Chaplains and Pastors to seniors serve in a multi-faith, multi-cultural environment. We are called to conduct thoughtful assessments of senior adults in our setting; sometimes regardless of our own spiritual convictions. But what is “spiritual assessment” and how do we conduct this?

Assessments are carried out all the time in many areas of life.  For example, Canada Revenue Agency appraises our incomes in order to tax us.  In school, teachers and professors assessed the work of students through exams and papers. Every time we meet a new person, in the first few seconds we make an almost subconscious assessment – do I like this person? Can I trust them? – in order to decide how we will relate in the present and possible future.

It is important for the Spiritual Care Provider to assess the various aspects of an individual’s spirituality.  Has faith in God been part of how this person copes with changes and challenges in life?  What beliefs or values guide this person’s choices?  Are there any practices which have helped them to make sense of their world and their place in it?   Are there any pressing needs at the moment?

The Spiritual Care Provider has many tools to choose from (see the bibliography at the end). First however, let us note that the process of assessment needs to be guided by a desire to foster relationship / rapport and to encourage healthy spirituality and coping strategies. We are not judging others; we too are on a spiritual journey and need others to assess us.  Moreover, assessment needs to be done from a place of humility.  Candidly, there are healthy and unhealthy / dysfunctional aspects to our own lives and relationships.  We are there to walk alongside and give input as trust is developed.

King David’s statements at the opening and the closing of Psalm 139 (paraphrased) is significant here:  O God, You search me / You investigate me and You know me … Search me , Great God, and know my heart.  Test me, and know my divided thoughts … noble and shameful … and see if there is any offensive way in me and guide me instead in the everlasting way !  And finally, who I am – my values and experiences and needs – will affect my perspective on who the resident is as I begin to assess her. The Apostle Paul also assessed all the churches with the threefold “faith, love and hope”. Read the opening verses of each Pauline letter to see how this is spelled out for us.

There is a growing consensus that Spiritual Assessment is important in health care (Hodge, 2006).  Healthy spirituality can enable individuals to cope with life’s challenges such as stress, illness, unresolved issues, obstacles, depression, anxiety.  (Koenig et al., 2001;  Pargament, 1997).  There is a great variety of Spiritual Assessment tools available, with moderate to non-existent evidence base (Rower, 2006;  Flannelly, 2006;  Hall and Edwards, 2001).  Steinhauser (2006) argues that “an evidence-based approach to discussing spiritual concerns … may improve the quality of the clinical encounter (p. 101).”

Definition of Spiritual Assessment

Spiritual Assessment is the process of gathering and organizing data into a coherent format which can provide the basis for helping seniors think through their beliefs and convictions. For the Christian, it is looking for the presence and action of God or for the involvement of a value or belief system and being sensitive to the condition and needs of the individual.

Purpose of Spiritual Assessment

Spiritual Assessment is meant to enable intentional care planning, intervention and evaluations; to facilitate communication;  and to provide a baseline for quality improvement and research.  With regard to facilitating communication, Pruyser (1976) suggests that each professional discipline has a distinct perspective.  In other words, no one profession has the complete picture.  The greater the number of different perspectives we can bring to the assessment, the more likely it is that we will come to an adequate understanding of the person.

A spiritual assessment is best be done through ongoing, informal conversation and then later organize and recorded including subsequent observations.  A certain amount of consistency is required to provide a baseline for sharing information with other health care providers and for use in quality assurance and research.

Here are some practical ways to conduct spiritual assessment

  • Use the same set of questions for all residents. Keep these open ended rather than “yes” “no”.
  • Watch for how God is at work in a person’s life, and how best to encourage the resident’s response to God’s presence and action. Listen for the events in their lives that shaped them spiritually.
  • As much as possible, the resident should be allowed to construct or guide their own expression of their spiritual world view. They are the expert.  The Spiritual Care Provider is the facilitator.  How does the person sense their own spiritual journey is going?
  • Generally, the validity and reliability of existing tools is poorly demonstrated. In no way should any of these tools be considered as “scientifically” proven to diagnose spiritual conditions rather, they can serve as helpful guides and useful for helping the Spiritual Care Provider to see what she might have missed.  All of the tools reported below provide a reasonable degree of information and precision.
  • How has their faith enabled them to process both the trials and victories of life?
  • To what extent do their convictions and beliefs emerge from their own conclusions? Or, do they merely recite what they were told to say from childhood or by their religious group? When it is “crunch time”, what values really supports the senior in their belief and actions?
  • Be wary of simply reducing the person as a religious group such as “Catholic, Baptist, Buddhist or Methodist”. They are far more than a religious group. What are their own convictions and beliefs?

REFERENCES

Donavon, D. W (2014) “Assessments”  in Professional Spiritual and Pastoral Care  edited by Stephen Roberts. Woodstock, Vermont SkyLight Publishing. Pp. 42-60. NOTE: this entire textbook has over thirty practical chapters on chaplaincy issues across several domains.

Flannelly, K. J. (2006). A test of the factor structure of the patient spiritual needs assessment scale. Holistic Nursing Practice, 20 (4), 187-190.

Hall, T. & Edwards, K. (1996). The initial development and factor analysis of the spiritual assessment inventory. Journal of Psychology and Theology, 24 (3), 233-246.

Hodge, D. R. (2006). A template for spiritual assessment:  A review of the JCAHO requirements and guidelines for implementation. Social Work, 51 (4), 317-326.

Koenig, H.G., King, D. E., & Carson, V. E. (2001) Handbook of religion and health. NY:  Oxford University Press. Excellent example of the many resources available through Harold Koenig and his associates

Pargament, K.I. (1997). The psychology of religion and coping. NY: Guilford.

Pruyser, P. (1976). The minister as diagnostician. Westminster Press.

Steinhauser, K. (2006) Are you at peace? One item to probe spiritual concerns at the end of life. Internal Medicine, 166 (1), 101-105.

Assessment Tools

Spiritual Assessment Inventory (SAI), Hall and Edwards, 1996, 2002
The SAI  measures 5 aspects of spirituality:  awareness of God, disappointment with God, grandiosity or self-importance, realistic acceptance of God, and instability in relationship to God.

The Purpose in Life Test  (PIL), Maholick, 1999.The PIL detects existential vacuum or emptiness in one’s life.

The Seeking of Noetic Goals Test  (SONG), Crumbaugh, 1977
The SONG measures the strength of motivation to find meaning in life.

The Spiritual Well-Being Scale (SWS), Paloutzian and Ellison, 1982
The SWS measures religious and existential well-being.

INSPIRIT
The INSPIRIT examines the degree of religiosity and belief system.

PAUSE (Waters, 2004)
The PAUSE looks at physical condition, affect, understanding, spiritual health, support system, and coping with crises.

Spiritual Ecomaps (Hodge, 2007), helping to look at marital and family spirituality.

Written by Rev. David Van Essen