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



This study utilized a cross-sectional descriptive correlational design to explore the relationships between and among spiritual perspective, mindfulness, and spiritual care practice and to assess the impact of spiritual perspective and mindfulness on spiritual care practice of hospice and palliative nurses. Permission to conduct the study was obtained from Seton Hall University's institutional review board and the HPNA Board of Directors.

Theoretical Framework

Watson's[23] theory of human caring provided the theoretical framework for this study. According to Watson,[23] in order for a nurse to build a caring relationship, he/she must first understand self and cultivate his/her own spiritual growth in order to be sensitive to self and other. Building this relationship is cultivated by presence, authentic listening, and being present for another in the moment.[23]

Sample Size

A power analysis was conducted to determine the sample size needed to reduce the risk of a type II error.[24] An a priori analysis[25] was conducted for a 2-tailed test with medium effect size (0.30), power of 0.80, and level of significance set at 0.05. The minimum sample size required was 80.

Sample Recruitment

A convenience sample was recruited from the HPNA. An invitation to participate in the survey was included in 2 HPNA eNewsletters sent to members in October and November of 2014. In addition, members of the Research and Advanced Practice Nurses HPNA Special Interest Groups received an e-mail invitation. Licensed RNs and advanced practice nurses were eligible to participate if they had 1 or more years of experience providing direct patient care in a hospice or palliative care setting and had provided at least 36 hours of direct patient care in the 2 weeks prior to taking the survey.

Data Collection

Data were collected electronically using SurveyMonkey. A link to the survey was included in the eNewsletters and e-mail invitations. If a member was interested in taking the survey, he/she accessed the link. Informed consent was implied if the survey was completed and submitted. Collected data were directly imported into IBM SPSS for Windows version 22 (IBM Corp, Armonk, New York).


Spiritual Perspective. Spiritual perspective was measured with the Spiritual Perspective Scale (SPS) (P. G. Reed, Spiritual Perspective Scale [SPS], 1986 [unpublished instrument]). The SPS assesses an individual's perceptions of the extent to which he/she holds certain spiritual views and engages in spiritually related interactions. The SPS has 10 items measured on a Likert-type scale. Six questions assess views on spirituality ("strongly disagree" to "strongly agree") such as "My spirituality is especially important to me because it answers many questions about the meaning of life" (P.G. Reed, 1986, page 2 [unpublished instrument]). Four questions address frequency of spiritual behaviors ("not at all" to "about once a day") such as "In talking with your family and friends, how often do you mention spiritual matters?" (P.G. Reed, 1986, page 1 [unpublished instrument]). The scale is scored by averaging the 10 items, with higher scores indicating a more salient spiritual perspective. The SPS has been found reliable, with Cronbach's α's greater than .90. Validity of the SPS was supported with all item-scale correlations greater than 0.60 and average interitem correlations ranging from 0.54 to 0.60 (P. G. Reed, 1986 [unpublished instrument]).

Mindfulness. Mindfulness was measured with the Mindful Attention Awareness Scale (MAAS), trait version.[8] The MAAS contains 15 items that describe attributes uncharacteristic of mindfulness such as "I drive places on 'automatic pilot' and then wonder why I went there."[8](p826) Items are scored on a 6-point Likert-type scale 1 ("almost always") to 6 ("almost never") and then averaged. Higher scores reflect a higher level of mindfulness. The MAAS has undergone extensive psychometric testing, which supported its validity; internal reliability ranged from 0.80 to 0.87 in the initial studies.[8]

Spiritual Care. Spiritual care practice was measured with the Nurse Spiritual Care Therapeutics Scale (NSCTS).[26] The 17-item Likert-type scale measures the frequency of specific therapeutics a nurse uses with the intent of providing spiritual care for patients and families such as "Encouraged a patient to talk about what gives his/her life meaning amidst illness."[26](p688) The NSCTS rates how often in the past 72 or 80 hours (depending on working a 12- or 8-hour shift and full- or part-time hours) did they provide a specific therapeutic from 1 ("never/0 times") to 5 ("very often/more than 12 times"). The responses are summed to determine a total score. Higher scores indicate more frequent use of spiritual care practices. Evidence of content and construct validities, as well as expected correlations between spirituality/religiosity measures and those having spiritual care education, has been reported.[26] The internal reliability for the NSCTS was 0.93.[26]

Demographics. Demographic questions included information pertaining to both personal and professional characteristics, as well as prior education in spiritual care (Table 1 and Table 2).


Descriptive statistics were used to describe the sample characteristics and scores for the SPS, MAAS, and the NSCTS. Cronbach's α reliability coefficients were calculated for each instrument. Relationships between study variables were assessed with Pearson correlation coefficient or Spearman ρ if assumptions for parametric statistics were violated. A simple linear regression was used to evaluate the impact of mindfulness on spiritual care practice. The level of significance was set at ≤0.05 for statistical analysis. Pairwise deletion was used to address missing data with sample size still adequate to maintain a power of 0.80 even when certain cases were deleted.