Spiritual Assessment



Inthe recent past, there has been a growing interest in spiritual careand spiritual needs has emerged as part of daily nursing care thatshould be met for patients however, there is a concern that mostnurses still feel uncomfortable doing a spiritual assessment (Hodge,2015). This is usually difficult when a patient does not presentclues concerning his/her spiritual/religious preferences or when apatient possesses a spiritual perspective that is unfamiliar to anurse. Nevertheless, there are spiritual assessment tools that can beused by nurses in assessing and planning for spiritual needs. Thisreport will discuss three spiritual assessment tools, which includeSpiritual Health Inventory (SHI), Spiritual Perspective Scale (SPS),and FICA. The validity and reliability of these tools will bediscussed and their use in a health assessment.

SpiritualHealth Inventory (SHI)

TheSpiritual Health Inventory entails a 31-item self-report instrumentwhich is worded in the first person. In using this tool, respondentsusually rank how frequent they have experienced the behavior orfeeling described on a 1-to-5 Likert scale. A rank of 5 is anindication of a frequent occurrence, while a rank of 1 is anindication that the occurrence is infrequent. When using this tool,scores are usually determined through reversing subject-recordedratings of every negative indicator of spiritual health, and then theratings for all items are summed up. Higher scores are usually linkedwith higher levels of spiritual health. This tool is usuallyunswerving with the author’s definition of spiritual health, whichis an indication that it is consistent. Thus, because the tool isconsistent, it can be considered reliable (Hodge, 2015). Content andconstruct validity for this tool are based on a review of literature,factor analysis, and input from an expert panel. On the other hand,this tool can be considered to have ease of use because it justrequires patients to give self-reports, which are used in finding outtheir ranking. In a hospital setting, this tool can be used by askingpatients to provide responses to the 31-item self-report showing howthey rank their behavior or feelings. In determining their scores,subject-recorded ratings of every negative indicator of spiritualhealth would be reversed and ratings for all items summed up.Patients having high levels of spirituality would be noted by theirhigh scores.

SpiritualPerspective Scale (SPS)

Thisis another spiritual assessment tool that can be used by nurses itwas initially known as religious perspective scale. This toolcomprises of 10 items, which are used to measure the patients’viewpoints on the extent to which spirituality infuses their lives aswell as in spiritually-related interactions (Frank-Stromborg &ampOlsen, 2004). The spiritual perspective scale may be administered inform of a structured questionnaire or interview. When using thisscale, responses from patients are usually ranked on a scale of 1-6.Here, scores are normally determined through calculating thearithmetic mean across all the items. Higher scores are an indicationof greater spiritual perspective. An example of an item that apatient may be asked when using this tool may involve, “how oftendo you mention spiritual matters when with friends or family?”validity and reliability of the spiritual perspective scale have beendepicted in both healthy and terminally ill adult individuals. Thisindicates that the tool can be considered to be valid and reliable.When it comes to its use, it may not be easy to use due to itscomputations (requires calculation of arithmetic mean) however, anurse having good mathematical skills can easily use this tool. In ahospital setting, this tool can be used by nurses, where they cangive patients structured questionnaires or else involve them in astructured interview containing 10 items that measure theirviewpoints regarding their spirituality extent in their lives. Theseperspectives should then be ranked on a scale of 1-6. After this,nurses should then calculate the arithmetic mean across all the 10items in order to establish the score of every patient. Patients thathave higher scores should be indicated to have greater spiritualperspective. On the other hand, patients having lower scores shouldbe indicated to have inferior spiritual perspectives.

FICAAssessment Tool

Thistool became developed by Dr. Cristina Puchalski in 1996 (incollaboration with Drs. Sumalsky, Teno &amp Matthews). The toolprovides an efficient integration of spirituality to a normal medicalassessment. The foundations of the tool are: FICA where Frepresents the presence of faith, meaning or belief I represents thesignificance of spirituality on a person’s life and the belief orvalue system on a person’s capacity to make health care decisionsC represents spiritual community while A- represents addressing ofneeds with interventions (Borne man et al., 2010).

FICAtool can be performed by first establishing faith (F) of anindividual. Here, questions that aid in determining the faith of aperson are put across to a respondent. Importance and Influence (I)questions then follow these questions aid in discovering howsignificant faith is to an individual. On the other hand, community(C) questions help in understanding how well the respondent relateswith individuals around him/her. The questioning concludes withasking questions relating to a patient’s care plan.

FICAtool makes use of open ended questions, which allows an opportunityfor more descriptive information. FICA respondents usually rate faithor spirituality as important or very important in assisting patientto handle and control stress. FICA tool identifies elements of lifethat offers the greatest spiritual support. The tool’s frameworksuggests that inquiry of beliefs opens the door to advanceconversation concerning other issues that patients may beexperiencing. FICA tool may draw spiritual belief data on decisionsassociated with health care. The tool helps in eliciting vitalclinical information such as ability of coping which may affectpatient outcomes.Evaluationof the FICA tool reveals that the spiritual data gathered assists increating clinical plans, but most feel its assessment goes beyondjust healthcare system and extends to the community. The FICA tool isthe simplest tool for quick assimilation. FICA is considered as atool that is easy to use with patients in clinical assessments(McSherry &amp McSherry, 2006). Besides, the tool is considered tobe reliable because it can be used to dig more information concerninga patient. Once used, the tool can make a patient give moreinformation that may assist in the provision of healthcare. In ahealth care setting, this tool can be used in assessing spiritualityof patients through providing a questionnaire having a guide of theFICA questions. It is through the responses offered by patients thata nurse can be in a position to assess the spirituality of patients.


Borneman, T., Ferrell, B. &amp Puchalski, C.M. (2010). Evaluation of theFICA Tool for spiritual assessment.Pain Symptom Management. 40(2):163-73.

Frank-Stromborg,M., &amp Olsen, S. J. (2004). Instrumentsfor clinical health-care research.Sudbury, Mass: Jones and Bartlett Publishers.

Hodge,D. R. (2015). Spiritualassessment in social work and mental health practice.New York: Columbia University Press.

McSherry,W., &amp McSherry, W. (2006). Makingsense of spirituality in health care practice: An interactiveapproach.London: Jessica Kingsley.