Spiritual assessment

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Interview
Then complete a spiritual assessment on someone in your community. Use the form
found below the rubric. Use bullet points or numbers rather than complete sentences.
Be sure to choose an appropriate tool. You can use the assessment from the chapter
on spirituality found in your textbook, or choose one found in the literature or online
such as the
HOPE tool: http://www.aafp.org/afp/2001/0101/p81.html
FICA tool: http://smhs.gwu.edu/gwish/clinical/fica/spiritual-history-tool
FACT tool: http://www.professionalchaplains.org/files/resources/reading_room/
spiritual_history_tool_fact_larocca_pitts.pdf
During the interview you will choose an appropriate spiritual nursing action based on
your assessment and state how/why you chose the nursing action. What was the result
of the action (e.g. what did the interviewee think of the nursing action and/or how did
they respond to the nursing action?). What are your thoughts on the experience of doing
this assessment (e.g. main takeaway(s), surprises, reactions). Please keep the form to
three or fewer pages.

SPIRITUAL ASSESSMENT ASSIGNMENT INSTRUCTIONS

Overview-Important Definitions

Holistic Nursing: The American Holistic Nurses Association (AHNA & ANA 2013. p. 1) created the following definition in 1998; “all nursing practice that has healing the whole person as its goal….honors the interconnectedness of self, others, nature, and spirituality.”

Spirituality: The feelings thoughts, experiences, and behaviors that arise from a search for meaning. That which is generally considered sacred or holy. Usually though not universally, considered to involve a sense of connection with an absolute, imminent, or transcendent spiritual force, however named, as well as the conviction that meaning, value, direction, and purpose are valid aspects of the individual and universe. The essence of being and relatedness that permeates all life and is manifested in one’s knowing, doing and being. The interconnectedness with self, others, nature, and God/Life Force/Absolute/Transcendent. Not necessarily synonymous with religion (AHNA & ANA, 2013, p. 91)

“Spiritual assessments not only glean religious beliefs and practices, but also query a person’s meaning and purpose in life and how that may have changed due to the present health experience” (AHNA & ANA p. 12).

AHNA & ANA. (2013). Holistic Nursing: Scope and standards of practice, 2nd Edition. Silver Spring, MD: Nursebooks.org.

Preparation

First read chapter 22 in Blais and Hayes and complete the Spiritual Assessment online learning module.

I
nterview

Then complete a spiritual assessment on someone in your community. Use the form found below the rubric. Use bullet points or numbers rather than complete sentences. Be sure to choose an
appropriate tool. You can use the assessment from the chapter on spirituality found in your textbook, or choose one found in the literature or online such as the

HOPE tool:
http://www.aafp.org/afp/2001/0101/p81.html

FICA tool:
http://smhs.gwu.edu/gwish/clinical/fica/spiritual-history-tool

FACT tool:
http://www.professionalchaplains.org/files/resources/reading_room/spiritual_history_tool_fact_larocca_pitts.pdf

During the interview you will choose an appropriate spiritual nursing action based on your assessment and state how/why you chose the nursing action. What was the result of the action (e.g. what did the interviewee think of the nursing action and/or how did they respond to the nursing action?). What are your thoughts on the experience of doing this assessment (e.g. main takeaway(s), surprises, reactions).
Please keep the form to three or fewer pages.

RUBRIC

Element

Element

Fully Addressed

Element

Partially Addressed

Element

Insufficient or Not Addressed

Pts Poss

Pts Earned

· Appropriate assessment tool chosen, Source & Reference Included (2 pts)

2

· Assessment sufficiently covers all areas of the tool

20

· Nursing action appropriate

· Nursing action based on the assessment and how chosen

· Results of action included

8

· Includes own thoughts/takeaways on experience of doing the assessment

6

Spelling, Grammar, APA

Free of spelling, typographical, and grammatical errors, uses bullet points or numbering, reference in proper APA

4

Total Points

40

SPIRITUAL ASSESSMENT FORM

(Please keep information you fill in to two-three pages)

Student Name____________________ Professor Name_______________________

Date: __________ Interviewee Initials________ Age ______Gender______

Pertinent Diagnosis (if any) _________________________________________

Short description of interviewee and how you know them (don’t give away person’s identity): _______________________________________________________

Name of tool__________________

Source (Citation)______________ (include reference at bottom of form):

Questions Asked-use bullet points

Interviewee Responses-use bullet points

Nursing Action(s)-use bullet points

Why Chosen-use bullet points

Result of Nursing Action: Interviewee thoughts/reactions-use bullet points

Your own thoughts/take-aways-use bullet points

Spiritual Assessment Form

(Please keep information you fill in to one-two pages)

Date:

XX/XX/20XX Interviewee Initials:

XX Age:

XX Gender:

Female Pertinent Medical Diagnosis (if any):

Cataract surgery on on her right eye.

