Nurse Education in Practice 57 (2021) 103227

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Nurse Education in Practice

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Perceived professional competence in spiritual care and predictive role of

spiritual intelligence in Iranian nursing students
Mehrnaz Ahmadi a, 1, Fateme Estebsari b, *, 2, Saeed Poormansouri c, 3, Simin Jahani a, 4,
Ladan Sedighie d, 5
a
Medical and Surgical Nursing Department, School of Nursing and Midwifery, Nursing Care Research Center in Chronic Disease, Ahvaz Jundishapur University of
Medical Sciences, Ahvaz, Iran
b
Community Health Nursing Department, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
c
Treatment Deputy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
d
Medical and Surgical Nursing Department, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

A R T I C L E I N F O A B S T R A C T

Keywords: Aim/objective: The aim of this study was to identify the relationship between perceived competence in spiritual
Spiritual care care and spiritual intelligence among nursing students.
Spiritual care competency Background: One of the most important duties of nurses is to pay attention to the spiritual needs of patients and
Spiritual intelligence
provide them with proper spiritual care. Therefore, professional competence in this area is essential for nurses
Iran
Nursing students
and nursing students. Also, spiritual intelligence is a factor influencing the caring behaviors of nurses.
Design: A cross-sectional and correlational study
Settings/Participants: This study was included 510 undergraduate nursing students in two public faculties of
nursing in Iran in the 2018-2019 academic year.
Methods: The samples were selected using a census method. A demographic information questionnaire, the valid
and reliable Iranian questionnaire of nurses’ competencies in spiritual care and the spiritual intelligence self-
report inventory (SISRI) were used to collect data.
Results: A significant positive correlation was found between nursing students’ competence in spiritual care and
spiritual intelligence (p < 0.001, r = 0.26). No significant differences were found between the mean competence
scores of spiritual care in terms of demographic characteristics. There were significant differences between the
mean spiritual intelligence score in terms of age, marital status, history of clinical practice and academic year.
The regression model indicated that for increased rates of spiritual intelligence, professional competence in
spiritual care would rise as much as 0.39.
Conclusion: Spiritual intelligence can affect the competence of nursing students in providing spiritual care to
patients. Therefore, to promote students’ spiritual intelligence, appropriate plans with the aim of promoting the
level of critical thinking and spiritual self-awareness are recommended.

1. Introduction relationship between spirituality and physical health and psychological

well-being (Bożek et al., 2020; Elk et al., 2019; Jahromi and Akbar,
In recent years, attention to spiritual care as an important part of the 2020). Spiritual care can play a role in improving a patient’s coping
holistic approach to patient care has been expanding (Elk et al., 2019). skills in times of crisis and creating a positive outlook about life.
International research has shown that there is a strong positive Moreover, it has a positive effect on the physical and mental health of

* Corresponding author.
E-mail address: fa_estebsari@yahoo.com (F. Estebsari).
1
(0000-0002-6621-5704)
2
(0000-0001-7011-8731)
3
(0000-0002-4946-8195)
4
(0000-0002-4407-6993)
5
(0000-0002-7275-4464)

https://doi.org/10.1016/j.nepr.2021.103227
Received 12 June 2021; Received in revised form 31 August 2021; Accepted 4 October 2021
Available online 5 October 2021
1471-5953/© 2021 Elsevier Ltd. All rights reserved.

