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Spiritual assessment

The spiritual assessment form, rubric and a sample paper is attached.

Overview-Important Definitions
Holistic Nursing: The American Holistic Nurses Association (AHNA & ANA 2013. p. 1)
created the following definition in 1998; “all nursing practice that has healing the whole
person as its goal….honors the interconnectedness of self, others, nature, and
Spirituality: The feelings thoughts, experiences, and behaviors that arise from a search
for meaning. That which is generally considered sacred or holy. Usually though not
universally, considered to involve a sense of connection with an absolute, imminent, or
transcendent spiritual force, however named, as well as the conviction that meaning,
value, direction, and purpose are valid aspects of the individual and universe. The
essence of being and relatedness that permeates all life and is manifested in one’s
knowing, doing and being. The interconnectedness with self, others, nature, and
God/Life Force/Absolute/Transcendent. Not necessarily synonymous with religion
(AHNA & ANA, 2013, p. 91)
“Spiritual assessments not only glean religious beliefs and practices, but also query a
person’s meaning and purpose in life and how that may have changed due to the
present health experience” (AHNA & ANA p. 12).
AHNA & ANA. (2013). Holistic Nursing: Scope and standards of practice, 2nd
Edition. Silver Spring, MD: Nursebooks.org.
First read chapter 22 in Blais and Hayes and complete the Spiritual Assessment
Then complete a spiritual assessment on someone in your community. Use the form
found below the rubric. Use bullet points or numbers rather than complete sentences.
Be sure to choose an appropriate tool. You can use the assessment from the chapter
on spirituality found in yourtextbook, or choose one found in the literature or online such
as the
HOPE tool: http://www.aafp.org/afp/2001/0101/p81.html
FICA tool: http://smhs.gwu.edu/gwish/clinical/fica/spiritual-history-tool
FACT tool:
During the interview you will chooseanappropriate spiritual nursing action based on your
assessment and state how/why you chose the nursing action. What was the result of
the action (e.g. what did the interviewee think of the nursing action and/or how did they
respond to the nursing action?). Whatare your thoughts on the experience of doing this
assessment (e.g. main takeaway(s), surprises, reactions).Please keep the form to three
or fewer pages.
 Appropriate assessment tool chosen,
Source & Reference Included (2 pts)
 Assessment sufficiently covers all areas of
the tool
 Nursing action appropriate
 Nursing action based on the assessment
and how chosen
 Results of action included
 Includes own thoughts/takeaways on
experience of doing the assessment
Spelling, Grammar, APA
Free of spelling, typographical, and
grammatical errors, uses bullet points or
numbering, reference in proper APA
Total Points
or Not
Pts Poss
(Please keep information you fill in to two-three pages)
Date:__________ Interviewee Initials________ Age______Gender______
Pertinent Diagnosis (if any) _________________________________________
Short description of interviewee and how you know them (don’t give away person’s
identity): _______________________________________________________
Name of tool__________________
Source (Citation)______________ (include reference at bottom of form):
Questions Asked-use bullet points
Interviewee Responses-use bullet points
Nursing Action(s)-use bullet points
Why Chosen-use bullet points
Result of Nursing Action: Interviewee
thoughts/reactions-use bullet points
Your own thoughts/take-aways-use bullet
Spiritual Assessment Form
Student:Anna “Anya” Karchevsky, RN, BS Completion Student (assignment used with
student’s permission)
Date: XX/XX/20XXInterviewee InitialsGN Age68GenderFemale
Pertinent Medical Diagnosis:DM-2, Clinical Depression, General Anxiety
Disorder,CHF Short description of interviewee and how you know them: The person I
am interviewing is a current client of mine. She is a 68-year-old female of the Hindu
faith that was born in Guyana. She immigrated to the US in 2001 because her son and
grandkids where living here. He husband passed away 5 years ago and she is battling
many mental health issues along with chronicdiagnoses.
Name of tool:SPIRIT Model for Assessing Spirituality
Source:Blais and Hayes, 2016, p. 435
Questions Asked (use bullet points)
• Do you belong to any religious
orspiritual community?
• What is your source of strength,
hopeand comfort?
• Do you believe in a higherpower?
• What lifestyle activities or practices
doesyour religion encourage,
discourage, orforbid?
• What does your spirituality/religion mean
• Are there any unresolved areas in your
life atthis point that you would like us to
assist you with addressing?
• In what ways can the nursing staff assist
you and your family during the time you
are inhomecare?
• Are there specific elements of nursing
