Nursing Care Plan for Spiritual Diagnosis: A Comprehensive Guide

Assessment

Spiritual assessment is a critical component of holistic nursing care. It involves understanding a patient’s spiritual beliefs, values, and practices to provide patient-centered care that addresses their spiritual needs. Standardized tools and models can guide nurses in conducting sensitive and thorough spiritual assessments.

Subjective Spiritual Assessment

Subjective assessment relies on gathering information directly from the patient about their spiritual experiences. Agencies frequently employ standardized spiritual assessment tools upon patient admission. When such tools are unavailable, the FICA model offers a structured yet open approach to inquire about a patient’s spiritual beliefs without judgment.¹ The FICA model includes these key questions:

F – Faith or Beliefs: “What are your spiritual beliefs?” “Do you consider yourself a spiritual person?” “What gives meaning to your life?” These questions explore the patient’s foundational beliefs and sense of purpose.
I – Importance and Influence: “How important is your faith or spirituality to you?” “How has your current health situation or hospitalization affected your spiritual practices and beliefs?” This delves into the significance of spirituality in the patient’s life and how illness impacts it.
C – Community: “Are you connected with a faith community or spiritual group?” “Does this community provide support or comfort during difficult times?” “Is there anyone who supports you in your spirituality?” This explores the role of community and support systems in the patient’s spiritual life.
A – Address: “How can we, as healthcare providers, support your spiritual beliefs and practices while you are in our care?” This question directly asks the patient about their needs and how the healthcare team can assist them.

Another valuable tool for spiritual assessment is the HOPE tool, which can be seamlessly integrated into a medical interview. HOPE is an acronym that guides nurses in exploring key spiritual dimensions:²

H – Sources of Hope, Meaning, Comfort, Strength, Peace, Love, and Connection: This broad question opens the door to discussing a wide range of spiritual resources beyond formal religion. It initiates therapeutic communication and allows patients to define spirituality in their own terms.
O – Organized Religion: This question explores the patient’s involvement with organized religion, including their faith tradition and community.
P – Personal Spirituality and Practices: This delves into individual spiritual practices that may be important to the patient, such as prayer, meditation, or spending time in nature. Normalizing statements, like “For some people, their religious or spiritual beliefs act as a source of comfort and strength… Is this true for you?”, can facilitate open conversation.
E – Effects of Spirituality on Medical Care and End-of-Life Issues: This crucial question addresses how the patient’s spirituality influences their healthcare decisions, particularly concerning treatment choices and end-of-life care. It can reveal potential conflicts between spiritual values and medical interventions, fears about death, and needs for spiritual support during medical treatment.

Alt text: A nurse is shown listening intently to a patient in a hospital bed, demonstrating empathetic communication during a spiritual assessment.

For further information on utilizing the HOPE tool, resources are available online, offering detailed guidance on its application in clinical practice.

Objective Spiritual Assessment

Objective assessment involves observing patients for nonverbal and verbal cues that may indicate spiritual distress or well-being. Nurses should be attentive to behaviors and statements that suggest a patient is struggling to find meaning, purpose, or hope in their current situation. Observing the presence and quality of supportive relationships is also crucial.³

Patients dealing with chronic or serious illnesses may express statements indicative of spiritual distress. These statements should alert nurses to the need for focused spiritual care. Examples of such statements include:⁴

Lack of Meaning: Statements like, “I don’t understand why this is happening to me,” or “I feel like my life has no purpose anymore,” reflect a struggle to find meaning in their current experience.
Hopelessness: Expressions such as, “There’s no point in trying,” or “I’ve lost all hope for the future,” indicate a lack of positive anticipation and a sense of despair.
Mystery and questioning: Questions like, “Why me?” or “What have I done to deserve this?” reveal a struggle to understand their suffering and the larger picture of their life.
Isolation and Loneliness: Statements such as, “I feel completely alone,” or “Nobody understands what I’m going through,” highlight feelings of disconnection and lack of social support.
Helplessness and Powerlessness: Expressions like, “I have no control over anything anymore,” or “I feel so helpless,” indicate a loss of agency and an inability to influence their situation.

