Psychometric properties of the taiwanese version of the spiritual care-giving scale: an exploratory cross-sectional study with nursing students
- Open Access
- 31.01.2026
- Research
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Abstract
Introduction
Nurses frequently provide care in situations involving illness, death, or crisis, which can pose significant spiritual and emotional challenges for the caregivers themselves [1]. Frontline nurses may experience heightened empathy, leading to their own spiritual struggles, moral distress, and feelings of helplessness while supporting patients. This highlights the importance of addressing nurses’ spiritual well-being alongside patient care to promote resilience, professional growth, and sustainable practice [2].
Nursing students, in particular, often lack not only experience in caring for terminally ill patients but also the ability to navigate their own spiritual distress and growth. Recognizing this gap, numerous studies have emphasized the integration of spiritual care education into nursing curricula. The literature highlights various approaches, including teaching spiritual assessments, enhancing nursing students’ spiritual knowledge, incorporating spirituality into nursing education and textbooks, embedding spiritual development in nursing programs, and offering training in spiritual care. Strengthening nursing students’ spiritual care competence and fostering their own spiritual growth before they enter clinical practice are essential for their long-term professional and personal development as healthcare providers [3, 4].
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Spiritual-care competence is increasingly recognized as essential in holistic nursing, yet its assessment in educational settings continues to evolve. In Taiwan, several tools have been developed to assess spirituality among nursing students and professionals. However, many of these instruments primarily focus on spiritual well-being rather than addressing specific spiritual learning needs. For example, Hsiao and Huang [5] developed the 24-item Spiritual Health Scale (SHS) short from to assess dimensions such as “Connection to Others,” “Meaning Derived from Living,” “Transcendence,” “Religious Attachment,” and “Self-Understanding.” While the SHS demonstrates good reliability and validity, it lacks components that assess spiritual practices, which are critical for nursing education. The Spiritual Well-Being Scale (SWBS) is another widely used instrument, available in over 10 languages, and evaluates two dimensions: religious well-being (RWB) and existential well-being (EWB) [6]. Although effective in assessing general spiritual well-being, its focus on religion and existential beliefs may not fully align with Taiwan’s predominantly Taoist and Buddhist cultural context, limiting its ability to capture nursing students’ spiritual learning needs.
In contrast, the Spiritual Care-Giving Scale (SCGS), developed by Tiew and Creedy (2012) [7], is a 35-item self-report tool specifically designed to assess nursing students’ competence in spiritual care across five dimensions: General Properties of Spiritual Care, Spirituality Perspectives, Defining Spiritual Care, Spiritual Care Practices, and Spiritual Care Attitudes. Each item is rated on a 6-point Likert scale (1 = strongly disagree, 6 = strongly agree), yielding a total score range of 35–210. The SCGS has demonstrated strong reliability and validity across diverse populations and languages, including Turkish [8], Simplified Chinese [9], and Arabic [10]. Unlike SWBS and SHS-SF, the SCGS incorporates spiritual practice as a core dimension, making it particularly suitable for nursing education and fostering students’ spiritual development.
This study aims to translate the SCGS into a culturally adapted Taiwanese version (SCGS-T) and evaluate its psychometric properties among Taiwanese nursing students. The SCGS-T not only provides a structured framework to assess students’ baseline understanding of spirituality but also supports targeted educational interventions to enhance specific dimensions of spiritual care competence. By filling the current gap in culturally validated instruments, the SCGS-T ensures relevance and applicability for nursing education in Taiwan, facilitating both assessment and development of students’ spiritual-care competence.
Methods
Study design and sample
This study employed an exploratory cross-sectional design and used convenience and snowball sampling for participant recruitment. The inclusion criteria were nursing students aged 20 years or older who were willing to participate in the survey. The exclusion criteria were those unwilling to participate or those diagnosed with mental health disorders. The required sample size was determined using the guideline that each item should have five times the number of participants for adequate calculation [11]; with 35 items in the SCGS, a minimum sample size of 175 was required.
