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Needs for nurses to provide spiritual care and their associated influencing factors among elderly inpatients with stroke in China: A cross-sectional quantitative study

Published online by Cambridge University Press:  26 April 2022

Zhangyi Wang
Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
Haomei Zhao
Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, HeBei, China
Yue Zhu
Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
Siai Zhang
Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
Luwei Xiao
School of Nursing, University of South China, Hengyang, Hunan, China
Haiqin Bao
Transplant Intensive Care Unit, Tianjin First Central Hospital, Tianjin, China
Zhao Wang
Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
Yue Wang
Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
Xuechun Li
Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
Yajun Zhang*
Operating Room, The Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
Xiaoli Pang*
School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
Author for correspondence: Xiaoli Pang, School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China. E-mail:; Yajun Zhang, Operating Room, The Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China, E-mail:
Author for correspondence: Xiaoli Pang, School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China. E-mail:; Yajun Zhang, Operating Room, The Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China, E-mail:



To investigate the spiritual care needs and associated influencing factors among elderly inpatients with stroke, and to examine the correlations among spiritual care needs, spiritual well-being, self-perceived burden, self-transcendence, and social support.


A cross-sectional quantitative design was implemented, and the STROBE Checklist was used as the foundation of the study. A convenience sample of 458 elderly inpatients with stroke was selected from three hospitals in China. The sociodemographic characteristics questionnaire, the Nurse Spiritual Therapeutics Scale, the Functional Assessment of Chronic Illness Therapy—Spiritual Well-being, the Self-Perceived Burden Scale, the Chinese Self-Transcendence Scale, and the Perceived Social Support Scale were used. Descriptive statistics, correlation, Student's t-test, ANOVA, non-parametric, and multiple linear regression analyses were used to analyze the data.


The total score of spiritual care needs was 29.82 ± 7.65. Spiritual care needs were positively correlated with spiritual well-being (r = 0.709, p < 0.01), self-transcendence (r = 0.710, p < 0.01), and social support (r = 0.691, p < 0.01), whereas being negatively correlated with self-perceived burden (r = −0.587, p < 0.01). Religious beliefs, educational level, residence place, disease course, spiritual well-being, self-perceived burden, self-transcendence, and social support were found to be the main influencing factors.

Significance of results

The spiritual care needs were prevalent and moderate. It is suggested that nurses should enhance spiritual care knowledge and competence, take targeted spiritual care measures according to inpatients’ individual personality traits or characteristics and differences of patients, reduce their self-perceived burden and improve their spiritual well-being, self-transcendence and social support in multiple ways and levels, so as to meet their spiritual care needs to the greatest extent and enhance their spiritual comfort.

Original Article
Copyright © The Author(s), 2022. Published by Cambridge University Press

