How undergraduate nursing students learn to care for patients spiritually in clinical studies--a review of literature

Strengths and challenges with spiritual care: Student feedback from the EPICC Spiritual Care Self-Assessment Tool

AIM

To explore qualitative data from students' self-reported competencies in spiritual care gathered during testing of a student self-assessment tool based on the EPICC Spiritual Care Education Standard.

DESIGN

Reflexive thematic analysis of qualitative data from a multinational study on validating a new self-assessment tool.

METHODS

The EPICC Spiritual Care Education Standard for competency in spiritual care was developed to enhance nurses' and midwives' ability to provide spiritual care by creating a baccalaureate education standard for spiritual care competencies. Spiritual care researchers then developed a self-assessment tool to raise student awareness of spirituality and track personal and professional growth in spiritual care competency. The EPICC Spiritual Care Competency Self-Assessment Tool, tested at eight universities in five countries, provided many opportunities for student comments, resulting in rich qualitative data presented here.

RESULTS

Themes related to strengths, weaknesses and areas for improvement. Identified strengths were similar across countries: caring attitudes, general knowledge of caring and compassion and good communication skills. Weaknesses/challenges touched on spirituality as overlooked in some cultures but part of life for others, complex questions were hard to understand, and self-assessment tools are common for some and rare for others. Areas for improvement included need for knowledge of religious and other deeply held beliefs and for greater spiritual assessment skills. Similarities across countries related to basic training in communication and compassionate care for nurses globally. Differences lay in the challenges and/or barriers for spiritual care and may relate to cultures within countries and/or university test sites.

RELEVANCE TO CLINICAL PRACTICE

The Tool raises awareness of spirituality among students and working nurses, providing an accessible way to self-check personal and professional growth in spiritual care competencies, which increases student and nurse capacity to become more knowledgeable and skilled in facilitating spiritual care, thus be role models for students at the intersection of spirituality and health.

Pharmacy students' attitudes and beliefs about spirituality and spiritual care in professional education in Zimbabwe

INTRODUCTION

A majority of Zimbabweans are religious and/or spiritual. Spirituality and spiritual care (SC) are important parts of patient care. The study's objective was to investigate pharmacy students' attitudes/beliefs about spirituality and SC in pharmacy education and practice in Zimbabwe.

METHODS

This cross-sectional descriptive nationwide study gathered data from pharmacy students at the University of Zimbabwe (UZ) and Harare Institute of Technology. The 38-item survey measured students' spirituality and SC perspectives and their religious and demographic characteristics.

RESULTS

Most respondents were Christian (89%), female (54%), and attended the UZ (63%). Slightly over half agreed/strongly agreed that they "would like to undertake coursework that will make them competent in providing SC to patients" (52%), SC education would improve their clinical performance (51%), and education that promotes spiritual well-being or integration will make them more empathetic and compassionate practitioners (63%). Pharmacy students also believed that more education on spirituality should be given to pharmacy students (48%), SC is an important part of pharmacy practice (74%), "discussing patients' spiritual or religious beliefs can improve the pharmacist-patient relationship" (74%), and anticipated to incorporate spirituality into professional practice upon graduation (50%).

CONCLUSIONS

Most pharmacy students in Zimbabwe considered themselves spiritual/religious and had positive perceptions about spirituality and SC in pharmacy education and practice. There was a positive association between students' personal religiosity and their beliefs about SC. Students anticipated that SC would be incorporated into their education and future professional practice and indicated they wanted more education and training to feel competent in SC.

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.

