Monday, March 4, 2019

Spiritual Needs Assessment



George Fitchett, DMin, PhD at Rush University Medical Center, Chicago, IL, one of the foremost researchers in clinical pastoral care, compares the level of inquiry, context, length and mode in the spiritual assessment instruments most commonly used by hospital and hospice chaplains. The two most prevalent are known by the acronyms HOPE and FICA.  They are both quite basic and can be used by volunteers and other non-professionals to derive a brief spiritual history.  However, most chaplains develop their own style of assessing and use approaches that go deeper than these two models.  Fitchett gives good examples in his book explaining why and how to go about this.  Of course, any instrument has to be adapted to the particular situation and should be used in such as way that it does not come across as impersonal.  If it interferes offering the kind of compassionate human response a person in need would benefit from the most, it should be set aside.  

The HOPE assessment addresses these questions:

H: sources of hope
What are your sources of hope, strength, comfort, and peace?
What do you hold on to during difficult times?
O: organized religion
Are you part of a religious or spiritual community?
Does it help you? How?
P: personal spirituality and practices
Do you have personal spiritual beliefs?
What aspects of your spirituality or spiritual practices do you find most helpful?
E: effects on medical care and end-of-life issues
Does your current situation affect your ability to do the things that usually help you spiritually?
As a doctor, is there anything that I can do to help you access the resources that usually help you?
Are there any specific practices or restrictions I should know about in providing your medical care?
If the patient is dying: How do your beliefs affect the kind of medical care you would like me to provide over the next few days/weeks/months?

The FICA assessment asks about:

Faith and belief:
Do you have spiritual beliefs that help you cope with stress? If the patient responds "no," consider asking: what gives your life meaning?
Importance:
Have your beliefs influenced how you take care of yourself in this illness?
Community:
Are you part of a spiritual or religious community?
Is this of support to you, and how?
Address in care:
How would you like me to address these issues in your health care?
 
Both of these provide a way to estimate what helps a person to cope with difficult situations and whether or not they are in spiritual distress.  I have trained volunteers to use these tools successfully and conduct initial visits and developed a feedback instrument for them to let me know if they encountered an emotion such as sorrow, anger, fear, despair or distress, and how intense this feeling was on a scale of one to ten.   

Some of our chaplains use Paul Pruyser's model for spiritual diagnosis: 

  1. Awareness of the Holy: What if anything is sacred, revered?

  2. Providence: What has God promised you?

  3. Faith: Do you have an affirming vs negating stance in life?

  4. Grace or Gratefulness: Do you believe in human kindness, generosity, the beauty of giving and receiving?

  5. Repentance: Do you have feelings of contrition, remorse or regret and can I accept forgiveness?

  6. Communion: Do you have feelings of kinship with the whole chain of being?

  7. Sense of Vocation: Are you willing to be a cheerful participant in creation?
Others prefer the 7X7 model:


Personally, I prefer to use this cross-cultural model in a multi-faith environment like ours: