The SAI is a 49-item self-report questionnaire designed to assess five aspects of spirituality: Awareness of God, Disappointment (with God), Grandiosity (excessive self-importance), Realistic LoAnxious? CareNotesthat focus on which focus on issues surrounding death include: "Saying Good-bye to a Loved One Who is Dying," "Coping When Someone You Love Is Dying," "Facing the Fear of a Loved One's Death," "Handling the Heartbreak of a Sudden Death," "Losing Someone Close," "Embracing Hospice: Living as Death Approaches," and "Finding Your Way After the Death of a Spouse.". These devices are useful for a diverse patient population. The type of abuse was also significantly related to scores on the Spiritual Injury Scale, with more "severe" forms of abuse (i.e., sexual and physical abuse) associated with higher scores. 29. With several modifications, the final scale included from McSherry's SPA is Rokeach's Ultimate Values Test. What is impact of health crisis on the persons work, daily life, plans/hopes for the future? 126. This means institutional chaplains' counseling styles are often non-directive, supportive, and flexible. The religious answer to anger is forgiveness towards those who have hurt us. D. R. Hoge, "A Validated Intrinsic Religious Motivation Scale,", After gathering demographic information that includes gender, race, marital status, and educational level and military status, the first spiritual assessment question asked is, The next three questions score the patient's, The next question asked assesses the patient's ultimate values. How To Stop Being Abusive to Your Partner, How to stop divorce proceedings in California, How to win your ex wife back from another man, how-to-make-someone-fall-in-love-with-you-online, I want to know my future husband through astrology. 105. The greater this alignment the less spiritual injury there will be, and vice versa (Figure 2A and 2B). The next process that is addressed is the area of spiritual injury or distress (see diagram below). The issue of abuse is an item pastoral counselors and chaplains cannot afford to ignore. 46ff. AA literature, especially books and pamphlets that focus on the 4th and 5th Steps, also address guilt issues. Correlations with self-reported frequency of religious behavior and attitudes are strongly supportive of the concurrent validity of the Spiritual Injury Scale. critically reviewing the literature on spiritual assessment, and eventually developing our own model, which we called the 7 by 7 model for spiritual assessment. "Finding God in Pain or Illness," and "When Your Prayers Go Unanswered.". In both, A spiritual injury issue closely related to lack of meaning and purpose is despair. 96. Search Item response theory (IRT) was applied to evaluate the psychometric properties of the Spiritual Assessment Inventory (SAI; Hall & Edwards, 1996, 2002). Elliot's The Wasteland and The Hollow Men are classical expressions of people and culture adrift. "(64) He then offers a suggested way out by indicating that atonement can be found in service,(65) that we need a mission in life, and that the warriors mission to kill and destroy must be transformed into the mission to heal. (101), Certainly many of the patients pastoral counselors and chaplains meet up with, especially those chaplains ministering to the mentally ill and chemically dependent, are asking the question as to whether or not they can go on. Shame is often associated with just, While the initial research that encouraged the development of the, In addition to pastoral counseling and worship as resources for forgiveness in addressing guilt, several other resources come to mind. Spirituality and medical practice: using the HOPE questions as a practical tool for spiritual assessment. (95) Mary Louise Bringle(96) writes a contemporary expose' which contains a useful historical summary of how Christianity has responded and treated despair. Historically, this conflict between values and behavior was understood as "sin," or "missing the mark." In instances where the behavior is illegal, the consequences are often incarceration or even violent death. Elisabeth McSherry, Daniel Kratz, and William A. Nelson, "Pastoral Care Departments: More Necessary in the DRG Era? ir7;Z U" L2FAYi@9Z37 S[^>:_1l~i[. The purpose of this activity is to help you in identifying a sense of your spirituality. Lawrence Holst, "The Patient Self-Determination Act--Problems and Opportunities," The Caregiver Journal, Vol. Looking at one tradition and its rituals from a different perspective or culture often brings with it a sense of appreciation and new understanding of the importance of both traditions and their similarities. The range of possibilities is a low score of 7 and a high score of 31. It is now possible to test the theory, faith statements, or hypotheses--for in fact this is what systematic theology or systems of faith are all about: hypotheses--of Paul Tillich or any faith system to determine its validity and value for the human enterprise. Posted on October 5, 2020. Many pastoral care departments are struggling to make the transition from inpatient to outpatient care. Spiritual assessment tools can be utilized by healthcare providers to help assess a patient's spiritual need and to help formulate an individualized plan of care. This Spiritual Assessment Manual is meant to assist in assessing spirituality as well as address four concerns. The first is a Spiritual Injury Scale (SIS) or Index. (124) Another resource chaplains need to be familiar with, especially chaplains who serve on ethics committees, is a report put out by the Hastings Center titled Guidelines on the Termination of Life-Sustaining Treatment and the Care of the Dying.