Spiritual Needs Assessment
According to Potter and Perry (2009), one’s awareness of inner self and having a sense of connection to a higher being is the meaning of spirituality. Spirituality is a force that provides a person with intrinsic energy that promotes and enhances their well-being. It also helps a person achieve the balance needed to cultivate a positive life and to cope with everyday life stressors (Potter & Perry, 2009). Florence Nightingale believed that spirituality within a healing hospital environment, and caring for an individual’s spiritual needs is just as important as caring for their physical needs (Potter & Perry, 2009). Spiritual assessment is defined as the process from which health care providers identify a patient’s spiritual needs related to their mental health care (Spiritual Competency Resource Center, n.d.). In 2005, as evidence-based research demonstrated a correlation between supporting a patient’s spirituality with their health and their ability to cope with an illness, The Joint Commission (TJC) announced the requirement for health care organizations to include “a spiritual assessment as part of the overall assessment of a patient to determine how the patient’s spiritual outlook can affect his or her care, treatment, and services.” (p. 1). Patients deserve the best holistic care from health care providers, and it is through a spiritual assessment upon admission that providers will be guided to providing such care. Introduction And Spiritual Assessment Interview
This author recognizes that a spiritual assessment tool is a powerful mechanism that will allow a health care provider gain insight into an individual’s spirituality and to assess how individuals practice spirituality in everyday life. As there are many spirituality assessment tools in circulation and being used in clinical practice, this author will use FICA (Puchalski, 2000) that was developed by Christina Puchalski in 2000 for this essay paper. The acronym FICA stands for Faith and Belief, Importance, Community and Address in Care. This model, during a time of unfamiliarity about the patient’s spiritual belief, will provide the basis for an organized, and open non-biased assessment (Puchalski, 2000).
This author completed a spiritual needs assessment on Mr. Oliver, a 74 old neighbor who was recently discharged from a local hospital after having lung surgery due to cancerous lung nodule diagnosis. The following spiritual assessment, following the FICA model, demonstrates questions and answers (Q&A) (M. Oliver, personal communication, August 10, 2014):
1) Q: What is your faith or belief? A: “I am a practicing, and have been all my life, a Seventh-day Adventist. And remember my faith is a Protestant Christian denomination” Q: What things do you believe in that give meaning in your life? A: “Of course it is my loving wife, my three children, and now several grandchildren. I am blessed by God with such love. God gives me meaning in life, if it wasn’t for him and for my faith, I would be a lost soul. And of course to be interviewed by my neighbor on my faith gives meaning to my existence.”
2) Q: What importance does your faith or belief have in your life? A: “It has great importance. If I didn’t go to church every Saturday, I would feel at a loss and I would have no meaning in my daily activities. My whole family attends church as a family. Then of course when I and the wife go on vacation, I am okay with missing church. God does believe in rest.” Q: How have your beliefs influenced your behavior during this illness? A: “Funny you ask that question. After I found out I had a cancer of the lung, I became angry with God and questioned why did this happen to me. Several weeks before surgery I was very angry and did not attend church. Then I realized that God does have a plan and I better start acting like an apostle of God. God sure did affirm my belief in his plan after my doctor told me all cancer was removed and I will have a normal life moving forward.” Q: What role do your beliefs play in regaining your health? A: I believe praying and attending church will help me recover from surgery and stay cancer free. I pray every morning and during lunch time with my wife. Prayer is very powerful for me.”
3) Q: How about people and your spiritual community? Who is important to you? A: “I attend the Seventh-day Adventist church of Frisco. Since we are still considered a new and upcoming city, we don’t have a large congregation. But we worship and celebrate together like a family. And family is very important to my spiritual needs, this is my immediate family and friends at church. They are a great support system for me”
4) Q: How would you like your health care provider to address your health issues in your healthcare? How would you like me as your neighbor help you with your health? A: “I want an environment of trust from my health care team. I want them to listen to my concerns and answer questions in a timely manner. I want honesty at all times and transparency from health care team. My religion helps me heal and remain positive, I want them to recognize and support my faith. I also want them to support my family during my hospitalization. Knowing you as a health care provider, and as a neighbor, I am glad that I can come to you to ask questions, get clarifications, and ask for guidance.”
Assessment Findings
Upon completion of the spiritual needs assessment, this author determined his neighbor’s faith-based religion, beliefs and spiritual ritual which are very important for this neighbor. As Mr. Oliver has a strong belief in God, he seeks strength from prayer, church, and from his family. Also noted was his strong belief in his friends at church. Allowing time with God, prayer, family, and friends allows Mr. Oliver to express and practice his spirituality. Mr. Oliver was very appreciative of the fact that I chose him to interview, and the fact that I interviewed him in the privacy of his home. I explained to Mr. Oliver that spirituality can be a sensitive subject, and I wanted to interview/assess him in his genuine environment. His spirituality is a celebration and I didn’t want to make him feel I was asking questions simply because I have to (Dameron, 2005). Mr. Oliver clearly vocalized the importance of his health care team being honest and transparent with him during both his health crisis and for health promotion. He wants support and recognition during hospitalization from health care providers on his faith. He demonstrated a strong will and desire to have his family present during a hospital stay, and he wants support from his providers to his family if needed.
