Assessment of spiritual care competency and influencing factors among nurses at the National Institute of Cancer Care, Sri Lanka: a descriptive cross-sectional study

Abstract

Background

Spiritual care is a key element of holistic nursing care, highlighted in the nursing process for addressing patients’ spiritual needs.

Objectives

This study aimed to identify the level of spiritual care competence among nurses and factors influencing spiritual care provision for patients with cancer at the National Institute of Cancer Care (NICC), Sri Lanka.

Design

A descriptive cross-sectional study.

Setting

NICC, Sri Lanka (Apeksha Hospital).

Participants

220 purposively selected nurses at the NICC from January to March 2023. Sociodemographic characteristics were collected through a self-administered questionnaire. The study used a pretested and reliability checked, validated 27-item Spiritual Care Competency Scale (SCCS), with scores ranging from 27 to 135 on a 5-point Likert Scale. Descriptive statistics and Pearson correlation were analysed using SPSS (V.25).

Results

The response rate was 86.6%. Among the 220 participants, the mean age was 33.66 years, with 95.91% (n=211) being female. Most learnt about spiritual care via hospital manuals (n=62, 28.18%). The Cronbach alpha value for the SCCS was 0.88. The mean spiritual care competency score was 100.71±10.60, with highest competencies in communication and professionalisation (4.09 and 4.8). Significant associations were found between spiritual care competency and in-service education (p=0.018), age (β=0.155, p=0.021), working experience (β=0.181, p=0.007), time for family commitment (p=0.006) and marital status (p=0.001).

Conclusions

Spiritual care competency among nurses at the NICC was moderate. To enhance competency, it is recommended to implement structured, continuous in-service education programmes on spiritual care practices. Additionally, support should be provided for nurses’ personal and professional development, addressing factors such as work–life balance and family commitments.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• The study used a validated and culturally adapted version of the Spiritual Care Competency Scale-27, ensuring measurement relevance to the Sri Lankan context.

• A descriptive cross-sectional design allowed for assessing spiritual care competency across a broad nursing population at a single point in time.

• The study was limited to a single healthcare institution, which may affect the generalisability of study findings.

• Purposive sampling allowed the selection of nurses with relevant experience, enhancing the relevance of the findings.

Background

Spirituality is a main aspect of human life that resonates with the meaning and purpose of life. It further indicates being connected with the present moment, with themselves, with other people and with the environment. Also, it may recognise a higher power and utmost values or principles.¹,³

Spiritual care is one of the main elements of holistic care in nursing which is highlighted in the nursing process used to assess and address the spiritual needs of patients and provide religious and existential support by collaborating with a multidisciplinary team.³,⁵ It is also renowned as an excellent strategy which helps older adults suffering from spiritual distress to regain strength, meaning and the ability to bear suffering in later life.^{2 3} Spiritual care demands mutuality, trust, ongoing dialogue and continuing presence according to nurses’ perspective. Furthermore, it includes not only trusting the patient, their feelings and their abilities but also developing trust towards a nurse as both a professional and an individual.^{6 7}

The spiritual care-related competence expects to assess and provide adequate care related to the spiritual requirements of a patient. This further defines the knowledge, skills and attitudes required to deliver spiritual care.^{7 8} The importance of this competency was emphasised in healthcare since it is an integral component of holistic care which focuses on all dimensions of an individual including physical, mental and spiritual aspects. Nurses need to play an active role in addressing the patients’ spiritual needs because it is observed to have a positive correlation with quality of life and enhanced patient satisfaction of care.⁷⁹,¹²

Reception of spiritual care has scientifically proven to have a huge impact on patients in terms of acceptance of hospice care at the end of their lives, lowering the chances of getting to depression and lowering the hospitalisation costs.^{7 13} Furthermore, some international research studies have proven that patients having spiritual and religious needs are directly linked with physical health and well-being and, therefore, there is a need to support patients with spiritual needs.¹⁴,¹⁷