(125). The final section is the result of Granger Westberg's contribution to the more familiar work of Holmes. Preliminary research conducted at the VA Medical Center in Bedford, Massachusetts indicates that it is a valid and reliable instrument. 119. The first goal of the current study is to investigate discriminant validity of the Spiritual Injury Scale by examining the relationship between depression, anxiety, and the Spiritual Injury Scale. This standardization of pastoral care is brought about by two forces. Let us hope that pastoral care is not one of the casualties. This puts chaplains and pastoral counselors at a decided disadvantage when operating in a modern medical center or clinic. Both models overcome the limitations of a purely objective or scientific model in that they allow for flexibility and clinical judgement, but they provide no empirical data or criteria for measuring their effectiveness. (84), A classical resource for dealing with meaninglessness, both from a diagnostic and therapeutic perspective, is the penetrating analysis offered by Victor Frankl. A clinical Algorithm or Flow Chart is a graphic format that sets forth a stepwise procedure for making decisions about the diagnosis and treatment of clinical problems. As a companion, our goal is always to understand first. Spiritual assessment tools such as the FICA, the HOPE questions, and the Open Invite provide efficient means of eliciting patients' thoughts on this topic. 5. 579-580. Kieran Kavanaugh and Otilio Rodriquez, The Collected Works of St. John of the Cross (Washington, DC: ICS Publications, Institute of Carmelite Studies, 1973). 43. Copyright 2021 Spiritual Assessment - All Rights Reserved. Dianna M. Zckerman, S. Kasl, and A. Ostfeld, "Psychological Predictors of Mortality Amoung Elderly Poor: The Role of Religion, Well-Being and Social Contracts,", 41. Paul Pruyser, Between Belief and Unbelief (New York: Harper & Row, Publishers, 1974). His focus on feelings and the client's frame of reference did not lend itself to asking the questions needed for making a thorough diagnosis of the patient's condition. 28, No. If the person completing the assessment answers yes to this question, then a follow-up question asks, Are you currently in a physically or sexually abusive relationship? Pruyser, The Minister As Diagnostician. Elisabeth McSherry, Daniel Kratz, and William A. Nelson, "Pastoral Care Departments: More Necessary in the DRG Era? If the individual items in the Holmes/Westberg Inventory are considered separately, 66 items are identified that have implications for spiritual care, and none of them are "ethereal.". Peter Marin, "Living in Moral Pain," Psychology Today (November 1981) p. 68. I am regularly asked to fill out such a survey when I visit my medical clinic. The Pipe Ceremony, the Sweat Lodge, the Making of Relatives, the Sun Dance, and the Spirit-Calling Ceremony all center on healing, renewal, and restoration. %PDF-1.6 % First, much of the background for the development of the SIS originated in work done in a VA Medical Center with many veterans who served in Vietnam. %PDF-1.2 % Download PDF. If a sense of accomplishment, or financial security, or social recognition are most important in a person's hierarchy of values, and these are achieved through vocation, then if retirement, problems at work or loss of job are checked off, these areas of concern need to be addressed. Instead, they need to be weighted -- which the Holmes/Westberg, The point of all this is that the absence of spiritual injuries is not necessarily the goal of treatment nor does it represent spiritual health. These questions will elicit specific and concrete responses. As noted in Chapter 3, the 8 spiritual injuries are 1) guilt, 2) anger or resentment, 3) grief or sadness, 4) lack of meaning or purpose, 5) despair or hopelessness, 6) feeling that God/life has been unfair, 7) religious doubt or disbelief, and 8) fear of death. 