Abstract
BACKGROUND: Spiritual care is a vital component of holistic nursing and midwifery. This study aimed to assess nursing and midwifery students' perceived competence in spiritual care and to examine the predictive roles of two key constructs: professional self-efficacy (encompassing care, support, and professional situations) and professional identity (self-image, social modeling, retention benefits and turnover risks, social comparison and self-reflection, and independence of career choice). METHODS: This cross-sectional study was conducted from September 2024 to January 2025 among 201 undergraduate nursing and midwifery students who had completed at least two semesters and had begun clinical internships, ensuring exposure to both theoretical education and practical training. Participants completed a demographic questionnaire that included personal and educational characteristics, as well as selected items such as clinical work experience and previous training in spiritual care. They also completed the Iranian Scale for Assessment of Nurses' Competencies in Spiritual Care, the Nursing Profession Self-Efficacy Scale, and the Professional Identity Scale for Nursing Students. Data were analyzed using t-tests, ANOVA, Pearson correlation, and multiple regression. RESULTS: A significant positive correlation was observed between spiritual care competence and both self-efficacy (r = 0.547, p < 0.001) and professional identity (r = 0.369, p < 0.001). Regression analysis revealed that professional self-efficacy (β = 0.475, p < 0.001), professional identity (β = 0.148, p = 0.022), prior training in spiritual care (β = 0.145, p = 0.017), and independence of career choice (β = 0.124, p = 0.037) were key predictors, explaining 37% of the variance. CONCLUSION: The findings suggest that students' self-perceived ability to provide spiritual care is associated with their confidence, professional identity, and prior training. Incorporating comprehensive spiritual care training into curricula can enhance students' confidence and skills, thereby better preparing them for holistic clinical practice. CLINICAL TRIAL NUMBER: Not applicable.