The compulsion to offer spiritual care in nursing is linked with increasing evidence which shows that the spiritual dimension has an impact on a person’s overall health and well-being.^{18 19} Spiritual interventions are identified to impact not only the patients but also the nurses who are involved in providing spiritual care.¹⁹,²¹

In a situation like this, observing the spiritual care competence of nurses becomes an essential requirement.²² It was evident that patients sought the support of nurses to address their spiritual needs.^{23 24} For a successful provision of spiritual care for patients, there should be a correct perception of spirituality and spiritual care among nurses to comprehend the patients’ spiritual requirements.^{24 25}

Despite the obligation that nurses need to be involved with spiritual care activities, research indicates that nurses typically feel that they are inadequately prepared for the implementation of spiritual care in practice.^{19 26} Spirituality, religion and spiritual care have a great impact on patients diagnosed with cancer. This was observed through different groups of people’s viewpoints, such as patients, nurses and physicians. Studies also identify that only 3% of the physicians and nurses are involved in completing a spiritual history and only 4% of patients indicated that nurses made their referrals to a chaplain.^{22 27}

Globally, the prevalence of chronic diseases like cancer has gone up, and the WHO has predicted that the incidences of cancer will rise from 14.1 million in the year 2021 to 24.6 million in the year 2030.^{28 29} Considering the situation in Sri Lanka, it was evident that the cumulative risk of developing cancer before the age of 75 is 11.9% for males and 11.2% for females. And the cumulative risk of dying from cancer before age 75 is 7.5% for males and 5.9% for females. It indicates that a considerable proportion of the population is susceptible to cancer during their lifetime.³⁰

Nurses play a pivotal role in delivering holistic patient care, which encompasses the crucial aspect of attending to the spiritual needs of critically ill patients. Addressing these spiritual needs has been associated with improved quality of life and is regarded by many patients as an integral component of comprehensive nursing care. In Sri Lanka, religious arrangements are often made by the patients’ family, and the nursing staff should accommodate these arrangements as far as possible. However, there remains a notable dearth of published literature that specifically explores the spiritual care competency levels of Sri Lankan nurses and the factors that influence this competency.

The conceptual framework of this study is based on the assumption that nurses’ spiritual care competency (dependent variable) is influenced by a combination of individual factors (such as age, gender, clinical experience, family commitments and educational level) and contextual factors, particularly the availability of in-service training on spiritual care (independent variables).

Understanding how these factors are associated with spiritual care competency can help identify areas for targeted professional development and policy intervention. This framework guided the selection of variables, informed the data collection process and underpins the analysis of relationships between nurse characteristics and their competency in providing spiritual care to patients with cancer.

This study aims to fill this gap by examining the extent to which nurses at National Institute of Cancer Care (NICC) are involved in spiritual care-related activities and identifying the factors contributing to their spiritual care competency.

Methods

Aim

This study aims to identify the level of spiritual care competence among nurses at NICC and factors contributing to their spiritual care competency.

Study setting and population

The NICC, also known as Apeksha Hospital, is the largest leading hospital for cancer care in Sri Lanka functioning under the Ministry of Health. It is a tertiary care centre for oncology in Sri Lanka, which provides comprehensive cancer-related multidimensional services to a diversity of patients diagnosed with cancer such as palliative care. A descriptive cross-sectional study was conducted with purposively selected nurses (N=220) employed at the NICC, from January 2023 to March 2023. The inclusion criterion was nurses who had completed 5 years or more of work experience

Sampling

The sample size was calculated using Yamane (1973)³¹ formula, n=N/1+N (0.05)2, since the total population of the study setting is a known population. The original sample size calculated was 254 nurses. The response rate of the sample is 86.6%.

