Revised January 01, 2004
From the Joint Commission Website: Spiritual Assessment
Q: Does the Joint Commission specify what needs to be included in a spiritual assessment?
A: Spiritual assessment should, at a minimum, determine the patient’s denomination, beliefs, and what spiritual practices are important to the patient. This information would assist in determining the impact of spirituality, if any, on the care/services being provided and will identify if any further assessment is needed.
The standards require organizations to define the content and scope of spiritual and other assessments and the qualifications of the individual(s) performing the assessment.
Examples of elements that could be but are not required in a spiritual assessment include the following questions directed to the patient or his/her family:
Who or what provides the patient with strength and hope?
Does the patient use prayer in their life?
How does the patient express their spirituality?
How would the patient describe their philosophy of life?
What type of spiritual/religious support does the patient desire?
What is the name of the patient’s clergy, ministers, chaplains, pastor, rabbi?
What does suffering mean to the patient?
What does dying mean to the patient?
What are the patient’s spiritual goals?
Is there a role of church/synagogue in the patient’s life?
How does your faith help the patient cope with illness?
How does the patient keep going day after day?
What helps the patient get through this health care experience?
How has illness affected the patient and his/her family?
Copyright 2008 The Joint Commission. All rights reserved.
Patients Desire Prayer in the Hospital
Specifically regarding prayer, 75% to 82% of Americans claim to pray regularly and/or believe in the healing power of prayer (2,3) and without specifically asking them, it is easy to overlook something that is important to them. Being hospitalized is disorienting and foreign to most people. I inform my patients of their option to take a sleeping pill while they’re in the hospital. Most patients would not think to ask for it until it is too late simply because they do not know that it is an option. I do not insist that they take a sleeping pill but I want them to know that it is offered. In the same way, most patients would not think to ask for prayer because they do not know that it is offered; that prayer with their doctor is an option. Patients are free to refuse a sleeping pill and they are free to refuse prayer if it is not something that they feel will be helpful.
(2) 75% of 35,000 Americans age 18 or older reported that they pray at least once per week, with 58% praying at least once per day.
Data from the Pew Forum U.S. Religious Landscape Survey conducted May 8 to Aug. 13, 2007 among more than 35,000 Americans age 18 and older; released in 2008.
(3) A Time/CNN Poll found that 82% of Americans believed in the healing power of prayer. Time Magazine. June 24, 1996: 147:19.
How Do You Pray for Patients?
A patient must feel free to say “no” without feeling that a refusal will jeopardize their care or our doctor-patient relationship.
My “spiritual history” consists of two questions:
1. Were you raised with a faith or religion?
2. Are you practicing a faith now?
Listening to their words, tone and observing their facial expressions allows me to estimate their spiritual journey and I may ask further questions if I am unsure.
Because many people have been hurt by organized systems of religion, some people are very sensitive and will quickly feel judged. Regardless of what someone does or does not believe, I always smile and actively listen and encourage them on their journey. There is never any judgment on my part for anything about a patient; there is only warm acceptance and the desire to help. From my body language, people should feel that they are accepted and safe whether or not they desire prayer.
If surgery is not necessary but I feel that someone would be receptive to prayer, then I offer. The way the spiritual questions are answered is a good indication of whether or not people are open to receiving prayer. If in my judgment prayer will not be well received, I don’t offer.
Other questions that are useful in taking a spiritual history include:
1. What are your sources of spiritual support?
2. Is prayer something you use for spiritual support?
3. “Are you at peace?” promotes discussion of spiritual health, especially near end-of-life. (Steinhauser KE, et al ?Are You at Peace?? Arch. Intern. Med. 2006;166:101-105).
How Do You Pray in the Office?
In an office setting where I will not do surgery but feel that they will benefit from prayer, this is an example of what I would say:
Me: Many people find prayer helpful. I would be happy to say a prayer for your condition. Is that something you would like?
(Studies show that 70 to 80 percent of Americans claim to pray regularly and that many patients want prayer from their doctor.) (2-7)
Me: I can pray for you privately, on my own, or we could pray together now. Which would you prefer?
This honors the patient and the relationship and gives the patient the ability to refuse prayer with me if they are uncomfortable. Private prayer is not harmful.
Before elective surgery I might say:
Me: Your surgery is next week. I offer to pray with my patients before their surgery and many find that it gives them peace and comfort. If that is something you would like, you will need to ask me for that the day of your surgery.
I understand that awkwardness of offering prayer. However, because of the tremendous peace that prayer brings many patients, I believe that not offering prayer to someone who would benefit is not only unethical but cruel.
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