Spiritual Resources to Relieve Physical Pain

part 1

California/Nevada ACHSASacramento, California

November, 2013

Edmonton Symptom Assessment System (ESAS)Please circle the number that best desribes:

No pain 0 1 2 3 4 5 6 7 8 9 10 Worst possible painNot tired ……………….. Worst possible tirednessNot nauseated ……………….. Worst possible nauseaNot depressed ……………….. Worst possible

depression Not anxious ……………….. Worst possible anxietyNot drowsy ……………….. Worst possible

drowsinessBest appetite ……………….. Worst possible appetiteBest feeling of well being …… Worst possible feelingNo shortness of breath …… Worst possible SOBOther problem ………………..

ESASTwo pages (second page asks patient or

caregive to mark where it is that they are experiencing pain)

Can be filled by patient, caregiver or caregiver assisted

Validated tool for helping to manage symptoms of serious illness

Spiritual History Tool: HOPEH: What gives you hope in this time of illness?

O: Are you a member of a religious or spiritual community?

P: What aspects of your spiritual beliefs do you find most helpful and meaningful personally?

E: How do your beliefs affect the kind of medical care you would like me to provide over the next few days/weeks/months?

Spiritual History Tool: FICAF: What is your faith?

I: How important is it?

C: Are you part of a religious community?

A How would you like me as your provider to address these issues in your care?

Spiritual History Tool: SPIRITS: Do you have a formal religious affiliation? Do you

have a spiritual life that is important to you?P: In what ways is your spirituality important to you?I: Do you belong to any religious or spiritual groups or

communities?R: What specific practices/rituals do you carry out as

part of religious or spiritual life?I: Would you like to discuss religious or spiritual

implications of health care?T: Are there particular aspects of medical care that

you wish to forgo or have witheld because of your religion/spirituality?