Nursing Students' Professional Competence in Providing Spiritual Care in Iran

Providing spiritual care as a dimension of holistic nursing care is a task that requires competent caregivers. The present study seeks to examine the relationship of personal characteristics with perceived competence in Iranian nursing students and their professional competence in providing spiritual care. This cross-sectional study was conducted on all the nursing students at Semnan University of Medical Sciences, Semnan, Iran, using the census method (n = 224). The research sample consisted of 179 students who met the eligibility criteria. Data were collected using the Spiritual Care Competence Scale (SCCS). The mean SCCS score for respondents was 3.66. Using the cutoff point of >3.5, approximately three quarters of respondents (72.1%) perceived themselves to be competent in delivering spiritual care. The scores of competence and its domains were not significantly different in terms of history of participation in ethics training workshops, gender and marital status (P > 0.05). The scores were also not significantly correlated with age, semester and work experience. Although more than 70% of the nursing students perceived themselves competent in providing spiritual care, nursing curriculum planners should seek to promote the spiritual capacity and competence of nursing students in providing spiritual care through education and training.

The level of spiritual care competence of Polish nurses and the psychometric properties of the spiritual care competence scale (SCCS)

BACKGROUND

Providing effective spiritual nursing care requires development of professional competence which, when regularly evaluated, allows one to direct undergraduate and postgraduate nursing education in order to develop knowledge, skills and attitudes of nurses in the scope of spiritual care.

AIM

The aim of this study was to analyse the level of spiritual competence of professionally active nurses in Poland and, additionally, to analyse the psychometric properties of the Spiritual Care Competence Scale (SCCS).

METHODS

A cross-sectional study among Polish nurses (n = 343) was performed in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology guidelines.

RESULTS

An exploratory factor analysis identified five factors with 27 items explaining a total variance of 64.75%. Cronbach's alpha coefficient for the subscales ranged from 0.70 for 'Attitude toward the patient's spirituality' to 0.92 for 'Professionalisation and improving the quality of spiritual care'. Nurses reported a high level of spiritual competence (104.39 points) with better results in 'Attitude toward the patient's spirituality' and 'Communication, personal support and patient counselling' than in the 'Assessment and implementation of spiritual care', 'Professionalisation and improving the quality of spiritual care', and 'Referral, consultation and spiritual care'. Significant correlation was found between nurses' age, job seniority and spiritual competence, and between religiosity and spiritual competence.

CONCLUSIONS

The study showed satisfactory psychometric properties of the Polish version of the Spiritual Care Competence Scale, confirming its potential to measure the level of spiritual competence of nurses, both in education and research processes. SCCS-PL revealed five-factor structure with good internal consistency. The findings highlight the importance of providing professional education in respect of spiritual nursing care, especially in its practical dimension regarding skills development in which nurses obtained lower scores.

An online survey to describe pharmacy student spirituality and spiritual care perspectives

INTRODUCTION

Little is known about student pharmacists' perspectives of spirituality and spiritual care (SC) in pharmacy education and practice. The purpose of this study was to examine student pharmacists' perspectives about spirituality and incorporating SC in pharmacy education and practice.

METHODS

Student pharmacists were recruited from two private pharmacy schools in California, one religiously-affiliated and one non-religiously affiliated. A faculty member at each school invited student pharmacists via email or through Zoom (Zoom Video Communications) chat to complete the 37-item online survey through an embedded link. The investigator-designed survey was comprised of 22 items inquiring about spirituality and SC as well as several items assessing demographic and religious characteristics.

RESULTS

Participants included 470 student pharmacists (87.2% response rate) who were 28.9 ± 5.7 years old on average. Half of the respondents (50.5%) attended the non-religiously affiliated university. Most of the respondents were female (67%), Christian (67.8%), spiritual (79.2%), and religious (75.2%). They "agreed" or "strongly agreed" that: "understanding patients' spiritual beliefs is an important part of pharmacy practice" (83%), "I would pray with my patients as a pharmacist" (54.8%), "it is appropriate for a pharmacist to have spiritual or religious conversations with patients" (52.9%), and "it is appropriate for a pharmacist to pray with and for patients who request it" (66.9%). These beliefs were positively correlated with self-reported religiosity and spirituality.

CONCLUSIONS

Most students considered themselves spiritual and religious and felt that spirituality and learning about SC were important. The respondents' SC perspectives were associated with their religiosity and spirituality.

