Risk factors may include
Physical: Illness, hospitalization, pain
Psychological factors: Ineffective support or coping with condition, personal crisis, anxiety, fear of death, depression
Sociocultural: Lack of social interaction
Spiritual: Spiritual crises, suffering
Developmental and situational: Life transitons, aging; end-stage life crises
Possibly evidenced by
(Not applicable; presence of signs and symptoms establishes an actual diagnosis)
Desired Outcomes/Evaluation Criteria—Client Will
Express ability to once again participate in beliefs and rituals of desired religion.
Discuss beliefs and values about spiritual or religious issues.
Attend religious or worship services of choice as desired.
Verbalize concerns about end-of-life issues and fear of death.
1. Listen to client’s and SO’s reports and expressions of anger and concern or alienation from God. Note sense of guilt or retribution.
Rationale: May be suffering from severe or terminal illness or accident straining resources and affecting client’s ability to cope. Perception of guilt may cause spiritual crisis or suffering resulting in rejection of religious activities and symbols.
2. Discuss differences between grief and guilt and help client to identify and deal with each. Point out consequences of actions based on guilt.
Rationale: As client recognizes consequences of actions, they can be discussed, and desire to change may enhance new coping skills, avoid acting out of false guilt, and enable client to
resume desired religious activities.
3. Use therapeutic communication skills of reflection and active listening.
Rationale: Communicates acceptance and enables client to find own solutions to concerns.
4. Encourage expression of feelings about illness/condition and death.
Rationale: Allows client to identify how feelings are impacting situation and deal with them appropriately.
5. Determine sense of futility, feelings of hopelessness, and lack of motivation to help self.
Rationale: Indicators that client may see no, or only limited, options or personal choices available and lack energy to deal with situation.
6. Assess extent of depression client may be experiencing.
Rationale: Some studies suggest that a focus on religion may protect against depression.
7. Note recent changes in behavior, such as withdrawal from others and religious activities and dependence on alcohol or medications.
Rationale: Helpful in determining severity and duration of situation and possible need for additional referrals such as substance withdrawal. Lack of connectedness with self or others
impairs ability to trust others or feel worthy of trust from others or God.
8. Explore alternatives to, or modifications for, ritual based on setting and individual needs or limitations.
Rationale: Assists client to develop new ways of expressing religious beliefs and satisfying these needs.
9. Provide privacy for meditation, prayer, or performance of rituals, as appropriate.
Rationale: Allows client to engage in spiritual activites in own way without fear of interruption or judgment of others.
10. Refer to spiritual resources, such as spiritual advisor—who has qualifications and experience in dealing with specific problems individual is concerned about—or to facility’s chaplain or visiting clergy and parish nurse.
Rationale: Provides answers to spiritual questions, assists in the journey of self-discovery, helps client learn to accept, forgive self, and engage in desired rituals.