Spiritual Care Training Methods in Nursing Students: A Randomized Study

This study is a three-arm randomized controlled trial designed to evaluate the effects of two different educational approaches for spiritual care training on final-year undergraduate nursing students. Although spiritual care is widely recognized as a core component of holistic nursing practice, undergraduate nursing education often remains limited in providing structured and practice-oriented learning opportunities that facilitate the translation of spiritual care knowledge into clinical practice. Therefore, this study compares a traditional didactic lecture approach with an interactive, collaborative learning method (Jigsaw technique), using a control group for comparison.

Eligible participants are fourth-year nursing students enrolled at a Faculty of Health Sciences in Türkiye. Fourth-year students were selected because they actively participate in patient care during their internship placements for approximately 24 hours per week, which provides an appropriate context for evaluating both perceptions and practice-related outcomes.

Participants are allocated into three parallel groups using simple randomization: (1) didactic lecture group, (2) Jigsaw technique group, and (3) control group. The educational intervention is delivered in two sessions, each lasting approximately 40-45 minutes, conducted outside regular class hours and scheduled at times convenient for students. Both intervention groups receive the same core content, developed based on current literature and reviewed by experts prior to implementation. The control group receives no training during the study period; however, after completion of data collection, students in the control group are offered lecture-based training to ensure educational fairness.

In the didactic lecture group, the content is delivered through PowerPoint-based presentations in a classroom setting. In the Jigsaw group, students are divided into small groups and learn the same content through structured peer teaching. The content is divided into four subtopics: (1) basic concepts of spirituality and spiritual care and nursing theorists' perspectives; (2) spiritual care within the nursing process and nursing diagnoses related to spiritual care; (3) spiritual care interventions; and (4) development and evaluation of nursing care plans. Students first work in main groups, then form expert groups according to assigned subtopics, and finally return to their main groups to teach their peers and complete group discussions.

Outcome assessments are conducted at three time points: baseline (pre-test), 15 days after completion of the intervention (post-test), and one month after the intervention (retention test). The primary outcome is nursing students' perceptions of spirituality and spiritual care. Secondary outcomes include the frequency of spiritual care therapeutics, nursing care plan performance scores, and (in the Jigsaw group) student evaluations of the Jigsaw learning method.

In addition to self-report scales, students' nursing care plans prepared during clinical internships are evaluated using a standardized 100-point scoring system based on the nursing process stages. Care plan evaluation includes assessment components related to spiritual care, identification of relevant nursing diagnoses, formulation of goals and expected outcomes, planning of nursing interventions, documentation, and evaluation of care outcomes.

Data are analyzed using appropriate parametric statistical methods. Baseline comparability of groups is examined using chi-square tests for categorical variables and one-way ANOVA for continuous variables. Changes in outcome measures across time and between groups are assessed using repeated measures ANOVA and one-way ANOVA, and post hoc comparisons are performed using the LSD test. Statistical significance is set at p < 0.05.

nclusion Criteria:

Fourth-year undergraduate nursing students enrolled at the Faculty of Health Sciences of Recep Tayyip Erdogan University (Türkiye).

Actively participating in clinical internship placements during the study period.

Willing to participate and providing written informed consent.

Not having received formal education or training specifically focused on spirituality or spiritual care during undergraduate nursing education.

Exclusion criteria

Students who did not provide informed consent.

Students who previously received formal education/training on spiritual care.

Students who were not active nursing students during the data collection period.

Students with incomplete post-test or retention-test data.

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