Spiritual Care—which refers to the spiritual dimension in the caring process—is an integral part of high-quality health care and a shared responsibility of all social and health care professionals. It takes patients' needs, options, resources, and limits in the field of spirituality into account (Frick, 2017). According to Nolan et al., spirituality can be understood as ‘the dynamic dimension of human life that relates to the way persons (individual and community) experience, express and/or seek meaning, purpose and transcendence, and the way they connect to the moment, to self, to others, to nature, to the significant, and/or the sacred’ (Nolan et al., p. 88). Spiritual Care understands spirituality as one of four dimensions of human health needs: physical, psychological, social, and spiritual. These dimensions affect one another and overlap but are also distinct dimensions. Each dimension plays a significant role in contributing to people's well-being and health.
In this paper, we argue that education related to the spiritual dimension of health is as important as the skills and competencies related to the physical, psychological, or social dimensions of health. Research consistently shows that health professionals are aware of spirituality in patient care, yet do not offer spiritual care. This is not only because of lack of money, time, or personnel resources but because of a lack of competency (Abdulla et al., 2019; O'Brien et al., 2019; van der Vis-Sietsma et al., 2019). Poor integration of spiritual care into caregivers' education is a reason for health professionals' lack of competency in providing spiritual care (Balboni & Balboni, 2019). In particular, newly graduated, less experienced health professionals do not feel confident in their spiritual care competency and believe that universities are not providing enough information on this topic (Giezendanner et al., 2017; de Diego Cordero et al., 2019; Esperandio et al., 2021). Relevant training can enhance the quality of spiritual care delivery and helps to prepare students in social and health care professions for this area (Moosavi et al., 2019). Reported outcomes of spiritual care training include increased levels of competency (Jones et al., 2021). Internationally, a great variety of educational strategies has been developed with a focus on teaching knowledge, skills and attitudes required to administer spiritual care (Paal et al., 2015; Helo, 2017; Jones et al., 2021). A majority of studies address nurses and midwives (Attard et al., 2019; McSherry et al., 2020; Vargas-Escobar & Guarnizo-Tole, 2020; van Leeuwen et al., 2021). In German-speaking countries, specific spiritual care trainings have been developed (Gratz & Roser, 2016; Prenner, 2016; Peng-Keller & Argiro, 2017; Gratz & Roser, 2019; Kunsmann-Leutiger et al., 2021). These trainings are mostly offered for health professionals in the context of palliative care. There is little interdisciplinary spiritual care education for students in diverse disciplines of the social and health care sector, and literature on their effectiveness is limited. Online spiritual care training is a growing topic of interest (Best et al., 2020; Pearce et al., 2020). Previous studies have demonstrated the efficacy of online education for spiritual care programs (Ellman et al., 2012; Petersen et al., 2017) and reported benefits of e-learning in terms of increased accessibility, improved self-efficacy, cost effectiveness, learner flexibility, and interactivity (Sinclair et al., 2016; Campbell et al., 2019; Mazanec et al., 2019). This study contributes to the existing body of knowledge by investigating the effectiveness of an interdisciplinary online spiritual care training. It addresses students from different social and health care disciplines, the future caregivers, namely students in social work and allied health care professions, for instance, nursing, medicine, pastoral care/theology, psychology, and so on.
