18.4 Applying the Nursing Process
Open Resources for Nursing (Open RN)
Now that we have reviewed the concepts related to spirituality and discussed beliefs and practices of common world religions, let’s apply the nursing process to promoting spiritual health.
Assessment
Subjective Assessment
Agencies often provide a standardized spiritual assessment tool to complete when a client is admitted. If a standardized assessment tool is not available, the FICA model can be used. The FICA model contains open-ended questions to ask clients about their personal spiritual beliefs in a way that is open and nonjudgmental[1]:
- F-Faith or beliefs: What are your spiritual beliefs? Do you consider yourself spiritual? What things do you believe in that give meaning to life?
- I-Importance and influence: Is faith/spirituality important to you? How has your illness and/or hospitalization affected your personal practices /beliefs?
- C-Community: Are you connected with a faith center in the community? Does it provide support/comfort for you during times of stress? Is there a person/group/leader who supports/assists you in your spirituality?
- A-Address: What support can we provide to support your spiritual beliefs/practices?
The HOPE tool is also helpful for incorporating spiritual assessment questions into a medical interview. HOPE stands for[2]:
- H: Sources of hope, meaning, comfort, strength, peace, love and connection
- O: Organized religion
- P: Personal spirituality and practices
- E: Effects of spirituality on medical care and end-of-life issues
The first part of the mnemonic, H, refer asking about the client’s sources of hope and basic spiritual resources, without focusing on religion. This approach initiates therapeutic communication with all clients regarding spirituality beyond traditional religion.
The second and third letters, O and P, refer to inquiring about the importance of religious rituals and specific aspects of their spiritual practices that are important to them. A useful way to introduce these questions is a normalizing statement such as: “For some people, their religious or spiritual beliefs act as a source of comfort and strength in dealing with life’s ups and downs. Is this true for you?”
The fifth letter, E, refers to the effects of a client’s spirituality and beliefs on decisions related to medical care and end-of-life issues. This may include barriers accessing preferred spiritual resources during medical treatment, fears related to end-of-life issues, and decisional conflicts related to the client’s values and beliefs and prescribed treatment.
Read more information about using the HOPE tool.
Objective Assessment
In addition to asking open-ended questions, it is important for the nurse to observe clients for cues indicating difficulties in finding meaning, purpose, or hope in life. It is also important to monitor for supportive relationships.[3]
Clients experiencing chronic or serious illness may make statements indicating spiritual distr