Nurses’ Perspectives on Spirituality and Spiritual Care for Critically Ill Patients in Intensive Care Units: A Systematic Review of Qualitative Studies

Nour Dhiaeyah Binti Supuan Zaki; Soh Kim Lam; Ahmad Aizuddin Bin Md Rami

doi:10.25159/2520-5293/21200

Authors

Nour Dhiaeyah Binti Supuan Zaki Universiti Putra Malaysia
Soh Kim Lam Universiti Putra Malaysia
Ahmad Aizuddin Bin Md Rami Universiti Putra Malaysia

DOI:

https://doi.org/10.25159/2520-5293/21200

Keywords:

spiritual care, spirituality, critically ill patients, intensive care, religion and belief

Abstract

Background: Nurses’ competencies in spiritual care are increasingly in demand in intensive care (ICU) units, yet their perspectives, preparedness and challenges in delivering such care remain unclear.
Aim: This qualitative systematic review explores ICU nurses’ understanding and perspectives of spiritual care for critically ill patients.
Method/Study Design: Following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines, eligible qualitative and mixed-method studies (2016–2025) were included, appraised using the Critical Appraisal Skills Programme checklist and synthesised using meta-aggregation.
Results: Fifteen studies generated seven themes on nurses’ understanding, practices, barriers and facilitators, benefits and strategies for improving spiritual care. Sub-themes addressed individual, patient, family and workplace factors.
Conclusion: Nurses’ competencies and delivery of spiritual care need to be enhanced in order to translate the benefits from theory to practice, particularly in critically ill patients.
Relevance to Clinical Practice: Nurse-led spiritual care interventions are promising in clinical settings and may improve nurses’ competence in identifying and addressing patients’ spiritual needs.

References

Abu-El-Noor, Nawal. 2016. “ICU Nurses’ Perceptions and Practice of Spiritual Care at the End of Life: Implications for Policy Change.” OJIN: The Online Journal of Issues in Nursing 21 (1). https://doi.org/10.3912/OJIN.Vol21No01PPT05 DOI: https://doi.org/10.3912/OJIN.Vol21No01PPT05

Abusafia, A. H., Z. Mamat, N. S. Rasudin, M. Bakar, and R. Ismail. 2021. “Spiritual Care Competence Among Malaysian Staff Nurses.” Nurse Media Journal of Nursing 11 (1): 1–9. https://doi.org/10.14710/NMJN.V11I1.34757 DOI: https://doi.org/10.14710/nmjn.v11i1.34757

Abusafia, A. H., Z. Mamat, N. S. Rasudin, M. Bakar, R. Ismail, and O. K. Taleb. 2021. “Spiritual Care in Southeast Asia: A Systematic Review of the Evidence for Spiritual Care Models, Interventions, and Outcomes.” International Medical Journal 28 (5): 547–551.

Atefeh, S., M. Zahra, N. M. Sadat, and H. Narges. 2025. “Silent Needs, Shared Stories: A Narrative Inquiry into Spiritual Care in Paediatric Critical Care Settings.” Nursing in Critical Care 30 (5): e70146. https://doi.org/10.1111/nicc.70146 DOI: https://doi.org/10.1111/nicc.70146

Akbari, O., M. Dehghan, and B. Tirgari. 2022. “Muslim Nurse’s Spiritual Sensitivity as a Higher Perception and Reflection Toward Spiritual Care: A Qualitative Study in Southeast Iran.” BMC Nursing 21 (1): 270. https://doi.org/10.1186/s12912-022-01044-4 DOI: https://doi.org/10.1186/s12912-022-01044-4

Alshehry, A. S. 2018. “Spirituality and Spiritual Care Competence Among Expatriate Nurses Working in Saudi Arabia.” Religions 9 (12). https://doi.org/10.3390/rel9120384 DOI: https://doi.org/10.3390/rel9120384

Atarhim, M. A., S. Lee, and B. Copnell. 2019a. “An Exploratory Study of Spirituality and Spiritual Care Among Malaysian Nurses.” Journal of Religion and Health 58 (1): 180–194. https://doi.org/10.1007/s10943-018-0624-0 DOI: https://doi.org/10.1007/s10943-018-0624-0

