ASSESSMENT Objective cues: >Sad/lonely >blame God for his disease >his family abandoned him >Parkinsons Disease

NURSING DIAGNOSIS Spiritual Distress r/t loneliness secondary to Parkinsons Disease as evidenced by inability to be introspective

PLANNING Long Term outcome: After 1 month of nursing intervention, the client will be able to verbalize acceptance of self as not deserving illness, no one is to blame Short Term outcome: After 2 weeks of nursing intervention, the client will be able to: -verbalized increase sense of connectedness and hope for future -demonstrate ability to help self/participate in care

NURSING INTERVENTION 1. Determine clients religious or spiritual orientation, current involvement and presence of conflicts 2. Establish environment that promotes free expression of feelings and concerns. Provide calm, peaceful setting 3. Listen to clients expression of anger, concern or alienation from God, belief that situation is a punishment 4. Ask how can you be most helpful. 5. Assist client to develop goals for dealing with life situation

RATIONALE -provide baseline for planning care and accessing appropriate resources -promotes awareness and identification of feelings -helpful to understand clients point of view and how they are questioning their faith -promotes trust and comfort -Enhances commitment to goal, optimizing outcomes and promoting sense of hope

EVALUATION Long Term outcome: FULLY ACHIEVED the client was able to verbalize acceptance of self as not deserving illness, no one is to blame Short Term outcome: FULLY ACHIEVED the client was able to: -verbalized increase sense of connectedness and hope for future -demonstrate ability to help self/participate in care

ASSESSMENT Objective cues: >Craniotomy Operation >Very Anxious >Fear

NURSING DIAGNOSIS Risk for Spiritual Distress r/t anxiety secondary to Craniotomy operation

PLANNING Long Term outcome: After 2 weeks of nursing intervention, the client will be able to identify meaning and purpose in own life that reinforces hope, peace and contentment Short Term outcome: After 1 week of nursing intervention, the client will be able to verbalized acceptance of self as being worthy, not deserving of illness

NURSING INTERVENTION 1. Determine clients religious or spiritual orientation, current involvement and presence of conflicts 2. Establish environment that promotes free expression of feelings and concerns. Provide calm, peaceful setting 3. Listen to clients expression of anger, concern or alienation from God, belief that situation is a punishment 4. Have the client identify and prioritize current/immediate need 5. Use therapeutic communication skills of reflection and activelistening

RATIONALE -provide baseline for planning care and accessing appropriate resources -promotes awareness and identification of feelings -helpful to understand clients point of view and how they are questioning their faith -helps client focus on what needs to be done and identify manageable steps to take -helps client find own solutions to concerns

EVALUATION Long Term outcome: FULLY ACHIEVED The client was able to identify meaning and purpose in own life that reinforces hope, peace and contentment Short Term outcome: FULLY ACHIEVED The client was able to verbalized acceptance of self as being worthy, not deserving of illness

ASSESSMENT Objective cues: >Diagnosed with cervical cancer >Scheduled for chemotherapy >Denial >Not cooperative with medical team

NURSING DIAGNOSIS Moral Distress r/t treatment decisions as evidenced by denial and not being cooperative with medical team

PLANNING Long Term outcome: After 2 weeks of nursing intervention, the client will be able to express sense of satisfaction with acceptance to resolution Short Term outcome: After 1 week of nursing intervention, the client will be able to Identify positive ways/actions necessary to deal with situation

NURSING INTERVENTION 1. Determine clients perceptions and specific factors resulting in a sense of distress and all parties involved in situation 2. Identify healthcare goals/expectation 3. Encourage involved individuals to recognize and name experience resulting in moral sensitivity. 4. Ascertain coping behaviors used successfully in the past that may helpful in dealing with current situation 5. Make time available for support and provide information as desired

RATIONALE -to identify cause/situation in which moral distress is occurring -New treatment/technology can prolong life -brings concerns out in the open so they can be dealt with -to assist individual to develop us of problem-solving skills -to help individuals understand the dilemma

