Spiritual distress assessment tool an instrument
OUTLINE
1. Introduction to spirtual assessment.
2. Description of the tool
3. Application of the tool
4. Reason for choosing the tool
5. Validity and reliability of the tool
6. Strengths and weakness of the tool
7. Refrences
8. Questionairres
I. Validity and reliability of the tool in previous research
In a study of patients (N = 203), aged 65 years and over with Mini Mental State
Exam score ≥ 20, shows that the SDAT has acceptable to good internal consistency,
as well as intra-rater and inter-rater reliability. Cronbach α was acceptable (0.60). Intra-
rater and inter-rater reliabilities were high (Intraclass Correlation Coefficients ranging
from 0.87 to 0.96). Intra-rater agreement about the presence versus absence of
spiritual distress was perfect (100%).The scale’s internal consistency was acceptable
(Cronbach a = 0.60) and Concurrent validity showed a significant positive correlation
(Spearman Rho = 0.43, P < .001).
The Spiritual Distress Assessment Tool (SDAT) is a 5-item instrument developed to assess unmet
spiritual needs in hospitalized elderly patients and to determine the presence of spiritual distress.
The objective of this study was to investigate the SDAT psychometric properties.
The Spiritual Distress Assessment Tool (SDAT) was
developed to address the need for a valid instrument
specifically designed to assess spiritual distress in hospitalized
elderly patients. The hypothesis was made that
spiritual distress arises from unmet spiritual needs. The
greater the degree to which a spiritual need remains
unmet, the greater the disturbance in spiritual state and
the greater the level of spiritual distress experienced by
the patient. Within this conceptual framework, the
SDAT was developed in three stages. First, a conceptual
model of spirituality, the Spiritual Needs Model, was
defined [22]. In this model, spirituality in hospitalized
elderly persons is defined as a multidimensional concept
that includes four dimensions: Meaning, Transcendence,
Values and Psycho-social Identity. Related spiritual
needs were systematically defined for each dimension.
The dimensions and their related needs are presented in
Table 1. Second, the SDAT instrument was developed
on the basis of this model [23]. A standardised set of
questions to be used in a semi-structured interview performed by a chaplain has been specifically
defined.
Moreover, a structured assessment procedure to identify
unmet spiritual needs and score the degree to which
spiritual needs remain unmet was successively developed.
The overall process for SDAT administration and
scoring is presented in Figure 1 and an example of
SDAT scoring is provided in Table 2. Finally, face validity
and acceptability of the SDAT instrument were evaluated
in chaplains experienced in hospital pastoral care.
Results confirmed very good face validity and showed
high acceptability of the SDAT [23]. Criterion-related validity was also
assessed using the Functional Assessment of Chronic Illness
Therapy- Spiritual Well Being (FACIT-Sp) [20] and
the question “Are you at peace?” [24]. In addition, based
on the hypothesis that spiritual distress would be correlated
with depressive symptoms and with difficulties in
discharge planning, concurrent validity of the SDAT was
assessed with the Geriatric Depression Scale (GDS) [25]
and the occurrence of a family meeting to define discharge
disposition, respectively. Finally, predictive validity
was investigated using rehabilitation length of stay
and nursing home discharge as outcome measures.
Development of the Spiritual Distress Assessment Tool
(Figure 1)
The development of The Spiritual Distress Assessment
Tool (SDAT) was based on a conceptual model of spiritual
needs assessment previously published under the
name of the Spiritual Needs Model [33].
Development of the Spiritual Distress Assessment
Tool was yet carried out in three stages.
a) Conceptualisation of spirituality and spiritual needs in
hospitalised persons: definition of the Spiritual Needs
Model [33]
An interdisciplinary group of health professionals (one
physician, four nurses, and three chaplains), working in
five different geriatric hospitals in Switzerland, met on
fourteen occasions over a two-year period to define and
conceptualise spirituality in the hospitalised person. The
group was directed by one of the co-authors (ER).
A literature search and review in PubMed and Google,
using “spirituality” and “religiosity” as search terms, was
performed to select and define candidate dimensions
that could characterize spirituality in hospitalised persons.
Candidate dimensions were discussed and consensus
was achieved through the sharing of spiritual care
experiences, role play and case analysis. Finally, using
the same process, the working party further defined the
spiritual needs corresponding to each selected dimension
of spirituality.
The work of the interdisciplinary group resulted in a
definition of spirituality in hospitalised persons, of the
dimensions that characterize a patient’ spirituality and
of the needs corresponding to each of these dimensions.
The overall concept was defined as The Spiritual
Needs Model [33]. b) Definition of the Spiritual Distress Assessment Tool
(SDAT) and guidelines for administration
Two of the authors (SM and ER) decided to integrate
the Spiritual Needs Model into hospital geriatric care
over a six month period in order to assess its practicability
in clinical care.
This phase of the research was conducted in the postacute
care unit of the Department of Geriatric Medicine,
University of Lausanne Medical Center. This 66-bed
unit admits patients aged 65 years and older and provides
interdisciplinary care to restore the highest possible
level of functional independence and quality of life.
Eighty percent of patients report a Judaeo-Christian religious
background.
During this phase, the leader of the working party
(ER) was integrated into the interdisciplinary team. He
performed systematic bedside assessments of patients’
spirituality using the framework of the Spiritual Needs Model and participated in weekly
interdisciplinary team
meetings to share the results of this assessment with
health professionals.
