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Palliative care nurses’ goals of spiritual care

Published online by Cambridge University Press:  25 September 2026

Rita Mascio Open the ORCID record for Rita Mascio [Opens in a new window] ,
Sandra Lynch ,
Jane Phillips  and
Megan Best
Rita Mascio*
Affiliation:
Institute of Ethics & Society, University of Notre Dame, Broadway, NSW, Australia
Sandra Lynch
Affiliation:
Institute of Ethics & Society, University of Notre Dame, Broadway, NSW, Australia
Jane Phillips
Affiliation:
School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
Megan Best
Affiliation:
Institute of Ethics & Society, University of Notre Dame, Broadway, NSW, Australia
*
Corresponding author: Rita Mascio, Email: 32009159@nd.edu.au
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Abstract

Objectives

Personal, self-selected goals are important determinants of behavior in work settings. The present study aimed to elicit palliative care nurses’ personal self-set goals of spiritual care and to test whether these goals were related to their spiritual care understanding.

Methods

Data were collected from a convenience sample of palliative care nurses who completed an anonymous, online survey asking qualitative data about how they understand spiritual care and their goals for spiritual care. We conducted content analysis on the goal data to create categories of goals and created sub-groups of nurses based on their understanding of spiritual care. We constructed a co-occurrence table showing the frequency with which goals and spiritual care understandings co-occur across nurses and used a goodness-of-fit test and visual inspection to assess the relationship between goals and understanding.

Results

Four categories of goals emerged: patient well-being, patient’s family well-being, task performance, and self-oriented goals. There was no apparent relationship between goals and spiritual care understanding.

Significance of results

Palliative care nurses’ goals for spiritual care are characterized by greater variety than implied by prescriptive spiritual care models/guides that assume some type of patient well-being goal. That there was no relationship between goal and spiritual care understanding may be due to the goal-elicitation question evoking higher-order goals that are unrelated to specific spiritual care behaviors, which may be more influenced by lower-order goals.

Keywords

nursespiritual carepalliative caregoalspiritual care model

Information

Type
Original Article
Information
Palliative & Supportive Care , Volume 24 , 2026 , e236
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Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
Copyright
© The Author(s), 2026. Published by Cambridge University Press.

Introduction

Goals are mental representations of outcomes or end states that an individual wants to achieve (Cane et al. Reference Cane, O’connor and Michie2012). Goals can range from broad general motives (e.g., to achieve a sense of belonging) to more specific goals (e.g., to greet this new patient warmly) (Wicker et al. Reference Wicker, Lambert and Richardson1984). Goals are a central concern in the explanation of behavior because most, if not all, action is purposeful and goal-directed (Austin and Vancouver Reference Austin and Vancouver1996). Goals serve to organize, direct, and maintain an individual’s actions (Locke and Latham Reference Locke and Latham1990). In work contexts, people have many self-set goals while performing their jobs, and these goals determine their work behavior (Naylor et al. Reference Naylor, Pritchard and Ilgen1980). The content of personal self-set goals thus matters because different goals are pursued in different ways (Grant and Gelety Reference Grant, Gelety, Moskowitz and Halvorson2009).

The spiritual care literature recognizes that goals and motivation are key factors influencing healthcare providers’ ability to provide spiritual care (Selman et al. Reference Selman, Brighton and Sinclair2018; Ikbal and Sari Reference Ikbal and Sari2024) and has explored empirically the content of spiritual care goals of chaplains (Visser et al. Reference Visser, Damen and Schuhmann2023) and volunteers (Mahilall and Swartz Reference Mahilall and Swartz2021). Regarding nurses’ goals, a recent systematic review (Mascio et al. Reference Mascio, Best and Lynch2021) identified a range of goals, listed in Table 1, which influence the behaviors of nurses providing spiritual care for dying patients; these goals varied in their focus (whether for patient, relationship and empathy, self, or colleagues). This review extracted goals from 25 qualitative studies sampling in toto a general group of nurses, working in a range of hospital and community settings, discussing their experiences in providing spiritual care.