EVALUATION Long Term outcome: FULLY ACHIEVED The client was able to express sense of satisfaction with acceptance to resolution Short Term outcome: FULLY ACHIEVED The client was able to Identify positive ways/actions necessary to deal with situation

ASSESSMENT Objective cues: >Sad/lonely >blame God for his disease >his family abandoned him >Parkinsons Disease

NURSING DIAGNOSIS Impaired Religiosity r/t ineffective support as evidenced by blaming God for his disease

PLANNING Long Term outcome: After 1 month of nursing intervention, the client will be able to verbalize concerns about end-of-life issues and fear of death Short Term outcome: After 2 weeks of nursing intervention, the client will be able to express ability to once again participate in beliefs and rituals of desired religion

NURSING INTERVENTION 1. Determine clients usual religious/spiritual beliefs, values, past spiritual commitment. 2. Use therapeutic communication skills of reflection and activelistening 3. Note client expression of anger, concern, alienation from God 4. Encourage client to identify individuals who can provide needed support 5. Discuss desire to continue/reconnec t with previous belief patterns and customs and current barriers

RATIONALE -provides baseline for understanding current problem

EVALUATION Long Term outcome: FULLY ACHIEVED The client was able to verbalize concerns about end-of-life issues and fear of death Short Term outcome: FULLY ACHIEVED The client will be able to express ability to once again participate in beliefs and rituals of desired religion

-communicates acceptance and enables client to find own solutions to concern -perception of guilt may cause spiritual crisis

ASSESSMENT Objective cues: >Craniotomy Operation >Very Anxious >Fear

NURSING DIAGNOSIS Moral distress r/t treatment decisions as evidence by anxiety

PLANNING Long Term outcome: After 2 weeks of nursing intervention, the client will be able to express sense of satisfaction with acceptance to resolution Short Term outcome: After 1 week of nursing intervention, the client will be able to Identify positive ways/actions necessary to deal with situation

NURSING INTERVENTION 1. Determine clients perceptions and specific factors resulting in a sense of distress and all parties involved in situation 2. Identify healthcare goals/expectation 3. Encourage involved individuals to recognize and name experience resulting in moral sensitivity. 4. Ascertain coping behaviors used successfully in the past that may helpful in dealing with current situation 5. Make time available for support and provide information as desired

RATIONALE -to identify cause/situation in which moral distress is occurring -New treatment/technology can prolong life -brings concerns out in the open so they can be dealt with -to assist individual to develop us of problem-solving skills -to help individuals understand the dilemma

EVALUATION Long Term outcome: FULLY ACHIEVED The client was able to express sense of satisfaction with acceptance to resolution Short Term outcome: FULLY ACHIEVED The client was able to Identify positive ways/actions necessary to deal with situation

ASSESSMENT Objective cues: >Diagnosed with cervical cancer >Scheduled for chemotherapy >Denial >Not cooperative with medical team

NURSING DIAGNOSIS Risk for Spiritual Distress r/t cervical cancer

PLANNING Long Term outcome: After 2 weeks of nursing intervention, the client will be able to identify meaning and purpose in own life that reinforces hope, peace and contentment Short Term outcome: After 1 week of nursing intervention, the client will be able to verbalized acceptance of self as being worthy, not deserving of illness

NURSING INTERVENTION 1. Determine clients religious or spiritual orientation, current involvement and presence of conflicts 2. Establish environment that promotes free expression of feelings and concerns. Provide calm, peaceful setting 3. Listen to clients expression of anger, concern or alienation from God, belief that situation is a punishment 4. review coping skills used and their effectiveness in current situation 5. Assist client to identify individuals/support groups that could provide ongoing support

RATIONALE -provide baseline for planning care and accessing appropriate resources -promotes awareness and identification of feelings -helpful to understand clients point of view and how they are questioning their faith -Identifies strengths to incorporate into plan and techniques -to relieve anxiety

EVALUATION Long Term outcome: FULLY ACHIEVED The client was able to identify meaning and purpose in own life that reinforces hope, peace and contentment Short Term outcome: FULLY ACHIEVED The client was able to verbalized acceptance of self as being worthy, not deserving of illness