The Integration of Gordons Health Assessment in Everyday Nursing Care - Essay Example

The Intergration of Gordon's Health Assessment in Everyday Nursing Care Introduction Making an accurate health assessment is one of the vital factors in providing quality patient care. The data gathered from these health assessments is one of the bases for physicians to make diagnosis and prognosis. But with the overwhelming tasks that nurses do in their everyday work load, one of the key elements in making their jobs easier is to become organized. One of systems that can be used to make patient interviewing and gathering of data organized is to use Gordon's functional health assessment (Jarvis, 2000). The functional health assessment according to Gordon is divided into eleven functions or categories. These functions relate to one another and can be used as evidence in making decisions on the outcomes of patient care. There are other factors that will affect the reliability of data that can be gathered in making health assessments that will be presented during the interview and physical assessment of the patient. Other factors such as physiological, psychological and even cultural factors can influence on how much or how little of the data can be gathered from the patient (Functional Health patterns, n.d.). Every patient will have different reactions when being interviewed about their health. Some patients may exhibit feelings of anger towards their health care provider stemming from previous encounters with other health care practitioners that left them with a bad impression. There is also the cultural aspect of the patient where they may find certain questions and medical practices opposed to their culture, tradition and beliefs. Others would be depressed about being or felling ill and refuse to cooperate. There is also the physical condition of illnesses where patients may be in too much pain or cannot give coherent answers because of adverse reactions to medication. The everyday stresses in the workplace can also affect the nurse that will be making the assessment. Personal conflicts and beliefs on culture and ethnicities can influence the way the assessment is being handled (Morrison & Ashley-Coe, 2001). Preparing for the interview is also a key element in making health assessments. Patient interviews need to be carefully planned. Interviewers need to get their patients' trust so that they can gather information as accurately as they can. As with any interview, it is important to maintain eye contact and avoid possible distractions. Learning from the patients' charts can give interviewers ideas on how to formulate questions for the assessment (Jarvis, 2004). It is the understanding of all these factors that can make a good health assessment, coupled with the theory of functional health patterns by Gordon. These functional health patterns divided into eleven subcategories can help in the evaluation of a patient's physical, emotional and psychological health. Case Study Maria is a female patient aged 60 years old with a history of diabetes and hypertension. For the past few months, the patient complained of having stomach cramps or indigestion and difficulty in sleeping. She also reported self medicating these cramps with over the counter medication but the symptoms was never alleviated. But she was not cooperative enough to submit herself to other lab testing in order to find out the cause of her stomach discomfort. She has been very diligent in taking her diabetic and hypertensive medication, but her blood sugar and blood pressure has been erratic. She attributes this to the discomfort that she has been feeling recently. The patient also reported having difficulty with her bowel movement where there were days where she could not void, the longest period being five days. There were two areas that had an impact on the patients' functional health or ability. These were Elimination and Sleep-rest. These two factors caused considerable discomfort to the patient and may be symptoms of underlying illnesses. For this, a comprehensive geriatric health assessment can be used in order to find out what needs to be recommended for the pain or discomfort that the patient is experiencing (Luk et.al., 2000). In gathering the needed data, one had to conduct an assessment or interview of the patient. For the interview open-ended questions were given to the patient concerning the two aspects of her discomfort, which was sleeplessness and indigestion. When asked about the pattern of elimination, the patient was a bit hesitant in answering the said question. It took a little longer to finish the assessment, with some questions needing to be repeated or clarified to the patient in order to make sure that they understood the question. One of the key elements in making a successful interview is to make the patient at ease with the questions. It is also important to gain the trust of the patient so that they are assured that the assessment is for their best interest (Jarvis, 2004). In planning a patient interview, it is best to establish a relationship with the patient so that you can get them to answer what is needed or vital in the assessment. For elderly patients, patience is needed and also pacing because elderly patients can tire much easily. Also they can be easily offended and may retreat or refuse to answer questions no matter how tactfully presented once they feel that they are under scrutiny or attack (Jarvis, 2004). Since the patient reported abdominal discomfort, it was important to ask the seven attributes of a symptom. This means asking where the point of pain is exactly located; identify what kind of pain (stabbing pain, etc.); asking the patient to rate the pain from one to ten; how often does it occur; the activities associated with the onset of pain; and if there are other symptoms associated with this abdominal discomfort. The other question or attribute was already answered when the patient mentioned that simple antacids or analgesics did not relieve the symptoms (Bickley et.al., 2007). With the data gathered from the symptoms of pain, health recommendations can be made for the patient. Further laboratory tests such as abdominal ultrasound can be made in order to diagnose the cause of the abdominal discomfort. The recommendations can be based on the comprehensive geriatric assessment of the patient (Luk, 2000). Areas that Had an Impact on the Patient's Functional Ability The patient presented symptoms of emotional stress associated with the transition to illness. In this stage patients are in denial that they are indeed in need of care. This denial stems from their image of being in the prime of their health, as opposed to the symptoms presented by their condition or illness. In the case of the patient presented, the abdominal pain already indicated the need for care. But the