NURSING CARE PLAN FOR SPIRITUALITY CUES S-The client verbalized, Bakit ako nagkakanser?

Siguro pinaparusahan na ako ni Lord dahil sa paninigarilyo ko at pag-inom ng alak - The client also verbalized, Siguro dahil na rin hindi ako nakakapagsimba na pati hindi na rin ako nakakapagdasal. - The client also said, Natatakot talaga akong mamamatay. Sino mag-aalaga sa mga anak ko? O- during the interview, the client was emotional and tearful - There were no observed rosaries or other religious articles on the patients hands NURSING DIAGNOSIS Spiritual Distress related to chronic illness of self (cancer that metastasize) as evidenced by questioning why God has done this GOAL AND NURSING RATIONALE OBJECTIVES INTERVENTION Spiritual distress is Goal: an experience of After an 8 hour profound shift of nursing disharmony in the interventions, the persons belief or patient will value system that express meaning threatens the and purpose in life meaning of his or and a sense of her life. During connectedness spiritual distress with self and the patient loses others. hope, questions his or her belief Objectives: system, or feels After one hour of Determine clients Provides baseline separated from his nursing for planning care religious/spiritual or her personal interventions, the orientation, current and accessing source of comfort client will discuss involvement, and appropriate and strength. Pain, beliefs/values resources. presence of chronic or terminal about spiritual conflicts. illness, impending issues. surgery, and the Be aware of It is still possible death or illness of influence of affect to be helpful loved ones are to client while caregivers belief crises that may remaining neutral/ system. cause spiritual; not espousing own distress. beliefs. (Carpenito-Moyet, 2006; Gulanick, Promotes Establish 2007; Berman, et awareness and environment that al, 2008) identification of promotes free feelings so they expression of feelings and can be dealt with concerns. Provide calm, peaceful setting when ANALYSIS EVALUATION EFFECTIVENESS: Was the client able to express meaning and purpose in life and a sense of connectedness with self and others? ____ Yes ____ No If No, why? ________________

Was the client able to discuss beliefs/values about spiritual issues? ____ Yes ____ No If No, why? ________________

or near him. After 2 hours of nursing interventions, the client will verbalize acceptance of self as not deserving illness or no one is to blame.

possible. Be open to the Encourages clients feelings expression of inner about illness or fears and concerns death, and teaches the client to value of confronting issues. Listen to client/SOs reports/expressions of anger, concern, alienation from God, belief that situation is a punishment for wrongdoing, and so forth. Note sense of futility, feelings of hopelessness and helplessness, lack of motivation to help self. Helpful to understand client/SOs point of view and how they are questioning their faith in the face of tragedy. . Was the client able to verbalize acceptance of self as not deserving illness or no one is to blame.? ____ Yes ____ No If No, why? ________________

These thoughts and feelings can result in the client feeling paralyzed and unable to move forward to resolve the situation. May indicate need for further intervention to prevent suicide attempt.

Listen to expressions of inability to find meaning in life, reason for living. Evaluate for suicidal ideation. Help client find a reason for living.

Helps client find own solutions to

concerns. . Helps client to begin to look at basis for spiritual confusion. Note: There is a potential for care providers belief system to interfere with client finding own way. Therefore it is most beneficial to remain neutral and not espouse own beliefs. Blaming self for what has happened impedes dealing with the grief process and needs to be discussed and dealt with.

Make time for nonjudgmental discussion of philosophic issues/questions about spiritual impact of current events/situation.

Discuss difference between grief and guilt and help client to identify and deal with each, assuming responsibility for own actions, expressing awareness of the consequences of acting out of false guilt. Use therapeutic communication skills of reflection and ActiveListening. Discuss use

Can help to heal past and present pain.

Promotes trust and

of/provide opportunities for client/SO to experience meditation, prayer and forgiveness. Provide information that anger with God is a normal part of the grieving process. Develop therapeutic nurseclient relationship. Ask how you can be most helpful. Convey acceptance of clients spiritual beliefs/ concerns. After 2 hours of nursing intervention, the client will be able to identify resources appropriately.

comfort, encouraging client to be open about sensitive matters.

Promotes sense of hope and willingness to continue efforts to improve situation.

Determine support Presence or lack of systems available support systems to client/SO(s). can affect clients recovery. Identify and may refer to resources that can be helpful (e.g., pastoral/parish nurse or religious counselor, crisis counselor, psychotherapy) Assist client to identify SO(s) nad people who could Specific assistance may be helpful to recovery, (e.g., relationship problems, suicidal ideation).

Was the client able to identify resources? appropriately ____ Yes ____ No If No, why? ________________

Ongoing support is required to enhance sense of

provide support as needed.

connectedness and continue progress toward goals. Provides answers to spiritual questions, assist in the journey of selfdiscovery, and can help client learn to accept and forgive self.

Assist clients to identify spiritual resources that could be helpful (e.g., contact with spiritual advisor who has qualifications in dealing with terminal or chronic illness Encourage participation in support groups if possible.

Discussing concerns and questions with others can help client resolve feelings.
(Doenges et al, Nurses Pocket Guide Diagnoses, Prioritized Interventions and Rationales 11th Edition, page 646-651)

Submitted By: Campos, Jennilise C. Capistrano, Maria Marza Beverly B. Castillo, Hubert Ban M. Coronel, Romina G. De Luna, Alvin Michael M. Dejamco, Kristine Joy G. BSN 203 August 17, 2011