00066 Spiritual Suffering

Domain 10: vital principles
class 3: congruence between values/beliefs/actions
Diagnostic Code: <00066
Nanda Tag: spiritual suffering
Diagnostic focus: spiritual suffering
Approved 1978 • Revised 2002, 2013, 2017, 2020 • Evidence level 3.2

NANDA Nursing Diagnosis Definition

Nanda nursing diagnosis « spiritual suffering ” is defined as: state of suffering related to the deterioration of the ability to integrate the meaning and purpose of life through connections with the self, the others, the world or a superior being.

Definite characteristics

  • Ira behaviors
  • crying
  • Decrease in creativity expression
  • disinterest in nature
  • Dysomnias
  • Excessive guilt
  • Express alienation
  • Express anger
  • Express anger towards a higher power to the self
  • Express concern about beliefs
  • Express concern about the future
  • Express concern about the value system
  • Express concerns about the family
  • Express distress
  • Express feel abandoned by a greater power than oneself
  • Express feelings of vacuum
  • Express not feel loved
  • Express not feel valued
  • Express insufficient value
  • Express loss of trust
  • Express loss of control
  • Express loss of hope
  • Express loss of serenity
  • Express need for forgiveness
  • Express repentance
  • Fatigue
  • Fear
  • Deterioration of the ability to introspection
  • Inability to experience importance
  • Imported duel
  • Perception of loss of the meaning of life
  • Identity questioning
  • Questionation of the meaning of life
  • Questionation of the sense of suffering
  • questions one’s dignity
  • Reject interaction with others

Related factors

  • Alteration in religious ritual
  • Alteration in spiritual practice
  • Anxiety
  • Barriers to experience love
  • Cultural conflict
  • Depressive symptoms
  • Difficulty to accept the aging process
  • Control of the inappropriate environment
  • Inadequate interpersonal relationships
  • loneliness
  • Loss of independence
  • Low self -esteem
  • Pain
  • Perception of having pending issues
  • Personal alienation
  • Separation of the support system
  • Social alienation
  • Sociocultural deprivation
  • Stressors
  • Inappropriate use of substances

Risk population

  • People who experience the birth of a child
  • People who experience death of significant people
  • People who experience infertility
  • People who experience vital transitions
  • People who experience racial conflict
  • People who experience an unexpected vital event
  • People exposed to death
  • People exposed to natural disaster
  • People exposed to traumatic events
  • People who receive bad news
  • People who receive terminal care
  • People with low educational level

Associated problems

  • Chronic disease
  • Depression
  • Loss of a body part
  • Loss of the function of a body part
  • Therapeutic regime

Suggestions of use

(a) Spiritual well -being should be considered in a general sense and not limited to religion. All people are religious in that they need something that gives meaning to their life. For some it is about believing in God in the traditional sense; For others it is a feeling of harmony with the universe; Even for others it can be family and children. When the patient believes that life does not have a meaning or a purpose, in any sense, spiritual suffering occurs. (b) Some of the following suggested alternative diagnoses can cause spiritual suffering.

Suggested alternative diagnostics

  • Chronic affliction
  • Ineffective coping
  • Anxiety before death
  • Decision conflict
  • Spiritual suffering, risk of

NOC Results

  • Quality of life: positive perception of current life circumstances
  • Hope: Optimism that is personally satisfactory and promoter of life
  • Dignified death: Personal actions to maintain control by approaching the end of life
  • Social participation: social interactions with people, groups or organizations
  • Spiritual health: connection with themselves, with others, with a superior power, with life, nature and the universe, which transcends the self and gives it power

Evaluation objectives and criteria

  • • Demonstrates hope, as manifested by the following indicators (specifying 1 to 5: never, rarely, sometimes, often or usually): express faith, a sense of inner life and peace
  • • Demonstrates spiritual well -being, as manifested by the following indicators (specify from 1 to 5: seriously, substantially, moderately, slightly or not compromised):
    • Meaning and purpose in life
    • Achievement of a spiritual vision of the world
    • Ability to love and forgive
    • Ability to pray and worship
    • Interaction with spiritual leaders
    • Connection with the inner self
  • Other examples

