Spirituality and Religious Diversity in Nursing: A Scoping Review

Spiritual care competencies among nursing students in the middle East and Asia: a systematic review

Spiritual care is recognized as a crucial component of holistic nursing education, significantly enhancing patient well-being, health outcomes, and decision-making. However, a systematic evaluation of spiritual care education programs in the Middle East and Asia remains limited. This systematic review aims to assess the effectiveness of spiritual care education programs in enhancing undergraduate nursing students' competencies in these regions. Following PRISMA-P guidelines and registered on PROSPERO (CRD42024552137), the study employed the PICOS framework for selection criteria: Participants (undergraduate nursing students), Intervention (spiritual nursing education programs), Comparison (education without spiritual content), Outcomes (spiritual care competencies), and Study design (RCT or quasi-experiment). Searches were conducted in Cochrane, Medline, PubMed, Sage, and Scopus from April to May 2024. Multiple reviewers independently performed data extraction and quality assessment using ROB 2 and ROBIN-I tools. A narrative synthesis approach explored data relationships and theoretical applications. Out of 1,350 reviewed articles, 10 studies involving 749 nursing students from Iran, Taiwan, and Turkey met the inclusion criteria. The interventions spanned from one month to a full semester and combined theoretical learning with clinical practice. The findings indicate that education in spiritual care significantly enhances students' self-awareness, knowledge, attitudes, and practical skills. The study emphasizes the importance of incorporating spirituality into nursing curricula to promote a holistic approach to patient care. Limitations of the study include differences in study designs, selection bias, variability among participants, and reliance on self-reported data. Future research should aim for longitudinal studies to evaluate long-term effects and create culturally sensitive assessment tools for measuring spiritual competencies.

Intersection of Religious Beliefs and Healthcare in Germany: A Guide to Integrating Religious Diversity in Medical Practice

Background The increasing diversity in Germany's population necessitates the application of culturally sensitive medical care. Religious and cultural beliefs significantly influence patient behavior and healthcare decisions. However, healthcare providers often lack knowledge in cultural beliefs related to medical treatment, particularly regarding minority religions such as Islam, the second-largest religious group in Germany. Addressing these gaps through medical education is essential for fostering intercultural competence and improving patient-centered care. Objective This pilot study assesses the knowledge of German medical students and a multi-faith expert group regarding Islamic-ethical principles in healthcare. Furthermore, expert interviews across multiple religions (Islam, Christianity, Judaism, Buddhism, Bahá'í, Jainism) explore additional faith-based considerations in clinical practice. In this context, the study aims to (1) identify knowledge gaps concerning religiously informed healthcare preferences, (2) generate foundational insights to inform medical education and promote culturally sensitive, patient-centered care, and (3) offer an insight into religious beliefs related to healthcare as an integral part of culture.  Methods For this pilot study, a custom multiple-choice (MC) questionnaire on Islamic-ethical principles was administered to 50 medical students (ST) and an expert group (E, n = 6) comprising clinicians and religious authorities from the aforementioned faiths. Additionally, qualitative interviews were conducted with each expert to gain deeper insights into religion-specific considerations relevant to medical care. Results The MC questions on dietary regulations and gender relations were mostly answered correctly (84% and 92%, respectively). However, overall, both students and experts demonstrated limited knowledge of Islamic-ethical principles in healthcare. This was reflected in the fact that students did not answer any of the related questions with complete accuracy, while experts achieved fully accurate responses in only 50% of the cases. The results of the interviews were summarized, providing a detailed comparison of eight categories influencing medical treatment across Christianity, Islam, Buddhism, Judaism, Bahá'í, and Jainism. Conclusion Our study serves as an initial guide to fostering awareness and sensitivity in intercultural patient care in Germany. The complexity and diversity of interpretations within each faith, depending on personal and cultural preferences, have to be considered in personalized medicine.

A comparative study of nurses' competencies in integrating religion/spirituality into patient care

BACKGROUND

There is a need of research to evaluate and compare the competencies of nurses in integrating patients' religion and spirituality into nursing practice in various settings, including general and psychiatric hospitals. By understanding the competencies of nurses working in different environments, tailored spiritual care training programs can be developed to meet their specific needs. This study aimed to evaluate and compare the competencies of nurses in integrating patients' religion/spirituality into nursing practice in both a general and a psychiatric hospital.

METHODS

This cross-sectional descriptive-analytical study was conducted in two hospitals affiliated with Kerman University of Medical Sciences in southeastern Iran. Quota sampling was used to select 200 nurses (100 nurses from each hospital) in 2023. The Religious/Spiritually Integrated Practice Assessment Scale (RSIPAS) was used to evaluate and compare nurses' competencies in integrating the religion/spirituality of patients into their nursing practice.

