Spiritual Assessment Tool


One healthcare goal is to ensure that patients are given quality physical, emotional and spiritual care. The spiritual aspect is complicated and reflects the individual internal elements that affect how these patients view health. Spirituality has been found to influence how a patient recovers (Puchalski, 2001). The concept of spirituality does not just refer to the religious aspects of an individual. Healthcare providers need to identify the spiritual needs of patients because it is a vital part of their recovery.

In 2001, the Joint Commission on Accreditation took a look into its standards and decided that it is a must that all patients must undergo initial spiritual assessment in all hospitals, mental health facilities, and homes (JACHO, 2005). This paper will discuss briefly two spiritual assessment tools and their clinical uses. The two spiritual assessment tools that will be addressed are HOPE and FICA.

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HOPE Assessment

The HOPE assessment tool is essential in incorporating the spirituality of an individual in the practices of healthcare. The aspects of HOPE concept are: H is for hope, strength or finding peace; P is for personal spirituality practices; O is for organized religion in the life of the patient; E is for effects of spirituality on medical practices (Anandaraja & Hight, 2001).

In hope assessment tool, a connection is created between the caregiver and the patient through statements that suggest you understand how difficult it is for them to be sick. After the connection is established, the next step is to ask a series of other questions like How are you holding up? The questions being asked should follow and relate to the letters of the assessment tool. HOPE is a tool that plays the role of identifying the role of spirituality in the lives of people. After the questions are asked, appropriate spiritual interventions are created to address and maintain the religious belief and preferences of the patient (Walsh, 2010).

FICA Assessment

The FICA assessment tool was created by Dr. Cristina Puchalski together with Dr. Sumalsky, Teno and Matthews back in 1996. The primary purpose of the FICA tool was to provide effective and efficient integration of spirituality to medical assessment (Walsh, 2010). The questionnaires used in FICA assessment were developed to help healthcare providers to know about the spiritual beliefs of patients in a medical setting. According to Puchalski (1996), she stated “FICA stands for F- the presence of faith, meaning or belief; I- importance of spirituality on an individual’s life and the belief/value system on the patient’s ability to make health care decisions; C-spiritual community; and A- addressing needs with interventions.”

While using the FICA tool, a series of questions are asked about the meaning of its letters. An example of the questions that can be asked is: Do you consider yourself to be spiritual? What role does spirituality play in your life? The questions used in the FICA assessment tool are open-ended thus giving room for descriptive data. According to FICA respondents, they considered spirituality as an essential aspect of their recovery and controlling stress (Anandaraja & Hight, 2001).


There is no doubt that these spiritual assessment tools are useful in clinical settings and the care patients receive in health institutions. Having an interest in the spirituality of patients is considered respectful during illness thus enhancing the relationship between the caregiver and the patient (Puchalski, 1996). The spiritual assessment tools open more room for conversation between patients and healthcare givers thus improving the quality of care in health institutions. The tools use open-ended questions hence creating an excellent atmosphere for the patients to express their feelings about the forms of treatment that they are receiving (Puchalski, 1996). These questions are important in clinical settings to come up with treatment plans for patients that are by their spirituality. Therefore, health institutions should incorporate spiritual assessment tools while treating patients for useful caregiving experiences.

Clinical Uses for HOPE and FICA Tools

According to several research studies that have been conducted, spiritual and physical needs are closely related hence integrating the spiritual aspect of patients into their medical needs is essential for effective care (Highfield, 2000). The only way that caregivers can be able to assess the spiritual aspects of the patient is if they have a sense of their spiritual belonging and establish connections with the patients.

Spirituality assessment has proved to be helpful when used with health assessment to develop a treatment plan for the patient. Spiritual assessment can be included in preventive care by helping the patients to identify and mobilize their internal resources like praying to give themselves strengths to handle whatever is happening in their lives.

Additionally, an individual’s spirituality affects how one deals with clinical situations. For example, patients can pray before surgery or taking medication to help them deal with their fears. Medical practitioners having an understanding of the spirituality of patients can make decisions of either continuing or stopping specific treatments like chemotherapy (Highfield, 2000).


Globally, more than eighty percent of people consider religion as being important in their lives. Therefore, issues of religion can have a wide range of effects that stretch into the medical world. Using spiritual assessment tools like HOPE and FICA in medical institutions can improve the confidence and experience of these individuals. If these spiritual assessment tools are used in a manner that is consistent with the religion and cultural practices of the patients, they can help patients achieve better holistic health hence having good healthcare experiences.



Anandarajah, G. & Hight, E. (2001). Spirituality and Medical Practice: Using the HOPE Questions as a Practical Tool for Spiritual Assessment. American Family Physician. 63(1). 81-89. Retrieved from http://www.aafp.org/afp/2001/0101/p81.html

Highfield, M.E. (2000). Providing spiritual care to patients with cancer. Clinical Journal of Oncology Nursing, 4. 115-120. PMID: 11235248. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed?term=Providing%20spiritual%20care%20to%20patients%20with%20cancer%20by%20highfield

JACHO (2005). Joint Commission on Accreditation of Healthcare Organizations: Evaluating your spiritual assessment process. Retrieved from: http://www.professionalchaplains.org/uploadedFiles/pdf/JCAHO-evaluating-your-spiritual-assessment-process.pdf

Puchalski, C. (2001, October). The role of spirituality in health care. Baylor University Healthcare Center Journal. 14(4). 352-357. PMC1305900. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1305900/

Walsh, F. (2010, September). Spiritual diversity: multi-faith perspectives in family therapy. Family Process. 19(3). 330-348. doi: 10.1111/j.1545-5300.2010.01326.x.

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