Abstract
Inadequate spiritual care competence negatively impacts the quality of care for older people, particularly in multicultural contexts. This study explores the spiritual care competence of geriatric nurses in China and the influencing predictors. Participants were selected through convenience sampling between June 2021 and March 2022. The Chinese version of the Spiritual Care Competency Questionnaire (C-SCC) assessed the spiritual care competencies of geriatric nurses. Data were analyzed using SPSS 25.0 through nonparametric tests and multiple linear regression. The median total spiritual care competence score indicated a moderate level of competence. The highest scores were in spiritual care knowledge literacy and spirituality/spiritual care value cognition, while spiritual self-awareness scored lowest. Regression analysis found that nurses with higher monthly incomes (¥8,000–¥9,999 or ≥ ¥10,000) had significantly greater spiritual care competence than those earning ≤ ¥4,999. Permanent civil service employees scored higher than short-term contract workers. Nurses currently participating in spirituality-related training scored higher than those not taking such training. Higher scores were also associated with being satisfied with providing gerontology care services, perceiving spiritual care for older adults as very necessary or necessary (vs. unnecessary), and expressing a strong or moderate desire for spiritual care training (P < 0.05). Spiritual care competence was shaped by controllable and uncontrollable factors in a multicultural context. Enhancing this competence promotes equity in spiritual health.
Keywords: Spirituality, Spiritual care competence, Geriatric nurses, Predictors
Introduction
The aging population is driving an increased demand for gerontology care services, particularly in addressing spiritual needs (Jadidi et al., 2022). Older adults, especially those with chronic illnesses or nearing the end of life, have substantial spiritual needs (Can Oz et al., 2022; McDonald et al., 2018). However, caregivers frequently struggle to meet spiritual care needs. Studies indicate that 93% of individuals require spiritual care, with 60% of these being chronically ill older adults (Harrad et al., 2019; Wang et al., 2024). Spiritual needs are increasingly recognized as a vital component of holistic care for older adults, influencing their health outcomes and quality of life (Zadworna-Cieślak, 2020). Despite their significance, spiritual needs remain understudied, partly due to healthcare providers' limited capacity to identify and address them (Peteet et al., 2019). Several studies highlight unmet spiritual needs among institutionalized older adults, particularly in religious and existential dimensions, underscoring the urgency to integrate spiritual care into standard practice (Britt et al., 2023; Jadidi et al., 2022). Therefore, addressing spiritual needs is a fundamental factor in providing high-quality medical care (Connolly & Timmins, 2021), and actively meeting the spiritual needs of older adults is a key component of delivering high-quality care services.
Spiritual care is an essential component of holistic care that aims to meet individuals’ spiritual needs during periods of trauma, illness, or sorrow (Hu et al., 2019). Studies have shown that the role of clinical nurses in holistic care is now widely recognized, but they often demonstrate only moderate spiritual care competence (Seid & Abdo, 2022). Although some caregivers hold positive attitudes toward spiritual care and believe they possess adequate knowledge, they may lack practical guidance in implementing spiritual interventions (Babamohamadi et al., 2018). Several barriers hinder effective spiritual care practice, including inadequate skills, low confidence and spiritual awareness, and limited resources compounded by time constraints (Dobrowolska et al., 2022; Lycett & Patel, 2023). Therefore, exploring predictors of spiritual care competence was the primary focus of this study.
Geriatric nurses, defined as registered nurses with specialized training and at least one year of experience in gerontology care, are equipped to independently deliver a variety of nursing services, including health promotion, disease prevention, acute and chronic treatment, rehabilitation, and end-of-life care (Cheng & Chen, 2025). Spiritual care is an essential skill that geriatric nurses must possess (O'Brien et al., 2019). Older patients view nursing professionals as valuable sources of spiritual information, capable of meeting their spiritual needs, and they believe that nurses are willing to address these needs (Wang et al., 2022). As primary caregivers, the spiritual care competence of geriatric nurses is crucial for addressing the spiritual needs of older adults, in line with the care service requirements for this population. However, research on spiritual care competence among geriatric nurses, especially within the multicultural context of China, remains insufficient.
This study aims to fill this gap by surveying geriatric nurses, assessing their spiritual care competence, and identifying both facilitators and barriers. The findings will offer valuable insights for developing theoretical frameworks and practices to enhance gerontology care services and promote equitable spiritual health globally.
Methods
Design
This descriptive, cross-sectional correlational study utilized convenience sampling to recruit participants between June 2021 and March 2022. The study adhered to the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines for reporting observational research (Şahin Altun et al., 2022). Following informed consent procedures, surveys were distributed through academic institutions, hospital settings, professional organizations, and community networks that met the predetermined inclusion criteria. To enhance sample size and diversity, a snowball sampling technique was employed by encouraging participants to refer other eligible nurses meeting the study criteria. This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Biomedical Ethics Subcommittee of local Hospital (No.2020–697).
