As providers of healthcare, it is of utmost importance that we treat our patients holistically. One part of treating the whole patient, is to identify any spiritual needs that need to be met. There is a distinction between spirituality and religion as one does not need to be religious to have spiritual coping mechanisms. It is also important to note that there may be cultural or religious needs or barriers that will need to be acknowledged and dealt with to provide effective spiritual interventions. There are many spiritual assessment tools available, but some discussed in this paper will be the FICA, FAITH, SPIRITual and HOPE methods. Once spiritual needs are met, we can establish deeper and more meaningful relationships with our patients and improve their outcomes.
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Definition of Spirituality
For nurses to be able to assess their patient’s spiritual needs, we must first understand what spirituality is. Spirituality in its most simplistic definition is what makes us who we are. It encompasses the things that bring us joy, pain, and the things that drive us to be better people. According to Noome, et al, (2017, p. 569) “spirituality is a natural part of human existence and can mean different things to different people. All people are spiritual, regardless of their religious beliefs” (2017, p. 569). Spirituality is so important to our patients and their outcomes, that World Health Organization named Spiritual Assessment as the fourth pillar of health (Ajam, et.al., p.795).
Catalano defines spirituality as “ a sense of meaning in life associated with a sense of inner spirit” and “ a way of life , usually informed by the moral norms of one or more religious traditions through which a person relates to other persons , the universe, and the transcendent in ways that promote human fulfillment and universal harmony” (2015, p. 522). Nevertheless, religion and spirituality are completely different things and it is not important to be religious in order to be spiritual. Catalano also defines culture as a “collective way of thinking that distinguishes one relatively large group from another over generations” (2015, p. 540).
One example of the value and significance of a spiritual assessment is a patient undergoing depression named Ken. The healthcare worker addressed his spiritual needs by asking about what he loved to do, and he began talking about how much he loved playing music before responsibilities of daily life took over. Asking these questions provide the clinician with insight into who this patient really is, what he likes to do and helps to build confidence in the treatment. (Hodge, p. 223).
The religious practices witnessed by Jehovah's Witnesses would be an example of how society influences religion. The one thing many health care providers can easily remember on their own is that Jehovah's Witnesses do not believe in blood transfusions being provided. Jehovah's Witnesses also do not accept that they go to the afterlife when they die (Religious Diversity, p.3).
A third example is related to the care of Muslim patients. This religion believes that a family member should be with a dying person to whisper words of faith into their ear as they pass away. After the person dies, the family members of the same sex will request to wash the patient, place their head on a pillow and turn the bed so that it faces Mecca (Religious Diversity, p 4-5).
All people have a spiritual side, and it is important as health care providers that we recognize this and understand the importance of addressing this with each interaction. We must understand that as inpatient nurses, our patients may be at a time of crisis such as anger over a diagnosis, worry over a financial situation, grief for the loss of the person they once were or over the loss of independence, or even anger at the healthcare system. While not every patient falls back to religion, all patients have some way in which they cope with situations they have been dealt. “The spirit is part of and affects every aspect of the whole person, so its care should concern all nurses. Spiritual distress can be as agonizing as physical pain, and unfulfilled spiritual needs can hinder a patient’s progress” (Meeting your patients spiritual needs, p.1). Even those who deny belief in a higher power are believed to be spiritual because the search for meaning in our lives is central to every human task and occurs daily (Stephenson and Barry, p.35).
A study completed on advanced cancer patients found that 88% considered religion important to them, and 72% of them reported that their spiritual needs were minimally supported or not supported at all by the healthcare system. Some of the spiritual care needs from nurses that patients expressed were “a desire for quiet time or space, nurses listening to their spiritual concerns, assistance with religious practice and arranging for a chaplain visit” (Nicole et. al, p 2).
A barrier to effective spiritual care in the hospital setting is a nurse’s own comfort level with spirituality and religion. While in hospital ICU’s the chaplain is usually the health care provider to provide for spiritual needs, however nurses are dealing with end of life situations as well. During a Dutch study of ICU nurses, written from the perspective of chaplains, it was pointed out that the nurse should be familiar with her own spirituality in order to help patients with theirs (Noome et al, p.572). These same chaplains pointed out that you must have a relationship with the patient/family and show interest to build trust before you can discuss deeper spiritual or religious issues (Noome et.al , p.573)
According to Obrien, Kinloch. Groves and Jack, when patients were asked about spiritual care they “expect all clinical staff to be interested in them as individuals and address their spiritual issues in a straightforward and accepting manner” (2018, p. 183).
There are some benefits for patients related to spirituality. According to Zhibad et.al, patients who have a strong spiritual side also have improved physical health. Spirituality also plays a large role in the acceptance of disease by giving them strength and a sense of power to control their lives (2016, p. 803). It is also proven, via studies of congestive heart failure patients that decreased physical function and frequent re-hospitalization rates can be attributed to religious/spiritual struggles (Lichter, 2013).
Knowing then, that when we treat our patients holistically, we improve outcomes and patients are better able to cope with physical ailments, how do we provide that care?
According to Kenyon, DiBernarndo, Howard, and Cramer some of the steps for nurses are spiritual screens, spiritual history and providing ranges of spiritual care (2017, p 4).
