ARTICLE IN PRESS

International Journal of Nursing Studies 44 (2007) 999–1010

www.elsevier.com/locate/ijnurstu

A study of nurses’ spiritual intelligence:

A cross-sectional questionnaire survey
Ke-Ping Yanga,, Xiu-Ying Maob
a
Cardinal Tien College of Nursing, 364, Chung-Cheng Road, Sin-Dien City 23148, Taipei, Taiwan
b
Department of Nursing, Peking Union Medical College Hospital, Beijing, People’s Republic of China
Received 12 September 2005; received in revised form 3 March 2006; accepted 10 March 2006

Abstract

Background: Nurse’s spiritual well-being may assure a positive attitude toward spiritual care, and assist patients in
overcoming spiritual distress. Spirituality is often related to one’s belief system. Spirituality on the part of nurses is yet
largely unheard of in a society with materialism which is one of the most destructive belief systems on the world.
Objectives: The objective of the study was to explore the profile of spiritual intelligence among nurses, and to examine
the effect of religions on nurses’ spiritual intelligence in China.
Design: This is a cross-sectional descriptive and inferential designed study.
Settings: The study was carried out in a medical center in China. Subjects were widely distributed, throughout seven
provinces, with 16 hospital settings.
Participants: A total of 130 registered hospital nurses, who were taking part in a 3-day, national nursing quality
conference held by the target medical center in China, were recruited by convenience sampling.
Methods: Wolman’s (2001) four-point Likert-type Psycho-Matrix Spirituality Inventroy (PSI) was distributed
collaboratively during the period of the conference. Upon receiving oral approval from nursing administrators, the
author ensured that subjects’ responses would remain confidential and that filling out the questionnaire was to be
construed as willingness to participate in this study.
Results: 1. The majority of nurses (90%) tended to experience numerous instances of physical emotional pain and
suffering throughout life.
2. Among the 130 subjects, only seven nurses clearly specified their religions, and religious beliefs accounted for most
of the variance in the criterion variable in the study.
Conclusions: Exploring nurses’ spiritual profiles, especially for those who seem to be unfamiliar with spiritual matters,
is a starting point on the journey to delivering spiritual care. Chinese nurses’ spiritual intelligence is only to be
excavated. The study draws attention to the diverse culture of the nurses’ concepts of spirituality, which is fundamental
to the delivery of truly holistic care of humans in a multi-faith society.
r 2006 Elsevier Ltd. All rights reserved.

Keywords: Psycho-Matrix Spirituality Inventory; PSI; Religious beliefs; Spiritual intelligence; Spiritual nursing

What is already known about the topic?

Corresponding author. Tel.: +886 2 2219 3590; 1. Nurses’ spiritual well-being may assure a positive
fax: +886 2 2219 7718. attitude toward spiritual care, and assist patients in
E-mail address: yang@ctcn.edu.tw (K-P Yang). overcoming spiritual distress.

0020-7489/$ - see front matter r 2006 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ijnurstu.2006.03.004

