Spirituality assessment in health care

Health Progress, Sep/Oct 2001 by Patton, Gary L

In Examining cc Patient's "Objects of Devotion," the Clinician May Find Clues to an Unhealthy Lifestyle

Spirituality is a concept increasingly discussed by various professional disciplines. Nursing, medicine, mental health, and even business are addressing the topic of the human spirit. Even people who have fundamental questions about spirituality seem to be asking those questions more often and more publicly.

Definitions of spirituality are many, yet each of them seems to focus on two general principles. Spirituality has to do with:

Finding meaning and purpose in life Developing awareness of and allegiance to something sacred

When a person lives according to these principles, life generally goes well. However, a person's spirit may be unhealthy. Just as we periodically need to assess our physical health, we need to assess our spiritual life as well. A person may experience a problem in any aspect of life. Although disease and discomfort are usually more evident when they occur in the body or mind, they can also occur as disruptions of the spirit (or soul).

SPIRITUAL ASSESSMENTS

Spirituality assessments can help us identify spiritual problems. Such assessments can range from lengthy written inventories, on one hand, to brief verbal inquiries, on the other, with various other kinds of surveys in between. However, several questions apply to them all: If spirituality involves privacy and personal choice, as it obviously does, why attempt an assessment of it? Who should do the assessing? Can spiritual assessments be useful to clinicians?

WHY AsSESS SPIRITUALITY?

Spiritual assessments are not intended to impose one person's values, beliefs, or practices on another. Indeed, the person doing the assessing views the assessed person's expression of his or her spiritual life as a matter of personal choiceand respects it as such. But just as a medical patient needs a physician's help in diagnosing a physical or mental problem, so people with spiritual problems need to have them assessed. People often sense that something is not well with them (or at least not as they would prefer it to be) without knowing how to identify or correct the problem. Hence assisting people with this essential aspect of their health is both appropriate and necessary for professionals. The expression of spirituality is a very personal matter, but people suffering from spiritual conflicts or seeking answers to questions about spiritual experiences often require assistance from others.

WHO SHOULD Do SPIRITUAL ASSESSMENTS?

Although chaplains, pastoral counselors, and clinically trained clergy are usually those whom people ask for help with spiritual issues, they need not be the only ones. In some cases, pastoral care professionals are simply not available to conduct spiritual assessments. In other cases, the person seeking the help may be uncomfortable speaking to someone closely identified with organized religion.

For these reasons, health care facilities may consider training other health care professionals to do assessments. A physician in an exam room, a nurse in a clinic, a therapist in an office-all can be taught how to conduct an initial assessment. If the assessment indicates that further intervention is necessary, the clinician can then consult those professionally trained in pastoral care.

True, clinicians sometimes say that they are uncomfortable talking with patients or clients about spiritual issues. Precisely because of such concern, health care organizations should encourage collaboration between their pastoral care professionals and those involved in medical, nursing, and psychiatric care. Through dialogue, patient care conferences, collaborative training, and inservice sessions, pastoral care professionals can show their clinical colleagues how to perform spirituality assessments.

WHAT TYPE OF SPIRITUAL AsSESSMENT?

One method that clinicians can use is based on a concept developed by the psychoanalyst Erich Fromm.

In The Revolution of Hope, Fromm argued that all human beings have what he called an "object of devotion."1 Although this "object" varies from person to person, in each case it gives meaning to the person's life and compels his or her devotion. Fromm believed that by observing a person's life closely, one could discern his or her object of devotion.

Everyone reveres his or her object of devotion, Fromm argued. However, not all objects of devotion are healthy, even if they are viewed with a sense of reverence. An object can compel devotion without necessarily being worthy of it. Indeed, the simple fact of devotion says more about the devoted person's attention and loyalty than it does about the actual worth of the object itself. When people talk about the objects of their devotion, they sometimes describe addictions or destructive practices. J. W. Fowler's "stages of faith" concept demonstrates how faith can grow and change over time= One can use the format of Fowler's "stages" to think about how people accommodate the objects of devotion in their lives and behavior.