Enrico De Luca

Background/Objectives: Spirituality is increasingly recognised as a core dimension of holistic and palliative care. Neurodegenerative diseases such as dementia, amyotrophic lateral sclerosis and Parkinson’s disease involve prolonged trajectories of loss, uncertainty and relational change, which may heighten spiritual and existential needs for patients, particularly among those involved in caregiving, such as family caregivers and, to a lesser extent, healthcare professionals. However, evidence on how spirituality is understood, experienced and addressed within neurodegenerative palliative care remains fragmented and conceptually heterogeneous. This scoping review aimed to map the literature on caregivers’ spiritual needs and challenges. Methods: A scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta Analyses extension for Scoping Reviews (PRISMA ScR). Searches were conducted across PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), APA PsycINFO, and Scopus, with no date or geographical restrictions. Grey literature was searched through Google Scholar and relevant organisational and policy sources in the field of palliative care and spirituality. Reference list screening of included studies and relevant reviews was also conducted. Quantitative, qualitative, and mixed methods studies published in English or Italian were included. Results: Twenty-four studies published between 2007 and 2025 were included. Findings were organised into three interconnected domains: spiritual needs, spiritual processes and spiritual care. Spirituality emerged as a dynamic, relational and context-dependent dimension of caregiving, encompassing meaning, identity, connection and coping with vulnerability and loss. Spiritual needs and processes were widely described, while spiritual care was inconsistently recognised within healthcare systems. Conceptual ambiguity, under-representation of end-of-life dementia and cultural imbalances were evident. The evidence predominantly focused on family caregivers, with limited representation of healthcare professionals. Conclusions: This scoping review highlights a persistent gap between caregivers’ lived spiritual experiences and system-level responses in neurodegenerative palliative care in caregiving contexts globally. The findings support integrated, caregiver-inclusive and culturally responsive approaches to spiritual care.

Introduction Spirituality has gained increasing attention in healthcare, particularly in palliative care, as it supports meaning, purpose and connection during illness. While literature extensively explores patients’ spiritual needs, growing evidence highlights the importance of addressing the spiritual needs of caregivers and healthcare professionals. Caregivers and relatives often face emotional, ethical and practical challenges during prolonged care pathways, impacting their well-being. Limited training and tools can hinder spiritual care, contributing to distress and burnout among professionals and unmet needs for families. Addressing spirituality in neurodegenerative disease palliative care is essential for holistic, person-centred approaches that foster coping, hope and ethical decision-making. This scoping review aims to map evidence on spiritual needs and challenges of caregivers, relatives and healthcare staff in end-stage neurodegenerative disease care. Methods and analysis This review will follow the Joanna Briggs Institute framework (JBI) for scoping reviews. The search and reporting process will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. Inclusion criteria followed JBI’s population, concept and context framework with no date or geographical limits; only English and Italian sources ensured accurate interpretation. Searches will use university-access databases and grey literature to capture policy and non-peer-reviewed sources. Databases selected: PubMed, CINAHL, APA PsycINFO and Scopus for comprehensive, multidisciplinary coverage. This inclusive approach is aligned with the purpose of scoping reviews, which aim to map the breadth and depth of available literature. Researchers independently screened titles/abstracts in Rayyan software with blinding, resolved discrepancies collaboratively, piloted and refined extraction tables, and jointly synthesised themes through iterative meetings to ensure rigour and consensus. Findings will highlight existing knowledge, identify gaps and inform future research and practice. Ethics and dissemination Since secondary data will be analysed, no ethical approval is required. The results will be disseminated through publications subject to peer review. The protocol has been registered with the Open Science Framework https://doi.org/10.17605/OSF.IO/X9275

