Independent Nursing Practice:
Independent Nursing Practice:
Holistic Areas of Assessment
Independent Nursing Practice: Holistic Areas of Assessment
Nursing practice is holistic. Nursing practice is based on human functioning and human
development. Patterns of human functions are used in nursing assessment, diagnosis, planning, and evaluation; the steps of the nursing process. Marjory Gordon’s Theoretical Base of Nursing uses eleven functional patterns to organize nursing critical thinking and decision-making.
School nurses use functional assessments to help students achieve
health and academic success.
In this context, assessment means helping students/families know themselves in order to take
responsibility and grow. Registered Nurses facilitate this process by:
• Encouraging their stories, listening to their words;
• Hearing their thoughts and feelings, observing their behaviors;
• Standing beside them, looking at the world through their eyes; and
• Providing thoughtful reflections of their words, perspectives, and behaviors back to
School nurses strive to understand others’ perspectives and points-of-view so they are effective
in the therapeutic nursing relationship.
This structure, (Marjory Gordon’s Functional Health Patterns), is one of several structures used to think about and organize data. This is only a structure; individual nurses use their own approaches and styles of building relationships and gathering assessment data.
This structure of patterns describes a consistent, organized method to think about and analyze
information about individual students/families. Each nurse decides which patterns, and the depth of information in each pattern, that should be assessed to assist the nurse in developing an IHP for a specific student depending upon:
• The developmental level of the student;
• The purpose of the nurse-student-family relationship; and
• The specific health issue to be addressed by the nurse.
Marjory Gordon’s Eleven Functional Health Patterns are:
1: Health Perception & Management
2: Value/Belief Patterns
4: Coping/Stress Tolerance
The following pages describe each pattern and examples of concerns or student behaviors that may be presented to the school nurse. These examples may indicate either healthy or
unhealthy functioning in that pattern.
Functional Health Patterns
HEALTH PERCEPTION & MANAGEMENT
Health Perception & Management:
What does health mean to the student? (i.e. How is health measured? What does the student believe about healthy choices? How are choices made? How are risks considered, acted upon, and/or accepted?)
• Family perspectives of the barriers to health care: (financial; transportation).
• Wellness care: (annual screening; exams; medical/dental).
• Illness care: (use of home remedies; use of medical provider; alternative medical practices;
knowledge/use of CPR, first aid)
• Risk Management:
o Safety: (use of seat belts; occupational hazards; recreational safety; bicycle helmet;
personal flotation device; home safety; smoke detector; etc., storage of harmful
o Use/Abuse of substances: (caffeine; tobacco; alcohol; OTC medications; prescription
drugs; illegal drugs)
o Exposure to violence: (in home; neighborhood; family; friends; guns or weapons in
home; where stored)
Adequate and Hygienic Environment: (running water; septic; student hygiene)
What are the guiding forces that direct this student’s life: choices, behaviors, feelings, and decisions?
• Goals: (What are the student’s goals for the present, for the future? Are there concerns or barriers for reaching those goals?)
• Values: (What does the student hold most dear, most important in life? What may create vulnerability when facing issues, events, or people with differing values?)
• Beliefs: (How does the student perceive right and wrong? Are there areas for gray, unknown territory, or only black and white? Is the student rigid or flexible with right or wrong, given circumstances, etc.?)
• Cultural Influences: (How do the student’s cultural norms influence behavior and choices?
Are the student’s cultural practices within the norm of the larger cultural group or different from the norms of the culture? Does the student have the opportunity to practice cultural traditions, interact with similar people with the same cultural context? Does the student live in a society where their cultural beliefs, practices are in conflict with the larger, majority population? Does the student feel safe to verbalize and practice customs/rituals?)
• Spiritual Beliefs: (From where does the student receive inner strength? From where does the student seek guidance...from an omnipotent source, from self? When the student needs spiritual help, from whom or what does he/she seek that help and support?)