Badanta, B., E. Rivilla‐García, G. Lucchetti, and R. de Diego‐Cordero. 2022. “The Influence of Spirituality and Religion on Critical Care Nursing: An Integrative Review.” Nursing in Critical Care 27 (3): 348–366. https://doi.org/10.1111/nicc.12645 DOI: https://doi.org/10.1111/nicc.12645

Bakir, E., S. Samancioglu, and S. P. Kilic. 2017. “Spiritual Experiences of Muslim Critical Care Nurses.” Journal of Religion and Health 56 (6): 2118–2128. https://doi.org/10.1007/s10943-017-0382-4 DOI: https://doi.org/10.1007/s10943-017-0382-4

Balboni, T.A., G. Fitchett and G. F. Handzo. 2017. “State of the Science of Spirituality and Palliative Care Research Part II: Screening, Assessment, and Interventions.” Journal of Pain and Symptom Management 54 (3): 441–453. https://doi.org/10.1016/j.jpainsymman.2017. 07.029 DOI: https://doi.org/10.1016/j.jpainsymman.2017.07.029

Baldacchino, D. 2015. “Spiritual Care Education of Health Care Professionals.” Religions 6 (2): 594–613. https://doi.org/10.3390/rel6020594 DOI: https://doi.org/10.3390/rel6020594

Başaran, F., M. Şahin, and H. Salık. 2025. “Spiritual Care Experiences of Nurses Working in a Gynaecology Clinic: A Qualitative Research.” Journal of Evaluation in Clinical Practice 31 (1): e70030. https://doi.org/10.1111/jep.70030 DOI: https://doi.org/10.1111/jep.70030

Bashar, F. R., A. Vahedian-Azimi, M. Salesi, M. Hajiesmaeili, S. Shojaei, B. Farzanegan, R. Goharani, S. J. Madani, K. G. Moghaddam, S. Hatamian, H. J. Moghaddam, A. Arrascaeta-Llanes, and A. C. Miller. 2018. “Spiritual Health and Outcomes in Muslim ICU Patients: A Nationwide Cross-Sectional Study.” Journal of Religion and Health 57 (6): 2241–2257. https://doi.org/10.1007/s10943-017-0543-5 DOI: https://doi.org/10.1007/s10943-017-0543-5

Berlin, A. 2017. “Goals of Care and End of Life in the ICU.” Surgical Clinics of North America 97 (6): 1275–1290. https://doi.org/10.1016/j.suc.2017.07.005 DOI: https://doi.org/10.1016/j.suc.2017.07.005

Booth, A. 2006. “Brimful of STARLITE: Toward Standards for Reporting Literature Searches.” Journal of the Medical Library Association 94 (4): 421–9, e205.

Bone, N., M. Swinton, N. Hoad, F. Toledo, and D. Cook. 2018. “Critical Care Nurses’ Experiences With Spiritual Care: The Spirit Study.” American Journal of Critical Care 27 (3): 212–218. https://doi.org/10.4037/ajcc2018300 DOI: https://doi.org/10.4037/ajcc2018300

Bremer, A., K. Dahlberg, and L. Sandman. 2012. “Balancing Between Closeness and Distance: Emergency Medical Services Personnel’s Experiences of Caring for Families at Out-of-Hospital Cardiac Arrest and Sudden Death.” Prehosp Disaster Med 27: 42–52. https://doi.org/10.1017/S1049023X12000167 DOI: https://doi.org/10.1017/S1049023X12000167

Burkhart, L., A. Bretschneider, S. C. Gerc, M. E. Desmond, M. Vanhanen, M. Meriläinen, T. Ala-Kokko, H. Kyngäs, P. Kaakinen, J. Q. Ho, C. Nguyen, R. Lopes, S. C. Ezeji-Okoye, W. G. Kuschner, M. Ahmed, M. G. Mohamed, G. S. K. Mahran, S. S. Mohamed, M. Zumstein‐Shaha and L. Vloet. 2023. “Spiritual Care in the Intensive Care Unit.” Nursing in Critical Care 10 (4): 279–287. https://doi.org/10.21608/asnj.2023.202784.1551 DOI: https://doi.org/10.21608/asnj.2023.202784.1551

Büssing, A., K. Baumann, N. C. Hvidt, H. G. Koenig, C. M. Puchalski, and J. Swinton. 2014. “Spirituality and Health.” Evidence-Based Complementary and Alternative Medicine 2–4. https://doi.org/10.1155/2014/682817 DOI: https://doi.org/10.1155/2014/682817

