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:
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H: sources of
hope
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What are your
sources of hope, strength, comfort, and peace?
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What do you hold
on to during difficult times?
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O: organized
religion
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Are you part of
a religious or spiritual community?
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Does it help
you? How?
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P: personal
spirituality and practices
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Do you have
personal spiritual beliefs?
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What aspects of
your spirituality or spiritual practices do you find most helpful?
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E: effects on
medical care and end-of-life issues
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Does your
current situation affect your ability to do the things that usually help you
spiritually?
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As a doctor, is
there anything that I can do to help you access the resources that usually
help you?
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Are there any
specific practices or restrictions I should know about in providing your
medical care?
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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?
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The FICA assessment
asks about:
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Faith and
belief:
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Do you have
spiritual beliefs that help you cope with stress? If the patient responds
"no," consider asking: what gives your life meaning?
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Importance:
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Have your
beliefs influenced how you take care of yourself in this illness?
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Community:
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Are you part of
a spiritual or religious community?
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Is this of
support to you, and how?
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Address in care:
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How would you
like me to address these issues in your health care?
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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:
- Awareness of the Holy: What if anything is sacred,
revered?
- Providence: What has God promised you?
- Faith: Do you have an affirming vs negating stance in life?
- Grace or Gratefulness: Do you believe in human kindness,
generosity, the beauty of giving and receiving?
- Repentance: Do you have feelings of contrition, remorse or
regret and can I accept forgiveness?
- Communion: Do you have feelings of kinship with the whole
chain of being?
- 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:
