The Four Worlds of Spiritual Assessment and Care

From the dawn of human consciousness, religious and spiritual expressions have been inexorably intertwined with some degree of assessment toward more effective care— whether such care is offered by shaman, imam, rabbi, shirpa, prophet, priest, pastor, physician, nurse, or lay minister. Currently, two major forces have brought spiritual assessment and care into sharp focus regarding the delivery of health care in the U.S. The first is the advent of managed care. The shift in emphasis from sickness-based to wellness-based reimbursement, spurred by spiraling costs, has brought close scrutiny to provider effects on patient outcomes. The second major force, related to the first, has been increased attention to alternative medicine and to previously unacknowledged adjuncts to traditional health-care delivery, most often understood by the terms holistic health or wellness. One of the sub-areas within holistic health is spiritual care. A measure of the increasing importance of spiritual care within the delivery of U.S. health care is the fact that the Joint Commission on Accreditation of Health Organizations (JCAHO) is gradually upgrading the place of chaplaincy services in the Standards. Thus, a clear, simple, user-friendly, inclusive, valid, reliable, useful diagnostic, care-anticipating, and outcomes-measurable spiritual-care model is becoming more a necessity in the increasingly demanding discipline of clinical chaplaincy.associated before retirement with the