RESULTS

The study revealed that nurses' competencies in integrating patients' religion/spirituality into nursing practice were moderate in both general (122.39 ± 19.40) and psychiatric hospitals (110.82 ± 25.63). Nurses in the general hospital had significantly higher competency scores compared to those in the psychiatric hospital (t = 3.59, p = 0.001). The type of hospital, work experience, and the involvement of professionals in providing religion/spirituality care were significant predictors of nurses' competencies in integrating patients' religion/spirituality into clinical practice.

CONCLUSIONS

The moderate levels of competencies among nurses highlight the need for further education and training to effectively integrate patients' religion/spirituality into nursing across various healthcare settings. The type of hospital also influenced their competencies. Therefore, it is crucial for nurses, particularly those working in psychiatric hospitals, to receive training that is tailored to the specific needs, culture, and context of their respective healthcare environments. It is essential to conduct a baseline assessment of nurses' readiness and competencies before implementing appropriate training programs.

Predicting the effect of ethical climate and spiritual well-being of nurses on respecting the patients' privacy in intensive care units: an analytical study

BACKGROUND

Ethical climate, observance of patients' privacy and nurses' spiritual well-being are of great importance in intensive care units (ICU). In addition, it is essential to identify spiritual and ethical predictors of patients' privacy. Thus, this study aimed to determine the predictive effects of ethical climate and nurses' spiritual well-being on patients' privacy in ICU.

METHODS

In this analytical cross-sectional study, 250 out of 500 ICU nurses were recruited using proportionate allocation stratified sampling. Data were collected using a demographic characteristics form, Patient Privacy Scale, Hospital Ethical Climate Survey, and Spiritual Well-Being Scale. The data were analyzed using Pearson correlation coefficient and hierarchical linear regression analysis.

RESULTS

The results showed that patients' privacy was associated with the hospital's ethical climate and nurses' spiritual well-being (P < 0.001). The hierarchical linear regression analysis indicated that, in step 1, patients (β = 0.22, P = 0.03) and managers' (β = 0.41, P < 0.001) subscales of ethical climate had a significant proportion of the variance of patients' privacy. In step 2, patients (β = 0.25, P = 0.01), managers' (β = 0.34, P < 0.001) subscales of ethical climate, and nurses' spiritual well-being (β = 0.17, P = 0.01) had a significant proportion of the variance of patients' privacy. According to step 2, these variables explained 40% of the changes in patients' privacy.

CONCLUSION

The results of the present study showed that the ethical climate and nurses' spiritual well-being were the predictors of patients' privacy. Given that 40% of the variance of the patients' privacy was recognized by these variables, it is suggested that further research should be conducted to determine other predictors.

Intersections of Compassion, Science, and Spiritual Care in Global Health for Public Health Benefits

Across the globe, spiritual care is offered by individuals, healthcare chaplains, and humanitarian, social and related spiritual groups on account of zeal, voluntary and paid services. Sometimes, services are provided without understanding the connectivity of compassion, spiritual care, and scientific protocols. There are instances where health professionals and managers disagree with spiritual caregivers or reject spiritual services because of poor service deliveries in conflict with healthcare protocols. Against this background, this article focuses on how spiritual care services can be provided scientifically to improve service delivery. It presents leading questions to link the scientific and compassionate approach to spiritual care. These include-What is science? What is compassion? What is spiritual care? What makes compassion and spiritual care scientific? Are there tenets of compassion in religions? How are compassion, science and spiritual care linked? What are the implications of the intersections for public health and safety? Hopefully, the provided answers may improve the service delivery performance of spiritual caregivers and their collaboration with healthcare professionals, social workers, and related groups.

Nurse's Spiritual Sensitivity Scale (NSSS): A Validity and Reliability Study in Turkey

Nurses carry out spiritual care based on ethical principles, and they must have spiritual sensitivity to meet spiritual care needs. Seen from this angle, it is important to determine nurse's spiritual sensitivity in order to meet patient's spiritual care needs, to increase patient-nurse communication and to adopt a holistic approach to care. For this reason, the aim of this study was to test the validity and reliability of the Turkish Nurse's Spiritual Sensitivity Scale. In the present study, a sample size of 207 nurses was reached in the data collection stage. The Turkish Nurse's Spiritual Sensitivity Scale (NSSS) is a Likert-type scale consisting of 20 items and a single factor. There are no reverse-scored statements on the scale. A score of zero shows no spiritual sensitivity, and four shows higher spiritual sensitivity. The minimum score on the scale is zero, and the maximum score is 80. It was seen in this study that the Nurse's Spiritual Sensitivity Scale is a valid and reliable measurement instrument for a Turkish sample. This scale can be used by professionals to determine the spiritual sensitivity of Turkish nurses.

