Spiritual Perspective, Mindfulness, and Spiritual Care Practice of Hospice and Palliative Nurses

Patricia Ricci-Allegra, PhD, RN, CPNP-AC/PC


Journal of Hospice and Palliative Nursing. 2018;20(2):172-179. 

In This Article

Abstract and Introduction


Spiritual care is a key tenet of palliative care. A nurse's spiritual perspective has been recognized as an influencing factor in spiritual care, and results from several studies have shown an increase in spiritual perspective as a result of participation in programs designed to develop mindfulness as well as developing skills necessary for spiritual care. A descriptive correlational design was used with a convenience sample of nurses from the Hospice and Palliative Nurses Association. Data were collected online using the Spiritual Perspective Scale, Mindful Attention Awareness Scale, and the Nurse Spiritual Care Therapeutics Scale. Spiritual perspective was positively correlated with age (ρ = 0.2, P = .046), years of registered nurse experience (ρ = 0.208, P = .039) and higher in those with a religious affiliation (U = 392.5, P < .001, r = 0.54). A positive correlation was found between mindfulness and spiritual care (r = 0.212, P = .05), with mindfulness explaining 4.5% of the variance in spiritual care. No significant relationships were found between spiritual perspective and mindfulness or spiritual care. Identifying mindfulness as a factor that may influence spiritual care has implications for education, research, and practice.


Spiritual care is not only an ethical obligation of the nursing profession[1,2] but also a key tenet of palliative care.[3,4] Nurses, as part of the interdisciplinary team, assess and attend to the patient and family's spiritual, religious, and existential needs within their scope of practice.[3,4] Spiritual care has been described as "…the most mysterious and often misunderstood part of palliative care."[5] (p546) There is no consensus on the definition, but it has been defined as "allowing our humanity to touch another's by providing presence, deep listening, empathy, and compassion."[5] (p546) Regardless of how spiritual care is defined, an important element is what nurses bring of themselves to the patient encounter.[5]

The Hospice and Palliative Nurses Association's (HPNA's) Position Statement on Spiritual Care states that spiritual care includes the "…ability of the professional caregiver to reflect on and recognize the importance of one's own spirituality…."[3](p2) Spiritual perspective is an indicator of the awareness of an individual's inner self and a sense of connection to a higher being, nature, and others or to some dimension or purpose greater than oneself that may be manifested in beliefs and actions (P. G. Reed, Spiritual Perspective Scale [SPS], 1986 [unpublished instrument]) and has been used as a measure of spirituality.[6] A nurse can acquire skills necessary to deliver spiritual care by acknowledging self as a spiritual being and experiencing, reflecting, and exploring the meaning of his/her own spirituality.[7]

In addition to reflecting and recognizing the importance of personal spirituality, the HPNA position statement[3] also indicates nurses should appreciate the significance of presence and be willing to be fully present in the provision of spiritual care. Mindfulness can be defined as "being attentive to and aware of what is taking place in the present."[8] (p822) Mindfulness facilitates being present, which is an essential skill for providing spiritual care.[7]

The term mindfulness is used in several ways in the health care literature. Mindfulness can denote a trait describing how mindful an individual is in general or a state indicating how mindful a person happens to be at a given time.[9] Mindfulness can also refer to practices, such as meditation, designed to increase an individual's level of awareness or attention.[9] Mindful practices can foster compassion,[10,11] and many enable an individual to respond to situations more reflectively and not only out of a habitual pattern.[12]