JAN JOURNAL OF ADVANCED NURSING

ORIGINAL RESEARCH

Development and psychometric testing of the Spiritual Care Inventory

instrument
Lisa Burkhart, Lee Schmidt & Nancy Hogan

Accepted for publication 5 February 2011

Correspondence to L. Burkhart: B U R K H A R T L . , S C H M I D T L . & H O G A N N . ( 2 0 1 1 ) Development and psycho-

e-mail: eburkha@luc.edu
Lisa Burkhart PhD RN
Associate Professor
Marcella Niehoff School of Nursing, Loyola
University Chicago, Illinois, USA
Lee Schmidt PhD RN
Assistant Professor, Director of PhD Program
Marcella Niehoff School of Nursing, Loyola
University Chicago, Illinois, USA
Nancy Hogan PhD RN FAAN
Distinguished Professor, Associate Dean for
Research
Marcella Niehoff School of Nursing, Loyola
University Chicago, Illinois, USA
metric testing of the Spiritual Care Inventory instrument. Journal of Advanced
Nursing 67(11), 2463–2472. doi: 10.1111/j.1365-2648.2011.05654.x
Abstract
Aim. This article is a report of the development and psychometric testing of the
Spiritual Care Inventory.
Background. Research supporting the positive association between spirituality and
health has lead to interest in providing spiritual care in healthcare settings. Few
instruments exist that measure the provision of spiritual care.
Method. In February/March 2007, a convenience sample of 298 adult and paedi-
atric acute care, ambulatory, home health, hospice staff and rehab nurses at two
hospitals (n = 248) and graduate students at a school of nursing (n = 50) completed
a 48-item initial version of the Spiritual Care Inventory. In study 2 from July
through August 2007, 78 staff nurses at one hospital (n = 30) and a different cohort
of graduate students at a school of nursing (n = 48) completed the 18-item second
version of the Spiritual Care Inventory.
Results. Exploratory factor analysis in study 1 supported a 3-factor solution
(spiritual care interventions, meaning making and faith rituals) with internal con-
sistency measures for the subscales above 0Æ80. In study 2, internal consistency
remained high.
Conclusion. Factor structures identify that spiritual care is a process of interven-
tion, meaning making and faith rituals.

Keywords: instrument development, spiritual care, Spiritual Care Inventory,

spirituality

Spirituality is a complex phenomenon grounded in philos-

Introduction
Spiritual care has been and continues to be recognized as an
integral part of nursing care, recognized by professional
nursing organizations [United Kingdom Central Council for
Nursing, Midwifery, and Health Visiting (UKCC) 2000,
American Nurses Association (ANA) 2001, ANA 2003,
2004] and healthcare organizations (Clark et al. 2003, Joint
Commission on Accreditation of Healthcare Organizations
2003, Burkhart et al. 2008).
ophy and is defined and perceived differently depending on
an individual’s worldview and culture and can include
existential and religious perspectives (Pesut 2006, Pesut &
Thorne 2007, Paley 2008, Lim & Yi 2009, Yang & Wu
2009, Yousefi et al. 2009, Van Dierendonck et al. 2010). In
the two research studies presented in this article, spirituality
is defined as a dimension of human beings associated with the
human expression of meaning, purpose and transcendence in
life (Lane 1987, Reed 1987, Narayanasamy 1996, Burkhart

