1 4 Use of Spirituality in Nursing Student’s Full Name Institutional Affiliation Course Full Name Instructor’s Full Name Date Illness affects both spiritual, mental, and the physical well-being and health of individuals. Spiritual care positively impacts the person' stress responses and there spiritual well-being, i.e., the ability to balance the physical, psycho-social, and spiritual elements of life. It also involves a sense of integrity, excellence, and interpersonal relationships. During nursing care, spiritual assessment plays an essential role since it makes it easier to determine whether any belief could impact the patient's health (J. Flowers Health Institute, 2022). Various formal spiritual evaluation tools help healthcare providers identify the spiritual needs of patients. The first tool is the HOPE evaluation tool which assists in the identification of the personal sources of hope and meaning. It also helps in finding out about spirituality and practices. The tool assesses hope, strength, comfort, and how the clients deal with challenging times. It helps in finding out whether the client is part of the religious community and how it is helping; it reveals the person's spiritual beliefs, the practices to determine what is most helpful, and the available spiritual resources. The other tool is the spiritual distress assessment tool (SDAT). Distress is a common impact of illness and it also occurs when there is the presence of unmet needs that results in disturbances in the individual's spiritual conditions. The tool helps uncover unmet spiritual needs and the possibility of the existing spiritual distress that affects the spiritual well-being of an individual (Puchalski, 2021). The outcome that shows a high degree of unmet spiritual needs indicates the greater level of disturbances in the spiritual state and spiritual distress the client encounters. The next tool is the FICA spirituality history tool. The word FICA is an abbreviation used to present the Faith and belief, the importance, community, and addressing in care. Faith together with the belief involve determining the client's spiritual beliefs and what they consider to be bringing the meaning of life to them. The importance involves the analysis or finding out the application of the spiritual beliefs are utilized in coping with the disease. The community involves learning how the clients participate in the spiritual or religious community (J. Flowers Health Institute, 2022). The address in care is the process of asking the client how they prefer their spiritual issues to be addressed by the healthcare providers during delivery of healthcare services. The FICA tool is utilized for the clinical evaluation of spirituality. It is used to guide the spiritual history and this is achieved through framing the questions instead of depending on the checklist. The FICA tool helps guide the conversation between providers and clients. The tool offers the best healthc.

1. 1
4
Use of Spirituality in Nursing
Student’s Full Name
Institutional Affiliation
Course Full Name
Instructor’s Full Name
Date
Illness affects both spiritual, mental, and the physical
well-being and health of individuals. Spiritual care positively
impacts the person' stress responses and there spiritual well-
being, i.e., the ability to balance the physical, psycho-social,
and spiritual elements of life. It also involves a sense of
integrity, excellence, and interpersonal relationships. During
nursing care, spiritual assessment plays an essential role since it
makes it easier to determine whether any belief could impact
the patient's health (J. Flowers Health Institute, 2022). Various
formal spiritual evaluation tools help healthcare providers
identify the spiritual needs of patients.
The first tool is the HOPE evaluation tool which assists in
the identification of the personal sources of hope and meaning.
It also helps in finding out about spirituality and practices. The
tool assesses hope, strength, comfort, and how the clients deal
with challenging times. It helps in finding out whether the
client is part of the religious community and how it is helping;
it reveals the person's spiritual beliefs, the practices to

2. determine what is most helpful, and the available spiritual
resources.
The other tool is the spiritual distress assessment tool
(SDAT). Distress is a common impact of illness and it also
occurs when there is the presence of unmet needs that results in
disturbances in the individual's spiritual conditions. The tool
helps uncover unmet spiritual needs and the possibility of the
existing spiritual distress that affects the spiritual well-being of
an individual (Puchalski, 2021). The outcome that shows a high
degree of unmet spiritual needs indicates the greater level of
disturbances in the spiritual state and spiritual distress the
client encounters.
The next tool is the FICA spirituality history tool. The
word FICA is an abbreviation used to present the Faith and
belief, the importance, community, and addressing in care. Faith
together with the belief involve determining the client's
spiritual beliefs and what they consider to be bringing the
meaning of life to them. The importance involves the analysis
or finding out the application of the spiritual beliefs are utilized
in coping with the disease. The community involves learning
how the clients participate in the spiritual or religious
community (J. Flowers Health Institute, 2022). The address in
care is the process of asking the client how they prefer their
spiritual issues to be addressed by the healthcare providers
during delivery of healthcare services.
The FICA tool is utilized for the clinical evaluation of
spirituality. It is used to guide the spiritual history and this is
achieved through framing the questions instead of depending on
the checklist. The FICA tool helps guide the conversation
between providers and clients. The tool offers the best
healthcare to a client (D'Souza & Astrow, 2020). The
information collected from the assessment is vital in directing
the treatment and the recovery process.
References

