Spirituality and Spiritual Distress
Spirituality is defined as connectedness with self, others, a life force, or God that allows people to experience self-transcendence and find meaning in life. Spirituality helps people discover a purpose in life, understand the vicissitudes of life, and develop their relationship with God or a Higher Power. Within the framework of spiritual-ity, a person discovers truths about the self, about the world, and about concepts such as love, compassion, wisdom, honesty, com-mitment, imagination, reverence, and morality. Often, spiritual be-havior is expressed through sacrifice, self-discipline, and spending time in activities that focus on the inner self or the soul. Religion and nature are two vehicles that people use to connect themselves with God or a Higher Power; however, bonds to religious institu-tions, beliefs, or dogma are not required to experience the spiritual sense of self. Faith, considered the foundation of spirituality, is a belief in something that a person cannot see (Carson, 1999). The spiritual part of a person views life as a mystery that unfolds over the lifetime, encompassing questions about meaning, hope, relat-edness to God, acceptance or forgiveness, and transcendence (Byrd, 1999; Sheldon, 2000; Sussman, Nezami, & Mishra, 1997).
A strong sense of spirituality or religious faith can have a pos-itive impact on health (Dunn & Horgas, 2000; Kendrick & Robinson, 2000; Matthews & Larson, 1995). Spirituality is also a component of hope, and, especially during chronic, serious, or terminal illness, patients and their families often find comfort and emotional strength in their religious traditions or spiritual beliefs. At other times, illness and loss can cause a loss of faith or mean-ing in life and a spiritual crisis. The nursing diagnosis of spiritual distress is applicable to those who have a disturbance in the belief or value system that provides strength, hope, and meaning in life.
Spiritually distressed patients (or family members) may show de-spair, discouragement, ambivalence, detachment, anger, resent-ment, or fear. They may question the meaning of suffering, life, and death, and express a sense of emptiness. The nurse assesses spiritual strength by inquiring about the person’s sense of spiritual well-being, hope, and peacefulness. Have spiritual beliefs and val-ues changed in response to illness or loss? The nurse assesses cur-rent and past participation in religious or spiritual practices and notes the patient’s response to questions about spiritual needs— grief, anger, guilt, depression, doubt, anxiety, or calmness—to help determine the patient’s need for spiritual care. Another sim-ple assessment technique is to inquire about the patient’s and fam-ily’s desire for spiritual support.
For nurses to provide spiritual care, they must be open to being present and supportive when patients experience doubt, fearfulness, suffering, despair, or other difficult psychological states of being. In-terventions that foster spiritual growth or reconciliation include being fully present; listening actively; conveying a sense of caring, respect, and acceptance; using therapeutic communication tech-niques to encourage expression; suggesting the use of prayer, med-itation, or imagery; and facilitating contact with spiritual leaders or performance of spiritual rituals (Sumner, 1998; Sussman, 2000).
Patients with serious, chronic, or terminal illnesses face physical and emotional losses that threaten their spiritual integrity. During acute and chronic illness, rehabilitation, or the dying process, spir-itual support can stimulate patients to regain or strengthen their connections with their inner selves, their loved ones, and their God or Higher Power to transcend suffering and find meaning. Nurses can alleviate distress and suffering and enhance wellness by meet-ing their patients’ spiritual needs.
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