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Data were collected using a paper-based survey distributed to nursing students through convenience and snowball sampling. Two of the authors were responsible for recruiting participants. To ensure confidentiality, each completed questionnaire was placed in a sealed envelope by the participant before submission. A small reminder was attached to the outside of each envelope, instructing participants to check that all questions had been answered before returning the survey. Participants were informed that no personally identifiable information would be collected, that participation was entirely voluntary, and that they would receive a small gift valued at approximately NT$50 upon returning their complete questionnaire. Completed questionnaires were returned via sealed collection boxes placed at accessible locations on campus. After collection, the research team checked all questionnaires for completeness, and only fully completed surveys were included in the final analysis. Data collection occurred between September and December 2024. A total of 308 questionnaires were distributed, with a 100% response rate. No missing data were present in the dataset analyzed.
Spiritual care-giving scale
The SCGS, developed by Tiew and Creedy [7], is a 35-item self-report measure with notable test-retest reliability (r = 0.811; p < 0.01). The scale encompasses five primary dimensions: attributes of spiritual care, spiritual perspectives, definitions of spiritual care, spiritual care attitudes, and spiritual care values. It employs a 6-point Likert scale, ranging from “strongly disagree” (1) to “strongly agree” (6). The total possible score for the SCGS ranges from 35 to 210. This range reflects the cumulative score across all 35 items, with higher scores indicating a greater agreement with the statements related to spiritual care.
Translation and cultural adaptation of the spiritual care-giving scale for taiwan
The authors obtained permission to translate and adapt the Spiritual Care-Giving Scale (SCGS) for use in Taiwan. The translation and cultural adaptation processes followed the standardized five-step approach outlined by Beaton et al. (2000) [12] to ensure that the Taiwanese version achieved semantic, idiomatic, experiential, and conceptual equivalence with the original instrument. In the forward translation stage, two bilingual translators independently translated the SCGS from English into Traditional Chinese. Translator A was a professional linguist without a healthcare background, whereas Translator B was a registered nurse familiar with spiritual care and Taiwanese clinical practice. Both were instructed to focus on conceptual meaning rather than literal wording.
During the synthesis stage, two translators and a bilingual researcher compared the two versions and resolved discrepancies by consensus to produce a reconciled version. Particular attention was paid to items with potential cultural or contextual differences in meaning. Back-translation was then conducted by two native English speakers fluent in Chinese, both unaware of the original SCGS and uninvolved in the previous steps, to check for inconsistencies and ensure that the translated items retained their original meanings.
An expert committee comprising two nursing faculty members and two clinical nurses with expertise in spiritual or palliative care reviewed all translated materials, including the forward, back-translated, and reconciled versions. The committee members included two clinical nurses (aged 48 and 40 years, with 20 and 18 years of experience, respectively; positions: palliative care head nurse and staff nurse) and two nursing professors (aged 40 and 52, with 4–24 years of teaching experience in spiritual care and 5–19 years of clinical experience, both serving as assistant professors). Each item was evaluated for clarity, relevance, and cultural appropriateness.
Pilot testing was subsequently conducted with a small sample of 20 Taiwanese nursing students’ representative of the target population. Feedback on item clarity, readability, and cultural relevance led to minor adjustments in wording. The final SCGS-T was confirmed to be culturally appropriate, conceptually equivalent to the original scale, and ready for psychometric evaluation in the main study.
Other instruments
In In addition to the SCGS, two other instruments were used to establish its criterion-related validity. The first, the Spiritual Well-Being Scale (SWBS), is a well-established tool assessing spiritual well-being across two dimensions: religious and existential. The second instrument, the Spiritual Health Scale-Short Form (SHS-SF), is a validated measure of subjective well-being, providing a robust comparison. Both instruments were administered in Taiwanese versions and were used to examine correlations with the SCGS, thereby supporting its validity in evaluating spiritual care among nursing students.
Demographic items
The demographic questionnaire contained items related to age, gender, religion, previous experience in courses related to death and dying, and the number of relatives and/or patients who had passed away.
