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Spirituality Research


Spirituality within healthcare has been a strong research theme at USW for the last 15 years. The research team and partners span a variety of disciplines (nursing, midwifery, chaplaincy, psychotherapy) reflecting the many professions involved in providing true holistic care for individuals facing life’s many challenges such as illness, loss or change. 


  • Spirituality will be an integral part of peoples’ care reflected in: the admission assessment; care planning and delivery; the Nursing & Midwifery Council ‘Code’ of professional standards and practice.
  • Spirituality will be a core element of all undergraduate nursing, midwifery, medical and allied health education programmes.
  • Healthcare chaplains will be equal partners within multidisciplinary healthcare teams.


  • To raise awareness with the caring professions, policy makers, health providers and professional bodies about the importance of peoples’ spirituality for their health, wellbeing and quality of life and to conduct high quality research that promotes and enhances that.
  • To ensure that the education nurses/midwives and other healthcare staff receive to equip them to provide spiritual care is underpinned by world leading research evidence. 
  • To foster opportunity for interdisciplinary discussion, debate, and sharing of ideas relating to the study of spirituality and best practice.


    Our ground-breaking research has identified important new knowledge on how to prepare and assess undergraduate nurses/midwives for spiritual care. We pioneered the first usable spiritual care competencies, identified what helps students learn and reached consensus on how spirituality and spiritual care are defined for nurse/midwifery education across Europe. 

    Our research is raising awareness of the importance of spiritual care with the UK regulatory body the NMC and amongst nurses/midwives globally; in Poland for the first time and in Brazil, China, Venezuela, USA, Canada, Kenya.

    What's more, it has changed and enhanced education, policy, and practice of nursing, midwifery and other health care professions in Wales, England/UK and Europe.  Examples of impact iclude:

    • Pre-registration nursing/midwifery students in Wales, England, Ireland, Austria, Poland, Netherlands, Norway, Malta, Portugal are now taught about spirituality using our research outputs, which is helping them to provide more person-centred care: 

    • Practising nurses in Wales, Ireland, Netherlands, Austria and England, and psychotherapists in Kenya are being taught about spiritual care using our research outputs. A tool designed to help nurses provide spiritual care is supporting UK organ donation teams in difficult end of life discussions with families. The Royal College of Nursing’s spiritual care educational resources are also being updated in light of this research evidence.

    EPICC launch July 2019, Cardiff - Vaughan GethingVaughan Gething, Welsh Minister for Health and Social Services, EPICC launch 2019

    Spiritual Education Research

    Project TeamProfessor Linda Ross (USW), Professor Wilfred Mcsherry (Staffordshire University, Visiting Professor USW), Rene van Leeuwen (Viaa University Netherlands), Josephine Attard (University of Malta), Tove Giske (VID University Bergen Norway), Tormod Kleiven (VID University Oslo Norway). Participants.

    Stakeholders include:

    • England NHS England, Public Health England.
    • Norway Norwegian Nursing Association.
    • Netherlands Danish Ethical Board, Dutch Higher Education Board.
    • Republic of Malta Nursing & Midwifery Board.
    • UK RCN, NHS Chaplaincy.
    • Wales Welsh Government (Chief Nursing Officer), Health Education Improvement
    • Wales (HEIW), Social Care Wales, Executive Nurse Directors (ENDs), Council of
    • Deans Wales (CoD), students.

    Funded by: Erasmus+ Key Action 2 Strategic Partnerships for Higher Education.

    The aim of the EPICC Project  (December 2016-August 2019) was to establish best practice in spiritual care education across Europe. 31 nurse/midwifery educators from 21 European countries and over 60 stakeholders co-produced six important novel outputs:

    1) Agreed definitions of ‘spirituality’ and ‘spiritual care’ for nurse/midwifery education for Europe.

    2) Four core spiritual care competencies (‘Spiritual Care Education Standard’), from the 54 identified by Attard et al 2019, for assessing student nurses/midwives

    3) Gold Standard Matrix for Spiritual Care Education outlining factors helping/hindering spiritual care competency development from the pilot and longitudinal studies above.

    4) Toolkit with activities to support student teaching and learning.

