Spiritual distress
Spiritual distress is a disturbance in a person's belief system. As an approved nursing diagnosis, spiritual distress is defined as "a disruption in the life principle that pervades a person's entire being and that integrates and transcends one's biological and psychological nature." Nursing diagnoses. Authors in the field of nursing who contributed to the definition of the characteristics of spiritual distress used indicators to validate diagnoses. The following manifestations of spiritual distress are a part of an abstract data gathered by LearnWell Resources, Inc from the studies of Mary Elizabeth O'Brien and is used as  a "Spiritual Assessment Guide" to present alterations in spiritual integrity. Seven manifestations of spiritual distress. The diagnosis of spiritual distress is defined by indicators that are present: spiritual pain, spiritual alienation, spiritual anxiety, spiritual guilt, spiritual loss, and spiritual despair. The indicators (pain, alienation, anxiety, guilt, loss, and despair) must or may be present in defining the characteristics of spiritual distress. The use of indicators in diagnosing alterations in spiritual health is controversial because indicators may appear related to both spiritual and psychosocial problems. Wilfred McSherry, a senior lecturer in the School of Care Sciences at the University of Glamorgan , published an article on the Journal of Advanced Nursing about potential dilemmas in conducting a spiritual assessment. The article argued that" "the area of spiritual assessment needs careful consideration, both nationally and internationally, by those professionals involved in the provision of spiritual care so that potential dilemmas can be identified and reviewed. Such consideration may prevent the construction and subsequent use of inappropriate assessment tools within practice.""