Patient Guide

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Spiritual Self-Assessment

Responding to the questions in this self-assessment can be helpful as a private exercise or an exploration with others as you reflect on your life and your beliefs. We want to be respectful of you. As you use this tool, you may want to substitute different terms more suitable to your tradition and beliefs. If you would like to explore with someone else, you are invited to contact a chaplain. You can reach us at (206) 288-1099 or pastoral@seattlecca.org.

Religious/Spiritual Background

  • Do you consider yourself a spiritual and/or religious person?
  • What are your key religious/spiritual beliefs/practices?
  • Who do you turn to for religious or spiritual support?

Communities/Support Systems

  • What people are in your support system (e.g., family, friends, colleagues)?
  • What types of support do they provide (e.g., emotional, practical)?
  • At this time, are they nearby or far away?

Cultural/Religious Needs

  • What rituals are important to you?
  • What special dietary requirements do you have?
  • What gender-specific needs do you have (e.g., a male chaplain, a female doctor)?
  • What is your language preference?

Spiritual Journey

  • What is your earliest spiritual/religious memory?
  • If you were writing a spiritual autobiography, what would be the title of the book and what would be the chapter headings (i.e., key moments/transitions in your spiritual life)?
  • Have there ever been some dark times in your life? If so, how did you get through them?
  • Who have been the key people in your spiritual journey—personal relationships and people you have read/heard about?

Sense of the Holy

  • What is most important to you?
  • How do you understand/experience God/the Sacred?
  • How do you nurture your soul or yourself?

Meaning

  • How do you make sense of what is happening in your life?
  • Where have you normally found meaning in life?
  • Where/how do you find meaning now?
  • For what are you most grateful?
  • What brings you joy?
  • What are your most significant losses?

Hopes

  • What are your hopes: immediate, intermediate, and ultimate?
  • What are your dreams?
  • Who are the key players in realizing your hopes and dreams?
  • How do you pray or for what do you pray, if you pray?
  • Of what are you most afraid?

Health and Healing

  • How have you experienced healing or positive changes in your life through this experience?
  • What are particular ways that you would like to experience healing (e.g., relationships, priorities, how you spend your time and/or money, emotions, spirituality)?
  • What does “healing” mean to you?

Dying and Death

  • What are your hopes, fears, and/or concerns regarding dying/death?
  • What are your beliefs about death and after-death?
  • If you could choose how you were going to die, how would you die?