Introduction

Building and sustaining a qualified nursing workforce are essential for ensuring public safety. It is critical to address current issues and developments in nursing competence [1]. It also represents an efficient strategy to regulate and improve health-related education and raise the care standard [2]. CBE has impacted how nursing education programs are designed [3]. Additionally, CBE has been suggested for nurse education reform [4].

Chronic illnesses and cancerous tumors are increasingly common as China’s economy grows and its elderly population rises. These conditions also increase the demand for quality of life and access to healthcare. Nurses are increasingly asked to satisfy patients’ spiritual needs [5]. With an increased demand for spiritual care, initial research focused on evaluating the attitudes of nurses and nursing students toward spirituality and spiritual care [6]. The foundation of spiritual care practice, however, is comprised of nursing students’ attitudes, level of perception, and capability [7]. To satisfy the immediate practical demands of nursing students for spiritual care and to encourage further spiritual care growth, a comprehensive system of talent training in spiritual care should be implemented.

In China, the procedure of spiritual care-giving needs to be more well-known. The concept of spirituality and spiritual care has yet to be uniformly defined in mainland China, and little research has been reported on spiritual care education. Moreover, religious education is not part of the regular educational system in Mainland China. Religion and faith are included in the spiritual realm, yet they are certainly not limited [8]. Therefore, this study examines non-religious strategies for promoting spiritual care.

In Chinese higher education, vocational college nursing interns refer to nursing students who have completed an internship in a 3-year junior college program for a degree and will be a vital backup force for the nurse workforce. The fundamental premise is that before leaving the learning environment, the student will demonstrate the acquisition of the indicated necessary knowledge, abilities, and attitudes expected for the designated educational process [3]. Therefore, it is essential to integrate spiritual care into the Chinese nursing school system as a structured and required course. To satisfy the immediate practical demands of nursing students for spiritual care and to encourage further spiritual care growth, a comprehensive system of talent training in spiritual care should be implemented.

Background

In nursing, nursing programs should train nursing interns by using the CBE framework [3]. The knowledge base is rapidly changing, and people are seeking access to high-quality healthcare services more and more due to the complexity of the healthcare environment. The inclusion of a focus on soft skills should be considered by nursing educators who emphasize health promotion and technical, medical, and organizational competence [9]. It supported the development of nursing programs that educate students on the human aspects of care and technical abilities. Especially spirituality has been indicated as a crucial but often overlooked component of patient health [10]. Understanding and addressing the needs of the human spirit when a person faces trauma, illness, or despair are what is meant by spiritual care [11]. Recent research has shown that spirituality and spiritual care are essential components of patient care [10]. However, evidence suggests that nurses must understand spirituality more to perform this task effectively [12]. Moreover, there needs to be more agreement on what constitutes spiritual nursing care [5].

In addition to spiritual care, EI is another factor commonly overlooked within the nursing curriculum [9]. However, EI is an essential element of a nurse’s character trait and is well known as a strong predictor of a person’s success in both their professional and personal lives [13]. Education professionals define EI, which was first put forth by Salovey and Mayer, as social intelligence that regulates one’s feelings and emotions and uses information as a supporting factor to direct one’s ideas and behaviors [14]. Furthermore, reflectively controlling emotions promotes emotional and intellectual growth [15]. EI is relevant to stress management and psychological adaptability [16]. The previous study conducted in the USA discovered links between emotional intelligence and spiritual well-being in undergraduate and graduate nursing students [17]. Additionally, a Malaysian study showed that EI relates to spiritual intelligence [18]. However, no research has been conducted in China on the association between spiritual perception and emotional intelligence for junior nursing interns from a competency-based perspective. Furthermore, we have yet to learn how EI interacts with NCC to affect the relationship between SCG and those skills.

Therefore, this study’s objectives were to evaluate the NCC of nursing interns and further investigate how they relate to SCG and EI, to justify the inclusion of SCG and EI in the nursing curriculum. The following research inquiries were addressed:

1, What is the status of nursing interns’ SCG, EI, and NCC in China?

2, What is the correlation between these three variables?

3, Is the mediating role of EI between SCG and NCC established?

Methods

Study design

Cross-sectional descriptive research was conducted on this issue. The predictive variables tested were SCG and EI. The outcome variable was nursing interns’ NCC.

