Spiritual assessment is a component of Joint Commission standards in recognition that spirituality can influence care, disease management and the delivery of services (Joint Commission, 2005). Feelings of peace, hope and comfort can lead to better health outcomes. For instance, the belief that illness is a trial one must overcome to be a stronger person encourages active participation in care. Supporting the client in achieving greater resilience enhances wellbeing, facilitates faster recovery and increases satisfaction with care. In this sense, spirituality helps find meaning and purpose in illness which enhances psychosocial functioning (Leeuwen, Schep-Akkerman & van Laarhoven, 2013). Thus, it is necessary to assess spiritual needs to ensure they are adequately met.
Techniques of spiritual assessment include observation and asking questions. While observation provides cues on the need to assess and the right timing to initiate it, asking questions brings to light sufficient information to determine individual needs. Utilizing a tool with appropriate open-ended questions makes the process systematic and easier to perform, allowing all areas to be explored (Piotrowski, 2013). The following questions, based on readings of literature, are what I deem to be the most important ones to ask. The use of this tool in assessing a neighbor yielded answers that follow each question.
1. Do you have spiritual beliefs that matter to you? Do these help you find meaning and purpose in life in a general sense and in times of illness?
The interviewee responded that she believes in God and life after death. She considers mortal life as a journey and a way to “show worthiness for an afterlife in heaven.” She believes reading the Bible can help her attain worthiness so this activity is very important to her. She associates worthiness with fulfilling one’s purpose in life which is something she thinks can be realized through following Biblical teachings, self-reflection and using God-given talents. Even in times of illness, she believes there is purpose in life. It is an opportunity to learn to totally entrust your life to God and to affirm his existence.
2. In times of difficulties or suffering, how do you find inner peace, hope or comfort? How do your spiritual beliefs help you deal with uncertainty, pain or fear?
According to the interviewee, she finds many of the passages in the Bible comforting and fills her with hope. Her knowledge that God is in control, even in times when she feels abandoned and helpless, helps her attain peace of mind. She further believes that God uses other people as instruments and she sees this in the love and support of family and friends and the work of doctors and nurses. She clarifies that this does not mean total dependence. To reach your full potential, you have to help yourself using your abilities and resources. God only steps in during times of need and one can call on him through prayer.
3. Do you share your spiritual beliefs with other individuals and if so are they a source of support? In what ways do they provide you with support?
The interviewee answered that she shares the same beliefs with her family which has helped strengthen the bonds between them. She said that her family has always been there for her and she is for them as well. At the time when her husband had a car accident, her siblings and mother often called to ask how he was doing, how things were going with her and the children and to ask if there was anything they could do. Their assurance that she and her family were always included in their prayers was a source of comfort. Members of her church also visited her husband in the hospital. Their pastor held Bible studies at the bedside and led prayers which gave them strength throughout the ordeal.
4. Do your spiritual beliefs encourage you to perform or avoid certain practices and if so, what are these practices? What does adherence or non-adherence to these practices mean to you?
Based on the response, the interviewee stated that the Bible teaches ways of thinking and behaving but it is an individual decision to follow. However, she believes we are responsible for our choices and actions and should be ready for any negative consequences of not doing what God wants us to do. She gives, as an example, the teaching that God regards our physical bodies as temples and it is our responsibility to care for it. By making the decision to abuse alcohol today, we should be ready to deal with the health consequences which call our attention to the need for obedience. She relates that her husband had the accident because of drunken driving and he has since taken better care of himself.
5. Would you like spirituality to be factored in the care you receive in healthcare settings and if so, how?
In her answer, she was happy to know that support for spirituality is also being assumed by healthcare professionals stating she would truly appreciate her spiritual beliefs and practices being respected while in the hospital. Specifically, allowing uninterrupted Bible studies and prayer meetings at bedside whenever possible is supportive. Nurses and doctors praying for or with their patients communicate care and will surely lead to hope and comfort. Enabling patients to read the Bible and related materials will be a blessing as well. Finally, she said that just knowing that people at the hospital care not only for her body but also her soul is itself an act of compassion and will truly make a difference.
Significant Discoveries
Based on the findings above, the interviewee clearly has a spiritual belief system rooted in organized religion. Her personal life is built around this belief system. Without it, she would not have found her life’s meaning and purpose. She is very appreciative of nurses who are now doing spiritual assessments. On the whole, her beliefs support health and should be reinforced by the nurse. Her idea that “God helps those who help themselves” promotes adherence to treatment and as much independence with self-care as possible. Her belief that the body is God’s temple promotes self-care and a healthy lifestyle. If she were a patient, she would need to be given time to read her Bible, pray and participate in spiritual activities with family and members of her church as these are sources of support. If I was her nurse, praying with her would also satisfy her needs.
Reflection on the Experience
Overall, the assessment went well and I attribute this to preparation on my part. I believe that being able to include spirituality as a domain of care requires developing the necessary knowledge, skills and attitudes. I read about spiritual assessment because I had to know how it is done and fully appreciate its benefits before I felt confident in doing it. I had to rehearse in my mind how I am going to go about it from introducing myself and the purpose of my interview to actually asking the questions. I needed to be empathic and actively listening. I also had to be conscious to approach the issue from the interviewee’s perspective and not mine. The interviewee was enthusiastic about the interview and answered the questions as best she could.
What I would do differently in the future is to list follow-up questions with each main question. In the assessment I performed, the answers to the initial questions were inadequate and I had to probe deeper to feel that I had a good grasp of her beliefs. Having prewritten questions saves one the time of thinking of the right questions to ask. Regarding barriers and challenges, I did not factor time when I planned my assessment and it took longer than the interviewee expected. I also imagine that for someone who is sick, a lengthy interview will drain much energy. I plan to perform this kind of assessment as often as possible because I expect that being accustomed will help me accomplish it in less time.
In conclusion, my experience using the spiritual assessment tool with a neighbor has been enlightening. I came to be fully convinced on how important and meaningful spiritual care is for patients. There is currently a debate on whether spirituality should be adopted as a domain of care or if healthcare should remain secular (Draper, 2012) and I now support the former. Using a tool indeed facilitates assessment. Having a set of questions provides structure to the activity and has kept me focused so that I was able to obtain all necessary information to make a confident assessment.
References
Draper, P. (2012). An integrative review of spiritual assessment: Implications for nursing management. Journal of Nursing Management, 20(1), 970-980. doi: 10.1111/jonm.12005.
Joint Commission (2005). Evaluating your spiritual assessment process. Retrieved from http://www.professionalchaplains.org/files/resources/reading_room/evaluating_your_ spiritual_assessment_process.pdf
Piotrowski, L.F. (2013). Advocating and educating for spiritual screening assessment and referrals to chaplains. Omega, 67(1-2), 185-192. doi: http://dx.doi.org/10.2190/OM.67.1-2.v.
van Leeuwen, R., Schep-Akkerman, A., & van Laarhoven, H.W. (2013). Screening patient spirituality and spiritual needs in oncology nursing. Holistic Nursing Practice, 27(4), 207-216. doi: 10.1097/HNP.0b013e318294e690.