• Religion: (Does student subscribe to a religious ideology? In what ideology was student
raised: what was the student taught to believe? Does student currently believe in those
tenants learned early in life? How does student feel about religious ideology at this time?
Does student have the opportunity to participate in religious services and fellowship?)
• Hope: (What brings joy and happiness to the student? From where does the student receive or search for hope?)
*Sometimes it is awkward to address sexuality issues with students, although they usually are
grateful to have a health provider who is open to discussing intimate issues. Who else can they ask?
What does sexuality mean to the student? What level of importance does it have to the individual?
• Sexual Identity: (comfortable with feminine and masculine “mix” within self; comfortable with opposite sex or same sex in conversations, relationships)
• Sexual Preferences/Patterns: (heterosexual, homosexual, bisexual, or self-stimulation,
celibacy, monogamy, multiple partners)
• Sexual Satisfaction: (What does sexual satisfaction mean to this student? Are intimacy needs met? Does student use alternative forms of sexual satisfaction other than intercourse? Does student have capacity or desire to reach orgasm, have adequate erections, and/or ejaculations?)
• Reproduction Patterns: (goals for reproduction, family planning, contraceptive methods)
• Safer Sexual Practices: (use of condoms; use of barriers when engaging in oral and anal sex; knows risks of having multiple partners?)
What does feeling stressed mean to this student? What pushes this student’s buttons?
• What are usual stressors: (Student is aware of daily, ongoing, anxiety-producing life events and patterns, and recognizes them as causing stress? High expectations from others? Time pressures, relationships, work, change, etc.? Patterns that disrupt or limit daily activities?)
• What are predictable stressors: (Holidays, cycles of home responsibilities, etc.?)
• What are crisis or emergency stressors: (Deaths, illnesses, accidents, eviction, etc.?)
• What are chronic, disabling stressors: (Chronic illness, family chaos, fears, phobias, etc.?)
Does student understand their unique physical and emotional response to stressors?
• What are usual responses to stress: (Student recognizes body’s response to stress [e.g. rapid pulse, sweaty hands, shouting, violent or self-destructive behaviors]? For chronic stress, student recognizes disease and chronic illness as result of stress [e.g. hypertension, headache, backache, chronic pain]?)
What does coping and adaptation mean to this student?
• Can student recognize issues that can be changed and things that cannot be changed? (If possible, change or modify the stressor, and if that is not possible, can student modify response to the stressor?).
• What are student’s usual coping styles? (Student is aware of and using a variety of coping strategies?)
1.) Physical: (relaxing, walking, running, etc.)
2.) Emotional: (crying, laughing, primal screaming, etc.)
3.) Social: (talking to a friend, calling the crisis line, etc.)
4.) Intellectual: (getting more information, problem solving, conflict resolution, assertive communication, etc.)
5.) Spiritual: (meditating, prayer, forgiving self, forgiving others, etc.)
6.) Creative: (music, art, reading, writing, etc.)
• Student feels competent and resourceful in dealing with stress: (Recognizes, copes, and manages stressor and/or stress response so that no long-term ill effects are evident?)
• Concerns in Coping and Stress: (Stressors or coping strategies cause problems for the student with health, relationships, work, or with legal systems?)
What is the meaning of food, nutrition and/or eating to the student? (What are the values/
perspectives of eating for this student? Eats to live? Lives to eat?)
• Food intake: (food plate, mealtime patterns, fluid intake)
• Special nutritional needs: (restrictions, supplements, calories)
• Dietary practices: (fad diets, purging, bingeing, use of drugs for weight control)
• Weight gain/loss patterns: (Consistent with growth and developmental needs?)
• Barriers to obtaining nutritious, culturally appropriate foods: (financial, isolation from
• Problems with digestion, metabolism: (diabetes, celiac disease, etc.)
• Food preparation and storage: (fast food consumption; Who prepares food and does the
family have refrigerator, stove, etc?)