Data collection method and tool

The self-administered questionnaire was composed of two sections: sociodemographic data screening tool and the Spiritual Care Competency Scale (SCCS). The SCC Scale was used with author permission. Part (1) The sociodemographic questionnaire includes age, gender, marital status, educational level, working experience, daily working hours, shift duration per week, number of night shifts performed per month, knowledge regarding spiritual care, the mode of getting to know about spiritual care, the nurses’ opportunity of ever receiving an in-service education programme on spiritual care and the nurses’ availability of time for the family commitment. Part (2) the 27-item SCCS (SCCS-27) was administered to evaluate the Spiritual Care Competency Level of nurses. The original SCCS-27 was developed by van Leeuwen et al.⁸ The SCCS-27 includes 27 items to determine the spiritual care competency levels under the following subdomains: Assessment and implementation of spiritual care (06 items), Professionalisation and improving the quality of spiritual care (06 items), Personal support and patient counselling (06 items), Referrals (03 items), Attitudes towards patient spirituality (04 items) and Communication (02 items), respectively. Each item scores 1–5 on a 5-point Likert scale (5-fully agree, 4-agree, 3-neither agree nor disagree, 2-disagree, 1-completely disagree). The maximum score of the SCCS questionnaire is 135, and spans a range of 27–135. The author has not defined the exact cut-off values for the SCCS. Yet van Leeuwen et al⁸ suggested mean <3.5 as low competency, mean between 3.5 and 4.5 as competence and a mean >4.5 represents high competency. The SCCS was translated and validated into many languages by different countries, namely, China, Japan, South Korea, Turkey, Iran, Spain, Indonesia, Sweden, the Netherlands and Brazil. Before the data collection, the tool was pretested among 30 participants who met the inclusion criteria, and they were excluded from the main study. The rigorous validation process was not followed for the instrument. The internal consistency of the tool was tested and reported Cronbach’s alpha value of 0.88 showing excellent reliability to use in the research study.

Data collection

Prior to the data collection, the nurses were informed regarding the purpose of the study. The procedure of the data collection was informed. The investigators of the study collected data, and the questionnaire was administered to the nurses, and they were provided with significant time to complete the questionnaire. A total of 220 nurses fully completed the questionnaire and handed it over. It was observed that there was no missing data for the collected data set.

Data analysis was conducted using descriptive and inferential statistical tests using SPSS V.25. Normal distribution of the data was confirmed through the Shapiro-Wilk test and parametric tests were used for analysis of data. The descriptive statistics were used to analyse the sociodemographic data. Spiritual care competency was observed for each item via descriptive statistics. The associations between the spiritual care competency score and the sociodemographic variables were tested together to observe the existence of relationships using the independent samples t-test, Pearson correlation, Spearman rank correlation, logistic linear regression and Mann-Whitney U test.

Patient and public involvement

Patients or the public were not involved in the design, or conduct, or reporting, or dissemination plans of our research, and it was not appropriate or possible to involve patients or the public in the design, or conduct, or reporting, or dissemination plans of the research.

Results

Out of the 220 participants, the mean age was reported as 33.66±8.567 years. The majority of them were female participants (n=211, 95.91%). The mean working experience of them was 8.9±7.9 years. It was observed that 75% (n=165) of the participants knew about the term spiritual care and most of them heard about spiritual care from the hospital manual (28.18%, n=62) (table 1).

Table 1. Sociodemographic characteristics of the participants.

Sociodemographic variables		Number	Percentage
Gender	Female	211	95.91
	Male	09	4.09
Marital status	Married	121	55.0
	Unmarried	99	45.0
Working unit	Medical unit	62	28.18
	Surgical unit	64	29.09
	Paediatric unit	22	10.00
	Other units	72	32.73
Educational level	Bachelor of nursing	56	25.45
	Diploma in nursing	164	74.55
Hours—shift duration per day	06 hours	26	11.82
	12 hours	104	47.27
	More than 12 hours	90	40.91
Do you know spiritual care	Yes	165	75.00
	No	55	25.00
Mode of knowing spiritual care	Newspaper, journal, magazine	30	13.67
	Hospital manual	62	28.18
	Poster, pamphlet	29	13.18
	Books	30	13.64
	Television	14	6.37
	Other	55	25
Participation in in-service education on spiritual care	No	104	47.27
	Yes	116	52.73
Time for family commitment	Yes	82	37.27
	No	138	62.73

The overall spiritual care competency score mean was 100.71±10.60 (minimum of 65 and maximum of 129). The scores earned by the registered nurses in the NICC (Apeksha Hospital) are indicated in table 2. Among the subscales of the SCCS, the subdomain communication scored the highest with a mean value of 4.086±0.7382. The lowest scored subdomain is assessment and implementation of spiritual care (3.6061±0.519).

