December 13th, 2018

 Our Spiritual Well-Being

We typically address the impact of mental and physical distress on our health, but what about spiritual distress? Our spiritual well-being is often left out and gets muddled with our emotional well-being, but they are not the same. Emotion is described as a reaction to a person, object, or situation in our life; it can be real or a thought. Our emotional responses are often connected to past experiences and are distinguished from reason or knowledge. Spirituality addresses the “big picture” – a search for meaning in our lives.

Spirituality has many definitions, and a secular vs. religious distinction helps to clarify the meaning (Soul Matters: The Spiritual Dimension Within Healthcare by Dr. Mabel Aghadiuno). Secular spirituality is not necessarily connected to a specific belief system or even religious worship. Instead, it arises from your connection with yourself and with others, the development of your personal value system, and your search for meaning in life. For many, spirituality takes on the more traditional form of religious observance, which includes a certain dogma, belief system and recognition of a higher power.
           
When it comes to sorting out the elements of “mind, body, spirit”, the whole point is that they are interconnected. Using this approach to healthcare is called holistic health. The mind-body connection is a well-known concept in medicine, but the spirit part is often cast aside. As health professionals, we assess physical and mental problems, but spiritual assessments are often dismissed as too time-consuming, not useful, irrelevant, or simply a check-box on the assessment form listing your religious practices (http://www.aafp.org/afp/2012/0915/p546.html).
           
Practitioners are typically not adequately trained in the area of spiritual assessment, or they do not believe it has a place in the biomedical world of clinical practice. Yet studies demonstrate that most patients want their spiritual needs assessed and addressed and that patients feel their spirituality does result in improvement in their well-being (https://link.springer.com/article/10.1007/BF02248742).
           
There are various spiritual assessment tools, but the groundwork begins with a patient simply wanting a trusting relationship with his/her doctor. Patients want their doctors to talk to them and to show some understanding. One could conclude that a doctor has the “power” to relieve suffering just by the “way they are.”  According to the National Institute of Health, one of the lines in the modern version of the Hippocratic Oath is: I will remember that there is art to medicine as well as science. Physicians can learn the science part (treating the disease) in medical school, but the artistic part (treating the patient) may take a lifetime of practice.
           
So, what types of questions are asked in a spiritual assessment and what is the purpose? The following are some sample questions from the FICA Spiritual History Tool (http://www.aafp.org/afp/2012/0915/p546.html):

1. Faith and Belief: Do you have spiritual beliefs that help you cope with stress?
   
2. If the patient responds "no," consider asking: what gives your life meaning?
3. Importance: Have your beliefs influenced how you take care of yourself in this illness?
   
4. Community: Are you part of a spiritual or religious community? Is this of support to you, and how?
   
5. Incorporate faith in approach to care: How would you like me to address these issues in your health care? (http://www.aafp.org/afp/2012/0915/p546.html)
   

           
A spiritual assessment is just as important as a physical and mental assessment. How do these three assessments come together to form a plan of care for the patient? Take for example, two patients (#1 and #2) who experience a motor vehicle accident, which leaves them with numerous injuries, pain and a long path of rehabilitation.
           
Physical:
Standard operation includes a physical assessment of each patient’s condition and pain level – it helps in determining the diagnoses and course of treatment. In remembering that medicine is “a science and an art,” the physical assessment (body) might be thought of as the “science” part of medicine because the disease or condition is being treated. At this point, both patients may have equal treatment and a similar plan of care.
           
Moving on to complete the plan of care, the emotional and spiritual assessments may be considered the “art” of medicine because now you begin to treat the individual patient, not just the disease or condition. This is where the plan of care becomes customized and the paths of healing may have different outcomes.

Emotional:
Let’s say that Patient # 1’s reaction is:

• Fearful that he/she will never be able to return to work and has financial worries.
  
• Feeling anxious that he/she will fall and the condition will worsen.
  
• Begins to experience depression.
  

Let’s say Patient #2’s reaction is:

• Thinks that the current health problem is just a “bump in the road”
  
• Appreciates the support of close friend/family ties
• Confident that there will be full recovery.
  

Spiritual: Now add to this the spiritual assessment:
Let’s say Patient #1: Lacks a support system, senses a loss of meaning or purpose in life, feels hopelessness, and experiences a loss of faith since the health crisis.
Let’s say Patient # 2: Practices prayer, has visitors from his/her place of worship, thinks he/she will learn from this experience, feels hopeful, and is at peace.
           
It is easy to see that the results of these assessments will make a difference in the approach to and care of the patients. These assessments are valuable tools, which can greatly impact the outcome of the patient’s health status.
           
Although we like to refer the spiritual assessments to the chaplaincy team, it is the doctors, nurses and health team members who need this knowledge in order to care for their patients. A spiritual assessment might be considered just another burden, but it is a valuable investment. Rather than ignoring it all, it can actually be refreshing to both parties (patient and practitioner) if the practitioner shows some honesty, humility, and compassion.
           
In conclusion, when people are struck with illness, the patient outcomes are potentially limited when healthcare providers are preoccupied with only the diagnosis and physical treatment. Illness is a human experience that impacts the lives of our patients on many levels: physically, mentally and spiritually. Our health is not just physical; it encompasses the mind, body and the soul.