What does exercise and activity mean to the student? (Does the student value exercise? Is there
excessive attention and need to exercise? Is there resistance to exercise? How does the student use recreational time?)
• Exercise Patterns: (usual daily routine; ability to perform ADL’s)
• Promotion of Exercise: (safe exercise; active play; sedentary play; solitary play; team play; opportunity for play outdoors; feels safe in neighborhood; values regular, scheduled exercise program’ type and amount; consciously chooses exercise opportunities, stairs, parking away from building entry)
• Work and Study: (employment, active or sedentary work, takes exercise breaks when quietly working)
• Recreational Activities: (with family, alone, with friends; hobbies/interests; hours watching TV, computer games, reading, hunting, fishing)
• Activity/Exercise Capacity: (ability to run, jump, walk reasonable distance without fatigue or pain; inability to move, stretch, bend; If mobility is impaired, how motivated to be independent?)
*It is important to understand the developmental level of the student and what developmental tasks are appropriate for the student to experience. Many of these patterns will be evolving over a student’s life span. This is especially true of the pattern of self-concept.
How does the student perceive self?
• Personality: (outgoing, reserved, predictable, student, strong-willed, controlling, adaptable, calm, orderly)
• Competencies: (organized, smart, street-wise, analytical, enterprising, practical, detailed, creative)
• Physical attributes: (body image, best physical features)
• Pride in self: (can accept compliments; can be self-congratulatory)
• Provides self-nurturing activities: (recognizes and appreciates own needs; feels comfortable asking for help to get needs met; has confidence that needs will be met by self or others)
• Understands that having and expressing a full range of emotions is normal and healthy:
(happiness, sadness, fear, anger; does not reject certain feelings as “bad”)
• Student feels “free” to express unique qualities and have others accept and honor those
qualities: (personality type, preferences, physical differences; competencies and/or deficits are understood and accepted by student)
• Concerns in self-concept: (self-destructive behaviors; self-denigrating comments)
What does elimination mean to the student? (How does the student perceive elimination? Are there issues of power and control or excessive attention made to bowel and bladder function?)
• Usual bowel and bladder patterns: (regular times; predictable elimination; frequency;
triggers for bowel movements [e.g. hot liquids, chocolate, etc.])
• Routine use of laxatives, diuretics, anti-diarrheals: (management of regularity with foods, medicines, use of colonics)
• History of elimination problems: (urinary tract infections, chronic constipation, colitis,
irritable bowel, neurogenic bladder)
• Menstrual Flow: (light, heavy, regular)
• Perspiration/usual sweat patterns: (in the context of bodily fluids)
What does sleep and rest mean to the student? (Are there meanings to excessive sleep and/or rest?
Does the student perceive sleep as valuable?)
• Hours of sleep and sleep patterns: (bedtime, awake-time, naps; total hours of sleep; night
student or day student? family work schedules)
• Sleep Effective: (feels rested on awakening; sleepiness in daytime; awakening at night,
• Promotion of sleep: (bed-time routines: story time, baths, reading, massage, warm milk,
medications to induce sleep, drugs to induce sleep)
• Effects of sleep deprivation: (irritability, inability to concentrate, depression)
• Sleeping place is safe, promotes sleep and rest: (privacy; numbers of people in sleeping
place; warmth, comfort, quiet, light; feels both physical safety and emotional safety in place
What are the meanings of different roles the student has or wants?
• Multiple Roles: (child, student, sibling, parent, spouse, employer, employee, professional; meeting responsibilities while juggling time and rights as a student regardless of role)
• Feels competent, confident, satisfied in roles?
What are the meanings of different relationships the student has or wants?
• Major relationships: (family, birth-order, friends, peers, co-workers, supervisors, employees, clubs, groups, significant others nearby or far away; recognizes responsibility of initiating, maintaining relationships)
• Quality of relationships: (supportive, dependable, nurturing; reciprocal, points and patterns of interactions; camaraderie or conflict with others)