Nursing Diagnoses Related to Spiritual Health

Based on both subjective and objective assessments, nurses can formulate appropriate nursing diagnoses related to spiritual health. NANDA-I (North American Nursing Diagnosis Association International) provides standardized diagnoses that facilitate clear communication and care planning. Table 18.4 outlines selected NANDA-I diagnoses relevant to spiritual well-being.

Table 18.4 Selected NANDA-I Nursing Diagnoses Related to Spiritual Health⁵

NANDA-I Diagnosis	Definition	Selected Defining Characteristics
Readiness for Enhanced Spiritual Well-Being	A pattern of experiencing and integrating meaning and purpose in life through connectedness with self, others, the world, and/or a Higher Power that is sufficient for well-being and can be strengthened.	– Expresses desire to enhance coping mechanisms – Expresses desire to increase life satisfaction – Expresses desire to deepen forgiveness of others – Expresses desire to improve interactions with significant others – Expresses desire to cultivate hope – Expresses desire to increase service to others – Expresses desire to enhance creative energy – Expresses desire to engage in more spiritual reading – Expresses desire to strengthen oneness with nature – Expresses desire to increase participation in religious practices – Expresses desire to enhance prayerfulness
Impaired Religiosity	Disruption in the ability to exercise reliance on religious beliefs and/or participate in rituals of a particular faith tradition.	– Expresses a desire to reconnect with previous belief patterns – Experiences difficulty adhering to prescribed religious beliefs and/or rituals – Expresses distress or sadness about separation from their faith community
Spiritual Distress	A state of suffering related to an impaired ability to experience meaning in life through connections with self, others, the world, and/or a power greater than oneself.	– Demonstrates anger or irritability – Expresses crying or tearfulness – Reports fatigue or lack of energy – Expresses fear or anxiety – Questions personal identity or self-worth – Questions the meaning and purpose of life – Questions the meaning of suffering

Nurse attentively listening to a patient during spiritual assessment

Sample Nursing Diagnosis Statements

Readiness for Enhanced Spiritual Well-Being: This diagnosis is applicable when a patient expresses a desire to grow and strengthen their spiritual well-being. A sample PES (Problem, Etiology, Signs/Symptoms) statement could be: “Readiness for Enhanced Spiritual Well-Being as evidenced by expressed desire to spend more time in nature and cultivate a deeper connection with the natural world.” Nursing interventions would focus on supporting the patient’s desire, such as suggesting visits to parks or incorporating nature-based activities into their care plan.

Impaired Religiosity: This diagnosis applies when a patient is experiencing difficulties in practicing their religion due to situational factors like hospitalization. A sample PES statement is: “Impaired Religiosity related to environmental barriers imposed by hospitalization as evidenced by patient’s statement of difficulty adhering to daily prayer rituals.” Interventions would aim to reduce barriers and facilitate religious practice, such as arranging for a visit from religious clergy or providing a quiet space for prayer.

Spiritual Distress: This diagnosis is used when a patient experiences suffering related to their spiritual beliefs or lack thereof, often in the context of illness or life challenges. For example, a patient with a new cancer diagnosis might experience spiritual distress. A sample PES statement could be: “Spiritual Distress related to anxiety and uncertainty associated with new cancer diagnosis as evidenced by crying, insomnia, and verbalizing questions about the meaning of suffering.” Nursing interventions would focus on providing emotional and spiritual support to help the patient cope with their distress.

Outcome Identification for Spiritual Care Plans

Establishing clear goals and SMART (Specific, Measurable, Achievable, Relevant, Time-bound) outcomes is essential for effective spiritual care planning. Outcomes should be individualized to each patient’s unique needs and situation.