3. D’Souza, K., & Astrow, A. B. (2020). Patient spirituality as a
component of supportive care: Assessment and intervention.
Current Treatment Options in Oncology,
21(2), 1-10.
J. Flowers Health Institute. (2022). Spiritual Assessment and
Counsel in Healthcare. Retrieved from
https://jflowershealth.com/spiritual-assessment-and-counsel/
Puchalski, C. (2021). Spiritual care in health care: Guideline,
models, spiritual assessment and the use of the© FICA Spiritual
History Tool. In
Spiritual needs in research and practice (pp. 27-45).
Palgrave Macmillan, Cham.
The Nursing Process in Practice
Formulating a Family Care Plan
Mr. R., an 80-year-old retired pipe fitter, lives with his wife; he
has had diabetes for 15 years. Although his diabetes has been
moderately controlled with diet and daily insulin, some
complications have occurred. He experiences arteriosclerotic
cardiovascular disease and peripheral neuropathy, and he
recently spent 2 months in the hospital due to circulatory
problems in his left leg. The progressive deterioration of
circulation resulted in an amputation below the knee. Although
fitting him with a prosthesis would be possible, he has refused
this and is wheelchair bound. Mr. R. currently depends on
someone else to help with transfers. He is cranky, irritable, and
demanding to almost everyone. He recently has stopped
following his diabetes regimen because he claims, “It just
doesn't matter anymore.”
Mr. R.'s wife, Doris, is a 74-year-old woman who has been a
homemaker most of her life. She has always been the
“watchdog” for Mr. R.'s health. Mostly through her changes in
food preparation and her lifestyle adjustments, Mr. R.'s diabetes
has been managed. She schedules his physician appointments,

4. buys his medical supplies, and administers his insulin. He is
now refusing to accept her help, and she is anxious and angry
about his behavior. They frequently have arguments, after which
Mrs. R. retreats to her room.
Mr. and Mrs. R. have three children and four grandchildren who
live in the same city. The eldest daughter, Patricia, calls or
stops by about once a week. The other children, Tom and Ellen,
are busy with their families and see their parents mostly on
holidays; they have very little communication with Patricia or
their parents. When the children do come to visit, Doris tries to
put on a happy expression and pretend that everything is going
well to avoid worrying them. She is also embarrassed about Mr.
R.'s behavior and does not want anyone from outside the family
to see what is happening.
On her initial home visit to this family, the community health
nurse notes that Mr. R. appears somewhat drowsy and unkempt.
Mrs. R. looks anxious and tired, her skin color is slightly ashen,
and she has circles under her eyes. When the nurse asks them
what they hope to get out of the nursing visits, Mrs. R. says,
“Actually, you don't need to keep visiting. In a few weeks we'll
be back to normal and doing fine.”
Based on a thorough assessment of the family, the community
health nurse may begin to develop a mutually acceptable plan of
care with the family.
Assessment
In the initial interview, the community health nurse completes a
genogram and an eco-map with the family (see Figures 13-3 and
13-4). After the second family interview, the nurse also
completes a family map that describes the members’
interactions with each other (see Figure 13-2). A family guide
to help structure a family assessment is presented in Box 13-7.
Completing the genogram helps break the ice to get the family
to talk about their situation. The genogram provides a safe and
thought-provoking way for Mrs. R. to supply appropriate
information about the situation. During this process, the nurse
obtains information about other family members, their general

5. levels of functioning, and the possibility of acting as resources.
She identifies family members’ patterns of closeness and
distance.
Box 13-7 Family Assessment Guide
I Identifying Data
Name:
_____________________________________________________
______________________________________________
Address:
_____________________________________________________
_____________________________________________
Phone
number(s):____________________________________________
_________________________________________________
Household members (relationship, gender, age, occupation,
education):___________________________________________
_________
Financial data (sources of income, financial assistance, medical
care;
expenditures):_________________________________________
__
Ethnicity:
_____________________________________________________
_____________________________________________
Religion:
_____________________________________________________
_____________________________________________
Identified
client(s):_____________________________________________
_________________________________________________
Source of referral and reason:
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________