Complication of increased intraocular pressure, resulting in blurred vision.

Short description of interviewee and how you know them (don’t give away person’s identity however):

She is a longtime family friend.

Name of tool:

A Spiritual Assessment Tool: FACT

Source:
LaRocca-Pitts, M. (2007).

Questions Asked (use bullet points)

Interviewee Responses (use bullet points)

F – Faith (and/or Beliefs, Spiritual Practices)

1. What is your faith or spiritual beliefs?

2. Do you consider yourself spiritual or religious?

3. Tell me more about what you mean when you say “it’s more than going to church.”

4. What things do you believe that give your life meaning and purpose?

A – Active (and/or Availability, Accessibility, Applicability)

5. Are you part of a religious or spiritual community?

6. Can you tell me about how you are active in your faith community?

7. Is support for your faith available to you?

8. Do you have access to what you need to apply your faith (or your beliefs)?

9. It sounds like reading the Bible is important to you. Can you tell me more about that?

10. Is there a person or a group whose presence and support you value at a time like this?

C – Coping (and/or Comfort); Conflict (and/or Concern)

11. How are you coping with your medical situation?

12. Is your faith (your beliefs) helping you cope?

13. How is your faith (your beliefs) providing comfort in light of your diagnosis?

14. Do any of your religious beliefs or spiritual practices conflict with medical treatment?

1. I am a Christian. I believe in Jesus Christ, the Father God, and the Holy Spirit.

2. I would consider myself more spiritual than religious. I have a personal

relationship with God. It’s more than just “going to church.”

3. For me it’s a part of me. It’s not a building, or a set of rules, that sometimes people think of when they hear the word

“religion.”

4. The two biggest things that keep me going is my faith and my family. I have a wonderful family. I’m blessed, with my husband, kids, and grandkids. I pray for them every day. My faith in Jesus is what gives it all meaning.

5. Yes, I am. I attend a nondenominational Christian church.

6. I go to church pretty much every Sunday, and go to the bible study on Wednesdays. I am involved with the women’s ministry.

7. The prayer chain is one thing that’s really helpful. When I had my surgery it was good to know that others in the church were praying for me. My family and friends, and the pastor are all supports too.

8. Yes. I have the Word of God in my heart. God always hears my prayers, even if I can’t read the Bible right now.

9. Yes, it is. I normally read the Scripture every morning while I drink my coffee. It’s kind of become my ritual over the years. Since my eye has been so blurry since the surgery, and light kind of bothers it I’ve had to put it on hold for now. I’ve been praying and listening to music.

15. Are there any particular concerns you have for your medical team?

10. Well, I always enjoy having the kids and grandkids around. They come when they can, but they are busy though with their own lives. A couple friends have called to check in on me too. It helps to know people are thinking of you and praying for your recovery. It is nice that you came to see how I’m doing.

11. Pretty well I’d say. The first few days was tough because we had to keep going in to get the pressure down in my eye, but that’s been better now.

12. Definitely. He is my strength.

13. I don’t have to worry because ultimately I know God is in control.

14. No, none that I can think of.

15. I’m concerned about the blurriness, but

they’ve assured me that will continue to get better. I’m already starting to see an

improvement. I’m hoping the surgery on my other eye will go a little better, but I’m not too worried. It will be alright.

Nursing Action(s)-use bullet points

Why Chosen-use bullet points

T – Treatment Plan

1. I asked her if she would like me to read her some scripture verses, and when she agreed, I read her passages she chose.

2. I offered to show her a Bible application on her kindle that will read Scripture to her out loud, and she was able to use it successfully.

1. She shared that this is something important to her, and is normally part of her daily routine. She can’t read due to her blurred vision and the strain it places on her eyes.

2. I saw she had a kindle on her table, and a smartphone, so I knew she must be at least somewhat familiar with applications. The program would allow her to continue her daily ritual, if she chooses to listen to the narrated Bible until her vision returns.

Result of Nursing Action: Interviewee thoughts/reactions use bullet points

Your own thoughts/take-aways-use bullet points

1. She was very pleased that I offered to read her scripture, and sat listening with her eyes closed. Afterwards, she thanked me.

2. She actually had the Bible app on her smartphone and kindle that I was going to show her, but she didn’t know it had the capability to read it to her. She was very appreciative, and was even showing her husband.

1. I was surprised at how uncomfortable at times I felt asking her these questions, even though I am also a Christian. I think the reason why I felt this way is because faith and spirituality is such a personal thing, I didn’t want to offend her, or cross boundaries. I think it will take practice to

be more comfortable, but it is worth it to truly care for my patients holistically.