Spiritual Well-Being Scale
The SWBS is a 20-item self-report instrument developed to measure spiritual well-being along two dimensions: Religious Well-Being (RWB) and Existential Well-Being (EWB). The RWB subscale assesses an individual’s perceived relationship with God, whereas the EWB subscale focuses on evaluating one’s sense of life satisfaction and purpose. Each item is rated on a six-point Likert scale, ranging from 1 to 6 (completely applicable). The subscale scores are calculated by summing the responses to their respective items, resulting in scores ranging from 10 to 60 for each subscale and 20 to 120 for the total SWBS score. The SWBS has demonstrated robust reliability across various studies. The test-retest reliability coefficients range from 0.88 to 0.99 for RWB, 0.73 to 0.98 for EWB, and 0.82 to 0.99 for the total SWBS score [6].
The Spiritual Health Scale-Short Form
The SHS short form (SHS-SF), developed by Hsiao et al. [5], has been designed to evaluate the spiritual well-being of nursing students. It comprises 24 items categorized into five subscales: connection to others, meaning in life, transcendence, religious attachment, and self-understanding. Participants respond to each item on a five-point Likert scale, ranging from 1 (completely disagree) to 5 (completely agree). Because all items are framed positively, higher scores indicate a greater level of spiritual health. The SHS-SF has a total score ranging from 24 to 120, with higher scores indicating better spiritual well-being. The scale demonstrated excellent internal consistency, with a Cronbach’s alpha of 0.93 (range from 0.88 to 0.93). Furthermore, the CR values for each subscale ranged between 0.88 and 0.90, supporting the instrument’s convergent reliability [5].
Statistical analysis
All analyses were performed using SPSS 24.0 and AMOS 24.0 for Microsoft Windows. Descriptive statistics were derived to summarize the sample characteristics, with an alpha level of 0.05 set for statistical significance. Item analysis included multiple methods, such as: (1) content validity index (CVI), (2) corrected item-total correlation, (3) factor loading, and (d) Cronbach’s alpha if an item was deleted. The CVI assesses the relevance of scale items to the measured construct. A scale-level CVI (S-CVI) score of ≥ 0.90 indicates good content validity [13]. The internal consistency and homogeneity of the SCGS-T were evaluated using Cronbach’s alpha, with values of ≥ 0.80 indicating strong internal consistency. Concurrent validity of the SCGS-T with the SWBS and SHS-SF was assessed using Pearson’s correlation coefficient, with a p-value < 0.05 considered indicative of a positive correlation [14]. Test–retest reliability is frequently assessed using the intraclass correlation coefficient (ICC) or Pearson correlation (r). Values above 0.70 are considered acceptable [15].
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To validate the construct of the C-SCCS, confirmatory factor analysis (CFA) was performed using AMOS Version 20.0. Several fit indices were examined to determine which CFA model best fit the dataset: root mean square error of approximation (RMSEA), chi-square, and changes in chi-square relative to changes in the degrees of freedom between models. RMSEA assesses the average residual variance and covariance, with values ≤ 0.10 considered indicative of a good fit [16]. When comparing models, a lower chi-square value suggests better model fit, assuming that the degrees of freedom are constant. Convergent and discriminant validity were evaluated using CR and average variance extracted (AVE). According to established guidelines, CR values should exceed 0.6, and AVE values should be greater than 0.5 to demonstrate acceptable validity [17, 18].
Ethical considerations
Authorization to utilize the SCGS in this study was secured from its original developers [7] prior to study commencement. Ethical approval was obtained from the Chang Gung Medical Foundation Institutional Review Board (IRB approval number: 202400049B0). Participants were provided with comprehensive written information explaining the study’s objectives; data collection process; and measures taken to ensure their rights, including voluntary participation, confidentiality, and anonymity. They were informed that their involvement was entirely optional and that they could withdraw from the study at any point without any repercussions. Those who consented to participate were required to sign an informed consent form before completing the survey questionnaires.
Results
Participant characteristics
A total of 308 nursing students participated in the survey. The majority of participants were female (n = 272, 88.3%), with an average age of 21.80 years (SD = 4.09). Most students identified as Taoist (64%) or Buddhist (5.8%). Regarding prior exposure to courses on death and dying, approximately 64.9% of the students had experience caring for individuals nearing death. Additionally, approximately 89.9% of the participants reported experiencing the death of one to five relatives or patients (Table 1).
