hi this is Professor ster and this session is on the F module of spiritual assessment the major goals of this session at least at the end is you should be able to distinguish religion from religion or religious religiosity from spirituality and you should be able to recall or explain Des or describe the F assessment tool which we will be talking about in in a few moments so I'd like to start out with a definition of spirituality spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment to self to others to Nature and to the significant or the sacred so it's a broad definition one way to look at it is spirituality is uh a way that people seek a a meaning to life and have a connectedness to something Beyond ourselves and that something could be other people other entities compete to the Divine religiosity is where one is part of a denomination or a or or a tradition and within that that tradition there are specific beliefs rituals behaviors that prescribe how the spirituality or how that religion is done and people um prescribe to that religiosity is a form of spirituality people can be spiritual and not be religious in other words people can be spiritual and not be tied to a specific denomination religion now the Pew Center for research every about 10 years or so does a religious landscape survey of the United States and they they survey about 35,000 people as a representative sample and I thought these this data kind of helps separate a little of the religious versus spirituality when they ask people if if they experience a deep sense of spiritual peace and well beinging at least once a week 65% of the people who are religiously Affiliated you know connected to a denomination um identified having this experience 40% of the people who are unaffiliated also identified having this experience when they ask people if they experience a deep sense of wonder about the universe at least once a week 45% of the religiously Affiliated did experience this whereas 47% 47% of the unaffiliated experience this the unaffiliated are those who do not like I said before not attached to a specific denomination they might for instance believe in God but not any specific prescribed to any specific denomination they might be agnostic in other words not disbelievers but not fully Believers and they might also be atheists these all can kind of fit within that realm spirituality is the umbrella and religion is one of the things that fits under when we just look from that survey and we look across at the landscape almost 90% of American residents believe in God almost 80% of them identify with a specific denomination and over half of the folks who live in the United States pray daily now there are some studies that have shown associations between either religion and or spirituality and different aspects of health so there are some that show better outcomes matter of fact there's I've read a double blind study that um for women for people not women for people who were undergoing surgery and the people who were undergoing surgery didn't know this and the people who were a distance away were given names and asked to pray for people and the people that they prayed for who didn't know they were being prayed for and who these people did not know when they did the analysis the statist they it was statistically significant that those who were prayed for had better health outcomes they recovered from surgery quicker they left the hospital hospitals quicker they were less uh complications these are other areas in which people have associations of spirituality with their health for folks in the United States religion plays an important role in their daily lives and actually 61% of folks say that it's the most important influence in your daily lives when they ask not hospitalized patients 94% of them believe that spiritual health is as important as physical health and 79% believe that spiritual faith can help people with disease now whether that means it's going to cure them or is helping them cope with it either way or and um there probably other ways that folks believe that it plays a role so this is to say that this is what our patients are thinking and we're going to be trained to be looking at one thing but we need to recognize that our patients have more parts to their lives than what we talk to them about in terms of medicine and health care in 1999 Jacob which is the Joint Commission on the accreditation of healthc care organizations they accredited the hospitals in the United States uh set up as one of their accreditation process um requirements that hospitals perform spiritual assessments on every patient and should identify at the minimum the patient's denomination their beliefs and their experim spiritual practices and that the hospitals should make patients have access to pastoral services and let me talk to you about pastoral services for a moment if you're in a hospital and at least in most hospitals and you call the chaplain the chaplain has been trained I use a lot of times in a specific denomination but they have been trained because they are chaplain in a hospital to be able to service people across denominations and they have contacts with folks in other denominations so let's say the person comes is um the chaplain is a Methodist chaplain and the person wants to uh be cath not wants to but they like they're Catholic and they like to have the P the Catholic Sacrament um no that Pastor may not be able to do the exact same thing but they can contact uh Catholic priest for instance to and make the connections for them to come in and receive the sacrament or or have someone else within the authorized within the Catholic church or they can if it's acceptable to the patient they might be able to administer it in you know through their denomination but um maybe not the exact same way the Catholics do so that's to know I want you to know that pastoral services and chaplain services in a hospital are not limited to one specific denomination when we think about the role of medical practice and its relation to spirituality our job is to basically understand the meaning of spirituality in our patients lives because as patients come to us they are diseased they are not comfortable they're they're stressed via their health care in um problem or their medical problem so they have a a disease and some of if they're thinking that spirituality is the most important influence in their life then that usually ends up causing some level of spiritual distress or maybe there's a level of spiritual comfort that will help them through this process so our job is to understand that role and then to help identify if there's distress um and provide ways and resources that they can address that so the spiritual assessment is a way to do that it's a process of gathering that information figuring out people's Val values and their beliefs and what they need and as we kind of help them move forward in their um their care the assessment has things like questions about their religion about their spiritual beliefs and who they might need in this process to help them um deal with their spiritual side so when do we perform a spiritual assessment clearly as I told you from Jacob anybody coming into the hospital anybody getting worked up as a hospitalized patient should have a spiritual assessment when someone's coming into the practice and they're getting their full complete hmp that's a place to do a spiritual assessment just as you finding out all the other um things that they had in their past and the things that are going on in their lives when you talk with people about their Advanced directives when do they want resuscitation and those type of things things um discussions around end of life care or long-term care those are places that spiritual assessment should be performed now we're going to get into the spiritual assessment too now there are multiple tools there's several tools and F which is the one we're going to talk about was developed by Dr