Nursing Diagnosis: Spiritual distress Application of NANDA, NOC, NIC

Nursing Diagnosis: Spiritual distress
Gail B. Ladwig

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

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)

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

NOC Outcomes (Nursing Outcomes Classification)

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

NIC Interventions (Nursing Interventions Classification)

Suggested NIC Labels

Nursing Interventions and Rationales

·         Observe client for self-esteem, self-worth, feelings of futility, or hopelessness. Verbalization of feelings of low self-esteem, low self-worth, and hopelessness may indicate a spiritual need.

·         Monitor support systems. Be aware of own belief systems and accept client's spirituality. To effectively help a client with spiritual needs, an understanding of one's own spiritual dimension is essential (Highfield, Carson, 1983).

·         Be physically present and available to help client determine religious and spiritual choices. Physical presence can decrease separation and aloneness, which clients often fear (Dossey et al, 1988). This study showed an overwhelming response that client's faith and trust in nurses produces a positive effect on client and family. Spiritual care interventions promote a sense of well-being (Narayanasamy, Owens, 2001).

·         Provide quiet time for meditation, prayer, and relaxation. Clients need time to be alone during times of health change.

·         Help client make a list of important and unimportant values. The number one need expressed by clients who had been hospitalized, which was expressed by persons of all denominations and faiths, was for their pastor/rabbi/spiritual advisor to not abandon them. For those who did not belong to a religious/spiritual group, their number one need was to at least be asked for some type of religious/spiritual preference (Moller, 1999). Clients are experts on their own paths, and knowing their values helps in exploring their uniqueness (Dossey et al, 1988).

·         Ask how to be most helpful, then actively listen, reflect, and seek clarification. Listening attentively and being physically present can be spiritually nourishing (Berggren-Thomas, Griggs, 1995). Obtain permission from the client to respond to spiritual needs from own spiritual perspective (Smucker, 1996).

·         If client is comfortable with touch, hold client's hand or place hand gently on arm. Touch makes nonverbal communication more personal.

·         Help client develop and accomplish short-term goals and tasks. Accomplishing goals increases self-esteem, which may be related to the client's spiritual well-being.

·         Help client find a reason for living and be available for support. "The need for a positive attitude for optimum healing was by far the most commonly mentioned subtheme by these participants and the strongest area of literature" (Criddle, 1993).

·         Listen to client's feelings about death. Be nonjudgmental and allow time for grieving All grief work takes time and is unique. Acceptance of client differences is essential to open communication.

·         Help client develop skills to deal with illness or lifestyle changes. Include client in planning of care. Clients perceived the experience of healing as an active process and expressed a desire to take conscious control (Criddle, 1993).

·         Provide appropriate religious materials, artifacts, or music as requested. Helping a client incorporate rituals, sacraments, reading, music, imagery, and meditation into daily life can enhance spiritual health (Conrad, 1985).

·         Provide privacy for client to pray with others or to be read to by members of own faith. Privacy shows respect for and sensitivity to the client.

·         See care plan for Readiness for enhanced Spiritual well-being.

Geriatric

·         Assist client with a life review and help client identify noteworthy experiences.

·         Discuss personal definitions of spiritual wellness with client. Listening attentively and helping elderly clients identify past coping strategies is part of helping with life review and finding meaning in life (Berggren-Thomas, Griggs, 1995).

·         Identify client's past sources of spirituality. Help client explore his or her life and identify those experiences that are noteworthy. Client may want to read the Bible or have it read to them. Older adults often identify spirituality as a source of hope (Gaskins, Forte, 1995).

·         Discuss the client's perception of God in relation to the illness. Different religions view illness from different perspectives.

·         Offer to pray with client or caregivers. Prayer was described as an important part of spirituality by caregivers (Kaye, Robinson, 1994).

·         Offer to read from the Bible or other book chosen by client. A religious ritual may comfort the client.

Multicultural

·         Assess for the influence of cultural beliefs, norms, and values on the client's ability to cope with spiritual distress How the client copes with spiritual distress may be based on cultural perceptions (Leininger, 1996).

·         Acknowledge the value conflicts from acculturation stresses that may contribute to spiritual distress. Challenges to traditional beliefs are anxiety provoking and can produce distress (Charron, 1998).

·         Encourage spirituality as a source of support. African-Americans and Latinos may identify spirituality, religiousness, prayer, and church-based approaches as coping resources (Samuel-Hodge et al, 2000; Bourjolly, 1998; Mapp, Hudson, 1997).

·         Validate the client's spiritual concerns, and convey respect for his or her beliefs. Validation lets the client know the nurse has heard and understands what was said (Stuart, Laraia, 2001; Giger, Davidhizer,1995).

Client/Family Teaching

·         Teach guided imagery, story telling, meditation, and the use of silence. Guided imagery, metaphors, meditative prayer, and prayers of silence are effective spiritual approaches the nurse can implement when caring for the patient with cancer (Brown-Saltzman, 1997).

·         Consider using art to express spirituality. This author tells a personal story about the activity of drawing flowers with her daughter and how it helped to explore spiritual issues (Toomey, 1999).

·         Encourage family and friends to visit and show their concern. Social networks support spiritual well-being (Young, Dowling, 1987).

·         Encourage family and friends to support client's belief through prayer. Positive effects of prayer include rapid recovery and prevention of complications (Byrd, 1988).

·         Include directions to hospital chapel when orienting client and family to hospital unit. Attendance at services and a visit to the chapel may be important to the client and family.

·         Refer client to spiritual advisor of choice. Nurses must collaborate with chaplains and relate to clergy to provide spiritual care for patients and families (VandeCreek, 1997). Caregivers who use religious or spiritual beliefs to cope with caregiving have a better relationship with care recipients, which is associated with lower levels of depression and role submersion (Chang, Noonan, Tennstedt, 1998).

·         Prepare for chosen religious rituals. Some religions may have ceremonies associated with healing and illness.

·         Refer to counseling, therapy, support groups, or hospice. The client may need more support and ongoing spiritual assistance.