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L. Burkhart et al.
& Solari-Twadell 2001, Burkhardt & Nagai-Jacobson 2002,
Tanyi 2006). This differs from religiosity in that religiosity is
associated with the rites and rituals of a faith tradition
(Easterling et al. 2000, Gamino et al. 2000, Burkhart &
Solari-Twadell 2001, Tuck et al. 2001). Expressing one’s
spirituality includes personal practices that promote a sense
of connectedness with self, others and/or a power greater
than oneself, which may or may not include religious
practices (Reed 1987, Narayanasamy 1996, Burkhart &
Solari-Twadell 2001, Burkhardt & Nagai-Jacobson 2002,
Buck 2006, Taylor 2006, Pesut & Thorne 2007).
Spiritual care in nursing practice is a complex interpersonal
relationship between nurse and patient intended to promote
patient spirituality (Tanyi 2006, Taylor 2006, Pesut &
Thorne 2007, Burkhart & Hogan 2008). These care encoun-
ters can affect nurses’ spirituality, which can affect nurses’
decision to engage in spiritual care in the future (Chung et al.
2007, Duggleby & Wright 2007, Burkhart & Hogan 2008).
This relationship between the provision of spiritual care and
the effect of that care on nurse spirituality needs to be further
studied, as it may impact future spiritual care provision. This
research is hampered by lack of empirically developed,
psychometrically sound measurement tools. The Spiritual
Care Inventory (SCI) was designed to measure spiritual care
in nursing practice from the nurses’ perspective. The SCI
items were derived from the concepts that comprise the
Spiritual Care in Nursing Practice grounded theory (Burkhart
& Hogan 2008).
Background
The body of spirituality research suggests that spirituality and
spiritual care are important aspects of health and health care.
People who have higher levels of spiritual well-being are
physically, psychologically and socially healthier. Specifically,
spiritual well-being is associated with better adherence to
treatment regimen (Simoni et al. 2006), and is associated
with less symptom distress (Younger et al. 2004, Manning-
Walsh 2005, Meraviglia 2006), less pain (Kaplar et al. 2004),
lower anxiety (Etnyre et al. 2006), better quality of life
(WHOQOL SRPB Group 2006) and lower mortality rates
(Strawbridge et al. 1997, Kaplar et al. 2004). Particularly for
the oncology patient population, higher levels of spiritual
well-being are associated with higher levels of well-being
(Meraviglia 2006), hope (Gibson & Parker 2003), coping
(Bowie et al. 2004), social functioning (Coleman 2003), self-
rated health (Krause 2006) and quality of life (Motyka et al.
2010) and less psychological stress (Mullen et al. 1993),
depression (Daaleman & Kaufman 2006, Edward et al.
2009), financial strain (Krause 2006) and suicidal ideation
2464
(McClain et al. 2003). Research has consistently demon-
strated that spirituality and spiritual coping is important to
health in western societies (Hilbers et al. 2010, Motyka et al.
2010, Van Dierendonck et al. 2010), Asia (Lim & Yi 2009,
Mok et al. 2009, Shih et al. 2009, Yang & Wu 2009,
Lundberg & Kerdonfag 2010), and the Middle-east (Lazar
2009, Yousefi et al. 2009). This suggests that spirituality is
not only important in coping with disease, but also has the
potential to improve quality of life, relieve symptoms and
lower mortality rates.
Research has operationalized spiritual well-being using the
Spiritual Well-being Scale (SWBS) (Ellison 1983, Paloutzian
& Ellison 1991), Functional Assessment of Chronic Illness
Therapy – Spirituality (FACIT-sp/FACIT-sp-12) (Brady et al.
1999), and the Spiritual Perspectives Scale (Reed 1986). The
SWBS (Ellison 1983) is a 20-item tool defining spiritual well-
being in terms of both religious (ten items) and existential
(ten items) perspectives. Psychometric properties have been
supported in over 300 studies (Paloutzian & Ellison 1991).
The FACIT instruments are a series of tools measuring
different aspects of health, originally developed for patients
with enduring illness. The FACIT-sp-12 measures spiritual
well-being and is comprised of two subscales: faith and
meaning/purpose (Brady et al. 1999, Peterman et al. 2002).
The FACIT organization (http://www.facit.org) publishes
over 100 studies demonstrating the tool’s strong psychomet-
rics. The Spiritual Perspectives Scale measures participants’
perceptions of the extent to which they hold certain spiritual
views and engage in spiritually related interactions, where
spirituality refers to an awareness of one’s inner self and a
sense of connection to a higher being, nature, others, or to
some dimension or purpose greater than oneself. Findings
supporting criterion-related validity and discriminant validity
have been reported (Reed 1986, 1987).
A few instruments exist that measure the provision of
spiritual care. Taylor (2006) published a 42-item instru-
ment (eight subscales) measuring spiritual interventions for
oncology patients and their caregiver(s), called SPIRIT.
This instrument was developed based on her previous
research, and the psychometric evidence of the instrument
included content validity (0Æ88) and coefficient alphas of
0Æ76–0Æ96 (Taylor 2006). This tool was designed to
specifically measure nursing interventions for patients at
end-of-life.
The instrument described in this article, the SCI, was
developed using data collected through a grounded theory
study of the provision of spiritual care by nurses (Burkhart &
Hogan 2008). Previous research has shown that empirically
derived instruments increase the opportunity of creating
items that represent a reliable and valid representation of the
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JAN: ORIGINAL RESEARCH Development and psychometric testing of SCI

