Supportive Care in Cancer

, Volume 27, Issue 3, pp 901–909 | Cite as

Factors affecting spiritual care practices of oncology nurses: a qualitative study

  • Soolmaz Moosavi
  • Camelia RohaniEmail author
  • Fariba Borhani
  • Mohammad Esmaeel Akbari
Original Article



Spiritual care is a component of the holistic nursing approach. But in practice, nurses face many challenges during the implementation of spirituality care. Thus, the aim of this study was to explore the barriers and facilitators affecting spiritual care practices by oncology nurses.


This qualitative study was conducted using a conventional content analysis based on semi-structured interviews with 25 participants, including cancer patients and their family members, oncology nurses, physicians, psychologist, and spiritual researcher-therapists.


The results showed that the two main themes of the study, “spiritual competency” and “spiritual inefficiency” in healthcare organization, were two major factors in implementing spiritual care practices for cancer patients by oncology nurses.


The findings of this study emphasize the necessity of developing coherent spiritual care programs in hospitals and removing administrative barriers. Teaching spiritual care in nursing courses at schools and continuing education programs for training of healthcare team members are necessary. Likewise, forming a spiritual care team with oncology nurses at the center and defining their members’ roles and responsibilities are essential. Hospital managers can also make fruitful steps by establishing a monitoring system and identifying the needs and barriers for spiritual care in oncology settings.


Spiritual care Obstacles Facilitators Cancer patient Oncology nurse Spiritual care team 



The present study is a part of the findings of the doctoral Thesis. Authors thank and appreciate all cancer patients, their family members, and healthcare team members as well as spiritual researcher-therapists participating in this study.