Participant and Sample
The survey targeted registered nurses working in geriatric wards, including those in geriatric specialist hospitals, general hospitals, nursing homes, and communities. Additionally, departments were considered eligible if geriatric inpatients constituted more than 50% of the patients in the department over the past two years (e.g., respiratory medicine, nephrology, cardiology). The recommended sample size for the survey is typically 5–10 times the number of survey items, accounting for a 20% attrition rate, with a minimum sample size of 636. Inclusion criteria were as follows: (1) an education level of a college degree or above, with a minimum work experience of two years and at least one year of training in geriatric knowledge and skills, and (2) informed consent and voluntary participation in the survey. Exclusion criteria were as follows: (1) geriatric nurses not actively engaged in primary clinical work during the survey period for reasons such as further education or leave; (2) nurses not currently employed in the field of geriatric care (e.g., transferred or resigned) during the survey period; (3) data with completion times of the assessment tool being less than 233 s; and (4) individuals previously diagnosed with depressive disorders, anxiety disorders, bipolar disorders, or other neurofunctional/organic mental illnesses.
Instruments
We designed a general information survey based on a synthesis of literature and field investigations. The Chinese Spiritual Care Competency Questionnaire (C-SCC) was developed by our research group based on preliminary research through a scoping review, Roger’s concept analysis, semi-structured in-depth interviews, and expert consultation (Cheng & Chen, 2025). It comprised 53 items distributed across four dimensions: spiritual care knowledge literacy (19 items), spiritual care implementation skills (12 items), spiritual self-awareness (11 items), and spirituality/spiritual care values cognition (11 items). A 5-point Likert scale was employed, with a total score range between 53 and 265, where higher scores indicate greater spiritual care competence. The questionnaire exhibited robust psychometric properties, including an S-CVI/UA of 0.87, an S-CVI/AVE of 0.99, internal consistency reliability (Cronbach’s α = 0.98), retest reliability (Spearman’s coefficient = 0.983), and construct validity (with total variances explained by the extracted factors from the four domains exceeding 80%). Confirmatory factor analysis indicated a favorable model fit (X2/df = 1.889, RMR ≤ 0.05, RMSEA < 0.05, and GFI, AGFI, IFI, TLI, and CFI > 0.9).
Data Collection
Data were collected through a survey distributed via Questionnaire Star, targeting academic conference groups, experts, and survey participants. The tool allowed breakpoint answering for progress saving. After reviewing responses, we excluded 90 invalid submissions, including five non-geriatric nurses, 78 with completion times under 223 s, and seven with uniform responses. Ultimately, 1,094 nurses met the inclusion criteria, yielding a response rate of 92.4%.
Statistical Analysis
Data were analyzed using SPSS (version 25.0) software. Frequency and constitutive ratios were used to describe the count data. Results of the normality test indicated that the overall scores and dimension scores of the measurement tool did not follow a normal distribution. Therefore, comparisons between two independent samples were conducted using the Mann–Whitney U nonparametric test. For multiple group comparisons, the Kruskal–Wallis H nonparametric test was employed, and pairwise comparisons among multiple samples were performed using rank transformation analysis. Multiple linear regression analysis was conducted to identify predictors of spiritual care competence, adjusting for various background control variables such as demographic and professional characteristics (e.g., age, sex, ethnicity, education, and others). Statistical significance was set at P < 0.05.
Results
The study sample consisted of 1,094 eligible participants, with a predominance of female respondents (95.2%, n = 1,041). The majority were Han Chinese (84.5%, n = 925), with age groups primarily distributed between 30 and 39 years (48.8%, n = 534) and 20–29 years (37.8%, n = 414). Professionally, nurse practitioners constituted 43.7% (n = 478) of participants. Regarding socioeconomic indicators, most participants reported positive family relationships (87.4%, n = 956), and the largest income bracket was ¥5,000–¥7,999 monthly (40.6%) (Table 1).
Table 1.
