Assessment of Spirituality in Older Adults: FICA Spiritual History Tool
Assessment of Spirituality in Older Adults: FICA Spiritual History Tool
Assessment of Spirituality in Older Adults: FICA Spiritual History Tool
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specialty practice series<br />
Best Practices <strong>in</strong> Nurs<strong>in</strong>g Care<br />
for Hospitalized <strong>Older</strong> <strong>Adults</strong><br />
From The Hartford Institute for Geriatric Nurs<strong>in</strong>g, New York University, College <strong>of</strong> Nurs<strong>in</strong>g<br />
Issue Number SP5, 2011<br />
Series Editor: Marie Boltz, PhD, GNP-BC<br />
Series Co-Editor: Sherry A. Greenberg, MSN, GNP-BC<br />
New York University College <strong>of</strong> Nurs<strong>in</strong>g<br />
<strong>Assessment</strong> <strong>of</strong> <strong><strong>Spiritual</strong>ity</strong> <strong>in</strong> <strong>Older</strong> <strong>Adults</strong>:<br />
<strong>FICA</strong> <strong>Spiritual</strong> <strong>History</strong> <strong>Tool</strong><br />
By: Tami Borneman, MSN, RN, CNS, FPCN<br />
Division <strong>of</strong> Nurs<strong>in</strong>g Research & Education, City <strong>of</strong> Hope National Medical Center and<br />
Hospice and Palliative Nurses Association<br />
WHY: <strong>Older</strong> adults <strong>of</strong>ten need to f<strong>in</strong>d a way to cope with serious illnesses and end <strong>of</strong> life issues while re-evaluat<strong>in</strong>g life and spirituality.<br />
Research has shown that patients rely on their religion to help them cope with their illnesses and want their cl<strong>in</strong>icians to ask about their<br />
spiritual concerns. The National Quality Forum (2006) and The National Consensus Project for Quality Palliative Care (2009) <strong>in</strong>clude spiritual<br />
care as one <strong>of</strong> eight cl<strong>in</strong>ical practice guidel<strong>in</strong>es. Hence, cl<strong>in</strong>icians need to <strong>in</strong>corporate a spiritual history <strong>in</strong>to rout<strong>in</strong>e patient care.<br />
BEST TOOL: The <strong>FICA</strong> <strong>Spiritual</strong> <strong>History</strong> <strong>Tool</strong> (<strong>FICA</strong>) (Puchalski, 1996) was developed <strong>in</strong> collaboration with primary care providers as a guide<br />
for cl<strong>in</strong>icians to <strong>in</strong>corporate open-ended questions regard<strong>in</strong>g spirituality <strong>in</strong>to a standard comprehensive history. <strong>FICA</strong> pocket cards and a<br />
demonstration on how to perform a spiritual history may be found at The George Wash<strong>in</strong>gton Institute for <strong><strong>Spiritual</strong>ity</strong> and Health website,<br />
www.gwish.org.<br />
TARGET POPULATION: Any older adult fac<strong>in</strong>g illness. As people age, they <strong>of</strong>ten reflect on the past. <strong><strong>Spiritual</strong>ity</strong>, however def<strong>in</strong>ed by the<br />
patient, is <strong>of</strong>ten a component <strong>of</strong> rem<strong>in</strong>isc<strong>in</strong>g that may re<strong>in</strong>force mean<strong>in</strong>g and value to a person’s life.<br />
VALIDITY AND RELIABILITY: Prelim<strong>in</strong>ary cl<strong>in</strong>ical evaluation (n=76; mean age 57) <strong>of</strong> the feasibility and usefulness <strong>of</strong> the <strong>FICA</strong> was<br />
conducted as part <strong>of</strong> a larger National Cancer Institute funded study (B. Ferrell, P.I). Content analysis was used to capture themes from <strong>FICA</strong><br />
open-ended questions along with descriptive data from the s<strong>in</strong>gle item <strong>FICA</strong> quantitative measure that asked patients to rate the importance <strong>of</strong><br />
faith/belief <strong>in</strong> their life on a 0 (not important) to 5 (very important) scale. The mean score <strong>of</strong> 8.40 <strong>in</strong>dicated that spirituality was important to<br />
patients, and data confirmed that the <strong>FICA</strong> was effective for assess<strong>in</strong>g several dimensions <strong>of</strong> spirituality based on correlation with spirituality<br />
<strong>in</strong>dicators <strong>in</strong> the Quality <strong>of</strong> Life (QOL) <strong>Tool</strong> - <strong>Spiritual</strong> Doma<strong>in</strong> (Borneman, et al., 2010).<br />
STRENGTHS AND LIMITATIONS: The <strong>FICA</strong> provides cl<strong>in</strong>icians with a quick and easy means to conduct a spiritual history. Prelim<strong>in</strong>ary data<br />
from one hospital and one sett<strong>in</strong>g found the <strong>FICA</strong> to be cl<strong>in</strong>ically useful. Further research is needed.<br />
FOLLOW UP: Follow up assessment <strong>in</strong>volves address<strong>in</strong>g all the issues <strong>in</strong> the <strong>FICA</strong> at every regularly scheduled visit. This enables the cl<strong>in</strong>ician<br />
