Spiritual distress refers to challenges to the spiritual well being or to the belief system that provide strength, hope, and meaning to life

Some factors that may be associated with or contribute to a person’s spiritual distress include physiologic problem, treatment-related and situational concern physiologic problems including having a medical diagnosis of terminal or debilitating diseases, experiencing pain, experiencing loss of a body parts or function, or experiencing miscarriage or stillbirth treatment related factors include recommendation for blood transfusions, abortion, surgery, dietary restriction, amputation of a body part or isolation situational concerns includes the death or illness of a significant others, inability to practice one’s spiritual rituals, or feeling of embarrassment when practicing them NANDA international (2007) offers the following as defining characteristic of spiritual distress

Ф expresses lack of hope, meaning and purpose in life, forgiveness of selfФ expresses abandoned by or having anger towards GodФ refuses interaction with friends and familyФ sudden changes in spiritual practicesФ request to see a religious leaderФ no interest in nature, reading spiritual literature

Help for Spiritual Distress, an Overview

Florence Nightingale wrote that, "The needs of the spirit are as critical to health as those individual organs which make up the body", wrote Florence Nightingale. Ever since then, spiritual care has been part of some nursing. Oldnall (1996) states that "each individual has spiritual needs regardless of whether the individual is religious or not." Spiritual Distress is an approved nursing diagnosis which McFarland and McFarlane (1997) define as "a disruption in the life principle that pervades a person's entire being and that integrates and transcends one's biological and psychological nature." Govier (2000), has identified the five R's of spiritual care:

Reason and Reflection - to find, meaning in life; the will live; to meditate on one's existence (via art, music or literature)

Religion - to express spirituality through a framework of values and beliefs, often actively pursued in rituals and religious practices.

Relationships - to relate to one's self, others and a deity (via service, love, trust, hope and/or creativity)

Restoration - to positively influence the physical aspect of care (life events can result in spiritual distress)

Govier (2000) cites a study by Amenta and Bohnet (1986) that suggests four tools to help nurses implement spiritual care:

Listening in an authentic manner; Being present; Accepting what the patient says; Using of self-disclosure.

Spiritual care interventions:

Weekly nondenominational prayer services A prayer corner in the family room, with increased availability of religious reading

material A monthly calendar placed in each patient's room listing the holy days of many different

religions A spiritual well-being checklist added to the Trinity Cancer Center resource books, with

patient instructions on contacting a chaplain if they have checked any spiritual concerns A book of prayers and meditations placed at the bedside in each room A monthly house-wide nursing newsletter that highlights spiritual-care nursing

diagnoses and interventions

Nursing Diagnoses: Seven Manifestations of Spiritual Distress

Abstracted from data used for development of the Spiritual Assessment Guide, the following nursing diagnoses related to alterations in spiritual integrity are presented for consideration. These may be considered seven manifestations of spiritual distress.

+"Nursing diagnoses: spiritual pain, as evidenced by expressions of discomfort of suffering relative to one's relationship with God, verbalization of feelings of having a void or lack of spiritual fulfillment, and/or a lack of peace in terms of one's relationship to one's creator.

+Nursing- diagnoses: spiritual alienation, as evidenced by expressions of loneliness or the feeling that God seems very far away and remote from one's everyday life, verbalization that one has to depend upon one's self in times of trial or need, and/or a negative attitude toward receiving any comfort or help from God.

+Nursing diagnoses: spiritual anxiety , as evidenced by expression of fear of God's wrath and punishment; fear that God might not take care of one, either immediately or in the future; and/or worry that God is displeased with one's behavior.

+Nursing diagnoses: spiritual guilt, as evidenced by expressions suggesting that one has failed to do the things which he should have done in life and/or done things which were not pleasing to God; articulation of concerns about the "kind" of life one has lived.

+Nursing diagnoses: spiritual anger, as evidenced by expression of frustration or outrage at God for having allowed illness or other trials, comments about the "unfairness" of God, and/or negative remarks about institutionalized religion and/or its ministers or spiritual care givers.

+Nursing diagnoses: spiritual loss, as evidenced by expression of feelings of having temporarily lost or terminated the love of God, fear that one's relationship with God has been threatened, and/or a feeling of emptiness with regard to spiritual things.

+Nursing- diagnoses: spiritual despair, as evidenced by expressions suggesting that there is no hope of ever having a relationship with God or of pleasing Him and/or a feeling that God no longer can or does care for one." (O'Brien, pp. 106,107.)