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patients’ and families’ problems and functional status and applies clinical cues to interpret deviations from the patient’s usual patterns (Johnson 2000). The model is applicable to all levels of care, allowing all problem areas to be identified. The information derived from the patient’s initial functional health patterns is crucial for interpreting both the patient’s and their family’s pattern of response to the disease and treatment. It is therefore considered particularly applicable for the cancer and palliative care settings where patients’ needs and responses vary enormously along their illness trajectory.

Box 2.2 Gordon’s functional health patterns

Health perception–health management.

Nutrition–metabolic.

Elimination.

Activity–exercise.

Sleep–rest.

Cognitive–perceptual.

Self-perception–self-concept.

Coping–stress tolerance.

Role–relationship.

Sexuality–reproductivity.

Value–belief.

(Gordon 1994)

Evidence-based approaches

Methods of assessment

Assessment information is collected in many different formats and consists of both objective and subjective data. Nurses working in different settings rely on different observational and physical data that may include assessment of vital signs, physical systems, symptoms and laboratory results. Subjective data are based on what the patient perceives and may include descriptions of their concerns, support network, their awareness and knowledge of their abilities/disabilities, their understanding of their illness and their attitude to and readiness for learning (Coyne et al. 2002, White 2003). A variety of methods have been developed to facilitate nurses in eliciting both objective and subjective assessment data on the assumption that if assessment is not accurate, all other nursing activity will also be inaccurate.

Studies of patient assessment by nurses are few but they indicate that discrepancies between nurses’ perceptions and those of their patients are common (Brown et al. 2001, Lauri et al. 1997, McDonald et al. 1999, Parsaie et al. 2000). Communication is therefore key for, as Suhonen et al. 2000 suggest, ‘there are two actors in individual care, the patient and the nurse’ (p.1254). Gaining insight into patients’ preferences and individualized needs is facilitated by meaningful interaction and depends both on patients’ willingness and capability in participating in the process and nurses’ interviewing skills. The initial assessment interview not only allows the nurse to obtain baseline information about the patient, but also facilitates the establishment of a therapeutic relationship (Crumbie 2006). Patients may find it difficult to disclose some problems and these may only be identified once the nurse–patient relationship develops and the patient trusts that the nurse’s assessment reflects concern for their well-being.

Assessment interviews

An assessment interview needs structure to progress logically in order to facilitate the nurse’s thinking (an example of such a structure can be found in Box 2.3) and to make the patient feel comfortable in telling their story. It can be perceived as being in three phases: the introductory, working and end phases (Crumbie 2006). It is important at the beginning to emphasize the confidential nature of the discussion and to take steps to reduce anxiety and ensure privacy since patients may modify their words and behaviour depending on the environment (Neighbour 1998).

Box 2.3 Carrying out a patient assessment using functional health patterns

Pattern Assessment and data collection are focused on

Health perception–management The person’s perceived level of health and well-being, and on practices for maintaining health.

Habits that may be detrimental to health are also evaluated.

Actual or potential problems related to safety and health management may be identified as well as needs for modifications in the home or for continued care in the home.

Nutrition and metabolism The pattern of food and fluid consumption relative to metabolic need.

Actual or potential problems related to fluid balance, tissue integrity.