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1. 00:00:00TRANSCRIPT OF VIDEO FILE:
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00:00:00BEGIN TRANSCRIPT:
00:00:00[music]
00:00:25Spiritual Assessment in Health Care
00:00:30DOREEN WESTERA No matter what the setting for
health care practice the age of the clients who are the focus for
healthcare services or the health problems and issues that they
may have. Spiritual assessment is an activity that all health care
professionals need to be able to engage in, to more fully
understand the client and to be able to provide holistic at
appropriate care. Spiritual assessment also provides a much
needed avenue to communicate additional information to other
professionals who are involved in the care of clients. Also, the
health care literature indicates that there is a connection
between spiritual well-being and health outcomes and that
spirituality can be an invaluable resource and strength for
clients that can be overlooked if not attended to. Spiritual
assessment is an imperative that is supported by the holistic
nature of healthcare professions by codes of ethics for health
care professionals. And by a growing and prolific body of
knowledge confirming the importance of spirituality to
health. Just, what is spiritual assessment? In its simplest
terms it is a means by which the healthcare professional can
endeavor to understand the spirituality of clients it helps a
professional answer questions such as, what spirituality means
to clients what gives meaning and purpose? What meaning do
they make of the particular health issue or concern with which
they are dealing? What is the quality of their relationships with
others and with a higher power? What are their spiritual beliefs
and practices and so on. How spirituality is described by each
client should determine the specifics of the assessment. For

2. example, if a client describes his or her spirituality as being
intricately connected to a particular religion than the client's
religious beliefs and practices should be included in the
assessment. Through sensitive and appropriate assessment a
comprehensive picture of the client spirituality emerges. Not
only should the way clients describe spirituality be
considered. But also how healthcare professionals themselves
described their own spirituality. This self-awareness as
important as the literature suggests that health professionals
who have a clear evidence sense of their own spirituality are
more capable to assess spirituality and also to provide better
spiritual care. Awareness of one's own spirituality is also
important in facilitating client-centered ethical
assessment. There are many models and tools of spiritual
assessment. Each with its strengths and weaknesses for example
stalls guidelines for spiritual assessment fit jets 7/7 model, the
Gerald's spiritual well-being scale, the fico method of spiritual
assessment and so on. This video program will focus primarily
on stalls guidelines for spiritual assessment. The intent is to
provide you with some questions that are helpful for you to use,
you will also see how a client's response to such questions can
then guide the health professional to provide appropriate
interventions. We will look at this assessment question and
answer process through the voices of two people who are
dealing with significant health problems, Doreen an Ed. Terrene
suffered a spinal cord infarction which resulted in bilateral
paralysis from the waist down, she underwent and lengthily
rehabilitation and was left with a lingering disability. Four
years after the spinal cord infarction, Doreen was
diagnosed with breast cancer and underwent surgery
chemotherapy and radiation. Today, five years later she remains
cancer-free. Ed was injured in a motor vehicle accident he and
his wife were traveling on the highway when his car hit a patch
of black ice. As a result of the accident Ed was left
quadriplegic. He continues a busy life as a writer and a
community activist. Let's look at some questions that are

3. commonly used in the spiritual assessment. It is not intended
that these questions be used in this sequential spiritual history
taking matter rather they are questions that the health
professional can weave into conversations with clients. The
logical place to begin is with the clients concept of
spirituality and how that person spirituality is nurtured and
expressed.
00:05:10What does spirituality mean to you?
00:05:15Doreen Dawe
00:05:15Nurse Educator
00:05:15DOREEN DAWE Spirituality to me refers to umm… a
God or a higher being and my relationship with that higher
being versus religion some people equate the two together quite
often but to me there are two very different items, religion
being a denominational, a set of practices that we have where
spirituality talks about my relationship with… with God.
00:05:45Ed Smith
00:05:45Writer
00:05:45ED SMITH I guess one spirituality is being aware of a
higher power. So in yourself. Uh… Creating force that has
created this creating things over and over again from the
cosmos, from the universe on down to below me and the baby in
the womb. Being aware of that kind of power and such side of
me and which I have very little control over I may have a lot of
control over me.
00:06:20Is spirituality or religion important to you and I if so,
how?
00:06:25DOREEN DAWE The religion part of spirituality is
important to me and that it… it gives me a method and a
means to connect with my spiritual faith and belief either
through church attendance through umm… church family and
friends that will be at church.
00:06:50ED SMITH The ritual is important in the sense that I
don't see myself as a lone entity in the universe. I'm not just me
or other human beings. There's more to it than it gives me a
sense of… of being part of something bigger than me, so I

