1. Duckett, Kathy BSN, RN

Article Content

A spiritual history is a critical element in the patient history, and is needed to provide a holistic approach to care, particularly at end-of-life care (Puchalski, 2006; Pulchalski & Romer, 2000). Unfortunately, it is not a commonly performed part of the patient assessment in home healthcare. Spiritual histories are necessary to provide an understanding of "how patients cope with their illnesses, the kinds of support systems available to them in the community, and any strongly held belief that might influence medical care" (Lucchetti et al., 2013, p. 159). There are many tools available for clinicians to assess a patient's spiritual history. Given the well-documented "paperwork" burden in home healthcare, it is important that a spiritual history tool chosen for use in home care be brief, flexible, appropriate for the patient setting, easy to use, and able to assist the home healthcare clinician in determining the patient's spiritual practices, needs, and resources (Lucchetti et al.).


Lucchetti et al. (2013) performed a systematic review of the literature incorporating 16 attributes that their research found to be important when assessing a spiritual history tool. They evaluated 25 tools and assigned a rating in terms of the number of these important attributes each tool contained. Their findings revealed the FICA(C) tool contained 13 of the 16 desirable attributes and it received the highest rating of the tools assessed (Lucchetti et al.). The FICA(C) tool asks questions in four categories that explain the acronym FICA: 1) Faith/beliefs, 2) Importance/influence, 3) Community, 4) Address (how the clinician can address, or take action on, spiritual issues) (Lucchetti et al.; Puchalski, 2006). The FICA(C) tool has been validated through research. Although the tool is intended to be used in end-of-life care, it has also been used effectively in other clinical settings and with other groups of patients (Lucchetti et al.).


Many home healthcare patients are dealing with debilitating diseases that result in significant lifestyle changes. Regardless of the disease process, there is often a sense of loss regarding the life they used to have, and the need to accept the limitations of their new life, including the reality that, while not necessarily at the end of life, they are now living with a chronic, and possibly debilitating disease. People with conditions such as end-stage heart failure, chronic obstructive pulmonary disease, and renal disease; multiple long- and short-term complications from diabetes; and progressive diseases such as Parkinson disease, Huntington disease, Alzheimer disease, or amyotrophic lateral sclerosis, often experience a similar sense of loss as those people living with a terminal disease such as cancer. In addition, many home healthcare patients are at the end of life, but for varied reasons are not offered, or do not choose, hospice or palliative care options. This leaves home healthcare clinicians, who are often not educated in end-of-life care in the same way hospice and palliative care clinicians are, trying to understand and address the spiritual needs of the patient.


People often confuse pain with suffering (Groves & Klauser, 2009). Pain is the sensation felt in response to physiological or emotional distress, and suffering is the individual's response to that pain (Groves & Klauser). Physical pain and spiritual suffering are often interrelated and we know that dealing with spiritual suffering can help relieve physical and emotional pain (Groves & Klauser). Understanding the role that spirituality plays in suffering would be valuable to the home healthcare clinician's understanding of how to help the whole patient. Awareness of how patients are coping with their disease process, what is important in their lives, what community support they have, and how patients think the healthcare community can assist them would be valuable information when creating a patient-centered plan of care.


Patient-centered care was designed to ensure that the patient is included as an active participant in his or her healthcare decisions (Berwick, 2009). Self-management of chronic and debilitating disease processes often require significant changes in the patient's routine and adherence to challenging lifestyle and medical regimens. In home healthcare we often ask patients: "What is important to you?" The question is posed to understand the patient's motivation to make the dietary, medical, and lifestyle changes necessary for them to meet their established goals. The patient's answer to this question also helps the clinician gain insight into the patient's comprehension of their disease process and the implications for their life. Understanding the spiritual needs of the patient is an essential, but often overlooked, aspect of patient-centered care in home healthcare. Using a tool such as FICA(C) provides the clinician with the resource needed to perform a comprehensive patient-specific assessment and develop a holistic, patient-centered care plan.


Many With Common Irregular Heartbeat Unaware of Stroke Risk

HealthDay News: Nearly one third of Americans newly diagnosed with the common heart rhythm disorder atrial fibrillation (AF) don't realize the condition puts them at increased risk for stroke, a new study finds. The irregular heartbeat in AF patients can cause blood to pool, which can cause blood clots that can lead to stroke, researchers explained. The study revealed misconceptions some patients had about AF. "This helps us see gaps in knowledge and understanding," said lead author Emily O'Brien, from the Clinical Research Institute at Duke University in Durham, N.C. O'Brien and her team surveyed 1,000 people diagnosed with AF in the past 6 months. Their median age was 69. About 63% strongly agreed that stroke is a major risk factor of AF. However, around 32% believed that heart attack is a major risk factor of AF, which is incorrect, the researchers reported. Sixty percent of the patients said they understood the role of blood thinners to manage their disorder. Yet only a minority said they understood their options for blood thinners (30%), drugs that control heart rhythm (16%), and ablation, a procedure to destroy tissue in the heart causing abnormal rhythm (12%). Just 13% of patients said their main source of information about AF was the internet, whereas nearly 73% said it was their doctor, the study revealed. "We thought in this day and age, we would see a higher proportion relying on the internet or family and friends for information," O'Brien said in a university news release. "But an encouragingly high proportion are relying on their provider."

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.



Berwick D. M. (2009). What 'patient-centered' should mean: Confessions of an extremist. Health Affairs, 28(4), w555. doi:10.1377/hlthaff.28.4.w555. Retrieved from[Context Link]


Groves R. F., Klauser H. A. (2009). The American Book of Living and Dying. Berkeley, CA: Celestial Arts. [Context Link]


Lucchetti G., Bassi R. M., Lucchetti A. L. (2013). Taking spiritual history in clinical practice: A systematic review of instruments. Explore, 9(3), 159-170. Retrieved from[Context Link]


Puchalski C. M. (2006). A Time for Listening and Caring: Spirituality & the Care of the Chronically Ill & Dying. New York, NY: Oxford University Press. [Context Link]


Puchalski C., Romer A. L. (2000). Taking a spiritual history allows clinicians to understand patients more fully. Journal of Palliative Medicine, 3(1), 129-137. Retrieved from