Unpacking characteristics of spirituality through the lens of persons of colour living with serious illness: The need for nurse-based education to increase understanding of the spiritual dimension in healthcare

AIMS AND OBJECTIVES

To examine the characteristics of spirituality as expressed by persons of colour living with serious illness.

BACKGROUND

Spiritual, Religious and Existential Care, as specified in the National Consensus Project (NCP) Guidelines, is a core domain of palliative nursing.

DESIGN OF THE STUDY

A constructionist approach to narrative analysis was used for this study and reported in accordance with the COREQ guideline.

METHODS

In-depth narrative interviews were conducted with 20 participants. These participants included persons of colour living with serious illness who were admitted to an acute-care hospital. Through a deductive coding approach, a codebook was created based on a broad definition of spirituality including: religion, self, family, community, nature and art/music/literature.

RESULTS

The major themes expressed were religion, self and family. Subthemes of religion included increased faith, support of the church community and God's intervention in patients' lives. Subthemes of self included increased self-worth, self-awareness of one's place in the world and individualised transition to new meaning in life. Subthemes of family included family adding meaning and purpose to their lives, family as an important source of strength and support, wanting to regain their health to go back to caring for their families, and believing that their illness had brought their family closer together.

CONCLUSION

The thematic analysis revealed a broader existential aspect of what brought value, meaning and purpose into their lives, despite their progressive physical illness. More research is needed to understand spiritual, religious or existential needs of persons of colour living with serious illness and how nurses can best support these needs. By understanding the components of spirituality, nurses can learn to recognise the signs of spiritual distress. This awareness also helps to know when a spiritual specialist is needed-either the patient's own spiritual guide(s) or the hospital chaplain. Nurses can also use spiritual assessment tools when performing a general assessment on the patient.

RELEVANCE TO CLINICAL PRACTICE

By understanding the components of spirituality, nurses can learn to recognise the signs of spiritual distress. This awareness also helps to know when a spiritual specialist is needed-either the patient's own spiritual guide(s) or the hospital chaplain. Nurses can also use spiritual assessment tools when performing a general assessment on the patient.

Spiritual care competence and its relationship with self-efficacy: An online survey among nurses in mainland China

AIMS

To explore the spiritual care competence among nurses in mainland China and determine its relationships with their self-efficacy and personal characteristics.

BACKGROUNDS

Nurses' perception of competence in spiritual care has critical effects on their own practice. Having a view of the nurses' spiritual care competence would help nurse managers recognize the weakness of spiritual practice.

METHODS

A descriptive cross-sectional study using online survey methods was carried out in 2,970 Chinese nurses. Spiritual care competence scale and General Self-Efficacy Scale were used to collect the data.

RESULTS

The total score of spiritual care competence scale was 58.5 (16.05). The highest score on competence was for communication (3.48 (0.97)), and the lowest was referral to professionals (2.25 (0.93)). Positive correlation was found between spiritual care competence and self-efficacy (r = .490, p < .01). Results of multiple linear regression analysis showed that self-efficacy, whether or not trained, experience of caring terminal illness patients, working experiences and first degree were the five factors associated with spiritual care competence (F = 217.425, p < .001, R²  = 26.7%).

CONCLUSIONS

Nurses showed different levels of competence in various dimensions of spiritual care. Their spiritual care competence was related to self-efficacy, whether or not received training, experience of caring terminal illness patients, working experiences and first degree of nursing education.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers have to realize that it is imperative to enhance the nurses' competence to address the spiritual care needs of patients. Appropriate ways to enhance the nurses' spiritual care competence are needed so as to improve spiritual practices.