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M. Ahmadi et al.
patients, facilitates the recovery process and increases the satisfaction of
patients and lead to improving the level of spiritual health, spiritual
performance and quality of spiritual life of patients (Baldacchino, 2015;
Hu et al., 2019; Veloza-Gómez et al., 2017). The International Council of
Nurses Code of Ethics for Nurses recognizes spiritual care as one of the
main duties of all nurses (International Council of Nurses, 2012).
Therefore, nurses require adequate preparation to address the spiritual
needs of patients. In this regard, one of the important goals of teaching in
nursing students is to prepare them to provide spiritual care to their
patients and to acquire competence in the provision of this kind of care
(Wu et al., 2016). There is little research known about factors influ­
encing professional competence in spiritual care in nursing students.
Spiritual intelligence as a framework for identifying and organizing the
skills and performance compatibilities could be one of the important
factors affecting the improvement of nurses’ competence in providing
spiritual care (Pinto and Pinto, 2020; Riahi et al., 2018). Therefore, in
the present study, the correlation between spiritual intelligence and
competence in spiritual care was investigated in nursing students.
2. Background
As one of the four dimensions of human holistic care, spirituality
includes a set of values, attitudes and hopes that connect people to a
superior being (Ahmadi et al., 2018; Ross et al., 2014). It is a quality that
goes beyond religious affiliation and strives to answer questions about
the meaning and purpose of life (Adib-Hajbaghery et al., 2017). The
effect of spirituality on healing human beings has received much
attention in the last two decades, as health professionals have found that
spirituality can have a significant effect on various aspects of patient
care (Bennett and Thompson, 2015; Farahaninia et al., 2018). Spiritual
care is a multidimensional concept defined as care activities that
improve people’s spiritual well-being by establishing a balance between
the physical, psychosocial and spiritual aspects of life (Cavendish et al.,
2003). Spiritual care activities include respecting, empathizing,
listening carefully to patients and helping them understand the disease
and its process (Baldacchino, 2015).
The World Health Organization defines health in four aspects:
physical, mental, social and spiritual health and emphasizes the
importance of spirituality in providing holistic care to patients (Chirico,
2016). Also, the nursing theorists such as Watson, Ray and Batty each
developed different theories that alluded to and used the concept of
spirituality in nursing and emphasized spirituality as an essential
dimension of nursing care that can affect patients’ health (Mohammadi
et al., 2015; Withers et al., 2017). Therefore, one of the most important
duties of nurses is to pay attention to the spiritual needs of patients and
provide them with proper spiritual care. As such, professional compe­
tence in this area is essential for nurses and nursing students (Baldac­
chino, 2015; Veloza-Gómez et al., 2017).
Fukada quotes Nakayama defined nursing competency as “the ability
to take action by combining knowledge, skills, values, beliefs and
experience acquired as a nurse” (Fukada, 2018). Professional compe­
tence in spiritual care is recognized as a continuously active process
defined by three related elements of awareness of human values,
empathy with the client and the ability to perform appropriate indi­
vidual interventions for each client. It also includes seven general
competencies: integrating one’s individuality and nursing role as a
profession; helping the patient to find the meaning of the disease and
accepting it; maintaining a positive relationship with patients and their
family; relationship with patients, interdisciplinary teams and clin­
ical/educational organizations; providing spiritual care during the four
stages of the nursing process (review, planning, implementation and
evaluation); observance of ethical issues in care such as confidentiality
and protection of information; and providing holistic care (Baldacchino,
2015).
Despite the paramount relevance of addressing spirituality as an
important part of the holistic approach to patient care, according to the
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Nurse Education in Practice 57 (2021) 103227
evidence, the spiritual dimension of patients is less considered in
healthcare systems and nurses do not have favorable competencies in
providing spiritual care (Adib-Hajbaghery et al., 2017; Baldacchino,
2015). One of the reasons for this could be the lack of adequate spiritual
care training for nurses (Baldacchino, 2015). Studies have also shown
that nurses receive adequate training in spiritual care neither during nor
after their studies (Chandramohan and Bhagwan, 2015; Lewinson et al.,
2015). Although many studies have been carried out on spiritual care
and integration of spirituality in medical education in Iran, there is no
evidence showing that the results of these studies have been addressed
in the health care system (Memaryan et al., 2017; Memaryan et al.,
2015). Despite the importance of this issue, it is still ignored in medical
education in Iran and is not yet defined as a separate subject in the
Iranian Bachelor of the nursing curriculum (Memaryan et al., 2015).
Among other reasons for not providing spiritual care to patients,
mention may be made of the overwork of nurses, lack of time, lack of
attention to personal spirituality and ethical issues and unwillingness to
provide spiritual care (Baldacchino, 2015). However, there are other
factors that can be considered as predictors of attention to spirituality in
nurses. More precisely, to understand the spiritual needs of others,
nurses need to have a clear understanding of their spirituality and ac­
curate knowledge of their beliefs. Developing their spirituality, nurses
will be able to reflect the nature of their real life on their performance
through trust and empathetic relationships (Moradnezhad et al., 2017).
Nurses’ spiritual experiences can enhance their positive attitude towards
spiritual care and be effective in helping patients to reduce their spiritual
distress (Zumstein-Shaha et al., 2020).
Spiritual intelligence has been described as a set of abilities for using
religious and spiritual resources through which issues related to mean­
ing and values are resolved (Shiasi et al., 2016). King defines spiritual
intelligence as a set of psychic adaptation capabilities based on the
immaterial aspects of reality, which can be developed through effort,
search and practice (King and DeCicco, 2009). According to Noble,
spiritual intelligence reflects a set of human experiences varying degrees
of which are possessed by all human beings (Nobel, 2000). Spiritual
intelligence is, thus, the foundation of a person’s beliefs that affect his or
her performance and can deepen one’s relationship with oneself and
others or the larger world in daily activities (Nouhi et al., 2014). One can
use this intelligence to frame and reinterpret one’s experiences (Mor­
adnezhad et al., 2017). Definitions of spiritual intelligence emphasize its
role in solving existential problems and finding meaning and purpose in
life, as well as solving problems and issues related to the meaning of life
and values (Miri et al., 2015).
Studies have shown that spiritual intelligence has a beneficial effect
on successful and efficient job management (Amram, 2009). Bagheri
et al. (2010) identified spiritual intelligence as one of the influential
factors in nurses’ happiness, indicating that nurses with higher spiritual
intelligence have a better adaptation to daily stresses (Bagheri et al.,
2010). According to Ghaleei and Mohajeran (2015), spiritual intelli­
gence had a role in improving mental health and reducing job stress in
nurses. Studies have also identified spiritual intelligence as a factor
influencing the caring behaviors of nurses. Studies conducted by Miri
et al. (2015) in Iran and Kaur et al. (2015) in Malaysia showed that the
promotion of spiritual intelligence and strengthening the beliefs and
personality of nurses could help improve the quality of patient care
(Kaur et al. 2015; Miri et al., 2015). Other studies have also shown a
positive and significant relationship between nurses’ clinical compe­
tence and spiritual intelligence (Karimi-Moonaghi et al., 2015). As such,
spiritual intelligence can be considered as one of the factors influencing
the clinical competence of nurses in the area of spiritual care.
Paying attention to spiritual care and teaching it to nursing students
is one of the concerns of the educational system (Ali et al., 2015; Bennett
and Thompson, 2015). Moreover, our knowledge of the factors related
to spiritual care can facilitate the training and implementation of spir­
itual care in nursing students. However, limited studies have been
conducted in this regard. Accordingly, this study was conducted to
M. Ahmadi et al.
determine the relationship between spiritual intelligence and spiritual
care in nursing students.
3. Materials and methods
3.1. Design and sample
This study was a cross-sectional and descriptive-correlational study
conducted in the 2018–2019 academic year in two public faculties of
nursing in Tehran and Ahvaz, Iran. The census method was used as the
sampling method, which included all undergraduate nursing students in
the second year and above. In the census method, in-depth information
related to an issue is covered, which helps in all-inclusive understand­
ing. Since, in this type of sampling, every item of the universe is taken
into account, the conclusions are more accurate and reliable (Kish,
1979).
Inclusion criteria consisted of passing at least two semesters of un­
dergraduate nursing (because of passing the basic concepts of care and
start of hospital internship) and consent to participate in the study.
3.2. Data collection tools
Data collection tools in this study included a demographic informa­
tion questionnaire, the Iranian questionnaire of nurses’ competencies in
spiritual care (Adib-Hajbaghery et al., 2016; Adib-Hajbaghery et al.,
2017) and the spiritual intelligence self-report inventory (SISRI) (King
and DeCicco, 2009). The demographic information questionnaire
included the students’ age, gender, marital status, academic year, his­
tory of clinical practice (yes and no) and history of training on spiritual
care (yes and no).
Nurses’ competencies in spiritual care scale (SANCSC) was a self-
report scale consists of 32 items in five areas: assessment and imple­
mentation of spiritual care (17 items), which assesses nurses’ skills in
providing spiritual care; human values (6 items) evaluates those values
which are at the core of nurse-patient interaction such as, respect,
acceptance, consideration; knowledge (4 items), which examines the
nurses’ knowledge of spirituality and patients’ spiritual needs; attitudes
(3 items) that include nurses’ attitudes toward spiritual care; self-
recognition (2 items) include nurses’ self-awareness toward spiritual
care. All items are responded and scored on a 5-option Likert scale from
‘always = 5′ to ‘never = 1′ , with the minimum and maximum score of 32
and 160, respectively. A total score of 118 and over were classified as
optimal professional competence in spiritual care, while scores 74–117
and 73 and lower were considered as moderate and poor competence,
respectively (Adib-Hajbaghery et al., 2016, 2017). The SANCSC was
previously developed and validated by Adib-Hajbaghery and Zehtabchi
in 2016 and its reliability estimated using Cronbach’s alpha coefficient,
which for the whole method was equal to 0.93. For the assessment and
implementation of the spiritual care it was 0.93, the domain of human
values was 0.83, the knowledge domain was 0.83, while the scope of the
attitude was 0.82 and for the self-recognition domain was 0.75. They
also confirmed the instrument’s content validity (content validity index
(CVI): 0.87–1 and content validity ratio (CVR): 0.6–1) (Adib-Hajbaghery
and Zehtabchi, 2016). In the present study, the reliability of the SANCSC
using Cronbach’s alpha coefficient was 0.94.
The Spiritual Intelligence Self Report Inventory (SISRI) was used to
assess students’ spiritual intelligence. This questionnaire was designed
and developed by King in 2008. This questionnaire is a self-report scale
consisting of 24 questions. The questions of this questionnaire are scored
based on a Likert scale from 0 (strongly disagree) to 4 (strongly agree).
The reliability of this questionnaire was obtained 0.95 in King’s study