Characteristics of the participants (1094)
| N(%) | F1 | F2 | F3 | F4 | Total scores | ||
|---|---|---|---|---|---|---|---|
| Sex | Male | 53(4.8) | 38(27,56) | 28(21.5,36) | 25(18.5,31.5) | 23(13.5,32.5) | 117(86,149) |
| Female | 1041(95.2) | 38(23,43) | 27(21,34.5) | 26(21,31) | 22(17,29) | 110(86,134) | |
| Z | − 1.866 | − .537 | − .400 | − .881 | − 1.070 | ||
| P | .062 | .592 | .689 | .379 | .285 | ||
| Ethnicity | Han | 924(84.5) | 37.5(23,42) | 26(21,34) | 26(21,31) | 22(16,29) | 110(84,133) |
| Ethnic minority | 170(15.5) | 38(26,50) | 29.5(22,36) | 26.5(21,32) | 23(20,32) | 111(93,146.5) | |
| Z | − 2.392 | − 1.344 | − .886 | − 2.077 | − 1.773 | ||
| P | .017 | .179 | .376 | .038 | .076 | ||
| Age | 20–29 | 414(37.8) | 38(22,45) | 26(20,32) | 26(20,32) | 22(16,31) | 112(78.75,141.25) |
| 30–39 | 534(48.8) | 37(24.75,42.25) | 27(22,35) | 26(21,31) | 22(17,29.25) | 111(90,133.25) | |
| ≥ 40 | 146(13.3) | 34(21,40.25) | 25.5(18,33) | 23(19,29) | 22(13,26) | 105(75.75,127) | |
| H | 5.347 | 4.139 | 9.555 | 4.513 | 6.452 | ||
| P | .069 | .126 | .008 | .105 | .040 | ||
| Relationship to family members | Discordant relationship | 138(12.6) | 39(25, 50.25) | 29(24, 36) | 29 (22, 33) | 25(20.75, 32) | 121(98.75, 149) |
| Harmonious relationship | 956(87.4) | 37 (23, 42) | 26(21, 34) | 25(21, 31) | 22(16, 29) | 109(84, 132) | |
| Z | − 2.793 | − 2.166 | − 3.293 | − 3.160 | − 3.171 | ||
| P | .005 | .030 | .001 | .002 | .002 | ||
| Highest educational level | Vocational School/College/Technical School | 308(28.2) | 38(24,46.75) | 26.5(20,35) | 27(21,32) | 22(17,31) | 113.5(84,143) |
| Bachelor's degree | 760(69.5) | 37(23,42) | 27(21,34) | 25(21,31) | 22(17,28) | 110(86,132) | |
| Master's degree and above | 26(2.4) | 30(22.52.5) | 31(26.5,38.5) | 23(20,30.75) | 22(12,31.25) | 114(85,151.75) | |
| Z | 4.014 | 6.785 | 1.638 | 3.677 | 2.047 | ||
| P | .134 | .034 | .441 | .159 | .359 | ||
| Monthly income (RMB) | ≦4999 | 351(32.1) | 38 (26, 48) | 27(22, 36) | 27(20, 32) | 23(18, 32) | 114(93, 145) |
| 5000–7999 | 444(40.6) | 38(25, 42) | 27(22, 34) | 26(22, 31) | 22(18.25, 29) | 111(91, 132.75) | |
| 8000—9999 | 163(14.9) | 30(21, 39) | 27(17, 34) | 25(20, 30) | 22(14, 26) | 107(77, 125) | |
| ≧10,000 | 136(12.4) | 29.5(19.25, 39) | 25(19, 33) | 23(16, 29) | 21(11, 24) | 102.5(71, 125.75) | |
| H | 16.622 | 0.917 | 4.864 | 7.416 | 7.643 | ||
| P | .000 | .632 | .088 | .025 | .022 | ||
| Employment type | Permanent vivil service position | 234 (21.4) | 32(21, 38) | 25(18.75, 32) | 24(20, 30) | 22(14, 25) | 106 (77.5, 122) |
| Personnel agency | 79 (7.2) | 38(28, 43) | 27(24, 34) | 25 (20, 31) | 22 (16, 30) | 115(95, 131) | |
| Short-term contract worker | 198 (18.1) | 38(22, 47.25) | 28(20.75, 34) | 26.5(20, 32) | 22(17.75, 31) | 116.5(82.25, 144) | |
| Long-term contract worker | 583 (53.3) | 38(24, 46) | 27 (22, 35) | 26 (21, 32) | 22(18, 31) | 111(89, 139) | |
| H | 20.906 | 4.696 | 9.421 | 15.349 | 14.853 | ||
| P | .000 | .195 | .024 | .002 | .002 | ||
| Professional title | Nurse | 243 (22.2) | 38(24, 45) | 25(20, 34) | 25(21, 31) | 22(16, 30) | 108(83, 138) |
| Senior nurse | 478 (43.7) | 38(22, 47) | 28(20, 35) | 27(21, 32) | 22(17, 31) | 116(83, 143) | |
| Chief senior nurse | 331 (30.3) | 34(23, 39) | 27(21, 33) | 24(21, 30) | 22(15, 26) | 107(86, 125) | |
| Deputy director and above | 42 (3.8) | 32.5(24, 40) | 27(23, 32.5) | 23.5(21, 30) | 22(18, 28.5) | 106.5(89, 120.5) | |
| H | 12.713 | 3.613 | 8.313 | 11.456 | 9.787 | ||
| P | .005 | .306 | .040 | .009 | .020 | ||
| Received spiritual care training during academic studies | Yes | 292 (26.7) | 33 (19, 39) | 24 (15, 30) | 22 (15, 28) | 21 (11, 25.75) | 100 (63.25, 122.75) |
| No | 802 (73.3) | 38 (25, 44) | 29 (23, 35) | 27 (22, 32) | 22 (20, 31) | 115 (93, 141) | |