Canfield, C., D. Taylor, K. Nagy, C. Strauser, K. VanKerkhove, S. Wills, P. Sawicki and J. Sorrell. 2016. “Critical Care Nurses’ Perceived Need for Guidance in Addressing Spirituality in Critically Ill Patients.” American Journal of Critical Care 25 (3): 206–211. https://doi.org/10.4037/ajcc2016276 DOI: https://doi.org/10.4037/ajcc2016276

Critical Appraisal Skills Programme (CASP), “10 Questions to Help You Make Sense of Qualitative Research.” CASP, Oxford. 2013. http://media.wix.com/ugd/dded87_ 29c5b002d99342f788c6ac670e49f274.pdf

Chandramohan, S., and R. Bhagwan. 2016. “Utilisation of Spirituality and Spiritual Care in Nursing Practice in Public Hospitals in Kwazulu-Natal, South Africa.” Religions 7 (3). https://doi.org/10.3390/rel7030023 DOI: https://doi.org/10.3390/rel7030023

Choi, P. J., F. A. Curlin, C. E. Cox. 2015. “The Patient Is Dying, Please Call the Chaplain: The Activities of Chaplains in One Medical Center’s Intensive Care Units.” Journal of Pain and Symptom Management 50: 501–506. https://doi.org/10.1016/j.jpainsymman.2015.05.003 DOI: https://doi.org/10.1016/j.jpainsymman.2015.05.003

Chew, B. W., L. H. Tiew, and D. K. Creedy. 2016. “Acute Care Nurses’ Perceptions of Spirituality and Spiritual Care: An Exploratory Study in Singapore.” Journal of Clinical Nursing 25 (17–18): 2520–2527. https://doi.org/10.1111/jocn.13290 DOI: https://doi.org/10.1111/jocn.13290

Connell Meehan, T. 2012. “Spirituality and Spiritual Care From a Careful Nursing Perspective.” Journal of Nursing Management 20 (8): 990–1001. https://doi.org/10.1111/j.1365-2834.2012.01462.x DOI: https://doi.org/10.1111/j.1365-2834.2012.01462.x

Cooper, K. L., E. Chang, L. Luck, and K. Dixon. 2020. “How Nurses Understand Spirituality and Spiritual Care: A Critical Synthesis.” Journal of Holistic Nursing 38 (1): 114–121. https://doi.org/10.1177/0898010119882153 DOI: https://doi.org/10.1177/0898010119882153

De Diego-Cordero, R., P. Suárez-Reina, B. Badanta, G. Lucchetti, and J. Vega-Escaño. 2022. “The Efficacy of Religious and Spiritual Interventions in Nursing Care to Promote Mental, Physical and Spiritual Health: A Systematic Review and Meta-Analysis.” Applied Nursing Research 67 (July). https://doi.org/10.1016/j.apnr.2022.151618 DOI: https://doi.org/10.1016/j.apnr.2022.151618

Dural, G. 2024. “Spiritual Care Experiences of Nurses Working in Intensive Care Units: A Qualitative Study.” Nursing in Critical Care 29 (3): 545–554. https://doi.org/10.1111/nicc.12975 DOI: https://doi.org/10.1111/nicc.12975

Flemming, K., A. Booth, K. Hannes, M. Cargo, and J. Noyes. 2018. “Cochrane Qualitative and Implementation Methods Group Guidance Series–Paper 6: Reporting Guidelines for Qualitative, Implementation, and Process Evaluation Evidence Syntheses.” Journal of Clinical Epidemiology 97: 79–85. https://doi.org/10.1016/j.jclinepi.2017.10.022 DOI: https://doi.org/10.1016/j.jclinepi.2017.10.022

Galutira, G. D., J. P. Valenzuela, C. J. Basatan, and E. Castro-Palaganas. 2019. “Spirituality and Spiritual Care in Nursing: A Literature Review.” Philippine Journal of Nursing 89 (1): 22–31.

