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  • Introduction
  • 1. Advance Care Planning
  • 2. Communicating Bad News
  • 3. Whole Patient Assessment
  • 4. Pain Management
  • 5. Assisted Suicide Debate
  • 6. Anxiety, Delirium
  • 7. Goals of Care
  • 8. Sudden Illness
  • 9. Medical Futility
  • 10. Common Symptoms
  • 11. Withholding Treatment
  • 12. Last Hours of Living
  • 13. Cultural Issues
  • 14. Religion, Spirituality
  • 15. Legal Issues
  • 16. Social and Psychological
  • More About:

  • Hospice Care
  • Clergy and Faith Communities
  • Additional Links
    Site Index
    Back to Module 14: Table of Contents
    Part I: How to Assess Spirituality

    When to Ask
    What to be Prepared for When You Ask
    How to Ask
    When and How to Refer to Professional Spiritual Caregiver/Chaplain

    When to Ask

    Assessment of religious/spiritual frameworks and needs by physicians, nurses, and other care providers can take place at various stages during the course of a relationship with a patient and family:

    • In the course of non-crisis care
    • At the time of initial diagnosis of life-threatening illness
    • At the time of admission to hospice/palliative care
    • In response to signs of spiritual suffering, possible indicators of which include:
      • Fear
      • Hopelessness
      • Guilt
      • Asking questions such as "Why hasn't God taken me yet?" or "What have I done to deserve this?"
    • As complex treatment decisions are faced regarding:
      • Artificial nutrition
      • Use of radiation or chemotherapy
      • Removal of life support
      • Use of antibiotics
    • When the time of death draws near


    What to be Prepared for When You Ask

    Assessment of religious/spiritual beliefs and needs is an exceedingly elusive and sensitive area. These may be considered to be very personal questions

    • Do not be surprised if you encounter some initial resistance or mistrust, especially if the patient/family adheres to a religious tradition with a history of persecution
    • Although patients and families want their physicians and nurses to take interest in this area, you are seen as experts in medical science primarily. You may even be perceived as threats to the experiential knowledge of the spiritual realm and to religious authority
        For Example
        Persons with a strong belief in faith healing may respond to news of their terminal illness by saying, "What does the doctor know anyway, he's not God"
        Some spiritual traditions accept the need for specific treatments by Western medicine -- such as surgery to remove a tumor -- but would look to their own healing practices for treatment of other diseases such as a "weak heart"
    • During your visit with a patient and family, physical and medical needs will demand most of your time and attention
      • Little room may be left for discussion of spiritual issues if the patient:
        • Is in physical pain
        • Has received an overload of medical information related to treatment options and prognosis

      • Possible ways to address this include:
        • Consult with other members of the interdisciplinary team to learn about relevant religious beliefs
        • Plan to follow-up with the patient and family at a later time to discuss these issues
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