Susceptible to diminished integration of meaning and purpose in life through connections with self, others, the world, and/or a power greater than oneself

• Altered religious ritual
• Altered spiritual practice
• Anxiety
• Awareness of having unfinished business
• Barrier to experiencing love
• Cultural conflict
• Depressive symptoms
• Difficulty accepting the aging process
• Excessive stress
• Inadequate interpersonal relations
• Inadequate self-esteem
• Inadequate social support
• Loneliness
• Loss of independence
• Pain
• Self-alienation
• Social alienation
• Sociocultural deprivation
• Substance misuse

• Chronic diseases
• Depressive disorder
• Loss of a body part
• Loss of function of a body part
• Terminal illness
• Treatment regimen

• Health history, including debilitating disease (e.g., rheumatoid arthritis); terminal illness; recurrent cancer; conditions that alter body image (e.g., burns and scars); relapse or exacerbation of neurologic disease (e.g., multiple sclerosis); alcoholism, depression, and drug abuse; and major traumatic injury
• Impact of current illness, injury, or disability on lifestyle
• Spiritual status, religious affiliation, beliefs, and practices; relationship with spiritual authority (e.g., priest, rabbi); beliefs about life, death, and suffering
• Psychological status, including perception of self, body image, problem-solving ability, and coping mechanisms; sources of support (family, partner, friends, caregivers); perception of medical diagnosis or health problem (progression, severity, prognosis, treatment options); reaction to illness, injury, or disability; self-image, mood, behavior, motivation, and energy level; stressors (finances, job, marital or partner discord, losses through death or separation); expressions of grief; and changes in sleep pattern
• Family status, including socioeconomic status; quality of relationships; communication patterns; methods of conflict resolution; ability of family members to meet patient's physical, emotional, and social needs; and family goals

• Patient will discuss current spiritual beliefs and concerns.
• Patient will discuss effects of illness, injury, or disability on personal beliefs and spiritual practices.
• Patient will use healthy coping techniques to maintain spiritual well-being.
• Patient will express feelings of spiritual well-being.
• Patient will be supported in efforts to pursue spirituality in coping with illness, injury, or disability.
• Patient will reach out to family members, partner, priest, minister, imam, rabbi, or others for assistance.

Suggested NOC Outcomes

• Assess the importance of spirituality in patient's life and in coping with illness. Note patient's participation in religious rituals and practices and personal desire to discuss spiritual beliefs. Assess the impact of the illness, injury, or disability on patient's spiritual outlook. Accurate assessment of the meaning of spirituality for patient is necessary before intervening.
• Assess patient's desire for help in coping with spiritual concerns to determine the extent to which patient is motivated to address spiritual concerns and open to help from others.
• Express your willingness to discuss spirituality if patient desires to reduce isolation and to bring spiritual issues into the open.
• Encourage patient to talk about spiritual or religious beliefs and practices. Listen actively to patient's discussion of spiritual concerns to foster open discussion.
• Encourage patient to express feelings related to recent life-threatening experience to help patient clarify and cope with personal feelings.
• Communicate acceptance of patient's expression of spiritual concerns, even if patient's feelings are angry and negative to reassure patient that feelings are valid.
• Show willingness to pray with patient, if the patient wishes, to provide spiritual support.
• Maintain a nonjudgmental manner. Keep conversation focused on patient's spiritual values to maintain the therapeutic value of your interaction with patient.
• Provide for continuation of patient's religious practices (e.g., help to obtain ritual items and respect dietary restrictions, if possible) to demonstrate support and convey caring and acceptance to patient.
• Arrange for visits by clergy, as appropriate, to provide patient with expert spiritual support. Provide privacy during visits.
• Collaborate with patient's clergyman or hospital chaplain to develop a plan to integrate spiritual interventions into patient's care to ensure continuity of care.

Suggested NIC Interventions

• Patient discusses current spiritual or religious beliefs.
• Patient discusses effects of illness, injury, or disability on beliefs and spiritual practices.
• Patient uses healthy coping techniques to maintain spiritual well-being.
• Patient expresses feelings of spiritual well-being.
• Patient is supported in efforts to pursue spirituality in coping with illness, injury, or disability.
• Patient reaches out to family members, partner, priest, minister, rabbi, imam, or others for assistance.

• Patient's statements regarding religious beliefs and practices
• Patient's statements indicating effect of current crisis on spiritual outlook
• Patient's statements indicating which rituals and practices help maintain spiritual well-being
• Patient's statements indicating effectiveness of interventions to promote spiritual well-being
• Visits with selected spiritual authority
• Additional referrals to clergy or chaplain
• Evaluations for expected outcomes

• Ghotbabadi, S. S., & Alizadeh, K. H. (2018). The effectiveness of spiritual-religion psychotherapy on mental distress (depression, anxiety and stress) in the elderly living in nursing homes. Health, Spirituality & Medical Ethics Journal, 5(1), 20-25.
• Harris, J. I., Usset, T., Krause, L., Schill, D., Reuer, B., Donahue, R., & Park, C. L. (2018). Spiritual/religious distress is associated with pain catastrophizing and interference in veterans with chronic pain. Pain Medicine, 19(4), 757-763. doi:10.1093/pm/pnx225
• Schultz, M., Meged-Book, T., Mashiach, T., & Bar-Sela, G. (2017). Distinguishing between spiritual distress, general distress, spiritual well-being, and spiritual pain among cancer patients during oncology treatment. Journal of Pain & Symptom Management, 54(1), 66-73. doi:10.1016/j.jpainsymman.2017.03.018