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 ARTICLE IN PRESS
1000 K-P Yang, X-Y Mao / International Journal of Nursing Studies 44 (2007) 999–1010
2. Spirituality is often related to one’s belief system, and
materialism is one of the most destructive belief
systems on the world.
3. Spirituality on the part of nurses is largely unheard of
in a materialistic, communistic society.
What this paper adds
1. The paper presents an empirical study exploring
spiritual intelligence among nurses, most of whom
were not religious, and whose childhoods, in a
changing materialistic communistic society, were
marked by a relative absence of religious activity.
2. The spiritual profile of the nurses in the communistic
society was one of pragmatism in their approach to
life, and of some naturalism in respect to ideology,
rather than reliance on any form of higher being for
peace of mind or awareness of a transcendent energy
source. They seldom addressed questions of the
existence of higher powers, life, death, and the
immortality of the soul.
3. The majority of the nurses (90%) tended to
encounter numerous instances of physical or emo-
tional pain and suffering throughout life. They may
mostly have observed more than one episode of
significant illness or injury, or even the actual loss of
a loved one through death.
1. Introduction
Since the beginnings of human civilization, nursing,
more than medicine or other allied health-care profes-
sionals, has been a vital force in integrating holistic
health concepts with traditional medicine, be it Eastern
or Western. Nursing often maintains holism, a state of
harmony between the body, mind and spirit, and
functions within that ever-changing environment (Dos-
sey, 1988). Spirit is a domain relating to religion, which
accepts all explicit and implicit notions and ideas as true,
and which relate, to a reality which cannot be verified
empirically (Baal and Beek, 1985). Materialism is
pragmatic and often can be verified empirically. How,
then, do nurses who believe in materialism rather than
idealism deliver spiritual care in a changing materialistic
society?
Spirit is an inner wisdom and awareness, and is a
valuable asset in the provision of holistic care. Dossey
(1988) noted that nurse healing (in which the nurse
serves as a healer, not a curer) is possible, when the
nurse is attuned every day to continuous discovery
about inner wisdom and awareness of one’s being. Inner
wisdom and awareness are natural instincts of human
beings, and spirituality influences one’s thoughts, words
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and deeds, and governs one’s body and mind (Yang,
1998). Exploring and promoting nurses’ spirituality
allows caring and innovative care pertaining to nursing
practice, health care, wellness, healing, and human
potential to be carried out. There are many nursing
perspectives that incorporate spiritual aspects, and
advocate their incorporation into nursing practice
(Van Leeuwen and Cusveller, 2004). Although the
concept of spirituality in nursing theories has remained
rather amorphous (Martsolf and Mickley, 1998), usually
nurses nevertheless neglect to assess and provide for
patients’ spiritual needs. Narayanasamy and Owens’s
(2001) study acknowledged that there was a variety of
models of spiritual care from the critical incidents
derived from nurse respondents, and that spiritual care
was apparently ‘‘largely unsystematic and delivered
haphazardly’’ (p. 454).
In order to understand the spiritual needs of others, it
is crucial for nurses to develop an understanding of their
own spirituality (Carroll, 2001), and an acute awareness
of their own beliefs and values (Freidemann et al., 2002).
Lickteig (2003) argues that being aware of and devel-
oping one’s own personal spirituality leads toward the
living of an authentic life. When nurses do develop their
own spirituality, the authentic nature of their life begins
to be reflected in their nursing practice, through trusting,
empathetic relationships. The notion here is that the
nature of nursing is spiritual (Elkins and Cavendish,
2004). The experience of spiritual well-being may predict
a positive attitude on the part of a nurse toward spiritual
care, and thus influence the overall provision in assisting
patients to overcome their spiritual distress (Narayana-
samy and Owens, 2001). According to Elkins and
Cavendish (2004), nursing is caring, nursing is spiritual,
and spirituality is private; it is assumed that promoting
nurses’ spiritual intelligence helps to provide assurances
of spiritual nursing care. The rapid development of
China may have aroused interest around the world, but
the spirituality of its nurses is largely an unknown
quantity for people outside the country.
1.1. Spirituality, religion and spiritual care
Numerous scholars have asserted that spirituality is
often limited to one’s religion, although the two terms
are not synonymous (Thompson, 2002; Burkhart, 2001)
but distinct in nature (Speck et al., 2004). Religion is
based on belief and is a commitment to doctrines and
practices (Manning, 2004). Spirituality, however, does
not require the practice of religious rituals, nor
participation in a religious organization (Castellaw et
al., 1999). Spirituality, in fact, is more than religion, just
as symbols are more than informational signs (Yang,
1998). Spirituality is a belief system which imparts
vitality and adds meaning to life events (Maugans and
Wadland, 1991); it is also a connection to the
 ARTICLE IN PRESS
K-P Yang, X-Y Mao / International Journal of Nursing Studies 44 (2007) 999–1010
transcendent, and gives value and purpose to life
(Manning, 2004). Manning (2004) noted that spirituality
is experienced in the secular and the sacred; and it can
result in choosing a religion, while religion can result in
developing spirituality. McSherry and Cash (2004)
however, argued that there are abundant definitions
with distinct layers of meanings depending upon the
individual’s personal interpretation or worldview; and
the word ‘‘spirituality’’ may become so broad in
meaning that it loses any real significance.
Williams (2003) argued that, ‘‘whilst many accept the
role of religious practice in the expression of spirituality,
given the emerging paradigm and the incorporation of a
broader perspective, expressions of spirituality cannot
be restricted to this narrow view’’ (p.22). McSherry et al.
(2002), however, confirmed that religiosity is a factor for
use in measuring spirituality and spiritual care perceived
by nurses. During life-changing events, people usually
turn to spirituality for comfort, hope, and relief (Elkins
and Cavendish, 2004); and nurses are perceived as
spiritual care providers (Cavendish et al., 2004). Most
nurses, however, associated the word ‘‘spiritual’’ espe-
cially with death and dying, an area of practice they find
difficult (Van Leeuwen and Cusveller, 2004; Narayana-
samy and Owens, 2001; Yang, 1998). Van Leeuwen and
Cusveller (2004) also confirmed that spirituality is a field
in nursing that is still in its infancy. In addition, nurses
claiming a religious affiliation were found to be more
likely to identify spiritual needs than those claiming
none (Ross, 1994). It was considered that half of these
nurses would refer their patients to the clergy to satisfy
their spiritual needs (Ross, 1994). The issue raised is the
competence or capacity of nurses to care for patients’
spirituality. This is seen as potentially problematic, with
the different concepts of spirituality in nursing theories
(MacLaren, 2004; Martsolf and Mickley, 1998).
1.2. Religions and social belief systems
Much of contemporary scholarly opinion rejects the
attempt to construct a general theory of religion, which
means that particular religious traditions are unique, sui
generic (distinctive in category or species) and incom-
mensurable, and cannot therefore be generalized (Rue,
2000). Zimmer (1999), however, has suggested that
religions have a historical tendency to align with secular
powers such as governments. Whenever this has been
done, governments have often promoted one religion
above all others, and tended to suppress differing or
competitive religious views. In India, for example, where
the different religions of Hinduism, Buddhism, Islam,
Sikhism, Jainism, and Christianity all currently co-exist,
a Turkish general, Qutb-ud-din became Turkish Sultan
of Delhi in 1199, and destroyed many temples and
suppressed all religions but Islam. Even modern science,
such as modern psychology, functions as a modern
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1001
religion in that it is firmly believed, made up of a unique
system of ideology and enforced amongst members of
that belief system. Most religions possess the tools of
enforcement and social control mechanisms that modern
governments adore (Zimmer, 1999). Zimmer (1999)
emphasized that materialism is the primary culprit. This
is often the case in communistic societies, as a result of
the following of the precepts of materialism. Zimmer
(1999) further concluded that, as a tool of self-conceived
world manipulators, materialism as applied to human
subjects is one of the most destructive belief systems on
the planet.
Materialism has been derided as a spiritually stunted
system since its inception. Communist governments see
independent religions as rivals for public loyalty (Lynch,
2005). Most scholars argue that Communistic societies
are likely to suppress religious belief (Lu, 2004;
MacInnis, 2005). People in communistic societies may
not acknowledge their spirituality, although spirituality
does not necessarily rely upon any secular, religious, or
agnostic themes (Oldnall, 1996). This begs an obvious
question: if the issue of spirituality is mostly neglected,
how is it that nurses’ spiritual intelligence gets promoted
and spiritual care gets delivered?
1.3. Nursing research on spirituality
Researchers have found that nurses believe that
spirituality is an integral part of their practice and that
they should pay greater attention to the spiritual
dimension of the patients (Van Dover and Bacon,
2001). Yang et al. (2001) also noted that nurses
encountered great difficulties in delivering spiritual care.
Oswald (2004), however, found that in the delivery of
services that involved spiritual care, nurses’ were aware
of the spiritual dimension of the task and that awareness
had a decisive impact on the manner in which the task
was performed, while perceptions of spirituality were
uncertain. Since there is an implicit need for spiritual
care from religious care, it is difficult to prove the
significance of non-religious spirituality to the general
population (MacLaren, 2004). It is unrealistic to expect
nurses to provide specialist religious care to all of their
patients, regardless of their own religious affiliation.
Narayanasamy (1999) reviewed 38 references on spiri-
tuality as applied to nursing and found that the holistic
understanding of spirituality has been derived almost
exclusively from the Christian theological tradition.
Nonetheless, the concepts of spirituality and spiritual
nursing care may well be a good starting point for
addressing the varying religious needs of patients.
A variety of health outcomes, such as quality of life,
bio-psychosocial functioning, were significantly influ-
enced by both spiritual intelligence and religions (Yang,
1998; Benjamins, 2005), which are crucial predictive
factors for a large proportion of people entering health
 ARTICLE IN PRESS
1002 K-P Yang, X-Y Mao / International Journal of Nursing Studies 44 (2007) 999–1010
care (Speck et al., 2004). Despite spirituality’s essential
role in health care, both acute and hospice nurses felt
that they were not adequately prepared to provide
spiritual care and were reluctant either to implement it
themselves or refer patients to others (Harrington,
1995). Fortunately, people have innate spiritual capa-
cities (Wolman, 2001). The restoration and development
of nurses’ spirituality and their spiritual capacities, is
therefore an urgent affair; especially for nurses working
in modern societies, which are multi-faith, multi-
cultural, and even non-religious. Research has indicated
that nurses can help terminal cancer patients to develop
coping strategies which allow them to engage in the
process of transacting self-preservation (Thomas and
Retsas, 1999), in which they achieve a sense of
transcendence of the self, which dispels fear of death.
No studies, however, have been found that examine
nurses’ spiritual intelligence, and the effects of religious
beliefs on their spiritual intelligence in a materialistic,
communistic society.
2. Aim and conceptual framework
The aim of the study was to explore spiritual
intelligence among nurses in a communistic society.
Specifically, the study aimed (1) to explore the profile of
spiritual intelligence among nurses; (2) to examine the
relationships between nurses’ individual characteristics
and spiritual intelligence; and (3) to examine the effect of
religions on nurses’ spiritual intelligence.
It was hypothesized, while controlling for nurses’
religious beliefs, that there are relationships between
their individual characteristics, such as age, marital
status, educational level, current position, years of
nursing experience, and their spiritual intelligence. It
was also hypothesized that religious beliefs affect nurses’
spiritual intelligence (Fig. 1). Spiritual intelligence is an
authentic intelligence that encompasses thinking, con-
ceptualization, and problem solving (Wolman, 2001). It
Nurses Characteristics
Nurses’
- Age
- Marital status
- Educational level
- Current position
- Years of nursing
Religious
Beliefs
Fig. 1. Conceptual framework of nurses’ spiritual intelligence and factors related thereto.
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is defined in this study in terms of Wolman’s (2001)
statement that, ‘‘Spiritual intelligence is the human
capacity to ask ultimate questions about the meaning of
life, and to simultaneously experience the seamless
connection between each of us and the world in which
we live’’ (p.84). Wolman’s (2001) seven spiritual factors:
divinity, mindfulness, extrasensory perception, commu-
nity, intellectuality, trauma, and childhood spirituality
were included in the conceptual framework for the
purpose of measurement.
3. Methodology
A cross-sectional descriptive and inferential study
design was implemented, with 130 registered hospital
nurses, who were widely distributed throughout China,
serving as its subjects. Wolman’s (2001) Psycho-Matrix
Spirituality Inventory (PSI) was used to measure nurses’
spiritual intelligence. It is a four-point scaled, self-
reported, 49-item questionnaire incorporating Wol-
man’s above-mentioned seven spiritual factors.
3.1. Sampling and participants
The study was carried out in a medical center in
mainland China. The entire sample of registered hospital
nurses, who were taking part in a 3-day, national
nursing quality conference held by the target medical
center, was recruited by convenience sampling. Upon
receiving oral approval from nursing administrators, the
author ensured that subjects’ responses would remain
confidential and that filling out the questionnaire was to
be construed as willingness to participate in this study. A
total of 199 copies of the PsychoMatrix Spirituality
Inventory were distributed collaboratively during the
period of the conference, and a total of 130 nurses
comprised the study sample, yielding a response rate of
65%. Subjects were widely distributed, throughout seven
provinces, with 16 hospital settings. They were all
Spiritual Intelligence
- Divinity
- Mindfulness
- Extrasensory perception
- Community
- Intellectuality
- Trauma
- Childhood spirituality
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K-P Yang, X-Y Mao / International Journal of Nursing Studies 44 (2007) 999–1010 1003

