Self-compassion, palliative care self-efficacy, and spiritual care preparedness among nursing students: a cross-sectional study

Preparing nursing students to deliver holistic palliative care requires both clinical competence and readiness to address patients' spiritual needs. Spiritual care preparedness may be associated with psychological resources and educational experiences; however, these relationships remain insufficiently understood, particularly in culturally specific contexts such as Saudi Arabia. To examine the associations among self-compassion, palliative care self-efficacy, and spiritual care preparedness among nursing students, and to explore whether palliative care self-efficacy demonstrates a cross-sectional indirect association between self-compassion and spiritual care preparedness. A single-center cross-sectional study was conducted between March and April 2026 among 284 third- and fourth-year nursing students at Northern Border University, Saudi Arabia. Data were collected using self-reported questionnaires, including the Self-Compassion Scale, the Palliative Care Self-Efficacy Scale, and the Student Survey of Spiritual Care. Data were analyzed using heteroscedasticity-robust regression models and bootstrap-based indirect effect analysis, adjusting for demographic and educational variables. Participants reported modest palliative care self-efficacy (M = 2.39, SD = 0.75), moderate spiritual care preparedness (M = 4.10, SD = 0.95), and moderate self-compassion (M = 3.19, SD = 0.78). In adjusted analyses, spiritual care preparedness was positively associated with higher self-compassion (B = 0.352, p < .001) and higher palliative care self-efficacy (B = 0.328, p < .001). Bootstrap analysis indicated a significant indirect association of self-compassion with spiritual care preparedness through palliative care self-efficacy (indirect effect B = 0.063; 95% BCa CI: 0.020-0.128). Self-compassion and palliative care self-efficacy were positively associated with spiritual care preparedness among nursing students. The findings also suggest a cross-sectional indirect association involving palliative care self-efficacy; however, the study design does not permit conclusions regarding causal pathways or mechanisms. These results support further investigation of confidence-building and psychological skill development in palliative care education through longitudinal and interventional research.