85. Spouse beginning or stopping work or school? Explain how the spiritual assessment would be used in a health assessment. These are the obstacles and impediments that create a sense of blockage in a person's life. Resources available to chaplains include Elizabeth Kubler-Ross's book, The importance of meaning and purpose in a person's life and the destruction it causes when it is missing has become apparent in research conducted with Vietnam veterans. A hypothesis that is now being studied is that health care resources consumed, i.e., length of stay, recidivism, cost of drugs, and other medical care costs are positively correlated with higher SIS scores. But before treatment could begin, it was necessary that an accurate religious diagnosis be made in order for therapy to be given that was appropriate and responded to the unique problem brought to the pastor's or chaplain's attention. These questions will elicit specific and concrete responses. They are the individuals who are diagnosed as suffering from an antisocial personality disorder, adult antisocial behavior or narcissistic personality disorder, people who are "constitutionally incapable of being honest with themselves"(141)and therefore cannot be helped. In speaking of his medical education, David Larson states that "during psychiatric training if one proposed that religion might not be harmfulin fact might even be beneficialone was laughed at as a relic of the Dark Ages or condemned as a religious incompetent. Walt Larimore. It is Rokeach's, The next section of the spiritual assessment is a scale developed by the author of this manual entitled. The plan of care for this visit is Initial spiritual assessment. These answers include frequency of attendance at organized worship services, the importance of religious faith, and religion and or God as a source of strength and comfort. a) FICA FICA is a spiritual historical tool that was created by Dr. Christine Puchalski together with Daniel Sulmasy, Joan Teno and Dale Mathews in 1996 with the view of providing means . The HOPE assessment tool uses the acronym to remember all elements of the assessment. This 44-item curriculum assessment tool was developed by Campinha-Bacote (2008) to measure the existence of cultural concepts taught in nursing schools. What in us has the power to shift so profoundly our relationship with the facts of what we've lived through? An alternative is to utilize the SIS as a screen for spiritual risk. Institutional survival ha pastorals often encouraged such an approach. Mary Louise Bringle, Ibid., pp. In addition to his own 7 x 7 model and Pruyser's model, he reviews Elisabeth McSherry's Spiritual Profile Assessment (SPA) and the model developed by the North American Nursing Diagnosis Association. 22. 74. John Hassler, North of Hope (New York: Ballantine Books, 1990). 11, No. A semi-structured interview technique focuses on explicit areas of clinical concern, but it also depends on the clinical skills and experience of the caregiver doing the interview. The excesses, the by-products, and waste from an affluent and powerful society have global consequences. Four additional changes have been made. SHAPE Spiritual Gifts Assessment by Solana Beach Presbyterian Church. The healing nature of religious rituals extends beyond the dominant forms of worship known to the majority culture. Healing the wounds inflicted on pastoral care departments by such practitioners is a long and arduous process. When the heavy hand of guilt is avoided and we have arrived by achieving success, we somehow sense estrangement and disharmony with our Creator and spiritual life at its most fundamental level, resulting in conscious or unconscious shame, for success is often purchased at someone else's expense. We seek to understand their spiritual reality and coping strategies by listening, validating their experience and feelings, and wondering with them about their hopes, dreams, fears, and beliefs. 6 (1) 1994; and Berg, Fonss, Ree, & VandeCreek, "The Impact of Religious Faith and Practice on Patients Suffering From a Major Affective Disorder: A Cost Analysis", The Journal of Pastoral Care, Vol. In writing about justification and healing the wound of guilt, Bonhoeffer states that first guilt must be confessed. The point of all this is that the absence of spiritual injuries is not necessarily the goal of treatment nor does it represent spiritual health. The value carries with it the imperative "should" or connotes "oughtness." 118. This is accomplished by reviewing the person's three highest values from the Rokeach Scale, as well as answers given to the Kasl Index. These are issues chaplains and pastoral counselors are equipped to face with the patient. 