    The patient will be able to:

    • • Recognize that the disease is a challenge for the belief system
    • • Recognize that the treatment conflicts with the belief system
    • • Show coping techniques to deal with spiritual suffering
    • • Express an acceptance of limited cultural or religious ties
    • • Discuss spiritual concerns and practices

    The dying patient will be able to:

    • • Express acceptance or preparation to die
    • • Reconcile with old relationships
    • • Express affection for loved ones

    NIC Interventions

    • Clarification of values: Help another person to clarify their own values ??in order to facilitate good decision making
    • Emotional support: provision of comfort, approval and encouragement, during moments of stress
    • Support in decision making: Provision of information and support to a patient who is making a decision regarding his health
    • Spiritual support: Help the patient to feel in balance and in communion with a higher power
    • Care at the end of life: promotion of physical comfort and psychological peace in the final phase of life
    • Socialization promotion: facilitation of another person’s ability to interact with others
    • Inspiration of hope: Facilitation of the development of a positive perspective in a certain situation
    • Improvement of coping: Help the patient to adapt to stressful factors, changes, or perceived threats, which interfere with the satisfaction of the demands and the roles of life
    • Improvement of spiritual growth: facilitation of growth in the patient’s ability to identify, relate and resort to the source of meaning, purpose, comfort, strength and hope in their life

    Nursing Activities


    • • For patients with some religious affiliation, assess the direct indicators of the patient’s spiritual state asking questions like these:
      • Do you think your faith is useful? How important is it for you at this time?
      • How can I help you support your faith? For example, would you like him to read any prayer?
      • Would you like to receive the visit of your spiritual advisor or hospital chaplain?
      • Please talk to me of any concrete religious practice that is important for you.
    • • Perform indirect evaluations of the patient’s spiritual state through the following:
      • Determine the concept that the patient has of God, observing the books that are next to the bed or the television programs that he usually see. Also, studying whether the patient’s life seems to have a meaning, a value and a purpose.
      • Determine what is the source of hope and strength of the patient. Is it God in the traditional sense, a family member or a
      • “Inner source” of force? You must see who the patient speaks most, or ask him: who is important for you?
      • Observe if it seems that the patient is praying when the staff enters the room, before meals, or during procedures.
      • Find elements such as religious literature, rosaries and religious cards of good wishes next to the bed.
      • Listen to what the patient thinks about the relationship between spiritual beliefs and their state of health, especially expressions such as: “Why has God left me?”, Or “If I have faith, I will put myself Good. ”

    Collaboration activities

    • • Communicate nutritional needs (for example, kosher food, vegetarian diet, diet without pork) to nutritionist
    • • Request spiritual advice to help the patient and the family to determine the needs subsequent to hospitalization, as well as community support resources
    • • (NIC) Spiritual support: channel with the spiritual advisor that the patient chooses


    • • Explain the limitations that hospitalization imposes on religious customs
    • • Make the immediate changes necessary to adjust to the patient’s needs (for example, encourage family members or friends to bring special food)
    • • Provide privacy and time to the patient for religious practices
    • • (NIC) Spiritual support:
      • Be open to the expressions of solitude and impotence of the patient
      • Use values ??clarification techniques to help the patient understand their beliefs and values, as required
      • Show empathy with the feelings of the patient
      • Listen carefully to the patient and establish a schedule for prayer or spiritual rituals
      • Ensure the patient that a nursing professional will always have available to support him in moments of suffering
      • Encourage the patient to attend religious services in the chapel, if you wish
      • Provide the patient with the religious articles you want, according to their preferences

    At home

    • • The above activities are suitable for home care
    • • Help the patient and relatives to create a home space for meditation or prayer

    Older people

    • • Organize help (for example, domestic assistance) to read sacred texts to the patient, if he wishes and cannot read them by himself