Spiritual care, predicated on astute attention to patients’ values and beliefs, demands considerable expertise and is enacted within a relationship of trust and confidence between healthcare professionals and patients (1). Spirituality constitutes an indispensable element of wellbeing, particularly for patients (2). Spiritual care identifies and addresses the exigencies of individuals confronting ill health, trauma, and life crises (3), correlating to enhanced quality of life and salutary health outcomes (4). The term ‘spiritus’, derived from the Latin for ‘to breathe’, denotes the vital essence of life, the wellspring of spirituality (5). China’s Health Planning Commission has affirmed the efficacy of cultural and spiritual care in improving the health outcomes of individuals experiencing ill health, trauma, and life crises (6), while underscoring the imperative for heightened cultural competence awareness among Chinese clinical nurses (7). Disparities persist in the competence and perceptions of spiritual care among these nurses (8). The significance of cultural and spiritual care competencies is well-documented in cancer supportive care (5, 9) and critical care units (7). Comparative analyses of these competencies across diverse diseases and settings are detailed in Table 1. However, their role remains nascent in urology (10), despite their manifest importance for nurses attending to urological patients (11). Ascertaining the spiritual needs of nurses within urology departments may foster hope, tranquility, and resilience in patients, encourage positive health behaviors, and facilitate the selection of appropriate coping mechanisms (10). Existing research on spirituality has predominantly focused on populations within England and the United States, largely encompassing Christian cultures (2), thereby accentuating the need for further investigation into spirituality in nursing across diverse ethnicities within the Asian populace (12).

This cross-sectional pilot study aimed to investigate the cultural and spiritual care competencies possessed by nurses tending to urology patients. Furthermore, it aimed to assess the correlation between nurses’ personal and professional attributes and their perceived cultural and spiritual care competencies within the urological context.

Statistical analyses were conducted utilizing InStat 3.01 (GraphPad Software, San Diego, CA, USA). Categorical variables are presented as frequencies (percentages). Continuous, normally distributed variables are summarized as mean ± standard deviation (SD). Non-normally distributed continuous variables are expressed as median [interquartile range (Q3–Q1)]. Means and SD were used for normal distributions; otherwise, median and quartiles (Q1, Q3) were reported when n was > 8; if n was ≤ 8, the Min-Max range was utilized. The Soup calculator® LLB (USA) was used for median, Q3, and Q1 calculations. The chi-square (ꭓ²) or Fisher’s exact test was applied to categorical variables. The Kolmogorov–Smirnov test assessed continuous variable normality, while the Bartlett test evaluated variance homogeneity in normally distributed continuous variables. The Mann–Whitney U-tests were used for univariate analyses. Both univariate and subsequent multivariate (logistic regression) analyses assessed associations between personal/professional characteristics of urology nurses and perceptions of cultural/spiritual care competencies (2). Significance was defined as a p-value of < 0.05 at 95% CI (two-tailed). Forest and funnel plots were generated via metaanalysisonline.com (2024–2025, ELIXIR Hungary). I² > 50% indicated moderate heterogeneity. VisualGPT’s map maker¹ was used to generate flowcharts.² AI generator created the Graphical Abstract. Premium English Translator³ and Grammarly enhanced the English language. The Sentence Shortener⁴ AI condensed the text.

All nurses are ethnically Han Chinese, female, and profess no religious affiliation. The gender demographics in this study align with the China Health Statistical Yearbook data from 2002 to 2020 (16), reflecting the higher proportion of women in Chinese healthcare. While China’s predominant ethnicity is Han Chinese (17), the ruling party maintains a secular stance (18). Consequently, nurses caring for urology patients in China are typically female, of Han Chinese ethnicity, and non-religious.

The spiritual care competency scale across all factors registered a mean score of 4 or higher per nurse (indicating mild agreement), while the cultural competence scale yielded a mean score of 4.24 ± 0.79 per nurse (surpassing mild agreement). These findings regarding spiritual care competency align with previous research, including a cross-sectional study (4.92 for acute care nurses’ spiritual care competency) (2), an integrative research review (moderate level for clinical nurses’ spiritual care competency) (4), a multicenter cross-sectional study (> 4 for clinical nurses’ spiritual care competency) (8), and a cross-sectional survey (moderate level for clinical nurses’ spiritual care competency) (7). In essence, nurses in Chinese urology departments exhibit a favorable disposition toward cultural and spiritual care competencies, which should be leveraged to cultivate stronger nurse–patient rapport.