Table 1 it leaves open the question of why they do what they do’’
Distribution of subjects’ demographic characteristics (n ¼ 130) (p. 126). The PSI is a four-point Likert-type scale, from
‘‘never’’, ‘‘seldom’’ to ‘‘frequently’’ and ‘‘almost al-
Characteristics n (%) Characteristics n (%)
ways.’’ Since, on a five-point scale, the mid-range,
Age (M7SD) 30.1077.04 Education ‘‘sometimes’’, is usually an option (p.126), Wolman
20–29 years 62(47.7) Graduate degree 12(9.2) (2001) excluded this category deliberately, as it is
30–39 years 52(40.0) Bachelor 51(39.2) crucial, when using the PSI, to make a definitive
X40 years 15(11.6) Junior college 55(42.3) statement one way or the other, rather than fall into
Vocational 7(5.4) the defensive posture of choosing ‘‘sometimes’’ as a
school default answer.
Religions Job years (M7SD) 8.3277.00
No religion 103(79.2) p3 years 45(34.6)
3.2.1. Contents of the study instrument
Buddhism 3(2.3) X3–5 years 9(6.9)
Catholic 1(0.8) X5–10 years 31(23.8)
The study data were collected using a self-reported,
Christian 1(0.8) X10 years 44(33.8) two-part, structured questionnaire that comprised six
Taoist 1(0.8) items about the subjects’ background data, such as age,
Islam 1(0.8) educational level, marital status, religiosity, position and
Missing 20(15.4) years of nursing experience, as well as three items of
organizational characteristics, such as location, the
Marital status Position
Married 67(51.5) Head nurse/ 6(4.6)
number of beds in their hospital, and the type of
Associate H.N. hospital they worked in. The second part of the
Single 62(47.7) Team leader 5(3.8) questionnaire was the Chinese version of the PSI, which
Basic nurse 114(87.7) consisted of seven spiritual factors with 49 items, and
every factor in the PSI contained seven items. Since 31
items out of the 80 from the original PSI were excluded
from the scoring, the study only measured 49 items for
the sake of conciseness and potential to be embraced by
potential subjects.
female, and age ranged from 21 to 49 years (M ¼ 30:1,
Definitions of the seven factors included in the PSI
SD ¼ 7:04). Half of the subjects were married (n ¼ 67,
were supplied by Wolman (2001), as follows.
51.5%), and a majority of them held at least an associate
degree (75.3%) followed by those with a bachelors
degree (39.2%). A majority of the nurses had no 1. Divinity refers to a sense of divine source of energy,
religious affiliation (n ¼ 103, 79.2%). Only seven nurses higher being or awesome wonder at natural phenom-
(5.4%) clearly specified their religion. Most of the ena. Statements such as ‘‘Blessings comfort me.’’
subjects were basic level nurses (n ¼ 114, 87.7%), who 2. Mindfulness means attention to bodily processes
had been employed as a nurse for either less than 3 years such as conscious eating, regular meditation, and
(34.6%) or more than 10 years (33.8%) (Table 1). exercises, such as Yoga or Tai Chi. Statements such
as ‘‘I set aside time for contemplation and self-
reflection.’’
3.2. Instrumentation 3. Extrasensory perception includes items that pertain
to the ‘‘sixth sense’’ or paranormal psychic events.
Wolman’s (2001) PSI, a groundbreaking system for Statements such as ‘‘I sense that something is going
evaluating the levels and areas of spirituality in people’s to happen before it happens.’’
lives without reference to a specific religious ideology, 4. Community describes social activities, including
was implemented in this study. PSI was constructed involvement in Parent–Teacher Organizations or
using seven factors: divinity, mindfulness, intellectuality, work of a charitable nature. Statements such as ‘‘I
community, extrasensory perception, childhood spiri- consult with clergy or spiritual healers.’’
tuality, and trauma, which emerged from the statistical 5. Intellectuality denotes a desire and commitment to
analysis in a pilot study. The PSI is an inventory based reading and discussing spiritual material and sacred
strictly on self-report and contains 80 items that make texts. Statements such as ‘‘I discuss spirituality
up human spiritual experience, activity, and behavior. openly with family and friends.’’
According to Wolman (2001), ‘‘Unlike some psycholo- 6. Trauma is often thought of as a crisis-oriented
gical measures, in which the meaning of answers is stimulus to spirituality, such as illness in self or
hidden from the subject or is inferred by the adminis- others or the death of a loved one. Statements such as
trator of the test or questionnaireyPSI captures ‘‘I think about serious physical injury that has
individuals’ conscious experience of their behavior; but happened to me.’’