Table 1.

Goals that influence the behaviors of nurses providing spiritual care for dying patients (adapted from Mascio et al. Reference Mascio, Best and Lynch2021)

Nurse spiritual/existential care was driven by patient, relationship, empathy, self and colleague goals; barriers were recovery focus, unwillingness and avoiding anxiety. See long description.
Table 1 Long description

Motivation and goals are grouped into five themes, each listing specific goals marked as facilitators or barriers for nurse spiritual and existential care. Under general goals of patient care, facilitators are patient wellbeing, bringing peace to the patient, and the patient feeling comfortable and cared for; barriers are helping the patient recover from illness and being unwilling to support or respond to spiritual, existential, or religious need. Relationship goals are all facilitators: creating communion and security with the patient, establishing a trusting relationship, and wanting meaningful conversations. Empathy goals are all facilitators: respecting how the patient sees things, putting oneself in the patient shoes, and understanding and respecting patient thoughts, feelings, and self evaluations. Self oriented goals include facilitators of striving for completeness, trying to be myself, and wanting to care for and be responsible for the patient, plus a barrier of trying to avoid potential anxiety about one own suffering or dying. Goals related to colleagues are facilitators: recognizing and using team expertise such as a chaplain, and committing to refer to a chaplain if the nurse is not spiritual.

+ = facilitator; − = barrier.

One aim of the current study is to elicit the goals that palliative care nurses, in particular, have for spiritual care. This aim is worth studying because goal formation is influenced by the experiences and beliefs of the individual (Austin and Vancouver Reference Austin and Vancouver1996). Compared to nurses practicing in other areas, palliative care nurses provide spiritual care more frequently (Taylor et al. Reference Taylor, Pariñas and Mamier2023), have stronger spiritual perspectives (Ronaldson et al. Reference Ronaldson, Hayes and Aggar2012) and more positive attitudes and beliefs (Taylor et al. Reference Taylor, Highfield and Amenta1999), develop relationships with patients and their families over a longer period of time (Yıldırım and Kocatepe Reference Yıldırım and Kocatepe2020), are more likely to notice spiritual needs in patients (Lundmark Reference Lundmark2006) and report greater ability and more comfort with spiritual caregiving (Taylor et al. Reference Taylor, Highfield and Amenta1999). Additionally, spiritual care is recognized as an essential part of palliative care (Gijsberts et al. Reference Gijsberts, Liefbroer and Otten2019). Due to these different experiences and beliefs, the spiritual care goals of palliative care nurses may differ from a general group of nurses.

Another aim of this paper is to explore the relationship between goals of spiritual care and certain types of spiritual care behaviors. Various lists of spiritual care behaviors/activities have been formulated (Sellers and Haag Reference Sellers and Haag1998; Mamier and Taylor Reference Mamier and Taylor2015; Ghorbani et al. Reference Ghorbani, Mohammadi and Aghabozorgi2020), which include referral to a spiritual advisor (Ghorbani et al. Reference Ghorbani, Mohammadi and Aghabozorgi2020), listening actively to a patient’s story of illness (Mamier and Taylor Reference Mamier and Taylor2015) and prayer (Sellers and Haag Reference Sellers and Haag1998). It has been suggested, though, that “… these activities do not form ‘flat’ lists of independent activities but rather have a geography in the sense that they form bundles of activities” (Mascio et al. Reference Mascio, Lynch and Phillips2023, p. 317) and that different bundles of practice are yoked with different understandings – or models – of spiritual care (Mascio et al. Reference Mascio, Lynch and Phillips2023). Nurses understand spiritual care in 4 qualitatively different ways described in Table 2 (Mascio et al. Reference Mascio, Lynch and Phillips2023). Now, according to psychological theory, if goals influence behaviors (Austin and Vancouver Reference Austin and Vancouver1996), then it is reasonable to expect that different bundles of practice might be related to different goals for spiritual care. This paper will explore whether such a relationship exists.

Table 2.