Participants

From June to July 2022, nursing interns from 9 nursing vocational colleges who had finished their internships were chosen as the research subject using a suitable selection approach, and 1990 students were included. Inclusion criteria: nursing interns majoring in vocational college nursing who have completed internship; informed, agreed to participate in this study. Exclusion criteria: drop out; take a leave of absence.

Instruments

Demographic information

Participating nursing interns provided information on their gender, household location, whether they have siblings, level of self-learning, student leadership, whether they have good interpersonal relationships, whether at least one parent works in the healthcare industry, monthly household income, and whether they plan to pursue a career in nursing in the future.

Competencies inventory for registered nurses (CIRN)

The CIRN, created by Liu et al., estimated the core competencies of nurses [19]. A total of 55 items (55 competencies) are included in the questionnaire, which is divided into 7 dimensions: clinical care (10 items), leadership (9 items), interpersonal relationships (8 items), legal/ethical practice (8 items), professional development (6 items), training/consulting (6 items), and critical thinking/research ability (8 items). The ratings for each item ranged from “high competency” (4 points) to “no competency” (0 points). Three overall competency levels were assessed: a total score of less than 110 indicated poor competency, 110–165 demonstrated moderate competency, and 165–220 indicated high competency. The Cronbach’s α coefficient of this scale was found to be 0.908, while Cronbach’s α coefficients for the individual dimensions ranged from 0.718 to 0.913. This instrument has previously been used to test the content validity among nurses in Macao [20]. The Cronbach’s α coefficient for our study was 0.901.

Chinese version of spiritual care-giving scale

The SCGS scale was developed by Tiew et al. [21], primarily intended to measure nursing interns’ opinions on spirituality or spiritual care. Because it has been used with nurses, it is considered valid and trustworthy. Hu et al. translated SCGS’s Chinese version (C-SCGS) into Chinese [11]. It consists of 34 items in 4 dimensions, the attributes of spiritual care, the definition of spirituality and spiritual care, spiritual perspectives, and the value of spirituality and spiritual care. The Likert 6-point scale was used, with each of the following points representing one: strongly disagree, disagree, relatively disagree, relatively agree, agree, and strongly disagree. Higher scores indicated more extraordinary spiritual care-giving skills; the total score ranged from 34 to 204 points. The Cronbach’s α coefficient was 0.940, and the Cronbach’s α coefficients for the individual dimensions ranged from 0.836 to 0.911. The Cronbach’s α coefficient in this study was 0.848.

The Chinese version of Wong and Law Emotional intelligence Scale (WLEIS-C)

EI was calculated using the WLEIS-C, and Wang Yefei translated and collated it [22]. The scale’s 16 items fall into four dimensions: self-emotion perception (4 items), emotion perception of others (4 items), emotion regulation (4 items), and emotion usage (4 items). It was scored on a Likert scale of 0 to 6, with 0 denoting “strongly disagree” and 6 denoting “strongly agree.” The EI is inversely correlated with the score. The Cronbach’s α coefficient was 0.891. The Cronbach’s α coefficient in our study was 0.916.

Data collection

This cross-sectional study was carried out using a mobile phone APP and an Internet-based questionnaire due to the COVID-19 epidemic. (https://www.wjx.cn/vm/m8yw2ep.aspx), where the study’s significance and goal were described. After following the instructions, participants were given the option of either accepting or rejecting the survey. Both confidentiality and anonymity were promised. Before the formal study, 26 nursing interns were pre-surveyed. The questionnaire was filled in 6–10 min. The questionnaire content was clearly expressed, and the items were set reasonably.

The researchers contacted the teachers or counselors ahead of time and distributed a questionnaire (Additional File 1). Each participant was only permitted to submit one survey. Excluding 179 invalid questionnaires (obvious logic errors or short answer duration), an efficient recovery rate of 91% was achieved for 1811 questionnaires.

Data analysis

The statistical analysis was performed using IBM SPSS 25.0, and the frequency and percentage values for the count data were used. Measurement data were described by mean ± standard deviation after the regular distribution test and were compared between groups by independent sample t-test or one-way ANOVA analysis. Pearson’s correlation analysis was used for correlation analysis. Mediating effect tests and analysis used the model 4 in the process plug-in SPSS developed by Hayes. Ninety-five percent confidence intervals were estimated using the bootstrap** approach to quantify indirect effect for the best test of mediation effect. The number of bootstrap samples was 5000. We inferred statistical significance if α was less than 0.05.

