Programs on spirituality in nursing students in the Americas: scoping review

Ricra Echevarria, Carmen Rocio; Zeladita-Huaman, Jhon Alex; Zegarra-Chapoñán, Roberto; Lema Morales, Julia María Eugenia

doi:10.1590/0034-7167-2025-0240

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REVIEW • Rev. Bras. Enferm. 79 • 2026 • https://doi.org/10.1590/0034-7167-2025-0240 linkcopy

Programs on spirituality in nursing students in the Americas: scoping review

Programas sobre espiritualidad en estudiantes de enfermería en las Américas: revisión de alcance

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objectives: to evaluate the state of the art regarding programs to strengthen spirituality and spiritual care implemented in nursing students in the Americas.

Methods: scoping review guided by PRISMA-ScR. Four electronic databases were consulted using MeSH and DeCS terms to include original studies published in peer-reviewed journals, conducted in the Region of the Americas, in English, Spanish, and Portuguese, with no date restriction.

Results: most studies were conducted in the United States, with students in their final years of study and at religiously affiliated universities. Four educational interventions and five programs were identified, in which mainly reflective and experiential educational strategies were employed.

Conclusions: the scarcity of educational initiatives in the Americas contrasts with the consensus on the importance of integrating spirituality into nursing education.

Descriptors:
Spirituality; Students, Nursing; Holistic Nursing; Religion; Program

Author/Year/Country	Objective of the study	Type of study/ Design	Conclusion
Burkhart and Schmidt(¹⁹) (2012) USA	To evaluate the effectiveness of the SCERP program in NS	Two-phase study. In the first phase, they developed the program; in the second phase, they conducted a randomized controlled clinical trial with a pre- and post-test design with two cohorts. Fifty-nine NS in their final year at a private university participated.	The study highlights that reflection and spiritual education through the SCERP program, developed during the final clinical practices of the NS, were effective in improving confidence, perception, and spiritual skills and in fostering reflective practices in professional training.
Catanzaro and McMullen(²⁰) (2021) USA	To explore and articulate effective teaching strategies to foster spiritual sensitivity in NS.	Qualitative study; participants were nursing students enrolled in a community health rotation at a Catholic university.	The study highlights the effectiveness of the teaching strategies implemented (use of reflective journals, review of specialized literature, and open dialogue in community and parish clinical settings) to increase the spiritual sensitivity of nurses.
Galloway et al.(²¹) (2017) EUA	To develop, implement, and evaluate a simulation exercise to improve knowledge and attitudes about spirituality and spiritual care.	Mixed study. Seventy-four second-year NS students from a public university participated.	The use of simulation as a teaching strategy was effective in improving confidence, knowledge, and attitudes toward spirituality in patient care.
Hoffert et al.(²²) (2007) USA	To evaluate the effectiveness of an intervention program to improve the comfort level of NS in conducting a spiritual assessment.	Quantitative, quasi-experimental, time series study (pre-test and post-test). Fifty-four third-year NS students from a church-affiliated university participated.	The study demonstrated that a structured educational program can improve NS competence and confidence in spiritual assessment.
Lovanio and Wallace(²³) (2007) USA	To develop and evaluate a pilot educational project focused on spirituality.	Quantitative, pre-experimental study, pre/post-test design of a single group, composed of 10 NS in their second year at a private Catholic university.	The pilot project had a positive impact on understanding and attitudes toward spirituality and spiritual care in NS.
Rakin and DeLashmutt(²⁴) (2006) USA	To describe a nursing school’s approach to motivating nursing students to explore and understand the concepts of spirituality and the role of nursing through clinical experience.	Qualitative case study. 188 NS students in their final year at a private Christian university participated.	Nursing students can develop a greater understanding of spirituality and the role of nursing through structured clinical experiences with patients who have spiritual needs and that incorporate active strategies that promote guided reflection through questions and discussions.
Rodrigues et al.(⁴) (2020) Brazil	To develop and validate an educational video on assessing patients’ spiritual needs.	Methodological study with descriptive analysis. Eight specialists and 15 students in their third and fourth years at a public university participated.	The use of educational videos, complemented by discussion and reflection on spirituality in an academic setting, can facilitate the teaching of intimate topics such as spirituality and better prepare students for clinical practice.
Taylor et al.(²⁵) (2014) USA	To Describe how a Christian nursing school systematically integrated spiritual care into the curriculum and evaluated its impact on course completion.	Descriptive study. Faculty members and students (approximately 500) enrolled in all years of study at a Seventh-day Adventist Christian university participated.	Integrating spiritual care into a nursing curriculum can be effective in teaching students about spiritual care.
Vargas and Guarnizo(²⁶) (2020) Colombia	To evaluate the effect of an educational intervention in NS to strengthen their perception of spirituality and spiritual care.	Parallel experimental study with a control and experimental group, but without blinding. Ninety students in their final year at a Christian university participated.	The educational intervention strengthened the perception of spirituality and spiritual care in people suffering from chronic diseases.