phenomenon of interest and decrease the likelihood of nursing classes, answered questions and collected completed
contaminating naturalistic data with instrument author(s) surveys without the faculty member for the course present.
biases (Hogan et al. 2001). All graduate students were currently employed and practicing
as Registered Nurses. At all three sites, 450 surveys were
distributed and a total of 298 surveys were completed,
The studies
yielding a response rate of 66%.
In the second study, a convenience sample of Registered
Aim
Nurses was obtained in two sites: a hospital and graduate
The aim of the two studies was to develop and test the nursing students in a school of nursing from July to August
psychometric properties of the SCI. 2007. Data collection procedures were similar to the first
study. None of the participants who gave data in study 1
participated in study 2. Data were obtained from an
Methodology
anonymous demographic questionnaire and the 18-item
In the first study, the initial 48-items were evaluated using SCI. Study surveys were distributed to 131 with 78 surveys
exploratory factor analysis to compare the underlying con- returned (59% response rate). The samples for the two
structs in the instrument to the original grounded theory on studies are described in Table 1.
which it was based. Psychometric properties – including
construct validity and internal consistency – were assessed.
A second smaller study was conducted to assess the
psychometric evidence of the instrument in study 1. In Table 1 Sample descriptive statistics
the second study, one additional item was added to measure Initial SCI Revised SCI
the theoretical category of ‘recognition of patient cue’, and Study sample (n = 298) (n = 78)
was stated as follows: ‘I can tell when a patient is needing Mean age of respondent 40 34
spiritual care’. This second study was conducted with a new Gender of respondent
sample to measure the psychometric properties of the Female 277 77
resulting 18-item instrument. Male 7 1
No answer 14 0
Ethnicity
Sample/participants Caucasian 216 51
African-American 15 6
For the first study, a targeted useable minimum sample size of Hispanic 14 3
240 was projected, based on the 48-item measure and a need Asian 41 12
for 5–10 usable responses per item to conduct exploratory Other 2 6
No answer 10 0
factor analysis (Polit 1996). Allowing for non-response an
Religion
estimated response rate of 40–50% was anticipated. A Catholic 161 34
convenience sample of Registered Nurses practising in an Non-Catholic Christian 88 35
urban area in the United States was obtained from three sites: Jewish 8 1
two hospitals (in two different health systems) and one school Muslim 4 0
None 21 5
of nursing from February to March 2007. In the hospitals, the
Other 7 2
PI attended staff meetings and posted flyers describing the
No answer 9 1
study. The PI visited hospital units on both 12-hour day and Highest level of nursing education
evening shifts to distribute survey booklets to all Registered Associate degree 44 8
Nurses working on that particular shift, described the study Diploma 28 4
and answered all questions. The following speciality units BSN 184 65
MSN 24 1
were visited: medical/surgical, ICU, paediatrics, obstetrics,
Doctorate 2 0
rehabilitation, skilled nursing, home health, ambulatory care, No answer 16 0
GI diagnostic testing, operating room and emergency room. Level of income
Nurses who chose to complete the anonymous survey, 25,000–49,999 23
deposited the completed survey in an envelope on the unit, 50,000–74,000 91
75,000+ 164
which was later collected by the PI. In the school of nursing,
No answer 20
the PI presented the research study to four graduate-level