In the literature, a variety of definitions and measurements of spiritual care competency exist (McSherry et al., 2002; van Leeuwen et al., 2009; Iranmanesh et al., 2012; Ross et al., 2014; Frick et al., 2019). Following van Leeuwen et al., we define spiritual care competency as the knowledge, skills, and attitudes required for spiritual care delivery (van Leeuwen et al., 2009). It includes cognitive, behavioural, and affective components, such as knowledge of religions, being spiritually aware, and feeling prepared to talk about spiritual needs (Ross et al., 2014; Frick et al., 2019). Based on a sample of nursing students, van Leeuwen et al. developed the Spiritual Care Competence Scale (SCCS), an instrument to measure spiritual care competency (van Leeuwen et al., 2009). Similarly, Frick et al. (2019) developed the Spiritual Care Competence Questionnaire (SCCQ), a German spiritual care competency instrument that addresses the linguistic and cultural situation of continental Europe and specifically the German-speaking context. It is validated with different health professions, such as nurses, physicians, and chaplains. The SCCQ considers the following ten topics of spiritual care competency: perception and recording of spiritual needs of patients, implementation of spirituality in team processes, one's own reactions to the topic and possibilities of intervention, impact of perceptions on one's own activities, development of one's own actions, development of one's own spirituality, proactive competence (empowerment), creating time/space, knowledge about other religions (‘foreignness competence’), discharge and transition management, and implementation barriers (Frick et al., 2019). These topics have been incorporated into seven different competency facets with different weightings. The seven facets can be understood as a differentiation of the three areas—
In order to evaluate spiritual care competency on both a coarse level and a fine level, we decided to differentiate the construct in two primary outcome variables. On the one hand, we examined the coarser spiritual care competency areas of
We implemented an interdisciplinary online spiritual care course named
Kirkpatrick's conceptual model provides a useful theoretical framework to consider course effectiveness (Kirkpatrick, 1996). The model identifies four levels of evaluation that can be transmitted to health care interventions (Pereira et al., 2008). The second level focuses on learners' changes in knowledge, skills, and attitudes. Accordingly, this study focuses on learners' pre- versus post-course changes in self-perceived
The aim of this study was to examine to what extent the online spiritual care course is suitable and effective in increasing perceived spiritual care competency among students in social and health care professions. Derived from that, our hypothesis was as follows: scores in spiritual competency and in spiritual care competency related constructs (
This study used a two-group pre-post-test quasi-experimental design with a time-by intervention analysis. The course's effects on students' self-reported spiritual care competency were assessed with quantitative methods using questionnaires.
Subjects were
For IG recruitment, students that were enrolled in the online spiritual care course
At baseline (T0), respondents provided information regarding their age, gender, nationality, marital status, religious preference, self-identification as a religious or spiritual person, study field, years of studying, previous vocational training, and familiarity with the concept of spiritual care. At T1, IG participants were asked about their course participation behaviour, including frequency and duration of online sessions, and number of modules worked on in the course. To control for other intervention variables, CG subjects were asked about any spiritual care–related input they got during interim interval.
Based on Wasner et al. (2008), we used twelve items measuring
The German assessment tool Spiritual Care Competence Questionnaire (SCCQ; Frick et al. 2019) is a self-administered questionnaire using a 4-point Likert scale (1 = strongly disagree to 4 = strongly agree) for measuring seven facets of spiritual care competency: (1)
To explore participants' sensitivity for the spiritual dimension, the Spiritual Sensitivity Scale (SSS; Tirri & Nokelainen, 2011) was used, a 11-item 5-point Likert-type self-assessment instrument (1 = totally disagree to 5 = totally agree) consisting of the following four dimensions: (1)
Based on Davis's Interpersonal Reactivity Index (IRI; Davis 1980, 1983), the German Saarbrücker Persönlichkeitsfragebogen (SPF; Paulus, 2009, 2019) measures respondents' self-assessed empathy with 16 items on 4 subscales –
The General Self-Efficacy Scale (GSES) is a self-administered questionnaire based on Bandura's concept of perceived self-efficacy (Bandura, 1997). In this study, the German version by Jerusalem and Schwarzer (2018) was used. For analysis, the ten items employing a 4-point Likert-type scale (1 = not at all true to 4 = exactly true) are summed to a total score of perceived self-efficacy (Schwarzer & Jerusalem, 1999). Cronbach's alpha of the GSES ranges from .80 to .90.
Descriptive statistics were run on demographic factors. Cronbach alpha coefficients were calculated to examine the internal reliability in all pre- and post-test scores (Cronbach, 1951). A
The
Description of study population.
Age in years, mean (SD; range) | 26.6 (8.2; 19–56) | 25.0 (6.9; 19–52) | .90 (t = .90) 2 |
Nationality*: German, % | 92% | 96% | .54 ( |
Gender*: female, n (%) | 63 (81%) | 50 (75%) | .13 ( |
Marital status*, % | .85 ( |
||
single | 68% | 69% | |
married | 16% | 15% | |
Study subject*, n (%) | .00 ( |
||
medicine | 12 (15%) | ||
nursing science | 5 (6%) | ||
theology/religious education | 14 (18%) | ||
healthcare sciences | 6 (8%) | ||
social work | 31 (39%) | 67 (100%) | |
others (psychology, philosophy/medical ethics) | 6 (8%) | ||
Semesters studied, mean (SD) | 5.5 (2.7) | 4.7 (2.0) | 1.82 (t = .07)2 |
Previous vocational training |
31% | 27% | .32 ( |
Self-assessed religiosity/spirituality (1 = not at all, 6 = completely true), mean (SD) | |||
spiritual | 4.6 (1.3) | 3.7 (1.3) | .00 (t = 4.35)2 |
religious | 4.2 (1.4) | 3.4 (1.4) | .00 (t = 3.10)2 |
Religious preference, % | .25 ( |
||
Catholic | 64% | 48% | |
Protestant | 15% | 28% | |
Muslim | 3% | 2% | |
other | 3% | 3% | |
none | 12% | 18% | |
Familiarity with spiritual care, % | 27% | 7% | .00 ( |
IG = Intervention Group; CG = Comparison Group; SD = standard deviation
Note. Beyond the presented options, individuals could choose the option “no reply” or “other”, rarely or not selected options (e.g., marital status: divorced, widowed; nationality: other – please specify; religious preference: Jewish)
Chi-square test,
independent-sample t-test.