Table 2. Mean and SD of Items of spiritual care competency scale.

Number	Scale items	Mean	SD
	Assessment and implementation of spiritual care	3.6061	±0.51915
1	I can report orally and/or in writing on a patient’s spiritual needs	3.67	±0.743
2	I can tailor care to a patient’s spiritual needs/problems in consultation with the patient	3.76	±0.688
3	I can tailor care to a patient’s spiritual needs/problems through multidisciplinary consultation	3.78	±0.979
4	I can record the nursing component of a patient’s spiritual care in the nursing plan	3.49	±0.836
5	I can report in writing on a patient’s spiritual functioning	3.25	±1.089
6	I can report orally on a patient’s spiritual functioning	3.69	±0.858
	Professionalisation and improving the quality of spiritual care	3.6409	±0.5511
7	Within the nursing ward, I can contribute to quality assurance in the area of spiritual care	3.78	±0.587
8	Within the nursing ward, I can contribute to professional development in the area of spiritual care	3.64	±0.938
9	Within the nursing ward, I can identify problems relating to spiritual care in peer discussions sessions	3.69	±0.751
10	I can coach other care workers in the area of spiritual care delivery to patients	3.65	±0.805
11	I can make policy recommendations on aspects of spiritual care to the management of the nursing ward	3.49	±0.884
12	I can implement a spiritual-care improvement project in the nursing ward	3.60	±0.899
	Personal support and patient counselling	3.7780	±0.4717
13	I can provide a patient with spiritual care	3.66	±0.725
14	I can evaluate the spiritual care that I have provided in consultation with the patient and in the disciplinary/multidisciplinary team	3.69	±0.660
15	I can give patient information about spiritual facilities within the care institution	3.75	±0.688
16	I can help a patient continue his or her daily spiritual practices (including providing opportunities for rituals, prayer, meditation, reading the Bible/Koran, listening to music)	4.01	±0.553
17	I can attend to a patient’s spirituality during the daily care (eg, physical care)	3.77	±0.858
18	I can refer members of a patient’s family to a spiritual advisor/pastor, etc If they ask me and/or if they express spiritual needs	3.79	±0.903
	Referral	3.6242	±0.5927
19	I can effectively assign care for a patient’s spiritual needs to another care provider/care	3.52	0.830
20	At the request of a patient with spiritual needs, I can in a timely and effective manner refer him or her to another care worker (eg, a chaplain/the patient’s own priest/imam)	3.64	±0.743
21	I know when I should consult a spiritual advisor concerning a patient’s spiritual care	3.72	±0.599
	Attitude towards patient spirituality	3.8807	±0.5824
22	I show unprejudiced respect for a patient’s spiritual/religious beliefs regardless of his or her spiritual/religious background	3.70	±0.764
23	I am open to a patient’s spiritual/religious beliefs, even if they differ from my own	3.73	±0.750
24	I do not try to impose my own spiritual/religious beliefs on a patient	3.94	±1.012
25	I am aware of my personal limitations when dealing with a patient’s spiritual/religious beliefs	4.15	±0.780
	Communication	4.0865	±0.7382
26	I can listen actively to a patient’s ‘life story’ in relation to his or her illness/handicap	4.09	±0.815
27	I have an accepting attitude in my dealings with a patient (concerned, sympathetic, inspiring trust and confidence, empathetic, genuine, sensitive, sincere and personal)	4.09	±0.751

The lowest scored item from each subdomain was extracted out to show the problematic areas that emerged in practice (table 3). Highest competencies scored above four were only four items: I can help a patient continue his or her daily spiritual practices (including providing opportunities for rituals, prayer, meditation, reading the Bible/Koran, listening to music) with a score of 4.01 (±0.553) item mean, I am aware of my personal limitations when dealing with a patient’s spiritual/religious beliefs with a score of 4.15 (±0.780) item mean, I can listen actively to a patient’s ‘life story’ in relation to his or her illness/handicap with a score of 4.09 (±0.815) item mean, I have an accepting attitude in my dealings with a patient (concerned, sympathetic, inspiring trust and confidence, empathetic, genuine, sensitive, sincere and personal) with a score of 4.09 (±0.751) item mean.

