Nursing Diagnosis: Spiritual Distress

NOC Outcomes (Nursing Outcomes Classification)

NIC Interventions (Nursing Interventions Classification)

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:
  • "What is the meaning of your illness?"
  • "How does your illness or treatment affect your relationship with God, your beliefs, or other sources of strength?"
  • "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.

Include Rationales?

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