A Nursing Diagnosis Validation Study:
Defining Characteristics of Spiritual Distress
Frances A. McHolm M.S.N.

Meeting of spiritual needs has been shown to facilitate coping with life-threatening illness. The purposes of this study, therefore, were to validate which signs and symptoms of spiritual distress nurses observed most frequently in oncology patients perceived to be experiencing spiritual distress, compare the identified cues to the present approved NANDA list, and compute standardized validity ratings for the lists of characteristics.

From a randomly selected national sample of 300 nurses who were members of the Oncology Nursing Society and who had at least a B.S.N., 97 subjects who had worked with oncology patients for at least six months completed two questionnaires: (1) a demographic data form and (2) the Spiritual Distress Defining Characteristics Tool (SDDCT) on which they rated by Likert scale the frequency of observing 41 behaviors associated with spiritual distress in the nursing literature.

By means of weighted ratio content validity ratings suggested by Fehring, subgroups of nurses in the study identified one to six critical defining characteristics with ratios greater than 0.75. These included "anxiety," "fear," "helplessness," "crying," "depression," and "cues that religious /spiritual needs are important." Twenty-five to 28 supporting characteristics of spiritual distress were identified with ratios greater than 0.50. Seven cues not included on the SDDCT were suggested by the respondents. The lists of cues identified in this study had content validity ratings of 0.64 - 0.66, as compared to the present NANDA approved list to which groups of nurses in the study gave ratings of 0.55 - 0.59.

This study has suggested a cluster of critical and supporting defining characteristics which may be clinically useful in identifying spiritual distress in oncology patients. Clarification of the concept of spiritual distress will enable nurses to have more confidence in utilizing the diagnosis in clinical practice. Greater emphasis on spiritual concerns in generic and continuing education programs and provision of staffing adequate to address spiritual needs in the clinical area are needed. Suggestions for further research include establishing reliability of the characteristics of spiritual distress listed on the SDDCT and determining validity by direct observation of characteristics in patients.