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L. Burkhart et al.
Instrument
Items for the SCI were initially derived from data collected to
generate a grounded theory to conceptualize the process of
nurses who give spiritual care in a clinical setting (Burkhart
& Hogan 2008). Participants in that study included 26 staff
nurses who worked across the continuum of care. The
resulting Burkhart/Hogan Spiritual Care in Nursing Practice
theory consisted of seven categories describing the process of
spiritual care in nursing practice. These theoretical categories
were labelled recognition of patient cue, decision to engage/
not engage in spiritual care, spiritual care intervention,
immediate emotional response, searching for meaning, for-
mation of meaningful memory and spiritual well-being.
Findings from the grounded theory study showed that
spiritual care is an intentional and interactive process
between the nurse and patient to promote the patient’s
spiritual well-being, and that these spiritual encounters can
lead to positive or negative spiritual memories that can
increase or decrease the nurse’s spiritual well-being (Burkhart
& Hogan 2008). Items for the SCI included at least three
statements per category. The wording of items directly
mirrored words and phrases from nurse participants.
An initial set of 48 items was developed. Two experts in
instrument and nursing theory development reviewed items
for clarity and consistency. The instrument was constructed
to measure the nurses’ perceived belief of the extent they give
spiritual care. Items were scrambled to avoid systematic bias
in responses. Nurses were asked to read each statement and
score how much s/he agreed the statement described how the
nurse gave spiritual care to patients. Items were measured
using a Likert-type scale, where 1 = strongly disagree to
5 = strongly agree. Higher scores implied a greater perceived
belief of the extent they gave spiritual care.
Ethical considerations
For both studies, Human Subjects Review Board approval
was obtained from one health system and the university
associated with the school of nursing. The second hospital
accepted the university IRB approval and gave administrative
approval. At the time of data collection, the PI did not teach
in the graduate programme nor served on graduate pro-
gramme committees, thus minimizing any coercive influences.
Results
The average age of the study participants was 40 in study 1
(SD = 11, range = 22–66) and 34 in study 2 (SD = 11,
range = 23–60). The majority of participants were women
2466
(93% and 99%, respectively) and Caucasian (72.4% and
65%, respectively). The majority of participants were Cath-
olic (54%, 44%) or non-Catholic Christian (30%, 45%). The
majority of the participants described their highest level of
education as baccalaureate (62%, 83%). Sample statistics are
described in Table 1.
In the first study, exploratory factor analysis (EFA)
procedures were used to assess the underlying dimensions
of the 48 items comprising the measure. Principal axis
factoring with varimax rotation was used in the analyses.
Criteria used to determine the number of factors to retain
included parallel analysis (Hayton et al. 2004), examination
of the scree plot, interpretability and the congruence between
the items and the original hypothesized factors. In addition,
for an item to be retained, the factor loading needed to meet
or exceed the 0Æ40 threshold, without evidence of important
cross-loading across two or more factors. After the explor-
atory factor analysis was completed, internal consistency
reliability was computed for each of the factors. A minimum
value of 0Æ70 for the internal consistency reliability was
established, consistent with a value for measures in a newer
area of inquiry (Nunnally & Bernstein 1994).
The results of the parallel analysis suggested ten factors in
which real-data eigenvalues exceeded random-data eigen-
values. However, the differences between the random and
real-data eigenvalues were more pronounced for factors one
through five, with only minimal differences (0Æ04–0Æ20) noted
in the differences for factors six through ten. A decision was
made to request a ten-factor solution to examine the scree
plot and also get a sense of the pattern of factor coefficients
for the 48 items of the measure. This ten-factor solution did
not converge, and the scree plot generated in this analysis
suggested a three-factor solution.
Since the parallel analysis suggested a five-factor solution
might also be plausible, this solution was requested through
EFA. An examination of the pattern of factor coefficients
revealed eight items with no coefficient greater than the 0Æ40
threshold and an additional two items that loaded on the fifth
factor, but were not deemed conceptually related. After
removing these ten items, an additional five-factor EFA
solution was generated, with a clearer factor structure pattern
beginning to emerge. Through examination of the factor
loadings and the scree plot, it became clear a three-factor
solution was needed.
Several iterations of three-factor solutions were obtained,
removing items that did not meet the 0Æ40 item loading
threshold after each analysis. This process continued until a
final, three-factor solution was obtained in which items
possessed sufficient loading (>0Æ40) on a single factor
without evidence of cross loading, along with conceptual
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JAN: ORIGINAL RESEARCH Development and psychometric testing of SCI

Table 2 Exploratory factor analysis results (n = 298)