For Readiness for Enhanced Spiritual Well-Being, a sample goal might be: “The client will demonstrate enhanced hope and spiritual well-being as evidenced by indicators such as expressing optimism about the future, demonstrating faith in their beliefs, articulating a sense of meaning in life, and reporting inner peace.”⁸ A related SMART outcome could be: “The client will verbally express a greater sense of meaning and purpose in life by the time of discharge from the hospital.”⁹

For Spiritual Distress, a sample goal statement is: “The client will demonstrate improved spiritual well-being, as evidenced by expressing feelings of faith, hope, meaning, and purpose in life, and demonstrating a sense of connectedness with self and others to share thoughts, feelings, and beliefs.”¹⁰ A corresponding SMART outcome could be: “The client will identify and express at least one personal source of purpose in life by the end of the week.”¹¹

Planning and Implementing Spiritual Interventions

Providing Holistic Spiritual Care

Nurses play a vital role in providing spiritual care. It is paramount that nurses offer support without imposing their own beliefs. Key guidelines for implementing therapeutic spiritual interventions include:

Client-Centered Approach: Take cues from the patient. Recognize that spiritual conversations can be sensitive. Allow the patient to lead the discussion and respect their boundaries. Pay attention to nonverbal cues that may indicate discomfort or unspoken feelings. Gently address discrepancies between verbal and nonverbal communication to encourage deeper sharing. For example, if a patient denies blaming a higher power for their illness but tears up, acknowledge the emotion and invite them to share more.
Directly Ask About Support Needs: Inquire directly about how you can support the patient’s spiritual needs. Facilitate their requests when possible, such as arranging visits from clergy, providing quiet time for prayer or meditation, or access to a chapel. Emphasize the connection between spiritual well-being and the healing process. Utilize available resources like hospital chaplains.
Respect Diverse Faith Traditions: Support patients within their own faith tradition without proselytizing or imposing personal beliefs. The nurse’s role is to respect and support the patient’s values, not to promote their own.
Active Listening and Validation: Listen attentively to patient’s fears and concerns without interjecting personal stories. Focus solely on the patient’s experience. Validate their emotions by naming and acknowledging them. This can help patients recognize and process their feelings more effectively.
Prayer and Spiritual Practices: Offer to pray with the patient if requested, or arrange for someone who can, such as a chaplain. If praying, focus on the patient’s preferences and beliefs. Ask the patient what they would like you to pray about. Having a short, general prayer suitable for diverse faiths can be helpful. If uncomfortable praying directly, connect the patient with a chaplain.

Alt text: A close-up image showing a nurse gently holding a patient’s hand, conveying comfort and support during a spiritual care intervention.

Sharing Encouragement and Inspiration: Offer encouraging thoughts or words, such as relevant scripture verses (based on patient preference) or inspirational poems, particularly during challenging times. Keep a few such resources readily available.
Presence and Therapeutic Touch: Sometimes, simply being present with a patient provides significant spiritual comfort. Quiet presence can be deeply comforting, especially during pain or sleeplessness. Therapeutic touch, with the patient’s permission, can also be a powerful tool for conveying empathy and support.¹⁴

The box below summarizes therapeutic nursing interventions for spiritual support. Additional interventions for grief and loss can be found in resources addressing grief and bereavement.

Therapeutic Nursing Interventions for Spiritual Support¹⁵, ¹⁶

Employ therapeutic communication to build trust and demonstrate empathetic caring.
Be present and available for active listening and empathetic expression.
Treat every patient with dignity and respect.
Assess the importance of faith and beliefs for the patient and family (e.g., religious services, prayer times, rituals).
Encourage life review and reminiscence as appropriate.
Be receptive to expressions of concern, loneliness, or feelings of powerlessness.
Provide privacy and quiet time for spiritual practices.
Be aware of religious rules, celebrations, and customs that may impact care (e.g., dietary needs, fasting, blood transfusion considerations).
Facilitate meditation, prayer, and other religious or spiritual rituals.
Pray with the patient, when appropriate and requested.
Provide access to spiritual music, literature, radio, television, or online resources as desired.
Educate patients on relaxation techniques, meditation, and guided imagery, as appropriate.
Arrange visits from chaplains, clergy, or spiritual advisors.
Promote hope within the patient’s personal framework, avoiding false reassurance.
Encourage forgiveness practices.
Facilitate interaction with family, friends, and support networks.
Encourage participation in relevant support groups.

Implementing Care and Addressing Conflicts

When implementing spiritual care interventions, nurses must always respect patient preferences. Accommodate spiritual and religious practices when safe and feasible. If a conflict arises between a patient’s spiritual beliefs and their treatment plan, clearly explain the rationale behind the medical intervention. If the patient remains unwilling to proceed due to their beliefs, advocate for negotiation and modification of the care plan with the healthcare team. Examples include advocating for rescheduling procedures around religious observances or adjusting dietary and medication schedules to accommodate religious practices like Ramadan.