Table 3. Problematic areas to improve in spiritual care competency in registered nurses in Sri Lanka.

Subdomains	Item	Mean	SD
Assessment and implementation of spiritual care	I can report in writing on a patient’s spiritual functioning	3.25	±1.089
Professionalisation and improving the quality of spiritual care	I can make policy recommendations on aspects of spiritual care to the management of the nursing ward	3.49	±0.884
Personal support and patient counselling	I can provide a patient with spiritual care	3.66	±0.725
Referral	I can effectively assign care for a patient’s spiritual needs to another care provider/care	3.52	0.830
Attitude towards patient spirituality	I show unprejudiced respect for a patient’s spiritual/religious beliefs regardless of his or her spiritual/religious background	3.70	±0.764

The relationship between selected demographic variables and nurses’ Spiritual Care Competency Scores (SCCS) was examined using appropriate statistical analyses. Gender differences were assessed using the Mann-Whitney U test, which showed that male nurses had a higher mean rank (144.72) than female nurses (109.04), but the difference was not statistically significant (U=641.500, p=0.099). An independent samples t-test revealed a significant difference in SCCS based on marital status, with married nurses scoring higher than unmarried nurses (mean difference=4.53, t (218)=3.218, 95% CI (1.76 to 7.31), p=0.001). Similarly, in-service spiritual care education was significantly associated with higher SCCS (mean difference=−3.39, t (218)=−2.390, 95% CI (−6.18 to –0.59), p=0.018). Nurses who reported having time for family responsibilities also scored significantly higher than those who did not (mean difference=4.05, t (218)=2.778, 95% CI (1.18 to 6.92), p=0.006). However, the educational level did not show a significant difference in SCCS between diploma and degree holders (t (218)=−0.557, mean difference=−0.91, p=0.578). The relationship between working hours per day and SCCS was assessed using Spearman rank correlation, which indicated a weak negative but non-significant correlation (ρ=−0.127, p=0.060). Finally, simple linear regression analyses demonstrated that both age and working experience were significant predictors of SCCS. For age, each additional year was associated with a 0.192 point increase in SCCS (B=0.192, β=0.155, F(1,218)=5.384, p=0.021), and for working experience, each additional year was associated with a 0.242 point increase (B=0.242, β=0.181, F(1,218)=7.393, p=0.007) (table 4).

Table 4. Association between sociodemographic variables and Spiritual Care Competency Score (SCCS).

Demographic variable	Test used	Key result	P value	Interpretation
Gender	Mann-Whitney U	U=641.500, mean rank (M=144.72, F=109.04)	0.099	Not significant. Males had higher ranks, but difference was not statistically significant.
Marital status	Independent Samples t-test	t (218)=3.218, mean diff=4.53, 95% CI (1.76 to 7.31)	0.001*	Significant. Married nurses scored higher on SCCS than unmarried nurses.
Educational level	Independent Samples t-test	t (218)=−0.557, mean diff=−0.91	0.578	Not significant. No difference in SCCS between diploma and degree holders.
In-service spiritual education	Independent Samples t-test	t (218)=−2.390, mean diff=−3.39, 95% CI (–6.18 to –0.59)	0.018*	Significant. Those who attend scored higher on SCCS.
Time for family commitment	Independent Samples t-test	t (218)=2.778, mean diff=4.05, 95% CI (1.18 to 6.92)	0.006*	Significant. Those with time for family had higher SCCS.
Working hours per day	Spearman Rank Correlation	ρ=−0.127	0.060	Not significant. Weak negative relationship with SCCS.
Age	Simple Linear Regression	B=0.192, β=0.155, F(1218)=5.384	0.021*	Significant. Each year of age is associated with a 0.192-point increase in Spiritual Care Competency.
Working experience	Simple Linear Regression	B=0.242, β=0.181, F (1218)=7.393	0.007*	Significant. Each year of experience adds 0.242 to SCCS.