to make the appropriate referrals (e.g. to pastoral counsel<strong>in</strong>g) depend<strong>in</strong>g on the f<strong>in</strong>d<strong>in</strong>gs.<br />
MORE ON THE TOPIC:<br />
Best practice <strong>in</strong>formation on care <strong>of</strong> older adults: www.ConsultGeriRN.org.<br />
Borneman, T., Ferrell, B., & Puchalski, C. (2010). Evaluation <strong>of</strong> the <strong>FICA</strong> tool for spiritual assessment. Journal <strong>of</strong> Pa<strong>in</strong> and Symptom Management,<br />
40(2), 163-173.<br />
National Quality Forum. (2006). A national framework and preferred practices for palliative and hospice care quality. Wash<strong>in</strong>gton, DC: National Quality Forum.<br />
National Consensus Project for Quality Palliative Care. (2009). Cl<strong>in</strong>ical practice guidel<strong>in</strong>es for quality palliative care (2 nd ed.). Available from<br />
http://www.nationalconsensusproject.org.<br />
Puchalski, C. (2006). <strong>Spiritual</strong> assessment <strong>in</strong> cl<strong>in</strong>ical practice. Psychiatric Annals, 36(3), 150-155.<br />
Puchalski, C., & Romer, A.L. (2000). Tak<strong>in</strong>g a spiritual history allows cl<strong>in</strong>icians to understand patients more fully. Journal <strong>of</strong> Palliative Medic<strong>in</strong>e, 3(1), 129-137.<br />
Sulmasy, D. (2006). <strong>Spiritual</strong> issues <strong>in</strong> the care <strong>of</strong> dy<strong>in</strong>g patients: “...it’s okay between me and God.” JAMA, 296(11), 1385-1392.<br />
Yoon, D., & Lee, EK. (2007). The impact <strong>of</strong> religiousness, spirituality, and social support on psychological well-be<strong>in</strong>g among older adults <strong>in</strong> rural areas.<br />
Journal <strong>of</strong> Gerontological Social Work, 48(3/4), 281-298.<br />
Permission is hereby granted to reproduce, post, download, and/or distribute, this material <strong>in</strong> its entirety only for not-for-pr<strong>of</strong>it educational purposes only, provided that<br />
The Hartford Institute for Geriatric Nurs<strong>in</strong>g, New York University, College <strong>of</strong> Nurs<strong>in</strong>g is cited as the source. This material may be downloaded and/or distributed <strong>in</strong> electronic format,<br />
<strong>in</strong>clud<strong>in</strong>g PDA format. Available on the <strong>in</strong>ternet at www.hartfordign.org and/or www.ConsultGeriRN.org. E-mail notification <strong>of</strong> usage to: hartford.ign@nyu.edu.
<strong>FICA</strong> <strong>Spiritual</strong> <strong>History</strong> <strong>Tool</strong> (Puchalski, 1996)<br />
Cl<strong>in</strong>ician Questions<br />
Patient Responses<br />
F<br />
Faith and Belief<br />
• Do you consider yourself spiritual or religious?<br />
• Do you have spiritual beliefs that help you cope<br />
with stress?<br />
If the patient answers “No,” the health care provider might ask,<br />
• What gives your life mean<strong>in</strong>g?<br />
Sometimes patients respond with answers such as family, career, or nature.<br />
I<br />
Importance<br />
• What importance does your faith or belief have <strong>in</strong><br />
your life?<br />
• Have your beliefs <strong>in</strong>fluenced how you take care <strong>of</strong><br />
yourself <strong>in</strong> this illness?<br />
• What role do your beliefs play <strong>in</strong> rega<strong>in</strong><strong>in</strong>g your health?<br />
C<br />
Community<br />
• Are you part <strong>of</strong> a spiritual or religious community?<br />
• Is this <strong>of</strong> support to you and how?<br />
• Is there a group <strong>of</strong> people you really love or who are<br />
important to you?<br />
Communities such as churches, temples, and mosques, or a group <strong>of</strong> like-m<strong>in</strong>ded friends can serve as strong support<br />
systems for some patients.<br />
A<br />
Address <strong>in</strong> Care<br />
• How would you like me, your healthcare provider, to<br />
address these issues <strong>in</strong> your healthcare?<br />
Available at www.gwish.org<br />
Repr<strong>in</strong>ted with permission from Christ<strong>in</strong>a Puchalski, MD, FACP<br />
Executive Director, The George Wash<strong>in</strong>gton Institute for <strong><strong>Spiritual</strong>ity</strong> and Health<br />
specialty practices series<br />
Best Practices <strong>in</strong> Nurs<strong>in</strong>g Care<br />
for Hospitalized <strong>Older</strong> <strong>Adults</strong><br />
From The Hartford Institute for Geriatric Nurs<strong>in</strong>g, New York University, College <strong>of</strong> Nurs<strong>in</strong>g<br />
A series provided by The Hartford Institute for Geriatric Nurs<strong>in</strong>g,<br />
New York University, College <strong>of</strong> Nurs<strong>in</strong>g<br />
EMAIL hartford.ign@nyu.edu HARTFORD INSTITUTE WEBSITE www.hartfordign.org<br />
CLINICAL NURSING WEBSITE www.ConsultGeriRN.org