued or represented in nurse education and practice. However, the nursing profession continues to make efforts to redress the balance by issuing statements and guidance for the inclusion of spirituality by nurses in their practice. A systematic literature review was undertaken and confirms that nurses are aware of their lack of knowledge, understanding and skills in the area of spirituality and spiritual care, and desire to be better informed and skilled in this area. Consequently, in order for nurses to support the spiritual dimension of their role, nurse education has a vital part to play in raising spiritual awareness and facilitating competence and confidence in this domain. The literature review also reveals that studies involving pre-registration are few, but those available do provide examples of innovation and various teaching methods to deliver this topic in nursing curricular.

Psychometric evaluation of the Nurse Spiritual Care Therapeutics Scale

To measure nurse-provided spiritual care, robust instrumentation is needed. This study psychometrically evaluated an instrument that operationalizes frequency of nurse-provided spiritual care, the Nurse Spiritual Care Therapeutics Scale (NSCTS). The 17-item NSCTS, with an established content validity index of 0.88, was administered online to registered nurses (RNs) in four hospitals. Responses from 554 RNs (24% response rate), most who identified as Christian, provided evidence for the NSCTS' reliability and validity. Internal reliability was supported by an alpha coefficient of .93. Validity was evidenced by item-total correlations ranging from .40 to .80, low to modest direct correlations between the NSCTS and Daily Spiritual Experience Scale and Duke University Religiosity Index, and strong loadings between 0.41 and 0.84 on one factor (explaining 49.5% of the variance) during exploratory factor analysis.

Student nurses' perspectives of spirituality and spiritual care

AIM

To investigate nursing students' perceptions of spirituality and spiritual care.

BACKGROUND

Spirituality is an essential part of holistic care but often neglected in practice. Barriers to spiritual care include limited educational preparation, negative attitudes towards spirituality, confusion about nurses' role, perceptions of incompetence and avoidance of spiritual matters. There is limited knowledge about students' perspectives of spirituality and spiritual care. Previous studies have predominantly focused on educational approaches to enhance spirituality. The next generation of clinicians may have different worldviews, cultural beliefs and values about spirituality and spiritual care from current nurses. There is a need to understand students' views and how their spiritual development is shaped in order to inform pre-registration education.

METHOD

A cross-sectional survey of final-year students from three educational institutions in Singapore was conducted from April to August 2010. Data included demographic details and responses on a new composite tool, the Spiritual Care Giving Scale (SCGS).

RESULTS

A response rate of 61.9% (n=745 out of 1204) was achieved. The lowest mean score was item 9, "Without spirituality, a person is not considered whole". Highest mean was item 2, "Spirituality is an important aspect of human being". Factor 5 (Spiritual Care Values) had the lowest mean with Factor 2 (Spirituality Perspectives) the highest. Participants considered spirituality as essential to being human; developmental in nature; and vital for individuals' state of well-being. Attributes important for spiritual care were identified. Multivariate analyses showed positive association between participants' scores and institution but not with other variables.

CONCLUSION

Participating student nurses reported a high level of spiritual awareness that was not constrained by age. Students affirmed the importance of spiritual awareness in order to address the spiritual needs of patients. There was some congruence between the perceptions of students in this ethno-culturally diverse Asian sample and responses by students in the UK and North America on the personal attributes needed to provide spiritual care. Comparative studies using the SCGS could inform our understanding of spirituality and best pedagogical approaches to develop spiritual awareness across the curricula and in clinical practice.