Older LGBTQ+ adults face persistent inequalities in health and social care, often shaped by historical trauma and systemic exclusion, raising critical questions about how ageing can be supported equitably. This public involvement project explored the narratives and expectations of older LGBTQ+ individuals regarding ageing, health, and social care. Public involvement events were organised and facilitated by an interdisciplinary group of academics between January and April 2025 in Cardiff, Exeter, and Bristol, locations chosen for their rural, coastal, and urban contexts. Creative participatory methods were used to engage LGBTQ+ individuals, aged 50 years old and over, in discussion and sharing narratives. The work found attendees wanting to talk about themes of isolation and invisibility in society, and within LGBTQ+ spaces, the need for inclusive spaces, as well as concerns about discrimination in healthcare settings. Throughout the three events, there was a clear desire among attendees for future research and advocacy, alongside the emergence of a strong community network committed to inclusive and affirming care. These insights can help guide future research projects and initiatives aimed at improving support for LGBTQ+ ageing.

Aim: This paper outlines key developments, innovations, and milestones in the field of spirituality and spiritual care in nursing. Design: A discursive paper. Results: Nursing scholars have significantly influenced the profession and contributed to the development of nursing knowledge, particularly in the field of spirituality and spiritual care. Key research has focused on nurses' perceptions and attitudes toward spirituality, clarifying foundational spiritual concepts, and establishing a framework of core spiritual care competencies for the profession. Conclusion: Despite these advancements, significant gaps remain in nurses' knowledge, understanding, and experience in providing spiritual care. The development of agreed‐upon spiritual care competencies at the European level offers important guidance for the profession, and educational initiatives are underway to support their integration. However, the field remains in an early stage of development, and further research is needed to embed spiritual care competencies into national and international nursing policy and practice. Moreover, continued research is also essential to inform and evaluate current educational programmes and nursing interventions, and to support the translation of evidence‐based knowledge into effective spiritual care delivery. Implications for the Profession and/or Patient Care: Spiritual support is proven to be an important consideration for many patients and families globally. Imbedding spiritual care education into both undergraduate and postgraduate nursing curricula is essential to prepare nurses to address the spiritual needs of patients in healthcare settings. Structured curricula that provide clear instructions on how to recognise, assess, and respond to spiritual concerns in clinical practice can enhance nurses' competence and confidence. Embedding spiritual care into education and training helps normalise spiritual care as a component of holistic nursing, supporting its inclusion in everyday care rather than treating it as an optional or marginal practice. Such educational integration has the potential to improve the consistency and quality of spiritual care across healthcare settings. Impact: Internationally there are evident gaps in the consistent provision of spiritual care to patients and their families. These are being addressed through conceptual clarity, the agreed‐upon competencies, and enhanced educational initiatives. It is essential to continue to increase awareness among the nursing profession on the necessity of addressing spiritual care needs, within the context of cultural perspectives to ensure that value is placed on the significance of these issues on a global scale. Patient or Public Contribution: There was no patient or publication contribution in this specific commentary.

Purpose: The need for authentic equality, diversity and inclusion (EDI) in nursing education and clinical practice is well documented, with many institutional initiatives developed over the past decade. Yet, despite these efforts, discriminatory behaviours toward nursing students and healthcare practitioners continue to surface—undermining institutional policies, professional codes and fundamental human values. This discursive paper presents a conceptual framework—the “Girandole” (French for the spinning child’s toy windmill or pinwheel)—designed to identify enablers and barriers to EDI in clinical learning environments. The paper also explores its application to current nursing placement experiences. Design/methodology/approach: An interdisciplinary, multi-cultural team of academics, clinicians and researchers, EDI leads, spontaneously united for a framework lab. The team activities and numerous EDI discussions led to co-designing the Girandole framework, which maps the domains influencing EDI in clinical education. Findings: The Girandole framework symbolises the rotating forces that influence EDI in nursing placements. The direction of the rotation of the vanes of the Girandole indicates whether these are enablers or obstacles for culturally and inclusively competent care and education. It provides a lens to examine the hidden curriculum, cultural competence and lived experiences, while promoting active bystandership and organisational accountability. Originality/value: This discursive paper offers a novel, visually engaging framework grounded in lived experience. The Girandole offers educators, mentors, students and institutions a practical tool to reflect on and improve EDI culture. Though developed in nursing, the Girandole is transferable to other healthcare professions, supporting inclusive and ethically grounded education.

