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John W. Fisher PhD, EdD – Researcher

Senior Fellow, Rural Health Academic Centre, Faculty of Medicine, University of Melbourne

Hon Sen. Research Fellow, Centre for Religious & Spirituality Education, Hong Kong Institute of Education, and

School of Education & Arts, University of Ballarat Visiting Professor, Institute of Health, Medical Sciences & Society,

University of Glyndŵr, Wales UK

j.fisher@ballarat.edu.au jwfisher@unimelb.edu.au

The SHALOM tool for assessment of patients’

spiritual needs

Catholic Health Australia National Conference Melbourne 26-28 August 2013

Assessing ‘spirituality’

• Religious denomination? • Frequency of attendance at religious services? • [√] That’s done! • NOT SO!!!

Spirituality & religion Both are multi-faceted

Kaleidoscope of views about R and S R (S) R=S RS S(R) S (xR) xSXR

Religious Humanist nihilist influenced by worldviews/beliefs Spirituality is what lies at the heart of a person being human

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Dimensions of health physical social emotional mental vocational

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Dimensions of health phySical P socIal R emotIonal menTal U vocationAl L

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Spiritual health and well-being

• Spiritual health is a fundamental dimension of people’s overall health and well-being, permeating and integrating all the other dimensions of health

(i.e., the physical, mental, emotional, social & vocational).

• It is a dynamic state of being, shown by the extent to which people live in harmony within relationships in up to four domains of spiritual well-being

(personal, communal, environmental, transcendental domains)

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Spiritual Well-being - expressed by the quality of relationships in each DOMAIN (note progressive synergism, where subsequent domains build on as well as build up ones they embrace)

PERSONAL COMMUNAL ENVIRONMENTAL TRANSCENDENTAL

self - worth.

joy, peace,

patience,

identity,

& religion.

hope,faith,trust.

forgiveness,

justice, love, awe & wonder

peak experiences

connectedness

with

Nature

ultimate concern, cosmic force,

Transcendent

Other,

God.

Faith

adoration,

worship.

awareness interpersonal

relations

self - in - depth

RATIONALIST deny inspiration

meaning,

purpose

& values

care, nurture &

stewardship morality,

culture,

The knowledge aspects of each domain are written in bold type, near the top of each cell (structure)

The inspiration aspects are written in italics, in the centre of each cell. (essence & motivation)

The expressions of well-being in each domain are written in roman type , at the bottom of each cell

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PERSONAL DOMAIN OF SWB Developing:…. Indicative not exhaustive 1. a sense of identity ‘spiritual thermometer’ 2. self-awareness 3. joy in life 4. inner peace 5. meaning in life

COMMUNAL DOMAIN OF SWB 1. a love of other people 2. forgiveness toward others 3. trust between individuals 4. respect for others 5. kindness toward other people

ENVIRONMENTAL DOMAIN OF SWB 1. connection with nature 2. awe at a breathtaking view 3. oneness with nature 4. harmony in the environment 5. sense of ‘magic’ in the environment

TRANSCENDENTAL DOMAIN OF SWB 1. personal relation with the Divine/God 2. worship of the Creator 3. oneness with God 4. peace with God 5. prayer life

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Spiritual Health And Life-Orientation Measure (SHALOM) Spirituality can be described as that which lies at the heart of a person being human. Spiritual well-being can be seen as a measure of how good you feel about yourself and how well

you relate to those aspects of the world around you, which are important to you. Please give two responses to each of the following items, by circling the numbers in each of the

two columns, to show: a. how important you think each area is for an ideal state of spiritual well-being, AND b. how you feel each item reflects your personal experience most of the time. Each response is graded: 1 = very low 2 = low 3 = moderate 4 = high 5 = very high. Do not spend too much time on any one item. It is best to record your first thoughts. Items a. ideal for b. how spiritual you feel Developing: well-being 1. a love of other people 1 2 3 4 5 1 2 3 4 5 2. personal relationship with the Divine/God 1 2 3 4 5 1 2 3 4 5

4. connection with nature 1 2 3 4 5 1 2 3 4 5

5. a sense of identity 1 2 3 4 5 1 2 3 4 5

Dissonance is fairest measure of quality of relationships in each domain (ideal - feel)

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Scoring SHALOM

• Personal domain – items 5, 9, 14, 16, 18

• Communal domain – items 1, 3, 8, 17, 19

• Environmental domain – items 4, 7, 10, 12, 20

• Transcendental domain – items 2, 6, 11, 13, 15

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Case studies using SHALOM

• Nancy, 80s, multiple ca., positive outlook on life • Pi24 Pf23 ; Ci24 Cf24 ; Ei25 Ef25 ; Ti25 Tf25

• Mary, 40s, recurring breast ca. • Pi25 Pf22 ; Ci24 Cf19 ; Ei13 Ef11 ; Ti5 Tf5

• Bill, 60s, COPD, low Per, Com, Env, high Tra

• Bob, 70s, testicular ca., all scores = 1

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After assessment

• Discuss dissonances (delicately) • “I notice a marked difference between your ideals and lived

experience on ‘forgiveness’. Would you like to discuss what is happening there for you?”

