Table 1 Summary of findings in included studies

Chiang et al. (2020), Taiwan

[29]

1) Spiritual care competencies

2) Caring behavior

3) Professional Commitment

4) Religious belief

The Spirituality and Spiritual Care course explored connections with higher beings, nature, and interpersonal relationships. It covered spirituality, spiritual tension, needs assessment, and nursing care models. Clinical cases included spinal cord injury, terminal cancer, and relapsing depression.

Self-relationships focused on mindfulness and stress perception. Interpersonal relationships were examined through Confucianism, emphasizing professionalism in nursing. Higher-being relationships explored Taiwanese religions, death interpretations, and belief-based coping, highlighted by pediatric cancer. Taoism’s perspective on human-nature connections emphasized sensory enhancement for well-being, with stroke rehabilitation as a case study.

These topics were examined using various teaching methods, such as traditional lectures, mindfulness-based stress reduction, case studies, experiential practice, and self-reflection. These topics were examined using various teaching methods, such as traditional lectures, mindfulness-based stress reduction, case studies, experiential practice, and self-reflection.

Spiritual care was assessed using the 15-item SCAS, measuring attitudes toward spiritual growth, core spirituality concepts, and spiritual nursing (Cronbach’s α = 0.95).

Caring behavior was evaluated with a 28-item scale covering illness trajectory support, patient advocacy, and patient knowledge (α = 0.95).

Professional commitment in nursing was measured by a 19-item scale assessing compliance, involvement, and retention (α = 0.93).

The Spiritual Health Scale (short version) examined nursing students’ well-being, including connection, meaning, and self-awareness (α = 0.92). A 17-item Religious Belief Scale assessed religious effects, divinity, queries, and stress (α = 0.87)

The spiritual education course group improved more in spiritual attitudes and caring behaviors than the control group at all assessment points (p < 0.001).

At follow-up, they also demonstrated higher professional commitment (p < 0.001). After a 3-week clinical practicum, the intervention group reported significantly lower stress levels (p < 0.001).

These findings suggest that the course effectively enhanced nursing students’ spiritual attitudes, caring behaviors, and spiritual health while reducing practicum-related stress.

Frouzandeh et al. (2015), Iran

[23]

Selfefficacy in providing spiritual care

The spiritual care training comprised three stages over four 2-hour sessions. The first stage covered spirituality concepts, spiritual tension, patient needs assessment, stress theories, and nursing processes. The second stage involved bedside training, holistic assessment, and care plan development. The third stage focused on small group discussions, care plan preparation, and a self-efficacy questionnaire. A follow-up post-test reassessed self-efficacy improvements after the intervention

Learning methods included speech, heuristic techniques like brainstorming, analysis of spiritual stress scenarios, small group discussions, sharing personal and clinical experiences, and deep-thinking exercises. Learning methods included speech, heuristic techniques like brainstorming, analysis of spiritual stress scenarios, small group discussions, sharing personal and clinical experiences, and deep-thinking exercises.

The questionnaire included eight statements rated on a Likert scale from none to completely (0 to 32). Content validity and surveying were used to establish its validity with 15 nursing faculty members. Reliability was assessed with a Cronbach’s alpha coefficient of 81%.

Nursing students’ self-efficacy in providing spiritual care increased from 13.74 (pretest) to 21.1 (post-test, p < 0.001). The significant improvement highlights the effectiveness of structured training. Findings suggest that a specialized curriculum enhances students’ ability to understand spirituality, assess patients’ spiritual needs, and develop appropriate care plans.

Hsiao et al. (2012), Taiwan

[30]

1) Spiritual health status

2) Level of clinical practice stress

The initial phase of the Spiritual Life Program (SLP), based on Lazarus and Folkman’s stress-coping theory, included two modules on personal spiritual awareness and spirituality. It then focused on strategies for enhancing spiritual well-being through stress relief, relationships, gratitude, self-worth, and purposeful living, fostering reflection and spiritual growth

The learning strategies included lectures on spirituality, reflective sheets with questions to explore personal meaning, discussions for sharing spiritual experiences, and practical activities like meditation to reinforce learning and self-awareness. These methods aimed to deepen understanding and personal growth through reflection, dialogue, and experiential practice.