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Ayik, C, Ozden, D and Kahraman, A (2021) Spiritual care needs and associated factors among patients with ostomy: A cross-sectional study. Journal of Clinical Nursing 30(11–12), 16651674. doi:10.1111/jocn.15721CrossRefGoogle ScholarPubMed
Bajjani-Gebara, J, Hinds, P, Insel, K, et al. (2019) Well-being, self-transcendence, and resilience of parental caregivers of children in active cancer treatment: Where do we go from here? Cancer Nursing 42(5), E41E52. doi:10.1097/NCC.0000000000000662CrossRefGoogle Scholar
Bandeali, S, des Ordons, AR and Sinnarajah, A (2020) Comparing the physical, psychological, social, and spiritual needs of patients with non-cancer and cancer diagnoses in a tertiary palliative care setting. Palliative and Supportive Care 18(5), 513518. doi:10.1017/S1478951519001020.CrossRefGoogle Scholar
Bar-Sela, G, Schultz, MJ, Elshamy, K, et al. (2019) Training for awareness of one's own spirituality: A key factor in overcoming barriers to the provision of spiritual care to advanced cancer patients by doctors and nurses. Palliative and Supportive Care 17(3), 345352. doi:10.1017/S147895151800055X.CrossRefGoogle Scholar
Brady, MJ, Peterman, AH, Fitchett, G, et al. (1999) A case for including spirituality in quality of life measurement in oncology. Psycho-Oncology 8(5), 417428. doi:10.1002/(SICI)1099-1611(199909/10)8:53.0.CO;2-43.0.CO;2-4>CrossRefGoogle ScholarPubMed
Bussing, A, Balzat, HJ and Heusser, P (2010) Spiritual needs of patients with chronic pain diseases and cancer - Validation of the spiritual needs questionnaire. European Journal of Medical research 15(6), 266273. doi:10.1186/2047-783x-15-6-266CrossRefGoogle ScholarPubMed
Bussing, A, Pilchowska, I and Surzykiewicz, J (2015) Spiritual needs of Polish patients with chronic diseases. Journal of Religion and Health 54(5), 15241542. doi:10.1007/s10943-014-9863-xCrossRefGoogle ScholarPubMed
Cai, LL and Wang, HY (2018) Status quo and influencing factors of spiritual care needs of patients with gastric cancer. Chinese Nursing Research 32(21), 34633466. doi:10.12102/j.issn.1009-6493.2018.21.042Google Scholar
Chan, HY, Yu, DS, Leung, DY, et al. (2016) Quality of life and palliative care needs of elderly patients with advanced heart failure. Journal of Geriatric Cardiology 13(5), 420424. doi:10.11909/j.issn.1671-5411.2016.05.016Google ScholarPubMed
Chang, YK, Kaplan, H, Geng, Y, et al. (2020) Referral criteria to palliative care for patients with heart failure: A systematic review. Circulation. Heart failure 13(9), e6881. doi:10.1161/CIRCHEARTFAILURE.120.006881CrossRefGoogle ScholarPubMed
Cousineau, N, McDowell, I, Hotz, S, et al. (2003) Measuring chronic patients’ feelings of being a burden to their caregivers: Development and preliminary validation of a scale. Medical Care 41(1), 110118. doi:10.1097/00005650-200301000-00013CrossRefGoogle ScholarPubMed
Cowey, E (2012) End of life care for patients following acute stroke. Nursing Standard 26(27), 4246. doi:10.7748/ns2012. ScholarPubMed
Dhar, N, Chaturvedi, S and Nandan, D (2011) Spiritual health scale 2011: Defining and measuring 4 dimension of health. Indian Journal of Community Medicine 36(4), 275282. doi:10.4103/0970-0218.91329CrossRefGoogle ScholarPubMed
Erichsen, NB and Bussing, A (2013) Spiritual needs of elderly living in residential/nursing homes. Evidence-Based Complementary and Alternative Medicine 2013, 913247. doi:10.1155/2013/913247CrossRefGoogle ScholarPubMed
Eriksson, G, Bergstedt, TW and Melin-Johansson, C (2015) The need for palliative care education, support, and reflection among rural nurses and other staff: A quantitative study. Palliative and Supportive Care 13(2), 265274. doi:10.1017/S1478951513001272.CrossRefGoogle ScholarPubMed
Huang, JY and Yang, XM (2010) Spiritual needs of the Chinese in stroke survivors in holistic care. Chinese Nursing Management 10(10), 2730. doi:10.3969/j.issn.1672-1756.2010.10.010Google Scholar
Jia, HX (2007) Evaluation and application of spirituality nursing in stroke patients. Chinese Journal of Modern Nurses 4(13), 11701171.Google Scholar
