This study, titled “Mediating Effect of Perceived Professional Benefit on the Relationship Between Spiritual Health and Spiritual Care Competence Among New Nurses: A Cross-Sectional Study,” was authored by Cancan Chen, Xiaofei Sun, Yanting Zhang, Zhenya Liu, Miaorui Jiao, and Yanli Hu. Published in the Journal of Nursing Management in 2025, it represents an open-access article. The research focused on understanding the relationship between spiritual health and spiritual care competence (SCC) among new nurses, specifically exploring the mediating role of perceived professional benefit in this relationship.
Background and Importance
Spiritual care is acknowledged as a fundamental aspect of holistic nursing and has already been integrated into nursing practice. The ability to deliver this care, known as spiritual care competence (SCC), is increasingly recognized as a crucial occupational skill for nurses, particularly for those new to the profession.
- Spirituality refers to the dynamic aspect of human existence concerning how people seek meaning, purpose, transcendence, and connection, individually and communally. It is vital in how individuals cope with life-threatening situations like illness.
- Spiritual care involves recognizing and responding to a patient’s spiritual needs, such as their need for meaningfulness, self-expression, and faith-based support. Nurses are often the primary healthcare professionals to encounter patients experiencing spiritual crises and play a key role in helping them cope with fear, uncertainty, and restoring inner peace.
- New nurses are defined as those who have entered clinical nursing within two years of graduation. They constitute a significant portion of the hospital workforce but face numerous challenges during their transition to practice. A notable issue is the lack of spiritual care education and training during their schooling, coupled with passive attitudes towards spirituality and death, which complicates their provision of spiritual care. This often results in patients’ spiritual needs going unmet. Therefore, promoting SCC among new nurses and identifying modifiable factors influencing it is crucial.
- Spiritual health, also termed “spiritual well-being,” describes the perception of life’s meaning, recognition of one’s own and others’ value, harmonious connections, possession of internal resources, and the ability to adapt to challenges. In Chinese culture, spirituality emphasizes achieving inner peace through harmonious connections with oneself, others, the natural world, or higher principles.
- Perceived professional benefit refers to the perceived job advantages of the nursing profession and the conviction that nursing contributes to people’s well-being. This concept, drawn from positive psychology, aligns with the broaden-and-build theory, which suggests that positive emotional experiences broaden individuals’ capabilities and build personal resources.
Previous studies have indicated a positive link between spiritual health and SCC among nurses. Additionally, perceived professional benefit has been positively related to SCC. This study specifically hypothesized that perceived professional benefit would mediate the relationship between spiritual health and SCC among new nurses.
Methods
The study employed a cross-sectional online survey design.
- Participants: A convenience sample of 299 new nurses was recruited from 10 tertiary hospitals in prefecture-level cities across Henan Province, China.
- Inclusion Criteria: Participants needed to possess a nursing practice certificate, have worked for less than two years, be directly involved in patient care, and volunteer to participate.
- Exclusion Criteria: Nurses who took breaks of 30 days or longer during the survey period were excluded.
- Data Collection: Data were collected from March to April 2021. Electronic questionnaires were distributed via instant messaging apps like WeChat, with informed consent obtained by completion of the questionnaire. The required sample size was 189, and 299 participants were considered adequate.
- Measurements:
- Sociodemographic Characteristics: Included sex, age, educational background, marital status, parental status, employment type, monthly income, religious beliefs, and department. These were used as control variables in the analysis.
- Spiritual Health: Assessed using the Chinese version of the Spiritual Health Scale Short Form (24 items, 5 aspects, 5-point Likert scale, score 24-120). Cronbach’s alpha was 0.942.
- Perceived Professional Benefit: Measured with the Chinese version of the Brief Perceived Professional Benefit Questionnaire (17 items, 5 factors, 5-point Likert scale, score 29-145). Cronbach’s alpha was 0.979.
- Spiritual Care Competence (SCC): Evaluated using the Chinese Version of the Spiritual Care Competence Scale (C-SCCS) (27 items, 3 dimensions, 5-point Likert scale, score 27-135). Cronbach’s alpha was 0.982.
- Data Analysis: IBM SPSS for Windows (version 26.0) was used.
- Pearson’s correlation coefficients detected bivariate relationships among the study variables.
- Mediation analysis was performed using Model 4 of the PROCESS macro for SPSS, with spiritual health as the independent variable (X), perceived professional benefit as the mediator (M), and SCC as the dependent variable (Y). Bootstrapping with 5000 simulations was used to calculate point estimates and 95% confidence intervals for effects.
Results
A total of 336 questionnaires were distributed, with 299 returned, yielding an 89% response rate.
- Sample Characteristics: The mean age of the nurses was 21.05 years (SD=1.55), with 88.6% being female. The majority were less than 24 years old (96.0%), unmarried (99.3%), contract/personnel agency-employed (89.3%), earned less than 4000 RMB monthly (95.3%), and had no religious beliefs (94.6%). Nearly one-third worked in surgical (28.1%) or internal medicine (29.1%) departments.