    5) Network and 6) Website for sharing best practice.

    Impact in Wales

    The EPICC Standard has been adopted across all pre-registration nursing programmes from September 2020

    Nursing students will be assessed through the Once  for Wales 2020 All Wales Practice Assessment Document and Ongoing Record of Achievement for Pre-registration Nursing Programmes

    EPICC outputs are helping to preparing student assessors.

    The EPICC Standard is a mandatory requirement of the new midwifery curricula and of the 2022 Health Education Improvement Wales commissioned pre-registration contracts for paramedicine, dietetics, physiotherapy, occupational therapy, speech and language therapy, podiatry, diagnostic radiography and therapeutic radiotherapy and oncology, operating department practitioners, physicians associates and all PTP healthcare science programmes.

    A tool from the EPICC Toolkit (2Q-SAM, Ross & Mcsherry 2018) is helping the South Wales Organ Donation Team to provide more compassionate person-centred care and to manage extremely challenging conversations around end of life, including organ donation and the COVID-19 pandemic.

    The EPICC outputs are helping to better prepare pre and post registration nursing, midwifery and allied health students for person-centred spiritual care at universities in Austria, Netherlands, Poland, Norway, Malta, Portugal, Kenya. Nurse/midwifery educators from six continents are using the outputs in a variety of ways.

    We are liaising with the RCN, an EPICC stakeholder, about updating the 2011 RCN spiritual care resources in light of EPICC’s evidence.

    Impact on policy

    The EPICC outputs are included in the following policies:

    The University Hospitals of North Midlands NHS Trust 2019 Spiritual Care Policy Document adopts the EPICC Standard

    The UK Board of Healthcare Chaplains (2020) Spiritual Care Competences for Healthcare Chaplains p33 adopts the EPICC Standard for non-specialist spiritual care givers, specifically nurses.

    The European Association of Palliative Care White Paper for the education of multidisciplinary palliative care practitioners across Europe promotes 2Q-SAM (Ross & Mcsherry 2018) from the EPICC Toolkit as ‘a really effective tool enabling people to provide spiritual care’.


    Mcsherry W, Ross L, Attard J, van Leeuwen R, Giske T, Kleiven T, Boughey A and the EPICC Network. (2020) Preparing undergraduate nurses and midwives for spiritual care: Some developments in European education over the last decade 2020

    Ross L, Holt J, Moene Kuven B, Ørskov B, Paal P. Educational context, evidence and exploration of professional fields of nursing and midwifery. In McSherry W, Boughey A, Attard J (Eds) Enhancing Nurses’ and Midwives’ Competence in Providing Spiritual Care through Innovative Education and Compassionate Care. Springer, Switzerland. Coming out 2021

    van Leeuwen R, Attard J, Ross L, Boughey A, Giske T, Kleiven T, McSherry W (2020) The development of a European consensus based Standard in spiritual care competencies for undergraduate nurses and midwives. Journal of Advanced Nursing. 

    Mcsherry W and Ross L (2020) Enhancing and advancing spiritual care in nursing and midwifery practice. Florence Nightingale series of RCN Fellow articles. Nursing Standard. 

    McSherry W, Ross L, Attard J, van Leeuwen R, Giske T, Kleiven T, Boughey A and the EPICC Network. (2020) Preparing undergraduate nurses and midwives for spiritual care: some developments in education over the last decade. Journal for the Study of Spirituality.  

    Jennifer Trueland (2018) Patients’ spiritual needs: the conversations that can help. Nursing Standard. 33, 9, 74-77.  

    Interview by Jennifer Sprinks for Nursing Standard on the omission of spirituality from the NMC Code. Sprinks J (2015) What about nursing’s ‘fourth dimension’? Nursing Standard, 29(44), pp 22-23

    Ross L, Mcsherry W. (2018). The power of two simple questions. Nursing Standard. 33, 9, 78-80

    Ross L, Mcsherry W. (2018). Two questions that ensure person-centred spiritual care. Nursing Standard.

    Project staff: Josephine Attard (PhD student 2011-2015, Midwifery Lecturer University of Malta), Professor Linda Ross (DOS), Maggie Kirk (Supervisor), Keith Weeks (Advisor).