*p<0.05 statistically significant.

Discussion

The study indicated that the overall mean spiritual care competency score of nurses at the NICC falls within the competent range but has not reached a high competency level. However, certain problematic areas were identified, particularly in the assessment and implementation of spiritual care, as well as in the professionalisation and quality improvement of spiritual care. The mean values in these areas fell below the low competency threshold. Other subdomains maintained scores within the competent range, yet none achieved a high level of competency. Consequently, the findings reveal that the spiritual care competency level of registered nurses at the NICC remains one step below excellent. Addressing this lack of competency is urgent, given that these nurses care for a vulnerable population, including patients diagnosed or potentially diagnosed with minor or major cancers. Additionally, high scores in spiritual care competency were significantly associated with sociodemographic factors such as marital status, participation in in-service educational programmes for spiritual care, family commitment time, age and the work experience of the nurses.

To date, there have been no recorded scientific articles published using spiritual care competency score questionnaire in the Sri Lankan context. However, numerous countries used this questionnaire to identify the spiritual care competency level of their respective nurses. Numerous studies identified which were published after 2018 observed the spiritual care competency level of nurses. Among them, only, an Iranian study,³² Turkish study and a study conducted in the USA⁷ using nurses reported a higher spiritual competency score than the current study. There were a number of other studies conducted in Asia, like China, Korea and Taiwan, that reported very low spiritual care competency scores.³³³,³⁵ Furthermore, an Egyptian study also recorded very low spiritual care competency levels using the same instrument.^{36 37}

Especially considering the highlighted competencies in the current study, the domain communication and attitudes towards patient spirituality received the highest mean value as a subdomain. Similar observations were reported in a USA study.⁷ Confirming the background of the USA, another study,²² from the USA confirmed that communication reported as the competency scored the best by nurses. Interestingly, the items included in the communication subdomain scored the highest score in Sri Lanka, which was the same for the USA study.²² A study conducted in the Netherlands also provided the same results that showcased the highest competence for communication for their nurses.¹⁷ Agreeing to the above findings, Taiwanese, Korean and Chinese studies reported communication as their best competency towards spiritual care and attitudes towards patient spirituality were highlighted in both Korean and Chinese studies, which recorded high scores for attitudes towards patient spirituality domain as well.³³,³⁵ Low spiritual care-related competencies were reported for the Sri Lankan context for the domain assessment and implementation of spiritual care, and if presented item-wise, the lowest means, “I can record the nursing component of a patient’s spiritual care in the nursing plan’, ‘I can report in writing on a patient’s spiritual functioning’ and ‘I can make policy recommendations on aspects of spiritual care to the management of the nursing ward’ were the lowest scored items of the scale which reported low competency. Interestingly, a consistently similar pattern was observed for the USA study.⁷ Also, another USA study²² and Netherlands study¹⁷ reported that the least competent subdomain area was professionalisation and improving quality of spiritual care. Interestingly, the Chinese study reports referral to professionals as the lowest scored subdomain. This is convincing because the current study also identified that the item ‘I can effectively assign care for a patient’s spiritual needs to another care provider/care’ scored a low mean value.³⁵ It was noted that regardless of the geographical area, there are a majority of similarities reported in high competencies and low competencies among nurses regarding spiritual care.

In the current study, several demographic variables showed significant associations with nurses’ spiritual care competency. Notably, participation in in-service education programmes, age, years of work experience and time allocated for family commitments emerged as significant associated factors with spiritual care competency score. Participating in an in-service programmes on spiritual care has shown its association with spiritual care competency scores, suggesting the critical role of ongoing professional development in enhancing competence levels. Similarly, increased age and longer work experience were moderately associated with higher competency, possibly reflecting the cumulative effect of clinical exposure and maturity. Nurses who reported more time for family commitments also showed higher competency levels, which may indicate the influence of personal life balance on one’s capacity for providing holistic care.

