1. Spiritual Screening and Spiritual Assessment: Different Tools to Serve a Common End Part 2
Patricia E Murphy RSCJ, PhD, BCC
National Association of Catholic Chaplains
April 16, 2015
Department of Religion, Health and Human Values,
Rush University Medical Center, Chicago, IL
based on a presentation by George Fitchett, DMin, PhD

2. Outline When Do We Do Spiritual Assessment
Why Is Spiritual Assessment Important
Inquiry about Spiritual Life
Research
Clinical Practice
Spiritual screening
Spiritual history-taking
Spiritual assessment
Next Steps in Spiritual Assessment

3. Screening, History Taking, Assessment
Fitchett & Risk, FICA Puchalski et al., Fitchett, 1993

4. Publications about Spiritual Assessment
PubMed, 1015

5. When Do We Do Spiritual Assessment?
There is no spiritual care that doesn’t have an assessment.
Every chaplain does spiritual assessment in every patient encounter.
The issue is intentional vs intuitive spiritual assessment.

6. Why is Spiritual Assessment Important?
Pastoral diagnosis is:
The touchstone of our identity
A distinct contribution to interdisciplinary care
(Paul Pruyser, 1976)

7. Why is Spiritual Assessment Important?
Spiritual assessment is foundation for:
caring
communicating
evaluating
educating
(Naming the pain and guiding the care,
D Denton, 2008)

8. Why is Spiritual Assessment Important?
STANDARD 1: ASSESSMENT
Assessment: The chaplain gathers and evaluates relevant data pertinent to the patient’s situation and/or bio-psycho-social-spiritual/religious health.

9. Why is Spiritual Assessment Important?
STANDARD 1: ASSESSMENT - INTERPRETATION
Assessment is a fundamental process of chaplaincy practice. Provision of effective care requires that chaplains assess and reassess patient needs and modify plans of care accordingly.
A chaplaincy assessment in health care settings involves relevant biomedical, psycho-social, and spiritual/religious factors, including the needs, hopes, and resources of the individual patient and/or family.
A comprehensive chaplaincy assessment process includes: Gathering and evaluating information about the spiritual/religious, emotional and social needs, hopes, and resources of the patient or the situation Prioritizing care for those whose needs appear to outweigh their resources

10. Spiritual Assessment: Positive Attitudes Among Canadian Chaplains
Aid communication with other department chaplains
Aid communication with interdisciplinary team
Establish chaplains as equal members of team
Study of CAPPE chaplains: survey, n=90, focus groups, n=15. O’Connor et al, JPCC, 2005

11. Discipline for Pastoral Care Giving – Arthur Lucas, 2001
Profile
Concept of Holy
Meaning
Hope
Community

12. “What Do Chaplains Contribute?”
“Chaplaincy is not always understood by other clinicians, or the understanding is actually a misunderstanding.”
“Our medical director talks in terms of educating the parade. There are always new faces, there are always new dynamics, and so as a result you can’t count on history to support you.”

13. Why is Spiritual Assessment Important: JCAHO Standard
Q: Does the Joint Commission specify what needs to be included in a spiritual assessment?
A: Spiritual assessment should, at a minimum, determine the patient's denomination, beliefs, and what spiritual practices are important to the patient.
This information would assist in determining the impact of spirituality, if any, on the care/services being provided and will identify if any further assessment is needed. The standards require organization's to define the content and scope of spiritual and other assessments and the qualifications of the individual(s) performing the assessment.
(JCAHO Website; January, 2004)

14. Three Levels of Clinical Inquiry about Spirituality and Religion

15. Refer for spiritual assessment re: possible RS struggle.
3 Actions:
Refer for spiritual assessment re: possible RS struggle.
Spiritual care requested, make referral.
No action: no indication of RS struggle, no interest in spiritual care.
Fitchett & Risk, 2009