Geer, J. van de, A. Visser, H. Zock, C. Leget, J. Prins, and K. Vissers. 2018. “Improving Spiritual Care in Hospitals in the Netherlands: What Do Health Care Chaplains Involved in an Action-Research Study Report?” Journal of Health Care Chaplaincy 24 (4): 151–173. https://doi.org/10.1080/08854726.2017.1393039 DOI: https://doi.org/10.1080/08854726.2017.1393039

Ghorbani, M., E. Mohammadi, R. Aghabozorgi, and M. Ramezani. 2021. “Spiritual Care Interventions in Nursing: An Integrative Literature Review.” Supportive Care in Cancer 29 (3): 1165–1181. https://doi.org/10.1007/s00520-020-05747-9 DOI: https://doi.org/10.1007/s00520-020-05747-9

Güner, T. A., and V. K. Akyüz. 2023. “Nurses’ Hospital Work: Exploring the Influence of Spiritual Levels on Care Behaviours and Life Satisfaction.” Spiritual Psychology Counselling 8 (3): 287–303. https://doi.org/10.37898/spiritualpc.1231522 DOI: https://doi.org/10.37898/spiritualpc.1231522

Han, K.H., K. C. Hung, Y. S. Cheng, W. Chung, C. K. Sun, and C. C. Kao. 2023. “Factors Affecting Spiritual Care Competency of Mental Health Nurses: A Questionnaire‐Based Cross‐Sectional Study.” BMC Nursing 22 (1): 202. https://doi.org/10.1186/s12912-023-01302-z DOI: https://doi.org/10.1186/s12912-023-01302-z

Hawthorne, D. M., and S. C. Gordon. 2020. “The Invisibility of Spiritual Nursing Care in Clinical Practice.” Journal of Holistic Nursing 38 (1): 147–155. https://doi.org/10.1177/0898010119889704 DOI: https://doi.org/10.1177/0898010119889704

Hjerrild, T. R., R. D. Nissen, and N. C. Hvidt. 2025. “Intensive Care Nurses’ Perspectives on Providing Spiritual Care in Denmark: A Qualitative Study.” Scandinavian Journal of Caring Sciences 39 (4): e70143. https://doi.org/10.1111/scs.70143 DOI: https://doi.org/10.1111/scs.70143

Holloway, M., S. Admanson, W. McSherry, and J. Swinton. 2011. Spiritual Care at the End of Life: A Systematic Review of the Literature. Hull, UK: University of Hull, Department of Health.

Hu, X., M. Jiao, and Y. Hu. 2025. “Factors That Facilitate or Hamper Oncology Nurses’ Delivery of Spiritual Care in China: A Qualitative Study.” Journal of Religion and Health. https://doi.org/10.1007/s10943-025-02362-y DOI: https://doi.org/10.1007/s10943-025-02362-y

International Council of Nurses. 2021. “The ICN Code of Ethics for Nurses.” https://www.icn.ch/sites/default/files/2023-06/ICN_Code-of-Ethics_EN_Web.pdf

Joanna Briggs Institute. 2014. Joanna Briggs Institute Reviewers Manual. Editorial Boards: Adelaide.

Jones, K. F., P. Paal, X. Symons, and M. C. Best. 2021. “The Content, Teaching Methods and Effectiveness of Spiritual Care Training for Healthcare Professionals: A Mixed-Methods Systematic Review.” Journal of Pain and Symptom Management 62 (3): e261–e278. https://doi.org/10.1016/j.jpainsymman.2021.03.013 DOI: https://doi.org/10.1016/j.jpainsymman.2021.03.013

Kang, K., J. Chun, K. H. Yong, and H.-Y. Kim. 2021. “Hospice Palliative Care Nurses’ Perceptions of Spiritual Care and Their Spiritual Care Competence: A Mixed‐methods Study.” Journal of Clinical Nursing. https://doi.org/10.1111/jocn.15638 DOI: https://doi.org/10.1111/jocn.15638

Kastner, M., A. C. Tricco, and C. Soobiah. 2012. “What Is the Most Appropriate Knowledge Synthesis Method to Conduct a Review? Protocol For a Scoping Review.” BMC Medical Research Methodology 12 (1): 1–10. https://doi.org/10.1186/1471-2288-12-114 DOI: https://doi.org/10.1186/1471-2288-12-114

Klimasinski, M. W. 2021. “Spiritual Care in the Intensive Care Unit.” Anaesthesiology Intensive Therapy 53 (4): 350–357. https://doi.org/10.5114/ait.2021.109920 DOI: https://doi.org/10.5114/ait.2021.109920