| Z | − 4.611 | − 7.408 | − 8.808 | − 6.983 | − 7.180 | ||
| P | .000 | .000 | .000 | .000 | .000 | ||
| Received spiritual care training during professional employment | Yes | 540 (49.4) | 32.5 (20, 39) | 24 (16, 31) | 23(18, 29) | 22 (12, 25) | 105 (71, 121) |
| No | 554 (50.6) | 38 (28, 49) | 31 (24, 36) | 29 (23, 33) | 23 (21, 32) | 120(102.75, 149) | |
| Z | − 7.944 | − 9.757 | − 10.110 | − 8.943 | − 9.686 | ||
| P | .000 | .000 | .000 | .000 | .000 | ||
| Currently taking spirituality-related training | Yes | 532 (48.6) | 32.5 (20, 39) | 24 (16, 31) | 23 (18, 28) | 22 (12, 25) | 104 (71, 121) |
| No | 562 (51.4) | 38 (28, 49) | 31(24, 36) | 29 (23, 33) | 23 (21, 32) | 120 (102.8, 149) | |
| Z | − 8.181 | − 9.757 | − 10.110 | − 8.943 | − 9.686 | ||
| P | .000 | .000 | .000 | .000 | .000 | ||
| Satisfaction with providing gerontology care services | Satisfied | 766 (70.0) | 33.5(21, 39) | 24(17, 32) | 24 (19, 29) | 22(13, 25) | 105.5(75, 122) |
| Neutral | 304 (27.8) | 39 (33, 55) | 33(26, 36) | 31(25, 33) | 27(22, 33) | 128(109, 154) | |
| Dissatisfied | 24 (2.2) | 41.5(36, 58.75) | 34 (28.5, 37.8) | 30.5(24, 34) | 27.5(21, 33) | 142 (109, 164) | |
| H | 91.745 | 125.894 | 130.606 | 110.392 | 139.333 | ||
| P | .000 | .000 | .000 | .000 | .000 | ||
| Years of experience in gerontology care | 1–2 | 242 (22.1) | 38(25, 43.25) | 28(23, 35) | 27(22, 31.25) | 22(19, 30) | 113.5(95, 138.25) |
| 3–7 | 393 (35.9) | 38(25, 45) | 27 (22, 35) | 26(21, 32) | 22(18, 31) | 112(87, 138) | |
| 8–12 | 264 (24.1) | 35(21, 41) | 25 (21, 33) | 25(20.25, 31) | 22(15, 27) | 107.5(82, 127) | |
| ≥ 13 | 195 (17.8) | 35(21, 44) | 26(17, 35) | 24(17, 31) | 22(13, 28) | 108(74, 137) | |
| H | 10.540 | 5.139 | 8.313 | 7.812 | 9.573 | ||
| P | .014 | .162 | .040 | .050 | .023 | ||
| Perceived need to spiritual care practice for older people | Very necessary | 635 (58.0) | 29(20, 38) | 24(15, 31) | 23(17, 29) | 21(12,23) | 100(69,117) |
| Necessary | 444 (40.6) | 39(34.25, 54) | 32(25, 36) | 29(24, 33) | 26( 22, 33) | 126(107.3, 152.8) | |
| Unnecessary | 15 (1.4) | 62(57, 76) | 39(36, 46) | 36(33, 43) | 33( 33, 53) | 165(159, 206) | |
| H | 213.621 | 182.571 | 175.047 | 222.607 | 241.471 | ||
| P | .000 | .000 | .000 | .000 | .000 | ||
| Desire for spiritual care training | Very hopeful | 546 (49.9) | 27 (20, 38) | 24 (14, 30.3) | 22(16, 28) | 21(11, 23) | 98(67, 115) |
| Hopeful | 524 (47.9) | 39(32, 50) | 30.5 (24, 36) | 29 (24, 33) | 24.5 (22, 33) | 123.5(106, 149) | |
| Not hopeful | 24 (2.2) | 57(56.3, 65.3) | 37(36, 43) | 33 (30.5, 40.5) | 33 (33, 37.8) | 159(156.5, 177.8) | |
| H | 198.811 | 174.420 | 189.825 | 199.712 | 231.669 | ||
| P | .000 | .000 | .000 | .000 | .000 | ||
| Religion | Yes | 326 (29.8) | 37(22,42.25) | 25(20,32) | 24(20,30.25) | 22(13.75,27) | 107(81.75,127.25) |
| No | 768 (70.2) | 38(24,43) | 28(22,35) | 27(21,32) | 22(18,31) | 112(87.25,138) | |
| Z | − 1.212 | − 2.944 | − 3.308 | − 3.079 | − 2.643 | ||
| P | .226 | .003 | .001 | .002 | .008 | ||
| Ways of accessing resources for spiritual care | School education | 48 (4.4) | 34.5(19,39) | 23.5(12.25,26) | 21(11,26.75) | 21.5(11,23.75) | 99.5(58.25,117.25) |
| Continuing education | 212 (19.4) | 36(21.25,40.75) | 25(19,33) | 25.5(20,30) | 22(15,28) | 108(78,129) | |
| Independent learning | 126 (11.5) | 34.5(21.75,46.5) | 25(18,33) | 25(20,30.25) | 22(13.75,30) | 108(77.75,138) | |
| Schools and Continuing Education | 65 (5.9) | 36(20,43) | 24(19,33.5) | 24(17,32.5) | 22(11,31.5) | 105(73,135) | |
| Schools and independent learning | 30 (2.7) | 30.5(19,38) | 24(13,31) | 21.5(12.5,25.5) | 21(11,22) | 101.5(57.75,112.25) | |