Authors’ contribution

SM and CR did the planning and design of the study. This study was supervised by CR. SM was the leading author for drafting of the article and responsible for identifying relevant references. FB and MEA contributed significant text. All authors, SM, CR, FB, and MEA, were in close collaboration and responsible for critical revisions of the manuscript. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 1(136):359–386. CrossRefGoogle Scholar
  2. 2.
    Fadavi P, Motlagh A ( 2016) Strategies to improve cancer care, outcomes in Iran ASCO annual meeting. American Society of Clinical Oncology (ASCO), Illinois, Daily News
  3. 3.
    Page AE, Adler NE (2008) Cancer care for the whole patient: meeting psychosocial health needs. National Academies Press. doi:
  4. 4.
    Murray SA, Kendall M, Boyd K, Worth A, Benton TF (2004) Exploring the spiritual needs of people dying of lung cancer or heart failure: a prospective qualitative interview study of patients and their carers. Palliat Med 18(1):39–45. CrossRefGoogle Scholar
  5. 5.
    Puchalski CM (2008) Spirituality and the care of patients at the end-of-life: an essential component of care. OMEGA 56(1):33–46CrossRefGoogle Scholar
  6. 6.
    Puchalski CM (2001) The role of spirituality in health care. Baylor University Medical Center Proceedings. Taylor & FrancisGoogle Scholar
  7. 7.
    Ahmadi Faraz M, Sherbafchi MR, Mousavizadeh R, Raeesi N, Ghaderi S, Shirvani A (2016) Introduction to principles of spiritual care. Isfahan Medical Sciences University, IsfahanGoogle Scholar
  8. 8.
    Visser A, Garssen B, Vingerhoets A (2010) Sprituality and well-being in cancer patients: a review. Psychooncology 19(6):565–572CrossRefGoogle Scholar
  9. 9.
    Ramezani M, Ahmadi F, Mohammadi E, Kazemnejad A (2014) Spiritual care in nursing: a concept analysis. Int Nurs Rev 61(2):211–219. CrossRefGoogle Scholar
  10. 10.
    Fawcett J, Desanto-Madeya S (2012) Contemporary nursing knowledge: analysis and evaluation of nursing models and theories. F.A. Davis company, PhiladelphiaGoogle Scholar
  11. 11.
    O’brien ME (2013) Spirituality in nursing: standing on holy ground. Jones and Bartlett, BurlingtonGoogle Scholar
  12. 12.
    Tanyi RA (2002) Towards clarification of the meaning of spirituality. J Adv Nurs 39(5):500–509CrossRefGoogle Scholar
  13. 13.
    True G, Phipps EJ, Braitman LE, Harralson T, Harris D, Tester W (2005) Treatment preferences and advance care planning at end of life: the role of ethnicity and spiritual coping in cancer patients. Ann Behav Med 30(2):174–179. CrossRefGoogle Scholar
  14. 14.
    Balboni TA, Vanderwerker LC, Block SD, Paulk ME, Lathan CS, Peteet JR, Prigerson HG (2007) Religiousness and spiritual support among advanced cancer patients and associations with end-of-life treatment preferences and quality of life. J Clin Oncol 25(2):555–560. CrossRefGoogle Scholar
  15. 15.
    Rahnama M, Fallahi Khoshknab M, Madah SSB, Ahmadi F (2015) Explaining the process of spiritual care in rehabilitation of cancer patients: a grounded theory study. Medical-Surgical Nursing Journal (MSNJ) 4(3):1–12Google Scholar
  16. 16.
    Tofighian T, Kooshki A, Borhani F, Rakhshani MH, Mohsenpour M (2017) Nursing students and nurses attitude toward spirituality and spiritual care. Med History J 8(29):45–62 Google Scholar
  17. 17.
    Rahimi N, Nouhi E, Nakhaee N (2013) Spiritual well-being and attitude toward spirituality and spiritual care in nursing and midwifery students. Iran J Nurs 26(85):55–65 URL: Google Scholar
  18. 18.
    Zamanzadeh V, Rassouli M, Abbaszadeh A, Alavi-Majd HNA, Mirza-Ahmadi (2014) Spirituality in cancer care: a qualitative study. J Qual Res Health Sci 2(4):366–378 URL: Google Scholar
  19. 19.
    Van Leeuwen R, Tiesinga LJ, Post D, Jochemsen H (2006) Spiritual care: implications for nurses’ professional responsibility. J Clin Nurs 15(7):75–84. Google Scholar
  20. 20.
    Ross L (2006) Spiritual care in nursing: an overview of the research to date. J Clin Nurs 15(7):852–862. CrossRefGoogle Scholar
  21. 21.
    Pearce MJ, Coan AD, Herndon JE, Koenig HG, Abernethy AP (2012) Unmet spiritual care needs impact emotional and spiritual well-being in advanced cancer patients. Support Care Cancer 20(10):2269–2276. CrossRefGoogle Scholar
  22. 22.
    Balboni TA, Paulk ME, Balboni MJ, Phelps AC, Loggers ET, Wright AA, Block SD, Lewis EF, Peteet JR, Prigerson HG (2009) Provision of spiritual care to patients with advanced cancer: associations with medical care and quality of life near death. J Clin Oncol 28(3):445–452. CrossRefGoogle Scholar
  23. 23.
