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The interplay between spiritual care practice, perception, and competency among critical care nurses: structural equation modeling study
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DOI：10.1186/s12912-026-05176-9.png)
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Abstract
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Spiritual care is a vital yet often overlooked component of holistic nursing, particularly in high-stress environments similar intensive care units. While critical care nurses’ spiritual perceptions and practices have been investigated, the mediating role of competency and the influence of demographic factors remain understudied. This study aimed to investigate relationships among spiritual perception, competency, and practice in critical care nurses, focusing on how competency mediates these relationships and the potential moderating role of demographic variables. A multicenter cross-sectional study was conducted with a convenience sample of 312 critical care nurses across three hospitals in Egypt. Data were collected from 14 intensive care units between February and March 2024 using an online questionnaire that included the Spiritual Care Practice Questionnaire, the Perception of Spirituality and Spiritual Care Rating Scale, and the Spiritual Care Competency Scale. Structural equation modeling was employed to analyze mediation and moderator variables. A total of 312 nurses participated in the study. Spiritual competency significantly mediated the relationship between spiritual perception and Spiritual Care Practice (unstandardized indirect effect = 0.302, p < 0.001; standardized β = 0.357). Structural relationships were evaluated based on individual path coefficients rather than the global model fit. Additionally, age significantly moderated the paths from spiritual perception to practice and from spiritual competency to practice; ICU type significantly moderated the paths from spiritual perception to practice, from spiritual perception to competency, and from competency to practice; gender did not significantly moderate any path; and education level significantly moderated the paths from spiritual perception to practice, from spiritual perception to competency, and from competency to practice. Years of ICU experience did not show a significant moderating role. Spiritual care competency was associated with the relationship between perception of spirituality and spiritual care and its practice among nurses. Specific demographic characteristics demonstrated significant interaction effects on selected pathways. Age and ICU type showed significant interaction effects on several structural pathways, whereas years of ICU experience did not demonstrate significant interaction effects, underscoring the need for tailored approaches to spiritual care training and practice. Integrating spiritual care competency into training programs for critical care nurses, while considering demographic factors, may enhance holistic care in intensive care units. Not applicable.
Keywords:
Critical care nursing
Competence
Perception
Spirituality
Structural equation modeling
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