Evaluation of Spiritual Care

Evaluating the effectiveness of spiritual care involves assessing the patient’s progress toward their established goals and SMART outcomes. Refer back to the overarching goal of spiritual health: “The client will demonstrate spiritual health as evidenced by feelings of faith, hope, meaning, and purpose in life, along with a sense of connectedness with self and others.”¹⁷ Review the individualized SMART outcomes to determine the extent to which the patient has achieved them and adjust the nursing care plan as needed to ensure ongoing spiritual support.

References

¹ Dameron, C. M. (2005). Spiritual assessment made easy… With acronyms! Journal of Christian Nursing, 22(1). https://www.nursingcenter.com/journalarticle?Article_ID=725343&Journal_ID=642167&Issue_ID=725337

² Anandarajah, G., & Hight, E. (2001). Spirituality and medical practice: Using the HOPE questions as a practical tool for spiritual assessment. American Family Physician, 63(1), 81-9. https://www.aafp.org/afp/2001/0101/p81.html

³ Ackley, B., Ladwig, G., Makic, M. B., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing diagnosis handbook: An evidence-based guide to planning care (12th ed.). Elsevier, pp. 869-872.

⁴ Puchalski, C. M., Vitillo, R., Hull, S. K., & Reller, N. (2014). Improving the spiritual dimension of whole person care: Reaching national and international consensus. Journal of Palliative Medicine, 17(6), 642–656. https://doi.org/10.1089/jpm.2014.9427

⁵ Herdman, T. H., Kamitsuru, S., & Lopes, C. T. (Eds.). (2021). Nursing diagnoses: Definitions and classification 2021-2023, Twelfth Edition. Thieme Publishers New York.

⁶ Nanddiagnoses.com. (n.d.). Impaired religiosity. https://nandadiagnoses.com/impaired-religiosity

⁷ Herdman, T. H., Kamitsuru, S., & Lopes, C. T. (Eds.). (2021). Nursing diagnoses: Definitions and classification 2021-2023, Twelfth Edition. Thieme Publishers New York.

⁸ Ackley, B., Ladwig, G., Makic, M. B., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing diagnosis handbook: An evidence-based guide to planning care (12th ed.). Elsevier, pp. 869-872.

⁹ Ackley, B., Ladwig, G., Makic, M. B., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing diagnosis handbook: An evidence-based guide to planning care (12th ed.). Elsevier, pp. 869-872.

¹⁰ Ackley, B., Ladwig, G., Makic, M. B., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing diagnosis handbook: An evidence-based guide to planning care (12th ed.). Elsevier, pp. 869-872.

¹¹ Ackley, B., Ladwig, G., Makic, M. B., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing diagnosis handbook: An evidence-based guide to planning care (12th ed.). Elsevier, pp. 869-872.

¹² “Praying_with_Patient.jpg” by Ahs856 is licensed under CC BY-SA 4.0

¹³ Nourian, F. (2018, March 16). 9 ways to provide spiritual care to your patients & their families. AdventHealth. https://careers.adventhealth.com/blog/9-ways-to-provide-spiritual-care-to-patients-and-their-families

¹⁴ Nourian, F. (2018, March 16). 9 ways to provide spiritual care to your patients & their families. AdventHealth. https://careers.adventhealth.com/blog/9-ways-to-provide-spiritual-care-to-patients-and-their-families

¹⁵ Wagner, C. M., Butcher, H. K., & Clarke, M. F. (2024). Nursing interventions classification (NIC) (8th ed.). Elsevier.

¹⁶ Ackley, B., Ladwig, G., Makic, M. B., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing diagnosis handbook: An evidence-based guide to planning care (12th ed.). Elsevier, pp. 869-872.

¹⁷ Ackley, B., Ladwig, G., Makic, M. B., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing diagnosis handbook: An evidence-based guide to planning care (12th ed.). Elsevier, pp. 869-872.