4. really don't understand don't know anything about but it's
important to me because it gives me a sense of belonging to
something bigger than I think we all need a sense of belonging
to something bigger than ourselves.
00:07:20In what ways do you nurture and express your
spirituality?
00:07:25ED SMITH Nurturing and expression are two different
things to me really nurturing my religion I do by going to
church to worship. Every Sunday morning and try not to fall
asleep during the sermon. And she knew choir and beyond to a
men's club and talking to friends and all that sort of thing or
religion very much bound of my daily life and life of my friends
and my family and so on. So expressing to store everything I
do.
00:07:55DOREEN DAWE I feel closer when I get into the… the
bigness of nature that I really feel how unique things are and
how I guess it I guess I feel like how can this be created by
anything but a… but a higher being and… and God. So I guess
nature is one way that I… I would I feel that helps nurture my…
my belief, my faith and I also umm… do a bit of art and…
00:08:30[sil.]
00:08:35DOREEN DAWE Umm… I also nurtured through my
relationship with people and this relationship that I have with
God I, the ways in which I guess I relate to God would be
through prayer meditation and Bible study.
00:08:50What gives you a sense of meaning and purpose?
00:08:55ED SMITH What gives my life meaning and purpose is
waking up every day and say, what really fills am I going to do
today you know, the day is not gonna be wasted no sorry, the
most that gonna be wasted I wanna make sure the years are
wasted, I've gonna have that (inaudible)done, I've gonna have
my columns done, I'm going to call that person I shall call last
week and say, how he's making out and this person is in a
hospital that makes me sure I dropped down there et cetera… et
cetera and everything I do is got to have some meaning and
that's what gives my life meaning and purpose. Helping my

5. friends my neighbors and do things that I hope will be helpful
to other people online.
00:09:35DOREEN DAWE I find relationships are really
important to me and my friends. Umm… For me life is because
of my faith and what I believe umm… and I guess what I
understand from the Bible, how we should live, I… my life I
guess is part of trying to live that way through being helpful to
others being kind to others having fellowship with people and I
guess so my life centers a lot around my relationships with
family with friends and I guess always what can I do for
people.
00:10:15DOREEN WESTERA With these four simple questions
the health professional can determine much about the
spirituality of the client both Doreen and Ed mentioned God or
a higher power in their concept of spirituality. A bit during
talks more specifically about her relationship with God as being
particularly significant. Both mentioned belonging to a faith
community as important in the nurturing of their
spirituality. But, they also assert that relationships with family
and friends are central. Doreen also mentions artwork in nature
as being specific ways to nurture her spirituality. Ed sees every
part of his life as connected to his spirituality, attesting to the
integrative nature of spirituality. Religion is important to both
and they both mentioned various spiritual or religious practices
that they engage in, such as church attendance, participation in
church groups, prayer, meditation and studying the Bible. This
religiosity would be important for the health care professional
to note. As it has implications for specific interventions that can
be part of spiritual care. Not all people will express a
connection with a higher power God or religion and this should
become evident by asking these four questions, in this case
subsequent assessment questions and comments could be
individually tailored to suit the clients particular worldview.
00:11:45Does God or a higher power function in your life and if
so, how?
00:11:50ED SMITH God is very present force in my life in the