Ethical considerations

The Heilongjiang Vocational Nursing College’s Ethics Committee approved this study (approval number:KY2022-168). Additionally, the participating nursing interns must provide their consent before completing the necessary data-collecting forms. All participants received information about the study’s goals, procedures, advantages, and potential hazards in the consent forms. The decision to participate was totally up to the participants; they were free to change their minds at any time. Participants’ identity information was not gathered, and their privacy was strictly maintained.

Results

Demographic information of the participants

Demographic characteristics of vocational college nursing interns are presented in Table 1. Females made up 82.2% of the nursing interns in the study; 49.5% of them have no siblings (Table 1).

Table 1 Data on demographic characteristics of the participants
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Effect of classification and continuous variables on vocational college nursing interns’ NCC

The relationships between the general factors and the overall scores for the nursing core skills were examined using an independent sample t-test or an analysis of variance. The NCC among nursing interns, whether working as a student leader, were different (t = 2.034, P = 0.043). Moreover, there were significant differences observed based on varying levels of self-learning evaluation (F = 16.573, P < 0.001) and the intended engagement in the nursing profession in the future (F = 19.049, P < 0.001). Notably, excellent interpersonal relationships had a significant impact on a nursing intern’s NCC (t = 5.540, P < 0.001) (see Table 2).

Table 2 Comparison of NCC scores with different characteristics (n = 1811, mean±SD)
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Correlation analysis of SCG, EI, and NCC

As shown in Table 3, the scores of NCC, EI, and SCG were (156.43±23.14), (61.55±9.10), and (167.64±20.52) respectively. The results indicated room for improvement because the NCC and SCG are moderate. The correlations between SCG, EI, and NCC showed that EI was positively correlated with SCG and NCC (r = 0.396, P < 0.001; r = 0.506, P < 0.001, respectively), and SCG was positively correlated with NCC (r = 0.402, P < 0.001) (Table 3).

Table 3 Means and correlation among SCG, EI, and NCC
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The mediating effect of EI between SCG and NCC

The relationships between SCG, NCC, and EI, which is regarded as a mediating variable, were investigated using route analysis. The mediating effect of EI between SCG and NCC was examined using the bootstrap confidence interval estimation method, as presented in Fig. 1 and Table 4. As can be seen in Table 4, SCG significantly positively predicts EI (β = 0.366, 95% C.I. = (0.282,0.449), t = 8.607, P < 0.001) and NCC (β = 0.350, 95% C.I. = (0.270,0.430), t = 8.606, P < 0.001). EI significantly positively predicts NCC (β = 0.348, 95% C.I. = (0.270,0.430), t = 8.338, P < 0.001). In addition, as can be seen in Fig. 1, after adding EI to the model as a mediator variable, the relationship between SCG and NCC was found to be decreased (β = 0.223, 95% C.I. = (0.143,0.304), t = 5.456, P < 0.001). This finding indicates that EI plays a partial mediating role in the relationship between SCG and NCC. As can be seen in Table 5, SCG and EI together were found to predict 36.29% of the variance in NCC (R2 = 0.207, P < 0.001). Accordingly, EI is an essential pathway for nursing interns’ SCG to impact NCC.

Fig. 1
figure 1

Path analysis diagram for prediction of NCC (mediation effect). Note: ***P<0.001

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Table 4 Mediating effects of EI on the relationship between SCG and NCC
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Table 5 Breakdown table of the total effect, direct effect, and the mediating effect
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Discussion

The responding Chinese nursing interns’ NCC for the current study was (156.43±23.14), which was marginally less than the outcomes reported in earlier studies of registered nurses in China (159.24 ± 29.837) [23]. The main reason maybe is that participants in previous studies have worked for more than 5 years, which made them experience more to improve their NCC. As they get more job experience, they become more adept and comfortable in their nursing position.

Additionally, it was discovered from the results that students who were functioning as student leaders had slightly more significant levels of NCC than other students. Nursing student leaders are bridges between teachers and ordinary students. They are responsible for communicating the teacher’s tasks to the students and giving feedback to the teacher on the students’ opinions. Leadership is developed mainly through practice [24]. Effective leadership is vital when promoting high-quality care provision [25].

Another study finding showed a higher evaluation of self-learning nursing interns with more robust NCC [26]. Self-evaluation is crucial to student learners’ ability to self-regulate their learning habits. Comparing their performance to predetermined standards, past concerts, or the performances of others, the learner then makes adjustments to their learning processes for the following time [27].

