At Risk for Spiritual Distress Related to Death Anxiety

Mrs. Lancaster is a 39-year-old Caucasian female who has a European heritage in which she has no strong ties remaining. English is her primary language. She appears to have behaviors consistent with American beliefs and values. She is married to Joseph Lancaster who works from home, and she has two school aged children, ages 8 and 10.

Mrs. Lancaster has a past medical history of cancer of the left breast. She has a family history on her mother's side of breast cancer. Mrs. Lancaster has since undergone a left mastectomy, followed by chemo and radiation therapy. Four months ago, she was further diagnosed with metastasis to the spine. Her treatment was complicated by sepsis, respiratory insufficiency, nausea, vomiting, and pain. She was later diagnosed with Congestive Heart Failure, spent 3 weeks in intensive care, ventilated, and received hyper alimentation. She returned home with some skilled nursing visits and home maker assistance. One week ago, she began reporting physical symptoms of headaches and episodes of blurred visions. MRI results are pending. She was discharged to her home with a referral to hospice care and palliative treatment.

Mrs. Lancaster has a nursing background that includes acute care nursing, and home visiting nursing. She wants to be at home with her children. She wishes to remain alert when she is with them but doesn't want them to see her suffering. She exhibits anxiety and expresses her concerns about the future welfare of the children and her husband. Mrs. Lancaster is depressed due to the loss of her independence, body image distortion, fear of facing death, and losing her family.

Nursing Diagnosis:

1. Chronic Pain r/t metastatic cancer AEB c/o back pain, headaches, and blurry vision.
2. Death Anxiety r/t unresolved issue regarding dying AEB expressed concerns about the future welfare of the children and her husband.
3. Activity intolerance r/t weakness from cancer AEB the need for home maker assistance
4. Self-care deficit r/t pain and activity intolerance AEB mother becoming her caregiver
5. Powerlessness r/t loss of independence AEB mother taking over patients' role as mother.

Mrs. Lancaster would benefit from a Religious/Spiritual assessment to aid in creating a care plan that will address her Anxiety and Depression in the face of her impending death. Hopelessness is a major characteristic of Spiritual Distress and this patient would benefit from the support offered by providing spiritual care. Spiritual assessment tools have been created to aide medical professionals in providing spiritual care to EOL patients. Once we control the patients' level of pain its important to work on their level of spiritual distress which has been noted in recent research to better enable patients' in dealing with the unanswered questions that come with preparing for death. Patients who received less spiritual care than desired reported more depressive symptoms and less meaning and peace. (Peteet pg. 281) Studies have concluded that patients who received spiritual care were better able to make the EOL decisions that allowed them to be at peace, even if not totally pain free. The anxiety related to her impending death is leaving her hopeless and at risk for spiritual distress.

Nursing Diagnosis: At Risk for Spiritual Distress related to Impending death as evidenced by increased depression, anxiety, and expressed concerns regarding the future welfare of the children and her husband.

Planning:

1. Patient will define her source of belief and/or higher power.
2. Patient will use a spiritual experience that provides her comfort.
3. Pt will connect with family to share her thoughts, feelings, and beliefs.

Implementation:

Interventions: *Create an accepting and nonjudgmental atmosphere to allow Mrs. Lancaster to express her feelings about her illness and impending death. *Assist Mrs. Lancaster in properly relieving her anger in appropriate ways. Encourage her to vocalize her perceptions, her fears, and allow her time to grieve. *Observe and listen empathetically to her communication.

Rationales: *Establishes a nurse patient relationship which will promote communication, allowing Mrs. Lancaster to openly express her inner fears, concerns, and her confronting issues.

*Anger can be wasted energy and its release when expressed in a constructive manner a source of new-found strength and energy, which can be utilized in more important areas. *Spiritual care may directly affect Mrs. Lancaster's ability to redefine hope and find some meaning in death.

Evaluation: Outcome met. Mrs. Lancaster has noticeable decreased anxiety and depression. She is utilizing her strength in preparing messages of hope and encouragement for her daughters. She is expressing her EOL wishes to both her husband and mother. She is now assisting them through their grieving processes.

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