For the questionnaire to the patient, item 4, which states “How often does the nurse

assess your spiritual or religious beliefs or practices that are pertinent to health”, shows 16 who
answered never (0 times), 12 who answered rarely about (1-2 times), 4 who answered
occasionally (about 3-6 times), 3 who answered often (7-11 times) and 0 who answered very
often (at least 12 times). The nurse to patient ratio in the Philippines is 1 nurse to 1 ward and
attends to all the needs of the patients by doing a physical assessment to prioritize the problem of
the patient, however forget to assess the spiritual or religious belief or practices that pertinent to
health. Nurses strive to provide holistic care, including spiritual care, for all patients. However,
in busy critical care environments, nurses often feel driven to focus on patients’ physical care,
possibly at the expense of emotional and spiritual care (Abu-El-Noor, 2016). Therapeutic
communication is very important especially to those who are hospitalized for a long period of
time, terminally ill or dying, that mostly need to provide spiritual care because when there is no
hope and death is imminent, spiritual care is more needed. Time management is also important to
provide the proper care and spiritual care to help maintain self-esteem, provide a sense of
meaning and purpose, giving emotional comfort and provide a sense of hope.
 For the questionnaire to the patient, item 5, which states “How often does the nurse listen
to your spiritual concerns”, shows 16 who answered never (0 times), 14 who answered rarely
about (1-2 times), 1 who answered occasionally (about 3-6 times), 3 who answered often (7-11
times) and 1 who answered very often (at least 12 times). Factors that significantly affected
nurses spiritual care included race, spiritual affiliation and hospice type, not all nurses are expert
or trained to assess and address spiritual needs of a patient. Lack of experience and lack of good
communication of nurses may lead to avoiding of questions about spiritual concern and may
avoid listening to the problems of the patient about spirituality because most nurses don’t know
how to communicate therapeutically to explore their feelings. Most health care providers
struggled to articulate definitions of spirituality whereas patients generally spoke with much
more ease, giving rich examples and health care provider had difficulty relating stories of
patients who had experienced spiritual distress while patients gave ready responses (Selby, D.,
et. al., 2016). , Spiritual distress and spiritual care may hinder the ability of health care providers
to effectively offer meaningful spiritual care. A focus on active listening, and by providing
presence may help limit the risk of a unmet spiritual needs of the patients.
 For the questionnaire to the patient, item 6, which states “How often does the nurse
encourages you to talk about how illness affects relating to God or whatever your ultimate other
or transcendent reality”, shows 25 who answered never (0 times), 7 who answered rarely about
(1-2 times), 1 who answered occasionally (about 3-6 times), 1 who answered often (7-11 times)
and 1 who answered very often (at least 12 times). Nurses usually work in the hospitals where
they provide hands-on care to patients by administering medications, managing intravenous
lines, observing and monitoring patients' conditions, maintaining records and communicating
with doctors, because of lack of time and they are also busy, nurses tend to forget to assess
spiritual needs and encourage the patient to verbalize or talk about how illness affects relating to
God or whatever their ultimate other or transcendent reality. Palliative care nurses are well
placed to provide existential and spiritual care to patients with the primary facilitator being the
nurse–patient relationship, the primary barrier being lack of time and the primary strategy being
undertaking further education in this area (Keall, R., 2014). The spiritual care that most
important is communication with compassion by the health care provider, to explore the feelings
of the patient.