Online education can increase psychiatric nurses’ confidence in spiritual care, but a high total score does not establish whether learning reaches every part of clinical work. Knowledge, communication, referral, and practice behavior may respond to instruction while organizational feasibility remains constrained. This study examined whether an eight-hour online course produced balanced improvement across spiritual-care domains or concentrated gains in activities under an individual nurse’s immediate control. Arm-level means and standard deviations from a controlled pretraining–post-training trial were organized as 24 arm–time outcome records: six Spiritual Care Competence Scale (SCCS) domains, four Religious/Spiritually Integrated Practice Assessment Scale (RSIPAS) domains, and both total scores. The trial included 50 nurses receiving four weekly online sessions and 45 controls, with follow-up one month later. Reported between-group tests, covariance analyses, and demographic regression findings were retained. Added calculations were percentage-of-maximum attainment, difference in changes, small-sample-corrected Hedges’ g, and control-adjusted headroom closure, defined as the between-arm difference in change divided by the training arm’s attainable pretraining headroom. Total SCCS and RSIPAS scores increased by 54.70 and 69.32 points in the training arm, compared with changes of −1.71 and 1.00 points in controls. The corresponding control-adjusted changes were 56.41 and 68.32 points. At follow-up, training-arm attainment reached 92.8% of the SCCS maximum and 84.5% of the RSIPAS maximum. Headroom closure was consistently high for SCCS domains (80.2–95.4%) and for RSIPAS practice behavior (86.4%), attitudes (76.8%), and self-efficacy (75.1%). Perceived feasibility closed only 22.7% of available headroom and reached 59.3% of its scale maximum. Its post-training standardized separation was g = 0.59 (95% confidence interval 0.18–1.01), whereas all other domain estimates exceeded 1.6. The course translated strongly into assessment, communication, referral, counseling, attitudes, self-efficacy, and reported practice behavior, but it did not similarly alter nurses’ perception that time, access, and institutional conditions permit spiritually integrated care. The research question is therefore answered asymmetrically: education closed most individual competency headroom, while organizational feasibility remained the principal limiting domain. Education should be paired with protected assessment time, accessible referral arrangements, documentation fields, and supervision if competence is expected to become routine care.
Online education can increase psychiatric nurses’ confidence in spiritual care, but a high total score does not establish whether learning reaches every part of clinical work. Knowledge, communication, referral, and practice behavior may respond to instruction while organizational feasibility remains constrained. This study examined whether an eight-hour online course produced balanced improvement across spiritual-care domains or concentrated gains in activities under an individual nurse’s immediate control. Arm-level means and standard deviations from a controlled pretraining–post-training trial were organized as 24 arm–time outcome records: six Spiritual Care Competence Scale (SCCS) domains, four Religious/Spiritually Integrated Practice Assessment Scale (RSIPAS) domains, and both total scores. The trial included 50 nurses receiving four weekly online sessions and 45 controls, with follow-up one month later. Reported between-group tests, covariance analyses, and demographic regression findings were retained. Added calculations were percentage-of-maximum attainment, difference in changes, small-sample-corrected Hedges’ g, and control-adjusted headroom closure, defined as the between-arm difference in change divided by the training arm’s attainable pretraining headroom. Total SCCS and RSIPAS scores increased by 54.70 and 69.32 points in the training arm, compared with changes of −1.71 and 1.00 points in controls. The corresponding control-adjusted changes were 56.41 and 68.32 points. At follow-up, training-arm attainment reached 92.8% of the SCCS maximum and 84.5% of the RSIPAS maximum. Headroom closure was consistently high for SCCS domains (80.2–95.4%) and for RSIPAS practice behavior (86.4%), attitudes (76.8%), and self-efficacy (75.1%). Perceived feasibility closed only 22.7% of available headroom and reached 59.3% of its scale maximum. Its post-training standardized separation was g = 0.59 (95% confidence interval 0.18–1.01), whereas all other domain estimates exceeded 1.6. The course translated strongly into assessment, communication, referral, counseling, attitudes, self-efficacy, and reported practice behavior, but it did not similarly alter nurses’ perception that time, access, and institutional conditions permit spiritually integrated care. The research question is therefore answered asymmetrically: education closed most individual competency headroom, while organizational feasibility remained the principal limiting domain. Education should be paired with protected assessment time, accessible referral arrangements, documentation fields, and supervision if competence is expected to become routine care.