Spiritual Assessment Tools
The approach to making difficult decisions is a very personal one, and some make those decisions based on religious beliefs while others make them based on a more philosophical approach. It is important as healthcare providers that we do not assume that a patient holds any one specific value or belief.
So how do we find out what values are most important to a patient? We can use any of the various spiritual assessment tools available to assist us.
The most common and user-friendly spiritual assessment tool is the FICA, developed by Pulchalski and Romer. The questions are arranged in the mnemonic FICA as follows:
F: Do you belong to a faith tradition?
I: How important is your faith to you?
C: Do you belong to a faith community?
A: How does your faith affect how you would like me to care for you? (Orr, p.5).
Another spiritual assessment tool is the FACT tool, which is reported to be most effective when used in a conversation instead of like a checklist. It is designed for the acute care setting and is short and to the point (La-Rocca-Pitts, p. 1).
A third spiritual assessment tool available is the FICA, which is very similar to the FACT tool, with a primary care emphasis (Blaber and Willis, p 431).
The SPIRIT assessment tool is most often used in palliative care settings, as this tool has a section to address planning for terminal events (Blaber and Willis, p 434).
And lastly the HOPE assessment tool, which is also most often used in palliative care (Blaber and Willis, p. 436).
I have 3 main areas in my nursing background which include the ICU, ER and Home Health. I was a brand new RN, right out of nursing school when I took an ICU job, thinking that I knew what that entailed. That position was not only tough related to skills and tasks but also very mentally and emotionally taxing. I can remember one evening, right after I got off orientation, when a mid-50’s age female was brought into our unit. She had been in the cath lab and had a STEMI, and her EKG now showed the classic “tombstone” or anterior MI. This is not a good prognosis, and the cardiologist who came to see her, sat on her bedside and told her that she would not be leaving the unit or going home again. I was not the primary RN for this patient but assisted with calling her sons to come and see her and say goodbye as well as calling the hospital chaplain up to see her. At the patients request we all, the cardiologist included, joined hands in prayer and it still stands out to me as one of the most significant events of my nursing career. My own faith and religious background made joining in prayer with the patient an easy task, and also gave me strength when it came to assisting that patient to die comfortably.
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Another example of meeting a patient’s spiritual needs was when I was in nursing school and was assigned a patient to follow who was going in for a heart cath and was very scared. I was able to sit with this patient and his spouse, and just offer a caring shoulder to lean on, and we discussed his family and his love for woodworking as well as his fears related to the procedure.
The final example of meeting spiritual needs was when I was still in nursing school, working as a PCA at the hospital while going to school during the day. I was placed in a room with a patient who was on 24-hour suicide watch. This patient was initially very stoic and closed off, but through the night began to open up to me and expressed that he had lost contact with family after a long ordeal with drugs and due to depression had decided to try to end his life. I was not able to do much more than provide a presence and listening ear, but it seemed to ease this patient’s fears and he knew in that moment that someone was truly hearing him.
It is important for us to remember that our own spirituality can positively affect our relationships with our patients. According to Larocca-Pitts “ Cure sometimes, relieve often, comfort always . Addressing spiritual concerns with your patients can provide comfort itself as it is a therapeutic intervention” (2017, p.2)
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- Ajam Zibad, H., Mohammadi Shahboulaghi, F., Foroughan, M., Rafiey, H., & Rassouli, M. (2016). What is the meaning of spiritual health among older adults? A concept analysis. Educational Gerontology, 42(12), 795–808. https://doi.org/10.1080/03601277.2016.1205349
- Blaber, M., Jones, J., & Willis, D. (2015). Spiritual care: which is the best assessment tool for palliative settings? International Journal of Palliative Nursing, 21(9), 430–438. https://doi.org/10.12968/ijpn.2015.21.9.430
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- Lichter, D. A. (2013, April). Studies Show Spiritual Care Linked to Better Health Outcomes. Retrieved October 5, 2019, from https://www.chausa.org/publications/health-progress/article/march-april-2013/studies-show-spiritual-care-linked-to-better-health-outcomes.
- Nicole, K., Kenyon, S., DiBernardo, L., Lobato, C., Howard, E., & Cramer, S. (2017). The Role of Nurses in Providing Spiritual Care to Patients: An Overview. American Society of Registered Nurses. Retrieved from https://www.asrn.org/journal-nursing/1781-the-role-of-nurses-in-providing-spiritual-care-to-patients-an-overview.html
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- O’Brien, M. R., Kinloch, K., Groves, K. E., & Jack, B. A. (2019). Meeting patients’ spiritual needs during end‐of‐life care: A qualitative study of nurses’ and healthcare professionals’ perceptions of spiritual care training. Journal of Clinical Nursing (John Wiley & Sons, Inc.), 28(1/2), 182–189. https://doi.org/10.1111/jocn.14648
- Orr, R. D. (2015, May 1). Incorporating Spirituality into Patient Care. Retrieved from https://journalofethics.ama-assn.org/article/incorporating-spirituality-patient-care/2015-05.
- Religious Diversity: Practical Points for Healthcare Providers. (n.d.). Retrieved October 5, 2019, from http://www.uphs.upenn.edu/pastoral/resed/diversity_points.html.
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