S2E5: On The Go Spiritual Assessment

Welcome to Following Jesus in Nursing, a podcast for nurses and students produced by InterVarsity's Nurses Christian Fellowship. I'm your host, Lara Kay Kaiser, and together, we'll be inspired by our guests' stories, tackle big questions with experts in the field, and walk together in following Jesus at the intersection of faith and nursing.

I was thinking about his spiritual needs, even in this Code Blue fast-paced, noisy situation. He asked me if he was dying. I told her that. And then I could say, can I pray for you? And I could ask the Holy Spirit, like, now, come be with John. And that he wasn't alone when he died, that someone was with him spiritually.

Welcome back, Kathy. We're doing our fourth topic in our season on Spiritual Care, a deeper dive. So today we have on-the-go spiritual assessment. I'm excited for the nitty gritty of how do we actually do this thing. So, Kathy, kick us off with what is spiritual assessment?

Well, thanks, Lara. I'm happy to be here. You know, we've talked about spiritual care is broader than religious care and involves facilitating these relationships with others, with the self, with God. Are there problems in those relationships? We talk about assessing spiritual needs.

So in the simplest terms, we've defined spiritual care as caring for the spirit. So I'm going to go back to that in the simplest terms. Spiritual assessment is simply assessment of the spirit. What is happening with the patient spiritually? Are their spiritual needs evident, like hopelessness or issues with forgiveness or relationship problems or suffering?

One thing I've tried to emphasize in nursing, we see people as fully integrated beings. We're body, mind, spirit. So when we do our nursing care, we are assessing their spirit, even as we're doing our physical assessment and assessing their psychological state and their mental understanding. So yeah, spiritual assessment is assessment of the spirit. How's the patient doing? Are they anxious? Are they afraid? Do they have questions about what's happening? What are they facing? So we think about these things as we go in and start doing our physical assessment and our care of the patient.

Yeah. So I've heard you talk about spiritual assessment tools. Tell me more about those. How do those help nurses with spiritual assessment?

Well, actually there are multiple assessment tools. It's kind of, you can kind of go crazy trying to figure these out. Some are for clinical practice to be, like, for that nurse on the go spiritual assessment. What can I, how can I remember what spiritual needs are, etc? And some are for research, they're more detailed.

And most of them have these acronyms to help you remember what to assess. They're probably the most famous ones. There's one called HOPE, H O P E. And so we think of spirituality and hope. And so it's about what is your source of hope, source of meaning, what sources of connection in your life?

The O is organized religion. Are you part of any kind of organized religion? P is what are your personal spirituality practices? And E is what are the effects of what's happening to you? How is your spirituality impacting your healthcare and how you're perceiving what's going on?

So HOPE is one. That's a very famous one. Another one is FICA. Faith: what's the importance of that in your life? What's your community? Who are the important people and groups? And address, how do you want me to meet your spiritual needs? And so I could go on and on with different ones. There's one called faith, one called trust. And so all of these tools get at the same thing. What's going on in terms of exploring meaning and purpose, forgiveness, relationships?

They're tools to help you think about a person's spirituality and uncover spiritual issues in their life. So you can really get into these tools and do these full blown spiritual assessments. But I'm not sure that that's realistic in everyday nursing practice.

Yeah. We called this episode on-the-go spiritual assessment. So how do these fit in the on-the-go busy day of a nurse?

I think like anything, you study them. So the tools help us think about what to look for. No, you're not going to do a full spiritual assessment with every patient, every shift, every day. Certainly on an admission you would take a spiritual history. And as you admit a patient, you're going to use the tools in your organization's admission forms.

They'll often ask, Are they part of a faith community? Would you like us to contact a pastor or spiritual leader? In day-to-day care, and nursing textbooks would agree with this, that we primarily do what's called a spiritual screen. So we're screening, we're just looking at what's going on spiritually with the patient. We're not doing this full blown assessment.