49. (143) The algorithm presented in this paper is data driven and quantitatively measurable. Their limitation, until caseloads are reduced for chaplains and adequate staffing patterns emerge, is that a lot of other patients in the hospital get neglected; they get little or no care from the pastoral care department. NUR 645E. These are areas that are often poorly handled by mental health professionals with no background or training in theology or spiritual direction. Do you have a spiritual life that is important to you? 51. H How can I Help you with any spiritual concerns? National guidelines in the U.S. recommend a spiritual assessment be included with most or all patients. Who is primary caregiver? Method:Data were collected from 101 male veterans who completed the Spiritual Issues Assessment, including the Spiritual Injury Scale and a questionnaire regarding current religious behavior and belief. Social Issues DimensionAre the present problems of the person created by or compounded by larger social problems? Larry VandeCreek puts it bluntly: "My point is this: doing research requires you to move back toward the perspectives of the sciences and mathematics. Perspective: What influences and shapes a persons worldview. Steps one through five are often well defined in Chaplain Service Manuals and Quality Assurance Plans. This is an opportunity to improve the quality of care patients receive during their hospitalization. The next three questions score the patient's Non-organized Religious Activity (NORA). How important is that for you? FICA Spiritual Assessment Tool FICA Is An Acronym That Can Be Used To Remember What Is Asked In A Spiritual History. AA literature, especially books and pamphlets that focus on the 4th and 5th Steps, also address guilt issues. This paper appears as Appendix A. Douglas John Hall, God & Human Suffering: An Exercise in the Theology of the Cross (Minneapolis: Augsburg Publishing House, 1986). (1) Not only did Pruyser emphasize the unique perspective ministers and chaplains bring to understanding human personality and problems, but he also contended that many problems were spiritual and required intervention and treatment that was religious in nature. The patient's highest value is __________, The patient's second highest value is __________, The patient's third highest value is __________. Elisabeth McSherry, Daniel Kratz, and William A. Nelson, "Pastoral Care Departments: More Necessary in the DRG Era?" Pruyser, The Minister As Diagnostician, pp. "The underdevelopment of the poor countries, as an overall social fact, appears in its true light: as the historical by-product of the development of other countries. The spiritual dimension of life affects and is affected by other dimensions of life. ; Berg, G.E., "The Use of the Computer as a Tool for Assessment and Research in Pastoral Care, Journal of Health Care Chaplaincy, Vol. With the Patient Self-Determination Act now in place in all hospitals, an opportunity was afforded chaplains to become involved in counseling patients regarding health care decisions and in providing information and education as to what a person's rights and responsibilities are. What is needed is a process by which such patients can be identified, and appropriate treatment prescribed. And when one's ultimate values focus on faith in God or knowing God's love, and spiritual stress is identified, this then needs to be included in the focus of attention in developing a treatment plan and in the provision of pastoral counseling. The subsequent interventions may or may not be spiritually based. What importance does this group have for you? "(51) In the same article Marin quotes Shad Meshad, on of the initiators along with William Mahedy of the Vietnam Veterans Outreach Program, who puts it this way:"We aren't just counselors; we're almost priests. Larry Holst outlines both the problems and the opportunities afforded patients through the Patient Self-Determination Act in an article published in. Harold Kuschner, When Bad Things Happen To Good People (New York: Avon Books, 1981). What are the sources of hope, strength, comfort, and peace? To deal with guilt, we simply convince ourselves that we're "okay" people and then go about the business of living. 46-52. The correlation with the F scale suggests that there may be a tendency for subjects tending to over-report symptoms to also score highly on the Spiritual Injury Scale. The Spiritual Needs Assessment Tool. The Spiritual Distress Assessment Tool (SDAT), developed by Monod and colleagues, 15 demonstrates that a quantifiable approach to assessing unmet spiritual needs is possible. Uwe Siemon-Netto, The Acquittal of God: A Theology for Vietnam Veterans (New York: The Pilgrim Press, 1990). A functional approach to spiritual assessment is concerned with how a person finds meaning and purpose in life and with the behavior, emotions, relationships and practices associated with that meaning and purpose. What has been lost is innocence. Evidence has linked a strong relationship between spirituality and medicine. The reason for including these pastoral concerns grows out of two experiences. 22 immutable defining characteristics of spiritual maturity. This may be why pastoral care programs have difficulty adjusting to an ambulatory care model. Infectious diseases are controlled and even eliminated. While this is somewhat supportive of the validity of the measure, it seems reasonable to ask whether the Spiritual Injury Scale may simply be a measure of depression or distress. Terminology We are now ready to pursue this investigation even further.