Nursing Forum 6

patient’s needs with an open mind in

order to gain understanding of the

patient’s beliefs. The patient’s needs and

beliefs can guide the assessor in terms

of how the patient wants to utilize spiri-

tual or religious beliefs in their care or

treatment.”

A staff member’s comfort in assess-

ing spirituality may be linked to his or

her own experiences with spirituality.

For this reason, if your organization or

community has pastoral care resources,

it may also be helpful to access

information from pastoral care profes-

sionals. Clinically trained, professional

pastoral care providers can offer insight

and assistance in developing spiritual

assessments for your organization.

Who Should Conduct a Spiritual Assessment?

Depending on the type and size of

your organization, different staff mem-

bers can and should conduct spiritual

assessments. As with other types of

assessments, the spiritual assessment

should be multidisciplinary. Physicians,

therapists, nurses, and clinical pastoral

staff should receive training on the value

of spiritual assessment and the tools

that should be used to assess a patient’s

spirituality.

Approaches to Determining Spiritual Assessment Content In designing a spiritual assessment, your

organization will need to determine the

mechanism(s) you will use to collect

information and when an in-depth spiri-

tual assessment will be necessary. Your

organization may want to consider the

following questions:

■ Will staff ask direct questions of the

patient regarding his or her spirituali-

ty? If so, some appropriate questions

may address support systems, prayer,

spiritual goals, religious or spiritual

resources used to cope with chal-

lenges, and beliefs about life and

illness.

AAskedandAnswered Evaluating your SpiritualAssessment Process Q Our organization is examining itsspiritual assessment process. What does the Joint Commission

require?

A Per standards and elements of per-formance (EPs) found in the “Provision of Care, Treatment, and

Services” (PC) chapter in the accredita-

tion manuals,* the Joint Commission

requires organizations to include a spiri-

tual assessment as part of the overall

assessment of a patient to determine

how the patient’s spiritual outlook can

affect his or her care, treatment, and

services. This assessment should also

determine whether more in-depth

assessments are necessary.

While the Joint Commission leaves

the specifics to each organization, spiri-

tual assessment should, at a minimum,

determine the patient’s religious affilia-

tion (if any), as well as any beliefs or

spiritual practices that are important to

the patient. While the content and for-

mat of the spiritual assessment will vary

depending on the organization and type

of patients served, organizations should

develop a basic policy regarding the con-

tent and scope of spiritual assessments

and outline who is qualified and compe-

tent to perform such assessments within

the organization.

Barriers to Addressing Spirituality Poor timing, lack of training, and

discomfort with the subject matter are

just a few of the barriers that can stand

in the way of a staff member’s conduct-

ing spiritual assessments effectively.

Organizations that encourage staff to

take time for the spiritual assessment

and provide staff with a clear framework

of that assessment can help to address

some of these challenges.

Assessing a patient’s spirituality and

the need for support can be a delicate

subject with some patients, and staff

members need to extract helpful infor-

mation without causing offense. The

main goal of the spiritual assessment

should be to identify the patient’s needs,

hopes, resources, and possible outcomes

regarding spirituality and determine

appropriate actions necessary to address

those issues. Individuals assessing a

patient’s spirituality must be careful not

to impose their belief system or defini-

tion of spirituality on the patient.

According to Sue Wintz, chair of the

Commission on Quality in Pastoral

Services, “It is essential to listen to the

Why Assess Spirituality? Spirituality is an often overlooked, yet still important element of patient assessment and care. Addressing and supporting patients’ spirituality can not only make their health care experiences more positive, but in many cases can promote health, decrease depression, help patients cope with a difficult illness, and even improve outcomes for some patients. In addition to the potential medical benefits, patients want their health care providers to discuss spirituality with them. In one study, a major- ity of patients indicated that they would like their physicians to ask whether patients have spiritual or religious beliefs that would influence their medical decisions if they became gravely ill.4 Another study found that 40% of patients felt that physicians should discuss pertinent religious issues with their patients, however only 11% of physicians frequently or always did.5

* Spiritual assessment–related standards and EPs can be found in PC.2.20, EP 4, for hospitals and ambu- latory care; PC.2.20, EP 20 for long term care; PC.2.60, EPs 1 and 3 for behavioral health care; and PC.2.20, EP 8 for home care.

Page 6 Joint Commission: The Source, February 2005, Volume 3, Issue 2

Copyright 2005 Joint Commission on Accreditation of Healthcare Organizations

■ Will staff be encouraged to use a

mnemonic device such as HOPE?