So as I enter into relation with the patient, I'm meeting them, I'm taking care of them. I'm trying to evaluate the presence or absence of spiritual needs or some kind of distress. And I'm trying to identify patients that need further spiritual assessment or maybe more in-depth care. So is there a spiritual need present? Is there a spiritual risk? Is there something going on that the patient needs further support? Can I meet that need? Is it appropriate for me to meet that need? Or is it going to take, like a chaplain visit or a visit from a spiritual expert or a spiritual director, someone with more spiritual care expertise than I. It's gonna take more time. So I'm doing this spiritual screen, what's going on?

So I say to the patient, Well, how are you feeling right now? Or do you have any questions I could help answer for you? What do you normally do when you feel this way? Or where do you typically turn for spiritual support? These are simple questions that I could ask, or I could maybe even ask, Is spirituality important to you as you cope today?

So I look for cues and these spiritual assessment tools are full of these questions. There are textbooks that really get into this, looking for meaning and support, but they can be just simple questions. How are you doing? What's going on? Does spirituality help you with this?

Then I think also I'm looking for cues, like, does the person really appear depressed? You know, no eye contact, looking down, they won't talk to me. Are they angry? Are they afraid? So I think in everyday practice, I guess I want to emphasize, we aren't gonna do these full blown spiritual assessments, but we study them so that we have ideas about what to look for in spirituality.

And then the screen suggests this need, that there may be a further need for spiritual history or spiritual assessment or more professional intervention, or can I just be with the patient in the moment and help them and I can answer a question or I can offer support?

Okay. I see. So sounds like you're saying when you study these tools kind of on your own time and you've got them integrated in your mind, then when the patient is in front of you, you're just kind of screening or scanning for, okay, what's the thing that rises to the surface? I might not go through every single letter of HOPE or FICA or whatever the tool is, but I just might say, okay. This seems important right now, and I'm just gonna ask this one or two questions.

Yeah.

Address this one or two emotional, spiritual needs that are very apparent.

I think so. And again, the spiritual, the psychosocial, it's all kind of integrated. I'm looking at this person as a whole person, but I'm aware of this. I studied at nursing school or I went to an in-service education about it at my hospital. So I'm thinking about the sirituality and the spiritual.

Yeah. Even those questions, I love those questions you mentioned, and even just having a handful of those good questions in your back pocket sounds really valuable. So, of course, you as the director of a ministry, Nurses Christian Fellowship, care abundantly about spiritual care, but help me situate this in sort of the secular environment of a hospital or health care organization. What are the requirements? What are the expectations around spiritual assessment in those contexts?

Well, I'm glad you asked that. So all hospitals, many most healthcare organizations, they are accredited by the Joint Commission. We used to call it the Joint Commission for Accreditation of Hospitals and Healthcare Organizations, JCAHHO, but now we just call it the Joint Commission. And they require spiritual assessment. They require, in order to be accredited, you have to show that you're evaluating spiritual needs, spiritual beliefs, the values, the spiritual preferences of the patients, the people you care for.

And they don't tell you exactly how to do it, but the standard is that you have to do it. And so they have suggestions for evaluating spiritual needs. They have some suggested questions, like what kind of spiritual/religious support do you desire? What's the name of your clergy or your ministers, your rabbi? So they get into faith background, but some of them are a little more, I think deeper, like what provides you with strength and hope?

Do you use prayer in your life? That's actually a Joint Commission question. Does the patient use prayer in their life? I love that. We can ask people. Wow. We can actually ask people if they pray or is prayer part of their faith? Do they have spiritual goals? What keeps you going day after day? That's another great question the Joint Commission suggests. So they had these questions, you know, how can I help you get through this healthcare experience? What will help you? And so what I love about that is that this isn't something that Nurses Christian Fellowship came up with, or some religious denomination. This is what our standard accrediting body says. You need to assess these things. This is an important part of care.

And of course the licensure exams, the NCLEX exams, they ask about spiritual assessment, same things. How is this a part of their life and what does it mean to them in this situation? And so this is what we're supposed to do. It isn't something that I came up with as the director of Nurses Christian Fellowship. You know, it's really an important part of care that's required by hospitals and organizations.

