[The nursing diagnosis of "spiritual distress", a necessary re-evaluation]

The subject of the study consisted in identifying the spiritual needs of the terminally ill patients, so as to investigate and specify the implementation field of the diagnosis of "spiritual distress" by the French nurses relative to the values and beliefs. The key moments, when the spiritual needs can express themselves also had to be spotted, in order to investigate the possible role of the nurse faced with the spiritual needs of the patients. The study was carried out on a population of 27 AIDS and cancer patients, hospitalized in two units of palliative cares of the Paris region and on a population of 20 nurses of these same units. It was made during the year 1996 by means of interviews with patients, comprising 51 open or half-open questions and questionnaires for nurses, comprising 20 questions. These tools have been structured on the basis of 4 main lines namely spirituality, religion, the ill being called "spiritual distress", nursing diagnosis (for the nurses). The results from the patients show that nearly all of them have had a feeling of ill being which would be of spiritual nature, where existential questioning prevails concerning the meaning of life, of death, of pain, of illness whereas only slightly more than a third of the nurses think that it happens frequently to the patients. The spiritual distress can be described as the failure of giving a meaning to one's life. Religion is mainly evoked in terms of rites with "mosaic" beliefs specific to each individual. The big majority of the nurses concerned by this study have an intuitive knowledge of the main features of the nursing diagnosis of "spiritual distress". This knowledge does not seem to be linked really to the training they had, but rather to their professional experiences and maybe to the personal life story. This nursing diagnosis does not seem to be adapted to our western culture. Its lack of discriminatory power and of flexibility does not make it very useful for the caretaker who needs to clarify beforehand the concepts of spiritual needs and of religious needs. As for the actions, the appeal to the religion representatives or to the psychologist is not always what the patients want even though the ill being appears mainly when the patients feel lonely ... we therefore resort to actions of relation of help with an active listening and help to the rereading of life for which the nurse is in a rather good position, according to the patients.