Models of spiritual care (Mascio et al. Reference Mascio, Lynch and Phillips2023)

Four spiritual care models progress from nurse directed actions for comfort to nurse patient partnership that supports patients to lead their own dying journey. See long description.
Table 2 Long description

Columns are Model and Meaning of spiritual care, followed by a bulleted list of behaviors associated with the spiritual care model. Model A, Active management of the patient experience, defines spiritual care as nurses deciding and performing actions they believe will bring peace and comfort, with nurses assessing by their own observations, directing passive patients, staying detached, and focusing on immediate needs and surroundings; a behavior label reads, Increasing competence. Model B, Responsive facilitation of patients wishes, defines spiritual care as identifying patients stated emotional or spiritual needs and meeting them, with nurses asking about overt needs, treating patients as customers with preferences, giving service through concrete tasks, and examples including end of life questions, coordinating family or unit services such as pastoral care, organizing requested religious activities, and helping complete final tasks. Model C, Accompany the patient on the dying journey, defines spiritual care as supporting patients in their final journey, with individualized care, encouraging patients to share thoughts and feelings, giving time and space for conversation, building trust, and emphasizing listening even when encounters are difficult. Model D, Empowering co action with the patient, defines spiritual care as walking alongside and collaborating with the patient, viewing patients as capable with resources, helping patients take responsibility for their experience, taking a more active coaching role than Model C, and being personally involved while not solving problems unilaterally.

Method

Overview

This work is part 2 of a 2-part study of palliative care nurses’ spiritual care behavior.

Data were collected, with institutional review board approval, from a convenience sample of 21 Australian palliative care nurses who completed an anonymous, online survey. The survey provided qualitative data about what spiritual care means for them and what they generally do to provide spiritual care, and provided quantitative demographic data (e.g., palliative care and nursing experience, training adequacy, spirituality, and frequency of provision of spiritual care). Analysis of this data, reported in Mascio et al. (Reference Mascio, Lynch and Phillips2026), found 4 different ways that nurses understand spiritual care, and that understanding was related to palliative care experience, spirituality, and frequency of spiritual care. The survey also elicited goals for spiritual care. This study presents an analysis of this goal-related data.

Elicitation of goals

After asking what they generally do to provide spiritual care, participants were asked, “Why do you do these things, i.e., what are you trying to achieve?” This question did not ask participants directly about their goals for spiritual care to avoid confusion with the term “goals of care,” which has a specialized meaning in healthcare (Secunda et al. Reference Secunda, Wirpsa and Neely2020). Participants were not provided with a list of goals from which to choose, because research suggests that when participants are presented with a list of alternatives, they tend to limit their choice to the offered alternatives, even when explicitly instructed that this is not necessary (Schuman and Scott Reference Schuman and Scott1987).

Analysis

Analysis of the goal data proceeded in 2 stages. The first stage developed categories of goals, and the next stage related these goals to the spiritual care model.

Stage 1. First, the goal data were coded into a discrete list of goals. The first author read each goal. This revealed that some responses contained more than 1 goal (e.g., indicated by the use of “and,” separate sentences, commas), so it was deemed that if an individual’s response contained more than 1 goal, then the response would be coded into more than 1 goal category. Existing goals identified in the review (Mascio et al. Reference Mascio, Best and Lynch2021) were used as baseline a priori codes, which were refined to suit the data. A preliminary code sheet was constructed, containing a description of the content domain for all goals, with examples and quotations from the data. The first researcher performed an initial categorization of goals. The responses and initial goal categories were presented to the other researchers, who discussed and decided upon together. Four goal categories emerged.

An external coder was then trained to use the code sheet to identify goals. The coder independently classified the goals described in participant responses; no new goal categories emerged in this process. Agreement with the researchers’ coding was achieved with 17/21 responses, with disagreements resolved by discussion to determine a final categorization of each goal.

Stage 2. A co-occurrence table (Cloutier and Ravasi Reference Cloutier and Ravasi2021) was then constructed, showing the frequency with which palliative care nurses’ goals and spiritual care understandings co-occur across nurses. The number of participants who expressed a particular goal and who had a particular understanding of spiritual care was calculated and entered in each cell of the co-occurrence table. Chi-square goodness-of-fit tests were initially planned to test for patterns between goals and spiritual care understanding.