(King and DeCicco, 2009). The King’s Spiritual Intelligence Scale by
Raghib et al. (2010) in Iran among a group of students at the University
of Isfahan is validated and its reliability estimated using Cronbach’s
alpha coefficient was 0.88 for the total scale. For domain of critical
existential thinking, it was 0.75, for personal meaning production
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Nurse Education in Practice 57 (2021) 103227
domain was 0.76, for transcendental awareness domain was 0.78 and for
conscious state expansion domain was 0.73. Moreover, face and content
validity were confirmed by psychologists. Also, for calculating the
construct validity, the exploratory factor analysis and first-order
confirmation factor analysis were calculated. The results of their study
showed that this scale is a valid and reliable tool for measuring spiritual
intelligence in the Iranian society and can be used in educational and
research environments such as universities (Raghib et al., 2010). Based
on Cronbach’s alpha method, the reliability of the tool was 0.91 in the
present study. This questionnaire has four subscales, including critical
existential thinking (5 questions), personal meaning production (7
questions), transcendental awareness (5 questions) and conscious state
expansion (7 questions). The questions of the spiritual intelligence
questionnaire are scored directly and only question 6 is scored reversely.
The total score obtained from this scale is in the range of 0–96 and the
higher the score, the higher will be individual’s spiritual intelligence
(Raghib et al., 2010). On this scale, scores from 0 to 32 indicate low and
undesirable spiritual intelligence, scores of 33–65 indicate moderate
spiritual intelligence and scores of more than 66 indicate high and
desirable spiritual intelligence (Moradnezhad et al., 2017).
3.3. Data analysis
Data analysis was performed using SPSS v.22 software. As the Kol­
mogorov–Smirnov test showed that the distribution of the data was
normal, parametric tests were used. Independent sample t-test and one-
way analysis of variance (ANOVA) were used to examine the statistical
difference between mean competency scores and spiritual intelligence in
nominal demographic variable subgroups (i.e., age, gender, marital
status, history of clinical practice and history of training on spiritual
care). The relationship between outcome variables (competence in
spiritual care and spiritual intelligence) were estimated in a correlation
matrix by Pearson correlation coefficients. Finally, stepwise-selection
multiple linear regression analyses of the overall competence in spiri­
tual care in nursing students and five domain scores were applied to
determine their predictors (P-value for entry <0.05).
3.4. Ethical considerations
This study was approved by the ethics committee of our university
(ethics code: IR.SBMU.RETECH.REC.1395.1111). Ethical considerations
including obtaining permission from the competent authorities,
explaining the objectives of the research to the participants and assuring
them about the confidentiality of the data and obtaining informed
written and oral consent from the samples were observed.
4. Results
Among a total of 630 nursing students, 510 answered the question­
naire completely that were included in the analysis. The response rate
was 80.95%. The mean age of nursing students was 21.97 ± 2.98 years.
Most of them (56.7%) were female and 86.7% were single and only
34.1% of students had received training about providing spiritual care.
The mean of the nursing students’ overall competence in spiritual
care was 116.81 ± 16. In total, 1.2%, 52.4% and 46.5% of students had
Table 1
The mean score of the nursing students’ professional competence in providing
spiritual care.
Areas of competence M±SD
Assessment and implementation of spiritual care 60.5 ± 10.01
Human values 22.76 ± 3.41
Awareness 14.28 ± 2.51
Attitude 11.37 ± 1.08
Self-awareness 7.88 ± 1.31
Overall competence 116.81 ± 16
M. Ahmadi et al.
poor, moderate and favorable competence in spiritual care, respectively
(Table 1). The mean score of nursing students’ spiritual intelligence was
67.86 ± 10.98. Moreover, 42.2% and 57.8% of nursing students had
moderate and high spiritual intelligence, respectively (Table 2).
No significant differences were found between the mean competence
scores of spiritual care in terms of age, sex, marital status, history of
clinical practice, academic year and receiving training on spiritual care.
However, a significant difference was found between some dimensions
of competence in spiritual care and sex, history of clinical practice, ac­
ademic year and receiving training on spiritual care (Table 3).
In the study, there were no significant differences between the mean
spiritual intelligence score in terms of sex and receiving training on
spiritual care. However, there were significant differences between the
mean spiritual intelligence score in terms of age, marital status, history
of clinical practice and academic year (Table 4). Also, using Pearson’s
correlation coefficient, a significant and positive correlation was found
between the spiritual intelligence and all subscales of nursing students’
competency (Table 5).
Independent variables that were significantly associated with out­
comes of the competence in spiritual care were included in the multiple
regression. The results of stepwise-selection multiple linear regression
analysis revealed that overall spiritual intelligence was predictor for
overall competence in spiritual care in nursing students. This model
explained 7% of the variance in competence in spiritual care (F=39.11,
p < 0.001). Also, this model indicated that the rise in spiritual intelli­
gence is associated with an increased level of competence in spiritual
care by as much as 0.39. For the assessment and implementation of
spiritual care domain, overall spiritual intelligence (B: 0.14; 95% CI
0.06–0.22) and academic year (B: 1.52; 95% CI 0.47–2.57) were
significantly associated with competence in spiritual care. The model
explained 4% of the variance in assessment and implementation of
spiritual care (F=11.76, p < 0.001). Overall spiritual intelligence (B:
0.08; 95% CI 0.06–0.11) was the only variable included in the final
model of the human values domain, explaining 7% of the variance
(F=42.27, p < 0.001). This was also the case for the self-awareness
domain where overall spiritual intelligence (B: 0.04; 95% CI
0.03–0.05) explained 14% of the variance in this domain (F=87.49, p <
0.001). Personal meaning production (B: 0.13; 95%CI 0.03–0.23), fe­
males (B: − 0.58; 95%CI − 1.007 to − 0.15) compared with males, history
of training on spiritual care (B: 0.48; 95%CI 0.04–0.92), academic year
(B: 0.32; 95%CI 0.05–0.58) and conscious state expansion (B: 0.09; 95%
CI 0.01–0.18) were significantly associated with awareness domain of
competence in spiritual care. The model explained 10% of the variance
in this domain (F=11.27, p < 0.001). Conscious state expansion (B: 0.09;
95%CI 0.03–0.16) and critical existential thinking (B: 0.07; 95%CI
0.01–0.13) were positively and history of clinical practice (B: − 0.69;
95%CI − 1.09 to − 0.3) was negatively associated with attitude domain
of competence in spiritual care. The model explained 10% of the vari­
ance in this domain (F=19.02, p < 0.001) (Table 6).
5. Discussion
This study aimed to determine the professional competence of
nursing students in the area of spiritual care and its relationship with
spiritual intelligence. The study results showed that the average pro­
fessional competence of students in the area of spiritual care was
Table 2
The mean score of the nursing students’ spiritual intelligence.
Areas of spiritual intelligence M ± SD
Critical Existential Thinking 20.08 ± 3.76
Personal Meaning Production 14.12 ± 2.82
Transcendental Awareness 14.16 ± 3.02
Conscious State Expansion 19.49 ± 3.33
Overall Spiritual intelligence 67.86 ± 10.98
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Nurse Education in Practice 57 (2021) 103227
moderate and relatively optimal, and almost half of the students had
high competencies in this regard. In line with the results of the present
study, the professional competence of nursing students was estimated as
optimal in the previous studies (Ahmadi et al., 2018; Aksoy and Coban,
2017; Attard jet al., 2014). However, in contrast to the results of the
present study, Adib-Hajbaghery et al. (2017) showed that nurses did not
have optimal professional competence in the area of spiritual care
(Adib-Hajbaghery et al., 2017). The optimal results related to profes­
sional competence in spiritual care in nursing students are a bit far from
expected as nursing students spend only their internships in hospitals.
This, on the one hand, is because of the introduction of spirituality and
spiritual care to the education of nursing students, which has been
considered in recent years (Ali et al., 2015; Bennett and Thompson,
2015) and, on the other hand, nursing students unlike nurses working
have not encountered issues such as work stress, lack of time and other
routine programs in the nursing profession (Ahmadi et al., 2018). As
such, they feel that in their internships, they have been able to meet the
needs of their patients about spiritual care and consequently, obtain
high scores in this regard.
In the present study, there was no significant difference in the total
competency score of nursing students in the area of spiritual care in
terms of age, sex, marital status, academic year, history of clinical
practice and history of training on spiritual care. This result is in line
with some previous studies (Ahmadi et al., 2018; Aksoy and Coban,
2017; Mohammadi et al., 2015). However, some aspects of spiritual care
competence were significantly different in terms of the history of clinical
practice, history of training on spiritual care and academic year. The
results of the present study showed that students with clinical experi­
ence obtained significantly lower scores in the dimension of "attitude"
compared with those without clinical experience. The weaker attitude of
this group of students in providing spiritual care to patients may be
attributed to the pressure of work that leads to reduced efficiency and a
lack of effective communication with patients. Another important point
in this regard is the prevailing clinical atmosphere where spiritual care
might be neglected. If there is no proper context for spiritual care in the
clinical environment, the nursing students will not understand the need
for spiritual care and as a result, a proper attitude will not be formed in
their minds (Little, 2010).
In line with the present study, similar studies have been conducted
by Ahmadi et al. (2018) in Iran and Aksoy et al. (2017) in Turkey to
determine the professional competencies of nursing students in the area
of spiritual care. According to the results of these studies, the students
who participated in the workshops with ethical themes obtained
significantly higher scores in spiritual care competence (Ahmadi et al.,
2018; Aksoy and Coban, 2017). The present study also showed that
students who participated in the workshops obtained higher scores in
spiritual care. However, except in the dimension of "awareness," this
difference was not significant in other dimensions and the total score. It
should be noted, however, that improving the level of awareness can be
a significant precondition for enhancing students’ professional compe­
tence in providing spiritual care. Determining the effectiveness of spir­
itual care training on improving the self-efficacy of nursing students in
providing spiritual care to patients, Frouzandeh et al. (2015) showed
that these training courses could improve the level of self-efficacy and
competence of students in providing spiritual care to patients (Frou­
zandeh et al., 2015). The results of other studies have also shown that
providing training in spiritual care to health care professionals is one
way to integrate spirituality in comprehensive patient care that can play
an influential role in improving nurses’ competence for providing spir­
itual care to patients (Paal et al., 2015; Hu et al., 2019). These studies
show the need to integrate spirituality and spiritual care in a structured
and comprehensive way in the curricula of nursing students.
Moreover, the results of the present study indicated that last year’s
students (semesters 7 and 8) were more competent than the second-year
students (semesters 3 and 4) in providing spiritual care. This difference
was significant in the dimensions of assessments and implementation of
M. Ahmadi et al. Nurse Education in Practice 57 (2021) 103227

