Spiritual Distress, Nursing Diagnosis for Spiritual Distress, and Nursing Interventions for Spiritual Distress.

Spiritual Distress, Nursing Diagnosis for Spiritual Distress, and Nursing Interventions for Spiritual Distress.

This guide is about spiritual distress, nursing diagnosis for spiritual distress, and nursing interventions for spiritual distress. It can be used to create educational nursing care plans for spiritual distress.

Spiritual Distress

Signs and Symptoms of Spiritual Distress

What is spiritual distress and what are the signs that someone may be in spiritual distress?

Spiritual distress can be defined as a state of suffering related to the impaired ability to experience meaning in life through connections with self, others, the world, or a superior being. It can also be defined as lack of hope, meaning, purpose, forgiveness, and intimacy with the divine or an anger of lack of interest about previously spiritually nurturing people or resources.

Defining Characteristics:

  • Expresses concern with meaning of life/death and/or belief systems;
  • questions moral/ethical implications of therapeutic regimen;
  • describes nightmares/sleep disturbances;
  • verbalizes inner conflict about beliefs;
  • verbalizes concern about relationship with deity;
  • unable to participate in usual religious practices;
  • seeks spiritual assistance;
  • questions the meaning of suffering;
  • questions meaning of own existence;
  • displacement of anger toward religious representatives;
  • anger toward God;
  • alteration in behavior/mood evidenced by anger, crying, withdrawal, preoccupation, anxiety, hostility, apathy; gallows humor (inappropriate humor in a grave situation)

What are the signs of spiritual distress?

Pain

  • Suffering relatives to one’s relationship with God
  • Verbalizing lack of peace/relationship w/God
Alienation
  • Expressing loneliness and negative attitude towards God
  • Punishment for something they’ve done
Anxiety
  • Expressing fear of God’s wrath & punishment
Guilt
  • Verbalizing concerns that they did not live a life ‘pleasing to God’
Anger
  • Verbalizing frustration at God for allowing ‘distressing’ situation
  • learning to accept
Loss
  • Feeling like they have lost God’s love
Despair
  • Expressing loss of hope of having a continuing relationship with God

What are the factors leading to spiritual distress?

  • Challenged belief and value system (e.g., due to moral/ethical implications of therapy, intense suffering);
  • separation from religious or cultural ties

What are the outcomes for nursing diagnosis of spiritual distress?

Suggested NOC Labels

  • Dignified Dying
  • Hope
  • Spiritual Well-Being

Client Outcomes

  • States conflicts or disturbances related to practice of belief system
  • Discusses beliefs about spiritual issues
  • States feelings of trust in self, God, or other belief systems
  • Continues spiritual practices not detrimental to health
  • Discusses feelings about death
  • Displays a mood appropriate for the situation

When a patient has the nursing diagnosis Spiritual Distress, a sample goal statement is, “The patient will demonstrate improved spiritual health as evidenced by one of the following indicators: feelings of faith, hope, meaning, and purpose in life with connectedness with self and others to share thoughts, feelings, and beliefs.” A sample SMART outcome is, “The patient will express a purpose in life by discharge.

Nursing Diagnosis for Spiritual Distress

What Causes Spiritual Distress?

How is spiritual distress diagnosed?

Events that place patient populations at risk for developing spiritual distress include birth of a child, death of a significant other, exposure to death, a significant life transition, severe illness or  injury, exposure to natural disaster, racial conflict, or an unexpected life event. Associated conditions that place a person at risk for developing spiritual distress include actively dying, chronic illness, illness, loss of a body part, loss of function of a body part, or a treatment regimen.

For example, a patient diagnosed with life-threatening medical diagnoses like cancer may experience spiritual distress as they move through the typical stages of loss. A sample PES statement is, “Spiritual Distress related to anxiety associated with illness as evidenced by crying, insomnia, and questioning the meaning of suffering.” A nurse would implement interventions to enhance coping.

Nursing Interventions for Spiritual Distress.

What can a nurse do to help a patient in spiritual distress?

Planning Interventions

Providing Spiritual Care

When providing spiritual care, the RN must not impose their religious or spiritual beliefs on the patient. There are several guidelines for therapeutically implementing nursing interventions to support patients’ spiritually:

