Worksheet 9

Assessing Spirituality and Religious Practices

Case Study

Read the following case study. Then, work through the steps of analyzing the case study data.

1. First, identify the abnormal data and strengths in subjective and objective findings,
2. Assemble cue clusters,
3. Draw inferences,
4. Make possible nursing diagnoses,
5. Identify defining characteristics,
6. Confirm or rule out the diagnoses, and
7. Document your conclusions.

Use the table below to collect subjective and objective date provided to guide you. Propose nursing
diagnoses that are specific to the client in the case study. Identify collaborative problems, if any, for this
client. Finally identify data, if any, which point toward a medical problem requiring a referral.

Case Study

Rhonda Logan is a 51-year-old divorced woman, with no children. She teaches in a parochial
elementary school, attends church regularly, and is the primary caregiver for an aging father in ill health.
Rhonda is seeking health care related to difficulty going to sleep and staying asleep. She also reports
frequent headaches, lack of appetite and motivation, and difficulty concentrating.
When interviewed, Rhonda relates that she initiated the divorce 6 months ago, ending a 25-year
marriage from an alcoholic, verbally abusive husband. She states that she feels guilty over her decision
to divorce because of her religious beliefs. Rhonda states she cannot understand how a loving God
would have placed her in such a loveless relationship. She indicates that if she had tried harder to
involve Mr. Logan in marriage counseling, perhaps things would have turned out differently. She further
reflects that if she had been able to have children or had devoted less time to her father, her ex-
husband would not have drunk so much.
During the interview with the nurse, Rhonda revealed that she fears that she may lose her job
because of the Church's view on divorce. She states that her students are the only thing that keeps her
"sane." Rhonda perceives less support from her colleagues during and after the divorce. She states that
she is disappointed in their lack of Christian support during these "dark times." She states that she
believes their behavior is hypocritical because she is hurting and most of the faculty is not acting in a
caring way. Though she attends church regularly, she reveals that she is "going through the motions" but
is feeling less and less connected to her congregation. The analogy that she shared was of an empty
eggshell, void on the inside, fragile on the outside, yet looking whole and strong to onlookers. The nurse
noted varied changes in her mood, vacillating among anxiety, anger, preoccupation, sadness, and crying.
Note: Please secure consent before starting the interview to actual client….
NURSING INTERVIEW GUIDE TO COLLECT SUBJECTIVE DATA
QUESTIONS FINDINGS
Biographical Data
Name (use Code Name or Alyas) Rhonda Logan

Gender Female

Address, Phone Number NA

Date and Place of Birth NA

Nationality or Ethnicity Christian

Marital Status Divorced

Religious or Spiritual Practices Attends church regularly

Primary and Secondary Languages spoken, written, English

and read; Birth Language
Educational Level NA

Occupation and Working Status Teacher and a caregiver

Who lives with the client? Identify significant others NA

Caregivers and support people for the client NA

Questions Findings
Current Symptoms
1. Affect corresponding to attitude? Varied changers in hear mood, vacillating among
anxiety, anger, preoccupation, sadness, and crying.
2. Culturally appropriate eye contact when describing NA
spiritual beliefs?
3. Expresses sense of hope for future and comfort None
from beliefs?
4. Ease with which client divulges information? NA

1. Perceived stress level? NA

6. Presence of spiritual conflicts/struggles?
7. Display of religious articles?
8. Desire to participate in usual religious practices?
Current Status
1. What do you believe has caused your illness? Do
you believe there is a spiritual cause for the illness?
2. Would you like to be visited by your own religious
The patient states that she’s disappointed in their lack
of Christian support
Attends church regularly
NA
She states that she is disappointed in their
lack of Christian support during these "dark
times." She reveals that she is "going through
the motions" but is feeling less and less
connected to her congregation.
The patient seeks health care and lack of Christian
figure (pastor, priest, etc.) or someone from pastoral support
care?
3. Are there any religious practices that you would like NA
to continue while in the hospital? (e.g., dietary
restrictions? Daily prayer rituals?)
4. Do your spiritual beliefs give you a sense of hope NA
and comfort?
5. Are you aware of any spiritual conflicts at present? She said that she fears that she may lose her job
because of the Church’s view on divorce.
Past History
1. Has your religion helped you cope in the past? No
2. Does your religion encourage you to practice health No
promotion activities?

Family History
1. Do you have strong social and spiritual support No
systems?

2. What religion does your family follow? Do all No

members of your immediate family follow the same
religion?
Lifestyle and Health Practices
1. How often do you attend religious Regularly
service/activities?
2. Do you have a strong connection with one or more No
religious groups?
3. Do you see any differences between your beliefs No
and current health care treatments?
4. Are you motivated to participate in health No
promotion activities?
Analysis of Data
1. Formulate nursing diagnoses (health promotion, Health Promotion
risk, and actual).  Readiness for enhanced social support
 Readiness for enhanced Christian support
Risk Diagnosis
 Risk for spiritual distress
 Risk for loneliness r/t separation from Christian
Support
Actual Diagnosis
 Spiritual distress
 Lack of social and Christian support
 Hopelessness
 Moral distress
2. Formulate collaborative problems RC: Depression
RC: Anxiety
RC: Insomnia