Spiritual care interventions in nursing: an integrative literature review

As an important part of the holistic care, spiritual care is considered an indicator of care quality. This study aims to identify and characterize nursing spiritual care interventions. In order to identify and select resources, an integrative review was done. The search was conducted in national and international databases such as Google Scholar, Scopus, INML, Iran Medex, Iran Doc, Web of Science, Wiley, SID, ProQuest, Ovid, Science Direct, PubMed, ebrary, Sage, CINAHL, and Magiran from 1994 to 2018. As a result, 1625 articles were detected, 59 of which were included in synthesis. Data extraction and analysis presented eight categories of spiritual care interventions in the field of nursing including (1) the exploration of spiritual perspective, (2) healing presence, (3) the therapeutic use of self, (4) intuitive sense, (5) patient-centeredness, (6) meaning-centered therapeutic interventions, (7) the creation of a spiritually nurturing environment, and (8) the documentation and evaluation of spiritual care.

The Invisibility of Spiritual Nursing Care in Clinical Practice

Background and Purpose: Spirituality has been identified as the essence of being human and is recognized, by many health care professionals, as a central component in health and healing. Scholars have identified spiritual nursing care as essential to nursing practice and include caring for the human spirit through the development of relationships and interconnectedness between the nurse and the patient. However, despite the recognition of spiritual practices as important to health, little attention has been given to spirituality in nursing practice and education in the literature. The purpose of this article is to explore factors contributing to the invisibility of spiritual nursing care practices (SNCP), recognition and offer strategies to enhance the visibility of SNCP. Two major factors that reduce visibility of SNCP are conceptual confusion differentiating between spirituality and religion and limited education in the area of spirituality including nursing curricula and organizations. Strategies to enhance visibility of SNCP include educational approaches in nursing curricula and health care organizations. to influence nurses’ perceptions about spirituality and creation of a culture of spiritual care. Conclusion: Holistic nursing includes assessing and responding to the spiritual needs of patients. Changes in nursing education and health care systems are needed to increase the visibility of SNCP.

Developing a spiritual care competency framework for pre-registration nurses and midwives

This paper identifies competencies in spiritual care from an in-depth literature review and develops a theoretical framework for competencies in spiritual care. It forms part of a larger modified Delphi study which recruited international nursing/midwifery experts. Using Braun and Clark (2006) adapted six-phase content thematic analysis, 7 domains and 116 competency items were generated from an in-depth literature review in three areas; spirituality and spiritual care, spiritual care education, and spiritual care curricular contents.

Teaching Spiritual Care Within Nursing Education: A Holistic Approach

Student nurses are unprepared to meet the spiritual needs of patients, and are often uncomfortable addressing this. This article aims to describe the student perspective of spirituality in relation to the holistic care model. Findings from the study provide insight about preparing nursing students to deliver spiritual care in nursing practice.

Nursing and midwifery students' perceptions of spirituality, spiritual care, and spiritual care competency: A prospective, longitudinal, correlational European study

BACKGROUND

Nurses and midwives care for people at some of the most vulnerable moments of their lives, so it is essential that they have the skills to give care which is compassionate, dignified, holistic and person-centred. Holistic care includes spiritual care which is concerned with helping people whose beliefs, values and sense of meaning, purpose and connection is challenged by birth, illness or death. Spiritual care is expected of nurses/midwives but they feel least prepared for this part of their role. How nursing and midwifery students can be prepared for spiritual care is the focus of this study.

OBJECTIVES

1. To describe undergraduate nursing and midwifery student's perceptions of spirituality/spiritual care, their perceived competence in giving spiritual care and how these perceptions change over time. 2. To explore factors contributing to development of spiritual care competency.

METHODS

Prospective, longitudinal, multinational, correlational survey design. A convenience sample of 2193 undergraduate nursing and midwifery students (69% response rate, dropping to 33%) enrolled at 21 universities in eight countries completed questionnaires capturing demographic data (purpose designed questionnaire) and measuring perception of spirituality/spiritual care (SSCRS), spiritual care competency (SCCS), spiritual wellbeing (JAREL) and spiritual attitude and involvement (SAIL) on 4 occasions (start of course n = 2193, year 2 n = 1182, year 3 n = 736, end of course n = 595) between 2011 and 2015. Data were analysed using descriptive, bivariate and multivariate analyses as appropriate.