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1004 K-P Yang, X-Y Mao / International Journal of Nursing Studies 44 (2007) 999–1010

7. Childhood spirituality comprises the spiritual experi-
ences of youth, including attendance at religious
services or being read to by parents from sacred texts.
Statements such as ‘‘My parents expected me to
attend religious services.’’
the data from each participant being collected in the data
base on the web site. The validity of the Chinese version
used for the study was confirmed by back-translation and
examined by a panel of five nursing and psychological
professionals fluent in both Chinese and English.

3.2.2. Reliability and validity 3.2.3. Statistical analysis

Reliability of the 49-item, Chinese version of the PSI Descriptive and inferential statistical techniques such
was pilot-examined by its internal consistency and Intra- as t-test, one-way ANOVA, correlation analysis, and
class Correlation Coefficient (ICC). The internal con- simple and multiple regression were applied to analyze
sistency of the summed variable was measured with the data by SPSS for Windows 11.0. The seven factor
Cronbach’s a coefficient, the value of which was 0.92, scores describe an individual’s spirituality profile. The
and the ICC was 0.88 (Table 2). Validity of the PSI was scores ‘‘high’’, ‘‘moderate’’, and ‘‘low’’ are descriptive
originally established by Wolman’s (2001) study on 714 rather than evaluative. The exercise provides an
individuals who were taking part in conferences oriented opportunity to acknowledge one’s own spirituality,
toward mind/body awareness, healing, spiritual prac- and a language which facilitates the sharing of spiritual
tices, and consciousness and self-empowerment (p.129), experiences. As noted by Wolman (2001), everyone is
and enhanced by the availability of on-line participation, spiritual, and each person possesses his or her own
experience of spirituality.
Table 2 Scoring the PSI is straightforward; the score on each
Reliability of the PSI, tested by Cronbach’s a and ICC item was assigned a number from one to four, with one
corresponding to ‘‘never,’’ and four to ‘‘almost always’’.
Factors Cronbach’s ICC (intraclass The scores for each item and factor were added up and
a correlation coefficient) divided by seven to acquire the factor score, which was
then identified on the inventory scale as high, moderate,
Average Single
measure measure or low. High, moderate or low scores are merely a
statistical convenience which does not reflect merit or
Divinity .794 .731 .279 demerit of any sort (Wolman, 2001).
Mindfulness .677 .643 .205
Extrasensory .766 .713 .262
perception
Community .612 .520 .134 4. Results
Intellectuality .708 .671 .225
Trauma .655 .503 .126 4.1. The profile of nurses’ spiritual intelligence
Childhood .758 .741 .290
spirituality The overall spiritual profile among the nurses studied
Total PSI .920 .137 .886 is illustrated in Table 3. For the purpose of statistical
convenience, a high score is a total PSI score of over

Table 3
Distribution of the profile of nurses’ spiritual intelligence

Items High Moderate Low Location of the majority

n (%) n (%) n (%)

Divinity 4(3.1) 4(3.1) 121(93.8) Low

Mindfulness 1(0.8) 12(9.4) 115(89.8) Low
Extrasensory perception 10(7.7) 27(20.8) 93(71.5) Low
Community 1(0.8) 51(39.8) 76(59.4) Low
Intellectuality 1(0.8) 7(5.6) 116(93.5) Low
Trauma 18(14.1) 99(77.3) 11(8.6) Moderate
Childhood spirituality 1(0.8) 8(6.2) 120(93.0) Low

Total PSI 0(0) 20(13.1) 97(82.9) Low

Note: 1. The categories High, Moderate, and Low had different implications, depending on the item, as defined by Wolman in 2001.
2. Where data were not supplied, they were not included in calculations for the total percentage.

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K-P Yang, X-Y Mao / International Journal of Nursing Studies 44 (2007) 999–1010 1005

Table 4
Correlations among the seven factors of the spiritual intelligence

Factors 1 2 3 4 5 6 7

1. Divinity 1
2. Mindfulness .623* 1
3. Extrasensory perception .728* .631* 1
4. Community .431* .503* .558* 1
5. Intellectuality .642* .624* .670* .501* 1
6. Trauma .556* .577* .611* .447* .647* 1
7. Childhood spirituality .335* .200* .427* .441* .366* .158 1
Total PSI .855* .821* .865* .675* .839* .773* .415*

*Statistically significantly different (po0.05).

