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Meeting the patient's spiritual needs is part of daily nursing care, yet many nurses feel uncomfortable performing a spiritual assessment. This is especially difficult when the patient presents no clues to their spiritual/religious preference or has a spiritual belief unfamiliar to the nurse. However, there are simple, easy-to-use assessment tools that can help us quickly assess and plan for spiritual needs.


An assessment, whether physical or spiritual, is used to gather data for planning nursing care. Some spiritual assessment tools come in Likert-type or numbered answers and are used for research. Others use fill-in-the-blank tools. Using acronyms, spiritual assessment tools assist with remembering key spiritual concepts. These devices are useful for a diverse patient population. Questions derived from the assessment areas can be easily tailored to a client's cognitive development or cultural background.1


One popular acronym tool is the FICA model.2 These are the areas of assessment and possible questions that could be asked:


F-Faith or beliefs: What are your spiritual beliefs? Do you consider yourself spiritual? What things do you believe in that give meaning to life?


I-Importance and influence: Is faith/spirituality important to you? How has your illness and/or hospitalization affected your personal practices /beliefs?


C-Community: Are you connected with a faith center in the community? Does it provide support/comfort for you during times of stress? Is there a person/group/leader who supports/assists you in your spirituality?


A-Address: What can I do for you? What support/guidance can health care provide to support your spiritual beliefs/practices?


None of the questions impart a religion or belief system onto the patient. These are open-ended questions that ask the patients about their personal spiritual beliefs. It is important for Christians and adherents of other religions to phrase questions in a spiritual assessment in a way that is open and non-judgmental.3 Many words Christians equate with spirituality have a Christian connotation. Examples include: church, prayer, worship, Bible, sacraments and God. Alternate words to use are faith/spiritual community, spiritual practices, meditation or quiet time, music, spiritual literature and higher/influential power or force.


Beyond the use of non-biased, open language, timing is also important in a spiritual assessment.4 With a physical assessment, nurses generally walk into the room and start asking questions. The personal nature of the spiritual assessment requires that nurses first choose the time to ask. A great opening would be to ask how patients are coping with their diagnosis, hospitalization, etc. Usually patients will immediately discuss physical problems, like pain, nausea and lack of sleep. Some may even discuss emotional problems, like fear and anxiety, without much prompting. As the conversation leads through the holistic dimension, you can bring up spiritual issues, like "How are you coping spiritually?" or "Has this been difficult for you spiritually?" Timing and caring communication lay the foundation for a moment of spiritual reflection and assistance.


Timing leads to a third point: "Establishing rapport and trust."5 Spirituality is a sensitive subject, and not everyone is open to discussing his or her beliefs. How well a patient discusses her spirituality is somewhat dependent on the nurse. A caring, empathetic nurse is more likely to develop and maintain a holistic rapport and trust with the patient. This is a time for patients to share their spiritual beliefs and concerns with the nurse, not the other way around. The key emphasis on a spiritual assessment is to be able to obtain patient information regarding spiritual health in order to plan nursing care.


Using the FICA model, let's perform a spiritual assessment on two patients:


Ms. Garcia is a twenty-five-year-old female admitted to the hospital with new onset diabetes. She is crying and has been refusing finger stick blood sugars and lab work.


The second patient, Mr. Brown, is a sixty-nine-year-old male, recently diagnosed with liver cancer. He is withdrawn and quiet, answering questions with a yes or no. There are no literature, religious icons or symbols in either patient's room to cue the nurse regarding their beliefs.


Ms. Garcia answered the following questions:


F-Faith or beliefs: What are your spiritual beliefs?"I don't really have any spiritual beliefs or religion, but I like to go to the woods and sit quietly, listening to nature. Sometimes I take a meditation book and think about the words and sayings."


I-Implications or Influence: Does reading your meditation book and sitting quietly in the woods provide strength and support for you during times of stress?"Yes. I am able to cope with my stressful job. When I was urinating too much and feeling sluggish and nauseated, I even prayed for my health. Now I don't think I could sit quietly. I am too upset."