Results

The 21 participants who responded to the survey were experienced palliative care nurses, and all were female. Table 3 shows the sample characteristics. Four categories of goals emerged, described in Table 4:

Table 3.

Characteristics of participants (N = 21)

All 21 nurses were female; nursing experience was mostly more than 20 years with 11 nurses, and spiritual care was often or very often for 20 nurses. See long description.
Table 3 Long description

Characteristics are reported as counts under the column header, Number of nurses, with a separate line showing, n. Nursing experience counts were 0 for less than 2 years, 0 for 2 to 5 years, 2 for 6 to 10 years, 8 for 11 to 20 years, and 11 for more than 20 years. Palliative care experience counts were 3 for less than 2 years, 1 for 2 to 5 years, 8 for 6 to 10 years, 6 for 11 to 20 years, and 3 for more than 20 years. Sex counts were 0 male and 21 female. Frequency of spiritual care counts were 1 sometimes, 15 often, and 5 very often.

Table 4.

Goal content categories

Four goal labels pair brief descriptions with quotations, covering patient wellbeing, patient family wellbeing, task performance, and self oriented satisfaction. See long description.
Table 4 Long description

Two columns list a goal label with its description, and an illustrative quotation. Patient wellbeing is described as achieving positive thoughts, feelings or experiences for patients, with quotations: Give patient comfort and peace; Giving value to life at the time of death is very important to the dying person; A sense that theyre not alone. Patients family wellbeing is described as achieving positive thoughts, feelings or experiences for the patients family, with quotations: Help the patient and family find peace; A lasting memory for the loved ones left behind; Comfort and support for family which includes patient. Task performance is described as fulfilling the task of caring to a certain level of performance, with quotations: Trying to make our care relevant and helpful to their needs; To show that we care about all aspects of their wellbeing; To provide holistic care, ensure nothing is overlooked or forgotten. Self oriented is described as achieving certain feelings or experience within the self, with the quotation: Seeing patients in a more settled state spiritually and emotionally brings great job satisfaction. Some quotations include brace marks around words to indicate categorisation notes.

{…} denotes that the enclosed patient-related goal was categorized under the patient well-being goal.

  • • patient well-being – to help achieve positive thoughts, feelings, or experiences in the patient);

  • • patient’s family well-being – to achieve positive thoughts, feelings, or experiences for the patient’s family;

  • • task performance – to fulfill the task of caring to a certain level of performance; and

  • • self-oriented – to achieve certain feelings/experience within the self.

Table 5 shows the co-occurrence matrix. It eventuated that most cell sizes were too small to conduct goodness-of-fit tests; only the first goal met the minimum cell size requirement (i.e., expected value of 5; Newbold Reference Newbold1988), and only by combining Models A and B, and Models C and D cells. The chi-square test for this goal was not significant; that is, the goal of patient well-being was equally likely to be mentioned by Models A and B groups combined as Models C and D groups combined.

Table 5.

Distribution of goals within the palliative care sample

Patient wellbeing was the most cited goal, with 18 respondents overall and counts of 1 in model A, 7 in B, 6 in C, and 4 in D. See long description.
Table 5 Long description

Goals are listed by spiritual care model A, B, C, and D, with sample sizes of 1, 7, 9, and 4, plus a column for number of respondents mentioning goal and a chi-square statistic column. Family wellbeing has counts of 0 in A, 2 in B, 1 in C, and 3 in D, with 6 respondents overall; the chi-square statistic cell shows c. Task performance has counts of 0 in A, 1 in B, 3 in C, and 0 in D, with 4 respondents overall; the chi-square statistic cell shows c. Self-oriented has counts of 0 in A, 0 in B, 1 in C, and 0 in D, with 1 respondent overall; the chi-square statistic cell shows c. For patient wellbeing, the chi-square statistic cell reads.69, p.41 with footnote markers a and b.

a Total number in this column is greater than 21 due to respondents mentioning multiple goals.

b This statistic was obtained by combining responses of Models A and B groups, and Models C and D groups.

c This statistic could not be calculated due to small cell sizes.