18.6, a moderate score is one between 13.4 and 18.6, and Table 5
a low score is one below 13.4. The total mean score for Nurses’ spiritual intelligence in relation to their individual
spiritual intelligence was 11.45 (SD ¼ 2:15, characteristics
range ¼ 7.14–17.43) a low score which applied to
Variables M7SD Rang t/f p
82.9% of the subjects (n ¼ 97). Trauma was the only (min–max)
factor with either a moderate or high PSI score.
Scores were low for divinity (n ¼ 121, 93.8%), mind- Age 0.48 .694
fulness (n ¼ 115, 89.8%), extrasensory perception 20–29 years 11.5472.21 7.43–17.43
(n ¼ 93, 71.5%), community (n ¼ 76, 59.4%), intellec- 30–39 years 11.2272.10 7.14–16.29
tuality (n ¼ 116, 93.5%), and childhood spirituality 440 years 11.7572.33 8.14–15.71
(n ¼ 120, 93%), and moderate for trauma (n ¼ 99, Religious beliefs 2.12 .037*
77.3%). It is worth noting that trauma earned the Yes 13.3472.95 8.86–16.14
largest single number (n ¼ 18, 14.1%) of high scores, No 11.3372.03 7.14–17.14
and only 11 nurses (8.6%) registered low scores in that
Marital status 1.02 .312
category (Table 3).
Married 11.2671.97 7.14–16.14
Correlation coefficient was also applied to examine Single 11.6772.35 7.43–17.43
the correlations among the seven factors of the PSI.
Only trauma and childhood spirituality had no significant Education 0.75 .523
relationship, while otherwise the seven factors were Graduate 11.8772.49 8.57–15.86
significantly and positively inter-correlated (Table 4). degree
Bachelor’s 11.1472.01 7.14–16.29
degree
4.2. Relationships between individual characteristics and Junior college 11.7472.32 7.43–17.43
spiritual intelligence Vocational 11.1871.63 8.29–12.71
school
There were no significant differences between nurses’
Position 0.06 .946
spiritual intelligence and their individual characteristics
Head nurse/ 11.6070.79 10.57–12.57
as measured by age, marital status, education, position,
associate H.N.
and years of nursing experience. Scores for spiritual Team leader 11.2372.62 7.14–13.86
intelligence tended to be higher in those groups with Basic nurse 11.5572.18 7.43–17.43
nurses who were: of the age of 40 and above
(M ¼ 11:75, SD ¼ 2:33); single (M ¼ 11:67, Years of nursing 0.69 .561
experience
SD ¼ 2:35); had master’s degrees (M ¼ 11:87,
o3 years 11.4872.21 7.43–17.14
SD ¼ 2:49); were employed as a head nurse or associate
3–5 years 11.4371.29 9.14–13.57
head nurse (M ¼ 11:60, SD ¼ 0:79); and those who had 5–10 years 11.8972.71 7.14–17.43
5 to 10 years of nursing experience (M ¼ 11:89, 410 years 11.1271.76 8.14–15.71
SD ¼ 2:71) (Table 5).
Correlation statistics such as Pearson’s r, Spearman’s *Statistically significantly different (po0.05).
r, and point-biserial correlation, as well as simple linear
regression analysis were further applied to test the correlated to, and, indeed, predicted childhood spiri-
effects of the predictors on each of the seven criteria. As tuality (r ¼ :23, b ¼ :23, adjusted R2 ¼ 4:3) signifi-
Tables 6 and 8 indicate only marital status significantly cantly (f ¼ 6:75, po0.05). Marital status contributed

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1006 K-P Yang, X-Y Mao / International Journal of Nursing Studies 44 (2007) 999–1010

Table 6
Correlations between nurses’ characteristics and the seven factors of PSI

Variables Factors

Divinity Mindfulness Extrasensory Community Intellectuality Trauma Childhood Total PSI

perception spirituality

Age .041 .029 .015 .065 .124 .056 .143 .023

Marital status .091 .122 .104 .058 .171 .006 .225 .095
Education .023 .052 .134 .069 .046 .072 .094 .057
Position .033 .087 .080 .052 .045 .166 .051 .117
Years of nursing .045 .006 .020 .071 .151 .054 .147 .016

Note: Nominal variables were analyzed by the point-biserial correlation.

 Statistically significantly different (po0.05).

Table 7 The stepwise regression coefficient further showed

The effect of religion on nurses’ spiritual intelligence that independent variables with nurses’ characteristics
alone yield no effect on their spiritual intelligence, but
Factors Religious beliefs that when religious beliefs are factored in, they account
Yes No t P
for 3.2% of the variance (b ¼ :21) in the criterion
variable (Table 8). Religious belief therefore accounted
M (SD) M (SD) for most of the variance in the criterion variables in the
study.
Divinity 2.14 (0.71) 1.67 (0.51 2.16 .033*
Mindfulness 2.18 (0.56) 1.99 (0.50 1.01 .315
Extrasensory 2.10 (0.77) 1.58 (0.40 3.11 .002*
5. Discussion
perception
Community 1.69 (0.57) 1.43 (0.28 2.20 .030*
Intellectuality 2.00 (0.56) 1.69 (0.43 1.80 .075 The majority of the subjects’ (n ¼ 97, 82.9%) mean
Trauma 2.14 (0.40) 1.82 (0.35 2.20 .030* scores for spiritual intelligence were in the low range of
Childhood 1.49 (0.93) 1.13 (0.18 3.33 .001* the PSI. Analysis of each of the factors of spiritual
spirituality intelligence showed that most of the subjects had low
scores for divinity (93.8%), mindfulness (89.8%), extra-
Total score 13.34 (2.95) 11.3372.03 2.12 .037*
sensory perception (71.5%), community (59.4%), in-
*Statistically significantly different (po0.05). tellectuality (93.5%), and childhood spirituality
(93.0%), with either moderate (77.3%) or high
the most to variances in childhood spirituality. The (14.1%) scores for trauma. Low scores for divinity
relative predictive value of marital status was higher indicate a pragmatic approach to life with little need for
among single nurses (M ¼ 11:67) than married reliance on any form of higher being for peace of mind.
(M ¼ 11:26) nurses. Low scores for mindfulness indicate that subjects do not
regularly set aside time for contemplation and self-
reflection, have low levels of need for association with
4.3. Effect of religions on spiritual intelligence others, and tend to be comfortable being on their own
and pursuing their own activities. Low scores for
A total of only seven (5.4%) respondents clearly extrasensory perception indicate that nurses rarely
specified a religious affiliation. The variables for demonstrate a range of intellectual or psychological
religious belief were divided into two groups to test activity that encompasses knowledge outside conven-
their relationship to spiritual intelligence. The results tional ways of knowing, and usually use their intellect
indicated that whether nurses had a religious affiliation and capacity for new knowledge in conventional,
had a significant relationship (f ¼ 2:12, po.05) to their pragmatic, but often highly effective ways. Low scores
spiritual intelligence (Table 5). Nurses with religious for community indicate that subjects tend not to spend
affiliations (M ¼ 13:34, SD ¼ 2:95) gained higher scores much time on school, civic, and political activities, or
on the PSI than those without (M ¼ 11:33, SD ¼ 2:03). spiritual communities; rather, they are most comfortable
Religious beliefs had a significant correlation with five of with a smaller, more intimate circle of friends or family.
the seven factors of the PSI: divinity, extrasensory Low scores for intellectuality indicate that subjects focus
perception, community, trauma, and childhood spiri- their intellectual activities on issues other than spiri-
tuality (Table 7). tuality, often experience life with enthusiasm, and focus

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K-P Yang, X-Y Mao / International Journal of Nursing Studies 44 (2007) 999–1010 1007

Table 8
Stepwise regression analysis of the factors in relation to spiritual intelligence