Table 3
Comparison competence in spiritual care in nursing students based on demographic variables.
Variables N Assessment and implementation of Human Awareness Attitude Self- Overall
spiritual care values awareness competence
M±SD M±SD M±SD M±SD M±SD M±SD

Age 19–21 254 60.21 ± 8.9 23.03 ± 3 14.09 ± 11.49 ± 7.78 ± 1.12 116.61 ± 13.39
2.26 1.83
≤ 22 256 60.79 ± 11.02 22.50 ± 14.47 ± 11.25 ± 7.98 ± 1.46 116.98 ± 18.26
3.75 2.73 1.93
P 0.5 0.08 0.08 0.1 0.09 0.7
value
Sex Male 221 61.04 ± 9.33 22.52 ± 14.6 ± 2.14 11.2 ± 7.95 ± 1.25 117.33 ± 14.09
2.87 1.68
Female 289 60.09 ± 10.5 22.95 ± 14.04 ± 11.49 ± 7.82 ± 1.35 116.41 ± 17.33
3.76 2.75 2.02
P 0.2 0.1 0.01 0.07 0.2 0.5
value
Marital status Singles 442 60.33 ± 10.27 22.78 ± 14.29 ± 11.32 ± 7.86 ± 1.29 116.61 ± 16.41
3.39 2.54 1.89
Married 68 61.6 ± 8.15 22.64 ± 14.19 ± 11.66 ± 8 ± 1.44 118.1 ± 13.1
3.52 2.38 1.82
P value 0.3 0.7 0.7 0.1 0.4 0.4
History of clinical practice Yes 101 60.34 ± 13.87 22.46 ± 14.78 ± 10.9 ± 7.95 ± 1.75 116.44 ± 23.94
4.86 3.33 2.44
No 409 60.54 ± 8.83 22.84 ± 14.16 ± 11.48 ± 7.86 ± 1.18 116.9 ± 13.38
2.95 2.26 1.7
P 0.8 0.4 0.07 0.02 0.6 0.8
value
Academic year Second 178 58.45 ± 10.54 22.89 ± 13.88 ± 11.46 ± 7.55 ± 1.14 114.65 ± 15.32
year 3.28 2.35 2.01
Third year 169 61.44 ± 6.52 22.31 ± 2.6 14.56 ± 11.23 ± 7.95 ± 1.04 117.11 ± 10.39
1.59 1.29
Fourth 163 61.76 ± 11.94 23.09 ± 14.42 ± 3.3 11.41 ± 8.14± 1.63 118.85± 20.66
year 4.17 2.23
P 0.003 0.09 0.03 0.5 < 0.001 0.05
value
History of training on Yes 174 61.61± 9.6 22.65± 14.68± 11.36 ± 7.93 ± 1.25 118.25 ± 14.78
spiritual care 3.18 2.07 1.77
No 336 59.93 ± 10.19 22.82 ± 14.07 ± 11.37 ± 7.85 ± 1.34 116.06 ± 16.57
3.52 2.69 1.94
P 0.07 0.5 0.005 0.9 0.5 0.1
value