• (May occur during completion of SHALOM. Note on pt record)

• “Would you like to discuss this with (choose appropriate): Counsellor, chaplain, family, friends, someone from church,

social worker, psychologist?” (record referral) • Follow up (reuse SHALOM)

For quality assurance Compare initial with subsequent responses on SHALOM to note

effectiveness of intervention/s. As well as pts’ swb, check swb of staff & carers

(How you live is what you give in terms of help for swb)

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• We are interested in your total well-being. At our core, or heart level, we humans are spiritual beings.

• In some of the questions, the word Transcendent is used. This refers to a belief some people have that their lives are influenced by SomeOne or SomeThing beyond the human and natural worlds.

Please CIRCLE ONE of the following to show what best describes any supernatural influence on your life, that is, the Transcendent influence on your life. (Please keep this interpretation in mind when you see ‘Transcendent’ in the questions that follow): Allah Angel/s Buddha Deceased person Deity/deities the Divine

Fate Father God Gaia God Heaven Higher power

Higher self Mystery Otherness Presence Something there Universal spirit

Not an area in which I believe Web survey: http://tinyurl.com/swbfisher j.fisher@ballarat.edu.au

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Some recent applications of SHALOM (10% of >300 studies in 22 languages) • ANZ – sp & aged care; intellectual disability; mental health care;

palliative care • Brazil – sp of patients & health professionals • Canada – sp & alcoholism; mental health of people affected by

political violence • Colombia, S. America – clinical Ns in a graduate program • Croatia – relation of sp to recovery from depression & suicide

ideation\ • Czech Republic – sp as protective measure in Alzheimer’s pts • India – psychosocial health; sp of mothers of ch with cancer • Indonesia – sp care in nursing; self-acceptance in haemodialysis

pts; improving swb

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• Iran – sp in community & preventative medicine; clinical epidemiologist sp & qol

• Ireland – swb of bereaved pa with stillborn babies • Israel – sp & geriatric rehabilitation • Italy – anxiety, depression R/S in parents of hospitalised ch • Mexico – sp & emotional regulation • Norway – adult pts’ sp concerns in life-threatening illness &

facing death • Pakistan – psychosocial health, parenting & attachment styles • Philippines – impact of prayer on Ns’ sp health • Portugal – menopause & sp • Singapore – coping, sp & mindfulness • UK – pts’ with neurological, nephrological & respiratory

diseases; pts’ & Ns’ swb • USA – mental hlth & wb; anxiety, depression in grad stu;

compassion fatigue & self-care among healthcare providers

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References • Fisher, J.W. & Brumley, D.J. (2008) Nurses’ and carers’ spiritual well-being in the

workplace. Australian Journal of Advanced Nursing, 25(4):49-57.

• Fisher, J.W. (2009) Reaching the heart: Assessing and nurturing spiritual well-being via education. EdD dissertation, University of Ballarat, Victoria, Australia. Available from http://archimedes.ballarat.edu.au:8080/vital/access/HandleResolver/1959.17/13481

• Fisher, J. (2010) Development and application of a spiritual well-being questionnaire called SHALOM. Religions, 1: 105-121.

• Fisher, J. (2011) The Four Domains Model: Connecting spirituality, health and well-being. Religions, 2: 17-28.

• Fisher, J.W. (2012) The importance of relating with God for spiritual well-being. In M. Weiss & M. Fowler (Eds.), Spirituality: New reflections on theory, praxis & pedagogy (pp.147-161). Oxford, UK: InterDisciplinary Press. Available at http://www.inter-disciplinary.net/wp-content/uploads/2012/02/fishersppaper.pdf

• Fisher, J.W. (2012) Staff’s and family members’ spiritual well-being in relation to help for residents with dementia. Journal of Nursing Education & Practice, 2(4): 1-9.

• Fisher, J.W. & Brumley, D.J. (2012) Palliative care doctors need help with spiritual well-being. Journal for the Study of Spirituality , 2(1): 49-60.

• Fisher, J.W. (2013) You can’t beat relating with God for spiritual well-being: Comparing a generic version with the original spiritual well-being questionnaire called SHALOM. Religions, 4(3):325-335.