RESULTS

Perceived competency increased significantly over the course of students' study which they attributed to caring for patients, events in their own lives and teaching/discussion in university. Two factors were significantly correlated with perceived spiritual care competency: perception of spirituality/spiritual care, where a broad view was preferable, and personal spirituality, where high spiritual wellbeing (JAREL) and spiritual attitude and involvement (SAIL) scores were preferable.

CONCLUSIONS

We have provided the first international evidence that perceived spiritual care competence is developed in undergraduate nursing and midwifery students and that students' perceptions of spirituality and personal spirituality contribute to that development. Implications for teaching and learning and student selection are discussed. The study is limited by attrition which is common in longitudinal research.

First-year Student Pharmacists' Spirituality and Perceptions Regarding the Role of Spirituality in Pharmacy Education

Objective: To measure student pharmacists' spirituality utilizing validated survey instruments and to determine perceptions regarding the anticipated role of spirituality in academic course work and professional practice. Methods: This was a cross-sectional, descriptive study. The survey was offered to all first-year student pharmacists during the first week of the fall semester (2012-2015). Descriptive and inferential statistics were used to analyze data. Results: A total of 580 students (98%) participated. The majority of students reported having each of the spiritual experiences on most days of the week or more frequently (58% to 89% based on individual item). Furthermore, 57% of students anticipate that matters of spirituality would be significant components of academic course work and 75% anticipate they would be incorporated into eventual professional practice settings. These perceptions were positively correlated to measures of spirituality and religiosity. Conclusion: These findings suggest that faculty should evaluate current and future incorporation of topics related to spirituality and health in pharmacy curriculum.

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.

Factors contributing to student nurses'/midwives' perceived competency in spiritual care

BACKGROUND

The spiritual part of life is important to health, well-being and quality of life. Spiritual care is expected of nurses/midwives, but it is not clear how students can achieve competency in spiritual care at point of registration as required by regulatory bodies.

AIM

To explore factors contributing to undergraduate nurses'/midwives' perceived competency in giving spiritual care.

DESIGN

A pilot cross-sectional, multinational, correlational survey design.

METHOD

Questionnaires were completed by 86% (n=531) of a convenience sample of 618 undergraduate nurses/midwives from six universities in four countries in 2010. Bivariate and multivariate analyses were performed.

RESULTS

Differences between groups were small. Two factors were significantly related to perceived spiritual care competency: perception of spirituality/spiritual care and student's personal spirituality. Students reporting higher perceived competency viewed spirituality/spiritual care broadly, not just in religious terms. This association between perceived competency and perception of spirituality is a new finding not previously reported. Further results reinforce findings in the literature that own spirituality was a strong predictor of perceived ability to provide spiritual care, as students reporting higher perceived competency engaged in spiritual activities, were from secular universities and had previous healthcare experience. They were also religious, practised their faith/belief and scored highly on spiritual well-being and spiritual attitude/involvement.

CONCLUSIONS

The challenge for nurse/midwifery educators is how they might enhance spiritual care competency in students who are not religious and how they might encourage students who hold a narrow view of spirituality/spiritual care to broaden their perspective to include the full range of spiritual concerns that patients/clients may encounter. Statistical models created predicted factors contributing to spiritual care competency to some extent but the picture is complex requiring further investigation involving a bigger and more diverse longitudinal sample.

Discerning the healing path--how nurses assist patient spirituality in diverse health care settings

AIMS AND OBJECTIVES

To examine nurses' experiences in spiritual care in diverse clinical settings, preferably not palliative care.

BACKGROUND

Spirituality is part of holistic nursing care. The concept of spiritual literacy is introduced as the nurse's ability to read the spiritual signs of the human experience.

DESIGN

Classical grounded theory methodology with open and selective coding was used to identify the participants' main concern and the strategies they used to resolve it, and to develop a substantive grounded theory.

