The relationship between spiritual well-being and moral resilience in nursing students: a mixed-methods study

This study was conducted to investigate the relationship between spiritual well-being and moral resilience among nursing students via a convergent parallel mixed-methods design.

The quantitative phase included 236 nursing students purposively selected from a university in the Central Anatolia Region of Türkiye (response rate: 62.9%). The quantitative data were collected via the three-factor spiritual well-being scale and the Rushton Moral Resilience Scale. The qualitative phase consisted of semistructured in-depth interviews with 17 nursing students selected through purposive sampling.

A weak positive correlation was found between the Harmony with Nature dimension and the overall Rushton Moral Resilience Scale score (r = 0.190, p = 0.003). A weak positive correlation was also identified between the overall Spiritual Well-Being Scale score and the overall Rushton Moral Resilience Scale score (r = 0.312, p < 0.001). In addition, the transcendence dimension was negatively correlated with moral adversity (r=-0.229, p < 0.001) and positively correlated with moral efficacy (r = 0.351, p < 0.001). The qualitative findings indicated that spiritual well-being was associated with moral resilience through empathy and compassion, a tendency toward right and good behaviors, motivation and satisfaction, coping with challenging situations, and professional responsibility. However, qualitative findings also revealed that spirituality-related values and beliefs may sometimes contribute to internal tensions in ethical decision-making processes.

Spiritual well-being was positively associated with moral resilience among nursing students. However, some aspects of spirituality may also create ethical tensions in clinical decision-making. Therefore, nursing education should strengthen content related to spirituality, ethics, cultural competence, and ethical decision-making while supporting students in managing potential value conflicts encountered in clinical practice.