NCP Nursing Diagnosis: Spiritual Distress

Nursing Diagnosis: Spiritual Distress
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels

* Hope
* Spiritual Well-Being

NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels

* Spiritual Support
* Coping Enhancement
* Emotional Support

NANDA Definition: Disruption in the life principle that pervades a person’s entire being and that integrates and transcends one’s biological and psychosocial nature

Spiritual distress is an experience of profound disharmony in the person’s belief or value system that threatens the meaning of his or her life. During spiritual distress the patient loses hope, questions his or her belief system, or feels separated from his or her personal source of comfort and strength. Pain, chronic or terminal illness, impending surgery, or the death or illness of a loved one are crises that may cause spiritual distress. Being physically separated from family and familiar culture contributes to feeling alone and abandoned. Nurses in the hospital, home care, and ambulatory settings can assist the patient in reestablishing a sense of spiritual well-being.

* Defining Characteristics: Expresses concern with meaning of life and death and/or belief systems
* Anger toward God (as defined by the person)
* Questions meaning of suffering
* Verbalizes inner conflict about beliefs
* Verbalizes concerns about relationship with deity
* Questions meaning of own existence
* Inability to choose or chooses not to participate in usual religious practices
* Seeks spiritual assistance
* Questions moral and ethical implications of therapeutic regimen
* Displacement of anger toward religious representatives
* Description of nightmares or sleep disturbances
* Alteration in behavior or mood evidenced by anger, crying, withdrawal, preoccupation, anxiety, hostility, or apathy
* Regards illness as punishment
* Does not experience that God is forgiving
* Inability to accept self
* Engages in self-blame
* Denies responsibilities for problems
* Description of somatic complaints

* Related Factors: Separation from religious and cultural ties
* Challenged belief and value system (e.g., result of moral or ethical implications of therapy or result of intense suffering)

* Expected Outcomes Patient expresses hope in and value of his/her own belief system and inner resources.
* Patient expresses a sense of well-being.

Ongoing Assessment

* Assess history of formal religious affiliation and desire for religious contact. Information regarding specific religion and importance of rituals or practices may improve understanding of patient’s needs.
* Assess cultural beliefs. Individuals may have other important beliefs besides religion that provide strength and inspiration. Likewise, physical impairments or suffering may be seen as "punishment from God."
* Assess spiritual meaning of illness or treatment. Questions such as the following provide a basis for future care planning:
o "What is the meaning of your illness?"
o "How does your illness or treatment affect your relationship with God, your beliefs, or other sources of strength?"
o "Does your illness or treatment interfere with expressing your spiritual beliefs?" Level of physical functioning, duration and course of illness, prognosis, and treatments involved can contribute to spiritual distress.
* Assess hope. Being hopeful provides a link to spiritual well-being.
* Assess whether patients have any unfinished business. Patients may not find peace or harmony until business is completed, such as resolving strained family relations.

Therapeutic Interventions

* Display an understanding and accepting attitude. Encourage verbalization of feelings of anger or loneliness. When interviewed later, after the crisis is resolved, patients list the nurse’s listening to concerns and the nurse’s technical competence as two of the most important items that helped create a sense of well-being.
* Structure your interventions in terms of patient’s belief system. Patients have a right to their beliefs and practices, even if they conflict with the nurse’s.
* Develop an ongoing relationship with patient. An ongoing relationship establishes trust, reduces the feeling of isolation, and may facilitate resolution of spiritual distress.
* When requested by patient or family, arrange for clergy, religious rituals, or the display of religious objects, especially when the patient is hospitalized. These help lessen feelings of separation and provide strength and inspiration. If patient belongs to a highly codified or ritualized religion, such as Orthodox Judaism, clergy is important at times of passage, such as birth or death. In times of crisis the patient may not have the inner strength to call clergy without assistance.
* If requested, pray with patient. This provides a sense of connectedness to others.
* Acknowledge and support patient’s hopes. Hopes are different from denial or delusions. Supporting a hope for discharge does not mean supporting a denial of the seriousness of the patient’s condition. Hope allows the patient to face the seriousness of the situation.
* Do not provide logical solutions for spiritual dilemmas. Spiritual beliefs are based on faith and are independent of logic.
* Facilitate communication between patient and family, clergy, and other caregivers. Patient may desire privacy or rest, or may not want clergy present, but may find it difficult to express.

Education/Continuity of Care

* Provide information in a way that does not interfere with patient’s beliefs, faith, or hopes. This demonstrates respect for patient’s individuality.
* Inform the patient and family of how to obtain religious rites or seek spiritual guidance. This may be essential when decisions about prolonging life, organ donation, or some medical therapy (e.g., blood transfusion) is a question in the patient’s mind.