| Course | NURS 6910 Introduction to Palliative Care: Principles of Hospice and Palliative Care |
|---|---|
| Week | Week 9 |
| Paper type | Spiritual and cultural assessment |
| Length | About 1,020 words, 6 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | Master of Science in Nursing (MSN) |
| Updated | September 2026 |
Free sample paper for NURS 6910 Week 9
"God Is Not Finished With Me": A FICA Spiritual History and Explanatory Model Assessment for a Retired Teacher With Metastatic Colon Cancer
Student Name
College of Nursing, Walden University
NURS 6910: Introduction to Palliative Care: Principles of Hospice and Palliative Care
Instructor Name
Month Day, Year
"God Is Not Finished With Me": A FICA Spiritual History and Explanatory Model Assessment for a Retired Teacher With Metastatic Colon Cancer
Case Summary
The composite patient is a 71-year-old retired fifth-grade teacher with colon cancer now present in both lungs and the liver. Two courses of chemotherapy are behind her, and her oncologist does not expect a third to hold the disease back. She lives alone in the house where she raised three children, now adults living nearby. She is the widow of a church deacon and remains active in her congregation, whose prayer chain calls her every evening. Her pain and fatigue have increased, and the palliative care nurse is meeting her at home for a second visit. At the first visit, when the nurse mentioned hospice as a future option, she said firmly, "God is not finished with me," and changed the subject.
The National Consensus Project guidelines treat spiritual, religious and existential aspects of care and cultural aspects of care as distinct domains of palliative care, each requiring assessment (Ferrell et al., 2018). This paper assesses both and then shows which parts of the care plan each finding changes.
Spiritual History Using FICA
The FICA tool guides a brief spiritual history through four areas: faith and belief, importance, community, and how the patient would like these addressed in care (Puchalski & Romer, 2000).
Faith and belief. Asked whether she considers herself spiritual or religious, she answered, "I am a Christian. I have been in that church since I was a girl." Asked what gives her life meaning, she named her faith, her children and the students who still write to her.
Importance. Her faith is central to how she understands the illness. "The doctors do what they can," she said, "and the rest is in God's hands. I pray for healing every day, and I believe He can still do it."
Community. Her congregation is her main source of support. Her pastor visits weekly, the prayer chain calls each evening, and church members bring meals.
Address in care. She wants her pastor involved in major decisions and asked that the team "not talk to me like I've given up on God."
Interpreting the Hope for a Miracle
Her statement that God is not finished with her, and her daily prayer for healing, could be misread as denial. Nothing in her words refuses care. She has accepted chemotherapy, attends every appointment and has agreed to palliative visits. Her hope for healing is held within a faith that also includes accepting God's will, and many patients hold hope for a miracle and a realistic understanding of their illness at the same time. The nurse's task is to plan alongside that hope rather than against it. Spiritual support from the medical team matters to outcomes: in a study of patients with advanced cancer, those whose spiritual needs were supported by the medical team had higher quality of life near death and greater use of hospice (Balboni et al., 2010).
Cultural Assessment Using Explanatory Model Questions
Kleinman et al. (1978) proposed that clinicians ask patients about their own explanatory model of illness, what they call it, what they think caused it, how they think it works and what they fear, rather than relying on generalizations about their culture.
What she calls the illness. "The cancer," and sometimes "this trial," in the sense of a test of faith.
What she thinks caused it. She is not sure. She wonders whether she ignored symptoms for too long while caring for her husband in his last year.
What she fears most. Being sent away when she needs help, and dying in pain. This fear has a history. Her younger brother died at 58 after an emergency department visit for abdominal pain from which he was sent home; he died two days later. She believes he was not taken seriously, and she associates the word hospice with being told that nothing more will be done.
What she hopes for. Healing, if God wills it; if not, to be at home, without pain, with her children and her pastor.
What Each Finding Changes
Table 1 links each finding to a specific change in the care plan.
Table 1
Assessment Findings and Care Plan Changes
| Finding | Change in the care plan |
|---|---|
| Faith central; wants pastor involved | Invite her pastor to the next family meeting with her permission; refer to the palliative chaplain to support both her hope and her preparation |
| Hope for healing held within faith | Use language that does not ask her to give up hope, for example "hoping for the best while preparing for other possibilities" |
| Evening prayer chain and meals from church | Include church members in the support map; ask whether she wants them told of changes in her condition |
| Fear of being sent away and of pain | Give her a direct phone number for the palliative team at any hour; make pain control the first goal of each visit |
| Brother's death after being sent home | Do not use the word hospice again until she raises it; when it is raised, describe what hospice adds, such as visits, a nurse on call and equipment, rather than what it stops |
| Wants to be at home with family | Plan for care at home, including the equipment and support she will need as her strength declines |
The changes are modest, but each is tied to something she said. Together they are designed to make the care team trustworthy in the way her brother's care was not.
Reflection on the Assessment
Two things stand out. First, her faith is a resource for her care, not an obstacle to it. Treating her prayer for a miracle as denial would have placed the team against the source of her strength. Second, her wariness of hospice is not a misunderstanding to be corrected with information; it is a reasonable response to her brother's experience. Hospice will be easier for her to consider if the team first earns her trust through reliable pain control and quick responses when she calls. The assessment will be revisited as her condition changes, since what matters to her may change too.