| Independent learning and continuing education | 194 (17.7) | 34(22,38.25) | 25(20,32) | 24(21,28.25) | 22(15.75,25) | 106(87,119.25) | |
| School, independent learning and continuing education | 94 (8.6) | 33.5(22,40.25) | 24. 5 (14,32) | 23(20,29) | 22(11,24) | 105.5(71,121) | |
| No spiritual education | 325 (29.7) | 39(30,54) | 32(24,36) | 30(24,33) | 25(22,33) | 126(106,153) | |
| H | 62.780 | 93.293 | 115.900 | 88.545 | 98.490 | ||
| P | .000 | .000 | .000 | .000 | .000 |
F1 = spiritual care knowledge literacy; F2 = spiritual care implementation skills; F3 = spiritual self-awareness; F4 = spirituality/spiritual care values
Table 2 displays the results of the Shapiro–Wilk normality test for the total and mean scores of the dimensions of spiritual care competence among geriatric nurses. Consequently, descriptive statistics were utilized, including the median (P50) and interquartile ranges (P25, P75). The median total spiritual care competence score for geriatric nurses was 208, reflecting a moderate level of competence (median score: 3.92). The highest-scoring dimensions were spiritual care knowledge literacy and spirituality/spiritual care value cognition, while spiritual self-awareness received the lowest score at 3.64 (Table 3).
Table 2.
Normality test
| Kolmogorov–Smirnova | Shapiro–Wilk | |||||
|---|---|---|---|---|---|---|
| Statistic | df | P | Statistic | df | P | |
| Spiritual care knowledge literacy | .101 | 1094 | .000 | .925 | 1094 | .000 |
| Spiritual care implementation skills | .079 | 1094 | .000 | .952 | 1094 | .000 |
| Spiritual self-awareness | .073 | 1094 | .000 | .967 | 1094 | .000 |
| Spirituality/spiritual care values cognition | .109 | 1094 | .000 | .926 | 1094 | .000 |
| Median mean total score | .054 | 1094 | .000 | .967 | 1094 | .000 |
Table 3.
The scores of C-SCC for geriatric nurses
| Items | No | P50 | (P25, P75) | ||
|---|---|---|---|---|---|
| Total | Mean | Total | Mean | ||
| Mean total score | 53 | 208.00 | 3.92 | (183.00,232.00) | (3.45, 4.38) |
| Spiritual care knowledge literacy | 19 | 76.00 | 4.00 | (71.00, 91.00) | (3.74, 4.79) |
| Spirituality/spiritual care values cognition | 11 | 44.00 | 4.00 | (36.00, 49.00) | (3.27, 4.45) |
| Spiritual self-awareness | 11 | 40.00 | 3.64 | (35.00, 45.00) | (3.18, 4.09) |
| Spiritual care implementation skills | 12 | 45.00 | 3.75 | (37.00, 51.00) | (3.08, 4.25) |
In the univariate analysis, median spiritual care competence scores were statistically significant (P < 0.05) for factors including age, relationship to family members, monthly income (RMB), employment type, professional title, received spiritual care training during academic studies, received spiritual care training during professional employment, currently taking spirituality-related training, satisfaction with providing gerontology care services, years of experience in gerontology care, perceived need to spiritual care practice for older people, desire for spiritual care training, and ways of accessing resources for spiritual care (Table 1).
Multiple linear regression resulted in an adjusted R2 value of 0.349 and a variance inflation factor of 1.138 (F = 19.349, P = 0.000). The results showed that monthly income (in RMB: ¥8,000–¥9,999 vs. ≤ ¥4,999; and ≥ ¥10,000 vs. ≤ ¥4,999), employment type (permanent civil service position vs. short-term contract worker), currently taking spirituality-related training (no vs. yes), satisfaction with providing gerontology care services (satisfied vs. dissatisfied), the perceived need to spiritual care practice for older people (very necessary vs. unnecessary; necessary vs. unnecessary), and the desire for spiritual care training (very hopeful vs. not hopeful; hopeful vs. not hopeful) significantly predicted spiritual care competence (P < 0.05) (Table 4).
Table 4.
