Addressing Spiritual Distress as a Nursing Diagnosis

Feeling distressed or hopeless during illness can profoundly impact one’s spirit. As holistic caregivers, nurses must be adept at identifying and responding to spiritual distress in patients. Implementing spiritual care preserves dignity and enhances healing.

Spiritual distress occurs when a health crisis causes anguish that compromises a patient’s core beliefs, meaning, or faith. Unlike general anxiety or depression, spiritual distress stems from deeply existential concerns over life purpose, mortality, or relationship to the divine. Left unaddressed, it inhibits optimal healing.

Defining Spiritual Distress in Nursing Practice

Spiritual distress is formally defined in nursing as “the state in which an individual or group experiences or is at risk of experiencing a disturbance in a belief or value system that provides strength, hope, and meaning to life.” This disturbance often manifests as psychological unease, disruptive behaviors, or questioning of deeply-held convictions.

Spiritual distress differs from psychological disorders like anxiety or depression. While these conditions may co-occur, spiritual distress focuses on strained relationships to self, others, the environment, or a higher power. It stems from core existential concerns over life’s meaning and fragility.

Signs of Spiritual Distress

Since spiritual distress involves internal turmoil over intangible concepts like meaning and faith, recognizable symptoms largely relate to resulting behaviors, emotions, and thought patterns. Common cues of spiritual distress include:

  • Excessive anxiety, anger, guilt, sadness, or hopelessness
  • Social withdrawal or isolation
  • Restlessness or agitation
  • Regression to prior religious or cultural practices
  • Verbalizing loss of meaning/purpose in life
  • Questioning faith or religious beliefs
  • Nonadherence to medical recommendations

Changes in psychological state or actions can signify the patient is struggling to reconcile their illness experience with deeply-held convictions that give life meaning. They may feel punished, abandoned, or hopeless. This understandably hinders coping.

Why Identifying Spiritual Distress Matters in Nursing

Recognizing and addressing spiritual distress is an essential nursing function. Reasons this diagnosis matters include:

Impact on Healing and Recovery

Unresolved spiritual turmoil impedes patients coping with illness or trauma. Those able to resolve existential questions and find sources of hope often demonstrate better resilience. Facilitating this process through spiritual care promotes healing.

Holistic, Patient-Centered Practice

Considering patients’ emotional and spiritual needs recognizes their whole personhood. Much like tending to physical and psychological concerns, nurturing spiritual well-being provides holistic care.

Can Worsen Without Proper Diagnosis and Treatment

Just as unchecked pain or nausea worsens patient outcomes, unaddressed spiritual distress exacerbates suffering. Appropriate diagnosis facilitates needed spiritual care.

Impact on Sense of Self and Dignity

Being unable to find meaning or purpose during illness can diminish patients’ sense of identity and self-worth. Restoring spiritual integrity restores dignity.

Influence on Coping Abilities

Unresolved spiritual concerns inhibit development of healthy coping mechanisms and resilience. Targeted spiritual care fosters growth of these capacities.

Common Contributing Factors to Spiritual Distress

While spiritual distress can arise under any health condition, certain illness experiences commonly trigger or worsen it. These include:

Life-Threatening or Terminal Diagnosis

Facing potential loss of life often provokes deep reflection on meaning, purpose, and beliefs about the afterlife.

Sudden, Unexpected Illness or Trauma

Abrupt adversity challenges worldviews and closely-held assumptions about security and predictability.

Pain, Impaired Cognition, or Consciousness

Loss of clarity or focus inhibits spiritual practices that ordinarily provide comfort.

Loss of Independence or Dignity

Illness-related dependency and compromised privacy may conflict with self-image.

Alienation from Support Systems

Separation from loved ones disrupts connection to sources of shared meaning.

Nursing Interventions for Spiritual Distress

Once spiritual distress is identified, nurses can implement targeted care strategies. Effective interventions include:

Active Listening and Building Trust

Providing nonjudgmental listening establishes trust and allows patients to voice complex feelings over their health crisis, relationships, meaning, and faith.

Encouraging Expression of Thoughts and Beliefs

By creating a safe space for patients to share beliefs, values, and cultural-spiritual practices, nurses help relieve distress.

Respecting Patient Dignity and Autonomy

Honoring patients’ values and supporting participation in meaningful rituals preserves dignity and agency during vulnerability.

Referrals to Spiritual Care Services

Chaplains, clergy members, or counselors can provide specialized spiritual guidance through in-depth discussions or rites.

Offering Emotional and Social Support

Nurturing coping skills, encouraging interactions with loved ones, and providing reassuring presence all help mitigate spiritual distress.

Facilitating Cultural or Religious Practices

Accommodating important rituals, symbols, or observances reinforces coping connections.

Encouraging Life Review and Reminiscence

Reflecting on cherished memories and meaningful lifetime events promotes continuity and purpose.

Assisting with Advanced Directives

Clarifying wishes around medical interventions toward end of life eases angst.

Creating a Spiritual Care Plan

To fully integrate spiritual care, nurses can develop individualized plans to continually assess and address spiritual needs. Key steps include:

Initial Spiritual Assessment Upon Admission

Early assessment identifies current spiritual views, practices, and vulnerability to distress.

Documenting Concerning Signs and Symptoms

Note psychological cues, behaviors, or conversations indicating spiritual distress.

Consulting Interdisciplinary Team

Inform physicians, social workers, dietitians, and rehab therapists to provide holistic supportive care.

Ongoing Evaluation and Adjustment

Regularly re-evaluate spiritual state and adjust interventions accordingly.

Referrals to Outpatient Spiritual Counseling Post-Discharge

Connect patients to community resources for continued spiritual support after hospitalization.

Patient and Family Education

Teach coping strategies and offer literature on finding hope, meaning, and connection during illness.

Special Considerations for Pediatric and Geriatric Populations

Three key high-risk populations warrant tailored approaches to assessing and addressing spiritual distress:


Assess developmental stage, use age-appropriate language, and provide comforting objects from home.


Emphasize peer support and explore creative arts for emotional expression.

Screen for isolation and loss; reminisce and facilitate rituals.

Integrating spiritual care into the nursing process improves identification and treatment of spiritual distress. By proactively addressing this common but under-recognized diagnosis, nurses can profoundly impact patient healing.