Christina pelski Dr pachowski is an internist she does geriatric and palea care right here at GW the MFA she's the director of gwish which is the George Washington Institute of um spiritual and health spirituality and health she um helped she developed this tool and the tool can be used for anyone who's religious or anybody who's spiritual it's not limited to a specific religion and the tool is fair fairly simple it deals with the pneumonic the pneumonic is f i c i CA sorry f f for Faith I for importance or influence C for community and a for address so we'll talk about each individual part so f are questions that get at the one's Faith or belief or meaning and I I do want to say that you have an article to read and it goes into more depth so I'm just going to touch on these so these are some of the questions do you consider yourself spiritual or religious and if so what spiritual beliefs help you to cope with your dis your stress not just your disease but your stress and if you do and as you talk about that what are those spiritual beliefs and ultimately and this is for everybody whether they claim they're spiritual or not what gives your life meaning what's important to you in your life and so that's a very important question I is for importance or influence so what importance does faith or belief have in your life and on a scale of one to five how do you rate that excuse me not one to five zero to five how do you rate that so zero is none obviously five is the most you know what beliefs influenced how you handle stress we talked a little about that in the in the faith part and what role do you think your beliefs play in your Healthcare decision making that's important sometimes we want patients to make decisions or we we're kind of you know to make decisions very quickly and understanding what role Faith might have in this process you know because sometimes the patient will tell you directly I need to pray on it I need to talk to my minister or my Imam about this um and they need more time but your job is to kind of understand that beforehand so this will help you down the road and help the patient C is for Community are you part of a spiritual or religious community you know one can say that they have they're part of a specific denomination and not part of a community maybe they don't go to church um a specific church so they don't have a specific Community even though they prescribe to a specific religion is this of support to you is there a group of people you really love or who are important to you so some let's say one is part of a specific and I'm going to use Church a specific Church let's say a thousand people in the church um but within that there's a small group of people that they more associate with maybe they've been active in in certain projects together or whatever and that group is really important to them so there that is part of their Community maybe it's part of maybe it's their family and within their family there's this there's a smaller spiritual area or group of people that are very important to them in that process A is for address and Care the other part of a is action I'll get to that on the next slide how would you like us as your providers to use this information as we care for you you know is there anyone or any persons who you like to speak with about this so for many people they might say yes I'd like to speak to uh my Rabbi or I'd like to speak to my Minister um you know I'd like to have my prayer group I'd like to talk with my prayer group that might be important maybe I um now that you have this information um you allow me to have certain things that the other part of a is action or address and this is the part that is what are the parts of action that can happen while we're you know they're in this the medical care system that will help the patient in their period of spiritual distress one is we can easily refer them to the chaplain or to pastoral services or even to their own spiritual leader some of these other things are things that we might help facilitate doesn't mean that we will necessarily be the ones to do we can facilitate maybe a place for them to have place or time for specific rituals uh patient might say hey I I'd like to be able to play some music and those type of things it's important to know these like let's say for instance the patient is of a religion where there are a group of people that will come in and they'll chant and they won't even be chanting in English and um you have another roommate of this patient who has a different religion and that that might be kind of disturbing for us so it's important to know this and then see how we can facilitate it so everybody can um can so we can be concerned about the the wellbeing of all the patients that are that are involved in the process what do we do with this information when we get it now that we we've taken this assessment what do we do with this information well one is we put it in the chart the obvious part of the chart to put it in is social history another spot is the the HPI and that is specifically if it's if it's related to the patient's main reason for being in the hospital or being at coming in for this visit so it could be charted simply as Mrs Jones is uh active member of the Methodist Church or maybe their specific Church the first national or First National Methodist Church and there's also a part of a women's prayer group and she would like her Minister and her prayer group to be contacted and allowed to be pray with her during this visit another place is under the treatment plan or the care plan where you can put contact Mrs Jones's Minister and put the name of the minister in the church or you contact pastoral services so they can contact the minister or whatever else and by the way when you tell the patient you're going to do something you need to do it so if you tell them that you're going to contact their Minister then you need to do that if you if you decide that you run into like a family member and the family member says they'll do it and then under the stress that everything that's going on they don't do it it will look like you didn't follow through on what you said so if you say well I'll talk to your child about this or I'll talk to your family about it or I'll talk to the chaplain people about it that's what you need to do okay know that many hospitals have a spiritual care section of the electronic medical record the chart and just like those chaplain look at the medical record to kind of know what's going on for the patient you should look at that to know what's going on for them in their spiritual side so the goals of spiritual assessment are for us to understand and identify the patient spiritual needs and then to help be able to coordinate resources for them during our interactions with them as a clinician note that the spiritual assessment can be the intervention that the patient needs the assessment as their spiritual intervention that in itself can happen just like the medical interview itself can sometimes be therapeutic many times there are effects positive effects of the spiritual assessments Studies have shown that just taking the spiritual assessment improves the patient ability to cope with illness and it improves the the positive effect of the patient clinician relationship J you know a lot of times patients are their diseased they're uncomfortable they think we're only going to deal with the medical part and so they have to figure out in their own quietness how to how to deal with their spiritual aspects having the ability to just bring it out in the open that you bring it forward and that it's it's something that you'll allow or there's a space that will allow for it to be addressed really is helpful for with the patient and it improves it's know shown to improve compliance and basically save you time in the long run so this is something that I learned and I think we should all think about we cure sometimes we relieve often but we Comfort always thank you