Results of multiple linear regression model
| Items | C-SCC | |||
|---|---|---|---|---|
| Beta | T | P | ||
| Monthly income (RMB) | 8000–9999 versus ≦4999 | .089 | 2.940 | .003 |
| ≧10,000 versus ≦4999 | .083 | 2.656 | .008 | |
| Employment type | Permanent Civil Service Position versus short-term contract Worker | .074 | 1.976 | .048 |
| Currently taking spirituality-related training | No versus Yes | − .088 | -2.896 | .004 |
| Satisfaction with providing gerontology care services | Satisfied versus Dissatisfied | .244 | 2.988 | .003 |
| Perceived need to spiritual care practice for older people | Very necessary versus Unnecessary | .654 | 4.492 | .000 |
| Necessary versus Unnecessary | .436 | 3.070 | .002 | |
| Desire for spiritual care training | Very hopeful versus not hopeful | .410 | 3.422 | .001 |
| Hopeful versus not hopeful | .241 | 2.072 | .038 | |
Discussion
Overall Spiritual Care Competence and Dimensional Variations
This study found that geriatric nurses' spiritual care competence was at a moderately high level, with dimension scores ranked in descending order as: spiritual care knowledge literacy, spirituality/spiritual care value cognition, spiritual care implementation skills, and spiritual self-awareness. These findings can be attributed to several factors. Healthcare professionals globally have recognized the importance of addressing spiritual needs, leading policymakers to develop comprehensive strategies integrating spiritual care as essential components of palliative medicine and hospice care (Chu et al., 2022). Furthermore, advancements in palliative medicine have created a supportive framework for spiritual care, particularly in addressing older adults' spiritual needs (Hennessy et al., 2020). Concurrently, medical and technological progress has led nurses to prioritize spiritual care as a key factor in optimizing health outcomes (McKnight & Livingston, 2019; Ricci-Allegra, 2018; Schreiber et al., 2022). Ongoing scholarly exploration is expected to enhance the understanding, training, management, implementation, oversight, and dissemination of spiritual care, thereby promoting its recognition and advancement.
Despite spiritual care competence being above a moderate level, an imbalance across dimensions was observed. This discrepancy underscores the insufficiency of research on spiritual care, which primarily focuses on theoretical frameworks, highlighting the need for further development in spiritual care practice and the requisite qualifications for care providers. While respondents demonstrated strong scores in spiritual care knowledge literacy and spirituality/spiritual care value cognition, the median score for spiritual self-awareness was notably low. Spiritual self-awareness is crucial for nurses to effectively address patients' spiritual needs and provide spiritual care (McGee et al., 2023; Rajabipoor Meybodi & Mohammadi, 2021). This emphasizes the urgent need for more in-depth research on the spiritual care practices of geriatric nurses.
Demographic Predictors of Spiritual Care Competence
There are notable differences in spiritual care competence among ethnic groups, with Han respondents scoring higher in spiritual care knowledge literacy and spirituality/spiritual care value cognition compared to minority participants. This discrepancy can be attributed to two main factors. First, ethnic characteristics and the use of convenience sampling have limited representation from minority regions, particularly in China, where the Han population is predominant among 56 ethnic groups, each with distinct beliefs, values, and lifestyles. This highlights the need for in-depth studies on spiritual care competence specific to these ethnic characteristics. Second, the limitations of spiritual care research in China remain, as it is still in an exploratory phase and primarily focused on developed areas with a Han majority. This phenomenon reveals not only the limitations within the research field but also the impact of multicultural contexts on the dissemination of spiritual care concepts, shaping the understanding and needs of different ethnic groups. Therefore, it is essential to adopt an open perspective and maintain sensitivity to spirituality to promote balanced development and spiritual health across diverse cultures.
As nursing professionals progress in age and experience, particularly those aged 40–49 years, they demonstrate enhanced maturity in both life perspectives and professional development. Research indicates that this period represents a critical phase for career advancement and spiritual care competency development (Coventry et al., 2015; Vázquez-Calatayud et al., 2021). During this career stage, nurses typically transition from knowledge acquisition to practical application of their skills, resulting in significantly higher scores in both spiritual self-awareness (p < .05) and care knowledge compared to younger cohorts. This pattern is further evidenced by the strong correlation between professional rank and spiritual care competencies, with charge nurses demonstrating markedly superior capabilities relative to staff nurses (β = 0.42, p < .01). These findings suggest that professional title not only reflects accumulated knowledge but also indicates achieved maturity in spiritual care practice. Consequently, nurses in this developmental stage are uniquely positioned to address complex patient needs through more compassionate and effective care delivery. Future research should investigate targeted training interventions during this critical career phase to optimize spiritual care provision for diverse patient populations.
Research demonstrates a positive correlation between the duration of geriatric care experience and nurses' understanding of older adults' spiritual needs (Smith et al., 2022). Longitudinal exposure to geriatric populations enhances nurses' spiritual sensitivity, particularly in recognizing and responding to patients' existential concerns (Li et al., 2022). Evidence suggests that experienced geriatric nurses develop more profound spiritual awareness through their clinical practice (Akgün Şahin & Kardaş Özdemir, 2016). Through meaningful engagement with older adults, these nurses cultivate shared experiences encompassing faith, hope, and existential meaning, thereby enriching their spiritual care competencies (Speck, 2016). Consequently, nurses with extensive gerontological care experience typically demonstrate superior spiritual care proficiency compared to their less-experienced counterparts.
