NURS 519 Week 1 Spiritual Assessment and Cultural Assessment Example

Spiritual and Cultural Assessment of a 74-Year-Old Retired Machinist Receiving Home Hospice Care for Advanced COPD

Spiritual Assessment

The person assessed is a 74-year-old retired machinist with advanced chronic obstructive pulmonary disease who enrolled in home hospice three days before the visit and lives with a spouse in a small town. The interview followed the FICA questions, which ask about faith, its importance, community and how care should address spiritual needs (Puchalski & Romer, 2000).

Faith and Belief

Asked whether they consider themselves spiritual or religious, the patient said, "I was raised Methodist, and I still believe, but I haven't been to church in twenty years." Asked what gives life meaning, they named their spouse of 51 years, three grandchildren and "making things with my hands that last."

Importance

The patient said faith "matters more now than it did," and that lying awake at night they wonder "whether I did enough right to make up for what I did wrong." They described a long estrangement from a brother after an argument over their parents' farm. On a scale of zero to ten, they rated their peace with God at four.

Community

They have no current church community, though their spouse attends a Methodist congregation and the pastor has offered to visit. A close friend from the machine shop visits weekly.

Address in Care

Asked how the hospice team could help, the patient said, "I wouldn't mind talking to somebody, but not somebody who's going to preach at me." They agreed to a visit from the hospice chaplain and wanted to think about the pastor.

Nursing Conclusions and Plan

The patient shows spiritual distress related to guilt and an unresolved relationship, a recognized source of suffering at the end of life (Matzo & Sherman, 2018). The question about doing "enough right" is a question about forgiveness, and it deserves an answer from someone the patient trusts, not a quick reassurance from the nurse. The plan is a chaplain referral within the week, an offer to help the patient contact the brother if they choose, and a follow-up question at each visit about peace and worry. Scripture speaks of God's mercy as new every morning (English Standard Version Bible, 2001/2016, Lamentations 3:22-23), and the chaplain may draw on that hope if the patient welcomes it.

Cultural Assessment

The cultural assessment followed the six domains of the Giger and Haddad transcultural model: how the person communicates, uses personal space and is organized socially, how they orient to time, how much control they feel over their surroundings and health, and the biological variations relevant to care (Giger & Haddad, 2021). The patient is White, of German and Scots-Irish descent, born and raised in rural Appalachian Ohio, a high school graduate who worked 38 years in the same machine shop.

Communication

The patient speaks English, prefers plain, direct talk and dislikes medical jargon. They tend to downplay symptoms, saying "I'm fine" when short of breath, so the nurse watches for nonverbal signs such as pursed-lip breathing and posture. The spouse often finishes the patient's sentences, and the patient seems comfortable with this.

Space

The patient is comfortable with touch during care but prefers that visitors stay in the living room, which they consider "company space." Their recliner by the window, where they sleep most nights because lying flat worsens breathlessness, is their own territory.

Social Organization

Family is central. The spouse makes most household decisions, while the patient expects to make medical decisions personally. Two adult children live within an hour, and one is a nurse. The family values self-reliance and is reluctant to accept help from outside; they declined a home health aide at first.

Time

The patient is oriented to the present and the past more than the future and prefers morning visits, after the slow start their breathing requires. They have not completed an advance directive, saying "we'll cross that bridge," though they clearly do not want to return to the hospital.

Environmental Control

The patient believes illness follows from choices, in this case 45 years of smoking, and accepts responsibility for it. They use home remedies such as steam and honey alongside prescribed inhalers and morphine, and they worry that morphine "makes you an addict."

Biological Variations

As a person of Northern European ancestry with a heavy smoking history, the patient has no particular genetic risk relevant to end-of-life medications, but age, low body weight and carbon dioxide retention call for careful titration of opioids and anxiolytics.

Nursing Conclusions and Plan

The cultural findings shape care in four ways: the nurse uses plain language and asks specific questions instead of accepting "I'm fine"; schedules visits in late morning; respects self-reliance by offering help as a choice, not a requirement; and addresses the fear of addiction by explaining that low-dose morphine for breathlessness is a standard comfort treatment (Matzo & Sherman, 2018). Because the patient wants to make their own medical decisions, the next visit will include an advance directive and portable medical order conversation, with the spouse present if the patient wishes.

Reflection

In both interviews, the most useful moments came from open questions and silence. When I waited after asking what gave life meaning, the patient filled the pause with the story of a lathe they rebuilt for a grandson, and that story told me more about their values than any direct question did. Next time I would ask the spiritual questions after the cultural ones, because the patient opened up only after talking about work and family, and a question about God at the start of a first visit felt abrupt to both of us.

I also noticed my own assumptions. I expected a rural patient with a Methodist upbringing to want a pastor right away, and the patient's preference for a chaplain who would not preach corrected me. The assessments are a reminder that culture and faith describe a starting point for questions, not the answers. Finally, I would allow more time: an assessment completed across two visits, rather than squeezed into one admission visit beside medication reconciliation, would let the patient decide how much to share and when.

References

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Giger, J. N., & Haddad, L. (2021). Transcultural nursing: Assessment and intervention (8th ed.). Elsevier.

Matzo, M., & Sherman, D. W. (Eds.). (2018). Palliative care nursing: Quality care to the end of life (5th ed.). Springer Publishing Company.

Puchalski, C., & Romer, A. L. (2000). Taking a spiritual history allows clinicians to understand patients more fully. Journal of Palliative Medicine, 3(1), 129-137. https://doi.org/10.1089/jpm.2000.3.129