Independent T-tests and chi-square analyses revealed significant differences between IG and CG by study subject, religious/spiritual self-assessment, and familiarity with the concept of spiritual care (
Cronbach alpha coefficients were calculated for each measurement and subscale. For most of the measures, reliability was moderate. The lowest alpha coefficient (α = .30) was found in the CG pre-test in the subscale
Reliability of scales.
Spiritual care competency areas (12-ksa) | .63 – .68 | .57 – .75 | .60 – .71 | .57 – .72 |
Spiritual care competency facets (SCCQ) | .45 – .93 | .46 – .78 | .55 – .93 | .31 – .79 |
Spiritual sensitivity (SSS) | .42 – .74 | .30 – .72 | .56 – .77 | .50 – .72 |
Empathy (SPF) | .60 – .81 | .59 – .77 | .59 – .80 | .70 – .79 |
General self-efficacy (GSES) | .88 | .88 | .87 | .86 |
12-ksa= 12 items measuring knowledge, skills, attitudes concerning spiritual care; SCCQ= Spiritual Care Competence Questionnaire; SSS= Spiritual Sensitivity Scale; SPF= Saarbrücker Persönlichkeitsfragebogen; GSES= General Self-Efficacy Scale; IG = Intervention Group; CG = Comparison Group
At baseline (T0), means of IG and CG scores in
The time by intervention analysis showed the following effects on the primary outcome measures: there were significant interactions in each of
Results for the secondary outcome measures were as follows: for
Mean, standard deviations, and repeated measures analyses of variances (ANOVA) in spiritual care competency measures at baseline (T0) and after (T1) intervention (Intervention Group) or interim interval (Comparison Group).
Primary outcomes | ||||||||||
Spiritual care competency areas (12-ksa) | ||||||||||
Knowledge | 6.08 | 1.70 | 7.96 | 1.14 | 5.39 | 1.67 | 5.66 | 1.64 | 0.17 | |
Skills | 6.23 | 1.57 | 7.56 | 1.33 | 5.56 | 1.69 | 5.84 | 1.57 | 0.10 | |
Attitudes | 7.77 | 1.34 | 8.84 | 1.01 | 6.88 | 1.98 | 7.02 | 1.74 | 0.07 | |
Spiritual care competency facets (SCCQ) | ||||||||||
Perceptual competence | 3.09 | 0.49 | 3.26 | 0.41 | 2.81 | 0.59 | 2.79 | 0.59 | 0.03 | |
Team-spirit | 1.75 | 0.63 | 2.09 | 0.70 | 1.56 | 0.58 | 1.66 | 0.60 | 0.03 | |
Documentation competence | 1.40 | 0.62 | 2.84 | 0.85 | 1.22 | 0.40 | 1.37 | 0.46 | 0.38 | |
Self-awareness and proactive opening | 2.71 | 0.61 | 2.93 | 0.53 | 2.18 | 0.67 | 2.24 | 0.63 | 0.02 | |
Knowledge about other religions | 2.79 | 0.55 | 3.05 | 0.61 | 2.80 | 0.70 | 2.60 | 0.58 | 0.11 | |
Competence in conversation technique | 3.45 | 0.60 | 3.53 | 0.47 | 3.27 | 0.62 | 3.22 | 0.61 | 0.01 | |
Proactive empowerment competence | 2.75 | 0.67 | 3.03 | 0.58 | 2.27 | 0.79 | 2.30 | 0.72 | 0.02 | |
Secondary outcomes | ||||||||||
Spirituality-based component: Spiritual sensitivity (SSS) | ||||||||||
Awareness sensing | 3.90 | 0.85 | 4.04 | 0.72 | 3.75 | 0.75 | 3.66 | 0.80 | 0.04 | |
Mystery sensing | 4.06 | 0.57 | 4.12 | 0.61 | 3.79 | 0.59 | 3.75 | 0.65 | 0.01 | |
Value sensing | 4.40 | 0.67 | 3.75 | 0.65 | 3.76 | 0.88 | 3.76 | 0.77 | 0.02 | |
Community sensing | 3.94 | 0.84 | 3.85 | 0.84 | 3.34 | 0.90 | 3.39 | 0.94 | 0.01 | |
Care-based component: Empathy (SPF) | 3.79 | 0.36 | 3.80 | 0.39 | 3.67 | 0.38 | 3.67 | 0.44 | 0.00 | |
Competence-based component: General self-efficacy (GSES) | 2.88 | 0.45 | 3.00 | 0.39 | 2.90 | 0.44 | 2.91 | 0.37 | 0.04 |
12-ksa= 12 items measuring knowledge, skills, attitudes concerning spiritual care; SCCQ= Spiritual Care Competence Questionnaire; SSS= Spiritual Sensitivity Scale; SPF= Saarbrücker Persönlichkeitsfragebogen; GSES= General Self-Efficacy Scale; IG = Intervention Group; CG = Comparison Group
Note.