    Funded by the Universities of South Wales and Malta. 

    The study developed the first Spiritual Care Competency Framework (54 items) for student nurses/midwives informed by international evidence (in-depth literature review), stakeholders and spiritual care experts (modified Delphi). It paved the way for the European wide EPICC project which followed. 


    Triggered the EPICC Project providing evidence on which to base it.


    Attard J (2015) Design and validation of a framework of competencies in spiritual care for nurses and midwives: a modified delphi study. Unpublished PhD thesis, USW

    Attard, J., Ross, L. Weeks, K. (2019) Developing a spiritual care competency framework for pre-registration nurses and midwives. Nurse Education in Practice.

    Attard, J., Ross, L. Weeks, K. (2019) Design and development of a spiritual care competency framework for pre-registration nurses and midwives: a modified Delphi study. Nurse Education in Practice

    Project staff: At VID University Bergen Norway: Tove Giske, Professor Wilfred Mcsherry, Charlotte Delmar,  Linda Rykkje, Britt Haugland. 

    Professor Linda Ross (USW). Pamela Cone, Azusa Pacific University, CA. Rene van Leeuwen, Viaa University, the Netherlands

    Funded by VID Specialized University Bergen Excellence in Research fund.

    The project objective is to develop new and innovative approaches to clinical teaching and learning of spirituality within the undergraduate nursing program, as well as developing practice to foster environments that promote spiritual and holistic patient care.


    Five work packages including:

    • Scoping review of literature related to nursing students’ spiritual care learning in clinical studies
    • Two PhD studentships to develop innovative teaching programmes for nurses in nursing homes and in mental healthcare settings.
    • Develop a self assessment spiritual care competency questionnaire based on the EPICC Framework, to help students and assessors to assess their competency .
    • Build on above to develop a spiritual care education nursing program in Haiti.

    A multinational longitudinal investigation of student nurses’ and midwives’ perceptions of spirituality and competence in delivering spiritual care 2011-2015

    Led by: Professor Linda Ross (USW), Professor Wilfred Mcsherry (Staffordshire University, Visiting Professor USW), Rene van Leeuwen (Viaa University Netherlands), Donia Baldacchino (University of Malta), Tove Giske (VID University Norway).

    Supported by: Dr Paul Jarvis (USW) and Annemiek Schep-Akerman (Viaa University Netherlands), Tibertius Koslander (Halmstad University Sweden), Jenny Hall (University of West of England UK), Vibeke Østergaard Steenfeldt (University College Absalon Denmark)

    Aru Narayanasamy (University of Nottingham), Beth Seymour (Glasgow Caledonian University).

    University staff from the following universities who additionally collected data: University College Zealand in Denmark, 5 universities in the Netherlands (Viaa Christian University of Applied Sciences in Zwolle, Christian University of Applied Sciences in Ede, Saxion

    University of Applied Sciences in Deventer and Enschede, University of Applied Sciences in Amsterdam) and at the 8 universities in Norway (Haraldsplass diakonale høgskole, Betanien diakonale høgskole, Høgskolen i Bergen, Høgskulen i Sogn og Fjordane, Høgskulen Stord

    Haugesund, Diakonova, Diakonhjemmets høgskole). 

    Funded by: Royal College of Nursing

    First multinational longitudinal prospective study (2011-2015) commencing with 2193 students from 21 universities in 8 countries confirming the findings from the cross-sectional pilot study. Other important findings were that spiritual care competency develops over time which students attributed to caring for patients, personal life events and teaching/discussion. Even students with low SCC scores improved. 


    Provided new evidence on which to base the EPICC Project.


    Ross L, Mcsherry W, Giske T, van Leeuwen R, Schep-Akkerman A, Koslander T, Hall J, Østergaard Steenfeldt V, Jarvis P (2018) Nursing and midwifery students’ perceptions of spirituality, spiritual care, and spiritual care competency: a prospective, longitudinal, correlational European study. Nurse Education Today, 67, 64-71.