Yeah. As someone who's not a nurse and experiences these spaces as a patient, I find that very comforting and encouraging that this is a value, because that's one of the first things I think of from a patient or family member perspective is, is the whole person being cared for and attended to.

And I think it's fascinating. We get questions to NCF from nursing students or nurses, like, Can I pray with a patient? And I'm like, actually the Joint Commission says you can ask patients if they use prayer in their life. They encourage us to ask that. So I find that very satisfying to know that the secular world, the Christian world, this faith-based world, like we all realize the importance of spirituality and health and illness. It's critical.

Yeah. So coming back to doing the spiritual assessment, then what happens? So what comes out of the spiritual assessment?

So all nurses were taught the nursing process assessment, and then there's diagnosis and planning and intervention. So there's a diagnosis and there are official nursing diagnoses related to spirituality. When we think about from a school learning point, you know, what are the official nursing diagnoses? And they're in what's called domain 10, which is life principles. And there are three official nursing diagnoses related to spiritual well-being.

And three of them are related to religiosity. I think for me as a practicing nurse and for most nurses, you know, we don't go through an assessment and come up with one of these six official nursing diagnoses, impaired spiritual well-being, or risk for impaired spiritual well-being, that these are the diagnoses, or they have impaired religiosity. But I think we realize that something's going on and we come up in our minds, we're like, ah, this person is struggling. They're having a struggle in their connection with their significant other, or they're feeling very afraid or what's the meaning of this? How come I was diagnosed with cancer?

What's going on in my life? And that refers to spiritual well-being. People have impaired spiritual well-being, so they have this diminished sense of meaning and purpose in life through those connections with the self, the others, the world, and the power greater than oneself. And so I kinda got lost in that definition there for a little bit, but we come up with a diagnosis and we can have an official nursing diagnosis. And like I said, there are six that are officially nursing, North American Nursing Diagnosis Association.

But I think we come up with a sense of here's what's going on and I need to do something about it. And so if the person's angry, if they're having fear, feeling empty, they have sense of guilt, is further assessment needed, or do I do an intervention? And so actually just like we have six official nursing diagnoses for spirituality and religiosity, we have two official spiritual nursing interventions. And if you look at the textbooks, they're spiritual growth facilitation. So I can help the person identify what's going on and connect or reconnect with sources of meaning or purpose or comfort.

I can help them in that situation and I can offer spiritual support. You know, I can help them connect with a greater power. Again, I could get a chaplain or I could offer to pray with the patient. So I do this assessment and I come up with some sort of diagnosis. And a nursing diagnosis is something a nurse can do something about. So it's not like I make a medical diagnosis and I order a medication. Most of us, unless we're advanced practice nurses, we can't do that. But I come up with a spiritual diagnosis and I realize this person is struggling spiritually. They're having impaired spiritual well-being, or they need help with this. And so then I say, okay, something needs to be done. And I do something about it, whether it's talking to the patient, whether it's offering spiritual support, whether it's getting a chaplain and doing more spiritual assessment. What's exciting to me is that this is truly part of what we're supposed to be doing as nurses. It's not an add on, it's not cheap. Can I, do I have time for this? But it's all a part of what I'm doing as I care for the patient.

Yeah. And I think that's helpful that it follows the same process that any other aspect of a person's care would follow. So assess, diagnose, plan, intervene.

Nursing process. That's the nursing process.

Yes. I'm learning. I'm learning from you all. And next episode, we're gonna be talking more about the interventions. So I'd love to hear a story just about a time when you have used spiritual assessment with a patient.

Yeah. So I think as you grow as a nurse, like at first, you know, I remember thinking, okay, what's the tool? Have I assessed their spiritual beliefs? How are they using them in their life? You know, wait, have I done this?

Have I done that? And so it's all like in piecemeal, but then as I matured as a nurse, it sort of came together, congealed. And so I'm looking at the spiritual, the physical, the psychological, it's all kind of, I love the word amalgamated. Like it all comes together for me. And so it isn't like I stop and say, I'm going to do a spiritual assessment.