Ku, Y. L. 2016. “Spiritual Needs and Care of Patients from Nurses’ Perspectives on the ICU.” Journal of Nursing & Care 5 (4). https://doi.org/10.4172/2167-1168.1000357 DOI: https://doi.org/10.4172/2167-1168.1000357

Mamier, I., E. J. Taylor, and B. W. Winslow. 2019. “Nurse Spiritual Care: Prevalence and Correlates.” Western Journal of Nursing Research 41 (4): 537–554. https://doi.org/10.1177/0193945918776328 DOI: https://doi.org/10.1177/0193945918776328

Meşe, S., Y. Sazak, and M. Kalaycı. 2025. “End-Of-Life Spiritual Care from the Perspective of Intensive Care Nurses in Türkiye: An Exploratory Mixed Study.” Journal of Religion and Health 64 (5): 4088–4110. https://doi.org/10.1007/s10943-025-02401-8 DOI: https://doi.org/10.1007/s10943-025-02401-8

Noome, M., D. M. Beneken Genaamd Kolmer, E. van Leeuwen, B. M. Dijkstra, and L. C. M. Vloet. 2017. “The Role of ICU Nurses in the Spiritual Aspects of End-Of-Life Care in the ICU: An Explorative Study.” Scandinavian Journal of Caring Sciences 31 (3): 569–578. https://doi.org/10.1111/scs.12371 DOI: https://doi.org/10.1111/scs.12371

O’Brien, M. R., K. Kinloch, K. E. Groves, and B. A. Jack. 2019. “Meeting Patients’ Spiritual Needs During End‐of‐Life Care: A Qualitative Study of Nurses’ and Healthcare Professionals’ Perceptions of Spiritual Care Training.” Journal of Clinical Nursing 28: 182–189. https://doi.org/10.1111/jocn.14648 DOI: https://doi.org/10.1111/jocn.14648

Rasinski, K.A., Y. G. Kalad, J. D. Yoon, and F. A. Curlin. 2011. “An Assessment of US Physicians’ Training in Religion, Spirituality, and Medicine.” Medical Teacher 33 (11): 944–945. https://doi.org/10.3109/0142159X.2011.588976 DOI: https://doi.org/10.3109/0142159X.2011.588976

Reig-Ferrer, A., C. De La Cuesta-Benjumea, M. D. Fernández-Pascual, and A. Santos-Ruiz. 2019. “A View of Spirituality and Spiritual Care in a Sample of Spanish Nurses.” Religions 10 (2). https://doi.org/10.3390/rel10020129 DOI: https://doi.org/10.3390/rel10020129

Riahi, S., F. Goudarzi, S. Hasanvand, H. Abdollahzadeh, F. Ebrahimzadeh, and Z. Dadvari. 2018. “Assessing the Effect of Spiritual Intelligence Training on Spiritual Care Competency in Critical Care Nurses.” Journal of Medicine and Life 11 (4): 346–354. https://doi.org/10.25122/jml-2018-0056 DOI: https://doi.org/10.25122/jml-2018-0056

Rufaida Ibdah, R., R. Zeilani, and M. Atout. 2024. Jordanian Nurses’ Perspectives of Spirituality and Spiritual Care: A Qualitative Study. Cancer Nursing 47 (1): E38–E46. https://doi.org/10.1097/NCC.0000000000001159 DOI: https://doi.org/10.1097/NCC.0000000000001159

Sanders, L., S. Kopis, C. Moen, A. Pobanz, and F. Volk. 2016. “Perceptions of Spirituality and Spiritual Care in Religious Nurses.” Journal of Christian Nursing: A Quarterly Publication of Nurses Christian Fellowship 33 (4): 214–219. https://doi.org/10.1097/CNJ.0000000000000308 DOI: https://doi.org/10.1097/CNJ.0000000000000308

Shaheen, N., A. Shaheen, A. Ramadan, M. T. Hefnawy, I. A. Ibrahim, M. E. Hassanein, M. E. Ashour, and O. Flouty. 2023. “Appraising Systematic Reviews: A Comprehensive Guide to Ensuring Validity and Reliability.” Frontiers in Research Metrics and Analytics 8. https://doi.org/10.3389/frma.2023.1268045 DOI: https://doi.org/10.3389/frma.2023.1268045