(152). 1. A chaplaincy assessment in health care settings involves relevant biomedical, psycho-social, and spiritual/religious . Two other indexes are included in this assessment model that are not included in the SPA. We are not so much afraid that we do not measure up to a transcendent canon of human righteousness as that there are no transcendent standards of goodness, beauty, or truth beyond our own lingering desire that such standards might exist. Pastoral presence is necessary but not sufficient in today's competitive healthcare environment. ", 21. The individual who arrives in the clinic or hospital who is spiritually "dead on arrival" (DOA) will not show spiritual distress or injury. There is a category of patients, however, who seemingly do not suffer spiritual injuries, whose moral development is seemingly underdeveloped or immature. Often, these questions not only take you to the heart of the core beliefs that define who they are, but it also gives you a strong sense of their "Whole Health Mission," the goal or aspiration that explains their reasons for wanting to be healthy in the first place. Paul Tillich, The Courage To Be (New Haven & London: Yale University Press, 1952) pp. Paul Pruyser, (19) Elisabeth McSherry,(20) Harold Koenig,(21) and David and Susan Larson(22) are all examples of persons from other professions taking the initiative in writing about the significance of religious faith in personal well-being and health care. Do you feel aggravated by love relationship situation? 59-66. He refers to Kasl's frequency of church attendance scale as Organized Religious Activity (ORA). The computerized version of this assessment instrument intentionally gathers data about our common, human existence, places it alongside the practices, values and symbols of religious faith, and asks what the correlations between the two might be. The maximum score is 13. Vocation and ObligationsDo the persons' beliefs and sense of meaning in life create a sense of duty, vocation, calling or moral obligation? 5 (1998):373. Theologically this behavioral change is understood as repentance, with repentance meaning not only remorse but also a literal "turning around." It screens for depression, anxiety, changes in my health care status since my last visit. E Effects on medical care and end-of-life issues: Has being sick (or your current situation) affected your ability to do the things that usually help you spiritually? 49, No.4, 1995). This question is illustrated on the following screen. The Spiritual Needs Assessment for Patients (SNAP) Care and management of patients is a very crucial exercise in the recovery process of a patient. If this question is answered positively, then three additional questions ask about military sexual trauma, if the abuse has happened in the past two years, and if the person is currently in an abusive relationship. God is the initiator; I am the recipient of God's grace. It is Rokeach's Ultimate Values Test(44) as already modified by McSherry. Rokeach's Ultimate Values Inventory, that is the basis for the values inventory contained within this assessment instrument also gives the pastoral counselor and chaplain a framework for addressing meaning and purpose in life with the counselee. How do you participate in this group/community? Elizabeth Kubler-Ross, On Death and Dying (New York: The MacMillan Company, 1969). The importance of meaning and purpose in a person's life and the destruction it causes when it is missing has become apparent in research conducted with Vietnam veterans. Such events beyond our control are often fatalistically labeled acts of God. AA's slogan, "Let Go and Let God" also addresses the issue of anger. 49. This assessment instrument places two dimensions of human experience alongside of each other: it makes an analysis of the human situation out of which existential questions arise. The person taking the assessment is asked, The possible range of scores that a person can realize is a low score of 8 and a high score of 32. This includes rage and bitterness towards God that needs to be addressed by the pastoral counselor. There are no "right" or "wrong" answers, however it will help you in identifying areas in which you may want to seek further resources or support. The original Holmes, Where conflict exists between a person's core beliefs and values, and her or his behavior or life experiences, cognitive and spiritual dissonance is inevitable. One of these items ships sooner than the other. Because of a lack of resources and minimal coverage, chaplains visit newly admitted patients, provide worship opportunities in the hospital, call on patients before and after surgery, make routine visits, and are available to those who take the initiative to seek them out. While church attendance and faith in God are highly correlated, many respondents to the assessment rely