“Stand by the roads and look,
and ask for the ancient paths,
where the good way is, and walk in it,
and find rest for your souls.”
What is a Spiritual Assessment?
Spiritual assessment is a process of exploring a person’s inner life to understand how they order their world and what gives meaning to their life. It helps us understand how they are responding to their current reality and life changes.
A spiritual assessment emerges from a soulful connection as we walk with people on their journey as companions in Christ.
We seek to understand their spiritual reality and coping strategies by listening, validating their experience and feelings, and wondering with them about their hopes, dreams, fears, and beliefs. To do this work, we may employ an assessment tool, which helps us develop a framework of coping styles (e.g. evade/encounter, embrace).
As a companion, our goal is always to understand first. We embark on a spiritual assessment with the hope that this tool will help us lead our care receiver to:
- An improved level of self-esteem
- Decreased anxiety and developing serenity
- An improved sense of direction and purpose
- A heightened sense of “connectedness” with self, others, and the transcendent
- Increased resiliency
A spiritual assessment commonly considers:
- Current life situation
- Values and belief systems
- Coping mechanisms and resources
- Religious and spiritual experiences and development
- Concept of transcendence
- Capacity for hope
- History of chemical use
Spiritual categories often considered:
- Shame/belovedness
- Resistance/acceptance
- Alienation/reconciliation
- Confusion/integration
- Independent/dependent/interdependent
- Separate/fused
"Five F's" of Spiritual Assessment
Facts:
What are the circumstances the person has to deal with? What illness, event, loss? How long?
Feelings:
What emotions are the person experiencing? How well are they coping? Dealing with situation or avoiding or discounting it? How do feelings aroused in me inform me about what the person might be experiencing?
Family:
Does the person have supportive family members or friends in area? Who is primary caregiver? Other support systems and is the person well connected? What are feelings/issues for family? How well are they coping?
Faith:
What is the person’s belief system and does the person find strength and support from faith? What values give the person meaning? Who or what gives the person strength, hope, peace? Is the person connected with a spiritual caregiver or faith community that is a resource to them? What are spiritual issues?
Future:
Is the person hopeful or despairing in their situation? What is impact of health crisis on the person’s work, daily life, plans/hopes for the future? What is meaning of present crisis for the person?
Perspective: What influences and shapes a person’s worldview.
Action orientation: How a person is driven to act — or not act.
Role clarity: How a person chooses a role and how closely she/he identifies with it.
Decision logic: What framework a person uses to decide.
Fortitude: How a person determines when to hold and when to fold.
Motivation: What inspires and drives a person's actions and decisions.
The 7x7 Model
A Functional Approach to Spirituality
The 7 x 7 model employs a functional approach to spiritual assessment. A functional approach to spiritual assessment is concerned with how a person finds meaning and purpose in life and with the behavior, emotions, relationships and practices associated with that meaning and purpose.
Assess Spirituality in Holistic Context
The spiritual dimension of life affects and is affected by other dimensions of life. Spiritual assessment must be undertaken in the context of a multi-disciplinary, holistic assessment.
Description of the 7 x 7 Model
The 7 x 7 model for spiritual assessment has two broad divisions: a holistic assessment and the multi-dimensional spiritual assessment. These are illustrated below.
Holistic Assessment
Medical (Biological) Dimension
Psychological Dimension
Family Systems Dimension
Psycho-Social Dimension
Ethnic, Racial, Cultural Dimension
Social Issues Dimension
Spiritual Dimension
Spiritual Assessment
Beliefs and Meaning
Vocation and Obligations
Experience and Emotions
Courage and Growth
Rituals and Practice
Community
Authority and Guidance
Holistic Assessment
The holistic assessment looks at six dimensions of a person's life.
Medical Dimension
What significant medical problems has the person had in the past? What problems do they have now? What treatment is the person receiving?
Psychological Dimension
Are there any significant psychological problems? Are they being treated? If so, how?
Family Systems Dimension
Are there at present, or have there been in the past, patterns within the person's relationships with other family members which have contributed to or perpetuated present problems?
Psycho-Social Dimension
What is the history of the person's life, including, place of birth and childhood home, family of origin, education, work history and other important activities and relationships. What is the person's present living situation and what are their financial resources?
Ethnic, Racial or Cultural Dimension
What is the person's racial, ethnic or cultural background. How does it contribute to the person's way of addressing any current concerns?
Social Issues Dimension
Are the present problems of the person created by or compounded by larger social problems?
Spiritual Assessment
The spiritual assessment looks at seven dimensions of a person's spiritual life.
Belief and Meaning
What beliefs does the person have which give meaning and purpose to their life? What major symbols reflect or express meaning for this person? What is the person's story? Do any current problems have a specific meaning or alter established meaning? Is the person presently or have they in the past been affiliated with a formal system of belief (e.g., church)?
Vocation and Obligations
Do the persons' beliefs and sense of meaning in life create a sense of duty, vocation, calling or moral obligation? Will any current problems cause conflict or compromise in their perception of their ability to fulfill these duties? Are any current problems viewed as a sacrifice or atonement or otherwise essential to this person's sense of duty?
Experience and Emotion
What direct contacts with the sacred, divine, or demonic has the person had? What emotions or moods are predominantly associated with these contacts and with the person's beliefs, meaning in life and associated sense of vocation?