I'm just thinking about this. An amazing thing that happened. I worked in the coronary intensive care unit and I remember caring for a man named John, and this was like fast spiritual assessment intervention, put it all together quickly. I'd just gotten out of report. It was a day shift seven AM to seven PM. And this guy, John, goes into atrioventricular dissociation.

So his heart is not beating right, right? And so we call a Code Blue and the cath lab comes and we're gonna insert a pacemaker in the patient's room because his heart is not working. And I was his primary care nurse. So I wasn't involved in getting the pacemaker inserted and getting all the machines in and the fluoroscopy and, you know, but I'm in the room with him because he's very nauseated and he keeps retching. And I thought, I'm not gonna leave this guy alone. And I didn't want him to choke. And everyone else had a task to do with getting the pacemaker inserted. So I'm at the head of his bed, I'm his primary care nurse, and I'm trying to help him. He has to lay on his back because they go up through the groin and I have a wet rag on his forehead and I'm thinking this guy's in very serious risk of dying. And I remember thinking, I hadn't really had a lot of chance to talk to him or meet him.

So I haven't done a full blown spiritual assessment, but I kept thinking, I want this man to know that I'm with him, that I'm here, that he's not alone. And I realized this room is packed and there's a million people in here and machines and buzzing and paper ripping, you know, opening packages, but I am with him. And so I'm trying to be close to him and he kept trying to cover up his groin because you have to expose the groin to get the catheter in, but you could tell it was embarrassing to him to have his private areas exposed. So I kept trying to adjust the sheet over his personal area and I leaned down. I told him, I said, I've got you covered. I've got you covered. And I just kept trying to be with him. And I said, John, I'm here, I'm here. And I'll never forget, he looked at me and he said, Nurse, am I dying? And I froze.

I have to tell you, I wasn't sure what to say, you know, Nurse, am I dying? And I just prayed a quick flash prayer. And I said, John, we're doing everything that we can to help you, but there's a possibility you might die. And I thought to myself, this man knows this is serious. He knows he's potentially dying.

He's in and out, you know, he's throwing up. He feels horrible. And I just thought he needs a spiritual intervention now. I just looked at him and I said, Can I pray for you? And he shook his head, yes. And I just prayed. I said, Jesus, will you be with John right now? He needs you right now. You know what's going on. And I pray for John to be fully with Jesus.

This prayer is like thirty seconds, twenty seconds, it's not very long. And within just a few moments, he lost consciousness and he died. And it was just so intense and so sad. And I remember, you know, thinking, Oh man, I'm so glad I was there. I so glad that I was his nurse. I'm so glad that I could be with him as he passed, as he died.

So he's passed away. The cardiologist has gone out and told his family and I'm cleaning him up. You know, these rooms after these codes are a mess, there's blood and fluids and paper everywhere. So I cleaned the room, I got him as presentable as I could. And I brought his wife in and I will never forget, you know, obviously this is so dramatic and so sad. And she said to me, he was all alone. There was no one here with him when he died. And I explained to her how I was there and that I had prayed with him and prayed for him. And she just sobbed, she fell in my arms and she said, Oh, thank you. Because that was her biggest fear. You know, it's interesting, she didn't say, Well, what happened? What was done? What was his EKG? Did they get the catheter in?

She just felt like he was all alone and he died all alone and that somehow I, as his nurse, I was thinking about his spiritual needs, even in this Code Blue fast-paced, noisy situation. He asked me if he was dying. I told her that, and then I could say, can I pray for you? And I could ask the Holy Spirit like right now, come be with John and that he wasn't alone when he died, that someone was with him spiritually. That's kind of a quick spiritual assessment diagnosis intervention, not a lot of time, but that happened very, very quickly.

And I think that's what happens in on the on-the-go nursing practice. And you're thinking about the spiritual and you just on the forefront. It's a part of everything you're doing in your nursing. And so, yeah, you do it, you think about it, it comes and you do it.