Table 1
Participant characteristics (N = 308)
Variable | n (%) |
|---|---|
Gender, n (%) | |
Male | 36 (11.7%) |
Female | 272 (88.3%) |
Age, mean/standard deviation | 21.8(4.1) |
Religion, n (%) | |
Taoist | 197 (64%) |
Buddhist | 18 (5.8%) |
Christian | 16 (5.2%) |
Catholic | 4 (1.3%) |
I-Kuan Tao | 5 (1.6%) |
No faith | 68 (22.1%) |
Previous experience in courses related to death and dying | |
Yes | 200 (64.9%) |
No | 108 (35.1%) |
Number of relatives and/or patients who had passed away | |
0 | 27 (8.8%) |
1 − 5 | 277 (89.9%) |
6 − 10 | 4 (1.3%) |
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Reliability and validity
Internal consistency reliability
The Cronbach’s alpha coefficients for the SCGS-T were 0.98 for the total scale, 0.96 for general properties of spiritual care, 0.91 for spirituality perspectives, 0.83 for defining spiritual care, 0.94 for spiritual care practices, and 0.87 for spiritual care attitudes.
Test–retest reliability
The 35-item questionnaire was tested twice with 59 nursing students over a three-month interval. The mean total score on the first test was 170.11 (SD = 20.26), and the mean total score on the second test was 177.95 (SD = 23.04); these results indicate that the test and retest did not significantly differ, yielding a test–retest coefficient of 0.85. Therefore, test–retest reliability was deemed adequate.
Content validity
Four nursing scholars were invited to evaluate the content validity of the SGSC-T. The experts rated most of the items as highly relevant, resulting in an acceptable overall assessment. The item-level CVI (I-CVI) values ranged from 0.9 to 1.0, with an S-CVI of 0.9.
Concurrent validity
The concurrent validity of the SCGS-T was assessed by calculating correlation coefficients with the SWBS and SHS-SF. Descriptive statistics indicated that the mean total score of the SCGS-T was 180.8 ± 20.9 (range 35–210), reflecting relatively high perceived spiritual care competence among the participants. The mean total score of the SWBS was 72.0 ± 8.5 (range 20–120), and the SHS-SF was 96.1 ± 12.9 (range 24–120), indicating moderate to high levels of spiritual well-being and subjective happiness. Pearson’s correlation coefficient analysis showed that the SCGS-T total score was significantly positively correlated with the SWBS score (r = 0.52, p < 0.01) and the SHS-SF score (r = 0.59, p < 0.01). The SWBS and SHS-SF scores were also strongly correlated (r = 0.75, p < 0.01), supporting the criterion-related validity of the SCGS-T (see Table 2).
Table 2
Descriptive statistics and correlations among SCGS-T, SWBS, and SHS-SF (N = 308)
Variable | Mean ± SD | Range | 1 | 2 | 3 |
|---|---|---|---|---|---|
1. SGSC-T | 180.8 ± 20.9 | 35–210 | 1 | - | - |
2. SWBS | 72.0 ± 8.5 | 20–120 | 0.52** | 1 | - |
3. SHS-SF | 96.1 ± 12.9 | 24–120 | 0.59** | 0.75** | 1 |
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Convergent validity and discriminatory validity
The results of the final CFA model indicated that the five-factor structure achieved acceptable model fit indices. Bagozzi and Yi [17] pointed out that the χ²-to-degrees of freedom ratio should be as small as possible when testing model fit, with a ratio less than 3 being ideal. In this study, the χ²-to-degrees of freedom ratio of the model was less than 3 (2.83). The CFI for the model was 0.84, and the RMSEA value was 0.09 (RMSEA values between 0.05 and 0.10 suggest “acceptable” fit [16]. Overall, the fit indices met the standard criteria.
The factor loadings for all items across the five factors ranged from 0.62 to 0.93; therefore, it can be concluded that the observable variables in this study demonstrate appropriate reliability. The CFA results for the SCGS-T supported the five-factor structure, confirming the following factors: Factor 1, general properties of spiritual care (items 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, and 35); Factor 2, spirituality perspectives (items 1, 2, 3, 4, 5, 6, 7, 8, and 9); Factor 3, defining spiritual care (items 10, 11, 12, 13, and 14); Factor 4, spiritual care practices (items 15, 16, 17, 18, 19, and 23); and Factor 5, spiritual care attitudes (items 20, 21, and 22) (Fig. 1; Table 3).