spiritual care, awareness and self-awareness. This result is in line with
Yazdan Parast et al. (2017). In Pipkin’s et al. (2020), last year nursing
students, compared with first-year students, obtained higher scores in
the area of spirituality and spiritual care, though these differences were
not significant. Contrary to the results of the present study, no statisti­
cally significant difference was observed between second and
fourth-year students in the studies of Abbasi et al. (2014) in Iran and
Aksoy and Coban (2017) in Turkey. This difference in the results may be
attributed to the time of the above studies. The concepts of spirituality
and spiritual care have recently been introduced into nursing courses
and more attention has been paid to the teaching of spiritual care to
students. However, the high sample size of the present study, which
helped to find minor differences between the two groups, should not be
overlooked.
In the present study, the average spiritual intelligence of students
was assessed to be good and high and most of them had a high level of
spiritual intelligence. The results of previous studies on the spiritual
intelligence of nursing students have also shown high levels of spiritual
intelligence in these students (Ahmadi et al., 2018; Mohammadi et al.,
2018). Miri et al. (2015) and Karimi-Moonaghi et al. (2015) also showed
a relatively good level of spiritual intelligence in nurses that is consistent
with the present study (Ebrahimi Barmi et al., 2019; Karimi-Moonaghi
et al., 2015; Miri et al., 2015). Contrary to the results of the present
study, Yang et al. (2007), conducting a study to determine the spiritual
intelligence of nurses in China, showed that 82.9% of nurses had low
spiritual intelligence. They also reported that only seven participants of
their study had religious beliefs. The high level of spiritual intelligence
in Iranian nursing students and nurses can be attributed to religious
beliefs and inclination to spiritual values in Iranian society; because
believing in religious values and having religious beliefs are necessary
features for the formation of spiritual intelligence in individuals
(Ahmadi et al., 2018).
No significant difference was observed in this study in the total score
of spiritual intelligence and its dimensions between men and women and
the history of training on spiritual care, which is consistent with some
previous studies (Mohammadi et al., 2018; Moradnezhad et al., 2017).
According to the results of the present study, the older students ob­
tained higher scores in spiritual intelligence. This difference was sta­
tistically significant in the total score and all dimensions except the
Conscious State Expansion. A significant relationship was observed be­
tween age and spiritual intelligence in the studies of Yang et al. (2007)
and Ahmadi et al. (2018), suggesting that the increase of age can
improve spiritual intelligence. These studies are in line with the present
study. This may be due to the greater acceptance of spiritual experiences
with the increase of age.
Moreover, in this study, the spiritual intelligence of married people
was higher than that of the singles and this difference was significant in
the total score of spiritual intelligence as well as the dimensions of
Critical Existential Thinking and Transcendental Awareness. Although
spiritual intelligence has a mostly non-acquisitive nature, the impact of
the environment and social conditions cannot be ignored. Marriage
seems to be one of the factors which play a significant role in spiritual
maturity and that is why married people in the present study had higher
spiritual intelligence compared with single people. However, most
studies showed no significant difference in marital status impact on
spiritual intelligence scores (Ahmadi et al., 2018; Mohammadi et al.,

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Table 4
Comparison Spiritual intelligence in nursing students based on demographic variables.
Variables N Critical Existential Personal Meaning Transcendental Conscious State Overall Spiritual
Thinking Production Awareness Expansion intelligence
M ± SD M ± SD M ± SD M ± SD M ± SD

Age 19–21 254 19.62 ± 3.47 13.52 ± 2.6 13.59 ± 2.73 19.49 ± 3.12 66.23 ± 9.62
≤ 22 256 20.54 ± 3.98 14.72 ± 2.91 14.72 ± 3.19 19.49 ± 3.54 69.48 ± 11.98
P 0.005 < 0.001 < 0.001 1 0.001
value
Sex Male 221 19.94 ± 3.5 14.2 ± 2.66 14 ± 2.82 19.48 ± 3.15 67.63 ± 10.1
Female 289 20.19 ± 3.95 14.06 ± 2.95 14.28 ± 3.17 19.5 ± 3.47 68.04 ± 11.62
P 0.4 0.5 0.2 0.9 0.6
value
Marital status Singles 442 19.92 ± 3.75 14.08 ± 2.79 14.01 ± 3.04 19.4 ± 3.34 67.42 ± 11.05
Married 68 21.1 ± 3.69 14.41 ± 3.05 15.08 ± 2.72 20.11 ± 2.19 70.72 ± 10.1
P 0.01 0.3 0.007 0.09 0.02
value
History of clinical Yes 101 21.05 ± 4.52 15.06 ± 3.47 15.08 ± 3.52 19.67 ± 4.02 70.89 ± 14.41
practice
No 409 19.84 ± 3.51 13.89 ± 2.59 13.93 ± 2.84 19.45 ± 3.14 67.12 ± 9.83
P 0.01 0.002 0.003 0.6 0.01
value
Academic year Second 178 20.06 ± 3.4 13.9 ± 2.49 14.01 ± 2.76 20.03 ± 3.19 68.01 ± 9.67
year
Third year 169 19.02 ± 3.43 13.91 ± 2.48 13.52 ± 2.77 18.99 ± 2.78 65.44 ± 9.05
Fourth 163 21.21 ± 4.14 14.58 ± 3.41 14.98 ± 3.36 19.42 ± 3.89 70.21 ± 13.42
year
P < 0.001 0.04 < 0.001 0.01 < 0.001
value
History of training on Yes 174 20.23 ± 3.78 14.41 ± 2.82 14.48 ± 3.15 19.82 ± 3.24 68.95 ± 11.33
spiritual care
No 336 20 ± 3.76 13.97 ± 2.82 13.99 ± 2.94 19.32 ± 3.37 67.3 ± 10.77
P 0.5 0.09 0.1 0.07 0.1
value

Table 5
Correlation between spiritual intelligence and competence in spiritual care in nursing students.
Areas Critical Existential Personal Meaning Transcendental Conscious State Overall Spiritual
Thinking Production Awareness Expansion intelligence
r (P value) r (P value) r (P value) r (P value) r (P value)

Assessment and implementation of 0.16 (<0.001) 0.14 (0.001) 0.1 (0.02) 0.14 (0.001) 0.16 (<0.001)
spiritual care
Human values 0.25 (<0.001) 0.21 (<0.001) 0.2 (<0.001) 0.25 (<0.001) 0.27 (<0.001)
Awareness 0.2 (<0.001) 0.25 (<0.001) 0.14 (<0.001) 0.22 (0.001) 0.24 (<0.001)
Attitude 0.18 (<0.001) 0.15 (<0.001) 0.13 (0.002) 0.21 (<0.001) 0.2 (<0.001)
Self-awareness 0.22 (<0.001) 0.19 (<0.001) 0.20 (<0.001) 0.23 (<0.001) 0.25 (<0.001)
Overall competence 0.23 (<0.001) 0.21 (<0.001) 0.16 (<0.001) 0.23 (<0.001) 0.26 (<0.001)