Finnish Palliative Care Nurses' and Physicians' Perceptions of Spirituality and Spiritual Care Related to Their Attitudes toward End-of-Life Care

Background

Spiritual care constitutes an indispensable aspect of palliative care (PC). Health care professionals encounter challenges when addressing spiritual care at the end of life. Developing appropriate attitudes toward end-of-life care can facilitate the acquisition of competencies needed for effective delivery of spiritual care.

Aim

To explore the perceptions of spiritual care and attitudes toward end-of-life care among PC professionals.

Design

The Finnish version of the "Spirituality and Spiritual Care Rating Scale" (SSCRS-FIN) and a newly developed "Attitudes toward End-of-Life Issues" (AEOLI) questionnaire were validated and utilized.

Setting/Participants

Both questionnaires were distributed to PC professionals involved in PC through an online survey. Exploratory and confirmatory factor analyses were conducted. The newly derived factors were subsequently examined for their associations with age, gender, profession, affiliation with a religious community, personal interpretation of spirituality, and years of professional experience.

Results

A total of 204 participants took part in the study (163 nurses, 19 nursing students, and 22 physicians). Exploratory factor analysis demonstrated satisfactory internal consistency, as indicated by Cronbach's alpha coefficients, for the five factors of SSCRS-FIN: "Spirituality" (0.733), "Existential" (0.614), "Spiritual Needs" (0.599), "Passive Spiritual Care" (0.750), and "Active Spiritual Care" (0.665); and for the seven factors of AEOLI: "Anxiety" (0.823), "Discussion" (0.924), "End-of-Life" (0.573), "Education" (0.692), "Medically Induced Death" (0.859), "Suffering" (0.671), and "Knowledge" (0.444). Confirmatory factor analysis demonstrated satisfactory fit values for both questionnaires. Significant positive correlations were observed between end-of-life care and the factors "Existential," "Spiritual Needs," and spiritual care factors, whereas an inverse correlation was found among "Anxiety," "Medically Induced Death," and all factors of SSCRS-FIN.

Conclusions

Valid and reliable questionnaires for assessing spiritual care (SSCRS-FIN) and attitudes toward end-of-life care (AEOLI) were developed. Attitudes toward end-of-life care were positively correlated with perceptions of spiritual care.

Promoting Spiritual Coping of Family Caregivers of an Adult Relative with Severe Mental Illness: Development and Test of a Nursing Intervention

Severe mental illness disrupts daily functioning, burdening family caregivers, who often adopt spiritual coping strategies. With comprehensive skills, mental health nurses can promote well-being and mental health. The aim is to develop and test the nursing intervention "promoting spiritual coping" in the family caregivers of home-dwelling people with mental illness. This study was conducted in two distinct stages. Initially, the intervention was developed according to the first phase of the Framework for Developing and Evaluating Complex Interventions. Secondly, the intervention protocol was tested in a mixed-method pilot study. An intervention protocol was developed and tested on ten family caregivers. The intervention comprised three sessions, and before-and-after assessments were conducted. Significant improvements were observed in the outcomes, with caregivers expressing that discussing spirituality and religiosity benefited them. This intervention prioritized the therapeutic relationship of the nurses and family caregivers. The intervention "promoting spiritual coping" was created and evaluated as a suitable approach for mental health nurses to use in a psychotherapeutic context with family caregivers of individuals with mental illness.

Spiritual Care[Givers] Competence in Palliative Care: A Scoping Review

To deliver spiritual care, professionals must be skilled in physical, mental, social, and spiritual care. Spiritual care competence includes knowledge, behaviors, attitudes, and skills that enable successful or efficient care. This review aims to identify the scope of competence and the specific skills, knowledge, and attitudes used in providing spiritual care to people needing palliative care, and the main challenges and facilitators. A scoping review was developed using the Joanna Briggs Institute methodology. Six databases (Web of Science; MEDLINE/Pubmed; Scopus; CINAHL; MedicLatina and SciELO) were searched in September 2023, with an update in January 2024. The resulting 30 articles were analyzed using a content analysis approach. Information was categorized into three domains: cognitive, affective, and functional (based on three personal resources: intrapersonal, interpersonal, and transpersonal). Palliative care professionals face a lack of training and insufficient preparation to deliver spiritual care. Spiritual care competence depends on professional spiritual development and experience, spiritual intelligence (cognitive), spiritual humility (affective), and having a critical and reflexive mind (functional). In the future, palliative care should seek to improve competent spiritual care. This review could help clarify the real configuration of competent spiritual care and lead to improvements in a professional's empowerment when delivering effective spiritual care to patients and families.

