Defining characteristics of spiritual distress: an integrative review
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NANDA International 2012 Conference Abstract
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Session 5.3
Nursing Knowledge Track

Authors
Sílvia Caldeira
Margarida Vieira

Question
Spiritual distress is a diagnosis accepted to NANDA since 1978, reviewed in 2002 (NANDA, 2009). It is introduced in taxonomy II at domain 10 (life principles), class 3 (value/belief/action congruence). It is defined as the impaired ability to experience and integrate meaning and purpose in life through connectedness with self, others, art, music, literature, nature, and/or a power greater than oneself. Taxonomy II proposes 28 defining characteristics. Identify the clinical indicators of spiritual distress  in nursing literature.

Results / Findings
The sample was 37 articles, published between 2001-2010(59,5%), in English language (89,2%). Most frequent type was content validation (24,3%), narrative reviews (16,2%), theoretical reflections (13,5%) and descriptive research (10,8%). The only clinical validation was from Brazil (Chaves, 2010). Most authors were nurses (64,9%), that were the first to publish about this subject even before 1990. Also physicians, chaplains and social workers were identified. This review results in 38 defining characteristics: 16 defining characteristics identified in literature were not in taxonomy II of NANDA-I.

Discussion / Conclusion
A central idea in literature review is the link between spiritual distress and disturbances in the meaning in life, peace, forgiveness, hope, relationships, values and beliefs, spiritual practices and creativity. Spiritual distress is defined by NANDA-I as an “impaired ability” and this not define what it is spiritual distress but the cause. NANDA-I lists defining characteristics according to several connection (self, others, art, music, literature, nature, Power Greater than Self), but in a holistic and ontological approach it is hard to distinguish them. Listing defining characteristics by previous spiritual areas could be a more objective way to organize them and help nurses to diagnose. Spiritual distress as a state of suffering related to lack of spiritual well-being, is not properly classified in class 3, domain 10. It lacks a class related to spiritual well being “a state of individual well being related to experience and integrate meaning in life through connectedness with self, others, the world and a Power Greater than self”.

Method
An integrative literature review was conducted since March until May 2011. The search databases were Ebscoh (Cinahl, Medline, Cochrane, Dare, PsycInfo, MedicLatina, Health Technology Assessments, Academic Search Complete), Lilacs, Scielo, National Library of Portugal, RCAAP (Science Open Access Repository of Portugal) and Portuguese nursing journals.

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