Introduction

Spiritual care, defined as the aspect of healthcare that addresses the human need for meaning, purpose, and connection in the context of illness and suffering, is a cornerstone of holistic nursing practice [1,2]. Its significance is underscored by the World Health Organization’s recognition of spirituality as a vital component of quality of life [3]. A robust and growing body of evidence demonstrates that patients’ spiritual well-being is positively associated with critical health outcomes, including enhanced coping abilities, improved psychological adjustment, better treatment adherence, and higher overall quality of life [4–6]. For example, a longitudinal study of palliative clients found that structured spiritual care interventions contributed to sustained spiritual well-being over time [5], while a cross‑sectional study among patients with diabetes reported a significant positive association between spiritual wellbeing and treatment adherence [6].Consequently, the ability to competently assess and address spiritual concerns is no longer an optional skill but an ethical and professional imperative for nurses across all clinical settings [7–10].

Despite this clear mandate, a pervasive and well-documented gap exists between the recognized importance of spiritual care and nurses’ readiness to provide it. Global studies consistently report moderate to low levels of spiritual care competence among nursing professionals and students, characterized by deficiencies in knowledge, communication skills, and the confidence to engage in spiritual interventions [11–13]. A recent scoping review and a meta-analysis confirm this troubling trend, highlighting a universal need for effective educational interventions [14,15].

This discrepancy is largely driven by insufficient training, which continues to represent a major barrier to integrating spirituality into routine clinical practice [11,16,17]. Historically, spiritual care education has relied predominantly on conventional, face-to-face formats such as classroom lectures, workshops, and seminars [16,17]. While valuable for foundational knowledge transfer, these models are fraught with systemic limitations that hinder scalability and long-term impact. Key challenges include: (1) Low accessibility and participation: Nurses often face logistical barriers (e.g., shift work, geographical constraints) and low participation rates, sometimes as low as 10%, when training requires time away from clinical duties [11,17,18]; (2) High resource intensity: Traditional programs entail significant costs for instructors, venues, and materials, limiting their sustainability and reach [19,20]; and (3) Pedagogical constraints: These methods often emphasize theoretical content over practical application, offering few opportunities for interactive learning, clinical simulation, or personalized feedback, which are crucial for developing complex relational skills [21–23].

Digital educational technologies, by their very nature, are positioned to address these specific limitations. The digital transformation of healthcare education presents a pivotal opportunity to overcome these barriers. Digital health technologies, encompassing online learning platforms, mobile applications, virtual and augmented reality simulations, and blended learning ecosystems, have revolutionized pedagogical approaches by offering unprecedented flexibility, scalability, and interactivity [24,25]. Several systematic reviews suggest that e‑learning can achieve comparable effects to traditional methods in improving knowledge and skills in nursing education, with potential added benefits in learner engagement and accessibility [24,26,27]. However, the evidence base varies, and findings are not uniformly consistent across all educational contexts or outcome measures. The core strengths of digital interventions, including self-paced learning, just-in-time knowledge access, immersive simulation, and collaborative online communities, align perfectly with the need for continuous, practice-based professional development in spiritual care [28–30].

However, digital education also carries well‑documented risks. Disparities in digital literacy can exacerbate educational inequalities, especially when access to reliable technology or technical support is uneven [24]. The relational depth of face‑to‑face encounters may be diminished in technology‑mediated interactions, raising concerns about the development of empathic communication and therapeutic presence—skills central to spiritual care [31,32]. Engagement and motivation can be difficult to sustain in self‑directed digital formats, particularly when learning demands high levels of reflection or emotional openness [24]. Moreover, digital tools may lack the cultural and contextual sensitivity required to address spiritually nuanced content, as standardised platforms may not easily accommodate diverse religious, philosophical, or personal belief systems. These limitations are especially relevant to spiritual care education, where holistic, person‑centred competence depends heavily on relational practice and contextual understanding.

Nevertheless, the very features, including fixed schedules, geographical constraints, resource intensity, that make traditional spiritual care education inaccessible or unscalable are precisely what digital technologies can mitigate. The key question is not whether digital methods can fully replicate face‑to‑face relational depth, but how they can be designed and deployed to complement existing approaches, reduce barriers to entry, and offer new forms of reflective and simulated practice (e.g., safe repetition of difficult conversations, just‑in‑time knowledge reinforcement). Recognising both potential and perils, a growing number of pioneering studies have begun to explore digital tools specifically for spiritual care education.

Initial implementations range from online courses delivered via platforms like Zoom [33,34] to mobile apps for spiritual assessment training [35] and virtual simulations for practicing difficult conversations [36,37]. Preliminary findings are promising, suggesting positive impacts on learners’ spiritual care knowledge, self-efficacy, attitudes, and perceived competence [35,38,39].

