Reader Question: Spiritual assessment required in all settings
Question: Does the Joint Commission’s standard on spiritual assessment apply only to behavioral health or to all health care settings? What are we expected to do in making this spiritual assessment?
Answer: The Joint Commission on Accreditation of Healthcare Organizations expects you to conduct a spiritual assessment of every patient in every health care setting, explains Pat Staten, RN, MS, associate director of standards interpretation. A different standard applies to each setting, but they all require essentially the same thing. The only exception is behavioral health, in which Standard PE.1.21.4 requires a more thorough assessment of a patient’s spiritual outlook.
Exactly how you conduct the spiritual assessment is up to you, and it will vary from one setting to another, Staten says. The purpose of the assessment is to determine how a patient’s religion or spiritual outlook might affect the care he or she receives. In the most typical inpatient setting, such as a patient admitted through the emergency department, the spiritual assessment should be conducted at the outset as part of the admission process, Staten says.
At a minimum, the spiritual assessment should determine the patient’s religious denomination, beliefs, and what spiritual practices are important to the patient. Staten says the extent of the assessment will depend on the circumstances. For a patient admitted for a routine, low-risk procedure, it may be sufficient to inquire about his or her religion and offer to have the appropriate clergyman stop by. The patient’s response may dictate how much you need to explore further. A patient who says he is Catholic might be informed that there is a priest at the hospital who can be summoned, but a patient who says she is a Jehovah’s Witness will require further discussion about how her beliefs will affect her medical care. The spiritual assessment also may indicate a need to provide a special diet or other unique concerns.
For a patient admitted to hospice or behavioral health, a more thorough assessment may be in order than in most other settings. The behavioral health setting requires a deeper assessment because so many aspects of treatment are tied to 12-step programs with religious components (a higher power and the need for prayer or meditation). A patient’s religion or spiritual beliefs can have a profound impact on the effectiveness of such treatment, so the Joint Commission requires providers to assess that impact up front.
Staten cautions that simply asking about the person’s religion is not sufficient to comply with the Joint Commission standards. Assessing a person’s spirituality must go further.
"I don’t know if people really understand well the difference between religion and spirituality," she says. "The spiritual assessment includes asking about a person’s religious denomination, but it’s more than that. Even if a patient says he or she doesn’t belong to any particular religion, he or she may still have beliefs that affect the care you provide, beliefs that you should take into consideration. You should ask if the person has any personal beliefs about spirituality beyond just the denomination."
The Joint Commission provides these examples of questions that could be asked, but are not required, in a spiritual assessment:
- Who or what provides the patient with strength and hope?
- Does the patient use prayer in their life?
- How does the patient express their spirituality?
- How would the patient describe their philosophy of life?
- What type of spiritual/religious support does the patient desire?
- What is the name of the patient’s clergy, ministers, chaplains, pastor, rabbi?
- What does suffering mean to the patient?
- What does dying mean to the patient?
- What are the patient’s spiritual goals?
- Is there a role of church/synagogue in the patient’s life?
- How does faith help the patient cope with illness?
- How does the patient keep going day after day?
- What helps the patient get through this health care experience?
- How has illness affected the patient and his/her family?
[For more information, contact:
• Pat Staten, Associate Director of Standards Interpretation, Joint Commission on Accreditation of Healthcare Organizations, One Renaissance Blvd., Oakbrook Terrace, IL 60181. Telephone: (630) 792-5000.]
Question: Does the Joint Commissions standard on spiritual assessment apply only to behavioral health or to all health care settings? What are we expected to do in making this spiritual assessment?You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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