6. sense that I'm aware of that higher power, umm… where as not
just me Ed Smith or even my family if there's just more. I don't
think God interferes in my life, God doesn't do my action
whatsoever, I don't blame God for what happened at all. We live
with the results and the consequences of decisions we make and
thus that.
00:12:15How would you describe God?
00:12:15DOREEN DAWE My relationship with God is a day to
day, moment by moment… a thing I guess in that. I… I see God
as a core my spirituality in God is core of who I am as a person
and I… I seek through that relationship I guess the way I am as
a person nowhere relate to others. So I use God and I guess the
Bible as a way of relating on Earth and as a guide I guess to
how I relate to others the things that I choose to do, how I live
my life… God to me is a, I guess a supreme being and my
understanding of God is… is a god of love. He's God of
forgiveness, he's the God of grace and… and I guess a god of
caring.
00:13:20ED SMITH I have no idea of what god is like, none
whatsoever. I go to worship and I feel good when I am
worshiping. And I rely… rely a deal uh… my church family for
that, they lift me up right away, I'm upheld by their beliefs and
their phase and so on.
00:13:40DOREEN WESTERA We see that God is a part of the
lives of both Doreen and Ed, although Doreen is more
specific and her description of God when clients put God in the
conversation so to speak. Then there is a logical progression to
providing spiritual care. So that God is part of that care but then
the second question becomes important. What is that clients
perception of God. Doreen's concept of God is a positive one.
However some clients may describe God is judgmental or
inclined to punish them for wrongdoing. It is important for
health professionals to note whether God is perceived as a
strength giving source or as someone or something that is
perceived to negatively impact the person's life. God is helper
or God is judge. For people who do not believe in God or a

7. Supreme Being inquiring as to what prime values may guide
their lives might be an order such as, what is the most important
thing or person that gives your life meaning and purpose?
00:14:45What is your source of strength and hope?
00:14:45ED SMITH Don't mean this I only modest
store egotistical or anything but by strengths in me that's where
it has to be if it's not from inside, I'm not gonna have any that's
my… my feeling anyway. I developed that in line with my
family, my wife, my family. Uh… Of extremely supportive right
from day one. Uh… My church family very… very supportive,
very accommodating all the stuff and everything. So, all kinds
of sources of strength that way but still ultimately come from
down here.
00:15:25DOREEN DAWE My source of strength and hope
is… is through God, my belief in God and when I have major
issue or issues or trials come uh… I guess in my path or my day
to day life it through my prayer and belief in God and I guess
eternal protection that I pray and I get my support and hope
through that through my prayer and meditation when I was
going through my health issues and I would have a few life-
threatening events during those health issues. I would pray and I
would read scriptures which would help call me through those
crises. My other sources of strength will come through my
immediate family umm… and my very close friends and my
church family they threw all these different relationships. I… I
guess any kind of major event… events or things that
happened to me… to me in my life. Uh… These are people that
I guess come together and talk through their encouragement and
support help me through.
00:16:45DOREEN WESTERA Note that both Doreen and Ed
mentioned family friends and their church community as
sources of support. These are relationships that are traditionally
mutual and based on trust. Doreen also mentions God and says
that when her life was endangered at the height of her health
crisis, prayer and scripture provided support for her. You can
see from this comment that her anxiety was diminished by

8. religious practices. This indicates the importance for health
professionals to assess whether such practices are a support for
clients. The assessment may reveal that some clients have little
support in their lives and hopelessness may be the norm. In such
cases the spiritual needs of love and relatedness and hope. May
become the focus of the health professionals attention. Other
questions to determine sources of support and hope include who
do you turn to for help if you need it. How did they help? And
who are the most important people to you.
00:17:50Are there any religious or spiritual practices that are
important to you?
00:17:55ED SMITH I do like going to church for the most
part. I like seeing my crowd again that I've seen for a week.
Uh… I like seeing same require. I enjoy going to the men's
club, Tushman's club. Seems like that, and there are other
things done little all the time projection so on. So, I like be a
part of… so I… I very rarely get a chance read very much. I
listen more I listen to books on tape and that sort of thing when
I'm going to sleep on a time. That's like a most of my writing
from and most of my my reading from. Uh… Meditation I don't
meditate very much I don't have to time to mediate.
00:18:40Is prayer helpful to you? Id so, what happens when you
pray?
00:18:40DOREEN DAWE Prayer is an important part of my
daily life. Uh… Prayer and meditation quiet time. When I pray
it, I guess through prayer I… I… I talk about my issues and
there's a calmness that I get through sharing these issues and
sometimes answers when I cry. When I have uh… challenges
that I can't tackle or whatever I… I have my. I gained strength
when I pray and umm… I guess it keeps me I guess somewhat
stable.
00:19:20What religious or spiritual belief and values do you
have that contribute to your sense of well-being?
00:19:20ED SMITH If you say of being a church on your hands
and knees their hands folded dread but and eyes shut, no, I don't
see that as a prairie time I'm saying about the spiritual. Saying