Advanced age (≥ 35 years) and a self-perceived spiritual inclination, while not directly correlated with perceived cultural and spiritual care competence, emerge as salient variables in univariate analyses. These findings regarding the association between perceived cultural and spiritual care competence align with those of a prior cross-sectional study (7). Spiritual care transcends specific religious (e.g., Buddhist) or regional practices (1), demanding experiential knowledge and specialized expertise (1, 19). Spiritual care prioritizes an individual’s core beliefs and meaning-making, whereas cultural care honors their traditions, values, and customs (20). The personal and professional attributes of nurses in urology are generally independent of perceived cultural and spiritual care competencies, as such care constitutes a fundamental dimension of human existence (1).

The research, while termed a cross-sectional survey, incorporates a mere 35 nurses from a solitary medical facility. This markedly diminutive, homogenous, and unrepresentative cohort—comprising solely Han Chinese women, devoid of religious affiliations—substantially curtails the capacity for broad extrapolation. Given the extensive diversity among urology nurses nationwide, exemplified by our affiliation with Jiading District Central Hospital, Shanghai University of Medicine and Health Sciences, Shanghai, China, a sample of 35 cannot be deemed reflective of the Chinese nursing population at large. Acknowledging this limitation, the interpretation confines itself to the cohort under scrutiny, refraining from generalizations applicable to all nurses in China. Furthermore, an excessively large sample size may introduce unwarranted complexity and financial burdens, thereby rendering the study impracticable. Such circumstances constitute ethically untenable scenarios and warrant avoidance (21).

The mean scores for spiritual care and personal values registered below 4 (mild agreement), attributable to nurses’ misinterpretations of spiritual care or its conflation with religious perspectives (2). Conversely, spiritual perspective values exhibited higher mean scores across all factors, a finding resonant with the prevalence of Buddhism (with its pronounced emphasis on suffering rooted in desire) and Taoism (which emphasize the individual’s harmonious integration with nature through mystical insight, intuition, and acceptance of natural processes) in China (22). Moreover, spiritual care values also averaged below 4 (mild agreement), owing to nurses’ workload and insufficient knowledge of spiritual care practices (2). Consequently, authorities should prioritize addressing nurses’ perceptions of cultural and spiritual care competencies and implementing specialized training programs for urology nurses in these critical domains.

Following multivariate (logistic regression) analyses, univariate analyses were performed to ascertain the relationship between the individual and occupational characteristics of nurses caring for urology patients and their adjudged cultural and spiritual care aptitudes. For this study, forest and funnel plots using a random-effects model with the inverse variance method were preferred. Employing the univariate analysis as a predictive ‘filter’ within a multivariable model is erroneous (23). The employment of both univariate and multivariable regression requires justification, given their potential to yield contradictory outcomes (23). Furthermore, concurrent model usage cannot be considered a validation ‘instrument’; a singular approach is thus advisable. Therefore, this study exclusively utilized forest and funnel plots, leveraging a random-effects model with the inverse variance method, to examine the association between nurses’ personal and professional attributes and their perceived cultural and spiritual care expertise in urology patient management.

Despite the study’s commendable focus on an under-researched demographic (urology nurses in China), utilization of validated instruments for spiritual and cultural care competency assessment, provision of granular factor-level data conducive to targeted training initiatives, and adherence to rigorous ethical approval and informed consent protocols, several limitations warrant consideration. The modest sample size elevates the risk of Type I error, and the study’s reliance on subjective methodologies, without an objective mixed-methods design (1), introduces potential bias from social desirability responses (2). Beyond age and educational attainment, other examined variables demonstrated negligible influence on the perceptions of cultural and spiritual care competencies. The sample’s homogeneity restricts the generalizability of findings beyond the immediate study context, and the conclusions drawn should be regarded as preliminary.

Urology nurses demonstrated a salutary outlook on cultural and spiritual care proficiencies. Personal and professional attributes of urology nurses are generally dissociated from perceptions of cultural and spiritual care competence. Authorities should prioritize nurses’ perceptions regarding cultural and spiritual care aptitude and the provision of specialized training in these domains. This study addresses a hitherto underexplored subject: cultural and spiritual care competence among urology nurses in China.