Attending to patients' spiritual needs is no longer an option for health care organizations, although wide latitude on how to meet these needs exists. The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) acknowledges patients' "fundamental right to considerate care that safeguards their personal dignity and respects their cultural, psychosocial, and spiritual values."

JCAHO recommends that health care organizations (1) acknowledge patients' rights to spiritual care and (2) provide for these needs through pastoral care and a diversity of services that may be offered by certified, ordained, or lay individuals.

I work closely with nurses to help make the connection between spirituality and the physical, emotional, social, and cognitive aspects of individuals. We discuss the importance of understanding the diversity of approaches to spirituality and how they should consider more than formal religion when assessing a patient's spiritual needs. Five categories of spirituality are helpful in assessing an individuals approach and needs: capacity, search, doing, experience, and evil, although some spiritual systems do not incorporate evil. At the base of this hierarchy of categories is capacity, that is, the ability to love and be loved and to relate to something larger than self. The search dimension of spirituality occurs when people look for meaning, purpose, and direction in their lives. Or they may search for truth, power they can use, or in the Eastern sense, harmony and balance. Many nurses expect that patients' spirituality will fall under the category of doing, which includes a specific religious orientation or the practice of a spiritual discipline on a regular basis without any formal involvement in a religion. Such spiritual disciplines include meditation, prayer, fasting, and the giving of alms or money.

Experience is the broadest category of spiritual life. There are many types of spiritual experiences such as "Being Connected" and "Sharing Belief in a Higher Power." The experience of "transcendence" implies that one has encountered something utterly beautiful beyond a person's capacity to understand or even categorize through normal sensory channels. The spirituality experience can also be an "area of apprehension" rather than comprehension, referring to the ability to know that something is real but in a way that defies our usual way of understanding. Finally, spirituality is sometimes experienced as an added sense. Some individuals who have experienced danger, for example, develop high levels of intuition and are said to have acquired this sixth sense. Finally, evil is the opposite of all other definitions of spirituality. This category is included since we cannot approach all persons as spiritual beings with the assumption that spirituality can only be positive.

In our pressured health care world, it is impossible for nurses to conduct complete assessments of spiritual needs. However, the model offered here can help you to read the patient's direct and subtle cues for spiritual care.