The design and validation of a framework for competencies in spiritual care for nurses and midwives : a modified Delphi study

This study aimed to develop a competency framework in spiritual care for nurses/midwives to address the lack of guidelines in nursing/midwifery education and clinical practice. The study adopted a mixed methods approach, using an eclectic framework through three main phases. In Phase 1, spiritual care competencies were categorised under seven domains which were developed from an in-depth literature review and five focus groups with stakeholders. In Phase 2, the competency framework underwent two rounds of consensus by experts using a modified Delphi method with high response rates (Rl: 75.78%; n=241; R2: 85.06%; n=205). No significant differences were identified between the characteristics of Round 2 respondents and non-respondents which enhanced the reliability of the consensus reached on 54 competency items arranged in seven domains. Consensus was assumed if experts rated items within the highest region on a 7-point Likert form scale (5, 6, or 7) and a predetermined cut-off point of 75% threshold or greater. A six factor model was identified through the exploratory factor analysis which paralleled five of the original domains. During consultation with international researchers in the field and modified Delphi educators (n=107) (Phase 3), 38 competency items were categorised as achievable at pre-registration level, the majority of which are consistent with existing pre­ registration regulatory education requirements. Fifteen items were categorised as being achievable at post-registration level and one item was common at both levels. Thus, two competency frameworks were produced namely, a 39 item pre­ registration framework and a 16 item post-registration framework. Thematic analysis identified enhancers/inhibitors to the implementation of the framework in education, research and/or clinical practice. The development of a generic framework of competencies in spiritual care provides new knowledge on the delivery of spiritual care by nurses/midwives to guide education and clinical practice. Recommendations are given for education, clinical practice and policy. Further research is needed to test both the pre- and post­ registration frameworks of competencies which emerged from the consultation phase of the study.