Iranian Journal of Medical Education

Introduction: Clinical competence is a fundamental requirement for nursing interns, encompassing the integration of technical skills, ethical reasoning, and spiritual care competencies. Despite growing emphasis on holistic nursing, spiritual dimensions of care remain insufficiently addressed in clinical nursing curricula. Limited attention to these dimensions may hinder the development of clinical performance self-efficacy, which is essential for autonomous and confident practice. Therefore, this study aimed to investigate the effect of a structured spiritual skills training program on nursing interns’ clinical performance self-efficacy.
Methods: In this quasi-experimental study with a pretest posttest control group design, 70 nursing interns in semesters 5 and 6 were randomly assigned to experimental and control groups using a lottery method. The inclusion criterion was willingness to participate in the study. Exclusion criteria included previous training in spiritual therapy, concurrent study in psychology or seminary sciences, and prior clinical work experience. Participants who failed to complete the questionnaires or were absent from more than one intervention session were considered to have met the withdrawal criteria. The experimental group received spiritual skills training through blended sessions delivered in three subgroups. Sessions 1, 5, and 8 were conducted in person, whereas the remaining sessions were delivered through the faculty’s virtual learning platform. The sessions incorporated interactive lectures, question and answer activities, group discussions, and assignments. The control group did not receive the intervention and continued their routine training, which focused primarily on clinical procedures and medical order management. To maintain research ethics, the educational content was provided to the control group after completion of the study. To minimize information diffusion, participants in the intervention group were informed about the ethical importance of maintaining confidentiality and were asked not to share the educational materials with peers. Data were collected using a demographic information form and the 24. Cheraghi Nursing Students’ Clinical Performance Self Efficacy Questionnaire. The questionnaire consists of 37 items across four subscales: patient assessment, nursing diagnosis and planning, implementation of care plans, and evaluation of care plans. Items are rated on a five-point Likert scale, yielding total scores ranging from 37 to 185, with scores above 100 indicating high self-efficacy. The questionnaire was administered at pretest and again one month after the intervention. Data were analyzed using descriptive statistics, including frequency, percentage, mean, and standard deviation, and inferential statistics, including the chi-square test, independent samples t-test, and paired samples t-test.
Results: The two groups were homogeneous in terms of demographic characteristics at baseline (p > .05). At pretest, the mean clinical performance self-efficacy scores did not differ significantly between the experimental and control groups (131.51 ± 14.69 vs. 129.44 ± 14.96, respectively; p = .57), and no significant between group differences were observed across the self-efficacy domains. At posttest, the experimental group demonstrated a significant increase in clinical performance self-efficacy compared with its pretest scores. The posttest mean score was 146.61 ± 17.87 in the experimental group, compared with 125.96 ± 23.66 in the control group, with a significant between group difference (t = 5.80, p < .001). In contrast, the control group showed no significant change in clinical performance self-efficacy from pretest to posttest (p = .45).
Conclusion: The findings suggest that structured spiritual skills training can enhance clinical performance self-efficacy among nursing interns. The observed improvement indicates that incorporating structured spiritual care training into clinical education may help nursing interns approach holistic patient care with greater confidence. Integrating spiritual care modules into clinical internships could provide opportunities to connect conceptual knowledge of spirituality with practical clinical decision making. Future research could examine whether these gains in self-efficacy are sustained over time and whether spiritual skills training translates into improvements in observed clinical performance and patient outcomes. Further studies may also investigate the feasibility of incorporating spiritual assessment into broader frameworks for evaluating professional nursing competence alongside established clinical skill measures.