References
Balboni, T. A., Paulk, M. E., Balboni, M. J., Phelps, A. C., Loggers, E. T., Wright, A. A., Block, S. D., Lewis, E. F., Peteet, J. R., & Prigerson, H. G. (2010). Provision of spiritual care to patients with advanced cancer: Associations with medical care and quality of life near death. Journal of Clinical Oncology, 28(3), 445-452. https://doi.org/10.1200/JCO.2009.24.8005
Ferrell, B. R., Twaddle, M. L., Melnick, A., & Meier, D. E. (2018). National Consensus Project clinical practice guidelines for quality palliative care guidelines, 4th edition. Journal of Palliative Medicine, 21(12), 1684-1689. https://doi.org/10.1089/jpm.2018.0431
Kleinman, A., Eisenberg, L., & Good, B. (1978). Culture, illness, and care: Clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine, 88(2), 251-258. https://doi.org/10.7326/0003-4819-88-2-251
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
Reading the NURS 6910 Week 9 instructions
Week 9 assignments generally ask you to assess a patient's spiritual and cultural needs in serious illness and to show how the findings change care. Papers often run three to five pages. Use a recognized spiritual history tool and a person-centered cultural approach rather than a checklist of group beliefs. Record the patient's answers in her own words. Interpret statements about faith with care, especially hope for a miracle, and avoid labeling it as denial without evidence. Look for history that explains present attitudes, such as a family member's experience of care. Close by linking each finding to a concrete change in the care plan, and say how the assessment will be revisited.
How this NURS 6910 Week 9 example is built
A case summary introduces the patient and her congregation and cites Ferrell and colleagues on spiritual and cultural domains. The FICA section, citing Puchalski and Romer, records her faith, its importance, her community and how she wants it addressed. An interpretation section explains her hope for healing and cites Balboni and colleagues on spiritual care and quality of life near death. The cultural section, citing Kleinman and colleagues, records what she calls the illness, its cause, her fears and her hopes, including her brother's death. Table 1 links six findings to care plan changes. A reflection section argues that her wariness of hospice is earned and must be answered with trust.
Reading the NURS 6910 Week 9 rubric
Spiritual and cultural assessments are usually graded on use of appropriate tools, depth and respect in the assessment, and application to the care plan. Tool credit depends on applying each part to the patient rather than describing the tool. A strong assessment surfaces something particular to this woman, such as a family history behind a fear. Respect is a real criterion here, and interpreting faith statements without dismissing them earns it. Application often carries the most weight: graders look for each finding to change something in care. Evidence about spiritual care and cultural humility supports the analysis. APA citations and clear organization, often with a table, complete the rubric.
NURS 6910 Week 9 help from the desk
Assessments lose marks when they describe what a religious or cultural group is said to believe instead of what this patient believes. Another loss is labeling a hope for a miracle as denial and planning to correct it. Some papers complete the tool and never connect it to care. Others treat mistrust as a knowledge gap to be fixed with information. Use FICA and explanatory model questions, record her words, interpret faith with respect, look for history and link each finding to a change. The desk can draft an assessment for the patient your scenario describes. Invite the patient's own faith leader into planning only with her permission. Revisit the assessment when her condition changes, since what she needs from her faith community may change too.
Get a NURS 6910 Week 9 example written to your instructions
Include the case from your Week 9 prompt and the rubric, and mention any spiritual or cultural tool your course requires. The assessment is written to that person's beliefs and history, each finding tied to a plan change, and reaches you inside 24-48 hours. A first sample carries no fee.
More NURS 6910 papers and MSN samples
- NURS 6910 Week 1: Discussion post
- NURS 6910 Week 2: Concept comparison paper
- NURS 6910 Week 3: Models of care analysis
- NURS 6910 Week 4: Eligibility and referral memo
- NURS 6910 Week 5: Goals of care plan
- NURS 6910 Week 6: Communication case
- NURS 6910 Week 7: Family assessment
- NURS 6910 Week 8: Discussion post
- NURS 6910 Week 10: Palliative Case Analysis
- NURS 6910 Week 11: Reflection
- NURS 6730 Week 9: Communication plan
- NURS 6720 Week 9: Evaluation plan
- DNRS 6501 Week 9: Discussion post
- NURS 6710 Week 9: Priority setting paper
NURS 6910 Week 9 questions, answered
What is FICA?
A spiritual history tool developed by Christina Puchalski, organized around faith and belief, importance, community, and address in care. The example records each part in her own statements and then interprets them. It is brief by design, which suits a first conversation, and your course may pair it with a longer spiritual assessment or a chaplain's formal evaluation.
How does the paper handle her hope for a miracle?
It quotes her, interprets the statement as hope expressed within her faith, and plans alongside it rather than against it. Her pastor is invited into the family meeting, and the chaplain is asked to support both hope and preparation. Papers that call this denial usually lose credit, and the example shows why: nothing in her words refuses care.
Why use Kleinman's questions instead of a cultural checklist?
Because a checklist describes what a group is said to believe, while Kleinman's explanatory model questions ask what this person believes about her own illness. That difference protects against stereotyping and surfaces findings a checklist would miss, such as her brother's death. A rubric naming another cultural assessment framework gets the same findings rebuilt on that framework.
Where can I find a free NURS 6910 Week 9 sample paper?
This page holds the full assessment, FICA history, explanatory model findings and the care plan table, open to read free. An assessment for the patient your scenario describes can be requested.
Why does the NURS 6910 Week 9 plan stop using the word hospice?
Because the patient links it to her brother being sent home and dying days later; the team waits for her to raise it and then describes what hospice adds, such as visits and a nurse on call.