Yeah. That's a good example of that is very on the go. And, yeah, like you said, just so impactful that that's the first thing that his wife asked about and what an honor and a privilege that you were there for that moment to be the one who could be present in the midst of a really chaotic space.

And I think most situations you would have more time. You would do a further assessment. You would ask, you know, but there wasn't time. And I just said, Can I pray for you? And the guy shook his head and I'm like, okay. Let's do it. But I think that's where Jesus puts us as his nurses in those places.

Yeah. To be ready whether you've got ten seconds or, you know, twenty minutes. Well, any final takeaways for you from today?

Yeah. I think as nurses, I don't want spiritual assessment to be some, oh my gosh, it's out there. And you know, have you read the books? Have you? Yeah, we need to study and we need to think about spirituality, but spiritual assessment unfolds in this dynamic non linear fashion. It isn't something you stop and say, I'm going to do a spiritual assessment. And you may need to do that, but you have these questions in mind. You have the sense that I need to see what's going on spiritually with this patient and are they okay? And then it just follows. You come up with a conclusion or diagnosis and you think about what intervention is needed.

And we talk about assessment, diagnosis, intervention separately, because we need to pull them all apart and understand them, but they're really the same process. So we're asking questions, we're listening carefully, we're listening for cues, you know, how is this person doing? What are they struggling with? What's going on? What might they need right now?

And I was taught this in school, but it was just so much a part of my life that the spiritual care of my patients was much a part of my nursing because spirituality was so much a part of my life. And so I'm ready, I've spent time with Jesus and I'm thinking about where is this patient? What do they need from me? And I think it may not feel normal, like how do I add this on? But it's not really piecemeal. It really does kind of all fit together. And it's like any other nursing skill: you practice it and it just kind of becomes second nature to think about the spiritual and what's going on and to ask good questions of your patients and be ready to respond.

Yeah. I like what you said there about just practicing it and it becomes part of your nature. So, you know, maybe it starts small, just working in one or two questions to patients, but just starting somewhere, starting to practice it so that it does become part of that habit and part of your skills.

Some of in nursing school, you may be asked to do a spiritual assessment on yourself or one of your friends. That's a great way to learn spiritual assessment as you practice it kind of like we practice giving injections. You practice doing a spiritual care assessment. So you take the tool and you do all the pieces of it, but it becomes second nature and a part of your nursing.

Yeah. That's a great idea. Well, thank you again, Kathy. This is fun as always, and I look forward to talking to you again in the next episode.

Thanks, Laura. See you then.

To summarize today's conversation, spiritual assessment is just as much part of the nursing practice as physical assessment. But we don't need to see it as just one more task to be checked off. We can see it as an organic expression, an extension of who we are as followers of Jesus. Over and over again this season, Kathy has mentioned that what makes her nursing practice organic, integrated, spirit-led and adaptable to on-the-go situations all comes down to one basic yet profound thing: spending time with Jesus. We cannot emphasize this enough because it's the foundation of spiritual care for us as Christians.

And we cannot care well spiritually for others if we ourselves are not being spiritually formed around Jesus. We're all being spiritually formed in some way. What or who has the biggest impact on your spiritual formation? Our prayer today for all of us, myself and Kathy included, is that we become people who choose more and more each day to sit at the feet of Jesus and be formed by him more than anything or anything else.

So thanks for joining us for another inspiring episode of Following Jesus in Nursing. We hope you've been encouraged and equipped in integrating your faith with your nursing practice.

Be sure to check out our show notes for info about connecting with Nurses Christian Fellowship, as well as links and resources mentioned in today's episode. Don't forget to check out NCF membership at ncf-jcn.org and use the coupon code 'following' for $10 off. And remember, as you go about your work as a nurse, you are not alone. Jesus is right there with you, guiding your steps and using you to bring healing to those in need. Thanks for listening to Following Jesus in Nursing, and may your faith continue to be a light in the world of healthcare.