This article explores the history of spiritual assessment tools as a lens through which to consider the place of spirituality and religion in American healthcare. While precise definitions of spiritual assessment have evolved with the concept, the phrase generally refers to the process of evaluating someone’s spiritual needs and resources and addressing those needs in the context of clinical healthcare. We trace the diffusion of spiritual assessment tools from their origins in chaplaincy and pastoral counseling in the 1970s through nursing, medicine and social work in subsequent decades. While engaging with patients around religion and spirituality began as the professional jurisdiction of chaplains, spiritual assessment tools were designed – in part - to enable professionals in other fields to talk with patients about these topics. As such they are both a mechanism of diffusion – a set of questions healthcare professionals who advocate for greater attention to spirituality and religion teach their colleagues to ask – and a symbolic representation of how that diffusion is taking place and where there have been conflicts and bumps along the way.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Individual spiritual assessment tools, as described throughout this chapter, make varying assumptions about what spirituality is and how to approach and measure it though there is much overlap in the dimensions. This approach mirrors broader approaches to spirituality and religion evident in ethnographic research about religion and spirituality in large academic medical centers Cadge, W. (2012). Paging God: Religion in the Halls of Medicine. Chicago, University of Chicago Press. For more on the relationship between spirituality and religion see Bender, C. (2007). “Religion and Spirituality: History, Discourse, Measurement.” SSRC Forum, Bender, C. (2010). The New Metaphysicals: Spirituality and the American Religious Imagination. Chicago, University of Chicago Press.
It is important to note that chaplains are not taught to conduct spiritual assessments in any standard ways in their training.
Our goal is not to evaluate particular assessment tools. For evaluative discussion see the discussion of the six areas along which they should be evaluated in Fitchett, G. (1993). Assessing Spiritual Needs: A Guideline for Caregivers. Minneapolis, Augsburg Publications. The Healthcare Chaplaincy Network, an advocacy organization for chaplains based in New York City, also published the following to help chaplains evaluate such tools: https://www.healthcarechaplaincy.org/docs/publications/sri/pb_discerning_patient_needs_spiritual_assessment.pdf
There are also a number of articles catalogued in PubMed that describe the process of spiritual assessment in the United Kingdom. We do not include those here because of the differing relationship between healthcare organizations and the state and differing requirements about chaplaincy and spiritual care. Also, we rely on whether authors said particular tools were for clinical use in deciding which tools to include in this article.
For one critical discussion see Bishop, J. (2013). “Of Idolatries and Ersatz Liturgies: The False Gods of Spiritual Assessment.” Christian Bioethics 19(3): 332–347.
There are also a number of theologians cited in the early pastoral care literature whose ideas influenced developing ideas of spiritual assessment as described by Fitchett, G. (1993). Assessing Spiritual Needs: A Guideline for Caregivers. Minneapolis, Augsburg Publications.
For more on this history see c. 2 in Cadge (2012). Paging God: Religion in the Halls of Medicine. Chicago, University of Chicago Press.
For further description of this movement see Cadge (2012).
LaRocca-Pitts refers to this as a spiritual history tool, rather than a spiritual assessment tool though argues that because of the follow-up questions, the tool “blurs the conceptual differences between a spiritual history and a spiritual assessment” LaRocca-Pitts, M. (2008). “FACT: Taking a Spiritual History in a Clinical Setting.” Journal of Health Care Chaplaincy 15: 1–12.
For details see Cadge (2012). Paging God: Religion in the Halls of Medicine. Chicago, University of Chicago Press.
Some of the tools designed by and for social workers included spiritual lifemaps, ecomaps, genograms, ecograms and other things not previously a part of spiritual assessment.
An important exception during the 2000s is the Ironson-Woods Spirituality/Religiousness Index that was designed mostly for research to “include items that were both pertinent to traditional religion and relevant for those who described themselves as spiritual only or as both religious and spiritual” Ironson G, Solomon GF, Balbin EG and e. al. (2002). “The Ironson-Woods Spirituality/Religiousness Index is associated with long survival, health behaviors, less distress and low cortisol in people with HIV/AIDS.” Ann Behav Med 24: 34e48.
See 2001, January 63(1).
These letters were published in volume 64(3).
This response was published in volume 64(3).
Such concerns during the 2000s were further evident amongst nurses in an editorial authored by two British nurse-educators Draper, P. and W. McSherry (2002). “A critical view of spirituality and spiritual assessment.” J Adv Nurs 39(1): 1–2.
