[This is an excerpt from The Chaplain Skillset Series, Vol 3: Understanding the Spiritual Assessment. A complimentary copy is available as an e-book on Amazon.com thru April 24, 2016.]
Chapter Two: What Is A Spiritual Assessment?
Rev. Keith A Evans DC, DMin and Zacarias C Buhuro MA, MDiv
For chaplains in any setting, the unspoken protocol is to assess the spirituality and beliefs of the individual which they are ministering. Completing a spirituality assessment allows the chaplain to see what spiritual or faith-specific resources the individual may need for the situation. To do this well, one must understand what spirituality is and what the objectives of completing a spiritual assessment might be.
For a quick review of how spirituality is defined, Christina Puchalski MD of George Washington Institute of Spirituality and Health states,
Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred (Puchalski, 2014, p. 642).
Stephen R. Covey states, “The spiritual dimension is your core, your center, your commitment to your value system. It’s a very private area of life and a supremely important one” (Covey, p. 170).
One can quickly assess from just these two definitions of spirituality that spirituality is multi-faceted and complex.
Chaplains are often asked, “Is there a difference between spirituality and religion?” Some may disagree but my generalized answer is, “Yes.” First of all, everyone has a spirituality within them, whether they personally recognize it or not. People are spiritual in nature. Secondly, I view religion as the way an individual or group determines how they learn and practice (rites, rituals and worship) their spirituality, beliefs and their theologically-based faith. Religion is where your theology, doctrines and dogmas are developed. However, I do not believe a person can commit to and authentically practice a religion without a sense of their own spirituality or spiritual needs. But one may express their spirituality outside of traditional religious practices.
George Fitchett’s book Assessing Spiritual Needs: A Guide for Caregivers (1993) has become a classic among professional chaplains and as a vital clinical pastoral education resource. Fitchett’s work revealed that many approaches were being used to accomplish a spiritual assessment. He discovered that chaplains were using a broad range of spiritual assessments from informal and personal methods to very precise, impersonal “diagnostic” surveys.
Fitchett discusses the importance of the spiritual assessment. For the chaplain, the spiritual assessment becomes the foundation for developing an action plan which will direct soul care, as well as to promote intentional and effective spiritual communication, as well as a way to evaluate chaplaincy interactions, maintain personal accountability, quality assurance, and establish the role and purpose of the chaplain. But whichever spiritual assessment model that is used by a chaplain, these objectives should be foundational to the model’s overall purpose.
Through Fitchett’s research and personal experience, he developed his own spiritual assessment model called the 7 x 7 Model. This model is conceptual, functional, holistic, and provides a great framework for chaplains in any setting for spiritually assessments. In brief, he states that holistic wellness is built around seven dimensions:
- Family systems
- Ethnic and cultural
- Societal issues
- Spiritual dimensions
One can easily see the influence which each of these seven dimensions has upon an individual’s life and perceptions of holistic wellness.
Within the Spiritual dimension, Fitchett’s 7 x 7 Model describes seven smaller categories which give the broader perspective and complex intricacies for an individual’s overall spirituality:
- Beliefs and meaning
- Vocation and consequences
- Experience and emotion
- Courage and growth
- Ritual and practice
- Authority and guidance
In Douglas Edward Robinson’s doctoral work on spiritual assessment and his evaluation of Fitchett’s 7 x 7 Model, he states,
For review, the two hemispheres of assessment are the Holistic and Spiritual…It is likely that you will not gain all the information you seek in the first visit, or during all of your visits. Time does not always permit this thorough an assessment. Remember that hospital patient needs and challenges can rapidly change. Hospitalized patients may present with multiple issues. When this is the case, you may first need to address the most crucial issue, before tending to the others. The important thing to remember is that spiritual care in the hospital is need-based and fluid. Let the patient direct you to the areas in greatest need of intervention. Spiritual welfare and appropriate intervention is always more important than getting all the information. Promoting such integration requires an appropriate assessment of patient spirituality, and definition of conditions for spiritual interventions, that improve patient care (Robinson, 2012).
Fitchett’s 7 x 7 Model seems daunting at first glance, but it actually is a common-sense and thorough approach. It hits upon all aspects of life. If a chaplain, or any person ministering to another, can remember to utilize just a few of these sections, they will more than likely have a meaningful encounter. Of course, the inclusion of all seven areas of the spiritual dimension remains the objective goal.
The next chapter will review a few of the more common spiritual assessments which are in the literature and being practically used in different clinical and public ministry settings. But first, let’s hear about some of the benefits of a chaplain using spiritual assessments.
The Practical Benefits of the Spiritual Assessment
Performing a spiritual assessment should not be about imposing a set of rigid questions on an individual. It should be an interactive conversation between individuals. This discussion will center on healthcare settings, but the spiritual assessment can be administered in any setting with individuals who may be hurting spiritually.
Buhuro: Upon admission to the hospital, patients may undergo a spiritual screening, which is generally very short in nature. The spiritual screening simply asks questions such as, “Do you have spiritual beliefs? Do you have a faith or church preference? Do you want a local minister or church to visit you while you are admitted?”
However, as the patients stay for one or more days, there is a need for a professional chaplain to do the spiritual assessment. A spiritual assessment helps to address the patient’s needs in a more holistic way and also to engage the patients on the meaning of their life as they are dealing with an illness.
One may not claim to belong to any organized religion or may even claim that they are “atheists.” What is important to know is that the spiritual assessment taps into the core of what and who the person is, in terms of meaning making of what is happening in their life.
What does it mean, for example, for a mother that is accustomed to waking up every morning, going to work, taking care of her family and so on…but now she is in the hospital facing a serious illness? What does she make of news about a new diagnosis that may interfere with her daily life? How does she cope with that? Who supports her? How can others be of support to her?
The spiritual assessment deals with the ultimate meaning of life regardless of the person’s religiosity. In my work with hospice patients, one of the dominant issue which often needed to be addressed was their pain. The pain here is not only physical, but emotional, psychological and spiritual pain…..
Covey, Stephen R. The 7 Habits of Highly Effective People, Signature Edition 4.0. Salt Lake City: FranklinCovey, date not listed.
Fitchett, George. Assessing Spiritual Needs: A Guide for Caregivers. Minneapolis: Augsburg Fortress, 1993.
Puchalski, Christina M., Robert Vitillo, Sharon K. Hull and Nancy Reller. “Improving the Spiritual Dimension of Whole Person Care: Reaching National and International Consensus.” Journal of Palliative Medicine 17, no. 6, 2014: 642.
Robinson, Douglas Edward. “Pastoral Care: A New Model For Assessing the Spiritual Needs of Hospitalized Patients.” D.Min. dissertation. Liberty Baptist Theological Seminary, August 2012: 111-112. http://www.digitalcommons.liberty.edu