C-Community: Is there a group or person whom you have met with, meditated with or you think of providing spiritual support and/or guidance?"Yes, my friend is definitely a support to me. Even though I have never considered it spiritual, he comes over, and we talk, share meditation books and even go on walks to vent."


A-Address: As your nurse, is there something I can do to provide spiritual support for you?"You have already helped me. I realized by talking with you that I need to call my friend and talk with him about what is going on. He can bring my meditation book."


Using the FICA spiritual assessment, we discovered that Ms. Garcia says she is not spiritual, yet she practices spirituality in her life. We see that she has spiritual support through her friend and through meditation books. Ms. Garcia's assessment reveals her spiritual needs, but also communicates that the nurse is caring and open to discussing her issues. This begins a rapport between the nurse and the patient, laying the foundation for further spiritual discussions and caring nursing interventions. Later the nurse can check with Ms. Garcia and see how she is doing, continuing to assess and develop a relationship with her. Eventually the nurse might ask permission to talk further about spiritual beliefs and offer to pray with Ms. Garcia.


Let's look at Mr. Brown, the man with liver cancer.


F-Faith or beliefs: Do you have any spiritual or faith beliefs?


"I'm Buddhist." I-Implications/Influence: Are there spiritual items or practices that give you spiritual support?"Meditation and prayer. It is important for me to keep my mind calm and clear of disturbing thoughts, so I can focus on healing and strength. I usually have my CD player for music and chants. I also have some sacred teachings of Buddha that inspire and strengthen me. But I forgot them at home."


C-Community: How about people or a group-is there someone that provides spiritual support?"I usually attend the temple and meet with other Buddhists."


A-Address: Is there something I or someone else can assist you with? "I would like some quiet time. My wife is bringing my CD player and some meditation books. This will help me to be calm and gain strength for my healing."


Mr. Brown's spiritual assessment revealed he has a specific spiritual belief, which is Buddhist. The assessment explained that his previous quietness was possibly related to his spiritual practices. He mentioned an important component of his spiritual life was to have quiet time. As his nurse, I would schedule uninterrupted quiet times for him to meditate and listen to his CDs. Another intervention for Mr. Brown would be a referral to the chaplain or spiritual care coordinator to visit with him. A referral to these professionals within the health care system can be appropriate, especially when the nurse may be unfamiliar with specific spiritual needs of the patient. A referral can also be made for any patient needing to connect with a faith organization in the community, such as a temple, synagogue or church.

Table. HELPUL TOOLS ... - Click to enlarge in new windowTable. HELPUL TOOLS FOR SPIRITUAL ASSESSMENT

A spiritual assessment assists the nurse in planning holistic nursing care. Whether the nurse is unclear about the patient's spiritual belief or the patient has a spiritual belief unfamiliar to the nurse, acronym models such as FICA provide the basis for an organized, open and non-biased assessment.




[white square] Acronym Spiritual Assessment tools give nurses an easy pneumonic for assessing clients.


[white square] Spiritual assessment occurs best in a relationship of rapport and trust.


[white square] Good spiritual assessment uses open-ended questions, non-biased language and appropriate timing.



1 Kristen Mauk and Nola Schmidt, Spiritual Care in Nursing Practice (Philadelphia: Lippincott Williams & Wilkins, 2004), pp. 209-27. [Context Link]


2 Christina Puchalski and A. L. Romer, "Taking a Spiritual History Allows Clinicians to Understand Patients More Fully," Journal of Palliative Medicine 3, no. 1 (2000): 129-37. Available online at the George Washington Institute for Spirituality and Health, Accessed July 30, 2004. [Context Link]


3 Elizabeth J. Taylor, Spiritual Care: Nursing Theory, Research, and Practice (Upper Saddle River, NJ: Prentice Hall, 2002), pp. 119-21. [Context Link]


4 Ibid. [Context Link]


5 Ibid. [Context Link]