Assessing Spiritual Needs - HOPE

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 non-
threatening 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.
2
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?’
3
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?’
4
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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Assessing Spiritual Needs:

The H.O.P.E. Assessment Tool

When assessing spiritual needs we ask questions in the same way as we

The HOPE Assessment Tool

• It covers critical areas

The HOPE tool is effective, efficient, recognised and easy to remember. It

H = Sources of hope, meaning, comfort, strength, peace, love and connection

‘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?’

‘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?’

‘How are things with your family and friends?’

‘Is there anyone with whom you have to ‘make up’?’

‘Would it be helpful to speak to a chaplain/spiritual leader?’

‘Are there any specific practices or restrictions I should know about in

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