Mr. M. is 52 years old and in the infirmary for treatment of dehydration resulting from diarrhea that occurred after receiving chemotherapy for colon cancer. The physician recently discussed with Mr. M. permanent assignment to the infirmary for end-of-life care. Mr. M. is listless and unengaged while in the infirmary. He expresses loneliness and frustration that he has no visitors especially now that he has cancer. He is estranged from family because he was physically abusive to his wife and daughter. Mr. M. was convicted of child sexual abuse and has been incarcerated for 10 years. As you leave the room Mr. M. says to you “God must be punishing me for all the bad that I have done in my life. How am I ever going to make amends?”
This is a patient in spiritual distress. Spiritual distress is defined by the North American Nursing Diagnosis Association (NANDA) as “the disruption in the life principle that pervades a person’s entire being and that integrates and transcends one’s biological and psychosocial nature” (2001). A patient in spiritual distress loses hope, questions their belief system, or feels separated from personal sources of comfort and strength (Gulanick et al., 2003). Assisting patients to address spiritual distress is one of the competencies for nursing care of patients at the end of life established by the American Association of Colleges of Nursing (2004). Chapter 8 in the Essentials of Correctional Nursing discusses spiritual distress in the correctional population, provides cues to identify the condition and recommends nursing interventions to address spiritual distress.
To summarize nursing care for a patient in spiritual distress involves four components:
- A nurse-patient relationship. Patients report that their distress was relieved when the nurse cared for them as a person, not as a number; gave patients freedom of choice when possible and when the nurse listened and gave the patient a chance to talk (Creel, 2007; Sellers, 2001).
- Spirituality is a coping mechanism and can be used by patients to transcend illness and suffering (Emblem & Halstead, 1993).
- Active listening and facilitating the patient’s verbalization of concerns are skills vital to provision of spiritual care. Nurses do not need to know about specific beliefs, religions or spiritual practices to provide effective spiritual care (Martin, Burrows and Pomillo, 1983).
- Spiritual care resembles psychosocial care in that it involves demonstration of respect for the patient, listening and appropriate self-disclosure (Sellers, 2001; Taylor, 2003).
Nursing interventions for a patient with symptoms of spiritual distress include:
- Developing an ongoing relationship with the patient that demonstrates trust to reinforce the patient’s connectedness to others.
- Respect and support the patient’s faith and religious belief system by making appropriate referrals.
- Assist the patient to sort out ethical dilemmas in health care decision making.
- Be aware of the patient’s suffering and act to ease suffering by showing compassion.
- Encourage reflective prayer as a means to transcend immediate experiences of pain and suffering.
- Allow the patient to verbalize anger and fear.
- Help the patient deal with feelings of guilt and instill hope (Villagomeza, 2005).
Pitfalls to avoid in addressing issues of spiritual distress include:
- Trying to solve the patient’s problems or resolve unanswerable questions.
- Going beyond the nurse’s role or expertise or imposing personal spiritual beliefs on the patient.
- Providing premature reassurance to the patient (Lo, B. et al., 2002).
What do you think would be the best response to the questions posed by Mr. M. in the case example at the beginning of this post? How would you address his distress? For more on spiritual distress in End-of Life Care see Chapter 8 of the Essentials of Correctional Nursing which can be ordered directly from the publisher. If you use Promo Code AF1209 the price is discounted by $15 off and shipping is free.
References and Resources:
American Association of Colleges of Nursing. (2004) Peaceful death: Recommended competencies and curricular guidelines for end-of-life nursing care. Retrieved My 16, 2011 from http://www.aacn.nche.edu/Publications/deathfin.htm
American Psychosocial Oncology Society. Distress Management Training for Oncology Nurses. Retieved September 1, 2013 t http://www.apos-society.org/professionals/meetings-ed/webcasts/webcasts-ican2.aspx#.
Creel, E. (2007). The meaning of spiritual nursing acre for ill individuals with no religious affiliation. International Journal for Human Caring 11(3): 14-21.
Emblem, J. D. & Halstead, L. (1993). Spiritual needs and interventions: Comparing the views of patients, nurses and chaplains. Clinical Nurse Specialist 7(4): 175-182.
Gulanick, M. , Myers, J., Klopp, A., et al. (2003) Nursing Care Plans: Nursing Diagnosis and Intervention. 5th ed. St. Louis: Mosby
Lo, B., Ruston, D., Kates, L.W. et al. (2002). Discussing religious and spiritual issues at the end of life: A practical guide for physicians. Journal of the American Medical Association. 287(6): 749-754.
Marie Curie Cancer Care (2003). Spiritual and religious care competencies for specialist palliative care. Retrieved September 1, 2013 at http://www.mariecurie.org.uk/Documents/HEALTHCARE-PROFESSIONALS/spritual-religious-care-competencies.pdf
Martin, C., Burrows, C., & Pomilio, J. (1983). Spiritual needs of patients study. In Fish, S. & Shelly J. (Eds) Spiritual care: The nurse’s role. Downer’s Grove, IL: Intervarsity Press.
North American Nursing Diagnosis Association. (2001) Nursing Diagnosis: Definitions and Classification. 2001-2002. Philadelphia.
Sellers, S. (2001). The spiritual care meanings of adults residing in the Midwest. Nursing Science Quarterly 14 (3): 239-249.
Taylor, E.J. (2007) What Do I Say? Talking with Patients about Spirituality. Templeton Press: Philadelphia.
Taylor, E.J. (2003). Nurses caring for the spirit: Patients with cancer and family caregiver expectations. Oncology Nursing Forum 30(4): 585-590.
Villagomeza, L. R. (2005). Spiritual distress in adult cancer patients. Holistic Nursing Practice. November/December: 285-294.
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