  • Take cues from the patient: When bringing up spiritual health with patients, understand this may be a difficult topic for them to discuss. Let them lead the conversation and do not press further than they want to share. Also, be aware of the patient’s nonverbal cues. They may be saying one thing but their body language is saying something different. Gently point out the contradiction and seek clarification. For example, a patient may state that they don’t blame God for their illness, but begin to tear up as they say it. By responding, “I noticed you became tearful when you said that…what is causing the tears,” the door is opened for them to share more of their thoughts and feelings.
  • Ask the patient how you can support them spiritually: An important way to assist a patient with their spiritual health is to ask them what they need to feel supported in their faith and then try to accommodate their requests, if possible. For example, perhaps they would like to speak to their clergy, spend some quiet time in meditation or prayer without interruption, or go to the onsite chapel. Explain that spiritual health helps the healing process. Many agencies have chaplains onsite that can be offered to patients as a spiritual resource.
  • Support patients within their own faith tradition: Because patients can sometimes feel as if they are a captive audience, it is not appropriate for the nurse to take this opportunity to attempt to persuade a patient towards a preferred religion or belief system. The role of the nurse is to respect and support the patient’s values and beliefs, not promote the nurse’s values and beliefs.
  • Listen to a patient’s fears and concerns without adding your own stories: In an effort to empathize with a patient who is telling their story, it is easy for the nurse to start adding personal examples from their own life. Although this may seem helpful, it is usually only distracting and shifts the focus from the patient to the nurse. Focus on the patient’s fears and concerns. Name and validate the emotions that are heard when possible. Sometimes patients don’t realize what they are feeling until it is pointed out to them.
  • Pray with a patient if requested (or provide someone who will): Some nurses may feel reluctant to pray with patients when they are asked for various reasons. They may feel underprepared, uncomfortable, or unsure if they are “allowed to.” Nurses are encouraged to pray with their patients to support their spiritual health, as long as the focus is on the patient’s preferences and beliefs, not the nurse’s. See Fig below for an image of a nurse praying with a patient. Having a short, simple prayer ready, that is appropriate for any faith, may help in this situation. If a nurse does not feel comfortable praying, the chaplain should be requested to participate in prayer with the patient.
  • Share an encouraging thought or word: Similar to the preceding prayer suggestion, a scripture verse (based on the patient preferences) or an inspirational poem may be helpful to share during difficult times. Having a few verses or thoughts readily available can be very helpful during critical moments.
  • Use presence and touch: Sometimes the mere presence of a nurse is spiritually comforting for patients. Words are not always needed. It can be very comforting to know that someone will be sitting quietly next to them as they fall asleep or are in pain. Touch can also be a very powerful therapeutic tool to provide comfort (after asking permission of the patient).

 

Image showing a Nurse Praying with a Patient
Nurse Praying with a Patient

 

See the following box for a summary of therapeutic interventions that nurses can implement to provide spiritual support. Review additional interventions for enhancing coping for patients and family members experiencing grief in the “Grief and Loss” chapter.

Therapeutic Nursing Interventions to Provide Spiritual Support

  • Use therapeutic communication to establish trust and empathetic caring.
  • Be present and actively listen to the individual’s feelings and express empathy.
  • Be open to the individual’s expressions of loneliness and powerlessness.
  • Be open to the individual’s feelings about illness and/or death.
  • Encourage the individual to reminisce and review their past and focus on events and relationships that provided spiritual strength and support.
  • Provide privacy and quiet time for spiritual activities.
  • Offer opportunities for the patient to practice their religion.
  • Encourage the patient to engage in spiritual, meditative, or mind-body practices to promote spiritual healing.
  • Arrange visits with the chaplain, patient’s pastor, or other spiritual advisor.
  • Pray with the individual, as appropriate.
  • Provide spiritual music, literature, radio, television, or online programs as appropriate.
  • Promote hope however the individual defines it for their situation without providing false reassurance.
  • Encourage forgiveness.
  • Encourage participation in interactions with family members, friends, and others.
  • Encourage participation in support groups

Implementing Interventions

Nurses should support patients’ spiritual and religious preferences when implementing interventions to support their spiritual well-being. The nurse should respect and listen to the patient’s expression of beliefs and not impose their own beliefs on the patient. Spiritual or religious practices should be accommodated if safe and feasible to do so. If a patient has a spiritual belief, value, or practice that conflicts with their treatment plan, the nurse should explain the rationale for the intervention or treatment.

If the patient is not willing to complete the treatment as planned due to their spiritual or religious beliefs, the nurse should attempt to negotiate the treatment plan with the patient and/or health care provider. For example, a nurse can advocate for rescheduling a procedure after the Sabbath or modifying the dietary plan and medication administration times during Ramadan.

Evaluation

When evaluating the effectiveness of interventions in promoting a patient’s spiritual health, refer to the overall goal, “The patient will demonstrate spiritual health as evidenced by the following indicators: feelings of faith, hope, meaning, and purpose in life with connectedness with self and others.” From there, review the patient’s progress toward the personalized SMART outcomes that have been customized to their situation.

An Example of a Nursing Care Plan for Spiritual Distress

Nursing Care Plan For Spiritual Distress

Spiritual Distress, Nursing Diagnosis for Spiritual Distress, and Nursing Interventions for Spiritual Distress.

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