However, this nascent field is characterized by significant fragmentation and methodological heterogeneity. Existing studies vary widely in their technological approaches (e.g., synchronous vs. asynchronous, standalone apps vs. comprehensive platforms), pedagogical designs, intervention durations, and outcome measures. Crucially, there is a conspicuous absence of a scoping review that systematically maps this heterogeneous landscape specifically for nursing populations. A synthesis is needed to consolidate the characteristics of these interventions, their outcome measures, and their implementation challenges to guide future development and research.

Given nurses’ central role as primary providers of continuous, holistic care and the explicit definition of spiritual care as a core nursing competency [40–42], this scoping review will focus specifically on the population of nursing students and registered nurses. Unlike physicians who primarily concentrate on diagnosis and treatment, or chaplains who hold specialized religious roles, nurses serve as round-the-clock bedside caregivers with the most sustained and direct patient contact [43]. Empirical evidence shows that the frequency and quality of nurse-provided spiritual care are directly associated with patient outcomes, including spiritual well-being, treatment adherence, and overall quality of life [6,8,12]. Moreover, the barriers nurses face, including shift work, heavy clinical workloads, and limited access to traditional training, are distinct from those encountered by other spiritual care providers [11,15]. This focused approach ensures depth, coherence, and practical relevance for the nursing profession. The important topic of interprofessional digital spiritual education is thus identified as a distinct and necessary area for future investigation.

The importance of conducting this scoping review lies in its potential to bridge a critical gap at the intersection of two pressing priorities in contemporary nursing education: the urgent need to strengthen spiritual care competencies and the growing reliance on digital learning modalities. Without a comprehensive synthesis of the existing evidence, educators and curriculum developers risk investing in digital interventions that may not align with the pedagogical demands of spiritual care, a domain that requires relational depth, reflective practice, and cultural sensitivity. By systematically mapping the available literature, this review will provide the foundational evidence needed to guide future educational innovation, resource allocation, and research design in this underexplored area.

To address this critical knowledge gap and inform the future development of evidence-based digital education, this scoping review aims to systematically map and synthesize the existing literature on digital technology-assisted spiritual education and training for nurses and nursing students. Specifically, this review seeks to: (1) Identify and categorize the types of digital technologies and pedagogical strategies employed; (2) Synthesize reported outcomes related to spiritual care competence and the tools used to measure them; (3) Explore the facilitators, barriers, and implementation challenges associated with these digital programs; (4) Highlight key research gaps and methodological limitations to guide future inquiry and innovation. A preliminary search of the PROSPERO international prospective register of systematic reviews and the JBI Evidence Synthesis database (conducted in March 2026) did not identify any existing or ongoing scoping reviews on the use of digital technologies in spiritual care education specifically for nurses and nursing students. This confirms that the proposed review will be the first to systematically consolidate evidence in this area.

Methods

Stage 2: Identifying relevant studies

A systematic and comprehensive search strategy will be developed in consultation with a health sciences librarian. The following electronic databases will be searched from their inception to the present date: PubMed/MEDLINE, Embase, CINAHL Complete, PsycINFO, Web of Science Core Collection, Scopus, the Cochrane Library (including CENTRAL), China National Knowledge Infrastructure (CNKI), WanFang Data, and VIP Database for Chinese Technical Periodicals (VIP). The search strategy will combine controlled vocabulary (e.g., MeSH, Emtree) and free-text keywords related to three core concepts: (1) Population: nurses, nursing students; (2) Intervention: digital technology, e-learning, online education, mobile applications, virtual reality; and (3) Phenomenon of Interest: spiritual care, spiritual education, spirituality. Boolean operators (AND, OR) will be used appropriately. The preliminary search strategy for PubMed is presented in Table 1. This strategy will be adapted for the syntax and functionalities of each database. To minimize publication bias, we will also search for grey literature through Google Scholar, OpenGrey, and relevant professional organization websites (e.g., Sigma Theta Tau International). For grey literature, we will include only documents that provide sufficient methodological detail to assess eligibility (e.g., full conference papers, technical reports, dissertations). For abstracts without full text, we will attempt to contact authors for additional information; if unavailable, the record will be excluded. Furthermore, the reference lists of all included studies and relevant systematic reviews will be hand-searched to identify additional eligible records.

Download:

• PNG
  larger image
• TIFF
  original image

Table 1. Preliminary search strategy for MEDLINE.

https://doi.org/10.1371/journal.pone.0353851.t001

Stage 3: Study selection

All retrieved records will be imported into EndNote X20 (Clarivate Analytics) for deduplication. The remaining unique citations will then be uploaded to the web-based systematic review manager Rayyan [47] for the screening process. Study selection will involve two sequential phases: ① Title and Abstract Screening: Two independent reviewers will screen all titles and abstracts against the pre-defined eligibility criteria (Table 2). Articles deemed potentially relevant by either reviewer will proceed to full-text review; ② Full-Text Review: The full texts of all potentially eligible studies will be retrieved and assessed independently by the same two reviewers against the inclusion/exclusion criteria. Discrepancies at either stage will be resolved through discussion between the reviewers. If consensus cannot be reached, a third senior reviewer will be consulted to make a final decision. To assess inter-rater reliability, Cohen’s kappa coefficient will be calculated. Based on established guidelines, such as the Cochrane Handbook [48], a kappa value of ≥0.60 will be considered acceptable, as this threshold indicates “good” to “substantial” agreement. If the kappa value falls below 0.60, reviewers will discuss discrepancies, refine the screening criteria, and repeat screening on a new sample until satisfactory agreement (≥0.60) is achieved [49].