- Scale Scores and Correlations:
- The mean scores were: Spiritual Health = 95.79 (SD=13.91), Perceived Professional Benefit = 73.18 (SD=10.26), and SCC = 103.53 (SD=19.57).
- Significant positive correlations were found:
- Spiritual health was correlated with perceived professional benefit (r=0.655, p<0.01).
- Spiritual health was correlated with SCC (r=0.524, p<0.01).
- Perceived professional benefit was positively correlated with SCC (r=0.421, p<0.01).
- Mediation Effects:
- The total effect of spiritual health on SCC was significant [effect = 0.569, 95% CI (0.419–0.719)].
- A direct effect of spiritual health on SCC was observed [effect = 0.187, 95% CI (0.002–0.373)].
- Crucially, spiritual health had an indirect effect on SCC via perceived professional benefit [effect = 0.382, 95% CI (0.260–0.531)]. This indirect effect accounted for 67.1% of the total effect.
- This indicates that perceived professional benefit acts as a significant mediator in the relationship.
Discussion and Implications for Nursing Management
This study is the first to report the mediating effect of perceived professional benefit on the relationship between spiritual health and SCC specifically among new nurses. The findings confirm positive correlations among spiritual health, perceived professional benefit, and SCC. Spiritual health influences SCC both directly and indirectly through perceived professional benefit.
- Moderate SCC Levels: The new nurses in the study showed moderate levels of SCC, consistent with prior research. Despite the potential for improved SCC during the COVID-19 pandemic due to closer nurse-patient relationships and heightened spiritual concerns, the results suggest that further improvements in SCC are needed for new nurses. This need is amplified by the general lack of spiritual care education in medical schools and inadequate spiritual training in Chinese hospitals.
- Spiritual Health as a Foundation for SCC: Spiritual health was positively associated with SCC, aligning with previous studies. A high level of spiritual health acts as an intrinsic motivation for nurses to provide spiritual care and is considered a prerequisite for high-quality spiritual care. New nurses with higher spiritual health are better equipped to engage in open communication, actively listen to patients’ spiritual beliefs, and facilitate comprehensive discussions to align care plans with patients’ spiritual convictions.
- The Mediating Role of Perceived Professional Benefit: The study’s key finding is that spiritual health influences SCC through perceived professional benefit. New nurses with better spiritual health are more likely to perceive greater professional benefits, which in turn enhances their SCC.
- Spiritual health serves as a resource that helps new nurses cope with job stress, like addressing patients’ spiritual needs. This leads to a deeper understanding of humanistic care and improved patient care competency.
- By recognizing their own spiritual health, new nurses can find meaning and purpose not only for themselves but also in assisting patients, thereby enhancing their spiritual care ability.
- This spiritual well-being can also generate positive feedback from both life and work, contributing to higher levels of professional benefit.
- Perceived professional benefit, as a positive professional perception (e.g., related to “saving lives” and achieving self-worth), helps new nurses recognize the value of their careers and encourages sustained efforts, ultimately improving their SCC.
The implications for nursing management are significant: healthcare managers can promote the SCC of new nurses by both directly cultivating their spiritual health and indirectly enhancing their professional benefits.
- Direct Promotion (Spiritual Health): Interventions targeting spiritual health improvement can include spiritual care education and training programs, such as lecture-based learning, group discussions, and simulated clinical skill practice.
- Indirect Promotion (Perceived Professional Benefit): Healthcare administrators should prioritize nurses’ perceived professional benefit from a positive psychological perspective. This can be achieved through interventions that evaluate and improve occupational cognition, helping nurses realize their worth.
By implementing these strategies, healthcare organizations can foster improved SCC among new nurses, which ultimately contributes to optimizing nursing quality and promoting patients’ overall spiritual health.
Strengths and Limitations
Strengths of the study include:
- It specifically focuses on SCC among new nurses, an area rarely addressed in prior studies.
- The Chinese version of the Spiritual Care Competence Scale (C-SCCS) used in the study demonstrated good reliability and validity.
- The study uniquely tests the mediating effect of perceived professional benefit on the relationship between spiritual health and SCC among new nurses, providing an empirical basis for future intervention strategies.
Limitations of the study include:
- The cross-sectional design prevents the establishment of causation; thus, longitudinal or interventional studies are warranted.
- The use of convenience sampling from Henan Province limits the generalizability of the findings, suggesting future studies should use random samples from diverse hospitals and regions.
- The reliance on self-report questionnaires may introduce response bias from participants.
In conclusion, the study found that new nurses exhibit moderate levels of SCC. Crucially, perceived professional benefit mediated the relationship between spiritual health and SCC among new nurses. This highlights the importance for healthcare managers to implement interventions that focus on cultivating spiritual health and enhancing perceived professional benefit to effectively improve SCC among new nurses.
Reference: Kumar, D., & Uchoi, E. (2025). Using artificial intelligence for spiritual well-being: conceptualizing predictive models. Journal of Spirituality in Mental Health. https://doi.org/10.1080/19349637.2025.2454427