Reference

LaRocca-Pitts, M. (2007).
A Spiritual Assessment Tool: FACT
http://www.professionalchaplains.org/files/resources/reading_room/spiritual_history_tool

_fact_larocca_pitts.pdf

Spiritual Assessment Form

Student:
Anna “Anya” Karchevsky, RN, BS Completion Student (assignment used with student’s permission)

Date: XX/XX/20XX
Interviewee Initials
GN Age 68
Gender
Female

Pertinent Medical Diagnosis:
DM-2, Clinical Depression, General Anxiety Disorder, CHF Short description of interviewee and how you know them: The person I am interviewing is a current client of mine. She is a 68-year-old female of the Hindu faith that was born in Guyana. She immigrated to the US in 2001 because her son and grandkids where living here. He husband passed away 5 years ago and she is battling many mental health issues along with chronic diagnoses.

Name of tool: SPIRIT Model for Assessing Spirituality

Source: Blais and Hayes, 2016, p. 435

Questions Asked (use bullet points)

Interviewee Responses (use bullet points)

· Do you belong to any religious or spiritual community?

· What is your source of strength, hope and comfort?

· Do you believe in a higher power?

· What lifestyle activities or practices does your religion encourage, discourage, or forbid?

· What does your spirituality/religion mean to you?

· Are there any unresolved areas in your life at this point that you would like us to assist you with addressing?

· In what ways can the nursing staff assist you and your family during the time you are in homecare?

· Are there specific elements of nursing and medical care that your beliefs/religion discourage/ forbid?

· Are there any specific spiritual or religious beliefs or practices that you hold in regards to end of life?

Source: Blais & Hayes, 2016, p. 435

· “Yes, I belong to the faith that is named Hinduism”

· “The source of my strength is through meditation and attending the Hindu temple where I can meet with the members of my community and socialize around my friends”

· “We have many gods that someone might pick to follow. I follow the god Ganesh. He is the son of Lord Shiva (destroyer of worlds) and Goddess Parvati. Because I moved from Guyana to America I pray to Ganesh to help in my new ventures in this world/country.”

· “We are encouraged to meditate and do yoga daily to help us be more grounded and at peace with our mind, body, and soul. We are discouraged to judge people; we hope that if someone lives a pure life that karma would not bring them harm. We are forbidden to eat cow. Cow is a holy animal to use.”

· “My religion means everything to me. It is how I live my life.”

· “At this point in my life I do not feel like I have anything unresolved. I am a proud grandma; my granddaughter is in school to be a doctor. My goal is to get better and start to manage my disease and mental health.”

· “I would love for the homecare nurses to make sure take off their shoes when they enter my home. It is believed that walking round in dirty shoes in a house brings bad karma from the world into the house.”

· “I will not take any medications that might have animal products. I am vegetarian. Many people from my faith might not be vegetarian but will not

eat cow/beef. If at any point I will need a home

health aide to assist me, I ask for only female aides. In my faith we can not have a member of the opposite sex see us, unless it is our spouse. I know I am diabetic, but fasting is very important to me. I am working with my doctor to help control my sugar levels while fasting.

· Please remember that I would like to die at home not in a hospital. Death is a very important transition. There are many karmic implications that require proper prayer and rituals during the

transition of death.”

Nursing Action(s)-use bullet points

Why Chosen-use bullet points

· Assessed the client in contacting her temple to help arrange a swami (religious leader) to come visit the client at her home while she is with homecare.

· Ensured to take off my shoes every time I stepped into the patient’s home

· Keep an open line of communication between the patient and the nurse. This helps create trust between the patient and the nurse.

· Educated client on the spiritual support team that we have with the homecare agency

· Assigned a spiritual assessment guideline for all clinicians to use with all visits

Source: Blais & Hayes, 2016, p. 438.

· This will help the client stay connected with her religions group and leader while she is battling her disease at home. This will help the patient have a sense of connection and feel she is still remembered and cared for by her community and spiritual faith.

· Patient believes that if you wear shoes from outside that it will bring in bad karma from the world around her into her private house.

· This will ensure a therapeutic line of communicate between the patient and nurse and help develop a good working and trusting relationship

· This information provided allows the patient to know that if there are anytime during the homecare episode her leader can not make it over that she has support and another source

· If the guideline is embedded in the assessments, it will ensure spiritual assessments are completed and spiritual competence is addressed. It will be the

patient’s choice if she wants to address her spirituality every visit but at least it will be addressed.

