Nursing diagnosis: Spiritual Distress related to physical and psychological stress; energy-consuming anxiety; situation, loss(es), intense suffering; separation from religious or cultural ties; challenged belief and value system
Possibly evidenced by
Expressions of concern about disaster; the meaning of life, death and/or belief systems
Inner conflict about current loss of normalcy and effects of the disaster, anger directed at deity, engaging in self-blame
Seeking spiritual assistance or chooses not to participate
Reports of somatic symptoms
Desired Outcomes/Evaluation Criteria—Client Will
Verbalize increased sense of self-concept and hope for future.
Discuss beliefs and values about spiritual issues.
Verbalize acceptance of self as being worthy.
Nursing intervention with rationale:
1. Determine client’s religious or spiritual orientation, current involvement, and presence of conflicts.
Rationale: Provides baseline for planning care and accessing appropriate resources.
2. Establish environment that promotes free expression of feelings and concerns. Provide calm, peaceful setting when possible.
Rationale: Promotes awareness and identification of feelings so they can be dealt with.
3. Listen to client’s and SO’s reports or expressions of anger, concern, alienation from God, belief that situation is a punishment for wrongdoing, and so forth.
Rationale: Helpful to understand client’s and SO’s point of view and how they are questioning their faith in the face of tragedy.
4. Note sense of futility, feelings of hopelessness and helplessness, and lack of motivation to help self.
Rationale: These thoughts and feelings can result in the client feeling paralyzed and unable to move forward to resolve the situation.
5. Listen to expressions of inability to find meaning in life or reason for living. Evaluate for suicidal ideation.
Rationale: May indicate need for further intervention to prevent suicide attempt.
6. Ask how you can be most helpful. Convey acceptance of client’s spiritual beliefs and concerns.
Rationale: Promotes trust and comfort, encouraging client to be open about sensitive matters.
7. Discuss difference between grief and guilt and help client to identify and deal with each, assuming responsibility for own actions and expressing awareness of the consequences of acting out of false guilt.
Rationale: Blaming self for what has happened impedes dealing with the grief process and needs to be discussed and dealt with.
8. Discuss use of, and provide opportunities for client and SO to experience meditation, prayer, and forgiveness. Provide information that anger with God is a normal part of the grieving process.
Rationale: Can help to heal past and present pain.
9. Assist client to develop goals for dealing with life situation.
Rationale: Enhances commitment to goal, optimizing outcomes and promoting sense of hope.
10. Identify and refer to resources that can be helpful such as pastoral or parish nurse, religious counselor, crisis counselor, psychotherapy, and Alcoholics or Narcotics Anonymous.
Rationale: Specific assistance to resolve life stressors such as relationship problems, substance abuse, or suicidal ideation are important to advance recovery process.