Furthermore, whether a nursing intern with an excellent interpersonal relationship impacts the NCC score, consistent with the previous study, healthcare work is a team collaboration. Team collaboration is an essential factor that affects performance [28]. In other words, team members’ interactions can influence the workplace [29]. So, nursing interns with better interpersonal skills can better interact with others, interpersonal relations are an essential human factor of communication [30], and interpersonal relationships are a dimension of NCC.

Supporting previous research [31], the findings of the study revealed that nursing interns who intend to make nursing their career in the future have higher NCC. Nursing interns who intend to pursue a career in nursing are highly motivated to learn and can take the initiative to acquire knowledge and skills that will enhance their NCC. Nursing interns who expressed a strong interest in nursing had a clear career plan and earned NCC scores significantly above the mean [3].

The study first investigates associations between EI, SCG, and NCC in Chinese nursing interns. Our study indicates a medium association between SCG and NCC (r = 0.402, P < 0.001). Previous studies have explained the importance and necessity of incorporating spirituality into primary nursing education from the patient’s perspective [32], the nurse’s perspective [33], the nursing student’s perspective [34], and the medical humanism perspective [35], respectively. In the present study, this is a new perspective showing that develo** and improving SCG may improve nursing interns’ core competencies.

The NCC should be used as a teaching guide [26]. CBE is well renowned for enhancing the connection between academic achievement and employment opportunities [36]. Higher education and more spiritual care training are required to raise perception levels [37]. Therefore, it is necessary to add spiritual nursing education to primary nursing education to enhance the NCC of nurses.

Another study outcome showed that 36.29% of the overall benefit came from the mediating role of EI between SCG and NCC. It shows that EI is an important mediating variable between SCG and NCC, and it is necessary for nursing interns to transform SCG into NCC. According to the findings of this study, which were in line with earlier research [38], EI is a crucial component of nursing care and positively impacts the standard of care. Nursing education must address this issue to equip students better to handle both their own emotions and those of the patient.

Therefore, to increase the NCC of nursing interns, educational content to improve SCG and EI must be incorporated into the foundation module of medical curricula for nursing students. Educators should emphasize the cultivation of nursing students’ SCG and EI by training nursing interns in their education process.

Implication for nursing educators

In the present study, in China, essential nursing competencies among interns are at a middle level; yet, there is still potential for improvement. In general, nursing interns, who are student leaders, have a higher level of evaluation of self-learning, have better interpersonal skills, and intend to pursue a nursing career in the future have higher NCC. To enhance students’ self-efficacy and promote their engagement in learning and life with a more positive mindset, teachers should incorporate students’ self-evaluation into their instructional evaluations, in addition, it is beneficial to implement various teaching methods, such as group discussion and cooperative learning, to increase student participation and exercise their communication and interpersonal skills. Furthermore, teachers should focus on cultivating students’ professionalism through multiple strategies, including building professional beliefs and fostering a deeper appreciation for the nursing profession. Moreover, little agreement exists over what spiritual nursing care comprises [12]. A core competency-based nursing education framework should incorporate spiritual care and EI training courses to enhance the NCC of nursing interns.

Limitations

Since undergraduate and graduate students were not included in the sample, which was drawn from students at nine nursing institutions, the generalizability of the results may be constrained. Second, the data for this study were gathered using a cross-sectional design at a particular moment in time. This study was unable to detect any longitudinal changes in the NCC of nursing interns. Finally, the variables in this study were gathered using a self-reporting method, which may influence the participants’ subjective emotions.

Conclusions

In China, nursing interns’ core competencies were slightly lower. The NCCs of college nursing interns were related to whether they work as student leaders, their level of evaluation of self-learning, whether college nursing interns with good interpersonal relationships, and whether they intend to engage in the nursing profession in the future. In addition to demographic factors, the process by which spiritual care-giving capacity influences nursing interns’ core skills is examined for the first time in this study from the standpoint of EI. The study showed that the SCG of nursing interns was positively correlated with EI and NCC. SCG and EI significantly predicted NCC, and the effects of the two were mediated through EI. Consequently, to enhance the fundamental nursing abilities of students, the two crucial factors of SCG and EI should be considered. Regular courses and training in spiritual care and EI is a vital strategy to improve nursing interns’ NCC. So that teachers can develop the curriculum on spirituality and EI in nursing education and more effectively model and promote the integration of spirituality into healthcare practices.