This post is going to be a little bit of inside baseball but I think it can be followed by those with an interest, even if you are not employed in the work of a hospital chaplain or a hospice chaplain or corporate chaplain or law enforcement chaplain. I’m going to write from my vantage point of a hospital chaplain and will trust that you can make the application to other chaplaincy roles.
A spiritual assessment is a tool that a hospital chaplain uses when visiting patients. The objective of the chaplain is to evaluate what kind of spiritual support a patient may need or welcome, and the assessment is the tool used to help determine that.
When I say “tool,” I mean something that a chaplain carries mentally to help guide him or her in their conversation with the patient. Generally speaking and in my own experience, the chaplain does not carry a clip board or tablet to facilitate a survey or ask 20 questions of the patient.
Our approach as chaplains is a very relaxed one with a hope to connect on a relational level. We do not approach in any type of aggressive manner that could possibly imply urgency or demand attention. We are chaplains. We are men and women who are in this role because our hearts are gifted in pastoral care, not in the roles of an evangelist or prophet.
So back to the discussion of the spiritual assessment as a tool…most chaplains have been trained in using either one of two popular assessments known as the FICA model or the HOPE model. Both make use of the acronym format which makes it easier to remember when we are in the patient’s room.
FICA stands for the words, Faith, Importance, Community, and Address Care Plan. HOPE stands for the reminder of Source of Hope, Organized Religion, Personal Spirituality or Practices, and Effects on Condition.
If you are employed as a chaplain you are familiar with these two assessment models or have at least studied them in detail somewhere along your training journey. So I am not going to go into any further explanations with these two models. However, I would like to share with you a model that I came up with for myself that I think is simpler and more flexible.
The model that I wish to share with you is CPR. Yes, just like the abbreviation for cardiopulmonary resuscitation. Why? Because most times we are doing the work of spiritual resuscitation. We aim to try to draw out of the patient what whatever spiritual foundation or strength they may have inside them to help them in their own healing process and well-being as the deal with their health problems.
Here’s what CPR stands for in the spiritual assessment:
C — Chaplain. Coping. Care.
P — People Support. Processing. Practices.
R — Religious Support. Resiliency. Resources.
In this model, I have a cardiopulmonary resuscitation image in my mind that equates the heart beating again to having spiritual strength again. There are three words assigned to each of the CPR letters because they are levels that the assessment may potentially get to. So allow me to walk you through how I use this assessment.
Chaplain — The assessment begins with identifying myself at the patient’s door and inside their room as one of the hospital chaplains. The patient must understand that my role there is as hospital clergy and that I am available to them for spiritual support. Often at this point a patient will inform me if I am welcomed or what their spiritual position is, and I’ll follow that lead.
Coping — I ask a diagnostic question: How are you coping? Sometimes I may ask, How are your spirits? These diagnostic questions are designed to encourage a thoughtful response from the patient. It may go without saying but if I find the patient to be severely ill or medicated or in a deep sleep, my visit is pretty much over before it starts. If family are present, I may visit with them briefly than exit.
Care — If a patient can’t be engaged with the diagnostic question on coping or how’s your spirit, I will ask something about their care, like Do you feel like you are making progress or doing better?
People Support — If it’s not clear I may ask about the patient’s family. This question may begin with Are you from this area? or Do you have family in town here? If they have family nearby or a close friend or at least close to a family by phone or internet, I always try to at least affirm that.
Processing — This is a second chance to ask the diagnostic coping questions if they didn’t answer it earlier. I may say, So do you feel like your family/friends help you process this health issue? The next point leads out of this one, too.
Practices — Here I am interested in knowing if they practice any type of activity that helps them cope and process their stress or anxiety. I’m most interested in religious practices but here I’m interested in learning how they have dealt with challenges before.
Religious Support — It is important to me to learn if they have any kind of religious support, like a church membership, a religious practice, or a personal faith in God. If I don’t know I will usually ask, Do you have any kind of church background or religious beliefs? This almost always let’s me know if I can support them and how I can support them.
Resiliency — I will make the connection between their religious support and its positive impact upon their resiliency in dealing with their health condition. If they have no religious support, I may refer to their family support as a positive impact upon their resiliency in dealing with their health condition. Sometimes if the patient has no religious involvement or interest, my visit will focus on encouraging resiliency.
Resources — The final thing in assessing a patient’s spirituality for support of their healing and restoration to health, is to simply ask myself if their are any resources I can offer or point them toward. Sometimes patients ask for a Bible, which is a resource I can get for them. Perhaps the most popular resource I leave is when a Christian patient talks about their practice of prayer and desire for a better or more frequent prayer practice. It’s not a traditional resource but I leave them some encouragement and tips for that expressed need.
I should mention that the CPR model is only a tool that helps me remember some key points for the patient’s spiritual assessment and its subsequent outcome. Rarely does a visit follow exactly like I laid out above. Sometimes a visit may jump around from point to point without any order because I will follow the patient’s conversation.
There are generally two things that hold true to nearly every visit and that is how the assessment starts and how the assessment ends. I haven’t mentioned yet how I typically conclude the spiritual assessment but I nearly always begin with the diagnostic question on coping.
So, how do I usually conclude the assessment? I typically conclude the spiritual assessment and my visit by mentioning prayer. Prayer, I have found, is a very harmless topic for all Christian faiths and differing religious systems. All religions practice some form of prayer. If a patient has identified themselves as an atheist or some type of pagan, then I may not conclude this way.
Otherwise, when the moment to end the visit has come I will say something like this, Well, I will be praying for you. Then I will listen to how they respond or react. If it’s a positive response or even unclear I will add, Would you like for me to pray with you now real quick or would you like me to just keep you in prayer?
If the patient says, Keep me in prayer, I will affirm that I will exit the room. If the patient says, You can pray with me now. Then I’ll pray with the patient and then exit the room. Every now and then a patient will say, Both, can you do both? Of course that is always good to hear.
This question on prayer is something I learned from another chaplain and later from a hospice chaplain, and is something that I have come to appreciate using as a conclusion in my visits.