This paper aims to identify problems in estimating and the interpretation of the magnitude of intervention-related change over time or responsiveness assessed with health outcome measures. Responsiveness is a problematic construct and there is no consensus on how to quantify the appropriate index to estimate change over time between baseline and post-test designs. This paper gives an overview of several responsiveness indices. Thresholds for effect size (or responsiveness index) interpretation were introduced some thirty years ago by Cohen who standardised the difference-scores (d) with the pooled standard deviation (d/SDpooled). However, many effect sizes (ES) have been introduced since Cohen's original work and in the formula of one of these ES, the mean change scores are standardised with the SD of those change scores (d/SDchange). When health outcome questionnaires are used, this effect size is applied on a wide scale and is represented as the Standardized Response Mean (SRM). However, its interpretation is problematic when it is used as an estimate of magnitude of change over time and interpreted with the thresholds, set by Cohen for effect size (ES) which is based on SDpooled. Thus, in the case of using the SRM, application of these well-known cut-off points for pooled standard deviation units namely: ‘trivial’ (ES<0.20), ‘small’ (ES≥0.20<0.50), ‘moderate’ (ES≥0.50<0.80), or large (ES≥0.80), may lead to over- or underestimation of the magnitude of intervention-related change over time due to the correlation between baseline and outcome assessments.Consequently, taking Cohen's thresholds for granted for every version of effect size indices as estimates of intervention-related magnitude of change, may lead to over- or underestimation of this magnitude of intervention-related change over time.For those researchers who use Cohen's thresholds for SRM interpretation, this paper demonstrates a simple method to avoid over-or underestimation.

Aim.  This study contributes to the development of a valid and reliable instrument, the spiritual care competence scale, as an instrument to assess nurses’ competencies in providing spiritual care. Background.  Measuring these competencies and their development is important and the construction of a reliable and valid instrument is recommended in the literature. Design.  Survey. Method.  The participants were students from Bachelor‐level nursing schools in the Netherlands (n = 197) participating in a cross‐sectional study. The items in the instrument were hypothesised from a competency profile regarding spiritual care. Construct validity was evaluated by factor analysis and internal consistency was estimated with Cronbach’s alpha and the average inter‐item correlation. In addition, the test–retest reliability of the instrument was determined at a two‐week interval between baseline and follow‐up (n = 109). Results.  The spiritual care competence scale comprises six spiritual‐care‐related nursing competencies. These domains were labelled:
1 assessment and implementation of spiritual care (Cronbach’s α 0·82)
2 professionalisation and improving the quality of spiritual care (Cronbach’s α 0·82)
3 personal support and patient counseling (Cronbach’s α 0·81)
4 referral to professionals (Cronbach’s α 0·79)
5 attitude towards the patient’s spirituality (Cronbach’s α 0·56)
6 communication (Cronbach’s α 0·71). These subscales showed good homogeneity with average inter‐item correlations >0·25 and a good test–retest reliability. Conclusion.  This study conducted in a nursing‐student population demonstrated valid and reliable scales for measuring spiritual care competencies. The psychometric quality of the instrument proved satisfactory. This study does have some methodological limitations that should be taken into account in any further development of the spiritual care competence scale. Relevance to clinical practice.  The spiritual care competence scale can be used to assess the areas in which nurses need to receive training in spiritual care and can be used to assess whether nurses have developed competencies in providing spiritual care.

Aim.  To determine the effects of a course for nursing students on developing competence in spiritual care and the factors that might influence the effects. Background.  Studies suggest that role preparation in nursing for spiritual care is poor. For the assessment of competence, few or no explicit competency framework or assessment tools seemed to be used. Design.  Quasi‐experimental crossover design (pre–post‐test). Method.  The subjects were students from Christian nursing schools in the Netherlands (n = 97). The intervention consisted of a course in spiritual care. Competencies were measured with an assessment tool, the Spiritual Care Competence Scale. Data were analysed by t‐test procedures (paired‐samples t‐test). At T1 vignettes were added to assess the quality of the students’ own analyses. These data were analysed by a Mann–Whitney test. Regression analyses were performed on the influence of student characteristics on the subscales of the assessment tool. Results.  Ninety‐seven students participated in this study. Analysis showed statistically significant changes in scores on three subscales of the Spiritual Care Competence Scale between groups (T1) and over time for the whole cohort of students on all subscales (T2). Clinical placement showed as a negative predictor for three subscales of the Spiritual Care Competence Scale. Experience in spiritual care and a holistic vision of nursing both showed as positive predictors on certain competencies. A statistically significant difference was observed between groups in the student analysis of a vignette with explicit spiritual content. Conclusions.  The outcomes raise questions about the content of education in spiritual care, the measurement of competencies and the factors that influence competency development. Relevance to clinical practice.  The results provide nurse educators with insight into the effects of education in spiritual care on students’ competencies and help them consider a systematic place for spiritual care within the nursing curriculum.