andmedical care that your beliefs/religion
• Are there any specific spiritual or
religious beliefs or practices that you hold
in regards to end oflife?
Source: Blais& Hayes, 2016, p. 435
Interviewee Responses (use bullet points)
• “Yes, I belong to the faith that is
• “The source of my strength is through
meditation and attending the Hindu
temple where I can meet with the
members of my community andsocialize
around myfriends”
• “We have many gods that someone might
pick to follow. I follow the god Ganesh.
He is the son of Lord Shiva (destroyer of
worlds) and Goddess Parvati. Because I
moved from Guyana toAmerica I pray to
Ganesh to help in my new ventures in this
• “We are encouraged to meditate and do
yoga daily to help us be more grounded
and at peace with our mind, body, and
soul. We are discouraged to judge people;
we hope that if someone lives a pure life
that karma would not bring them harm.
We are forbidden to eat cow. Cow is a
holy animal touse.”
• “My religion means everything to me. It
is howI live mylife.”
• “At this point in my life I do not feel like
I have anything unresolved. I am a proud
grandma; my granddaughter is in school
to be a doctor. Mygoal is to get better and
start to manage my disease and
• “I would love for the homecare nurses to
makesure take off their shoes when they
enter my home. It is believed that walking
round in dirty shoes in a house brings bad
karma from the world into the house.”
“I will not take any medications that
might have animal products. I am
vegetarian. Many people from my faith
might not be vegetarian but willnot
eat cow/beef. If at any point I will need a
Nursing Action(s)-use bullet
• Assessed the client in contacting her
temple to help arrange a swami
(religious leader) tocome visit the
client at her home while she is with
• Ensured to take off my shoes every time
Istepped into the patient’shome
• Keep an open line of communication
betweenthe patient and the nurse. This
helps create trust between the patient and
• Educated client on the spiritual support
teamthat we have with the
• Assigned a spiritual assessment
guideline forall clinicians to use with
Source: Blais& Hayes, 2016, p. 438.
Result of Nursing Action:
Interviewee thoughts/reactions
use bullet points
health aide to assist me, I ask for only
female aides. In my faith we can not have a
member of the opposite sex see us, unless
it is our spouse. I know I am diabetic, but
fasting is very important to me. I am
working with my doctor to help control my
sugar levels while fasting.
• Please remember that I would like to die
at home not in a hospital. Death is a very
important transition. There are many
karmic implications that require proper
prayer and rituals duringthe
transition of death.”
Why Chosen-use bullet points
This will help the client stay connected
with her religions group and leader while
she is battling her disease at home. This
will help the patient have a sense of
connection and feel she is stillremembered
and cared for by her community and
• Patient believes that if you wear shoes
from outside that it will bring in bad
karma from the world around her into her
• This will ensure a therapeutic line
ofcommunicate between the patient and
nurse and help develop a good working
and trustingrelationship
• This information provided allows the
patient to know that if there are anytime
during the homecare episode her leader
can not make it over that shehas support
and anothersource
• If the guideline is embedded in the
assessments, it will ensure spiritual
assessments are completedand spiritual
competence is addressed. It will bethe
patient’s choice if she wants to
address her spirituality every visit
but at least it willbe addressed.
Your own thoughts/take-awaysuse bullet points
The patient reported that after seeing her
swami she felt a sense of peace about her
current health condition and was given
more motivationmentally to keep fighting
her healthconditions
The patient reported that she has
beenstruggling with depression since
she has moved from her home country
and her son has been away on business.
She stated that when cliniciansaddress
how she is feeling spiritually that she
feels more connected with the
The most important thing that I took away
fromthis assignment is the importance of
completing a spiritual assessment when
first meeting ourpatients
We need to embed the assessment into
ourinitial assessments and to repeat a
modified assessment with eachvisit.
The way a person views their health
might be in direct connect to how they
perceive their faithand spirituality
When a patient is fighting a health
condition, their faith or spirituality can be
a great coping tool. Nurses who take the
time to learn what theirbeliefs area can
help guide positivecoping.
Blais, K. & Hayes, J. S. (2016). Professional nursing practice: Concepts and perspectives (7th
ed.). Prentice Hall

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