2018; Moradnezhad et al., 2017). Therefore, marriage cannot be
considered effective in improving the level of spiritual intelligence and
more research should be conducted in this regard.
Additionally, clinical records and being last year nursing students
were identified as factors playing a role in promoting students’ spiritual
intelligence in the present study. It seems that students in their final year
of education and entering the clinical environment as a nurse, have a
better acceptance of spiritual experiences and achieve spiritual matu­
rity. No study was found to be consistent with the present study in this
regard. However, investigating the relationship between spiritual in­
telligence and student self-efficacy, the results of a study conducted by
Zamirinejad et al. showed a direct and significant relationship between
spiritual intelligence and student self-efficacy (Zamirinejad et al., 2016).
Since spiritual intelligence is the ability to focus on problem-solving to
adapt and achieve goals (Zamirinejad et al., 2016) and self-efficacy re­
fers to people’s belief in their own ability to produce certain levels of
performance (Viswam et al., 2017), the direct relationship between
spiritual intelligence and self-efficacy can be justified. Moreover, ac­
cording to the results of studies that the self-efficacy of nursing students
improves with the increase of academic years (Van Horn and Christman,
2017; Viswam et al., 2017), it is evident that last year students get higher
scores in spiritual intelligence.
Based on the results of the present study, a significantly positive
relationship was observed between spiritual intelligence and its con­
stituent dimensions and the professional competence of nursing students
in spiritual care and its dimensions (p < 0.001). According to the results
of multiple linear regression, spiritual intelligence was able to predict
7% of changes in the professional competence of nursing students in
spiritual care. The regression model showed that for each increase in the
students’ spiritual intelligence, their professional competence in spiri­
tual care increases 0.39 times. Spiritual intelligence and different di­
mensions of it were also found to be the main predicting factor for
different domains of competence in spiritual care. Although the per­
centage of variances obtained by the models are low, it can still be
predicted that improvements in the spiritual intelligence of nurses will
increase their competence in spiritual care. These results are consistent
with the results of Ahmadi et al. (2018). The effect of spiritual intelli­
gence on nurses’ performance has also been shown in other studies.
Measuring the relationship between nurses’ clinical competence and
spiritual intelligence, Karimi-Moonaghi et al. (2015) showed a positive
significant relationship between spiritual intelligence and nurses’ clin­
ical competence. Miri et al. (2015) also showed a positive significant
relationship between spiritual intelligence and the quality of nursing
care. In the study of Kaur et al. (2015), spiritual intelligence had a

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Table 6
Stepwise-selection multiple linear regression models with the total and the five domain scores of competence in spiritual care as dependent variables.
R R2 AdjR2 Independent variables 95%CI Sig

Model B SE β t Lower Upper

bound bound

Overall competence 0.26 0.07 0.07 Constant 90.37 4.28 – 21.1 81.96 98.78 <
0.001
Overall spiritual intelligence 0.39 0.062 0.26 6.25 -0.26 0.51 <
0.001
Assessment and implementation of 0.21 0.04 0.04 Constant 49.08 2.74 – 17. 91 43.70 54.46 <
spiritual care 0.001
Overall spiritual intelligence 0.14 0.04 0.161 3.68 0.06 0.22 <
0.001
Academic year 1.52 0.53 0.124 2.85 0.47 2.57 0.004
Human values 0.27 0.07 0.07 Constant 16.92 0.91 – 18.59 15.13 18.71 <
0.001
Overall spiritual intelligence 0.08 0.01 0.277 6.50 0.06 0.11 <
0.001
Awareness 0.31 0.10 0.09 Constant 11.89 0.84 – 14.6 9.42 12.35 <
0.001
Personal meaning 0.13 0.05 0.151 2.68 0.03 0.23 0.007
production
Gender (ref: male) -0.58 0.21 -0.114 -2.66 -1.007 -0.15 0.008
History of training on 0.48 0.22 0.091 2.14 0.04 0.92 0.032
spiritual care
Academic year 0.32 0.13 0.105 2.40 0.05 0.58 0.016
Conscious state expansion 0.09 0.04 0.130 2.32 0.01 0.18 0.021
Attitude 0.31 0.10 0.09 Constant 8.1 0.49 – 16.33 7.12 9.07 <
0.001
Conscious state expansion 0.09 0.03 0.175 3.07 0.03 0.16 0.002
History of clinical practice -0.69 0.20 -0.148 -3.46 -1.09 -0.30 0.001
Critical existential thinking 0.07 0.02 0.147 2.57 0.01 0.13 0.01
Self-awareness 0.38 0.14 0.14 Constant 4.76 0.36 – 13.21 4.05 5.47 <
0.001
Overall spiritual intelligence 0.04 0.005 0.383 9.35 0.03 0.05 <
0.001

significant effect on nurses’ caring behaviors. Riahi et al. (2018) con­
ducted a study to investigate the effect of spiritual intelligence training
on the competence of spiritual care in nurses. The results showed that
spiritual intelligence training and, consequently, the improved level of
spiritual intelligence had a positive effect on improving the competence
of nurses in spiritual care. The results of these studies are in line with the
present study. Based on these results, it can be said that the promotion of
spiritual intelligence can improve the quality of nursing care and affect
the performance of nurses. Spirituality is a natural quality in humans
and is a source of thoughts, feelings and values. As an important concept,
spirituality is the basis of nursing activities (Kaur et al., 2015). People
with high spiritual intelligence have an overview of life and, by having
moral virtues, are greatly able to solve problems and adapt to them. As
nursing is a stressful profession, higher levels of spiritual intelligence
can improve the competence of nurses in providing nursing care (Kar­
imi-Moonaghi et al., 2015).
6. Conclusion
According to the results of this study, most nursing students enjoyed
high levels of spiritual intelligence and had reasonable competence in
the area of spiritual care. However, no significant difference was
observed in the total score of spiritual care competence and spiritual
intelligence between students who participated in the workshops and
those who did not. This was despite the fact that the students who
participated in the workshops were expected to be significantly more
competent. This shows the need to pay attention to the quality of edu­
cation in spiritual care and eliminate the gap between theoretical and
practical education in providing this kind of care. Integrating spirituality
into the nursing education curriculum as well as using role-modeling can
be effective in this regard (Timmins et al., 2015; Baldacchino, 2015).
Furthermore, this study showed that spiritual intelligence could
affect the competence of nursing students in providing spiritual care to
patients. Therefore, to promote students’ spiritual intelligence, appro­
priate plans with the aim of promoting the level of critical thinking and
spiritual self-awareness are recommended. However, results of multiple
linear regression showed spiritual intelligence was able to predict only
7% of changes in the professional competence of nursing students in
spiritual care. Therefore, it is also recommended to conduct studies that
can show other predictors of students’ competence in providing spiritual
care.
7. Implication
One of the aspects that nurses must pay special attention to is to
consider spiritual care as an unquestionable part of patient-centered
holistic care. In this regard, preparing nursing students and improving
their competence to provide spiritual care is essential. The result of this
study brings new insight into the importance of spiritual self-awareness
and training as a way for improving nurses’ competence in providing
spiritual care. Therefore, the inclusion of spiritual intelligence and
spiritual care issues in nursing undergraduate curriculum training is
necessary. Considering the significant relationship between clinical
practice and spiritual intelligence, necessary platforms should be pro­
vided by educational managers and planners and faculty members to
create appropriate learning spaces in clinical settings. The results of this
study will also be helpful for all health care providers, including nurses,
physicians, psychologists and spiritual care providers, to promote their
spiritual intelligence as an influential factor in providing optimal spiri­
tual care to patients.
8. Limitations
Using an indigenous instrument for assessing the nursing students’
competence in spiritual care may be viewed as a strength of this study.
However, some limitations should be noted. First, self-report bias may