These distinctions were first written about in Massey, K., G. Fitchett and P. A. Roberts (2004). Assessment and Diagnosis in Spiritual Care. Spiritual Care in Nursing Practice. K. L. Mauk. Philadelphia, Lippincott, Williams & Wilkins: 209–243
For additional discussion of these issues see Puchalski, C. B, B. Ferrell, R. Virani, S. Otis-Green, P. Baird, J. Bull, H. Chochinov, G. Handzo, H. Nelson-Becker, M. Prince-Paul, K. Pugliese and D. Sulmasy. (2009). Improving the Quality of Spiritual Care as a Dimension of Palliative Care: the Report of the Consensus Conference. Journal of Palliative Medicine. 12(10): 885–904
LaRocca Pitts calls many of what we write about as spiritual assessment tools, spiritual history tools. For more on these jurisdictional disputes see Cadge (2012). Paging God: Religion in the Halls of Medicine. Chicago, University of Chicago Press. VandeCreek, L. (1999). “Professional chaplaincy: an absent profession?” Journal of Pastoral Care 53(4): 417–432.
On spiritual generalists and specialists see Robinson, M. R., M. M. Thiel and E. C. Meyer (2007). “On being a spiritual care generalist.” American Journal of Bioethics 7(7): 24–26. Chaplain Annette Olsen also developed a tool in the late 2000s, BASIC-6 Spiritual Care Screen, designed in her words, “to be tools-for-transition between the initial spiritual care screen (generally done by multidisciplinary caregivers or a rounding chaplain), the chaplain’s spiritual assessment process, and the patient’s discharge, transfer or decendent caregiving” Olsen, A. (2009). “Olsen’s BASIC-6 Spiritual Care Screens.” PlainViews 6(22). This tool helps the chaplain makes sense and be the expert on various other spiritual assessments that have been conducted.
This is one attempt to help educate chaplains about spiritual assessment: https://www.healthcarechaplaincy.org/docs/publications/sri/pb_discerning_patient_needs_spiritual_assessment.pdf. Chaplains also see spiritual assessment as just one aspect of their work Cadge (2012). Paging God: Religion in the Halls of Medicine. Chicago, University of Chicago Press.
Anandarajah, G., & Hight, E. 2001. Spirituality and Medical Practice: Using the HOPE Questions as a Practical Tool for Spiritual Assessment. American Family Physician, 63(1), 81–89.
Balboni, M. J. 2013. A Theological Assessment of Spiritual Assessments. Christian Bioethics 19(3), 313–331.
Bender, C. 2007. Religion and Spirituality: History, Discourse, Measurement. SSRC Forum. http://religion.ssrc.org/reforum/Bender.pdf
Bender, C. 2010. The New Metaphysicals: Spirituality and the American Religious Imagination. Chicago: University of Chicago Press.
Berg, Gary E. 1994. The Use of the Computer as a Tool for Assessment and Research in Pastoral Care. Journal of Health Care Chaplaincy 6(1), 11–25.
Berger, P. 2015. The Hospital: On the Interface between Secularity and Religion. Society, 52(5) Sept/Oct.
Berggren-Thomas, P., & Griggs, M. J. 1995. Spirituality in aging: spiritual need or spiritual journey? Journal of Gerontological Nursing, 21(3), 5–10.
Bishop, J. 2013. Of Idolatries and Ersatz Liturgies: The False Gods of Spiritual Assessment. Christian Bioethics, 19(3), 332–347.
Cadge, W. 2012. Paging God: Religion in the Halls of Medicine. Chicago: University of Chicago Press.
Clark, D. 2007. From Margins to Centre: A Review of the History of Palliative Care in Cancer. Lancet Oncology, 8(5), 430–438.
Draper, P., & McSherry, W. 2002. A critical view of spirituality and spiritual assessment. Journal of Advanced Nursing, 39(1), 1–2.
Fitchett, G. 1993a. Assessing Spiritual Needs: A Guideline for Caregivers. Minneapolis: Augsburg Publications. (Reprint edition Lima, Ohion: Academic Renewal Press, 2002).
Fitchett, G. 1993b. Spiritual Assessment in Pastoral Care: A Guide to Selected Resources. Decatur, GA: Journal of Pastoral Care Publications.
Fitchett, G. 2012. Next Steps for Spiritual Assessment in Healthcare. In M. Cobb, C. M. Puchlaski, & B. Rumbold (Eds.), Oxford Textbook of Spirituality in Healthcare (pp. 299–305). New York: Oxford University Press.
Hay, M. W. 1989. Principles in building spiritual assessment tools. The American Journal of Hospice Care, 6(5), 25–31.
Hodge, D. R. 2001. Spiritual assessment: a review of major qualitative methods and a new framework for assessing spirituality. Social Work, 46(3), 203–214.
Hodge, D. R. 2013. Implicit spiritual assessment: an alternative approach for assessing client spirituality. Social Work, 58(3), 223–230.
Holland, E. 1985. The Art of Hospice Spiritual Care. In K. Gardner (Ed.), Quality Care for the Terminally Ill: An Examination of the Issues, Special issue of Quality Review Bulletin (pp. 136–140). Chicago: Joint Commission on the Accreditation of Hospitals.
Ironson, G., Solomon, G. F., Balbin, E. G., et al. 2002. The Ironson-Woods Spirituality/Religiousness Index is associated with long survival, health behaviors, less distress and low cortisol in people with HIV/AIDS. Annals of Behavioral Medicine, 24, 34e48.