Download:

• PNG
  larger image
• TIFF
  original image

Table 2. Eligibility criteria for title and abstract screening.

https://doi.org/10.1371/journal.pone.0353851.t002

The study selection process will be documented in detail and presented using a flow diagram adapted from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) statement [46]. The diagram will illustrate the number of records identified from all sources, duplicates removed, records screened at the title/abstract and full-text levels, and studies included in the final review, with specific reasons for exclusions at the full-text stage. The study selection process is anticipated to be completed within two to three months after the search is conducted, depending on the volume of records retrieved.

Discussion

This scoping review protocol outlines a systematic approach to map the emerging evidence on digital technology-enabled spiritual education for nurses and nursing students. By synthesizing intervention characteristics, outcome measures, and implementation factors, this review will generate a comprehensive landscape analysis of the field. The anticipated findings are expected to offer significant theoretical, practical, and policy implications for integrating spirituality into nursing education in the digital age.

The primary contribution of this review will be the creation of a structured evidence map that clarifies the current state of knowledge. By categorizing digital interventions (e.g., online modules, virtual simulations, mobile apps) and linking them to pedagogical strategies and outcomes, this work will help identify effective educational components and mechanisms of impact. Theoretically, it may reveal how specific technological affordances (e.g., interactivity, immersion, asynchronous access) support the development of complex spiritual care competencies, such as reflective practice or empathetic communication. For nursing educators and curriculum developers, the synthesis will provide a practical toolkit of evidence-based digital strategies. It will highlight which approaches show promise for improving specific competencies, potentially informing the design of more engaging, scalable, and cost-effective training programs. For healthcare institutions, insights into implementation barriers and facilitators will be crucial for strategic planning and resource allocation to support staff development in spiritual care.

The rigor of this review is underpinned by its adherence to established scoping review methodology (JBI and PRISMA-ScR guidelines) and its comprehensive, inclusive search strategy. The protocol employs a systematic search across multiple interdisciplinary databases (e.g., CINAHL, PsycINFO, MEDLINE) and includes Chinese databases (CNKI, WanFang) and grey literature, minimizing geographical and publication bias. The use of dual, independent reviewers at all stages (screening, extraction) enhances reliability and reduces error. The decision to employ a scoping review methodology is particularly appropriate for this nascent field, as it allows for the broad inclusion of diverse study designs necessary to map the full scope and nature of available evidence, rather than being limited to narrowly defined interventions for a focused efficacy estimate.

Several limitations must be acknowledged. First, the expected heterogeneity in study designs, intervention types, and outcome measures may preclude definitive conclusions about comparative effectiveness and limit quantitative synthesis. Second, the review’s focus on nurses and nursing students, while justified, excludes other vital spiritual care providers (e.g., chaplains, social workers), potentially overlooking valuable interprofessional educational models. Third, as a review of published literature, its conclusions will be constrained by the existing evidence base, which may lack long-term follow-up data, robust controlled trials, and studies from low-resource settings. Fourth, in keeping with the established purpose and methodological guidance for scoping reviews, this study will not include a formal critical appraisal of individual sources. This feature, common to all scoping reviews, means that the synthesis focuses on describing the volume, nature, and scope of the evidence landscape rather than providing an assessment of the quality or certainty of the findings presented. Consequently, our findings will be presented as a descriptive mapping of available interventions, outcomes, and implementation factors, without making claims about the quality or certainty of the evidence (e.g., we will not state that “high‑quality evidence shows” a particular effect). Moreover, it is important to acknowledge that the available literature on digital education interventions may be subject to publication bias, with studies reporting positive findings more likely to be published. This limitation should be considered when interpreting the breadth and nature of the mapped evidence [24].

Conclusion

This protocol describes a plan to conduct the first comprehensive scoping review dedicated to digital spiritual education in nursing. Despite its limitations, this review is poised to fill a critical knowledge gap by systematically cataloging and analyzing a dispersed body of literature. The resulting evidence map will not only illuminate current practices and their reported outcomes but will also explicitly identify key research priorities. Potential directions for future research may include: 1) developing and evaluating theory-driven digital interventions with explicit pedagogical frameworks; 2) designing rigorous randomized controlled trials with longer-term follow-up to assess sustained competency development; 3) creating and validating technology-sensitive assessment tools for spiritual care skills; and 4) exploring implementation science approaches to scale up successful digital training models across diverse clinical and educational settings. By charting this course, the review aims to catalyze more coordinated, methodologically sound, and impactful research, ultimately fostering the development of spiritual care competence among nurses—supported by appropriate digital solutions—to enable holistic, spiritually sensitive care.

Supporting information