Step Variable Adjusted R2 (%) F/p Final b t/p

Divinity 3.1 4.22/.043*

1 Religious beliefs .200 2.05/.043*
Extrasensory perception 7.1 8.86/.004*
1 Religious beliefs .283 2.98/.004*
Community 3.5 4.60/.034*
1 Religious beliefs .210 2.15/.034*
Intellectuality 3.4 4.41/.038*
1 Marital status .209 2.10/.038*
Trauma 3.3 4.40/.038*
1 Religious beliefs .205 2.10/.038*
Childhood spirituality
1 Religious beliefs 8.3 10.19/.002* .298 3.19/.002*
2 Marital status 11.1 7.36/.001* .192 2.05/.043*
Total PSI 3.2 4.06/.047*
1 Religious beliefs .207 2.01/.047*

Note: 1. The above model shows the independent variables with individual characteristics and religions.
2. The model of independent variables with individual characteristics only showed no significant correlation with the PSI factors.
3. *Statistically significantly different (po0.05).

on the concrete here-and-now in a rational and practical
approach to the world. Low childhood spirituality
indicates that religious activity was relatively absent
from the subject’s childhood (Wolman, 2001, pp.
135–141).
Among the seven factors of spiritual intelligence,
trauma was the only one to register scores above the low
range. Trauma is thought of as a crisis-oriented stimulus
to spirituality. A moderate or high score for trauma
reflects personal encounters with physical or emotional
pain and suffering (Wolman, 2001). This experience can
be the subjects’ own, or the witnessing of the suffering of
someone close. At the extreme, trauma refers to the
actual loss of a loved one through death. According to
Wolman (2001), subjects with high scores on trauma
have usually had, or observed, more than one episode of
significant illness or injury (p.140). Of the subjects in this
study, 14.1% had encountered or suffered more than
one episode of significant pain, perhaps due to a major
catastrophe in their society, which might have been
either a natural or a man-made calamity, such as a
political revolution, war, or a devastating earthquake, or
might have been due to professional exposure to difficult
situations, or critical incidents. Indeed, the causes of
such episodes merit further research.
Since trauma is dynamically related to other factors,
particularly divinity, and no spirituality exists in
isolation (Wolman, 2001), the failure of this study to
establish a correlation between trauma and childhood
spirituality suggests a need for further investigation.
Moreover, the low childhood spirituality of the great
majority of respondents (n ¼ 120, 93%) may indicate an
absence of a divine energy source among nurses in their
childhood. Wolman (2001) noted that there may have
been extensive and deep ethical discussions within the
family, that such discussion might have contained little,
if any, formal ritual instruction or expression, and that it
might have been more cultural than religious or spiritual
in nature. This explanation is quite consistent with
Chiu’s (2001) notion that Chinese women gained
spiritual strength and support through their connected-
ness with their families, and often consciously and
unconsciously anchored themselves in their cultural
values, which provided spiritual strength.
Trauma was also found to be significantly and
positively correlated to divinity, mindfulness, extrasen-
sory perception, community, and intellectuality, but
failed to correlate with childhood spirituality in this
study. Trauma may have a positive or negative effect on
a person’s life (Smith, 2004). A traumatic event forces
individuals to examine or re-examine their understand-
ing of identity, responsibility, justice, guilt, suffering,
and forgiveness (Grant, 1999). Fallot and Heckman’s
study (2005) noted that frequent childhood abuse and
childhood sexual violence were associated with negative
spiritual/religious coping in adulthood. According to
Smith (2004), the devastation of trauma damages an
individual’s sense of trust and security in the world,
which is integral to their sense of self, their relationships
with others, and their concept of spirituality. When this
trust collides with an atypical or life threatening event,
the ability to rely on our spiritual belief system is

