Cultural and Spiritual Dimensions of Holistic End-of-Life Nursing Care in Chronic Kidney Disease: A Systematic Review

Background Chronic kidney disease (CKD) patients at the end of life (EOL) face complex physical, emotional, cultural, and spiritual challenges requiring holistic nursing care. However, the integration of cultural and spiritual care within EOL practice remains inconsistent, leading to fragmented approaches to patient dignity and well-being. Objective This review synthesized evidence on the cultural and spiritual dimensions of holistic end-of-life nursing care in CKD and identified frameworks guiding culturally grounded nursing practice. Methods A systematic search was conducted in Scopus, ScienceDirect, Web of Science, PubMed, and SAGE Journals for studies published between 2015 and 2025. The review followed the PRISMA 2020 guidelines and JBI Manual for Evidence Synthesis (2024) using the Population–Concept–Context (PCC) framework. Twenty-four eligible studies were analyzed thematically through narrative synthesis. Results Three major themes and one cross-cutting finding were identified. Culture shaped meaning, decision-making, and dignity in care, while spirituality provided strength, acceptance, and peace. Cultural humility emerged as an essential nursing competence bridging cultural and spiritual dimensions. Yet, integration between these aspects remained limited due to institutional and educational barriers. Cultural humility was recognized as the mediating factor fostering a unified and compassionate approach to holistic EOL nursing care. Conclusion Cultural and spiritual dimensions are inseparable in achieving holistic and dignified end-of-life nursing care for CKD patients. Integrating these elements through cultural humility can transform nursing into a culturally grounded and spiritually attuned practice.