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LESSON 7
Assessing Spirituality

 

Spiritual Assessment Defined

Spiritual assessment is the process by which health care providers can identify a patient's spiritual needs pertaining to their mental health care. The determination of spiritual needs and resources, evaluation of the impact of beliefs on healthcare outcomes and decisions, and discovery of barriers to using spiritual resources are all outcomes of a thorough spiritual assessment. At St. Elizabeth's Hospital in Washington, D.C., the Chaplain Program, headed by Clark Aist, conducts a "Spiritual Needs Assessment" on each inpatient, concluding with a treatment plan that identifies religious/ spiritual needs and problems, role of pastoral intervention, and religious/spiritual activities recommended.

When I started the year-long human sexuality training program at the UCLA Neuropsychiatric Institute, we were given the assignment to pair up and interview each other about our sexual histories--our first sexual memories, wet dreams, masturbation, petting, intercourse, sexual problems etc. After all, if we were going to ask our patients about their sexual experiences and problems, we needed to be comfortable listening to and talking openly about sexuality. Although we were all licensed mental health professionals, we had not been trained to talk with patients about their sexual functioning or problems, and this exercise was a great way to desensitize us (as in "systematic desensitization") to the topic of sexuality.

I have found the same approach to be helpful with the topic of spirituality, and have developed the following interview as a desensitization exercise for training mental health professionals to conduct assessments of spirituality. I have used it at numerous workshops and conference, and in my experience, most mental heath professionals have an untapped reservoir of spiritual depth that they have not had permission to bring it into their clinical practices. I have also used this assessment with patients in both the dual diagnosis and chronic pain groups I have led at the San Francisco VA.

The interview below was developed after consulting many assessment instruments published in books and articles, and disseminated at conference presentations. It can usually be completed in 10 minutes.

Spiritual Assessment Interview

A. RELIGIOUS BACKGROUND AND BELIEFS

1. What religion did your family practice when you were growing up?

2. How religious were your parents?

3. Do you practice a religion currently?

4. Do you believe in God or a higher power?

5. What have been important experiences and thoughts about God/Higher Power?

6. How would you describe God/Higher Power? personal or impersonal? loving or stern?

B. SPIRITUAL MEANING AND VALUES

1. Do you follow any spiritual path or practice (e.g., meditation, yoga, chanting)?

2. What significant spiritual experiences have you had (e.g., mystical experience, near-death experience, 12-step spirituality, drug-induced, dreams)?

C. PRAYER EXPERIENCES

1. Do you pray? When? In what way(s)?

2. How has prayer worked in your life?

3. Have your prayers been answered?

QUIZ EXERCISES 14-24: Spiritual Assessment Interview

 

Use the Spiritual Assessment Interview with yourself.

Record your answers for later insertion into the Quiz.

 

FICA

Another approach to spiritual assessment uses the acronym FICA.


F: FAITH AND BELIEFS
1) What are your spiritual or religious beliefs?

2) Do you consider yourself spiritual or religious?

3) What things do you believe in that give meaning to your life?


I: IMPORTANCE AND INFLUENCE

1) Is it important in your life?

2) How does it affect how you view your problems?

3) How have your religion/spirituality influenced your behavior and mood during this illness?

4) What role might your religion/spirituality play in resolving your problems?


C: COMMUNITY
1) Are you part of a spiritual or religious community?

2) Is this supportive to you and how?

3) Is there a person or group of people you really love or who are really important to you?


A: ADDRESS
1) How would you like me to address these issues in your treatment?

QUIZ EXERCISES 25-27: Spiritual Assessment Interview

 

Use the FICA with yourself.

Record your answers for later insertion into the Quiz.

 

FICA is described in more detail at the Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians web site.

REQUIRED QUIZ EXERCISE 28: FICA Spiritual Assessment

 

In the 5 cases in which the FICA Spiritual Assessment tool has been applied, the faith category includes such examples as: a) neither beliefs nor faith b) naturalist c) Buddhist d) all of the above.

Record your answer for later insertion into the Quiz.

HOPE Assessment

Yet another approach to spiritual assessment is entitled HOPE, where

H--sources of hope, strength, comfort, meaning, peace, love and connection
O--the role of organized religion for the patient
P--personal spirituality and practices
E--effects on medical care and end-of-life decisions

Questions used in this approach are on included in this article:

Spirituality and Medical Practice: Using the HOPE Questions as a Practical Tool for Spiritual Assessment GOWRI ANANDARAJAH, M.D., and ELLEN HIGHT, M.D., M.P.H American Family Physician

EXERCISE: Take 10 minutes and answer the questions for the FICA or the Religious and Spiritual History.

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