METHOD

Data were collected in 2008 and 2014 during eight focus group interviews with a total of 22 nurses recruited from a master's programme, postgraduate programmes and a local hospital. Data were analysed through constant comparison until the grounded theory emerged.

RESULTS

The participants' main concern was how to assist the patient to alleviation. The participants resolved this by Discerning the healing path, which comprises three stages: Tuning in on spirituality, Uncovering deep concerns and Facilitating the healing process. These three stages are accompanied all the way by the participants' Willingness to overcome own comfort zone and Building a trusting relationship.

CONCLUSION

Spirituality is of relevance for all areas of nursing care, not just dying patients or those in palliative care. Spirituality relates to the deep and important things in life and affects how patients face health issues. Nurses attend to spirituality in patients because the pain of the soul touches them and the calmness of spiritual peace amazes them.

RELEVANCE TO CLINICAL PRACTICE

The professional culture in the health care team socialises nurses into the workplace, and leaders need to pay close attention to how they can foster openness to spiritual matters. The personal and professional maturity of the nurse is fundamental to his or her willingness and ability to overcome own comfort zone.

Predictors of stress and coping strategies of US accelerated vs. generic Baccalaureate Nursing students: an embedded mixed methods study

BACKGROUND

Stress is an inevitable part of life and is especially pervasive in the lives of nursing students. Identifying the predictors of stress as well as coping strategies used can allow for the implementation of appropriate coping interventions to assist in the management of stress in nursing students. Mixed methods research that has been undertaken to gain an understanding about student stress, especially juxtaposing generic versus accelerated nursing students could not be identified.

OBJECTIVES

(1) Identify predictors of stress between accelerated and generic Baccalaureate Nursing (BSN) students; and (2) Describe stressors and coping strategies used by accelerated students in comparison with generic students.

DESIGN

Embedded mixed methods study.

SETTING

Accelerated and generic BSN third- and fourth-year nursing students at two Midwestern universities.

PARTICIPANTS

210 participants: accelerated (n=75) and generic (n=135).

METHODS

A questionnaire packet, including demographics, history of depression, the Perceived Stress Questionnaire, Rosenberg Self-Esteem Scale, Multidimensional Scale of Perceived Social Support, and open-ended questions were administered to students at the end of a class. Simultaneous multiple regression was used to examine predictors of stress. Content analysis was used to analyze qualitative data.

RESULTS

Predictors of stress for both the accelerated and generic groups included history of depression, year in the program, emotional support, and self-esteem. Fear of failure and clinical incompetence, problematic relationships, and time management issues were identified as major stressors. Coping strategies used by both groups included positive thinking and social support.

CONCLUSIONS

Senior students with a history of depression, low self-esteem, and little social support were more likely to experience high levels of stress. This gives educators the potential to identify at risk students and establish stress reduction programs. Encouraging students to use individualized coping strategies will be beneficial.

Nurses' and midwives' acquisition of competency in spiritual care: a focus on education

BACKGROUND

The debate that spirituality is 'caught' in practice rather than 'taught' implies that spiritual awareness comes about through clinical experience and exposure, requiring no formal education and integration within the curricula. This is challenged as it seems that providing students with a 'taught' component equips students with tools to identify and strengthen resources in 'catching' the concept.

AIM

This study forms part of a modified Delphi study, which aims to identify the predictive effect of pre- and post-registration 'taught' study units in spiritual care competency of qualified nurses/midwives.

METHODS

A purposive sample of 111 nurses and 101 midwives were eligible to participate in the study. Quantitative data were collected by the Spiritual Care Competency Scale (SCCS) (Van Leeuwen et al., 2008) [response rate: nurses (89%; n=99) and midwives (74%; n=75)].

RESULTS

Overall nurses/midwives who had undertaken the study units on spiritual care scored higher in the competency of spiritual care. Although insignificant, nurses scored higher in the overall competency in spiritual care than the midwives.

CONCLUSION

'Taught' study units on spiritual care at pre- or post-registration nursing/midwifery education may contribute towards the acquisition of competency in spiritual care.