Spiritual assessment in biomedicine

The recent surge of interest in links between spirituality and health has generated many assessment approaches that seek to identify spiritual need and suggest strategic responses for health care practitioners.

The interpretations of spirituality made within health frameworks do not do justice to the way spirituality is understood in society in general.

Spiritual assessment should not impose a view or definition of spirituality, but should seek to elicit the thoughts, memories and experiences that give coherence to a person’s life.

Spiritual assessment tools should not be used without adequate exploration of the assumptions made. Assessment processes need to be adequately conceptualised and practically relevant.

In agencies organised according to biomedical priorities, spirituality is a personal coping mechanism that need not be incorporated into the health treatment plan.

Integration is the patient’s issue – patients must work out how to incorporate their experience of the biomedical system into the rest of their lives.

Social perspectives that regard spirituality as a means of social support view spiritual care as the responsibility of the cultural and religious communities supporting the patient.

Practitioners operating within a social model may be more intentional about involving these communities in care, but they still leave the decision to participate to the patient and family.

In both these approaches, it is for patients to decide whether they will seek spiritual care alongside the health care being provided.

However, spiritual care may be seen differently within a biopsychosocial framework. Here spirituality is related to quality of life and is thus one of the individual characteristics that shape health beliefs and motivations. It affects compliance and outcomes, and is thus legitimately an area of interest for clinicians.

Criteria for appropriate spiritual assessment

Spiritual assessment should thus not impose a view, let alone a definition, of spirituality, but should seek to elicit the thoughts, memories and experiences that give coherence to a person’s life. This implies taking seriously the idea that spirituality preserves identity and sense of self, particularly in professionalised environments, and ensuring that professional practice assessments are made within a framework that matters to the patient.

This means identifying spiritual needs and resources in ways that

  • Respect patients’ perspectives and do not infringe privacy;
  • Involve all members of the interdisciplinary team to the extent that they are able and willing to contribute;
  • Permit clear documentation of needs, strategic responses to these needs, resources required, and outcomes;
  • Integrate strategies into an overall care plan in ways that are readily understood by all members of the interdisciplinary team;
  • Provide a shared framework for continuity of care between community agencies and inpatient services; and
  • Provide a place for religious care but do not conflate spiritual issues with religious practice. While spiritual care in general may be provided by a team, specific religious care is best provided by a person from the same faith community, preferably one willing to participate in the team.

Appropriate process for spiritual assessment

Spiritual assessment must be a process, not merely an event, as it needs to take account of emergent insights and accommodate the patient’s exploration of particular issues if he or she so chooses.

The discussion here applies to health care contexts in which process is possible (such as general medical practice, community health or residential care), rather than the brief encounters of day surgery or the emergency room.

The process should begin with a form of screening, preferably one that maps significant relationships within the domain of spirituality. This screening can be carried out descriptively, noting connections as they emerge in taking patient histories and in general clinical and informal encounters by all members of the team.

For more information see; Bruce D Rumbold. A review of spiritual assessment in health care practice. Medical Journal of Australia 2007; 186 (10): S60-S62

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