Proficiency and Practices of Nursing Professionals in Meeting Patients' Spiritual Needs within Palliative Care Services: A Nationwide, Cross-Sectional Study

Spirituality and spiritual needs are integral parts of the human experience, but they are often particularly important for palliative care patients. Spirituality has numerous positive effects, especially for those dealing with serious illness. Nevertheless, the spiritual dimension is sometimes overlooked in patient care. This study aims to determine the frequency of addressing the spiritual needs of palliative care patients in Croatia and to investigate the self-perceived confidence of caregivers in this task. A quantitative cross-sectional study was conducted involving 194 nurses in specialised palliative care services across Croatia. A specially developed and validated questionnaire was used for this study. The most common intervention undertaken by respondents was "promoting hope and optimism in patients" (88.4%), while the least common intervention was "reading books and other publications to patients" (13.9%). No statistically significant differences were found in the frequency of spiritual care in relation to the respondent's level of education, professional experience and nursing environment. Approximately two-thirds of the surveyed nurses stated that they "often" or "always" provided some kind of spiritual care to palliative care patients. However, study participants who indicated that they had received sufficient formal instruction in addressing spiritual needs and spiritual care interventions demonstrated a statistically significant tendency to engage in these practices, as well as greater confidence in their knowledge and skills in this area compared to those who lacked such training. The study suggests that there is a need to identify existing barriers to the provision of spiritual care and to develop strategies to overcome them. By placing emphasis on the spiritual needs and preferences of patients, nursing professionals and other healthcare providers have the opportunity to elevate the standard of holistic care and foster a sense of comfort and dignity among patients.

Development and Validation of the Nurses' Spiritual Sensitivity Scale in Southeastern Iran

Spiritual sensitivity refers to awareness and perception of the attitudes and feelings of others and helps nurses to recognize and take responsibility for the spiritual values and needs of patients. The dimensions of spiritual sensitivity remain unknown as there is no comprehensive and standardized scale for assessing nurses' spiritual sensitivity; therefore, the current research aimed to design and validate the nurses' spiritual sensitivity scale. We conducted this exploratory sequential study using eight stages suggested by DeVellis (2016) when developing the scale. We conducted this study among Iranian nurses from March 2021 to October 2022. Results suggested a 20-item scale with two components (nurses' professional spiritual sensitivity and nurses' internal spiritual sensitivity) that explained 57.62% of the total variance extracted. We were able to confirm convergent validity based on an acceptable correlation between the nurses' spiritual sensitivity scale and the King's spiritual intelligence scale (r = 0.66), which showed good stability (cronbach's alpha coefficient = 0.927, omega coefficient = 0.923, and icc = 0.937). Spiritual sensitivity in nurses is difficult to evaluate. Considering the acceptability of the psychometric properties of the "Nurses' spiritual sensitivity" scale, this scale can be used in clinical environments to evaluate nurses' spiritual sensitivity. Therefore, it is suggested that managers and policy makers should consider developing related guidelines to help nurses to become more spiritually sensitive and also to meet the spiritual needs of patients. We suggest further studies to confirm the study results in the nursing community.

Development and Validation of the Nursing Care and Religious Diversity Scale (NCRDS)

(1) Background: In response to the impact of religious intervention on health outcomes and the importance of documenting how nurses experience the spiritual need of 392 hospitalized patients, it is vital to provide the nursing profession with instruments to evaluate these spiritual aspects. This study describes the development and validation of the Nursing Care and Religious Diversity Scale (NCRDS); (2) Methods: A two-step design was used for NCRDS translation and psychometric validation. The tool design was developed in the first step, while the psychometric characteristics were tested in the second step. An inductive study was conducted to test the validity and reliability of the NCRDS tool. The overall sample consisted of 317 nurses; (3) Results: The final instrument comprised 25 items in five dimensions. The construct validity indicated five dimensions. The face and content validity were adequate. Test-retest reliability displayed good stability, and internal consistency (Cronbach's α) was acceptable (0.83); (4) Conclusions: Initial testing of the NCRDS suggested that it is a valid and reliable instrument to evaluate individuals in religious diversity, with five dimensions for evaluating the meaning of spirituality and individual belief, the religious healthcare environment, educational adequacy, spiritual and religious needs, and religious plurality.