Kass, J. D., Friedman, R., Leserman, J., Zuttermeister, P. C., & Benson, H. 1991. Health Outcomes and a New Index of Spiritual Experience. Journal for the Scientific Study of Religion, 30(2), 203.
Koenig, H. G. 2002. An 83 Year Old Woman with Chronic Illness and Strong Religious Beliefs. Journal of the American Medical Association, 288(4), 487–493.
Kuhn, C. C. 1988. A Spiritual Inventory of the Medically Ill Patient. Psychiatric Medicine, 6(2), 87–100.
LaRocca-Pitts, M. 2008. FACT: Taking a Spiritual History in a Clinical Setting. Journal of Health Care Chaplaincy, 15, 1–12.
Lewis, L. M. 2008. Spiritual Assessment in African-Americans: A Review of Measures of Spirituality Used in Health Research. Journal of Religion and Health, 47, 458–475.
Lo, B., Quill, T., & Tulsky, J. 1999. Discussing palliative care with patients. Annals of Internal Medicine, 130(9), 744–749.
Maugans, T. A. 1996. The SPIRITual History. Archives of Family Medicine, 5(1), 11–16.
Monod, S., Brennan, M., Rochat, E., Martin, E., Rochat, S., & Bula, C. J. 2011. Instruments measuring spirituality in clinical research: a systematic review. Journal of General Internal Medicine, 26(11), 1345–1357.
Moore, R. J. 2003. Spiritual assessment. Social Work, 48(4), 558–561.
Muncy, J. F. 1996. Muncy comprehensive spiritual assessment. The American Journal of Hospice & Palliative Care, 13(5), 44–45.
Nash, R. 1990. Life’s Major Spiritual Issues. The Care Giver Journal, 7(1), 3–42.
Newshan, G. 1998. Transcending the physical: spiritual aspects of pain in patients with HIV and/or cancer. Journal of Advanced Nursing, 28(6), 1236–1241.
O’Connor, T. S. J., O’Neill, K., Penner, C., Van Staalduinen, G., Meakes, E., & Davis, K. 2005. Not Well Known, Used Little and Needed: Canadian Chaplains’ Experiences of Published SPiritual Assessment Tools. The Journal of Pastoral Care & Counseling, 59(1–2), 97–107.
Olsen, A. 2009. Olsen’s BASIC-6 Spiritual Care Screens. PlainViews 6(22).
Pierpont, J. H. 2003. Spiritual assessment. Social Work, 48(4), 563–565.
Puchalski, C., & Romer, A. L. 2000. Taking a Spiritual History Allows Clinicians to Understand Patients More Fully. Journal of Palliative Medicine, 3(1), 129–137.
Robinson, M. R., Thiel, M. M., & Meyer, E. C. 2007. On being a spiritual care generalist. American Journal of Bioethics, 7(7), 24–26.
Rosmarin, D. H., Pirutinsky, S., & Pargament, K. I. 2011. A brief measure of core religious beliefs for use in psychiatric settings. International Journal of Psychiatry in Medicine, 41(3), 253–261.
Sharma, R. K., Astrow, A. B., Texeira, K., & Sulmasy, D. P. 2012. The Spiritual Needs Assessment for Patients (SNAP): development and validation of a comprehensive instrument to assess unmet spiritual needs. Journal of Pain and Symptom Management, 44(1), 44–51.
Skalla, K. A., & McCoy, J. P. 2006. Spiritual Assessment of Patients with Cancer: The Moral Authority, Vocational, Aesthetic, Social, and Transcendent Model. Oncology Nursing Forum, 33(4), 745–751.
Staten, P. 2003. Spiritual assessment required in all settings. Hospital Peer Review, 28(4), 55–56.
Stoddard, G., & Burns-Haney, J. 1990. Developing an Integrated Approach to Spiritual Assessment: One Department’s Experience. The Care Giver Journal, 7(1), 63–86.
Stoll, R. I. 1979. Guidelines for Spiritual Assessment. American Journal of Nursing, 79(9), 1574–1577.
Timmons, F., & Kelly, J. 2008. Spiritual Assessment in Intensive and Cardiac Care Nursing. Nursing in Critical Care, 13(3), 124–131.
VandeCreek, L. 1999. Professional chaplaincy: an absent profession? Journal of Pastoral Care, 53(4), 417–432.
VandeCreek, L., Ayres, S., & Bassham, M. 1995. Using INSPIRIT to Conduct Spiritual Assessments. Journal of Pastoral Care, 49(1), 83–89.
Yeadon, B. E. 1986. Spiritual assessment for a community-based hospice. Caring, 5(10), 72–75.
About this article
Cite this article
Cadge, W., Bandini, J. The Evolution of Spiritual Assessment Tools in Healthcare. Soc 52, 430–437 (2015). https://doi.org/10.1007/s12115-015-9926-y
- Spiritual assessment