16. FICA--Taking a Spiritual History
F--Faith and Belief "Do you consider yourself spiritual or religious?" or "Do you have spiritual beliefs that help you cope with stress?”
I--Importance "What importance does your faith or belief have in our life? Have your beliefs influenced how you take care of yourself in this illness?
C--Community "Are you part of a spiritual or religious community? Is this of support to you and how?
A--Address in Care "How would you like me, your healthcare provider, to address these issues in your healthcare?"
Puchalski CM, Romer AL. Taking a spiritual history allows clinicians to understand patients more fully. J Pall Med 2000;3: Copyright, Christina M. Puchalski, MD, Also see:

17. Guidelines for Pastoral Diagnosis - Paul Pruyser, 1976
Awareness of the Holy
what if anything is sacred, revered
Providence
what has God promised me
Faith
affirming vs negating stance in life
Grace or Gratefulness
kindness, generosity, the beauty of giving and receiving
Repentance
feelings of contrition, remorse, regret
Communion
feelings of kinship with the whole chain of being
Sense of Vocation
willingness to be a cheerful participant in creation

18. Discipline for Pastoral Care Giving – Arthur Lucas, 2001
Profile
Concept of Holy
Meaning
Hope
Community

19. The 7 x 7 Model for Spiritual Assessment
Published in 1993, Augsburg Press
Reprinted 2002, Available from Academic Renewal Press, Lima, Ohio

20. The Challenges of Evidence-based Spiritual Assessment*
Characteristics (Alternative)
Rationale
Quantifiable
(Narrative)
Identify degrees of R/S distress and R/S resources in order to inform care plan
Describe change in R/S distress or other sx in response to chaplain spiritual care
Valid
(Invalid)
Psychometric validity of instrument as measure of R/S issues relevant to patients with this diagnosis
Useful
(Waste of time)
Acceptable to patients
Acceptable to chaplains: helpful guide to spiritual care; consistent with identity and education
Provides information valued by other clinicians
Inclusive
(Pathologizes)
Inclusive and respectful of diverse R/S beliefs and practices
Universal
(Local)
The same model is used by all chaplains working with patients with this condition
My goal in this presentations is to have us explore what it means to develop an evidence-based approach to chaplains’ spiritual assessment. Can we name the issues and our concerns and bring them into focus? Can we look at the specific pros and cons, the tradeoffs, that would be associated with embracing an evidence-based approach to spiritual assessment?
This is my initial list of 5 Characteristics of e-b sp assessment, the benefits that may be associated with them (Rationale), and ways we might characterize sp assessments that did not exhibit these characteristics (Alternatives). What do you think about this?
*assume condition-specific models for spiritual assessment, e.g., PTSD

21. Evaluating Current Practice in Spiritual Assessment
Example
Quantifiable
Valid
Useful
Inclusive
Universal
7x7 no
unknown
possibly
Rush Screening Protocol
yes
partial
FICA
hopeful
Spiritual Pain Scale
What would it look like if we used these characteristics to evaluate existing models for spiritual screening, history-taking, or assessment? Here’s a list of 5 models and my evaluation. What do you think? What would you add or change?

22. What About the Electronic Medical Record?
Could eventually be a source for research, but not easy to get the data downloaded, currently.
Could influence how chaplains “assess” patient.

23. What do chaplains at Rush do?
EPIC dropdown menu
Assessment
Patient seems to be…
Patient described…
Sources of Emotional Support
Level of Support
Source of Emotion
Use at least 50% of 7 x 7
Yes all but 1 person
No, due to short LOS
Influenced by drop down menu
Yes – 1 and 1 somewhat
No – most
What do you do after introduction, any regular behavior?

24. When Do We Do Spiritual Assessment?
There is no spiritual care that doesn’t have an assessment.
Every chaplain does spiritual assessment in every patient encounter.
The issue is intentional vs intuitive spiritual assessment.

25. What do you do?
Do you screen for religious or spiritual struggle?  Yes or no
Do you use at least 50% of the categories in the 7 x 7 in your listening to do an assessment?

26. What do you do? Does the dropdown menu influence you?
What do you do after introduction? Any regular question or behavior?