9. about uh… God supreme being saying about well, I can do to
help somebody uh… that I make sure how to go about doing it, I
think all that is a form of prayer. I… I do play only prayer I
pray is Lord for, so I don't have a lot of time for prayer as we
normally understand it my prayers very personal to my stuff. I
think one though is just occurred to me that I have about God I
think helps me a lot as I don't believe him not got punishment. I
believe in God of love. So that what I do in my life doesn't
affect me one way or the other if I'm be helped to a neighbor.
I'm loving my neighbor to the best I can. From a family and a
friends. Such my religion. Somebody who believes that there's a
plan for us. Uh… I believe perhaps a little more broadly. So
there's this says, you are a child of the universe and the
universe is unfolding as it should which perhaps in my case it is
except if is unfolding as it should for me I'd rather it unfolded
in the other direction I prefer that it'd be way or this is God's
plan for me. I prefer to be another plan because I don't get a
choice on those things either I seen things just happen by
saintly life happens and you live with what happens, I can do
the best you can with it.
00:21:00DOREEN DAWE Through my… my beliefs I… I guess
I… I receive comfort and strength and hope, we pray we get
support and hope and sometimes things happen instantly and
sometimes we have to go through life as anybody who can
happen to anybody and whether you have a belief or not and
we'll end by going through things in life. Depending on how we
view it we can become stronger and grow through it and I feel
like my experiences because of my faith. Even though I… I will
I would like to be able to run again like I always ran but… but
I'm not doing that because of my faith I've been able to… to
achieve… I call a very good quality of life to I was able to get
back to work and I am physically active within the limits of
what I can do. Uh… But it was my faith that was my what
grounded me through all of these… this whole experience this
journey that I've been through from… from these major health
event.

10. 00:22:10What do you see as the connection between your
religious or spiritual beliefs and your level of health?
00:22:15DOREEN DAWE I feel that well I had to uh… journey
through these illnesses that the my inner being my… my
emotional strength has been, I guess protected like I feel as
strong as ever emotionally. Today I consider myself a very
healthy person in spite of my mind paralysis and in spite of my
cancer. I do, I guess it doesn't inhibit… inhibit me in any way
within myself except that I get tired easily or because I… I can't
do things I don't have the muscle function and normally have.
00:23:00ED SMITH I have fairly healthy I think I have many
problem I say, went onto doctor twice three times in the last
five years so. And I think that's probably because I don't spend
a lot of time worrying about what's going to happen in the
future but Sky got in store for me now if I live my life
carefully and have a look afterwards how best I can. I've got
people looking after me hope it's fine I can be, so I guess that
leads to good health good mental health anyway.
00:23:30DOREEN WESTERA The questions here explore
religious or spiritual practices, beliefs and values and their
potential impact on a person's health. Ed mentions his church
activities. He also mentions that he listens to books on
tape. This information is important as it hints at Bibli of
therapy or the use of books in a therapeutic way might be an
appropriate intervention for him. Both pray but note that each
sees prayer in a different way. Stole points out that religious
practices may not always be helpful. For example, health
professionals should note when clients verbalize the use of
prayer as a form of magic to make everything better. Asking not
only if the client prays but also what happens when he or she
prays. Is critical to exploring further the place of prayer in the
person's life. Some responses bake for further exploration. For
example, when Ed expresses a belief that life happens and you
live with what happens and you do the best you can with it. As a
health professional I would be curious about how this belief has
impacted on his coping and even his thriving in the midst of