Table 3 shows the AVE values, which ranged from 0.64 to 0.81, passing the suggested criterion of 0.5 and demonstrating satisfactory convergent validity for the SCGS-T. Convergent validity was further supported by the CR values for each construct, which ranged from 0.89 to 0.97, indicating strong convergent reliability of the SCGS-T. Additionally, the square root of the AVE values was not greater than the correlation values between constructs, confirming discriminant validity.
Table 3
Factor analysis results for the 35-item SCGS-T (N = 308)
Factor domain | Items | Factor loading | Residual | CR | AVE |
|---|---|---|---|---|---|
1.General properties of spiritual care | 24. Spiritual care should take into account of what patients think about spirituality | 0.92 | 0.18 | 0.97 | 0.79 |
25. Nurses who are spiritually aware are more likely to provide spiritual care | 0.89 | 0.19 | |||
26. Spiritual care requires awareness of one’s spirituality | 0.84 | 0.34 | |||
27. Spiritual care should be instilled throughout a nursing education program | 0.89 | 0.24 | |||
28. Spiritual care should be positively reinforced in nursing practice | 0.87 | 0.32 | |||
29. The ability to provide spiritual care develops through experience | 0.86 | 0.27 | |||
30. Spiritual care is important because it gives patients hope | 0.88 | 0.23 | |||
31. Spirituality is influenced by an individual’s life experiences | 0.90 | 0.18 | |||
32. Spirituality helps when facing life’s difficulties and problems | 0.92 | 0.13 | |||
33. Spiritual care requires the nurse to be empathetic toward the patient | 0.89 | 0.23 | |||
34. A trusting and respectful nurse–patient relationship is needed to provide spiritual care | 0.93 | 0.15 | |||
35. A team approach is important for spiritual care | 0.87 | 0.14 | |||
2. Spirituality perspectives | 1. Everyone has spirituality | 0.82 | 0.11 | 0.96 | 0.76 |
2. Spirituality is an important aspect of human beings | 0.89 | 0.11 | |||
3. Spirituality is a part of a unifying force which enables individuals to be at peace | 0.92 | 0.11 | |||
4. Spirituality is an expression of one’s inner feelings that affect behavior | 0.93 | 0.21 | |||
5. Spirituality is a part of our inner being | 0.93 | 0.15 | |||
6. Spirituality is about finding meaning in the good and bad events of life | 0.88 | 0.23 | |||
7. Spiritual well-being is important for one’s emotional well-being | 0.91 | 1.08 | |||
8. Spirituality drives individuals to search for answers about meaning and purpose in life | 0.88 | 0.19 | |||
9. Without spirituality, a person is not considered whole | 0.62 | 0.62 | |||
3.Defining spiritual care | 10. Spiritual needs are met by connecting oneself with other people, a higher power (including religious faith, inner moral strength, or harmony with nature), or nature | 0.74 | 0.17 | 0.89 | 0.64 |
11. Spiritual care is an integral component of holistic nursing care | 0.90 | 0.19 | |||
12. Spiritual care is more than religious care | 0.88 | 0.78 | |||
13. Nursing care, when performed well, is itself, spiritual care | 0.67 | 0.34 | |||
14. Spiritual care is a process and not a one-time event or activity | 0.79 | 0.32 | |||
4.Spiritual care practices | 15. Spiritual care is respecting a patient’s religious or personal beliefs | 0.79 | 0.19 | 0.95 | 0.78 |
16. Sensitivity and intuition help the nurse to provide spiritual care | 0.88 | 0.16 | |||
17. Being with a patient is a form of spiritual care, their fears, anxieties, and troubles | 0.90 | 0.14 | |||
18. Nurses provide spiritual care by respecting the religious and cultural beliefs of patients | 0.91 | 0.17 | |||
19. Nurses provide spiritual care by giving patients time to discuss and explore | 0.88 | 0.14 | |||
23. Nurses provide spiritual care by respecting the dignity of patients | 0.93 | 0.26 | |||
5. Spiritual care attitudes | 20. Spiritual care enables the patients to find meaning and purpose in their illness | 0.91 | 0.19 | 0.93 | 0.81 |
21. Spiritual care includes support to help patients observe their religious beliefs | 0.93 | 0.12 | |||