    Edwards A, Pang N, Shiu V, Chan C (2010) The understanding of spirituality and the potential role of spiritual care in end-of-life and palliative care: a meta-study of qualitative research. Palliat Med 24(8):753–770. CrossRefGoogle Scholar
  24. 24.
    Narayanasamy A, Owens J (2001) A critical incident study of nurses’ responses to the spiritual needs of their patients. J Adv Nurs 33(4):446–455CrossRefGoogle Scholar
  25. 25.
    Keall R, Clayton JM, Butow P (2014) How do Australian palliative care nurses address existential and spiritual concerns? Facilitators, barriers and strategies. J Clin Nurs 23(21–22):3197–3205CrossRefGoogle Scholar
  26. 26.
    Chan MF (2010) Factors affecting nursing staff in practising spiritual care. J Clin Nurs 19(15–16):2128–2136. Google Scholar
  27. 27.
    Wu LF, Lin LY (2011) Exploration of clinical nurses’ perceptions of spirituality and spiritual care. J Nurs Res 19(4):250–256. CrossRefGoogle Scholar
  28. 28.
    Graneheim UH, Lundman B (2004) Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 24:105–112. CrossRefGoogle Scholar
  29. 29.
    Guba EG (1981) Criteria for assessing the trustworthiness of naturalistic inquiries. Educ Technol Res Dev 29(2):75–91. Google Scholar
  30. 30.
    Puchalski C, Ferrell B, Virani R, Otis-Green S, Baird P, Bull J, Chochinov H, Handzo G, Nelson-Becker H, Prince-Paul M, Pugliese K, Sulmasy D (2009) Improving the quality of spiritual care as a dimension of palliative care: the report of the consensus conference. J Palliat Med 12(10):885–904CrossRefGoogle Scholar
  31. 31.
    Rassouli M, Zamanzadeh V, Ghahramanian A, Abbaszadeh A, Alavi-Majd H, Nikanfar A (2015) Experiences of patients with cancer and their nurses on the conditions of spiritual care and spiritual interventions in oncology units. Iran J Nurs Midwifery Res 20(1):25–33Google Scholar
  32. 32.
    Koenig HG (2014) The spiritual care team: enabling the practice of whole person medicine. Religions 5(4):1161–1174CrossRefGoogle Scholar
  33. 33.
    Ozbasaran F, Ergul S, Temel AB, Gurol Aslan G, Coban A (2011) Turkish nurses’ perceptions of spirituality and spiritual care. J Clin Nurs Midwifery 20(21–22):3102–3110. CrossRefGoogle Scholar
  34. 34.
    VandeCreek L (1997) Collaboration between nurses and chaplains for spiritual caregiving. Semin Oncol Nurs 13(4):279–280CrossRefGoogle Scholar
  35. 35.
    Chan MF, Chung L, Lee AS, Wong WK, Lee G, Lau CY et al (2006) Investigating spiritual care perceptions and practice patterns in Hong Kong nurses: results of a cluster analysis. Nurse Educ Today 26(2):139–150. CrossRefGoogle Scholar
  36. 36.
    Yong J, Kim J, Park J, Seo I, Swinton J (2011) Effects of a spirituality training program on the spiritual and psychosocial well-being of hospital middle manager nurses in Korea. J Contin Educ Nurs 42(6):280–288CrossRefGoogle Scholar
  37. 37.
    Abbasi M, Shamsigooshki E, Abolghasemi MJ (2013) Introduction to spiritual health. Nashrhoghooghi, TehranGoogle Scholar
  38. 38.
    Ahmadi Faraz M (2016) Mediation through praying. Isfahan Medical Sciences University, IsfahanGoogle Scholar
  39. 39.
    Abbasi M (2013) Islamic approach to spiritual health. Nashrehoghoghi, TehranGoogle Scholar
  40. 40.
    Tsai MT, Huang CC (2008) The relationship among ethical climate types, facets of job satisfaction, and the three components of organizational commitment: a study of nurses in Taiwan. J Bus Ethics 80(3):565–581CrossRefGoogle Scholar
  41. 41.
    Koren ME, Papamiditriou C (2013) Spirituality of staff nurses: application of modeling and role modeling theory. Holist Nurs Pract 27(1):37–44CrossRefGoogle Scholar
  42. 42.
    Grant D, O’Neil K, Stephens L (2004) Spirituality in the workplace: new empirical directions in the study of the sacred. Sociol Relig 65(3):265–283CrossRefGoogle Scholar
  43. 43.
    Dehghani K, Nasiriani K, Salimi T (2016) Requirements for nurse supervisor training: a qualitative content analysis. Iran J Nurs Midwifery Res 21(1):63–70CrossRefGoogle Scholar
  44. 44.
    Pesut B (2002) The development of nursing students’ spirituality and spiritual care-giving. Nurse Educ Today 22(2):128–135. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Soolmaz Moosavi
    • 1
  • Camelia Rohani
    • 2
    Email author
  • Fariba Borhani
    • 3
  • Mohammad Esmaeel Akbari
    • 4
  1. 1.School of Nursing & MidwiferyShahid Beheshti University of Medical SciencesTehranIran
  2. 2.Community Health Nursing Department, School of Nursing and MidwiferyShahid Beheshti University of Medical SciencesTehranIran
  3. 3.Medical Surgical Department, School of Nursing and MidwiferyShahid Beheshti University of Medical SciencesTehranIran
  4. 4.Cancer Research CenterShahid Beheshti University of Medical SciencesTehranIran

Personalised recommendations