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M. Ahmadi et al.
have been introduced by the nursing students in response to the items of
the questionnaires; therefore, results might not wholly reflect their
competency level. It might be necessary to conduct observational studies
to better assess nursing students’ competence in providing spiritual care.
Second, the cross-sectional design of the study did not allow for mea­
surement of the variables over time and cannot be used to infer
causality.
Funding
This study was supported by research deputy of the Shahid Beheshti
University of Medical Sciences, Tehran, Iran.
Author contributions statement
Ahmadi, Estebsari, Poormansouri, Jahani, and Sedighie involved in
the study conception/design. Ahmadi, Estebsari, Poormansouri, and
Sedighie contributed to the data collection/analysis. Ahmadi, Estebsari,
Poormansouri, Jahani, and Sedighie drafted the manuscript. Ahmadi,
Estebsari, and Jahani involved in critical revisions for important intel­
lectual content and administrative/technical support and supervised the
work. Ahmadi, Estebsari, Poormansouri, Jahani, and Sedighie approved
the final version to be submitted.
Conflict of interest
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Acknowledgements
This study was extracted from a research proposal approved by the
Student Research Committee, Shahid Beheshti University of Medical
Sciences, Tehran, Iran (NO:1395/77496). The researchers appreciate all
staff in “Student Research Committee” and “Research & Technology
Chancellor” in Shahid Beheshti University of Medical Sciences for their
financial support. In addition, the researchers are thankful to the
“Research & Technology Chancellor” of Ahvaz Jundishapur university
of Medical Sciences, for their cooperation and all the nursing students
who participated in this study.
References
Abbasi, M., Farahani-Nia, M., Mehrdad, N., 2014. Nursing students’ spiritual well-being,
spirituality and spiritual care. Iran. J. Nurs. Midwifery Res. 19 (3), 242–247.
Adib-Hajbaghery, M., Zehtabchi, S., 2016. Developing and validating an instrument to
assess the nurses’ professional competence in spiritual care. J. Nurs. Meas. 24 (1),
15–27.
Adib-Hajbaghery, M., Zehtabchi, S., Azizi Fini, I., 2017. Iranian nurses’ professional
competence in spiritual care in 2014. Nurs. Ethics 24 (4), 462–473.
Ahmadi, M., Izadi, A., Poormansouri, S., Sedighie, L., Estebsari, F., Zarea, K., 2018.
Relationship between nursing students’ professional competence in spiritual care
and spiritual intelligence. Avicenna J. Nurs. Midwifery Care 25 (5), 189–199.
Aksoy, M., Coban, G.I., 2017. Nursing students’ perceptions of spirituality and spiritual
care. Int. J. Caring Sci. 10 (3), 1136–1147.
Ali, G., Wattis, J., Snowden, M., 2015. Why are spiritual aspects of care so hard to
address in nursing education?’a literature review (1993-2015). Int. J. Multidiscip.
Comp. Stud. 2 (1), 7–31.
Amram, J.Y., 2009. The Contribution of Emotional and Spiritual Intelligences to Effective
Business Leadership. Institute of Transpersonal Psychology.
Attard, J., Baldacchino, D.R., Camilleri, L., 2014. Nurses’ and midwives’ acquisition of
competency in spiritual care: a focus on education. Nurse Educ. Today 34 (12),
1460–1466.
Bagheri, F., Akbarizadeh, F., Hatami, H., 2010. The relationship between nurses’
spiritual intelligence and happiness in Iran. Procedia-Soc. Behav. Sci. 5, 1556–1561.
Baldacchino, D., 2015. Spiritual care education of health care professionals. Religions 6
(2), 594–613.
Bennett, V., Thompson, M.L., 2015. Teaching spirituality to student nurses. J. Nurs.
Educ. Pract. 5 (2), 26–33.
Bożek, A., Nowak, P.F., Blukacz, M., 2020. The relationship between spirituality, health-
related behavior and psychological well-being. Front. Psychol. 11, 1–13.
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.
Nurse Education in Practice 57 (2021) 103227
Cavendish, R., Konecny, L., Mitzeliotis, C., Russo, D., Luise, B.K., BS, M.L., Bajo, M.A.M.,
2003. Spiritual care activities of nurses using nursing interventions classification
(NIC) labels. Int. J. Nurs. Terminol. Classif. 14 (4), 113–124.
Chandramohan, S., Bhagwan, R., 2015. Spirituality and spiritual care in the context of
nursing education in South Africa. Curationis 38 (2).
Chirico, F., 2016. Spiritual well-being in the 21st century: It’s time to review the current
WHO’s health definition. J. Health Soc. Sci. 1 (1), 11–16.
Ebrahimi Barmi, B., Hosseini, M.A., Abdi, K., Bakhshi, E., Shirozhan, Sh, 2019. The
relationship between spiritual intelligence and resiliency of rehabilitation staff.
J. Pastoral Care Couns. 73 (4), 205–210.
Elk, R., Hall, EJ, DeGregory, C., Graham, D., Hughes, BP., 2019. The Role of Nurses in
Providing Spiritual Care to Patients: An overview. Journal of Nursing.
Farahaninia, M., Abasi, M., Seyedfatemi, N., JafarJalal, E., Haghani, H., 2018. Nurses’
attitudes towards spiritual care and spiritual care practices. J. Client-Cent. Nurs.
Care 4 (2), 61–68.
Frouzandeh, N., Aein, F., Noorian, C., 2015. Introducing a spiritual care training course
and determining its effectiveness on nursing students’ self-efficacy in providing
spiritual care for the patients. J. Educ. Health Promot. 4, 34.
Fukada, M., 2018. Nursing competency: Definition, structure and development. Yonago
Acta Med. 61 (1), 001–007.
Ghaleei, A., Mohajeran, B., 2015. The relationship among spiritual intelligence, mental
health and job stress in nurses in imam khomeini hospital of mahabad. Avicenna J.
Nurs. Midwifery Care 23 (4), 14–21.
Hu, Y., Jiao, M., Li, F., 2019. Effectiveness of spiritual care training to enhance spiritual
health and spiritual care competency among oncology nurses. BMC Palliat. Care 18
(1), 1–8.
Jahromi, M.F., Akbar, R.E., 2020. spiritual needs of hospitalized patients from nurses’
viewpoints: a qualitative study. Arch. Venez. De Farmacol. Y. Ter. 39 (8), 916–922.
Karimi-Moonaghi, H., Gazerani, A., Vaghee, S., Gholami, H., Salehmoghaddam, A.R.,
Gharibnavaz, R., 2015. Relation between spiritual intelligence and clinical
competency of nurses in Iran. Iran. J. Nurs. Midwifery Res. 20 (6), 665–669.
Kaur, D., Sambasivan, M., Kumar, N., 2015. Impact of emotional intelligence and
spiritual intelligence on the caring behavior of nurses: a dimension-level exploratory
study among public hospitals in Malaysia. Appl. Nurs. Res. 28 (4), 293–298.
King, D.B., DeCicco, T.L., 2009. A viable model and self-report measure of spiritual
intelligence. Int. J. Transpers. Stud. 28 (1), 68–85.
Kish, L., 1979. Samples and censuses. Int. Stat. Rev. /Rev. Int. De. Stat. 47 (2), 99–109.
Lewinson, L.P., McSherry, W., Kevern, P., 2015. Spirituality in pre-registration nurse
education and practice: a review of the literature. Nurse Educ. Today 35 (6),
806–814.
Little, N.K., 2010. Clinical pastoral education as professional training: some entrance,
curriculum and assessment implications. J. Pastor. Care Couns. 64 (3), 1–8.
Memaryan, N., Rasooli, M., Vahidshahi, K., 2017. Developing educational goals and
expected competencies for teaching spiritual health to the students of medical
sciences. Iran. J. Med. Educ. 17, 116–125.
Memaryan, N., Rassouli, M., Nahardani, S.Z., Amiri, P., 2015. Integration of spirituality
in medical education in Iran: a qualitative exploration of requirements. Evid. -Based
Complement. Altern. Med. 2015, 1–7.
Miri, K., Keshavarz, A., Shirdelzadeh, S., Parsa, P., 2015. The relationship between
nurses’ spiritual intelligence and quality of nursing care based on nurses’& patients’
viewpoints. J. Urmia Nurs. Midwifery Fac. 13 (6), 518–524.
Mohammadi, Gh, Mirshahi, F., Movahedi, A., Taghavi, M., Moghadam Pasha, A.,
Mardani, M., Kavosi, A., 2015. Nurses and midwives attitude of hospitals of
Neyshabur city about spirituality and spiritual care. Med. Ethics J. 9 (33), 45–63.
Mohammadi, S., Soleymanpoor, L., Borhani, F., Roshanzadeh, M., 2018. Evaluation of
spiritual intelligence and spiritual health in nursing students of Boroujen. Iran. J.
Nurs. 1, 11–31.
Moradnezhad, M., Seylani, Kh, Navab, El, Esmaeilie, M., 2017. Spiritual intelligence of
nurses working at the intensive care units of hospitals affiliated with Tehran
university of medical sciences. Nurs. Pract. Today 4 (4), 170–179.
Nobel, K.D., 2000. Spirit. Intell.: A N. Fram. mind 9 2000 1 28.
Nouhi, E., Nakhaee, N., Rahimi, N., 2014. Spiritual intelligence and attitude towards
spirituality and spiritual care in nursing and midwifery students. Iran. J. Nurs. 27
(90), 150–159.
Paal, P., Helo, Y., Frick, E., 2015. Spiritual care training provided to healthcare
professionals: a systematic review. J. Pastor. Care Couns. 69 (1), 19–30.
Pinto, C.T., Pinto, S., 2020. From spiritual intelligence to spiritual care: a transformative
approach to holistic practice. Nurse Educ. Pract. 47, 102823.
Pipkins, C.M., Rinker, M.A., Curl, E., 2020. Spiritual care perceptions of baccalaureate
nursing students. J. Holist. Nurs. 38 (1), 131–138.
Raghib, M., Siadat, A., Hakiminiya, B., Ahmadi, J., 2010. The validation of king’s
spiritual intelligence scale (SISRI-24) among students at University of Isfahan.
J. Psychol. Achiev. 17 (1), 141–164.
Riahi, S., Goudarzi, F., Hasanvand, Sh, Abdollahzadeh, H., Ebrahimzadeh, F.,
Dadvari, Z., 2018. Assessing the effect of spiritual intelligence training on spiritual
care competency in critical care nurses. J. Med. Life 11 (4), 346–354.
Ross, L., van Leeuwen, R., Baldacchino, D., Giske, T., McSherry, W., Narayanasamy, A.,
Schep-Akkerman, A., 2014. Student nurses perceptions of spirituality and
competence in delivering spiritual care: a European pilot study. Nurse Educ. Today
34 (5), 697–702.
Shiasi, M., Etebarian, A., Abadi, Z.Z., Ahmadi, M., 2016. The effect of spiritual
intelligence on the productivity of employees at Isfahan University of Medical
Sciences based on structural equation model. J. Health Adm. (JHA) 19, 63.
Timmins, F., Murphy, M., Neill, F., Begley, T., Sheaf, G., 2015. An exploration of the
extent of inclusion of spirituality and spiritual care concepts in core nursing
textbooks. Nurse Educ. Today 35 (1), 277–282.
M. Ahmadi et al. Nurse Education in Practice 57 (2021) 103227

