Palliative care preparedness among undergraduate nursing students in Northern Saudi Arabia: a cross-sectional study of Knowledge, Attitudes, and Spiritual Care

BACKGROUND: Palliative care is a core component of holistic nursing practice, yet international and regional evidence indicates persistent gaps in nursing students' preparedness, particularly in knowledge, attitudes, and spiritual care competence. In Saudi Arabia, these gaps are influenced by cultural expectations and variable curricular integration. OBJECTIVE: To assess palliative care preparedness among undergraduate nursing students in Northern Saudi Arabia across three domains knowledge, attitudes toward caring for the dying, and spiritual care preparedness and to examine their associations with palliative care training and clinical experience. METHODS: A cross-sectional study was conducted among 232 third- and fourth-year nursing students using stratified random sampling. Data were collected using the Palliative Care Knowledge Test (PCKT), the Frommelt Attitude Toward Care of the Dying Scale-B (FATCOD-B), and the Student Survey of Spiritual Care (SSSC). Descriptive statistics, Mann-Whitney U tests, Pearson correlations, and multiple linear regression were performed. RESULTS: Students demonstrated moderate knowledge (M = 13.78/20), with higher scores in psychiatric and dyspnea management domains. Clinical experience with dying patients was associated with significantly higher knowledge (p = 0.0189). Attitude scores were generally positive (M = 3.13/5), though slightly lower among students with training or clinical experience. Spiritual care preparedness was moderate (M = 3.86/6) and did not differ by training or experience. A weak negative correlation was observed between knowledge and attitudes (r = - 0.143, p = 0.0296). CONCLUSION: Nursing students in Northern Saudi Arabia exhibit moderate preparedness for palliative care. Clinical exposure enhances knowledge, while spiritual care readiness appears culturally grounded rather than training dependent. Findings highlight the need for integrated, culturally responsive palliative and spiritual care education within undergraduate nursing curricula.