Result of Nursing Action: Interviewee thoughts/reactions use bullet points


Your own thoughts/take-aways-use bullet points

· The patient reported that after seeing her swami she felt a sense of peace about her current health condition and was given more motivation mentally to keep fighting her health conditions

· The patient reported that she has been struggling with depression since she has moved from her home country and her son has been away on business. She stated that when clinicians address how she is feeling spiritually that she feels more connected with the clinicians.

· The most important thing that I took away from this assignment is the importance of completing a spiritual assessment when first meeting our patients

· We need to embed the assessment into our initial assessments and to repeat a modified assessment with each visit.

· The way a person views their health might be in direct connect to how they perceive their faith and spirituality

· When a patient is fighting a health condition, their faith or spirituality can be a great coping tool. Nurses who take the time to learn what their beliefs area can help guide positive coping.

References

Blais, K. & Hayes, J. S. (2016).
Professional nursing practice: Concepts and perspectives (7th ed.). Prentice Hall

Assessment Results and Interventions

Date: 
_XX/XX/20XX_  Interviewee Initials:_
XX _ Age: _
XX_ Gender:__
F_

Pertinent Medical Diagnosis (if any) _
None_________________________________

Short description of interviewee and how you know them (don’t give away person’s identity however):
Coworker______________________________________________

Name of tool:__
SPIRIT Model

Source
(Blais & Hayes, 2016, p. 435)

Questions Asked (use bullet points)

Interviewee Responses (use bullet points)

S

· Do you have a formal religion?

· Source of strength/hope/comfort?

· Any spiritual practices?

P

· Describe your spiritual beliefs/practices

· Describe beliefs/practices you don’t accept

· Comfort methods in pain/fear

· How is spirituality meaningful in daily life?

I

· Do you belong to religious community?

· How important is a spiritual community?

R

· Lifestyle activities practices encouraged/discouraged by religion.

I

· Any nursing cares forbidden by religion?

· Anyone you want to include in your care?

T

· Are there important spiritual practices regarding end-of-life care?

S

· No, consider self agnostic.

· Family, my own morals, the desire to be good to others.

· Yoga feels spiritual, because it makes me feel strong and calm.

P

· It’s our duty to take care of each other and the earth, cause no harm to others, take care of ourselves, raise children to be good people.

· Don’t accept judging others, causing physical/mental harm, being greedy.

· For comfort, I rely on my own strength (when able), otherwise, family and friends. In pain, I use yoga/breathing practices.

· It makes me think about my daily actions, how I am treating people, always. I exercise to make sure I take care of myself.

I

· I have no spiritual community. Most people I know believe in God, I don’t.

· I was raised Catholic and miss this part about religion.

R

· No religion guides my lifestyle practices. I still observe religious holidays (Xmas, Easter) because it’s fun and for my kids.

I

· Can’t foresee any cares that would be affected by spiritual practices.

· Would just include family/close friends in care.

T

· I am concerned about how someone who doesn’t believe in God has a funeral. I’ve never been to a non-religious one.

· I am scared that I’ll be dying some day and terrified without the comfort of a Heaven waiting for me.

Nursing Action(s)-use bullet points

Why Chosen-use bullet points

· Recommend finding a community of like-minded, spiritual people, suggest looking for Humanist organization to join to help with this.

· Suggest speaking to spiritual counselor if hospitalized, or informally at work (they are readily available).

· Community is something she misses, it would provide an extra source of support. Humanism aligns closely with JV’s beliefs.

· Spiritual counselors at our facility meet with all religions, including atheists/agnostics. They could discuss end-of-life ceremony options for Agnostics, help JV find deeper understanding of her spirituality.

Result of Nursing Action: Interviewee thoughts/reactions use bullet points

Your own thoughts/take-aways-use bullet points

· JV is aware of Humanism as an organization and agrees that she would benefit from a larger community of like-minded people.

· Her desire is for a close community like you’d get with a church, but without the religious/God aspect.

· She likes the idea of talking to one of our spiritual counselors about end-of-life rituals and how to find comfort in her last days.

· She thinks she is very likely to have an informal chat with one of the rounding pastors.

· Whatever a person’s religion/spirituality, there are likely to be concerns that need to be addressed.

· The RN should not assume that, because a patient isn’t “religious”, that they don’t have spiritual distress.

· Seemingly minor things can help with spiritual distress (ex: yoga and breathing, in JV’s case, help with pain/fear)

Reference

Blais, K. & Hayes, J. S. (2016). 
Professional Nursing Practice: Concepts and perspectives (7th ed.). Prentice Hall

References

Blais, K., & Hayes, J. S. (2016).
Professional Nursing Practice: Concepts and Perspectives (7th ed.). Hoboken, NJ: Pearson Education Inc.

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