In the absence of statistical information, resort was then made to visual inspection of Table 5. A clear pattern of goal distribution across the spiritual care models is not visually apparent. (A visual inspection of this Table may give the impression that task performance is more likely to be mentioned by Model B or C group, but non-zero numbers appear in these cells only because these 2 groups are the largest; similar reasoning applies to the self-oriented goal apparently being more likely to be mentioned by Model C).

Discussion

This study elicited 4 types of self-identified goals that palliative care nurses have for spiritual care: patient well-being, family well-being, task performance, and self-oriented goals. These goals are characterized by greater variety than implied by prescriptive spiritual care models/guides that assume some type of patient well-being goal (Nagai-Jacobson and Burkhardt Reference Nagai-Jacobson and Burkhardt1989; Lasair Reference Lasair2019; Taylor Reference Taylor2021; Ghorbani et al. Reference Ghorbani, Mohammadi and Ramezani2025). A comparison of results from the current study and the review (Mascio et al. Reference Mascio, Best and Lynch2021) – shown in Table 6 – has implications for our understanding and study of the motivations of palliative care nurses.

Table 6.

A comparison of goals obtained in the systematic review (Mascio et al. Reference Mascio, Best and Lynch2021) and the current study

Most goals differ between studies: family wellbeing and task performance appear only in the current study, while relationship, empathy, and colleague-related appear only in the review. See long description.
Table 6 Long description

Rows list eight goals and compare whether each goal appears in the systematic review column and the current study column, plus a consistency column and a possible reason column. Patient wellbeing is marked present in the review as facilitators and barriers, and present in the current study as facilitators only, with consistency listed as partially concordant; the reason text includes both concordance and discordance statements. Family wellbeing is marked absent in the review and present in the current study, with consistency listed as discordant and a reason referencing family and patient as the unit of care. Task performance is marked absent in the review and present in the current study, with consistency listed as discordant and a reason referencing spiritual care as essential in palliative care. Self-oriented is marked present in the review as facilitators and barriers, and present in the current study as facilitators only, with consistency listed as partially concordant and a reason contrasting curative focus settings with palliative care settings. Relationship, empathy, and colleague-related are each marked present in the review and absent in the current study, each with consistency listed as discordant and reasons that the goal elicitation wording in the current study may not have elicited them, with colleague-related also noting the question focused on patients. Performance improvement is marked absent in both studies, with consistency listed as concordant and a reason stating improvement motivation may appear as improving care rather than personal performance.

a A dashed check mark (✓) indicates goal is present as a facilitator but not a barrier.

The most commonly cited goal in the current study was patient well-being, with 18/22 nurses mentioning this goal. This goal was also the most frequently reported goal in the review (Mascio et al. Reference Mascio, Best and Lynch2021), reported by 16 of the 25 studies mentioning a goal. That this goal is the most common in both studies is not surprising because all nursing care aims to promote patient health and well-being (Hedlund Reference Hedlund2025). One difference between the review and the current study is that the former uncovered patient-oriented goals that acted as facilitators and barriers to spiritual care, while the current study found only facilitators. Example barriers identified by the review include: a desire to help patients recover from illness (Guedes Fontoura and De Oliveira Santa Rosa (Reference Guedes Fontoura and De Oliveira Santa Rosa2013), who studied nurses in a long stay unit of a general hospital) and an unwillingness to support or respond to spiritual/existential/religious need (Kuuppelomaki (Reference Kuuppelomaki2001), who studied nurses in inpatient wards in community health centers). One possible explanation for this difference could be that studies included in the review sampled nurses from contexts that normally have a curative focus and in which caring for dying patients can be stressful (Peterson et al. Reference Peterson, Johnson and Halvorsen2010). The current study, however, sampled nurses working in palliative care in which spiritual care of patients at end-of-life is an integral part (Gijsberts et al. Reference Gijsberts, Liefbroer and Otten2019).