6. _____________________________________________________
_____________________________________________________
_____________________________________
II Genogram
Include household members, extended family, and significant
others
Age or date of birth, occupation, geographical location,
illnesses, health problems, major events
Triangles and characteristics of relationships
III Individual Health Needs (for each household family member)
Identified health problems or concerns:
_____________________________________________________
___________________________
Medical diagnoses:
_____________________________________________________
________________________________________
Recent surgery or hospitalizations:
_____________________________________________________
____________________________
Medications and immunizations:
_____________________________________________________
____________________________
Physical assessment data:
_____________________________________________________
_________________________________
Emotional and cognitive functioning:
_____________________________________________________
__________________________
Coping:
_____________________________________________________
________________________________________________
Sources of medical and dental care:
_____________________________________________________
_______________________
Health screening practices:
_____________________________________________________

7. _______________________________
IV Interpersonal Needs
Identified subsystems and
dyads:_______________________________________________
_________________________________
Prenatal care needed:
_____________________________________________________
____________________________________
Parent–child
interactions:__________________________________________
_____________________________________________
Spousal
relationships:_________________________________________
________________________________________________
Sibling
relationships:_________________________________________
________________________________________________
Concerns about older
members:_____________________________________________
______________________________________
Caring for other dependent
members:_____________________________________________
___________________________________
Significant
others:_______________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_________________________________________________
V Family Needs
A. Developmental
Children and
ages:________________________________________________
____________________________________________
Responsibilities for other members:

8. _____________________________________________________
________________________
Recent additions or loss of
members:_____________________________________________
________________________________
Other major normative transitions occurring
now:_________________________________________________
___________________
Transitions that are out of sequence or
delayed:______________________________________________
_______________________
Tasks that need to be
accomplished:_________________________________________
______________________________________
Daily health-promotion practices for nutrition, sleep, leisure,
child care, hygiene, socialization, transmission of norms and
values:
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_________________
Family planning
used:________________________________________________
_______________________________________
B. Loss or Illness
Nonnormative events or
illnesses:_____________________________________________
_________________________________
Reactions and perceptions of ability to
cope:________________________________________________
________________________
Coping behaviors used by individuals and family
unit:_________________________________________________
________________
Meaning to the

9. family:_______________________________________________
__________________________________________
Adjustments family has
made:________________________________________________
________________________________
Roles and tasks being assumed by
members:_____________________________________________
____________________________
Any one individual bearing most of
responsibility:_________________________________________
____________________________
Family idea of alternative coping behaviors
available:_____________________________________________
_______________________
Level of anxiety now and
usually:______________________________________________
___________________________________
C. Resources and Support
General level of resources and economic exchange with
community:___________________________________________
______________
External sources of instrumental support (money, home aides,
transportation, medicines,
etc.):____________________________________
Internal sources of instrumental support (available from family
members):____________________________________________
_______
External sources of affective support (emotional and social
support, help with problem
solving):_____________________________________
Internal sources of affective support (who in family is most
helpful to whom?):
_________________________________________________
Family more open or closed to
outside?______________________________________________
________________________________

10. Family willing to use external sources of
support?______________________________________________
_________________________
D. Environment
Type of
dwelling:_____________________________________________
___________________________________________________
Number of rooms, bathrooms, stairs; refrigeration,
cooking:_____________________________________________
__________________
Water and
sewage:______________________________________________
________________________________________________
Sleeping
arrangements:_________________________________________
____________________________________________________
Types of jobs held by
members:_____________________________________________
__________________________________________
Exposure to hazardous conditions at
job:_________________________________________________
__________________________
Level of safety in the
neighborhood:_________________________________________
___________________________________________
Level of safety in
household:____________________________________________
____________________________________________
Attitudes toward involvement in
community:___________________________________________
________________________________
Compliance with rules and laws of
society:______________________________________________
______________________
How are values similar to and different from those of the
immediate social

11. environment?_____________________________________
E. Internal Dynamics
Roles of family members clearly
defined?______________________________________________
________________________
Where do authority and decision making
rest?_________________________________________________
____________________
Subsystems and
members:_____________________________________________
_____________________________________
Hierarchies, coalitions, and
boundaries:___________________________________________
_____________________________
Typical patterns of
interaction:___________________________________________
____________________________________
Communication, including verbal and
nonverbal:____________________________________________
______________________
Expression of affection, anger, anxiety, support,
etc.:_________________________________________________
_______________
Problem-solving
style:________________________________________________
________________________________________
Degree of cohesiveness and loyalty to family
members:_____________________________________________
_____________________________________________________
_____________________________________________________
____________________
Conflict
management:__________________________________________
______________________________________________
_____________________________________________________
_____________________________________________________

12. VI Analysis
Identification of family
style:________________________________________________
__________________________________
Identification of family
strengths:_____________________________________________
________________________________
Identification of family
functioning:___________________________________________
_________________________________
What are needs identified by family?
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_________________
What are needs identified by community/public health
nurse?_______________________________________________
_____________________________________________________
_____________________________________________________
_____