Chaplain Mark LaRocca-Pitts, PhD, on transforming anxiety into hope

Assessing Hope: The 4-F’s of Spiritual Assessment

The chaplain, as a member of the healthcare team, helps patients “mobilize and actualize their spiritual resources in such a way that they contribute to their own healing process.” [1] As a part of this process, the chaplain will conduct a spiritual assessment. One form of spiritual assessment is called “the 4- F’s”: facts, feelings, family and faith.

As spiritual beings, humans are nested in a web of relationships, connections and understandings that include ideas, other people, one’s own self, nature, and possibly God or a higher power. When sickness occurs, this web may be disturbed or disrupted thereby affecting a person’s spiritual sense of wholeness. By asking patients about the “facts” of their illness, about how they are “feeling,” about their “family,” and about their “faith,” the chaplain is able to assess whether or not the patient’s relational web is fueled by anxiety or hope.

If the assessment reveals in a particular area a sense of hope, then this area is spiritually well and can be utilized as a spiritual strength. If the assessment reveals in another area an anxiety-producing relationship, connection, or understanding, then this area indicates spiritual distress or a spiritual weakness. Rarely does the patient experience anxiety in all four areas, and often strengths in one area may offset weakness in another. The more overall hope the patient has the more likely the patient will have a favorable outcome.

Though patient acuity, patient load, and increasingly shorter lengths of stays often limit the chaplain’s ability to assess and intervene effectively, the chaplain can still use the assessment to increase the patient’s awareness of her or his spiritual strengths and weaknesses and to indicate how these might contribute to or detract from healing. If circumstances allow for a more concerted intervention, then the chaplain and the patient have various options.

For example, if the patient is experiencing anxiety in relation to the “facts” of his or her illness, whether these “facts” be medical, financial, clinical, or ethical, then the chaplain may address those for which he or she is qualified and then make appropriate referrals to other members of the healthcare team for follow up. If the patient’s anxiety is in relation to his or her “feelings,” then the chaplain may explore and help normalize these feelings as they relate to the illness process, and then, if needed, make referrals as appropriate to healthcare team members or outside agencies. If anxiety is found in the patient’s “family” or social support system, then the chaplain may help the patient determine where the dysfunction lies and the possible genesis and resolution of this dysfunction and again make referrals as appropriate. Finally, if the anxiety is found in relation to the patient’s “faith,” then the chaplain may help the patient explore the patient’s faith as it relates to the illness process and then encourage and possibly assist the patient in using his or her faith in the healing process. In this area the chaplain will also make referrals, as needed and as requested, to the patient’s particular faith community for appropriate follow up.

The goal of this form of spiritual assessment and intervention is to transform those areas in which the patient experiences anxiety into areas of hope for the patient. Hope has tremendous healing power for the patient. Though the transforming of anxiety to hope is one therapeutic area in which the chaplain contributes to the patient’s healing process, all who help the patient maintain hope in the face of a critical health crisis provide spiritual care for the patient.

 

[1] Mark LaRocca-Pitts, "Walking the Wards as a Spiritual Specialist," Harvard Divinity Bulletin, 32:3 (Summer, 2004), p. 29.

 

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