patient refused to acknowledge it and instead opted to self-medicate (Schuster, 2000). The patients' socio-economic status also affected her aspect of Health Management. She was diligent in making follow ups with her cardiologist, even the intake of medication, but she did not put into consideration other aspects of her health and well-being. She was a widow and unemployed and depended on the allowances given by her children. For her, there was the dilemma of additional health care costs, that's why she chose to self-medicate. Unemployment is one of the main determinants of health (Naidoo et.al., 2000). Using the older person evaluation sheet, the patient also indicated that she had little social activities. In mapping the functional health patterns, this related to the Activity-exercise category. There were physical constraints on the part of the patient where she felt that she could not do any exercise or there were days where she felt fatigued so could not do so. (Functional health patterns, n.d.). Appropriate Health Assessment Techniques One appropriate health assessment technique that can be beneficial for the said patient is to make regular screening for illnesses that are related to the digestive system. This geriatric screening can help in diagnosing illnesses even before the onset of the disease. With elderly patients, the earlier the illnesses are diagnosed the better the prognosis for diseases. The physical capacity of an elderly patient to be able to perform their daily routines such as feeding or bathing should also be considered. Making appropriate health assessments can also determine if the patient needs assisted living conditions or not (Luk et.al.,2000). In relation to the functional health assessment according to Gordon, the geriatric health assessment impacts largely the health management and cognitive-perceptual functional health. Elderly patients who have been screened and assessed show that they are able to avail of health services that are appropriate for their illness or physical condition, rather than those who have not been given the health assessment. This means that the mortality and morbidity for the control group have significantly decreased. Health Promotion Measures that would be appropriate for the case study, reference on gender, ethnicity and socioeconomic factors Health promotions are influenced largely by socioeconomic factors. Those who are in the low socioeconomic levels may have a higher mortality and morbidity rate than those in the higher levels. One explanation for this is that for those who are in the higher levels, they have options for treatment and healthcare. Education can also influence this disparity between the two levels, since those on the higher level may be more educated than those in the lower levels. This can affect a person's choices in health care and in decisions concerning health management such as regular annual physical check-ups (Naidoo et.al., 2000). Among the health promotion measures that would be applicable for the patient presented would be a recommendation for yearly check-ups or screening for colorectal cancer or other diseases that affects the digestive system. It is important to communicate with the patient the resources that are available to them. For the case study presented, her socioeconomic status is the deterrent for her to make regular visits to the doctor (Schuster, 2000). Conclusion Health assessments that take into consideration functional pattern or impacts benefit not only patients but health care workers as well. One benefit that can be gained from this by health care workers is that they can give the appropriate health recommendations for the patient. This health recommendation translates to better patient care because the patient seeks out what is really needed rather than what is just given as health management procedures for them (Bickley et.al., 2007). In integrating the functional health assessment with other health assessment techniques, there is a better chance of giving quality patient care. This is because the health assessments are able to narrow down on the specific needs of the patient by breaking down the basic functions of a person, rather than just making general health assessments. The focus on one specific health function in effect can contribute to the general well-being of the patient as a whole (Jarvis, 2004). In providing patient care, recommendations need to be explained to patients and their families in case the patient cannot make decisions for himself. The term "Informed Consent" needs to be emphasized in this aspect of health care so that patients and their families are informed of procedures and any possible risks associated with it. This also helps them in making decisions by exploring other possible treatments or prognosis for a disease. Take for example cancer and chemotherapy. With informed consent patients can choose to accept or decline the prognosis of chemotherapy and health care providers can recommend other forms of treatment (Jarvis, 2004). In giving recommendations, the emotional aspect of the person who is ill needs to be considered too. A family member who is ill can affect the self-esteem of immediate family members. This affects the coping or stress tolerance of the patient and their families. And in turn can influence the decisions that need to be made in heath care management (Schuster, 2000). Communicating with the patient in ways that there is trust and understanding between the patient and the health care provider is vital in bridging gaps made by policies or other factors. In understanding the functional health patterns and learning how to conduct interviews, health care practitioners can provide quality patient care and also improve patient care outcomes. Reference: Bickley, L. & Szilagyi, P. (2007), Bates' guide to physical examination and history taking, 9th ed. Philadelphia (PA): Lippincott Williams & Wilkins Functional Health Patterns Concept Maps [Online] wps.prenhall.com/wps/media/objects/.../FunctionalHealthPatterns.pdf, [Accessed 21 August, 2009] Jarvis, C. (2004), Physical Examination and Health Assessment, 4th Ed. Missouri (MO): Elsevier Luk, JKL., Or, KH., & Woo, J. (2000), Using the comprehensive geriatric assessment technique to asses elderly patients, HKMJ, March 2000, 6(1), p.93-98, available at: www.hkmj.org/article_pdfs/hkm0003p93.pdf [Accessed 21 August, 2009] Morrison, P. & Ashley-Coe, C. (2001), Managing emotional reactions in patients, families and colleagues in E. Chang ed., Transitions in nursing:preparing for professional practice, Australia: MacLennan and Petty Pty. Ltd. Naidoo, J. & Wills, J. ( 2000), Health promotion foundations for practice, 2nd ed. London: Harcourt Publishers Limited Schuster, P. (2000), Communication: the key to the therapeutic relationship, Philadelphia (PA):F.A.Davis Company Read More