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Spiritual Distress

Spiritual Distress

(_)Actual (_) Potential

Related To:
[Check those that apply]
(_) Pain
(_) Trauma
(_) Loss of body part/function
(_) Terminal illness
(_) Death of s/o
(_) Unable to practice religious rituals
(_) Other:_____________________________
____________________________________
____________________________________

 

As evidenced by:
[Check those that apply]
Major:
(
Must be present)
(_) Experiences a disturbance in belief system.
Minor:
(
May be present)
(_) Questions credibility of belief system.
(_) Demonstrates discouragement or despair.
(_) Is unable to practice usual religious rituals.
(_) Has ambivalent feelings (doubts) about beliefs.
(_) Expresses that he/she has no reason for living.
(_) Feels a sense of spiritual emptiness.
(_) Shows emotional detachment from self and others.
(_) Expresses concern, anger, resentment, fear - over the meaning of life, suffering, death.
(_) Requests spiritual assistance for a disturbance in belief system.

 

Date &
Sign.
Plan and Outcome
[Check those that apply]
Target
Date:
Nursing Interventions
[Check those that apply]
Date
Achieved:
  The patient will:

(_) Continue spiritual practices not detrimental to health.

(_) Express decreasing feelings of guilt and anxiety.

(_) Express satisfaction with spiritual condition.

(_) Other:

  (_) Assess current level of spiritual state: Comfort, distress, desire for minister, priest, rabbi to visit, desire to practice religious rituals.

(_) Implement patient requests regarding spiritual needs.

(_) Contact spiritual/religious advisor of patients choice.

(_) Discuss impact of stress on challenging one's spiritual beliefs.

(_) As patient desires, allow opportunity to discuss belief system, the meaning of illness/suffering within this system.

(_) Other:________________
________________________
________________________
________________________

 

 

__________________________
Patient/Significant other signature

 

__________________________
RN signature