Monthly income serves as a critical determinant of both individual livelihood security and family welfare, while also reflecting the extent of societal support available to individuals (Zhang et al., 2023). Regression analyses revealed that higher income levels significantly predicted greater spiritual care competence, particularly in three domains: spiritual care knowledge, self-awareness, and value recognition. This association may be attributed not only to improved material conditions but also to enhanced social support networks associated with higher socioeconomic status. Empirical evidence underscores social support as a vital component in spiritual care provision, serving as a primary resource for addressing existential needs (Ciria-Suarez et al., 2021; Ullrich et al., 2021). The biopsychosocial-spiritual model further substantiates these findings, demonstrating the interconnectedness of physical, psychological, and social dimensions in shaping spiritual care competencies (Du et al., 2023; Khoury et al., 2016).
Higher levels of education reflect an individual’s knowledge, cultural acceptance, and cognitive abilities (Tang et al., 2020). In this study, respondents with a master’s degree or higher showed weaker ability to implement spiritual care compared to those with lower education levels. Typically, nurses with higher qualifications are less engaged in direct clinical practice and often take on research or management roles (Mengual et al., 2023). Research on specific skills for implementing spiritual care among highly educated individuals is limited. However, this is not absolute; spiritual growth is often linked to triggering events, while education mainly fosters the capacity for spiritual awareness. Experience and exposure to spiritual care are crucial for developing competence (Cheng et al., 2021; Gupta et al., 2023). Moreover, the number of individuals with a master’s degree or higher in this study was fairly low, and the validation was based on numerical observations. Further consideration is required to determine whether education level is a significant influencing factor.
Training in spiritual care demonstrates a direct, positive association with spiritual care competence. Participants who received spirituality-related training during their academic or work periods demonstrated improved spiritual care competence. This indicates that spiritual care competence can improve with proper training and education, highlighting the need to enhance training mechanisms, particularly in linking education and training throughout nurses' careers. Multiple linear regression analysis showed that spiritual care training during academic periods enhances self-awareness, while training during work periods improves the ability to implement spiritual care. Respondents currently enrolled in spirituality-related training scored higher in both total spiritual care competence and individual dimensions, further confirming the importance of ongoing training in spiritual care. Regarding ways of obtaining spiritual care resources, we found that nurses who had used a method to acquire resources had higher spiritual care competence scores than those who had not received training in obtaining spiritual care resources (Shamsi et al., 2022). This evidence collectively establishes foundational training as a critical determinant of spiritual care proficiency.
Satisfaction with geriatric care services is also an indicator influencing spiritual care competence (Amiri et al., 2021). Nurses who are highly satisfied with their jobs tend to be more enthusiastic and motivated to enhance their nursing practice, including their spiritual care competence. The greater the recognition of the value of spiritual care in geriatric nursing, the better nurses are able to integrate it into their practice (Rykkje et al., 2022). This awareness may stem from education, training, personal interest, and research. Consequently, nurses' willingness to embrace spiritual care hinges on their perception of its importance in spiritual care. As they gain experience, their interest in enhancing spiritual care training increases, leading experienced nurses to reflect on their practice to better meet the complex needs of older people (Rouxel et al., 2016). They are more inclined to invest time and effort in acquiring new care skills, including spiritual care competence. The implications of these findings underscore the importance of fostering both job satisfaction and professional recognition of spiritual care’s value in geriatric nursing practice. Educational and healthcare institutions might consider implementing strategies that enhance nurses' understanding of spiritual care’s therapeutic potential while simultaneously improving overall job satisfaction metrics.
Nurses' attitudes and commitment to spiritual care are crucial, highlighting the need to foster awareness and interest in this area. Targeted interventions could include structured training programs that emphasize the importance of spiritual care, workshops on integrating spiritual care into daily practice, and mentorship programs pairing experienced nurses with those newer to the field. Additionally, creating a supportive environment that encourages reflection on personal spiritual beliefs and values may help geriatrics nurses feel more comfortable and committed to providing spiritual care.
Spiritual care requires consideration cultural backgrounds and religious beliefs (Deng et al., 2019). Considering the cultural backgrounds and religious beliefs of elderly individuals is a crucial step in implementing spiritual care. Nurses who share similar cultural or religious backgrounds with their patients are better equipped to understand their needs. Research indicates that individuals with religious beliefs demonstrate greater spiritual care competence than those without. This suggests that religious beliefs reflect an individual's spiritual state to some extent, although their expression and significance may vary across different cultures.
Limitation
This study has several limitations. First, convenience sampling may introduce selection bias, which could affect the generalizability of our findings. To mitigate this, we supplemented our approach with snowball sampling for certain groups, though some selection bias may still remain. Additionally, as a cross-sectional survey, this study captures data at a single point in time, limiting our ability to infer causation between variables. Furthermore, the reliance on self-reported data may introduce self-report bias, as participants’ responses could be influenced by personal perceptions or social desirability. Despite these limitations, the findings provide valuable insights into spiritual development.
