Nutritional-metabolic pattern
TABLE 6-2 TYPOLOGY OF 11 FUNCTIONAL HEALTH PATTERNS
PATTERN
DESCRIPTION
Health perception-health management pattern
Individual’s perceived health and well-being and how health is managed
Nutritional-metabolic pattern
Food and fluid consumption relative to metabolic needs and indicators of local nutrient supply
Elimination pattern
Excretory function (bowel, bladder, and skin)
Activity-exercise pattern
Exercise, activity, leisure, and recreation
Sleep-rest pattern
Sleep, rest, and relaxation
Cognitive-perceptual pattern
Sensory, perceptual, and cognitive patterns
Self-perception–self-concept pattern
Self-concept pattern and perceptions of self (body comfort, body image, and feeling state); self-conception and self-esteem
Roles-relationships pattern
Role engagements and relationships
Sexuality-reproductive pattern
Person’s satisfaction and dissatisfaction with sexuality and reproduction
Coping-stress tolerance pattern
General coping pattern and effectiveness in stress tolerance
Values-beliefs pattern
Values, beliefs (including spiritual), or goals that guide choices or decisions
Modified from Gordon, M. (2011). Manual of nursing diagnosis (12th ed.). Sudbury, MA: Jones & Bartlett.
Definition
Functional health patterns view the individual as a whole being using interrelated behavioral areas. The typology of 11 patterns serves as a useful tool to collect and organize assessment data and to create a structure for validation and communication among health care providers. Each pattern described in Table 6-2 forms part of the biopsychosocial-spiritual expression of the whole person. Individual reports and nursing observations provide data to differentiate patterns. As a framework for assessment, functional health patterns provide an effective means for nurses to perceive and record complex interactions of individuals’ biophysical state, psychological makeup, and environmental relationships.
Characteristics
Functional health patterns are characterized by their focus. Gordon (2011) uses five areas of focus: pattern; individual-environmental; age-developmental; functional; and cultural.
Pattern focus implies that the nurse explores patterns or sequences of behavior over time. Gordon’s term behavior encompasses all forms of human behavior, including biophysical, psychological, and sociological elements. Pattern recognition, a cognitive process, occurs during information collection. Cues are identified and clustered while gathering information. Patterns emerge that represent historical and current behavior. Quantitative patterns such as blood pressure are readily identified, and pattern recognition is facilitated when baseline data are available. As the nurse incorporates a broader range of data, patterns imbedded within other patterns begin to emerge. Blood pressure, for example, is a pattern within both the activity and the exercise patterns. Individual baseline and subsequent readings may present a pattern within expected norms. Erratic blood pressure measurements indicate an absence of pattern. This lack of pattern forms its own type of pattern. Functional health pattern categories provide structures to analyze factors within a category (blood pressure: activity pattern) and to search for causal explanations, usually outside the category (excessive sodium intake: nutritional pattern) ( Gordon, 2011 ).
Food intake examples illustrate the individual-environmental focus of Gordon’s framework ( Gordon, 2011 ). Reference to environmental influence occurs within many patterns in the form of physical environments within and external to the individual. Environmental influences in functional health patterns include role relationships, family values, and societal mores. Personal preference, knowledge of food preparation, and ability to consume and retain food govern the individual’s intake. Cultural and family habits, financial ability to secure food, and crop availability also influence food intake. Additionally, the person who secures, prepares, and serves the food controls nutritional intake for the family.
Each pattern also reflects a human growth and age-developmental focus ( Hockenberry & Wilson, 2010 ). As individuals fulfill developmental tasks complexity increases. These tasks, however, provide learning opportunities for the individual to maintain and improve health. Erikson’s framework, which organizes specific health tasks for the individual to accomplish at each developmental phase of the life cycle, continues to serve as the framework to assess and plan care ( Vogel-Scibilia et al., 2009 ). Erikson’s eight stages provide the traditional developmental assessment nurses generally use to plan care (see Table 6-3 on p. 139 ). Each stage presents a central task or crisis that must be resolved before healthy growth can continue ( Hockenberry & Wilson, 2010 ). Individuals develop their sense of autonomy in early childhood and struggle with the sense of shame and doubt. When this developmental level is achieved or resolved, the child moves on to develop initiative during the next stage.
Both age and developmental stage continue to provide the foundation for contemporary assessment of individuals’ health status. Developmental tasks begin at birth and continue until death. By considering current epidemiological data and recommended health behaviors, Gordon’s (2011) framework continues to be useful today for health promotion throughout the life span Therefore, Unit 4 uses Gordon’s framework to explore developmental tasks and their related health behaviors for health promotion.
Functional focus refers to an individual’s performance level. Other disciplines plan care using functional patterns, but assessment data vary among disciplines ( Boldt et al., 2010 ). Physical therapists and occupational therapists, for example, focus on physical ability to perform activities of daily living and rely on assessments of independent ability to carry out personal activities of daily living to develop their plans. For physicians, genitourinary function refers to frequency or voiding patterns and characteristics of urine, such as color, odor, and laboratory analysis results. In addition to these factors of genitourinary function, nurses assess how the particular voiding pattern affects lifestyle, particularly how urinary frequency affects sleep patterns and the ability to perform activities such as shopping or socializing. Additional concerns might include the individual’s ability to walk or climb stairs to the bathroom or to manage these activities safely at night. It has been suggested that all disciplines employ the International Classification of Functioning, Disability and Health to promote transdisciplinary communication about functional patterns that can be used along with the NANDA-I taxonomy ( Boldt et al., 2010 ).
Culture, age, and developmental and gender norms, considered during assessment, influence development of health patterns. Leininger defines transcultural nursing concepts of cultural care, health, well-being, and illness patterns in different environmental contexts and under different living conditions ( Andrews & Boyle, 2011 ). Culturally competent care is delivered with knowledge of and sensitivity to cultural factors influencing health behavior. Complex cultural patterns transmitted from former generations contribute to individuals’ health behavior. Culturally competent care respects the underlying personal and cultural reality of individuals. Nurses provide more culturally competent care when they identify and use cultural norms, values, and communication and time patterns in their self-reflection and interpretation of assessment information ( Bourke Bearskin, 2011 ).
Functional health patterns form a framework that centers on health and can account for cultural factors. Most nursing assessments use functional pattern assessment as a foundation to their practice. Although nursing theoretical and conceptual frameworks vary, the functional health pattern framework is relevant to most conceptual models. In fact, functional health patterns provide the structure used by NANDA-I to support nursing diagnosis nomenclature. Nursing classification of interventions and outcome nomenclature also use Gordon’s functional patterns as a foundation ( Boldt et al., 2010 ). Advantages of a functional health pattern framework specific to the practice of nursing include the following:
· •Provides consistent nursing language through collecting, organizing, presenting, and analyzing data to determine nursing diagnoses.
· •Allows flexibility to tailor content for individuals and situations.
· •Suits diverse practice areas (e.g., home, clinic, institution) for assessment of individuals (adult/children), families, or communities.
· •Supports theoretical components of nursing service, education, and research by organizing clinical knowledge using nursing diagnoses, interventions, and outcomes.
· •Incorporates medical science data while retaining the focus on nursing knowledge and practice.