Courage and Growth
Must the meaning of new experiences, including any current problems, be fit into existing beliefs and symbols? Can the person let go of existing beliefs and symbols in order to allow new ones to emerge?
Ritual and Practice
What are the rituals and practices associated with the person's beliefs and meaning in life? Will current problems, if any, cause a change in the rituals or practices they feel they require or in their ability to perform or participate in those which are important to them?
Community
Is the person part of one or more, formal or informal, communities of shared belief, meaning in life, ritual or practice? What is the style of the person's participation in these communities?
Authority and Guidance
Where does the person find the authority for their beliefs, meaning in life, for their vocation, their rituals and practices? When faced with doubt, confusion, tragedy or conflict where do they look for guidance? To what extent does the person look within or without for guidance?
Information taken from here
Spiritual Assessment Tools
F.I.C.A.
(Puchalski & Romer, 2000).
F - Faith, Belief, Meaning: “Do you consider yourself spiritual or religious?” or “Do you have spiritual beliefs that help you cope with stress?”
I - Importance or Influence of religious and spiritual beliefs and practices: “What importance does your faith or belief have in your life? Have your beliefs influenced how you take care of yourself in this illness? What role do your beliefs play in regaining your health?”
C - Community connections: “Are you part of a spiritual or religious community? Is this of support to you and how? Is there a group of people you really love or who are important to you?”
A - Address/Action in the context of medical care: “How would you like me, your healthcare provider, to address these issues in your healthcare?”
H.O.P.E.
(Anandarajah & Hight, 2001)
H – Sources of hope, meaning, comfort, strength, peace, love, and compassion: What is there in your life that gives you internal support? What are the sources of hope, strength, comfort, and peace? What do you hold on to during difficult times? What sustains you and keeps you going?
O – Organised religion: Do you consider yourself as part of an organized religion? How important is that for you? What aspects of your religion are helpful and not so helpful to you? Are you part of a religious or spiritual community? Does it help you? How?
P – Personal spirituality/practices: Do you have personal spiritual beliefs that are independent of organised religion? What are they? Do you believe in God? What kind of relationship do you have with God? What aspects of your spirituality or spiritual practices do you find most helpful to you personally?
E – Effects on medical care and end-of-life issues: Has being sick (or your current situation) affected your ability to do the things that usually help you spiritually? (Or affected your relationship with God?) As a doctor, is there anything that I can do to help you access the resources that usually help you? Are you worried about any conflicts between your beliefs and your medical situation/care decisions? Are there any specific practices or restrictions I should know about in providing your medical care?
F.A.I.T.H
(King, 2002)
F – Do you have a Faith or religion that is important to you?
A – How do your beliefs Apply to your health?
I – Are you Involved in a church or faith community?
T – How do your spiritual views affect your views about Treatment?
H – How can I Help you with any spiritual concerns?
S.P.I.R.I.T.
(Abridged: Maugans, 1997; Ambuel & Weissman, 1999)
S – Spiritual belief system: Do you have a formal religious affiliation? Can you describe this? Do you have a spiritual life that is important to you?
P – Personal spirituality: Describe the beliefs and practices of your religion that you personally accept. Describe those beliefs and practices that you do not accept or follow. In what ways is your spirituality/religion meaningful for you?
I – Integration with a spiritual community: Do you belong to any religious or spiritual groups or communities? How do you participate in this group/community? What importance does this group have for you? What types of support and help does or could this group provide for you in dealing with health issues?
R – Ritualised practices and Restrictions: What specific practices do you carry out as part of your religious and spiritual life? What lifestyle activities or practices do your religion encourage, discourage or forbid? To what extent have you followed these guidelines?
I – Implications for medical practice: Are there specific elements of medical care that your religion discourages or forbids? To what extent have you followed these guidelines? What aspects of your religion/spirituality would you like to keep in mind as I care for you?
T – Terminal events planning: Are there particular aspects of medical care that you wish to forgo or have withheld because of your religion/spirituality? Are there religious or spiritual practices or rituals that you would like to have available in the hospital or at home? Are there religious or spiritual practices that you wish to plan for at the time of death, or following death? As we plan for your medical care near the end of life, in what ways will your religion and spirituality influence your decisions?
F.A.C.T.
(LaRocca-Pitts, 2008ab)
F – “Faith (or Beliefs): What is your Faith or belief? Do you consider yourself a person of Faith or a spiritual person? What things do you believe that give your life meaning and purpose?”
A – “Active (or Available, Accessible, Applicable): Are you currently Active in your faith community? Are you part of a religious or spiritual community? Is support for your faith Available to you? Do you have Access to what you need to Apply your faith (or your beliefs)? Is there a person or a group whose presence and support you value at a time like this?”
C – “Coping (or Comfort); Conflicts (or Concerns): How are you Coping with your medical situation? Is your faith (your beliefs) helping you Cope? How is your faith (your beliefs) providing Comfort in light of your diagnosis? Do any of your religious beliefs or spiritual practices Conflict with medical treatment? Are there any particular Concerns you have for us as your medical team?”
T – “Treatment plan: If patient is coping well, then either support and encourage or reassess at a later date as patient’s situation changes. If patient is coping poorly, then 1) depending on relationship and similarity in faith/beliefs, provide direct intervention: spiritual counseling, prayer, Sacred Scripture, etc., 2) encourage patient to address these concerns with their own faith leader, or 3) make a referral to the hospital chaplain for further assessment.”
Taken from here.