The next most common goal was family well-being, reported by 6/22 nurses in our sample. This goal, however, did not emerge as a separate goal category in the review. This discrepancy may reflect the inherent palliative care perspective that sees family members and patients as the unit of care (Edwards et al. Reference Edwards, Pang and Shiu2010). Similarly, a task performance goal emerged as a goal in the current study but did not emerge as a separate goal category in the review. This disparity may again reflect the palliative care perspective that spiritual care is an essential part of palliative care (Gijsberts et al. Reference Gijsberts, Liefbroer and Otten2019). These disparities highlight the benefit of conducting discipline-specific studies.

A self-oriented goal emerged as a goal in the current study. Self-oriented goals were also reported in the review (Mascio et al. Reference Mascio, Best and Lynch2021), but the review uncovered self-oriented goals that acted as facilitators and barriers to spiritual care (e.g., striving to avoid potential anxiety about their own suffering/dying in Tornøe et al. (Reference Tornøe, Danbolt and Kvigne2015), who studied nurses in a general hospital), while the current study found only facilitators. As explained above, this difference may arise from care of the dying being stressful in curative contexts (Peterson et al. Reference Peterson, Johnson and Halvorsen2010) but an integral part of palliative care.

At first glance, the self-oriented goal – as well as the task performance goal – do not seem patient-centered in the conventional interpretation of patient-centered, i.e., as ensuring that patients’ preferences, needs, and values guide all clinical decisions (Committee on Quality Health Care in America 2001). However, close examination of the wording of the goals shows that they are in fact based on achievement of patient well-being. This blending of 2 disparate goals illustrates a concept in psychological theory called goal conflation, which arises from how goals are structured. Goals are commonly viewed as existing in a hierarchical framework (Carver and Scheier Reference Carver and Scheier1998), with a small set of superordinate goals at the top of the hierarchy that provide general organization for subordinate goals and orientation in life and over time. Beneath the highest-order goals are subgoals, which in turn cascade further into additional subgoals, with lower-level goals often contributing to the achievement of higher-level goals. Goals lower in the hierarchy tend to be more concrete and have a shorter time horizon than higher-level goals (cf. Austin and Vancouver Reference Austin and Vancouver1996).

Furthermore, psychological goal theory recognizes that many goals may be influencing individuals at any one time, but only a few are present in working memory at any one time (Austin and Vancouver Reference Austin and Vancouver1996), so that when individuals are asked to state their goals they respond only with goals that are salient at the time. For example, a person driving a car may say only that their goal is to arrive at the shops, but a sub-goal would almost definitely be to avoid accidents, which is not salient at the time of responding. Goal theory therefore suggests that, due to goal conflation, when nurses do not explicitly mention patient well-being as a goal, this does not necessarily mean that they do not strive to achieve patient well-being – that goal may simply be cascaded to another goal (such as task performance) which is a salient goal at the time of responding. This cascading of goals is adroitly seen in the quote “Seeing patients in a more settled state spiritually and emotionally brings great job satisfaction” – in this quote, the nurse does aim to have patients in a more settled state, but she described the self-benefit derived from achieving this goal.

The self-oriented goal requires an additional comment. The spiritual care literature tends to present personal gain in a disapproving way, as if it is unethical to ever have such a goal. For example, “Caregivers should … not be … concerned about personal gain” (Roloff Reference Roloff and Grung2022, p. 81); “Personal gain must have nothing to do with my nursing; spiritual care is not about me in any way” (Schoonover-shoffner Reference Schoonover-shoffner2011, p. 187); “such an approach would likely be self-serving, self-glorifying, and for personal gain” (Taylor Reference Taylor2011, p. 196). However, there are several reasons that warrant a more nuanced view of self-oriented goals. Several psychological goal theories have as their highest goal level a “self-ish” goal, such as happiness (Ferguson and Sheldon Reference Ferguson and Sheldon2013) and optimized personal meaning (Royce and Powell Reference Royce and Powell1983). Furthermore, positive personal feelings, meaningful work, and satisfaction with being part of a patient’s life act as personal rewards that facilitate nurses’ spiritual care (Mascio et al. Reference Mascio, Best and Lynch2021) – which helps patients. As well, the personal rewards (or self-benefits) of working in palliative care (e.g., feelings of usefulness, spiritual and personal growth) could contribute to palliative care professionals having lower levels of burnout than professionals working in other settings, despite being exposed to numerous stress factors (Parola et al. Reference Parola, Coelho and Cardoso2017). Based on this discussion, future work could explore more fully nurses’ goal structures when providing spiritual care, to help determine exactly when self-benefit goals are unethical.

The positive effects of self-oriented goals may have a practical benefit for nurses working in non-palliative areas and who feel their workplaces do not support spiritual care. Some studies of nurses’ barriers to spiritual care in general and in intensive care units report a lack of motivation to provide spiritual care due to salaries and other external benefits not supporting such care (Zakaria Kiaei et al. Reference Zakaria Kiaei, Salehi and Moosazadeh Nasrabadi2015; Momeni et al. Reference Momeni, Hashemi and Hemati2022). Momeni’s study concluded that “One of the most important factors in improving the quality of [spiritual] care, that nurses placed great emphasis on, was improving their salaries and benefits” (Momeni et al. Reference Momeni, Hashemi and Hemati2022, p. 578). In this kind of work situation, highlighting the potential self-oriented benefits of providing spiritual care could compensate somewhat for the lack of external benefits (cf. Morgan et al. Reference Morgan, Dill and Kalleberg2013) and encourage spiritual care to be provided.

Further comparison of the systematic review and the current study highlights that the former identified goals that the current study did not: relationship goals (e.g., an aim to create sense of communion and security with patient; Karlsson et al. Reference Karlsson, Kasén and Wärnå-Furu2017), empathy goals (e.g., a desire to understand the patient’s thoughts and feelings; Carroll Reference Carroll2001), and colleague-related goals (e.g., an intention to use the expertise of team members; Pittroff Reference Pittroff2013). It is plausible that these goals are sub-goals appearing lower in the goal hierarchy and thus act as a means of achieving the major goal of spiritual care. This possibility is illustrated by a finding in Carroll’s study (Reference Carroll2001): “The nurses demonstrated that they were able to help the spiritually distressed patient through … a genuine desire to understand the patient’s thoughts, feelings and self-evaluations” (p. 91); this statement suggests that the ultimate goal is to help the spiritually distressed patient and that a means of achieving this is through a desire to understand the patient’s thoughts, etc. Future research could explore the organization of multiple goals within and between persons.

At this point, the question should be asked why the review identified these goals and the current study did not. One answer may be that these differences are a method artifact. The review extracted goals from studies in which nurses described personal experiences of providing spiritual care (Karlsson et al. (Reference Karlsson, Kasén and Wärnå-Furu2017) asked participants to “… describe situations and experiences in end-of-life care … where they had been affected emotionally, as well as how they acted and reacted when caring for patients …” [p. 161]); this question may have encouraged participants to talk about specific actions and corresponding goals. On the other hand, the current study asked a broad question about what nurses were trying to achieve in spiritual care generally and was not tied to particular instances or patients, and so this question may have elicited more general, or higher-order, goals. This possibility – which should be tested by future research – is supported by empirical studies of the effect of question wording that found that different ways of wording goal elicitation questions produce different levels of goal specificity (Milyavskaya et al. Reference Milyavskaya, Leduc-Cummings and Carnrite2022; Scalia et al. Reference Scalia, van Deen and Engel2022).

