Spiritual Struggle, Post-Traumatic Growth, and Work-Related Outcomes: An Observational Study of Filipino Nurses

Purpose: Guided by holistic nursing theoretical framings, this study aimed to examine the associations among spiritual struggle, moral injury, post-traumatic growth, and the work-related outcomes of job satisfaction, burnout, and turnover intention. Design: A quantitative, cross-sectional, correlational design was employed. Methods: Data were collected from Registered Nurses providing direct patient care in hospitals in Manila, Philippines. Scales measuring spiritual struggle, moral injury, post-traumatic growth, turnover intention, and burnout, as well as one item assessing job satisfaction and demographic questions, were administered. Univariate, bivariate, and multivariate statistical analyses were conducted. Findings: The participants (n = 244) included 30% men and 83% who identified as Roman Catholic. Moral injury and spiritual struggle were associated with higher levels of burnout and increased turnover intention. Post-traumatic growth was negatively associated with job satisfaction and turnover intention, but unrelated to burnout. Age, work setting, and hours worked per week were associated with some nurses' spiritual responses. Conclusion: Nurse spirituality can be expressed through spiritual struggle, moral injury, and post-traumatic growth. These spiritual responses are related to work outcomes. Findings support interventions that promote spiritual well-being among Filipino nurses experiencing burnout, job dissatisfaction, or who intend to leave their work.