In contrast, gender, educational level and number of working hours per day did not show statistically significant associations. This suggests that formal educational attainment alone may not be sufficient to foster spiritual care competency without targeted training or reflective practice.

These findings partially align with previous literature. For instance, a study conducted in the USA by Green et al reported a significant relationship with years of experience, but not with age, indicating that experiential learning plays a more dominant role than chronological maturity.⁷ In Taiwan, Chen et al found that prior training in spiritual care, educational level and frequency of religious service attendance were significant predictors of competency.³ Another study in Taiwan by Hsieh et al highlighted a broader range of influencing factors, including age, work experience, clinical ladder level, interest in spirituality and exposure to role models and spiritual care scenarios.³³ Similarly, a Chinese study by Li et al supported the association between work experience and spiritual care competency.³⁵ However, an Iranian study by Heidari et al reported no significant associations between sociodemographic characteristics and competency, suggesting cultural or contextual variability in influencing factors.³²

In conclusion, the current study reinforces the importance of experience, age and specialised training as key contributors to spiritual care competency among nurses. The variability in findings across different countries also indicates the potential influence of contextual and cultural factors. Future research could incorporate broader variables such as institutional support, spirituality in practice settings and personal beliefs of nurses to develop a more comprehensive understanding of spiritual care competency.

In general, there were few coinciding areas of the current study and previous studies conducted in the world. Such as the working experience behaves as a common element that is significantly related to spiritual care competency scores. The other important sociodemographic factor is participating in in-service or educational programmes in spiritual care. Another study highlighted the same fact, which emphasises the strong requirement of well-structured professional development programmes. Incorporating spiritual care modules into preservice and in-service programmes on time would help to bridge the competency gap.

Strengths and limitations

There were some strengths and limitations of the current study as well. One major strength is that according to the authors’ knowledge, this is the first study to assess spiritual care competency using SCCS-27 in a Sri Lankan context. This can contribute as valuable baseline data for future research and nursing education.

However, there were some limitations recognised as well. This study was conducted only in one healthcare institution, which limits the generalisability of findings to other healthcare settings with different patient populations, cultural dynamics or organisational structures. While NICC is the largest specialised cancer care facility in Sri Lanka, nurses working in general hospitals, rural settings or primary care units may have different experiences and opportunities related to spiritual care, potentially affecting the external validity of the results.

Another limitation is the reliance on a quantitative, self-administered questionnaire, which may not fully capture the complexity of spiritual care in practice. The risk of self-reporting bias may have influenced responses, especially when assessing one’s own competencies in a sensitive area like spirituality.

Moreover, the study did not explore contextual or institutional factors such as workload and leadership support, which could significantly influence spiritual care delivery but were not within the scope of this investigation.

The current study results can nonetheless pave the way for qualitative inquiries, which would enable a deeper understanding of the lived experiences, practical barriers and contextual factors affecting spiritual care provision among nurses. It is also recommended that future studies incorporate patient perspectives to understand how nurses’ spiritual care competencies are perceived by care recipients, thereby offering a more comprehensive view of the impact and effectiveness of spiritual care in clinical practice.

Conclusions

The study concludes that the spiritual care competency level of nurses at the NICC is moderate. The highest competency observed was in the communication subdomain. This study represents the first assessment of spiritual care competency among Sri Lankan nurses. Consequently, it is recommended that further research implements structured educational programmes and strengthens institutional support for spiritual care practices. Such measures are essential to ensure holistic patient care in cancer settings.

Implications for practice

Enhancing spiritual care competency among nurses at the NICC requires implementing advanced communication training, continuous education programmes focused on spiritual care and robust institutional support. Integrating spiritual care into standard care protocols, promoting further research to address competency gaps and designing training programmes that consider sociodemographic influences are essential steps. By addressing these areas, healthcare providers can ensure comprehensive and compassionate care for patients with cancer.

Data availability statement

Data are available on reasonable request.