Spiritual care Meaning
Item Mean SD interventions making Faith rituals

I am present to patients when they express 3Æ96 0Æ62 0Æ67 0Æ17 0Æ03
meaning in situations
I listen to patients when they express meaning 4Æ15 0Æ55 0Æ69 0Æ12 0Æ05
in situations
I listen to patients when they are searching 3Æ99 0Æ65 0Æ76 0Æ23 0Æ04
for meaning in situations
I give patients an opportunity to express 3Æ99 0Æ65 0Æ75 0Æ18 0Æ10
spiritual aspects of themselves
After providing spiritual care, I take time to 3Æ24 0Æ92 0Æ03 0Æ64 0Æ32
think about it during quiet time
After providing spiritual care, I think about 3Æ61 0Æ88 0Æ22 0Æ76 0Æ12
what I learned from the situation
After providing spiritual care, I think about it 3Æ53 0Æ98 0Æ24 0Æ74 0Æ28
when I am by myself
Reflection helps me find meaning after 3Æ49 0Æ90 0Æ14 0Æ72 0Æ21
providing spiritual care
Reflection helps me accept distressing 3Æ76 0Æ80 0Æ22 0Æ64 0Æ15
spiritual care experiences
I learned how to provide spiritual care by 3Æ59 0Æ89 0Æ13 0Æ57 0Æ20
reflecting on past spiritual care experiences
Providing spiritual care is one of the things 2Æ96 1Æ15 0Æ12 0Æ61 0Æ27
that keeps me in nursing
After providing spiritual care, I find inner 3Æ44 1Æ02 0Æ23 0Æ56 0Æ27
peace and understanding by talking with
friends/family outside of work
Reflection helps me grow spiritually after 3Æ54 0Æ94 0Æ20 0Æ76 0Æ27
providing spiritual care in distressing
situations
Good memories of providing spiritual care 3Æ72 0Æ93 0Æ22 0Æ70 0Æ23
make me feel proud that I am a nurse
After providing spiritual care, I find inner 2Æ58 1Æ15 0Æ04 0Æ26 0Æ72
peace and understanding by reading
scripture
After providing spiritual care, I find support 3Æ21 1Æ10 0Æ07 0Æ44 0Æ78
through prayer
After providing spiritual care, I find inner 2Æ98 1Æ23 0Æ02 0Æ34 0Æ76
peace and understanding by attending
church
Subscale; mean (SD ) 16Æ06 (2Æ00) 34Æ90 (7Æ09) 8Æ75 (3Æ05)
Cronbach’s alpha internal consistency 0Æ82 0Æ92 0Æ86

Underlined value is the item assigned to the factor.

similarities among items in a factor. The final solution,
consisting of 17 items (listed in Table 2), explained 57Æ33%
of the variance. Subscales were constructed and internal
consistency estimates through Cronbach’s alpha and item
correlations were examined. Subscale 1 was labelled Spiritual
Care Interventions and was conceptually defined as inten-
tional nursing care interventions to promote the patient’s
spirituality. The items relate to being present to the patient
and facilitating the search for meaning in the situation; for
example, ‘I am present to patients when they express meaning
in situations’. The Spiritual Care Interventions subscale
consisted of four items, with an internal consistency reliabil-
ity of 0Æ82. Inter-item correlations ranged from 0Æ46 to 0Æ61,
with item-total correlations ranging from 0Æ60 to 0Æ68.
Subscale 2 was labelled Meaning Making and was concep-
tually defined as nurse spiritual reflective practices and
meaning interpretations of nurse–patient spiritual encoun-
ters. These items identify specific reflective practices and the
effect of those practices on the nurse’s perception of the
spiritual care encounter; for example, ‘Reflection helps me