    Clinical Care Research

    Project staff: Professor Linda Ross, Jackie Miles, Dr Paul Jarvis, Sara Pickett 

    Funded by Nevill Hall Thrombosis and General Research Fund 

    People with advanced heart failure (AHF) experience substantial spiritual needs. Spiritual interventions may enhance quality of life and reduce anxiety and depression, but studies are limited and none have focused exclusively on the AHF patient population. 

    This is the first feasibility randomised controlled trial (RCT) to ascertain the clinical and cost effectiveness of a spiritual intervention (spiritual support) in AHF patients.

    47 AHF patients randomised to control (standard care, n=25) or intervention (standard care plus spiritual support, n=22) groups. Spiritual support consisted of a 1-hour discussion facilitated by trained volunteers using a ‘Spiritual Enquiry Tool’ at two monthly intervals over six months. Participants completed validated measures of spiritual wellbeing, depression/anxiety and health related quality of life (QoL). Purpose designed questionnaires gathered information on demographics, NHS resource use, confounding factors and satisfaction with spiritual support.

    Results: spiritual support was highly valued by the 20 AHF patients randomised to receive it. Non-significant benefits of improved quality of life, reduced anxiety and cost savings require further investigation in a definitive trial.

    Key message

    Researchers must weigh up if the cost of running a well-designed trial of this nature is justified in the current economic climate where funding bodies are looking for value for money.


    Miles J (nee Austin), Ross L, Jarvis P, Pickett S. (2020) Spiritual support in end stage heart failure: a randomised controlled feasibility study. Journal of Health and Social Care Chaplaincy. 

    Ross L, Miles J (2019) Spirituality in heart failure: a review of the literature from 2014-2019 to identify spiritual care needs and spiritual interventions. Current Opinion in Supportive and Palliative Care. 

    April 2019-March 2022, KESS PhD studentship.

    Project staff: Marla Forrest (PhD student), Professor Linda Ross (DOS), Dr Anne-Marie Coll (Supervisor), Jackie Miles (Supervisor, Visiting Professor USW and Lead Nurse for Research - Heart Failure and Cardiac Rehabilitation ABUHB), Professor Wilfred Mcsherry (Advisor, Visiting Professor Staffordshire University).

    In Wales, the Health & Care Standards (2015) put person centred holistic care at the centre; spiritual care is a key aspect but nurses encounter challenges in providing it. For example nurses report feeling unprepared for spiritual care. Admission forms have a tendency to focus on religion/religious needs rather than broader spiritual needs, immediately excluding a large proportion of the population. This section of the form is frequently left blank meaning that the religious and non-religious spiritual needs of people may not be identified, and the resources which support them when well, therefore, may not be available to support them when facing uncertainty, illness, or death. 

    This study aims to identify how the spiritual needs of patients in NHS Wales can be better supported by nurses. A scoping review of the literature from 2010 to 2020 is underway to identify new initiatives for better supporting patients’ spiritual needs; the findings will shape the next stage of the study.

    Project staff: Professor Linda Ross, Jackie Miles (Visiting Professor USW, Lead Nurse for Research - Heart Failure and Cardiac Rehabilitation ABUHB)

    The study was funded by the Nevill Hall Thrombosis & General Research Fund.

    At this time (2006-2008) most research had focused on the spiritual care needs of cancer patients; few studies had focused on the needs of people dying from non-cancer conditions such as advanced heart failure. 

    This qualitative serial interview study explored the spiritual needs and spiritual support preferences of 16 end-stage heart failure patients and their carers in Aneurin Bevan University Health Board between 2006-2008. 

    Patients and their carers were interviewed at three-monthly intervals up to one year, 47 interviews) and were found to be struggling with spiritual/existential concerns alongside the physical and emotional challenges of their illness. These related to: love/belonging; hope; coping; meaning/purpose; faith/belief; and the future. As people’s condition deteriorated, the emphasis shifted from ‘fighting’ the illness to making the most of the time left. Spiritual concerns could have been addressed by: having someone to talk to; supporting carers; and staff showing sensitivity/taking care to foster hope. 