p < .05,
p < .001.
Greenhouse-Geisser.
The study's purpose was to determine the impact of an online spiritual care course on perceived spiritual care competency of students in social and health care professions. The primary outcomes relate to the three coarse spiritual care competency areas
These findings demonstrate the effectiveness and suitability of the examined online spiritual care educational strategy to increase aspects of spiritual care competency among students in social and health care professions. The most relevant aspect is the positive impact on cognitive parts of spiritual care competency, namely the increase in participants'
The findings are congruent with those of earlier studies. For example, a comparative intervention-control group study among nursing students in the Netherlands showed that some aspects of spiritual care competency improved after participating in a spiritual care course (van Leeuwen et al., 2008). More recently, Hu et al. showed the effectiveness of spiritual care training on spiritual care competency scores among oncology nurses in China (2019). Like Wasner et al. who found a highly significant impact of a palliative care training for medical students on all self-assessed
These findings should be interpreted with several limitations in mind. First, the choice of study population and its compilation. The sample was self-selected, and results might be affected by social desirability. There was no randomised assignment to intervention or control group and an influence of selection bias on the results must be considered. While all respondents in the comparison group studied social work, only 39% of IG students were students in social work. In terms of clinical practice, it is worth considering that social workers must meet different care requirements than medical health professionals such as physicians or nurses. So comparability of health care students to social work students is limited. However, all social and health care professions need a similar basic competency in spiritual care and can profit from interdisciplinary education. Another difference that might have affected the results and/or data quality is the collection of data (online vs. paper-pencil based). Additionally, data showed that IG students were more open to religiosity/spirituality and more familiar with the concept of spiritual care than CG students. Consequently, course participants were already spiritually committed and were thus more likely to experience (or report experiencing) a change in competency scores. Since most of the study population were female, single, and Catholic, generalisability to the overall population of social and health care students may be limited. However, gender distribution in this sample is close to the one in the overall social and health care sector. Another point that must be reflected on is the choice of measurements. The relatively low reliability coefficients (α < .60) for some subscales might have affected the validity of the results. Furthermore, the validation of the SCCQ-student version is about to be conducted. Additional research that builds on these findings is needed to better classify its results. Finally, this study focused on self-reported instruments and students' perceptions were assessed once after the online spiritual care course, without a follow-up assessment. As such, we are unable to determine whether the identified changes were temporary or long-lasting, nor whether there will be a translation of learning into actual behaviour change. Longitudinal studies with behavioural measures of effect would provide evaluation of the stability of these changes over a longer period and of the impact on client outcomes. Overall, this was a first step in improving spiritual care competency in future social and health care providers through online spiritual care training. Further educational strategies and a more sophisticated design would be the next step in providing stronger support for the effectiveness of spiritual care interventions on competency changes and their translation into clinical practice. Moreover, future variations of the course with varying technologies would be interesting for further research, e.g. efficiency of virtual reality learning scenarios or serious games in terms of role models or testing of individual spiritual care scenarios.
The online spiritual care course is an innovative interdisciplinary educational strategy that has the potential to impact competency in spiritual care. The study provides insights into whether and how online training can enhance
The present findings provided empirical evidence for the effectiveness of an online spiritual care training on social and health care students' perception of spiritual care competency. Participation in an online course increased their