Van Horn, E., Christman, J., 2017. Assessment of nursing student confidence using the
clinical skills self-efficacy scale. Nurs. Educ. Perspect. 38 (6), 344–346.
Veloza-Gómez, M., Muñoz de Rodríguez, L., Guevara-Armenta, C., Mesa-Rodríguez, S.,
2017. The importance of spiritual care in nursing practice. J. Holist. Nurs. 35 (2),
118–131.
Viswam, A., Kaviyabala, D., Sayujya, C.P., Thakur, V., Buvaneswari, R., 2017. Self-
efficacy among nursing students. Int. J. Curr. Res. 9 (8), 55748–55751.
Withers, A., Zuniga, K., Van Sell, Sh.L., 2017. Spirituality: concept analysis. Int. J. Nurs.
Clin. Pract. 4 (1).
Wu, L.F., Tseng, H.Ch, Liao, Y.Ch, 2016. Nurse education and willingness to provide
spiritual care. Nurse Educ. Today 38, 36–41.
Yang, Ke, P, Mao, Xiu, Y., 2007. A study of nurses’ spiritual intelligence: a cross-sectional
questionnaire survey. Int. J. Nurs. Stud. 44 (6), 999–1010.
Yazdan Parast, E., Afrazandeh, S.S., Ghorbani, H., Asadi, F., Rajabi, R., Naseri, L.,
Sekandari, F., 2017. Analysis of spiritual care competence in students of Ferdows
health and paramedical school: 2014-15. Iran. J. Nurs. 30 (105), 47–57.
Zamirinejad, S., Azizi, S., Shakeri, A., Hassandoust, Z., Mohammad, P.M., Yousefi, H.,
Akaberi, A., 2016. Predicting self-efficacy of students based on spiritual intelligence.
J. Sabzevar Univ. Med. Sci. 23 (2), 196–203.
Zumstein-Shaha, M., Ferrell, B., Economou, D., 2020. Nurses’ response to spiritual needs
of cancer patients. Eur. J. Oncol. Nurs. 48, 101792.

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