Johnson, R, Hauser, J and Emanuel, L (2021) Toward a clinical model for patient spiritual journeys in supportive and palliative care: Testing a concept of human spirituality and associated recursive states. Palliative and Supportive Care 19(1), 2833. doi: 10.1017/S1478951520000607.CrossRefGoogle Scholar
Kamijo, Y and Miyamura, T (2020) Spirituality and associated factors among cancer patients undergoing chemotherapy. Japan Journal of Nursing Science 17(1), e12276. doi:10.1111/jjns.12276CrossRefGoogle ScholarPubMed
Kendall, M (1975) Multivariate Analysis. London: Charles Griffin & Company Limited.Google Scholar
Kim, AS, Cahill, E and Cheng, NT (2015) Global stroke belt: Geographic variation in stroke burden worldwide. Stroke 46(12), 35643570. doi:10.1161/STROKEAHA.115.008226CrossRefGoogle ScholarPubMed
Labovitz, DL (2020) Stroke epidemiology and intersectionality: Understanding stroke outcomes in Mexican Americans in Corpus Christi. Stroke 51(10), 28862887. doi:10.1161/STROKEAHA.120.031848CrossRefGoogle ScholarPubMed
Lazenby, JM (2010) On “spirituality,” “religion,” and “religions”: A concept analysis. Palliative and Supportive Care 8(4), 469476. doi:10.1017/S1478951510000374.CrossRefGoogle Scholar
Li, MQ, Wang, Y, Xie, HY, et al. (2017) Research on the status and influencing factors of spiritual nursing needs of cancer patients. Chinese Journal of Nursing 52(8), 930934. doi:10.3761/j.issn.0254-1769.2017.08.007Google Scholar
Liang, MM and Zhang, MQ (2020) Relationship between self-perceived burden and quality of life of stroke patients. Cardiovascular Disease Journal of Integrated Traditional Chinese and Western Medicine (Electronic) 8(24), 7374.Google Scholar
Liang, S, Cheng, QQ, Chen, YY, et al. (2016) Research progress in spiritual care education. Journal of Nursing Science 31(3), 9497. doi:10.3870/j.issn.1001-4152.2016.03.094Google Scholar
Liu, XY, Wei, D, Chen, YY, et al. (2016) Reliability and validity of the Chinese version of the functional assessment of chronic illness therapy-spiritual well-being in cancer patients. Chinese Journal of Nursing 51(9), 10851090. doi:10.3761/j.issn.0254-1769.2016.09.014Google Scholar
Liu, Y, Zeng, YL, Chen, F, et al. (2019) The status quo and influencing factors of spiritual care needs of breast cancer patients. Nursing of Integrated Traditional Chinese and Western Medicine 5(2), 4143. doi:10.11997/nitcwm.201902010Google Scholar
Logroscino, G and Beghi, E (2021) Stroke epidemiology and COVID-19 pandemic. Current Opinion in Neurology 34(1), 310. doi:10.1097/WCO.0000000000000879CrossRefGoogle ScholarPubMed
Mohamed, CR, Nelson, K, Wood, P, et al. (2015) Issues post-stroke for Muslim people in maintaining the practice of salat (prayer): A qualitative study. Collegian 22(3), 243249. doi:10.1016/j.colegn.2014.01.001CrossRefGoogle ScholarPubMed
Moorley, CR, Cahill, S and Corcoran, NT (2016) Life after stroke: Coping mechanisms among African Caribbean women. Health & Social Care in the Community 24(6), 769778. doi:10.1111/hsc.12256CrossRefGoogle ScholarPubMed
O'Brien, MR, Kinloch, K, Groves, KE, et al. (2019) Meeting patients’ spiritual needs during end-of-life care: A qualitative study of nurses’ and healthcare professionals’ perceptions of spiritual care training. Journal of Clinical Nursing 28(1-2), 182189. doi:10.1111/jocn.14648CrossRefGoogle ScholarPubMed
Reed, PG (1991) Toward a nursing theory of self-transcendence: Deductive reformulation using developmental theories. ANS. Advances in Nursing Science 13(4), 6477. doi:10.1097/00012272-199106000-00008CrossRefGoogle Scholar
Ren, H, Liu, C, Li, J, et al. (2016) Self-perceived burden in the young and middle-aged inpatients with stroke: A cross-sectional survey. Rehabilitation Nursing 41(2), 101111. doi:10.1002/rnj.193CrossRefGoogle Scholar
Ripamonti, CI, Giuntoli, F, Gonella, S, et al. (2018) Spiritual care in cancer patients: A need or an option? Current Opinion in Oncology 30(4), 212218. doi:10.1097/CCO.0000000000000454CrossRefGoogle ScholarPubMed
Sastra, L, Bussing, A, Chen, CH, et al. (2021) Spiritual needs and influencing factors of Indonesian Muslims with cancer during hospitalization. Journal of Transcultural Nursing 32(3), 212220. doi:10.1177/1043659620908926CrossRefGoogle ScholarPubMed