(This device helps organize questions

around the topics of Hope, Organized

religion, Personal spirituality and

practices, and Effects on medical care

and end-of-life issues.)

■ Will staff be trained to observe cer-

tain indicators that might signal a

need for a further assessment? Such

indicators may include crying, anger,

resentment, depression, or “God

talk,” among others. Statements such

as “I pray nothing goes wrong,” or

“It’s in God’s hands now,” provide an

opportunity to investigate spirituality.1

■ When will staff conduct the spiritual

assessment? What type of patient

should receive an in-depth spiritual

assessment?

Involve Staff Because different staff members

throughout the organization may be

responsible for conducting a spiritual

assessment at some level, it is important

to involve multiple disciplines in under-

standing how the assessment is to be

designed and what it includes in order

for it to be utilized effectively.

Organizations should be sure to respect

the spiritual views of both religious and

nonreligious staff and patients in their

assessment tools.2

Providing education to staff regarding

spiritual assessment is critical. Training

staff on the appropriate content of the

spiritual assessment, as well as on the

different ways an assessment can be

documented, is very important. Once

training has occurred, assessment of

staff competence regarding spiritual

assessment should also take place to

make sure that any training provided is

appropriate.

Assuring Assessor Competence As with any other kind of assessment,

staff members conducting a spiritual

assessment should be competent to do

so. Cultural competence is particularly

important in this arena as different

cultures have different views on spiritu-

ality and religion. For example, a devout

Catholic patient from the Philippines

will have a strikingly different view of

religion and spirituality than a Native

American patient who may take his or

her spiritual strength from nature in

addition to or separate from a formal

religious tradition.

Staff members capable of conducting

a spiritual assessment may come from

varied backgrounds. The qualities that

make a good spiritual assessor do not

necessarily limit themselves to one par-

ticular job classification. Individuals

who will competently assess a patient’s

spirituality tend to have the following

characteristics:

■ A willingness and a desire to learn

about how to conduct a spiritual

assessment

■ An understanding that there are

many different spiritual and religious

perspectives

■ An ability to focus on spiritual issues

with a patient without forcing one’s

own beliefs on him or her

■ A comfort level with discussing

spiritual issues

■ A knowledge of appropriate respons-

es to spiritual disclosures, including

prayer, meditation, walks in quiet

nature areas, and so forth3 TheSource

References

1. Larson K.: The importance of spiritual assessment: One clinician’s journey. Geriatric Nursing 24(6): 370–371, 2003.

2. Graber D., Johnson J.: Spirituality and healthcare organizations. Journal of Healthcare Management, 36, 39–52, Jan./Feb. 2001.

3. Singh K.: Spiritual competency: An open letter to hospice colleagues. American Journal of Hospice and Palliative Care 16(4):616–618, 1999.

4. Ehman J.W., Ott B.B., Short T.H.: Do patients want physicians to inquire about their spiritual or reli- gious beliefs if they become gravely ill? Arch Intern Med 159:1803–1806, 1999.

5. Maugans T.A., Wadland W.C.: Religion and family medicine: A survey of physicians and patients. J Fam Pract 32:210–213, 1991.

6. Anandarajah G., Hight E.: Spirituality and medical Practice: Using the HOPE questions as a practical tool for spiritual assessment. American Family Physician 63(1): 81–88, 2001.

Spirituality vs. Religion— More than Just Semantics While many people use the words spirituality and religion interchangeably, they are in fact very different. Spirituality can be defined as a complex and multidi- mensional part of the human experience— our inner belief system. It helps individuals to search for the meaning and purpose of life, and it helps them experience hope, love, inner peace, comfort, and support.6

Religion refers to a belief system to which an individual adheres.1 Religion involves particular rituals and practices—the exter- nals of our belief system. Many people find spirituality through religion; however, some people find spirituality through communing with nature, music, the arts, quest for sci- entific truth, or a set of values and princi- ples.6 Not everyone is religious, nor is reli- gion a requirement for spirituality.

Within a spiritual assessment, it is impor- tant to determine if a patient has a religious affiliation; however, that is not the sole pur- pose of the assessment. A person may not practice religion, but may still have spiritual needs that should be met. Any assessment process should identify these spiritual needs, in whatever form they take.

Providing education to staff regarding spiritual assessment

is critical. Training staff on the appropriate content of the

spiritual assessment, as well as on the different ways an

assessment can be documented, is very important.

Page 7 Joint Commission: The Source, February 2005, Volume 3, Issue 2

Copyright 2005 Joint Commission on Accreditation of Healthcare Organizations