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 ARTICLE IN PRESS
1008 K-P Yang, X-Y Mao / International Journal of Nursing Studies 44 (2007) 999–1010
destroyed. It may also be a central attack on our
spirituality, our fundamental sense of life’s meaning and
purpose (Smith, 2004).
In the current study, the majority of the subjects had
no religious beliefs, yet the role of religious beliefs in
recovery following disasters is far too important to be
left aside (Taylor, 2001). Smith (2004) noted that
spirituality may be beneficial in the context of trauma
treatment. Taylor (2001) argued that religious beliefs are
usually neglected by academic psychologists in relation
to the provision of trauma treatment, and that greater
considerations should be given to spirituality and
personal values in the practice and theory relating to
such provision. Nonetheless, a traumatic event also
almost always leads to a search for new meaning and
purpose in life, and occurs in spiritual growth, whether
or not a person holds religious beliefs (Decker, 1993).
The subjects with religious beliefs had significantly
higher scores for spiritual intelligence than those with-
out. Religious belief accounted for most of the variance
in the criterion variables in the study (Table 8). Religion
and spirituality have been an integral part of health and
healing throughout history (Williams, 2003). Although
spirituality is a broader concept than religiosity, spiritual
care encompasses embraces many faiths and cultures
(Williams, 2003), however, religion has been a crucial
source of cultural ideals, and has provided images,
rituals, and symbols to link the individual to a larger
reality (McGuire, 1993). By way of Wolman’s PSI, the
author conducted this study into the natural instincts of
humans in the belief that each person has a distinctive
‘‘spiritual intelligence’’ even though some people live in
societies in which the right to practice traditional faiths
and religions is restricted. As expected, the results
showed that the majority of the nurses (79.2%) had no
religious beliefs. Only seven—out of 130—clearly
specified their religion, while the others (15.4%) supplied
no information.
In addition, nurses’ marital status significantly pre-
dicted intellectuality (R2 ¼ 3:4, b ¼ :21) and childhood
spirituality (R2 ¼ 4:3, b ¼ :23). VandeCreek and Nye
(1993) found that marital status related to one’s religious
heritage and pattern of attendance at places of worship.
No relationship between religions and marital status was
found among the subjects of this study. Nevertheless,
the relationship between religion and spirituality re-
mains potentially problematic, with some religions
denying the existence of secular spirituality (MacLaren,
2004). According to MacLaren (2004) secular spiritual-
ity and New Age movements are non-religious but
spiritually influential phenomena. The problem for
nursing is how to reconcile the immense variety of
approaches to spirituality. Further study is recom-
mended on this matter.
Results from the stepwise multiple regression showed
that religion significantly predicted nurses’ spiritual
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intelligence. Chiu (2001) asserted that Chinese religion
is a manifestation of Chinese culture, involving cultural
identity and ideology. The precise nature of the relation-
ship between these phenomena is unknown, yet this is
not the focus of the current study. Nevertheless, the fact
that religion significantly predicted nurses’ spiritual
intelligence may result from the substantial divergence
in the number of religious beliefs among the subjects.
Further investigation is therefore recommended. In
addition, numerous significant relationships have been
found between the severity of trauma-related and mental
health symptoms and more negative religious coping
(Fallot and Heckman, 2005). Whether subjects’ trauma
relates to their childhood abuse and violence or to their
religious coping in adulthood is also unknown and needs
to be probed further.
De Bellis’s (1999) study found that child abuse is
associated with alterations in the body’s major stress
systems; and these neurobiological effects may cause
delays or deficits in a child’s ability to achieve age-
appropriate behavioral, cognitive, and emotional reg-
ulation. Such traumatic memories are timeless and
unmodified by further experience (Van der Kolk,
1995). In this study, however, marital status contributed
the most to the variances in childhood spirituality when
compared to other factors of spiritual intelligence; the
fundamental reason for this remains unclear. According
to Chiu (2001), among Chinese immigrants with breast
cancer in the US, spiritual resources include family
closeness, traditional Chinese values, religion, alterna-
tive therapy, art, prose, literature and Chinese support
groups. These cultural themes may also have played an
important role in nurturing the spirituality of the nurses
in this study.
In addition, Fallot and Heckman (2005) found that
women from their study population rely considerably
more on positive than on negative spiritual coping.
Gender may be an essential characteristic which
influences one’s spiritual intelligence, but the study
subjects in this case were all female. How is spirituality
influenced by traditional Chinese culture and the
influence of politics on religion as far as mainly female
nurses living in a changing society with a unique belief
system are concerned? Future research, once again, is
recommended.
6. Conclusion and implications in nursing
The study explored spiritual intelligence among
nurses, most of whom were non-religious, in a changing
materialistic society. The spiritual profile of the nurses
was one of pragmatism in their approach to life, and one
of relative naturalistic in respect to ideology, rather than
reliant on any form of higher being for peace of mind or
awareness of a transcendent energy source based on
 ARTICLE IN PRESS
K-P Yang, X-Y Mao / International Journal of Nursing Studies 44 (2007) 999–1010
Wolman’s (2001) interpretation. They were seldom
involved with the variety of activities that include other
people. Their intellectual activities often focused on
issues other than spirituality, and seldom addressed
questions of the existence of higher powers, life, death,
and the immortality of the soul. In addition, trauma was
the most immediate and salient factor recorded on the
PSI in this study. The majority of nurses (90%) tended
to encounter numerous instances of physical or emo-
tional pain and suffering throughout life. They may
mostly have observed more than one episode of
significant illness or injury, or even the actual loss of a
loved one through death.
The results showed that the relative predictive value of
nurses’ marital status was greater than that of other
characteristic variables, but religious beliefs remain the
best relative predictor of nurses’ spiritual intelligence.
Although it is possible for an individual to be spiritual
but not religious, the study subjects appeared to have
low spiritual intelligence, and few had religious affilia-
tion. Whether nurses in a society in which religious
activity is restricted have difficulty delivering spiritual
care to both their clients and themselves remains the
important issue to be considered by future studies. The
subjects of this study, however, must have been
influenced by Confucianism, Taoism, and Buddhism,
all of which are closely related to the Chinese concept of
the Dao (the Way) as described by Chiu (2001) in his
account of the Chinese world view. The failure to study
the subjects’ individual religions in depth is the
limitation of this study, and should distinguish its
methodology as imperfect.
Since religious belief systems influence human beha-
vior, understanding nurses’ spiritual makeup, strengths,
and limitations is essential to being able to see and
improve their personal relationships and relationship to
the world. Future research is recommended in order to
gain this insight into nurses’ behavior. Internal experi-
ence, and empathy for the experiences of others gives
nursing a conscious context for nursing actions and
choices.
In addition, the nursing literature reveals a broad
spectrum of understanding of spirituality, yet little is
known about nurses’ spirituality, especially in commu-
nistic societies, whose faiths and value systems are quite
different from those of capitalist society. As MacLaren
(2004) argued, spiritual nursing is a means for nurses to
enquire into that which is fundamental about the human
condition and to give truly holistic care in a multi-faith
society. The most meaningful way of achieving this in