Author	Instructional design	Post-intervention outcome	Kirkpatrick Level
Hoffert et al.(²²)	Type: Educational workshop Session number/duration: 1 session of 90 minutes. Theoretical content: importance of spiritual assessment and care in nursing, difference between spirituality and religiosity, transition from spiritual assessment as a task to a way of being through care, active listening, and spiritual assessment. Methodological strategies: interactive seminar-type workshop, personal reflection, and application of tools.	There was a significant improvement in the perception of nurses regarding their ability to perform a spiritual assessment (p = 0.001). Nurses showed greater clarity in differentiating between spirituality and religion. An increase in nurses’ confidence in addressing spirituality with patients was reported.	2
Rodrigues et al.(⁴)	Type: educational video Session number/duration: 10-minute, 52-second video. Theoretical content of the video: definitions of spirituality and religiosity. Strategies for assessing patients’ spiritual needs. Application of the NURSE technique for patients’ emotional management. Spiritual care interventions. Methodological strategy: the video was structured in three phases: pre-production, production, and post-production. Interactive dialogues and questions to stimulate student reflection.	The educational video was well received and considered useful for future professional performance, as a motivational resource in assessing spiritual needs and providing comprehensive care. In addition, it encouraged critical reflection on nursing practice..	2
Vargas and Guarnizo(²⁶)	Type: lecture entitled “Spiritual Nursing Care: Integrity of the Human Being in Care” Session number/duration: single session. The effect was measured four months later. Theoretical content: reality of people with chronic diseases, McSherry’s conceptualization of spirituality and spiritual care. Methodological strategy: lecture with slides, 15-minute educational video, and delivery of reflective messages on spiritual care.	In the intervention group, they report that the intervention had a positive impact; specifically, the score increased significantly, both on the SSCRS scale and in the dimensions and perceptions: spirituality, spiritual care, and personalized care. In the control group, they do not report an increase in the score.	2
Galloway et al.(²¹)	Type: simulation exercise on spiritual care with standardized patients. Session number/duration: one semester Theoretical content: based on chapters from nursing books on spirituality and spiritual care. Simulation strategy: case study prior to simulation. The standardized patient represented a woman in spiritual distress after the death of her husband in an accident. The Debriefing for Meaningful Learning model was used to analyze the experience after the simulation. Methodological strategy: lecture, followed by a simulation exercise and debriefing session; at the end, the FICA spiritual assessment tool was applied.	The intervention group showed significant improvements in four factors of the SSCRS scale. Hope (p=0.006): increased perception of the value of hope in life and spiritual care. Meaning and purpose (p=0.02): greater awareness of how to help patients find meaning in difficult times. Spiritual care (p=0.006): greater recognition of respect, privacy, and active listening in spiritual care. Relationships (p=0.04): increased perception of the role of personal relationships in spirituality.	2

Author	Instructional design	Result after applying the program	Kirkpatrick Level
Burkhart and Schmidt(¹⁹)	Program: SCERP Duration: 6 weeks, during the last semester in which they perform their final clinical practices. Theoretical content: definition and how spirituality is experienced, professional identity; and how to provide spiritual care. Methodological strategy: two retreats, online discussions, and reflective practices (examination of conscience) were held.	The SCERP program was effective because: It increased the SCI score globally and in two dimensions (faith rituals and attribution of meaning). In other words, it increased the perception of nurses regarding their ability to provide spiritual care. Similarly, it increased the SCIP scale score, which represents an increase in HWs’ belief and self-confidence in their ability to provide spiritual care to patients and families.	4
Lovanio and Wallace(²³)	Program: Spiritual education pilot Duration: 10 weeks, during the development of a Geriatric Nursing course. Theoretical content: religion and spirituality, the spiritual dimension of holistic nursing, and spiritual interventions. Methodological strategy: lectures (initial and one each week), reflections and literature analysis, development of care plans, spiritual interventions with residents.	They report that the post-test SSCRS score was higher than the pre-test score and statistically significant. Similarly, they report differences between items. Students showed greater recognition of spirituality as a central component of holistic care. There were positive changes in attitudes toward spiritual care. The journals reflected positive experiences. The NPs emphasized the impact of the program on their perception of spiritual care and their relationship with patients.	2
Catanzaro and McMulleⁿ⁽²⁰)	Program: Experiential learning Duration: rotation of community health practices (1 semester) Theoretical content: impact of spirituality on health, aging, and hope. Methodological strategies: reflection and personal journals, practices in community settings, dialogues, and lectures.	The nurses demonstrated a significant increase in their spiritual sensitivity, manifested in greater awareness of their own spiritual needs and those of others, greater comfort in addressing spiritual issues with patients, and greater ability to provide care that integrates the spiritual dimension.	3
Rakin and De Lashmutt(²⁴)	Program: experiential learning implemented in a clinical rotation and community center. No. of sessions/duration: 4 consecutive weekly sessions. Methodological strategies: clinical experience focused on promoting “nursing presence”; that is, being fully present with the patient, providing emotional and spiritual support. Complementary activities: seminars, readings, and case studies on the connection between spirituality and health. Written reflections on the experience of spirituality in care. Student assessment: questionnaires and reflections were conducted after the clinical experience.	The nurses reported a greater understanding of spirituality as part of holistic care. They learned to differentiate between spirituality and religiosity. There was evidence of improvement in the students’ confidence and ability to offer spiritual care and practice “nursing presence”. The nurses were able to demonstrate “nursing presence” as the ability to connect with patients on a deep level and provide compassionate attention. Patients reported feeling more supported and understood by the nurses.	4
Taylor et al.(²⁵)	Type: integration of spiritual care into a study plan. Methodological strategy: lectures and group discussions on spirituality in nursing. Reflective journals on clinical experiences related to spirituality. Assessment of spiritual needs in care plans. Exposure to nurses specializing in spiritual care. Simulations and case studies on spirituality. Clinical practice with parish nurses.	The study revealed that 85% of nurses felt “quite” or “very well” prepared to offer spiritual care. Nurses indicated that clinical experiences were the most useful component for their learning. Final-year nurses felt confident in their ability to offer spiritual care to patients and valued spiritual care as an important part of nursing care.	4

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