Schafer, W, Princk, C, Kollhorst, B, et al. (2019) Antidepressants and the risk of hemorrhagic stroke in the elderly: A nested case-control study. Drug Safety 42(9), 10811089. doi:10.1007/s40264-019-00837-yCrossRefGoogle ScholarPubMed
Sharrief, AZ, Sanchez, BN, Lisabeth, LD, et al. (2017) The impact of pre-stroke depressive symptoms, fatalism, and social support on disability after stroke. Journal of Stroke and Cerebrovascular Diseases 26(11), 26862691. doi:10.1016/j.jstrokecerebrovasdis.2017.06.039CrossRefGoogle ScholarPubMed
Shen, YF and Dong, LH (2018) Analysis of present situation and influencing factors of spirituality care in aged patients with end stage lung carcinoma. Modern Medicine journal 46(4), 446451. doi:10.3969/j.issn.1671-7562.2018.04.023Google Scholar
Shi, HW, Liu, HX, Jiao, YC, et al. (2012) Research progress on influence of religious psychological coping on body and mind of cancer patients and its related factors. Chinese Nursing Research 26(17), 15421544. doi:10.3969/j.issn.1009-6493.2012.17.003Google Scholar
Taylor, EJ and Mamier, I (2005) Spiritual care nursing: What cancer patients and family caregivers want. Journal of Advanced Nursing 49(3), 260267. doi:10.1111/j.1365-2648.2004.03285.xCrossRefGoogle ScholarPubMed
The General Office of the National Health and Family Planning Commission of RBC (2017) The notice of the general office of the national health and family planning commission on printing and distributing the practice guide for hospice care (for trial implementation). Bulletin of the National Health and Family PlanningCommission of the RBC 7(2), 5373.Google Scholar
van Nieuw, AJ, Schaap-Jonker, H, Westerbroek, G, et al. (2020) Conversations and beyond: Religious/spiritual care needs among clinical mental health patients in the Netherlands. The Journal of Nervous and Mental Disease 208(7), 524532. doi:10.1097/NMD.0000000000001150CrossRefGoogle Scholar
van Nieuw, AJ, Schaap-Jonker, H, Anbeek, C, et al. (2021) Religious/spiritual care needs and treatment alliance among clinical mental health patients. Journal of Psychiatric and Mental Health Nursing 28(3), 370383. doi:10.1111/jpm.12685CrossRefGoogle Scholar
Wang, CF (2020) Structural Equation Modeling of the Current State of Spiritual Needs of Breast Cancer Patients and its Influencing Factors (Master). Jilin University.Google Scholar
Wang, XD, Wang, XL and Hong, M (1999) Handbook of Mental Health Rating Scale. Beijing: Chinese Mental Health Magazine.Google Scholar
Wu, YY and Jiang, YF (2010) Investigation and analysis of the self-perceived burden among cancer patients. Journal of Nursing Administration 10(6), 405407. doi:10.3969/j.issn.1671-315X.2010.06.011Google Scholar
Xie, HY, Li, MQ, Wang, Y, et al. (2017) Preliminary test of the reliability and validity of Chinese version of the Nurse Spiritual Therapeutics Scale. Chinese Nursing Management 17(5), 610614. doi:10.3969/j.issn.1672-1756.2017.05.010Google Scholar
Yang, NQ (2012) Experience of using the spiritual care model for a first-time stroke patient. Journal of Nursing 59(3), 113118.Google ScholarPubMed
Yu, L, Zhu, Y, Chen, W, et al. (2020) Incidence and risk factors associated with postoperative stroke in the elderly patients undergoing hip fracture surgery. Journal of Orthopaedic Surgery and Research 15(1), 429–404. doi:10.1186/s13018-020-01962-6CrossRefGoogle ScholarPubMed
Zeng, JS and Pu, CQ (2019) Evolution and renewal of diagnostic criteria for main types of cerebrovascular diseases in China. Chinese Journal of Neurology 52(9), 681683. doi:10.3760/cma.j.issn.1006?7876.2019.09.001Google Scholar
Zhang, SH (2018). Study on the physical-mental-social-spiritual status of cancer patients and their needs for nurses to provide spiritual care. Master, Nanchang University.Google Scholar
Zhang, J, Sun, JP, Zhang, L, et al. (2014) Reliability test of Chinese Self-Transcendence Scale in the elderly population. Chinese Journal of Gerontology 34(7), 19101911. doi:10.3969/j.issn.1005-9202.2014.07.083Google Scholar
Zimet, GD, Powell, SS, Farley, GK, et al. (1990) Psychometric characteristics of the multidimensional scale of perceived social support. Journal of Personality Assessment 55(3–4), 610617. doi:10.1080/00223891.1990.9674095CrossRefGoogle ScholarPubMed
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