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L. Burkhart et al.
accept distressing spiritual care experiences’. This subscale
consisted of ten items, and had an internal consistency
reliability of 0Æ92. Item intercorrelations ranged from 0Æ37 to
0Æ63, with item-total correlations ranging from 0Æ62 to 0Æ79.
Subscale 3 was labelled Faith Rituals and was conceptually
defined as nurse faith rituals in response to nurse-patient
spiritual encounters; for example, ‘After providing spiritual
care, I find support through prayer’. This subscale consisted
of three items, with an internal consistency reliability of 0Æ86,
inter-item correlations ranging from 0Æ63 to 0Æ74, and item-
total correlations ranging from 0Æ69 to 0Æ78. The three-factor
solution, including descriptive statistics for each item, is
detailed in Table 2.
In study two, the internal consistency reliability for the
three subscales was as follows: Spiritual Care Interventions
subscale was 0Æ87, Meaning Making was 0Æ94 and Faith
Rituals was 0Æ88. Subscale intercorrelations between Mean-
ing Making and Spiritual Care Interventions was r = 0Æ51
(P < 0Æ001), Faith Rituals and Spiritual Care Interventions
was r = 0Æ39 (P < 0Æ001), and Meaning Making and Faith
Rituals was r = 0Æ76 (P < 0Æ001). In examining the addi-
tional item included to assess the theoretical category of
recognition of patient cue, 69% of the respondents agreed or
strongly agreed with the item, while 19% were neutral, and
12% disagreed with the item (no participant chose strongly
disagreed). This distribution of responses indicates that a
majority of participants can recognize a cue. Based on these
findings this item was deleted from the final set of instrument
items.
Discussion
The sample, although sufficient in size for exploratory factor
analysis, was a convenience sample and was limited to one
geographical region and urban health systems in the United
States. Nurses who give spiritual care may have been more
inclined to complete the survey. The majority of the sample
was Christian and women. In these studies men are under-
reported, as there were only 2Æ5% and 1% of men in each
study, while there were 7% of men in nursing in the United
States (Health Resources and Services Administration 2008).
Also, the sample population was younger than working
nurses, as the average age of the participants was 40 and 35
respectively, and the national average age of working nurses
from 2004 to 2008 was 45Æ5 (Health Resources and Services
Administration 2008). Future research is needed with a more
heterogeneous sample with regard to religious preference,
gender and age.
Research has shown that higher levels of spiritual well-
being are associated with better health and that many
2468
patients want spiritual care. Nurses are in a position to give
this type of care as they are the most widely accessible care
provider, and the profession embraces a wholistic view of
health. The SCI gives a means by which to measure the
perceived ability of providing spiritual care and the impact of
that care on nurse spirituality. These studies demonstrate
acceptable construct validity evidence and internal consis-
tency estimates for the SCI.
This study further develops the Spiritual Care in Nursing
Practice theory (Burkhart & Hogan 2008). The grounded
theory category, ‘Search for Meaning’ is conceptually similar
to the subscale ‘Making Meaning’ and demonstrates consis-
tency with the theory. In the grounded theory, ‘Faith Rituals’
was a subcategory under ‘Search for Meaning’, as performing
faith rituals was one way to search for meaning. The
psychometric analysis recognized Faith Rituals as a separate
category, albeit highly correlated (0Æ76) with Meaning
Making. Both studies reflect a close relationship between
these two categories. The faith and meaning subscales in the
SCI are also conceptually consistent with subscales in other
spirituality tools in the literature; for example, the FACIT-
sp-12 has faith and meaning subscales and the SWBS has
existential well-being and religious well-being subscales
(Paloutzian & Ellison 1991, Brady et al. 1999). Also, items
from properties of two theory categories, Recognizing Patient
Cue and Decision to Engage in Spiritual Encounter, were
eliminated from the tool. While the data did not support
items reflecting these theoretical categories in the first study
and the additional item in the second study, heuristically it is
reasonable to assume that nurses identify a spiritual need and
are motivated to engage in an intervention. The fact that
statistical analysis did not identify a separate category is an
interesting finding. Evidence that the nurse recognized a need
for spiritual care is included in the provision of a spiritual
intervention.
It is also interesting that two items in the Meaning Making
subscale suggest that providing spiritual care positively
affects the nurses’ perception of their profession: ‘Providing
spiritual care is one of the things that keeps me in nursing’
and ‘Good memories of providing spiritual care makes me
feel proud that I am a nurse’. This is consistent with research
demonstrating an association between providing spiritual
care and nurse job satisfaction (Lazar 2009). Future research
could further explore the relationship between spiritual care
and nurse burnout. Providing spiritual care, meaning making
and faith rituals could buffer burnout, but this relationship
requires additional study.
Researchers can further study spiritual care in nursing
practice, operationalized with the SCI, in other theoretical
frameworks that have a nursing care intervention component.