22. I am comfortable providing spiritual care to patients | 0.87 | 0.23 |
Fig. 1
Confirmatory factor analysis (CFA) model of the SCGS-T. The model consists of five latent factors: General Properties of Spiritual Care, Spirituality Perspectives, Defining Spiritual Care, Spiritual Care Practices, and Spiritual Care Attitudes, each measured by corresponding observed variables (Q1–Q35). Correlations among latent factors are indicated by double-headed arrows. Model fit indices: χ²/df = 2.83, CFI = 0.84, RMSEA = 0.09
Discussion
This study analyzed the psychometric properties of the SCGS-T. The Taiwanese version consists of 35 items with five factors. In terms of the psychometric value of the SCGS-T, the reliability was acceptable, with an internal consistency (Cronbach’s) value of 0.98 The value was close to that reported in previous studies (0.83 − 0.96) [8‐10] (see also Hu, Tiew and Li 2019). In the present study, the test–retest reliability coefficient of 0.85 was good, with results similar to those of previous studies (0.73–0.97) [8‐10] (see also Hu, Tiew and Li 2019).
This study examined the construct validity (using CFA), convergent validity, and discriminant validity of the tool. For model fit in CFA, certain criteria of model fit are required. Based on the CFA. Based on the CFA, the model demonstrated acceptable but suboptimal fit (RMSEA = 0.09, CFI = 0.83). The relatively low CFI may be partly attributed to the sample characteristics, as this study used convenience sampling and the majority of participants were female nursing students, which may have restricted variance in item responses. Despite these considerations, all factor loadings were satisfactory, supporting the construct validity of the SCGS-T. Our factor loadings for the five-factor scale ranged from 0.62 to 0.93. This was higher compared to the factor models of the Chinese version (0.49 and 0.81) (Hu, Tiew and Li, 2019) and the Turkish version [8]. Therefore, we retained the 35 items similar to the original tool, consistent with previous studies [7, 9, 10] (see also Hu, Tiew and Li 2019).
The convergent validity of the SCGS-T was assessed using the AVE and CR. The thresholds for AVE and CR in this study were between 0.64 and 0.81, and 0.89 to 0.97, respectively. The AVE and CR values for each latent factor were ≥ 0.50 and ≥ 0.70, indicating that the SCGS-T demonstrates good convergent validity [16]. Concurrent validity was further tested, showing that the SCGS-T significantly correlates with the SWBS and SHS-SF. The methods used in this study showed that the Taiwanese version had acceptable construct validity, concurrent validity, internal consistency, and reliability.
In addition, during the cultural adaptation process, some SCGS items were contextually reinterpreted to better reflect Taiwanese sociocultural norms and professional values. For instance, item 24, “Spiritual care should take into account what patients think about spirituality,” was clarified to explicitly encompass aspects such as personal values, family harmony, and inner peace, thereby reflecting a holistic, relational worldview. This adaptation aligns with Taiwanese cultural emphasis on collectivism, filial piety, and interpersonal harmony, ensuring that the scale captures spiritual care practices relevant to both patients and healthcare professionals in Taiwan [19].Item 34, originally stated as “A trusting nurse–patient relationship is needed to provide spiritual care,” was adjusted to “A trusting and respectful nurse–patient relationship is needed to provide spiritual care” to reflect culturally appropriate expressions of trust in Taiwan, where structured yet empathic nurse–patient communication conveys trust through professional and respectful interactions [20]. These adaptations underscore East Asian healthcare tendencies, in which interactions emphasize role expectations and ritualized politeness rather than the individualized, trust-centered models common in Western contexts [21].