the context of a diverse society is by digging through the
‘‘mess of ideas’’ (MacLaren, 2004).
The study has drawn attention to the diverse culture
of the concept of nurses’ spirituality which is a multi-
dimensional aspect of life involving values and beliefs,
systems and culture, and a variety of activities. Spiritual
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1009
care policies should be established that are appropriate
to a multi-cultural and multi-faith society. Furthermore,
the concept of spirituality is a meta-narrative, a
postmodern appreciation of pluralism, and a way of
embracing different spiritual realities (MacLaren, 2004).
Spiritual nursing therefore, can be an opportunity for
nurses to enlarge their understanding of the human
condition rather than a narrowly defined concept to be
applied within a model of practice (MacLaren, 2004).
Exploring nurses’ spiritual profiles, especially for those
who seem to be unfamiliar with spiritual matters, is a
starting point on the journey to delivering spiritual care.
Nurses can begin to see patterns in their spirituality and
to change them if they choose. In the long term, the hope
of delivering spirituality in nursing practice in a
pluralistic society will be realized.
Acknowledgements
This study was funded by the Ministry of Education,
the Republic of China, and carried out in the People’s
Republic of China. The authors would like to
acknowledge Xing-Juan Wu for her assistance in the
collection of data, and all the nurses who participated in
the study.
References
Baal, J.V., Beek, W.E.A.V., 1985. Symbols for communication
an introduction to the anthropological study of religion.
Utrecht University, Assen, Van Gorcum.
Benjamins, M.R., 2005. Religion and functional health among
the elderly: is there a relationship and is it constant?
Research on Aging 27 (2), 119–135.
Burkhart, L., 2001. Report from the spirituality and religious-
ness diagnosis working group. Nursing Diagnosis 12 (2),
61–63.
Carroll, B., 2001. A phenomenological exploration of the
nature of spirituality and spiritual care. Mortality 6 (1),
81–98.
Castellaw, L., Wicks, M., Martin, J., 1999. Spirituality in white
older women with arthritis. Graduate Research in Nursing.
Available at: www.graduateresearch.com/wicks.htm
Cavendish, R., Luise, B., Russo, D., 2004. Spiritual perspectives
of nurses’ in the United States relevant to education and
practice. Western Journal of Nursing Research 26 (2),
1–16.
Chiu, L., 2001. Spiritual resources of Chinese immigrants with
breast cancer in the USA. International Journal of Nursing
Studies 38 (2), 175–184.
De Bellis, M.D., 1999. Developmental traumatology: neuro-
biological development in maltreated children with PTSD.
Psychiatric Times 16 (11), 14.
Decker, L.R., 1993. The role of trauma in spiritual develop-
ment. Journal of Humanistic Psychology 33, 33–46.
 ARTICLE IN PRESS
1010 K-P Yang, X-Y Mao / International Journal of Nursing Studies 44 (2007) 999–1010
Dossey, B.M., 1988. The transpersonal self and states of
consciousness. In: Dossey, B.M., Keegan, L., Guzzetta,
C.E., Kolkmeier, L.G. (Eds.), Holistic Nursing: A Hand-
book for Practice. An Aspen Publication, Rockville, MD,
pp. 23–37.
Elkins, M., Cavendish, R., 2004. Developing a plan for
pediatric spiritual care. Holistic Nursing Practice 18 (4),
179–186.
Fallot, R.D., Heckman, J.P., 2005. Religious/ spiritual coping
among women trauma survivors with mental health and
substance use disorders. The journal of Behavioral Health
Services & Research 32 (2), 215–224.
Freidemann, M., Mouch, J., Racey, T., 2002. Nursing the spirit:
the framework of systemic organization. Journal of
Advanced Nursing 39 (4), 325–332.
Grant, R., 1999. Spirituality and trauma: an essay. Traumatol-
ogy 5, Essay #2.
Harrington, A., 1995. Spiritual care: what does it mean to RN?
Australian Journal of Advanced Nursing 12 (5), 3–9.
Lickteig, M.K., 2003. Exploring a connected pedagogy: an
existential inquiry of spirituality in nursing education.
Unpublished Dissertation,. Georgia Southern University,
Georgia, US.
Lynch, D.J., 2005. Rice sends unmistakable signals to Asia
nations; visit to church in China emphasizes religious
freedom. USA Today, McLean, VA. March 21, p. 13.
Lu, Y.F., 2004. Chinese traditional sects in modern society: a
case study of Yiguan Dao. Unpublished Doctoral Disserta-
tion. City University of Hong Kong, Hong Kong.
MacLaren, J., 2004. A kaleidoscope of understandings:
spiritual nursing in a multi-faith society. Journal of
Advanced Nursing 45 (5), 457–462.
MacInnis, D., 2005. From suppression to repression: religion in
China today. Available at: www.currenthistory.com/archi-
vesep96/mcinnis.html
Manning, L., 2004. Mail call: praying for health. Newsweek
(international Ed.), 2005 ProQuest Information and Learn-
ing Company, January 12, p. 10.
Martsolf, D.S., Mickley, J.R., 1998. The concept of spirituality
in nursing theories: differing world-views and extent of
focus. Journal of Advanced Nursing 27 (2), 294–303.
Maugans, T.A., Wadland, W.C., 1991. Religion and family
medicine: a survey of physicians and patients. The Journal
of Family Practice 35 (4), 515–537.
McGuire, M.B., 1993. Health and spirituality as contemporary
concern. Annals of the American Academy of Political &
Social Science 527, 144–155.
McSherry, W., Cash, K., 2004. The language of spirituality: an
emerging taxonomy. International Journal of Nursing
Studies 41 (2), 151–161.
McSherry, W., Draper, P., Kendrick, D., 2002. The construct
validity of a rating scale designed to assess spirituality and
spiritual care. International Journal of Nursing Studies 39
(7), 723–734.
Narayanasamy, A., 1999. A review of spirituality as applied to
nursing. International Journal of Nursing Studies 36 (2),
117–125.
Downloaded for Anonymous User (n/a) at National Library of the Republic of Indonesia from ClinicalKey.com/nursing by Elsevier on
March 03, 2022. For personal use only. No other uses without permission. Copyright ©2022. Elsevier Inc. All rights reserved.
Narayanasamy, A., Owens, J., 2001. A critical incident study of
nurses’ responses to the spiritual needs of their patients.
Journal of Advanced Nursing 33 (4), 446–455.
Oldnall, A., 1996. A critical analysis of nursing: meeting the
spiritual needs of patients. Journal of Advanced Nursing 23,
138–144.
Oswald, K.D., 2004. Nurses’ perceptions of spirituality and
spiritual care. Unpublished Doctoral Dissertation. Drake
University, Des Moines, IA, US.
Ross, L.A., 1994. Spiritual aspects of nursing. Journal of
Advanced Nursing 19, 439–447.
Rue, L., 2000. Religion generalized and naturalized. Zygon,
Chicago, 35 (3), 587.
Smith, S., 2004. Exploring the interaction of trauma and
spirituality. Traumatology 10 (4), 231–243.
Speck, P., Higginson, I., Addington-Hall, J., 2004. Spiritual
needs in health care 329 (7458), 123.
Taylor, A.J.W., 2001. Spirituality and personal values:
neglected components of trauma treatment. Traumatology
7 (3), 111–119.
Thomas, J., Retsas, A., 1999. Transacting self-preservation: a
ground theory of the spiritual dimensions of people with
terminal cancer. International Journal of Nursing Studies 36
(3), 191–201.
Thompson, I., 2002. Mental health and spiritual care. Nursing
Standard: Official Newspaper of the Royal College of
Nursing 17 (9), 33–38.
Williams, J.K., 2003. An investigation of pre-nursing and
second year baccalaureate nursing students’ perception of
spirituality. Unpublished Master’s Thesis, University of
Texas-Pan American, US.
Wolman, R.N., 2001. Thinking with Your Soul: Spiritual
Intelligence and Why it Matters. Harmony Books, New
York.
Yang, K.P., 1998. Spiritual care in nursing practice. Journal of
Nursing 45 (3), 77–83 (in Chinese).
Yang, K.P., Yin, J.C., Lee, L.C., Shu, N.L., Hwang, R.M.,
2001. Holistic outcome measurement for terminally ill
cancer patients in medical centers in Taiwan. The Journal
of Nursing Research 9 (3), 43–56.
VandeCreek, L., Nye, C., 1993. Testing the death transcendence
scale. Journal for the Science Study of Religion 32 (3),
279–283.
Van der Kolk, B.A., 1995. The body, memory, and the
psychobiology of trauma. In: Alpert, J.L. (Ed.), Sexual
Abuse Recalled: Treating Trauma in the Era of the
Recovered Memory Debate. Jason Aronson, Northvale,
NJ, pp. 29–60.
Van Dover, L., Bacon, J., 2001. Spiritual care in nursing
practice: a close-up view. Nursing Forum 36 (3),
18–30.
Van Leeuwen, R., Cusveller, B., 2004. Nursing competencies
for spiritual care. Journal of Advanced Nursing 48 (3),
234–246.
Zimmer, G., 1999. Materialism & psychiatry function as
ideology and orthodoxy. Foundation for truth in reality.
Available at : www.sntp.net/essay1_2.htm