An Analysis of Perspective-Practice Gap in Spiritual Care Among Nurses in Kerala

Abstract

Background: While spiritual care is recognized as a fundamental component of holistic nursing, operationalizing it remains challenging, particularly in pluralistic societies like India. Previous assumptions suggest nurses may possess high personal spiritual perspectives but struggle to translate them into clinical practice due to systemic barriers. Objective: This study aimed to quantitatively analyse the "perspective-practice gap" among nurses in Kerala and assess the relationships between their practical spiritual care delivery, philosophical perspective, and religious attitudes. Methods: A descriptive, correlational cross-sectional design was utilized. A cohort of nurses (N = 165) in Kerala, India, completed the Indian-validated 15-item Spirituality and Spiritual Care Rating Scale (SSCRS). Data were analysed using paired-samples t-tests and Pearson correlations across the scale’s three validated factors: Spiritual Care (Factor 1), Spirituality Perspective (Factor 2), and Spirituality Attitude (Factor 3). Results: Contrary to the hypothesized gap, participants scored significantly higher in practical Spiritual Care (M = 4.10, SD = 0.76) than in philosophical Spirituality Perspective (M = 3.73, SD = 0.92), t (164) = 6.99, p < .001. A strong positive correlation existed between practical care and perspective (r = .689, p < .001). Notably, rigid Spirituality Attitudes showed no significant correlation with the ability to provide Spiritual Care (r = .016, p = .839). Conclusion: Nurses in Kerala demonstrate an "inverse" perspective-practice gap, excelling in operationalized spiritual care despite lower abstract philosophical perspectives. Furthermore, rigid religious attitudes do not influence clinical spiritual care competence, suggesting that nursing education should prioritize broad humanistic perspectives over specific religious frameworks.