Research

Research shows that hospital patients want a spiritual assessment included in their care plan.

Yet spiritual assessment isn’t easy. Rather, it’s a complex and challenging task that requires a number of personal qualities of clinicians.

It requires the ability to:

• be “present”
• listen
• understand the message beyond the words uttered
• pick-up on key words to respond appropriately (Paal, Frick & Jobin, 2017).

Spiritual Assessment Tools

To help clinicians include spiritual assessment in their care plans, there are many spiritual assessment tools available in the literature. They range in scope from Fitchett’s (1993) comprehensive 7 x 7 model in which seven holistic dimensions are evaluated, to Puchalski’s (2000) brief screening tool FICA that addresses four questions about:

1. Faith
2. Importance of faith to the patient
3. Church and /or Community
4. Address – how the patient would like clinicians to address her or his spiritual needs.

One tool I like is the Spiritual Distress Assessment Tool (SDAT) developed by Monod and colleagues (2010). The SDAT helps identify unmet spiritual needs and even to score levels of spiritual distress among hospitalized older adults.

Under rubrics of Meaning, Transcendence, Values, and Psychosocial Identity, the SDAT can be used to explore spiritual needs for life balance, connection, values acknowledgment, and control, as well as the spiritual needs to be loved, to feel forgiven and reconciled, to be recognized, to be listened to, and to feel heard. A follow-up article describes its validation process.

Ethics

However, it’s important to consider also the ethical risks of spiritual assessment in healthcare environments.

Jeffrey Bishop (2011), for example, critiques all forms of clinical assessment from the perspective of power and its imbalances in healthcare relationships.

The risk, he says, is “totalizing care” that leads to oppressive “totalitarian care,” especially in palliative care. “No assessment,” he says, “has been created in which researchers have shown that what the patient and family need most is a respite from healthcare professionals.”

References

Bishop J. (2011). The anticipatory corpse: Medicine, power and the care of the dying. Notre Dame, IN: University of Notre Dame Press.

Fitchett G. (1993). Assessing spiritual needs: A guide for caregivers. Minneapolis: Augsburg Fortress.

Koenig H. (2013). Spirituality in patient care: Why, how, when, and what. Third Edition. West Conshohocken, PA: Templeton

Monod S, Rochar E, Büla C, et al. (2010). The spiritual distress assessment tool: An instrument to assess spiritual distress in hospitalized elderly persons. BMC Geriatrics 10: 88.

Paal P, Frick E, Roser T, & Jobin G. (2017). Expert discussion on taking a spiritual history. Journal of Palliative Care, 32(1), 19-25. doi: 10.1177/0825859717710888.

Puchalski C. and Romer A. (2000). Taking a spiritual history allows clinicians to understand patients more fully. Journal of Palliative Medicine, 3, 129-37.