The Spiritual Health Scale (SHS) uses qualitative and quantitative methods to assess spiritual well-being. It consists of 47 items across five subcategories, with reliability (Cronbach’s alpha: 0.77–0.89).

The Clinical Practice Stress (CPS) scale measures nursing students’ stress during practice using six subscales (29 items, α = 0.91)1)

The Spiritual Learning Program (SLP) significantly improved spiritual well-being in the experimental group (p < 0.001), though the effect was temporary.

The experimental group showed a greater reduction in Clinical Practice Stress (CPS) scores than the control group (p < 0.05, t = 3.771, p < 0.001).

A longitudinal study is needed to assess long-term changes in spiritual well-being.

Ekramifar et al. (2018), Iran [22]

Moral sensitivity status

The education covers spiritual characteristics, skills, and well-being, emphasizing spirituality in education and nursing. It explores self-awareness, spirituality’s link to health, and its role in mental health, including spiritual problem-solving, forgiveness, faith, patience, meditation, and generosity, along with their stages, consequences, and personal growth

The intervention methods included lectures, question-answer sessions and in clinical setting.

The Moral Sensitivity Questionnaire (K-MSQ) assesses moral sensitivity using 30 questions across five dimensions: patient-centered care, professional accountability, ethical dilemmas, ethical decision-making, and benevolence. Originally developed in Sweden, its reliability was tested through a test-retest analysis, yielding a coefficient of 0.89 in this study

The intervention group showed a significantly higher mean moral sensitivity score than the control group (P < 0.001).

Future studies should examine how demographic factors influence moral sensitivity in nursing students and explore the impact of training methods, such as workshops, on their moral sensitivity.

Karaca et al. (2024), Turki [26]

1) Spiritual care competencies

2) Spiritual care perception

The curriculum included four hours each on spiritual care concepts, spiritual needs in palliative care, and the significance of spiritual care, plus six hours on nursing diagnosis and interventions. Case studies emphasized critical thinking. Three experts in psychiatry, fundamentals, and medical-surgical nursing evaluated the program content

The course was delivered through traditional face-to-face instruction, incorporating theoretical presentations, collaborative activities, idea generation, and interactive question-and-answer methodologies

The Spiritual Support Perception Scale (SSPS) measures perceptions of moral support and spiritual care, with higher scores indicating stronger perceptions. The scale has a maximum score of 60 and a Cronbach’s alpha of 0.82.

The Turkish version of the Spiritual Care Competence Scale (SCCS) assesses nursing proficiency in spiritual care across three domains. It consists of 27 items and has a reliability coefficient (Cronbach’s alpha) of 0.90.

The intervention group showed significantly higher mean scores than the control group in personal support and patient counseling (p < 0.002), attitude toward patient spirituality and communication (p < 0.004), and the spiritual support scale (p < 0.003).

Expanding this study to include spiritual care coursework for junior and senior students is recommended to compare cohorts and assess their knowledge levels

Momennasab et al. (2019), Iran

[24]

1) Spiritual well-being

2) Attitude toward spiritual care

The scenarios covered themes such as meaning and purpose, relationships with God and others, forgiveness, prayer, rituals, hope, and the presence of family and nurses.

Developed using nursing textbooks and clinical observations, the scenarios were revised and validated by five nursing faculty members

Kolb’s experiential learning emphasizes learning through experience. Group reflections followed Gibbs’ reflective cycle’s six stages: describing events, expressing feelings, evaluating, analyzing, concluding, and planning actions. This structured approach deepened understanding and improved learning through critical thinking and self-assessment

The Spiritual Well-Being Scale (SWBS) assessed participants’ spiritual well-being through 20 questions on a 6-point Likert scale, with a Cronbach’s alpha of 0.82.