Moreover, item 3 “Spirituality is a part of a unifying force which enables individuals to be at peace” was interpreted through the lens of harmony and balance—concepts deeply embedded in Confucian and Taoist traditions that shape Taiwanese notions of health and meaning [22]. Item 10, originally stated as “Spiritual needs are met by connecting oneself with other people, a higher power, or nature,” was adjusted to “Spiritual needs are met by connecting oneself with other people, a higher power (including religious faith, inner moral strength, or harmony with nature), or nature” to allow culturally appropriate, flexible interpretations of “higher power” in Taiwan [23]. Taiwanese nursing education and clinical practice emphasize multicultural sensitivity and promote understanding, non-judgment, and respect for diverse spiritual beliefs and expressions. In this context, spiritual care is conceptualized not as imposing one’s worldview, but as accompanying patients with openness and cultural humility [24] Similar adaptation efforts have been made in other Chinese-speaking contexts. For instance, although a Chinese version of the Spiritual Care-Giving Scale (C-SCGS) has been developed, several items related to religion were removed because most nurses in mainland China do not report any religious affiliation, resulting in a 34-item scale with four factors [9].
By contrast, the SCGS-T retains the religious and existential dimensions that are meaningful within Taiwanese culture. These culturally responsive adaptations ensure that the SCGS-T accurately reflects the lived experiences and professional expressions of spirituality in Taiwanese nursing, thereby supporting culturally grounded education and research in spiritual care.
Future recommendations for the application of spiritual care education for nursing students
Before implementing a spiritual care curriculum, it is recommended that nursing students’ spiritual competencies be assessed across various dimensions using the SCGS-T. This initial evaluation could support tailored course planning that addresses specific areas of need. Upon completion of the course, re-administering the SCGS-T would enable educators to measure students’ progress in each dimension. Such course designs could contribute to comprehensively enhancing students’ knowledge, skills, and attitudes in the field of spiritual care, thereby promoting their ability to apply these competencies in clinical practice (See Additional File 1).
Limitations
The present study has several limitations. First, the CFI was relatively low (0.84), indicating only a marginally satisfactory model fit. Moreover, examination of Fig. 1 revealed that correlations among the five SCGS-T facets exceeded 0.9, suggesting conceptual overlap and potential collinearity, possibly due to similarities in sample characteristics or the abstract, multidimensional nature of spiritual constructs. Such high correlations between latent factors can complicate the assessment of discriminant validity and may influence model fit indices in CFA [25, 26]. Second, the relatively small sample size, combined with convenience sampling and the limited number of male participants (n = 36, 11.7%), may have restricted sample diversity. The gender imbalance suggests that male perspectives could be underrepresented, particularly regarding gendered experiences or coping mechanisms. Future research should increase the sample size and employ stratified, purposive, or random sampling to achieve a more balanced gender distribution, thereby enhancing representativeness, generalizability, and external validity. In addition, researchers are encouraged to apply exploratory structural equation modeling (ESEM), which integrates features of CFA, EFA, and SEM within a single analytical framework, to overcome some of the limitations inherent in traditional CFA [27].
The use of convenience sampling may introduce selection bias and limit the generalizability of the findings, as participants who voluntarily join the study may differ systematically from those who do not. Potential biases can be mitigated in future research by adopting stratified, purposive, or random sampling strategies, thereby enhancing the representativeness and validity of the results [28].
Conclusions
This study demonstrates that the SCGS-T has acceptable reliability and validity, with an adequate model fit. It provides valuable insights into the use of the SCGS-T in nursing education, particularly within the Taiwanese cultural context, where spiritual care is often expressed through respect, professional interactions, and harmony with patients’ values and beliefs. The scale can be applied to assess nursing students’ knowledge, attitudes, and competencies related to spiritual care, thereby supporting curriculum development and learning evaluation in this domain. Future research is recommended to expand the application of the SCGS-T to clinical nurses, as well as to explore culturally specific expressions of spiritual care, in order to further enhance its utility in professional nursing practice.
Acknowledgements
Not applicable.
Declarations
Ethics approval and consent to participate
This study included experimental procedures that were reviewed by the ethics committee of the Chang Gung Medical Foundation Institutional Review Board (IRB no. 202400049B0). Informed consent was obtained from all the participants. All the methods and procedures carried out in this study were in accordance with the relevant guidelines and the Declaration of Helsinki.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
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