Identifying and meeting patients’ spiritual needs is integral to nursing in end of life care. However, spirituality, spiritual care and assessment models are still not fully embedded across the UK. While nurses often collaborate with chaplains or other spiritual care professionals to support patients, ambiguity and misunderstanding between spirituality and religion can cause challenges in delivering effective, person-centred care. This article explores the role of spirituality in nursing practice and introduces structured reflections and practical tools to support spiritual care in end of life settings. It discusses the potential of the horizontal transcendence model as an existential and relational approach to exploring meaning, identity and connection at the end of life. Nurses can use this model to help patients and their families navigate spiritual needs in diverse and inclusive ways. By offering reflective prompts and an accessible, practice-oriented framework, the authors invite nurses to engage with their own understanding of spirituality and integrate this awareness into the provision of compassionate holistic care.

In recent years, healthcare organizations and scholars, particularly in Western societies, have increasingly recognized the importance of the spiritual dimension in patient care. However, this aspect still needs to be fully integrated into everyday practices. Palliative care has begun to emphasize spirituality, addressing patients' psychological and existential needs through a holistic approach beyond the traditional biomedical paradigm. This concept analysis will first explore healthcare and medical professionals' challenges in implementing shared and patient-centered spiritual practices. It will then draw on experiences integrating spirituality in palliative care from Thailand and Italy and introduce two conceptual models for spiritual care and needs assessment from the UK. The discussion will encourage the implementation of integrated models of spiritual needs assessment and care in adult end-of-life and palliative care settings (that address any life-limiting illness). This approach will enable health professionals to effectively address patients' spiritual needs, fostering authentic conversations that are pivotal in integrating models and transforming the care experience into an empowering and meaningful one for staff and patients.

This accessible co-produced textbook presents essential knowledge, skills, and values relevant to all undergraduate student nurses up to Master’s level. The book is structured around seven pillars of learning, which were developed through extensive consultation with patients, practitioners and academics. Each chapter focuses on an engaging scenario from nursing practice or education, which serves as the focus for the application of the seven pillars. The text is designed to meet the requirements and standards of nurse regulators internationally, including the Nursing and Midwifery Council. It includes chapters on: the fundamentals of nursing care ethics and professionalism evidence for practice patient and public involvement no health without mental health global health leadership and management. The chapters include a range of features to help readers apply their learning, including the application of relevant international research and incorporating the voices of students, patients, and nurse educators. It enables readers to gain confidence and competence in their practice and serves as an important introduction for student nurses.

Fundamentals of care, the first of seven pillars of learning, is underpinned by a contemporary movement that refocuses attention on nursing and on the essential knowledge, skills, and values required for person-centred care. In 2012, a group of international nurse leaders initiated a debate, an action plan and a fundamentals of care framework. The framework provides nurses with a roadmap to help navigate through the elements of the fundamentals of care model. An anonymised scenario details the journey of a patient, Jay, through intensive care. The application of the fundamentals of care framework illustrates how this is an integral part of nursing practice, including in high-tech healthcare settings. In this chapter, crucial aspects of intensive care nursing, care-recipient nurse relationships and practice-related issues will be illustrated and analysed with the support of evidence. The chapter concludes by offering structured reflections focusing on the integration of the scenario and the framework into a realisable care narrative.

This opening chapter sets the scene for the book which is designed for undergraduate student nurses, educators, and practitioners. The chapter introduces the seven pillars of learning, which underpin the curriculum at the Academy of Nursing, University of Exeter, and which are a central component of the book. The seven pillars are applicable to undergraduate nurse education programmes everywhere and illuminate the art and science of contemporary nursing. This introduction also provides local and global context, and summarises the co-productive process which shaped this book, as well as presenting the four key themes that are threaded throughout the book with the acronym CARE: curiosity, advocacy, respect, and excellence.