The Spirituality & Spiritual Care Rating Scale (SSCRS) measured attitudes on spirituality and care, with reliability scores between 0.64 and 0.84

The mean score differences pre-post in intervention group:

1) Spiritual well being

(p = 0,0003)

2) Attitude to spiritual care (p = 0,047)

No significance found between group

Özveren et al. (2019), Turki

[27]

To achieve Spiritual care competencies

The intervention covered pain management, symptom control, loss, mourning, death, postmortem care, spirituality, spiritual care, influencing factors, the nursing process in spiritual care, spiritual distress as a diagnosis, patient-centered spiritual approaches, and the nurse’s role in family support.

No information

The SSCR, developed by McSherry (2002), measures spirituality and spiritual care with 17 questions. Its Cronbach’s alpha was 0.76, and in this study, it was 0.74, confirming reliability. The scale evaluates various dimensions related to spirituality and spiritual care.

Student nurses’ scores significantly improved post-training (p < 0.001), indicating enhanced perceptions of spirituality and spiritual support. The study recommends integrating more spiritual care training into nursing education to strengthen students’ understanding and application of spiritual care in practice

Sharifi et al. (2024), Iran

[25]

To achieve Spiritual care competencies

The intervention featured an empowering program covering spirituality, spiritual care, assessment, implementation, communication skills, dignity, individual support, counseling, hope therapy, and quality of life improvement, enhancing nurses’ ability to provide comprehensive spiritual care

The content of the intervention was explained and taught in the form of lectures and small group discussions

The validity and reliability of the SCCS were confirmed in Iran. Nasehi et al. (2013) found a Cronbach’s alpha of 0.78, while another study reported an alpha of 0.77 for the entire instrument, with subcategory values ranging from 0.65 to 0.85.

Significant differences were found between groups in overall spiritual care competence (p < 0.037) and two subscales: assessment and implementation of spiritual care, and professionalism in spiritual care (p < 0.05). Enhancing spiritual care skills in nursing students improves patient care, highlighting the need for greater curricular emphasi

Tsai et al. (2019), Taiwan

[31]

To achieve meaning of life, positive beliefs, and well-being among nursing students

A life-education intervention. The fundamental beliefs in life include self-awareness, determination, cognitive processes, introspection, broadening of horizons, independence, self-knowledge, personal encounters, and purpose in life

Simulated directed learning was used, integrating YouTube videos, e-books, and online movies. Nursing students accessed three topic contents in class and could download materials from an e-learning platform for future reference, enhancing flexibility and retention in their learning process

The study utilized instruments from the Life Attitude Profile by [36] and the Positive Coping, Spirituality and Well-being Scale by [37]. The content validity index (CVI) of the questionnaire was established at 0.95 by 7 expert scholars.

Significant differences were found in meaning of life, positive belief, and well-being between the intervention and control groups (p < 0.001). Directed learning simulations in life education interventions enhance these aspects, emphasizing the need for their inclusion in nursing education

Yilmaz et al. (2014), Turki

[28]

To achieve Spirituality and Spiritual Care competencies

1) The scenarios included patients with cancer or requiring heart surgery, aiming to challenge personal systems of meaning and purpose in life.

2) Concepts were discussed with patient care plans and

Students applied these concepts in clinical settings during a year-round internship with two semesters of 15 weeks each

The Spirituality and Spiritual Care Rating Scale by [34] The Cronbach’s alpha, on the Turkish version of the scale, was 0.76

Senior-level nursing students show significant differences in spiritual knowledge and attitudes (p < 0.001). Integrating interactive methods and spirituality into the curriculum enhances these aspects. Gordon’s FHPs provide a holistic framework for incorporating spirituality into nursing education effectively