Significant Discoveries Made During Assessment
This author recognized immediately during the interview how upset and angry Mr. Oliver was when he found out he had cancer. This was a significant discovery as it demonstrates that anger is a common and natural response to a life-threatening diagnosis (Potter & Perry, 2009). This anger demonstrated by Mr. Oliver may be his self-perception about the way cancer has changed his life, or the way friends and members of his family will be affected by his diagnosis. His anger was expressed in a safe, positive way, and it became an entity of power to help change things for the good. For example, Mr. Oliver’s anger about his cancer provided him with energy and strength needed to overcome his feelings of denial. This author feels that the open dialogue between him and Mr. Oliver went extremely well and was a significant discovery as it verified the important of open active communication, and active listening. Mr. Oliver’s ability to answer the assessment questions and share his personal feelings enhanced the relationship between him and the author. The fact Mr. Oliver was willing to share such personal health information and how he perceives and practices his spirituality spoke volumes about his character, and allowed the spiritual assessment tool to be beneficial during the interview process. This author discovered from Mr. Oliver, that through prayer and strong faith, that God will never fail you, and that God does have a plan.
What Went Well And Do Different In The Future
What went well was learning and supporting Mr. Oliver’s spirituality. When health care providers learn and support a patient’s beliefs, health care experiences are more positive and promote health, alleviate depression, and help the patient cope with a difficult illness and improve the outcomes of the patient (Potter & Perry, 2009). Even though Mr. Oliver was still recovering from his surgery, he showed a positive attitude towards life and appreciation of my wiliness to learn of his faith and current health crisis. My interview provided Mr. Oliver with recognition of his faith, thus meeting his spiritual needs. Another thing that went well was the fact of excitement showed by Mr. Oliver that I choose him to interview, his pride with his faith demonstrated this excitement. One thing this author will do different in the future is to remain and have a non-judgmental approach, and will remain careful not to impose his own belief value system to the patient to show respect of the patient’s beliefs. “When people experience a spiritual crisis and need spiritual care, they may choose to discuss their concerns only if they have been shown respect and appreciation.” (Touro Institute, n.d.).
Barriers Or Challenges
A major barrier and a challenge existed with the author’s lack of spiritual knowledge or the unfamiliarity of the neighbor’s belief system. Other barriers was poor timing from the author as Mr. Oliver stated he will not do it on Saturday as that is the day of worship in his faith. The author had feelings of nervousness before the interview, due from lack of subject matter with Mr. Oliver’s religion. Due from this lack of subject matter, the author lacked recognizing clues and/or cues from Mr. Oliver that would have opened doors to initiate a genuine conversation and interview. This author realized a barrier may have existed when questions were asked only during the assessment time, not allowing enough time for Mr. Oliver to reflect his true meanings and beliefs. To alleviate this barrier, this author could have given Mr. Oliver the spiritual needs assessment questions a few days before so he had plenty of time to reflect and think in the privacy of his home on his spiritual answers. A barrier will exist during a spiritual needs assessment as all patients are not the same and all patients will present with different values and beliefs (Dameron, 2005).
Spiritual Experience And Future Use
The experience this author obtained during this spiritual needs assessment is very impressive; the author has gained much knowledge on a religion he knew very little about, how this religion guides faith and spirituality with his neighbor, and how that accepting, learning, and acknowledging a different religion other than your own will build trust with people. This author learned that when you include a patient’s spiritual beliefs and rituals in their plan of care, this will ensure patients autonomy as well as a benefit to their healing process. As health care providers bring their own personal beliefs about religion and spirituality to their workplace, the spirituality assessment tool can be used to guide providers towards the patient’s belief on spirituality and not the caregivers. A key element for future use with the spiritual assessment tool is the fact that it will assist new and tenured health care providers to form an accurate spiritual care plan.

Conclusion
Excellent spiritual care is acknowledged as an important part of high-quality patient care within a healthy hospital environment. Decrease in anxiety and promotion of health is supported from effective spirituality care (Potter & Perry, 2009). With so many cultures and societies within our nation and within our health care system, the concept of spirituality will be found in every patient admission. Educating health care providers about the meaning of spirituality, implementing spiritual knowledge in the nursing practice, and establishing and supporting an accurate spiritual needs assessment tool are some strategies that lead to exceptional spiritual care of patients.

References
Dameron, C.M. (2005). Spiritual assessment made easy; with acronyms! Journal of Christian Nursing, 22(1), 14-16.
Potter, P.A., & Perry, A.G. (2009). Fundamentals of nursing. (7th ed.). St. Louis, MO: Mosby.
Puchalski, Christina. (2000). Taking a spiritual history allows clinicians to understand patients more fully. Journal of Palliative Medicine Vol. 3 No. 1, p.129 11. Ibid pg.130.
Spiritual Competency Resource Center. (n.d). Retrieved on August 10, 2014 from http://www.spiritualcompetency.com/recovery/lesson7.html
The Joint Commission. (2005). Evaluating your Spiritual Assessment Process,” from the Joint Commission: The Source (2005), located on the Professional Chaplains Web site Issue 2 (p.1). Retrieved on August 10, 2014 from https://lc-ugrad1.gcu.edu/learningPlatform/
Touro Institute. (n.d.). Spiritual assessment and care [PowerPoint slides]. Retrieved on August 10, 2014 from http://www.touroinstitute.com/6%20Spiritual%20Assessment/and%20Care.pdf