Assessing Spirituality

Nursing History
Because a persons spirituality and religious beliefs have the
potential to influence every aspect of being, an assessment of the
clients spirituality should be included in each comprehensive
nursing history. Helpful assessment guides are offered by Fish and
Shelly (1978), Stoll (1979), and OBrien (1982). Data area gathered
about the clients spiritual beliefs and practices, the effect of these
beliefs on everyday living, spiritual distress, and spiritual need.
sAmple questions are listed in the Focused Assessment Guide in the
accompanying display.
The following questions are from OBriens (1982) Spiritual
Assessment Guide :
Spiritual pain : Do you ever feel hurt or pain associated with
the spiritual or religious beliefs that you hold ?
Do you feel pain related to uncertainty or nonbelief ?
Spiritual alienation : Do you frequently feel far away from God ?
Does it seem that he is remote and far removed from you
everyday life ?
Spiritual anxiety : Are you afraid that God might not take care
of your needs ? That he might not be there when you need him ?
Spiritual guilt : Have you ever done things that God would be
angry at you for ? Are you feeling badly about things that you
have done or failed to do in your life ?
Spiritual anger : Are you angry at God for allowing you to be
ill ? Do you ever feel like blaming God for your illness ? Do you
think God is unfair to you ?
Spiritual loss : Do you ever feel that you have lost Gods love ?
That you have broken or weakened your relationship with God ?
Has God turned his back on you ?
Spiritual despair : Do you ever feel that there is no hope of
havinng Gods love ? Of pleasing him ? That God does not love
you anymore ?

If the client shares a spiritual problem, remember to use interview

questions to determine the spesific nature of the problem, its
probable causes, related signs and symptoms, when it first
began and how often it occurs, how it affects everyday living,
the severity of the problem and whether it can be treated
independently by nursing or needs to be referred, and how well
the client is coping with the problem.
Nursing Observation
Because many clients may find it difficult to talk about their
spiritual beliefs and problems, the nurse also observes the clients
behavior for sign of spiritual distress. A family member or close
friend may share significant observation.
Significant behavioral observation include sudden changes in
spiritual practice (rejection, neglect, fanatical devotion); mood
changes (frequent crying, depression, apathy, anger); sudden
interest in spiritual matters (reading religious books or watching
religious programs on television, visits to clergy); and disturbed
sleep. A nurse who observes these behaviors should follow up with
appropriate
interview questions. Often problem with spiritual
distress do not surface until well after a clients admission history
and examination.
Diagnosing
Spiritual distress may affect other areas of human
functioning. In the following nursing diagnoses, spiritual distress is
the etiology of another problem.
Impaired Adjustment to illness relatied to inability to reconcile
illness with spiritual belief.
Ineffective Individual Coping related to loss of religion as primary
support (feel abandoned by God).
Fear related to feeling unprepared for death and after-life
experience.
Dysfunctional Grieving : Despair related to belief that religion is
meaningless.
Hopelessness related to belief that no one cares-including God.
Powerlessness related to feeling victimized by a tyrannical and
arbitrary God.
Self-Esteem Disturbance related to failure to live according to
dictates of religion.
Sexual Dysfunction related to value conflict.
Sleep Pattern Disturbance related to spiritual distress.

High risk for Self-Directed Violence : related to feeling that life is

meaningless.
Planning : Client Goals
Nurses who are sensitive to the role spiritual beliefs play in
influencing both a persons thoughts about self and the word and
interactions with the word value spiritual health. Their interactions
with any client who values spiritualty are supportive of the following
client goals. The client will :
Identify spiritual beliefs that meet needs for meaning and
purpose, love and related ness, and forgiveness.
Derive from these beliefs strength, hope, and comfort when
facing the challenge of illness, injury, or other life crisis.
Develop spiritual practices that nurture communion with inner
self, with God, and with the world.
Express satisfaction with the compatibility of spiritual beliefs ang
everyday living.
Goal for clients in spiritual distress need to be individualized
and may include some of the following. The client will :
Explore the origin of spiritual beliefs and practice.
Identify factors in life that challenge spiritual beliefs.
Explore alternatives given these challenges : deny, modify, or
reaffirm beliefs ; develop new beliefs.
Identify spiritual supports (eg, spiritual reading, faith,
community)
Report or demonstrate a decrease in spiritual distress following
successful intervention.
Implementing
There are a varienty of interventions available to the nurse
who wishes to help clients meet spiritual needs. Like other nursing
skills, these interventions need to be practiced before the nurse is
able to use them confidently, competently, and at the right moment.
In this section, the following nursing interventions are
present :
a. Offering supportive presence.
b. Facilitating the clients practice of religion.
c. Nuturing spirituality.
d. Praying with a client.
e. Spiritual counseling.
f. Referring a client to a religious counselor, and
g. Resolving conflict between spiritual beliefs and treatment.

Evaluating
In general, the nurse evaluates the clients ability to :
Find meaning and purpose in the clients current condition.
Interact honestly with family, friends, and other who meet the
clients need for love and relatedness.
Derive strength and peace from the clients spiritual beliefs.
Reconcile any interpesonal differences causing the cliens
anguish (religious belief or law in conflict with medical therapy).