Since spiritual distress is difficult to assess nurses are likely to have varying degrees of success in meeting patients’ spiritual needs. However, in our study nurses provided incidents in which they were clearly sensitive to patients’ spiritual needs. Golberg [40] suggests that nurses carry out spiritual care at an unconscious level and that if nurses could be educated to be consciously aware of spiritual issues then patient care could be improved. However, others suggest many nurses were uncomfortable in dealing with patients’ spiritual needs [12, 41]. Further work is needed to establish how nurses level of insight into spiritual issues affects the spiritual care they provide.