Functional Health Patterns In Nursing

Nursing Care and Functional Health Pattern

Functional Health Patterns,11 factors and Health Patterns,Benefits of FHP, Research Outcomes About FHP.

Functional Health Patterns

    A functional health pattern (FHP) is a manifestation of an individual's behavior and responses across time. The typology of the 11 functional health patterns identifies and defines each pattern under the following categories: 

(a) health perception-health management.

(b) nutritional metabolic.

(c) elimination.

(d) activity-exercise.

(e) cognitive-perceptual.

(f) sleep-rest.

(g) self-perception-self-concept.

(h) role-relationship.

(i) sexuality-reproductive.

(j) coping-stress tolerance.

(k) value-belief (Gordon, 1982).

    The organization of the FHP assessment framework provides a structure to examine a sequence of behaviors and responses within each pattern area over time. Subjective and objective data obtained during the assessment of each health pattern facilitates pattern construction for the individual, family, or community. 

    Data from all of the functional health patterns' areas are assessed within the context of age and stage of development, culture and ethnic background, current health status, and environment. Each individual functional health pattern reflects a unique response to a particular experience.

    A health pattern may be described as functional, potentially dysfunctional, or dysfunctional. A functional health pattern is both mutually exclusive and interactive, reflecting a holistic perspective. Often data obtained about one pattern may be best understood in relation to information assessed in other patterns. 

    Behaviors (cues) obtained during an FHP assessment can be used to generate and support a tentative nursing hypothesis (eg. nursing diagnosis). To identify a clinical judgment (nursing diagnosis), data from all 11 functional patterns must be obtained and synthesized. 

    Clinical judgments are described as probabilistic and non causal statements. Historically, assessment tools were developed to assess clinical populations, frequently duplicating medical information. 

    The lack of a consistent nursing assessment framework resulted in inadequate data and limited information about nursing's judgments and contribution to care outcomes. The National League for Nursing was the first to support a movement away from nursing's task focus to one that was patient centered and problem-based. 

    Forty schools of nursing participated in a survey that generated a classification list of nursing's 21 problems (Abdellah, 1959). Later, in 1966, Henderson classified 14 basic needs related to patient care. This work identified human needs, articulated nursing functions, and helped direct nursing care toward patient responses.

11 factors and Health Patterns

    Gordon's (1982) typology of the 11 functional health patterns provided a structure for organizing and documenting patient behavior over time. The FHP framework offered nurses a consistent framework for identifying human responses that resulted in autonomous nursing interventions and linked evidence-based patient outcomes. 

    This focus continues to be consistent with the Professional Standards of Nursing Practice and Nursing's Social Policy Statement (American Nurses Association, 2003).

Benefits of FHP

    The FHP framework provides nurses with an opportunity to know the patient in a unique way. Through a series of semi-structured interview questions, each of the 11 functional health patterns is assessed as the individual's story unfolds. When additional information is required, the nurse uses branching questions to elicit new perceptions. 

    This descriptive approach to data collection is then subjected to analysis where data bits (or cues) are isolated and data are synthesized, leading to the formulation of tentative diagnostic statements that reflect phenomena of concern to nursing.

    Many clinical investigations have used the FHP framework as a structure for data collection, patient problem identification, and evaluation of care outcomes. These studies described high-frequency nursing diagnoses and isolated patient responses to phenomena (eg, eating disorders, sleep disturbances) and linked intervention strategies to specific nursing diagnoses. 

    Other investigations have used the FHP framework to validate cues as associated with a particular nursing diagnosis. Nurses working in clinical specialties (eg, ambulatory surgery, oncology, rehabilitation, and cardiovascular nursing) have used the FHP framework to identify patient responses (nursing diagnoses) throughout illness experience and recovery at home. 

    Nurse administrators, using data from FHP assessments, reported that findings help predict nurse and patient mix, help identify patient problems, link nursing interventions with evidence-based outcomes, and ultimately help cost out care more accurately. Nursing educators have used FHP assessment data to evaluate clinical reasoning skills and diagnostic accuracy (Lunney, 2003).

Research Outcomes About FHP

    Currently, research continues to clinically test an assessment screening tool using the 11 functional health patterns to generate screening questions. The Functional Health Pattern Assessment Screening Tool (FHPAST) is a patient-completed, functional health screening instrument (Foster & Jones, 2003). 

    The tool contains 58 items and organizes responses to each item on a 4-point scale. Psychometric properties of the tool have been established with well adult populations. To date, data analysis reveals the emergence of four factors: Interpersonal Perception, Risk/Threat to Function, Health Promoting Behaviors/Beliefs, and Health Protecting Behaviors. 

    The FHPAST is a reliable and valid assessment screening tool. The FHPAST assesses data across all pattern areas and is easily administered. The tool offers a quantitative measure of patient responses and identifies cues that guide further assessment by the nurse.

    The FHPAST has been used in the United States with a variety of populations across settings, including same day surgery with patients with congestive heart failure in an out-patient program. The tool has also been used to evaluate health perceptions and behaviors in black Caribbean populations. 

    In addition, the FHPAST has been translated into several languages including Portuguese, Spanish, and Japanese. In clinical practice, it has been used in England with HIV males, and as a screening tool to assess adults in medical inpatient units in Sao Paulo, Brazil. 

    Nurse researchers identified the tool's ease of administration and the ability of the tool to isolate functional health patterns requiring further assessment and evaluation as positive strengths.

    Movement toward the use of standardized nursing language and continued refinement of standardized nursing language classifications (NANDA, NIC, NOC, and the International Classification of Nursing Language, ICNP) will promote the use of a consistent database for communicating nursing assessments, diagnoses, interventions, and out- comes across countries. 

    The continued testing and refinement of the FHPAST will improve the use of a valid and reliable instrument to measure patient's functional health over time. The use of the FHP framework can expand nursing knowledge, isolate human experiences in illness and wellness, promote creative interventions, and help articulate evidence that is nurse sensitive.