PICOT Questions Template
September 7, 2022
Windshield Survey, Community Assessment Tool, Screening interviews
September 7, 2022

Spiritual Assessment

Then complete a spiritual assessment on someone in your community. Use the form
found below the rubric. Use bullet points or numbers rather than complete sentences.
Be sure to choose an appropriate tool. You can use the assessment from the chapter
on spirituality found in your textbook, or choose one found in the literature or online
such as the
HOPE tool: http://www.aafp.org/afp/2001/0101/p81.html
FICA tool: http://smhs.gwu.edu/gwish/clinical/fica/spiritual-history-tool
FACT tool: http://www.professionalchaplains.org/files/resources/reading_room/
During the interview you will choose an appropriate spiritual nursing action based on
your assessment and state how/why you chose the nursing action. What was the result
of the action (e.g. what did the interviewee think of the nursing action and/or how did
they respond to the nursing action?). What are your thoughts on the experience of doing
this assessment (e.g. main takeaway(s), surprises, reactions). Please keep the form to
three or fewer pages.