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JAN: ORIGINAL RESEARCH
What is already known about this topic
• People who have greater spiritual well-being have less
physical symptom distress, pain and lower mortality
rates. They have psychologically less depression, more
hope and better coping, and they have better social
functioning, less financial strain and are healthier.
• Nursing has historically recognized spiritual care
conceptually, but more recently, professional nursing
organizations have operationalized this recognition by
integrating spiritual care language in policy statements,
and healthcare organizations have developed policies in
providing spiritual care.
• Many instruments exist to measure spiritual well-being,
but few psychometrically sound instruments exist to
measure the provision of spiritual care.
What this paper adds
• The Spiritual Care Inventory is a 17-item tool with three
subscales: spiritual nursing interventions, meaning
making and faith rituals.
• Analysis of the initial 48-item Spiritual Care Inventory
demonstrated evidence of acceptable construct validity
using exploratory factor analysis and acceptable
internal consistency for the three subscales.
• Analysis of the resulting tool from the first study with a
new sample of nurses supported acceptable internal
consistency for the three subscales.
Implications for practice and/or policy
• The Spiritual Care Inventory instrument gives a method
to measure nursing spiritual care practice patterns, and
the effect of spiritual encounters on the nurse. The
Spiritual Care Inventory gives opportunities to study the
relationship between spiritual care practice patterns and
nurse burnout.
• The Spiritual Care Inventory can be used to measure the
effectiveness of educational initiatives designed to
promote spiritual care.
The SCI measures the process of providing spiritual care from
the nurses’ perspective. Spiritual care is a nursing care process
and would be compatible with theories that represent the
process of providing nursing care. The SCI could measure the
spiritual dimension of that care. For example, the SCI could
operationalize nurse perception or action in King’s theory of
goal attainment (King 1981). In the Neuman Systems Model,
 2011 Blackwell Publishing Ltd
Development and psychometric testing of SCI
the SCI can measure spiritual interventions designed to
promote spiritual health/wellness and resistance to stressors
(Neuman & Fawcett 2002). The SCI gives a method to
measure a dimension of care that has not historically been
measured.
Research comparing nurse perception of providing spiri-
tual care with actual nurse spiritual care can also support the
validity of the SCI intervention subscale and give additional
methods of measuring spiritual interventions. One way to
measure actual spiritual care given is by tabulating docu-
mented spiritual assessments and interventions in the health
record. The use of electronic health records (EHR) can
simplify this calculation if the EHR separately lists spiritual
assessments and interventions as documented areas (Burkhart
& Androwich 2009).
Conclusion
The literature supports the importance of spirituality and
spiritual care in promoting patient health and well-being.
This research has led to professional and institutional policy
changes to promote the provision of spiritual care. Future
research is needed to determine effective methods to carry out
this policy. The SCI can help measure the effectiveness of
these programme initiatives, using a pre-post test design with
nurses practicing in hospital, home health, or ambulatory
care settings. The studies reported in this article give
acceptable psychometric evidence to use of the SCI in urban,
western societies.
Many nursing schools integrate spiritual care into entry-
level nursing curricula (American Association of Colleges of
Nurses 2008). The literature has described examples of
curricula and courses integrating spiritual care (Narayanas-
amy 1999, Catanzaro & McMullen 2001, Wallace et al.
2008), but there is little evidence as to the impact of those
programmes on students’ perceived ability to give spiritual
care. The SCI has the potential to measure the effectiveness of
spiritual care curricular content. However, this type of
research requires additional SCI psychometric testing with
nursing students.
Previous research indicates that although patients and
nurses view spirituality and spiritual care to be important, the
level and perception of importance differs between cultures.
Future research is needed to test the psychometric properties
of the SCI in different cultures.
Research has led to policy and programme initiatives to
promote spiritual care as one strategy to promote patient
health. Future research is needed to measure the effectiveness
of these institutional and educational policies and programme
initiatives. The SCI can help further this line of research.
2469
L. Burkhart et al.
Funding
This research received no specific grant from any funding
agency in the public, commercial, or not-for-profit sectors.
Conflict of interest
No conflict of interest has been declared by the authors.
Author contributions
LB, LS and NH were responsible for the study conception
and design. LB, LS and NH performed the data collection.
LB, LS and NH performed the data analysis. LB, LS and NH
were responsible for the drafting of the manuscript. LB, LS
and NH made critical revisions to the paper for important
intellectual content. LS gave statistical expertise.
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