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Spirituality
and Cultural Diversity
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How
to Address Spiritual Issues in Patients
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| What
is a spiritual history? |
Taking
a spiritual history is the process of gathering relevant information
from a patient about spiritual values, religious beliefs, spiritual
needs and concerns, and whatever gives the patient's life and
illness meaning. It should also include questions about how their
religious and spiritual views affect their health, whether they
use religious coping, whether they have specific spiritual concerns
at the time, and whether they have a minister or other spiritual
counselor on whom to call.
When should I take a spiritual history?Taking a spiritual history should
be incorporated into the work-up of all hospital patients, new patients,
seriously ill patients, or in those with stress, distress, substance abuse
or issues related to spiritual or religious views. |
| How
do I take a spiritual history? |
Several
clinicians have developed tools for taking a spiritual history
that aid in the process and make the topics to cover easier
to remember, including the FAITH tool (King, 2002), HOPE
tool (Anandarajah 2001), and the FICA tool (Puchalski
2000).
At
MUSC, we teach the HOPE method of taking a spiritual
history because of its ease of use and the way it smoothly
transitions from social support to spiritual topics (Anandarajah
and Hight, Amer Fam Phys 2001). The HOPE questions, can be
seen at on the web at www.aafp.org/afp/20010101/81.html,
or summarized below:
| H |
addresses
the person's basic spiritual resources, such as sources
of Hope, without immediately focusing on religion or spirituality.
Using this method allows for meaningful dialogue with patients
of diverse backgrounds, including those whose spirituality
lies outside the boundaries of traditional religion or
those who have been alienated in some way from their religion.
It also allows those for whom religion, God or prayer is
important to volunteer this information. |
| O |
focuses
on the importance of Organized religion in patients' lives. |
| P |
focuses
on the specific aspects of their personal spirituality
and personal religious practices. If patients relate meaningful
experiences at this point, then the interviewer can proceed
with more specific questions regarding religion and personal
spirituality. If not, then one can ask open-ended follow-up
questions to open the door for patients to discuss important
spiritual concerns they may have. |
| E |
focuses
on the Effects of a patient's spiritual and religious beliefs
on medical care and end-of-life issues. These questions
help re-direct the discussion back onto clinical issues
and medical-decision-making. |
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FICA
tool
(Puchalski C,J Palliative Med 2000; 3: 129-137) |
| F |
Faith,
Belief, Meaning |
| I |
Importance
and Influence of religious and spiritual beliefs and practices
to the individual |
| C |
Community
or Church connections |
| A |
Address/Action
in the context of medical care |
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FAITH
tool
(King DE, Spirituality and Medicine, in Fundamentals
of Clinical Practice; Eds Mengel, Holleman and Fields; Plenum,
New York, 2002) |
| F |
Do
you have a Faith or religion that is important to you? |
| A |
How
do your beliefs Apply to your health? |
| I |
Are
you Involved in a church or faith community? |
| T |
How
do your spiritual views affect your views about Treatment |
| H |
How
can I Help you with any spiritual concerns? |
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| Spirituality & Health
at MUSC |
http://www.musc.edu/dfm/Spirituality/Spirituality.htm |
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