    Participants said they wold value a spiritual support home visiting service. Following a focus group/consultation with stakeholders, funded by HEFCW Collaborative Third Mission Fund, it was decided to seek funding to test the provision of such a service.

    The project paved the way for further studies in this area.


    Ross L and Austin J (2015) Spiritual needs and spiritual support preferences of people with end stage heart failure and their carers: implications for nurse managers. Journal of Nursing Management, 23, 1, 87-95

    A presentation of this research was given a top rating by delegates at the British Association for Cardiovascular Prevention and Rehabilitation Annual Conference in Manchester in 2015.

    Project staff: Austyn Snowden (Edinburgh Napier), Professor Linda Ross (USW), Professor Wilfred Mcsherry (Staffordshire), John Swinton (University Aberdeen)

    The 2019 project for NHS Education Scotland reviewed and revised the Scottish Standards, Competencies and Capabilities for spiritual care and provided a course outline for training health care chaplains.

    Project staff: Austyn Snowden (Edinburgh Napier), Professor Linda Ross (USW), Professor Wilfred Mcsherry (Staffordshire), George Kernohan (Ulster Uni), NHS Education Scotland, 

    Commissioned by Chief Scientist Office Scotland. March-September 2019. 

    The professional status of UK healthcare chaplains remains partial, with voluntary accreditation effective in achieving around 50% registration. This study set out to elicit reasons for this by surveying healthcare chaplains working in Scotland. 

    An online survey was created to gather demographic details and chaplains’ opinions on the importance of five key elements of professional status: A body of knowledge that underpins practice; A code of professional ethics; An occupational organization controlling the profession; Substantial intellectual and practical training; and provision of a specialised skill or service. 

    Most respondents (38/43) agreed that chaplains should belong to a professional body in order to maintain standards, ensure accountability and formalise professional development. They said that registration reinforced their professional status, added credibility and a clear governance structure to protect the public.

    However, a minority felt disconnected from the professionalisation agenda. This paper discusses the reasons for this. Further UK and international studies into the professional status of chaplains are planned.


    Snowden A, Enang I, Kernohan WG, Fraser D, Gibbon A, Macritchie I, McSherry W, Ross L, Swinton J (2020) Why are some healthcare chaplains registered professionals and some are not? A survey of healthcare chaplains in Scotland. Journal of Health and Social Care Chaplaincy.  

    January 2018-December 2020, KESS PhD studentship 

    Project staff: Professor David Pontin (DOS), Professor Linda Ross (supervisor), Jackie Miles (Supervisor, Visiting Professor USW and Lead Nurse for Research - Heart Failure and Cardiac Rehabilitation ABUHB)

    The study aims to identify which groups engage/do not engage with cardiac rehabilitation in Wales and what helps and hinders engagement in order to identify solutions to enhance uptake and engagement. This is a mixed methods study utilising literature reviews, secondary analysis of an existing cardiac data base and an online staff survey.


    Research Partners

    EPICC Malta


    The EPICC Network is a European network of midwife and nursing educators who share knowledge and skills in spiritual care. The network has reviewed good practice and developed new resources that can be applied to nursing and midwifery education in higher education institutions across Europe. Join the Network and attend the conference on education and research in spiritual care, 27-29 September 2021. Student conference.

    The International Network for the Study Of Spirituality (formerly BASS) is a network of scholars and practitioners with interests in concepts and practices associated with spirituality.  Professor Linda Ross is a founding Executive Committee Member, Membership Secretary and Executive Editor for the affiliated Journal for the Study of Spirituality. Attend the virtual conference on 7-8 June 2021, York St John University.

    All Wales Spirituality, Health and Wellbeing Special Interest Group provides evidence based advice and guidance to Welsh Government on spiritual, faith, beliefs and pastoral matters in relation to health services across Wales; advises on spiritual requirements set out in current legislation in Wales, and encourages partnership between statutory and Third sector organisations. 

    Contact us

    Professor Linda Ross, Professor of Nursing (Spirituality)

    Professor Linda Ross

    The International Network for the Study Of Spirituality (INSS) Spirituality Research


    Aneurin Bevan UHB logo UDIDD

    EPICC Project Professor Linda Ross, Spiritual Education