upon God for support in their lives and rank high on non-organized religious activity without ever going to church or participating in religious services. Report on the validity and reliability of the tool. 290-295. The authors who have already been named are one source of help. 132. The three values appear on the printout as: The next section of the spiritual assessment is a scale developed by the author of this manual entitled Spiritual Injury Scale(49) or SIS. Historically, the faith of the religious community has been a resource and support system for individuals facing death. Many pastoral care departments are struggling to make the transition from inpatient to outpatient care. It is a word that is also used interpersonally, as in an injury to his pride. It contains the following 5 questions under the heading spiritual dimension: The weight given to each item in the Holmes/Westberg Inventory is listed in the appendix to this program. A spiritual assessment is necessary to find out if any beliefs could impact health. Strongly. These are the issues often burdensome to patients seeking treatment in mental health centers and treatment programs. = 17.4), suggesting high levels of depression and anxiety in this sample. Or any of the Holmes/Westberg inventory catagories can be used that focus, for example, on marital/partner relationships, on finances, or on vocational concerns that have been itentified at the onset of counselling. Chaplains become adept at meeting patients where they are at. A future role for pastoral care in the outpatient arena may be administering an annual spiritual assessment, identifying specific problems, targeting intervention, and providing patient education on the role of religion and spirituality in prevention and wellness. Correlations between SIS scores and a variety of illnesses and diagnostic categories are much higher than similar correlations with the Holmes/Westberg instrument.(135). Spiritual assessments and inventories in treatment programs often address these issues, but usually respond to them using narrative statements or check-off blanks that do not lend themselves to quantitative analysis. Others can see through us. (1 Corinthians 12:21-26) We are to use our gifts to serve others for the benefit of the body. Has the person's life always been without meaning or purpose, or what event triggered a present sense of meaninglessness? Are you worried about any conflicts between your beliefs and your medical situation/care decisions? (107) Theologically the problem of evil is addressed as theodicy; both God's justice and love are challenged in the face of suffering and the enormous evil present from our perspective of the universe. If other patients come out of a fundamentalistic or pietistic tradition narrowly defined, chaplains can usually hit this ball as well when it is well pitched; and visits do not have to be too long. Biases identified by David Larson(140) in medical training predispose physicians from making such referrals for spiritual care. EXAMPLE ONE. The impact of death on us, and how our culture has dealt with it is documented in Ernest Becker's book, The advent of the Patient Self-Determination Act of 1991 provides chaplains with an opportunity, as well as with problems, in addressing end-of-life medical care decisions with patients and their families. ): 39, Change in Health, Behavior, or Attitude of a Member of the Household: 44, Change in Hours, Conditions, Travel, Etc. As a result, our profession now recognizes the need to treat the patient holistically, to include the patient's spirituality. Beginning with a person's values and religious behavior (Step 2) provides a context in which to view a person's life and those events considered harmful and dangerous to spiritual well being. Spiritual assessment tools are simply something that is supposed to aid a health care provider in gathering any information that may make the patient more comfortable, happy and able to recover. Individuals who report no spiritual injuries may have a belief system and core values that do coincide with their behavior, but the long-term outcome is spiritual death, communal isolation, illnesses such as untreated alcoholism or drug addiction, and eventual physical death. 27. I provide a wide range of services to both individuals and couples. How Can a Love Spell Caster Create White Magic Love Spells for You? It may be that the reason for this finding is that research to date using this instrument has been largely been administered in a veterans hospital with combat veterans of the Vietnam war. It is to be used to diagnose, treat and research mental and physical illness from the perspective of spiritual values, beliefs and practices. 17, No. Outstanding achievement (graduation, promotion, etc.)? The 7 x 7 model for spiritual assessment has been an important model for spiritual assessment since its development in the mid-1980s. 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