A noteworthy absence in both the systematic review and the current study is a goal such as “improving my performance in spiritual care.” According to Ericsson (Reference Ericsson2009), a renowned researcher in expertise and human performance, a motivation to improve is an essential component of expertise development. This absence may thus give an impression that nurses do not strive to enhance their performance in spiritual care. However, it is highly unlikely that nurses do not strive to improve, so this compels the exploration of a reason for this absence. Notice that all the quotes in the task performance goal in Table 4 focus on care: “Trying to make our care relevant …,” “To show that we care about all aspects of their wellbeing” and “To provide holistic care, ensure nothing is overlooked.” Notice also that 2 of these goals refer to absolute or extreme quantities: “… all aspects of their wellbeing” and “… ensure nothing is overlooked …” A similar finding of an apparent absence of focus on competence development was observed by van de Wiel et al. (Reference van de Wiel, van den Bossche and Janssen2011), who studied how physicians learn in the workplace; they found that “… activities contributing to learning in medical practice seem inherent to the job of providing high-quality patient care, rather than motivated by competence improvement goals” (p. 91). Based on this discussion, we posit that the motivation component of expertise development in a care context is a goal whose object of improvement is not “my performance” (a self-oriented focus) but on making “my care” the best (a relational focus).

Let’s turn now to the relationship between goals and the spiritual care model. We found that the goal of patient well-being was equally likely to be mentioned by Models A and B groups combined as Models C and D groups combined. In other words, nurses practicing Model A or B behaviors had the same goal of patient well-being as nurses practicing Model C or D behaviors. On a practical level, this result is not surprising as all nursing care aims to promote patient health and well-being (Hedlund Reference Hedlund2025). On a theoretical level, however, this result seems inconsistent with the psychological maxim that goals influence behaviors (Austin and Vancouver Reference Austin and Vancouver1996) and that different goals are pursued in different ways (Grant and Gelety Reference Grant, Gelety, Moskowitz and Halvorson2009): if nurses practice different behaviors of spiritual care, it is reasonable to expect that they would have different goals. A possible explanation for this inconsistency is that the wording of the goal-elicitation question in the current study evoked higher-order goals that are unrelated to specific spiritual care behaviors, which may be more influenced by lower-order goals. This explanation is bolstered by a finding in our previous study (Mascio et al. Reference Mascio, Lynch and Phillips2023) that found that spiritual care models differed in the purpose of the spiritual encounter, or what the nurse aimed to achieve in specific encounters with the patient. The nurse’s purpose in Models A and B is the completion of an immediate specific task, and in Models C and D is to further a process of spiritual journeying and relationship-building with the patient (Mascio et al. Reference Mascio, Lynch and Phillips2023). It appears, then, that purpose may be a goal, which resides lower in the goal hierarchy than the goal of patient well-being, and which does influence behavior. Future work could examine this idea.

Limitations

While a comparison of goals obtained via a systematic review and via direct questioning of nurses yielded several insights, several method-related factors limit the representativeness of data and interpretation of results. The use of a small convenience sample of palliative care nurses means that the representativeness of respondents is unknown. The small sample size allowed statistical testing of only the patient well-being goal and only by combining Models A and B groups and Models C and D groups. Future research should examine a larger representative sample to enhance the external validity of findings and allow the use of more robust statistical tests.

Conclusion

This study uncovered 4 self-identified goals that palliative care nurses have for spiritual care: patient well-being, family well-being, task performance, and self-oriented goals. A comparison of results from the current study and the review enhances our understanding of the motivations of palliative care nurses.

Acknowledgments

We thank D. Isaac for research assistance in completing this project.

Funding

The University of Notre Dame Australia supported the project financially.

Competing interests

None.

Ethical approval

The University of Notre Dame Australia gave ethical approval for the initial survey.

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Figure 0

Table 1. Goals that influence the behaviors of nurses providing spiritual care for dying patients (adapted from Mascio et al. 2021)Table 1 long description.

Figure 1

Table 2. Models of spiritual care (Mascio et al. 2023)Table 2 long description.

Figure 2

Table 3. Characteristics of participants (N = 21)Table 3 long description.

Figure 3

Table 4. Goal content categoriesTable 4 long description.

Figure 4

Table 5. Distribution of goals within the palliative care sampleTable 5 long description.

Figure 5

Table 6. A comparison of goals obtained in the systematic review (Mascio et al. 2021) and the current studyTable 6 long description.