Strang, S., I. Henoch, E. Danielson, M. Browall, and C. Melin-Johansson. 2014. “Communication about existential Issues with Patients Close to Death—Nurses’ Reflections on Content, Process and Meaning.” Psychooncology 23: 562–568. https://doi.org/10.1002/pon.3456 DOI: https://doi.org/10.1002/pon.3456

Tao, Z., P. Wu, A. Luo, T.-L. Ho, C.-Y. Chen, and S.-Y. Cheng. 2020. “Perceptions and Practices of Spiritual Care Among Hospice Physicians and Nurses in a Taiwanese Tertiary Hospital: A Qualitative Study.” BMC Palliative Care 19 (1): 96. https://doi.org/10.1186/s12904-020-00608-y DOI: https://doi.org/10.1186/s12904-020-00608-y

Teteh, D. K., B. Ferrell, O. Okunowo, A. Downie, L. Erhunmwunsee, S. B. Montgomery, D. Raz, R. Kittles, J. Y. Kim, and V. Sun. 2023. “Social Determinants of Health and Lung Cancer Surgery: A Qualitative Study.” Frontiers in Public Health 11: 1285419. https://doi.org/10.3389/fpubh.2023.1285419 DOI: https://doi.org/10.3389/fpubh.2023.1285419

Timmins, F., and S. Caldeira. 2017. “Understanding Spirituality and Spiritual Care in Nursing.” Nursing Standard 31 (22). https://doi.org/10.7748/ns.2017.e10311 DOI: https://doi.org/10.7748/ns.2017.e10311

Tong, A., K. Flemming, E. McInnes, S. Oliver, and J. Craig. 2012. “Enhancing Transparency in Reporting the Synthesis of Qualitative Research: ENTREQ.” BMC Medical Research Methodology 12 (1): 1–8. https://doi.org/10.1186/1471-2288-12-181 DOI: https://doi.org/10.1186/1471-2288-12-181

Türkben Polat, H., and A. A. Özdemir. 2022. “Relationship Between Compassion and Spiritual Care Among Nurses in Turkey.” Journal of Religion and Health 61 (3): 1894–1905. https://doi.org/10.1007/s10943-021-01287-6 DOI: https://doi.org/10.1007/s10943-021-01287-6

Veloza-Gómez, M., L. Muñoz de Rodríguez, C. Guevara-Armenta, and S. Mesa-Rodríguez. 2017. “The Importance of Spiritual Care in Nursing Practice.” Journal of Holistic Nursing 35 (2): 118–131. https://doi.org/10.1177/0898010115626777 DOI: https://doi.org/10.1177/0898010115626777

Wagner, A. S., M. Milzer, M. E. Schmidt, S. Kiermeier, I. Maatouk, and K. Steindorf. 2025. “Nurses’ Knowledge of Cancer-Related Fatigue and the Coverage of This Subject in Nursing Training: A Cross-Sectional Study.” Journal of Nursing Research 33 (2): e379. https://doi.org/10.1097/jnr.0000000000000666 DOI: https://doi.org/10.1097/jnr.0000000000000666

Weathers, E., G. McCarthy, and A. Coffey. 2016. “Concept Analysis of Spirituality: An Evolutionary Approach.” Nursing Forum 51 (2): 79. https://doi.org/10.1111/nuf.12128 DOI: https://doi.org/10.1111/nuf.12128

Willemse, S., W. Smeets, E. van Leeuwen, T. Nielen-Rosier, L. Janssen, and N. Foudraine. 2020. “Spiritual Care in the Intensive Care Unit: An Integrative Literature Research.” Journal of Critical Care 57: 55–78. https://doi.org/10.1016/j.jcrc.2020.01.026 DOI: https://doi.org/10.1016/j.jcrc.2020.01.026

Yuan, J., X. Hu, M. Jiao, T. K. S. Wong, L. Chen, and Y. L. Hu. 2025. ‟Spiritual Care Experiences of Nurses Caring for Cancer Patients in China: A Qualitative Research.” Supportive Care in Cancer 33 (8): 723. https://doi.org/10.1007/s00520-025-09786-y DOI: https://doi.org/10.1007/s00520-025-09786-y