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Assessing Spiritual Needs: The H.O.P.E. Assessment Tool

Assessing Spiritual Needs When assessing spiritual needs we ask questions in the same way as we assess patient's physical, psychological and social needs and record the findings in the medical records. The reason for this is that the information gathered will have an impact on the way the patient is cared for. In carrying out a meaningful assessment there should be a way of reaching an understanding of what would be helpful to those who would describe themselves as either religious or non-religious. The assessment should take the form of a conversation so allowing any key themes that emerge to be explored. In keeping with good practice, with regards to caring for a patient, just as there are regular assessments of symptoms, a spiritual needs assessment should also be ongoing.

The HOPE Assessment Tool The HOPE Assessment Tool was originally developed by Gowri Anadarajah and Ellen Hight at the Department of Family Medicine at Brown University before being published in a peer-reviewed journal. The Hope Assessment Tool meets the following criteria:·

It allows healthcare professionals to gather important information in a nonthreatening manner It is brief

· ·

It covers critical areas

The HOPE tool is effective, efficient, recognised and easy to remember. It allows the patient to tell his or her story, which is key to conducting any kind of assessment. When a patient consultation is taking place generally either a medical history is taken or previous known medical information is updated. As this is done, it is important to include questions that will help uncover any important spiritual issues that might be impacting on the patient's health and well-being. These questions can also provide an opportunity for the patient to tell his or her story, which can help you to understand their experience of health and disease. In one sense, it could be argued, the standard history and physical represents what is important to the healthcare professional, while the spiritual history represents what is important to the patient.


Explanation of the HOPE Tool

H = Sources of hope, meaning, comfort, strength, peace, love and connection First, establish an empathic connection with the patient e.g. `It must be very hard for you to find yourself so sick. How are you holding up? Follow the patient's lead ­ but you may then consider asking the following questions:`Would there be anything you would hope for even if you weren't going to get better?' `Are you able to hold onto a sense of your own dignity and purpose?' `What do you hold onto during the difficult times or when you are feeling down?' `Are there any spiritual or religious resources that you draw on?' If the answer to the above question is `Yes' go onto the O and P questions. If the answer is `NO' consider asking, `Was it ever?' If the answer is `Yes' ask: `What changed?' If the answer is still `NO' go onto the P questions.

O = Organised religion `Do you consider yourself to be religious?' `How important is this to you?' `Are you part of a religious or spiritual community?' `Does it help you? In what way?' `How are things between you and God?'


P = Personal spirituality and practices `Do you have any spiritual beliefs or practices?' `Do you believe in God?' `What kind of relationship do you have with God?' `What aspects of your spiritual/religious practices do you find most helpful?'

E = Effects that the above may have on medical care and end-of-life decisions `Has being sick (or your current situation) affected your ability to do things that usually help you spiritually?' (or affected your relationship with God) `How are things with your family and friends?' `Is there anyone with whom you have to `make up'?' `Is there anyone to whom you need to say `I love you' or `I'm sorry'? `Are you worried about any conflicts between your beliefs and your medical situation/decisions?' `As a doctor/nurse, is there anything that I can do to help you access the resources that usually help you?' `Would it be helpful to speak to a chaplain/spiritual leader?' `Are there any specific practices or restrictions I should know about in providing your medical care?' (e.g.dietry restrictions, use of blood products etc) If the patient is dying: `How do your beliefs affect the kind of care you would like me to provide over the next few hours/days/weeks/months?'


By following the above simple guideline we allow the patient to speak about where they are, not just physically but also, spiritually and that can have a tremendous impact on the way the patient perceives their treatment.



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