Validation of the Nursing Diagnosis "Spiritual Distress"
Among Cardiac Rehabilitation Clients
Vini Angel

This study sought to validate the nursing diagnosis of "Spiritual Distress" within a selected group of Phase II cardiac rehabilitation clients. The cardiac rehabilitation patient population was selected because of the many sudden and long-term adjustments to their health status and lifestyles that result from their cardiac disease, putting them at potential risk for "Spiritual Distress". The concepts of crisis event(s) and stress, loss, and meaning or purpose were chosen as the major components of "Spiritual Distress" because they focus on what may be core themes for the cardiac rehabilitation patient population and because a general review of the literature indicated these concepts were central to an overall definition of "Spiritual Distress."

Multi-methodological techniques including an open-ended questionnaire, a demographic survey, a visual analog scale and a medical chart review were utilized to gather data. The questionnaire and survey were completed in the privacy of the patient's home and returned in a self-addressed, stamped envelope. Data analysis of the questionnaire and chart review included the development of categories, using a manifest content analysis method. Manifest content analysis revealed twelve related categories and several sub-categories further illustrating the larger-identified categories of the three selected components of "Spiritual Distress" ("Crisis Event(s)/Stress", "Loss", and "Meaning and Purpose"). Labels for all identified sub-categories were derived by matching the presenting themes with descriptive titles extracted from the reviewed literature or the dictionary. Further credibility for the identified categories and sub-categories were obtained through having two cardiac rehabilitation clients and one cardiac rehabilitation nurse agree with the reasonableness and accuracy of the findings. A visual analog scale (VAS) was included to assess the relevance of the three concepts for this group of clients. The demographic data and scores from the visual analog scale were analyzed using frequency distributions. In addition to the VAS technique, a chart review provided an additional validity measure by indicating how prevalently spiritual issues were addressed in the medical record.

All three selected concepts of "Spiritual Distress" were validated as aspects of this nursing diagnosis by study participants. The category of "Loss" seemed to be the most frequently reported or easily identifiable component of "Spiritual Distress" and included losses due to modification of risk factors (i.e. diet and smoking), alienation from social environment, limitation of resources and alteration in volition. While further testing is needed to provide additional clarity and precision of the nursing diagnosis, "Spiritual Distress", client responses indicated that "Meaning and Purpose" be ascribed a hierarchical loading over "Crisis Event(s)/Stress" and "Loss". It is interesting to note that study participants highlighted "Meaning and Purpose" as a critical index of "Spiritual Distress", yet no reviewed chart cited "Meaning and Purpose" within its written context.