Conclusion
This study found that the surveyed geriatric nurses demonstrated above moderate level of spiritual care competence, yet exhibited deficiencies in spiritual care implementation skills and self-awareness. Predictors of spiritual care competence include both controllable and uncontrollable factors. Analyzing these predictive indicators helps identify barriers and facilitators to enhancing spiritual care competence. Advancing spiritual care competence in a multicultural context offers precise reference for training programs and supports clinical staff in spiritual practice. This approach promotes comprehensive development in spiritual care research, achieving a balance in spiritual health and contributing to global health equity.
Acknowledgements
We would like to express our sincere gratitude to all the participants and study members for their valuable contributions to this research. We also extend our thanks to the reviewers and editors for their insightful feedback and constructive suggestions. Additionally, we are deeply grateful to Professor Dongliang Yang, a statistical expert, for his expert guidance and support in the data analysis process, which significantly enhanced the quality of our work.
Appendix1 The items of the C-SCC for geriatric ward nurses (53 items)
|
F1 Spiritual care Knowledge literacy |
Spiritual care relies on a foundation of trust in the nurse–patient relationship Spiritual care necessitates professional resources from medical, social, psychological, and other domains Implementing spiritual care requires teamwork Effective communication contributes to the implementation of spiritual care Competence in spiritual care can be acquired through experiential learning Spiritual care requires nursing professionals to possess spiritual awareness Companionship with patients is an integral component of spiritual care Spiritual care is a process, not a one−time event or activity Social support contributes to spiritual care I am willing to provide spiritual care to patients I believe that spiritual care is an essential part of nursing Spiritual care necessitates nurses to have empathy for patients I recognize that spiritual care is a crucial aspect of nursing that embodies human values Spiritual care includes respecting patients' cultural and religious beliefs Sensitivity and intuition help nursing professionals deliver spiritual care I believe that spiritual care should be integrated into nursing education curricula I can actively listen to patients as they share their ‘life stories’ related to illness or disabilities Spirituality is an inherent aspect of our inner selves Everyone possesses spirituality (faith/belief) |
|
F2 Spiritual care Implementation skills |
I can implement improvement initiatives for spiritual care within the nursing unit I can propose measures/standards/guidelines related to spiritual care to the nursing unit's management I can effectively allocate patients' spiritual care needs, as outlined in the care plan, to different nursing providers, caregivers, or nursing trainers/educators I can assess and verbally or in writing report patients' spiritual needs I can incorporate spiritual care into the nursing care plan I can adapt nursing care to meet patients' spiritual needs/issues through consultation with patients I can adapt nursing care to meet patients' spiritual needs/issues through interdisciplinary collaboration I will document the successes and failures of spiritual care daily through methods such as journaling or reflective writing I believe I can provide personalized spiritual care to patients I will reflect on the outcomes of implementing spiritual care daily I will share my experiences in implementing spiritual care in the form of papers or publications with others in need When the results of spiritual care are not satisfactory, I will seek help from experienced individuals |
|
F3 Spiritual Self-awareness |
I regularly reflect on my life to seek and/or confirm my purpose I know what gives meaning to my life I feel that my beliefs, faith, etc., influence my personal work, life, and existence Regarding spirituality, I have my own insights I am aware of my life pursuits I use my beliefs to guide my daily life I often introspect on my spiritual needs I frequently acquire knowledge that promotes spiritual growth through reading, among other methods I often share life's challenges and joys with others based on my beliefs Spirituality is an important part of my life Forgiveness is a significant aspect of my personal faith |
|
F4 Spiritual/spiritual care values cognition |
Spirituality drives individuals to seek meaning and purpose in life Spiritual care helps patients find meaning and purpose in their illness Spirituality assists in coping with life's challenges and problems Spirituality can promote physical recovery Spiritual care allows patients to enhance their spirituality even in their final moments Spirituality is an essential aspect of human beings Spiritual care instills hope in patients Spirituality contributes to the development of emotional well-being Spirituality brings peace and serenity to individuals Spiritual care facilitates the realization of holistic care Spiritual needs are met through one's connections with others, higher powers, or the natural world |
Author Contributions
LC and QC performed study conception/design, critical revisions for important intellectual content, supervision, statistical expertise, and administrative/technical/material support; WC and LF did data collection/analysis; LC drafted the manuscript; and all authors reviewed and approved the final manuscript.
Funding
This research project was supported by the Research on the Supply–Demand Adaptation Mechanism and Strategy Optimization for End-of-Life Care for Terminal Patients (Grant/Award Number: SKQDJ2413).
Data availability
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Declarations
Conflict of interest
The authors report no actual or potential conflicts of interest.
Ethical Approval
This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Biomedical Ethics Subcommittee of West China Hospital (No.2020–697).
Consent to Participate
Informed consent was obtained from all individual participants included in the study.
Consent to Publish
Not applicable.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.