CFCN cheat sheet

Spirituality is the search for meaning, purpose, connection, and transcendence; religiosity refers to affiliation with a tradition and its practices - a person can be spiritual without being religious.

FICA structure: Faith/belief, Importance or Influence of belief, Community support, Address in plan of care.

HOPE structure: sources of Hope, Organized religion, Personal spirituality and practices, Effects on care and decision-making.

Markers of spiritual distress include hopelessness, questioning meaning, anger toward the divine, inability to pray, and withdrawal from the faith community.

Spiritual assessment is ongoing, not a single event: reassess at health transitions, new diagnoses, bereavement, and losses.

Referral decision rule: refer to chaplain or faith leader when the need involves rites, sacraments, or theological guidance, or exceeds nursing scope.

Accommodate ritual practice in the care plan: prayer times, Sabbath rest, fasting, dietary law, and religious attire - document the accommodation.

Spiritual distress can present somatically (insomnia, amplified pain, anxiety); screen spirituality when physical symptoms are unexplained or disproportionate.

Transtheoretical stages: precontemplation, contemplation, preparation, action, maintenance, termination; the intervention must match the stage (e.g., raise awareness in precontemplation, plan in preparation).

Motivational interviewing core skills are OARS: Open questions, Affirmations, Reflections, Summaries; resistance is rolled with, not confronted.

Teach-back: the learner restates the plan in their own words; used to verify comprehension, not to quiz recall of terminology.

Health literacy universal precautions: plain language, roughly 5th–6th grade reading level, 3–5 key points per session, pictures plus spoken word.

SMART objectives are Specific, Measurable, Achievable, Relevant, and Time-bound.

Socio-ecological levels for designing interventions: intrapersonal, interpersonal, organizational, community, and public policy.

Adult immunization decisions follow the current national immunization schedule; verify before advising, because intervals and age thresholds are revised periodically.

Screening program metrics: reach = attendees who were eligible divided by population screened; referral completion = referrals closed divided by referrals made.

Windshield survey domains: housing, zoning and land use, transportation, food access, visible health and social services, signs of disorder, and faith institutions.

Primary data come from surveys, focus groups, key informant interviews, and observation; secondary data include census, national survey systems, and county health rankings.

Asset-based approach maps existing strengths (congregations, food pantries, schools, volunteers) before cataloging deficits.

Assessment cycle: define population → collect data → prioritize → plan → implement → evaluate → revise.

Prioritization criteria: magnitude, severity, feasibility, community readiness, and available resources.

Logic model chain: inputs → activities → outputs → short-term outcomes → long-term impact.

Process evaluation measures implementation (dose, fidelity, reach); outcome evaluation measures change in health status or behavior.

A congregation profile captures demographics, health beliefs, worship and calendar patterns, leadership structure, and available space and volunteers.

Case management functions: assessment, planning, facilitation, care coordination, advocacy, monitoring, and evaluation.

Match resource intensity to need: self-management tools and peer support for low need; professional and specialty services for high need.

Care transition bundle: medication reconciliation, discharge instructions, follow-up appointment within about 7 days, and teach-back on warning signs.

Closed-loop referral requires documented confirmation that the client connected with the service - not just that a referral was sent.

The Hunger Vital Sign screens food insecurity by asking about running out of food or eating less in the prior 12 months due to money.

Screen the social determinants field by field: housing, food, transportation, utilities, income, and social isolation.

HIPAA minimum-necessary standard limits disclosure to the amount of information needed for the purpose; releases beyond treatment, payment, or operations require authorization.

Interprofessional referral targets: chaplain for spiritual needs, social worker for benefits and placement, pharmacist for regimen review, dietitian for nutritional counseling.

Core principles: autonomy, beneficence, nonmaleficence, justice, veracity, and fidelity.

Practice authority derives from the state nurse practice act and licensure; congregational role never expands scope into diagnosing or prescribing.

Dual relationships in a faith community (nurse plus fellow member or leader) require explicit role clarification and attention to power imbalance.

Mandatory reporting laws cover suspected child abuse, elder abuse, and dependent adult abuse; timelines are state-specific.

Confidentiality exceptions: imminent danger to self or others, reportable conditions, suspected abuse, and court order.

Informed consent elements: decisional capacity, disclosure, comprehension, and voluntariness.

Advocacy operates at three levels: individual client, community or institution, and policy.

Document only what was done within nursing scope; a ministerial act such as leading ritual is recorded as such, separately from clinical care.

Cultural humility is a lifelong process of self-reflection, redressing power imbalance, and institutional accountability - not a fixed competence checklist.

LEARN: Listen, Explain, Acknowledge, Recommend, Negotiate.

Kleinman explanatory model questions: What do you call the problem? What caused it? Why did it start now? What do you fear most?

Historical mistrust (e.g., Tuskegee) shapes engagement; address it directly rather than interpreting refusal as nonadherence.

Ramadan fasting: those who are ill, pregnant, or traveling are typically exempt; medication timing can be shifted to suhoor and iftar under prescriber guidance.

Some traditions restrict blood products, require kosher or vegetarian food, or observe Sabbath restrictions on activity - verify with the individual, since practice varies within every tradition.

Use trained medical interpreters, not children or untrained family, for consent and teaching; verify understanding with teach-back in the preferred language.

Accommodate religious attire and objects (head coverings, turbans, prayer rugs, anointing oil) during examinations and hospital visits.

SOAP format: Subjective, Objective, Assessment, Plan.

Document at the time of the encounter; late entries must be labeled as late with the actual date and time of entry.

No protected health information in unsecured email, text, or personal devices; use encryption and password protection per the HIPAA Security Rule.

Donabedian quality framework: structure, process, and outcome.

PDSA improvement cycle: Plan, Do, Study, Act - small tests of change before spread.

Incident reports are factual, objective, non-blaming, and separate from the clinical record; never alter the original note after an event.

Medication reconciliation is performed at every transition of care; high-alert medications receive an independent double-check.

Hand hygiene before and after every encounter; screen volunteer and staff immunization status per organizational policy.

Congregational health records are stored separately from congregation membership records and follow the same retention and access rules as clinical records.