11. health challenges. Also, when Doreen mentions that her faith
has been the grounding force in getting her through the multiple
health crisis she experienced. I would want to explore this
further. Drawing forth spirituality as a contributing factor to her
resilience. Identifying the client spiritual or religious beliefs
and practices is important but critical to the care of clients is
knowing whether these have changed as a result of the health
crisis.
00:25:20Has what happened to you made any difference in your
feeling about God or the practice of your faith?
00:25:20DOREEN DAWE My illnesses Initially affected my
ability to I guess. Uh… Go to church. So to speak and to be part
of the church family to get out so it changed my… my practice
in the sense that it became, my spiritual practice came to me
versus me going to it in the, in that I guess the prayer, the
meditation and the Bible Study became a big part of my
personal life on a one-to-one basis, so it… it probably
changed the whole experience is probably changed me in the
sense of my own dedication to… to practice on a… on a one-to-
one one basis with… with God, but I guess I still feel like God
is with me through out my experiences and when I go
through, so really I guess my view of God really hasn't changed
as a result of my experiences.
00:26:25ED SMITH When this happened it made no difference
at all to me or my face or my beliefs or anything because large I
didn't blame God my spiritual practices are the same, towards
the church, towards is I can go out and acquire laugh so they
got to come downstairs floors or just.
00:26:40If you think specifically in term of what happened to
you, had there been any meaning that you have developed in
these events?
00:26:45ED SMITH One of the important things about Chaplin's
result of all this and that gives my life a great deal of meaning
is having had an impact on I hope so Healthcare System, the
book I wrote from the ashes of my dreams is used by three
universities now that I know of in the reading materials and

12. their tax I speak to one group once every year the book itself
went worldwide sold came a kinda Canadian bestseller over and
over again and the reactions to that were fantastic. So that
makes a tremendous difference to me to my passion but I've
done there.
00:27:25DOREEN DAWE I feel that the going through the
experience has been umm… strengthening and not always
understanding why but… but it changes my view of life and…
and the way I see people like the when I see people suffering I
can go to a level that I was not able to go before I had this event
happened to me in my life but I think it can also broaden my
ability to feel compassion for people in who've had things
happen to them they have not been similar to what's happened to
me and that I realize when people have things going on in their
lives there's a lot more to it and we really need to be open to…
to be kind and to help other people and to try and walk in their
shoes try and help them or are there from where they're at where
they're at in their life in there what they're going through I
bring in some of the classes that I teach one course in
particular. I bring a lot of my experiences firsthand to the
classroom and I find that sometimes well it's vulnerable while
I'm sharing very intimate parts of my… my life with students I
have found very helpful enriching my teaching because I… I
know from their attention and the feedback that they give me
that it really made them see and appreciate what it's like to be
patient in the bed and that to they have to give care to it so I
share this with students to help them I guess realize how much
they can help others to develop to their full potential in
recovering through any kind of situation.
00:29:10DOREEN WESTERA Note that both Doreen and
Ed had adjustments at varying points in time with respect to
their religious practices because of their health status. Ed's
comments about not blaming God for what happened to him is
not always true for other clients as stole says, we seek answers
in the face of mystery. When clients ask why? Or why me or
why is this happening now? They are asking questions of

13. meaning. Such verbalizations can the health professional to
explore such questions in more depth or perhaps to refer the
client to a pastoral care professional. If the client chooses this
route as you can see both Ed and Doreen are very resilient. We
have seen in their comments set spirituality. A factor known to
contribute to resilience has been a major factor in the
development of their resilience. This provides additional
rationale for spiritual assessment. This program has highlighted
some questions that health professionals can use in conducting a
spiritual assessment as well as some key points about spiritual
assessment. Obviously the two people highlighted in this
program are responding to the questions that appear on the
screen in an actual interaction with a client responses should be
explored further as a health professional reflects expressed or
unexpressive feelings gives empathetic responses and so on. As
healthcare professionals we listen to client stories in the process
we may be instrumental in helping them to find the language to
express themselves. Whether we assess the spiritual dimension
of a client in an interview format or whether we ask a question
here or there in response to some casual queue from the client
the main point is that we do so on a continual basis sometimes
we do not even have to ask questions as clients will initiate
discussion about the spiritual issues that concern them but if we
do not address the spiritual dimension, spiritual needs that the
client may be grappling with maybe missed. Spiritual
assessment is a key to identifying such and the gate to helping
clients deal with them only then are we
providing comprehensive and ethical health care.
00:31:45[credits]
00:32:15END TRANSCRIPT