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Nursing Assignment

Functional Assessment in Nursing: A Cornerstone of Care

Functional assessment in nursing stands as a cornerstone, systematically evaluating a patient’s ability to carry out activities of daily living (ADLs) and instrumental activities of daily living (IADLs). These assessments are vital in tailoring care plans, ensuring patient safety, and promoting overall well-being.

Table of Contents

What is a Functional Assessment?

A functional assessment involves a methodical examination of a patient’s capacity to perform basic ADLs like bathing, dressing, toileting, and eating, as well as more complex IADLs such as cooking , shopping, managing finances, and taking medications.

Importance of Functional Assessment in Nursing

Strengths and Weaknesses : Functional assessments offer insights into a patient’s abilities and limitations, enabling nurses to create personalized care plans.

Risk Mitigation : Understanding mobility and balance limitations helps implement preventive measures, reducing the risk of falls and injuries.

Progress Monitoring : Regular assessments allow nurses to track a patient’s progress, adjusting care plans accordingly.

Discharge Planning : Crucial for gauging a patient’s readiness for discharge and planning appropriate follow-up care.

How are Functional Assessments Conducted?

Functional assessments employ various tools and methods:

Observation : Watching patients perform daily tasks during their routines.

Interviews : Gathering information from patients or their caregivers about task performance.

Standardized Assessments : Utilizing tools like the Barthel Index and Lawton IADL Scale for quantifying functional abilities.

Common Domains of a Functional Assessment

Physical Abilities: Assessing strength, range of motion , coordination, and balance.
Cognitive Abilities : Evaluating memory, attention, problem-solving, and judgment.
Sensory Abilities : Testing vision, hearing, and touch.
Communication Skills : Assessing understanding and expression capabilities.
Emotional and Psychosocial Well-being : Examining mood, coping skills, and social support.

Challenges of Functional Assessment

Subjectivity : Some aspects, like pain or fatigue, are subjective and challenging to measure.
Patient Cooperation : Illness, fatigue, or cognitive impairment may hinder cooperation.
Time Constraints : Nurses often face limited time for comprehensive assessments.

Strategies for Overcoming Challenges

Use Diverse Assessment Tools : Combine tools for a comprehensive understanding.
Involve Caregivers : Gather insights from caregivers regarding a patient’s capabilities at home.
Be Flexible : Adapt assessments to individual patient needs and abilities.
Document Carefully : Thorough documentation ensures the effective use of assessment findings in care planning.

Benefits of Functional Assessment in Nursing

Functional assessment improves patient care by allowing healthcare providers to tailor interventions based on individual needs. It enhances patient independence and contributes to better overall outcomes. Customized care plans address specific functional limitations, promoting a faster recovery.

Adaptations and Modifications in Nursing Care

Nurses implement various adaptations and modifications in care based on functional assessments. This may include the use of assistive devices, environmental adjustments, and patient education to ensure a conducive and supportive healthcare environment.

Training and Education for Nurses

Given the evolving nature of healthcare practices, continuous training and education are essential for nurses. Staying informed about the latest assessment tools and techniques ensures the delivery of high-quality care aligned with current standards.

Integration of Technology in Functional Assessment

The integration of technology in functional assessment is a growing trend. Digital tools and electronic health records streamline the assessment process , making it more efficient and improving the accuracy of data collection.

Future Trends in Functional Assessment

The future holds promising advancements in assessment tools and methodologies. Ongoing research and innovations aim to refine functional assessment practices, contributing to more accurate and personalized patient care.

Ensuring Ethical Considerations

Ethical considerations, including privacy and confidentiality, are paramount in functional assessment. Nurses must adhere to ethical standards, ensuring patient information is handled with utmost care and obtaining informed consent before assessments.

Patient and Family Involvement

Incorporating patient input and involving families in the functional assessment process are crucial components. Understanding the patient’s perspective and having family support contribute to a more holistic approach to care .

Measuring Success in Functional Assessment

Success in functional assessment is measured through patient feedback and continuous improvement. Regular assessments of the effectiveness of interventions ensure that care plans are adaptive and responsive to changing patient needs.

In Functional Assessment in Nursing conclusion, functional assessment is integral to nursing care. Accurate evaluations enable the development of personalized care plans, enhance patient safety and independence, and ultimately contribute to improved patient outcomes.

Is functional assessment only for elderly patients?

No, functional assessment applies to patients of all ages, ensuring tailored care plans.

How often should functional assessments be conducted?

Assessment frequency varies but should be regular for effective care planning.

Do all healthcare providers use the same functional assessment tools?

While there are common tools, healthcare providers may use different assessments based on their specialty and patient population.

Please note that this article is for informational purposes only and should not substitute professional medical advice.

Latest Articles

Guide to Gordon’s Functional Health Patterns with Examples, Model, and Standard in Nursing Care

Wilson logan.

July 24, 2023
Nursing Theories

Gordon Functional Health Patterns is a theoretical framework for health assessment developed by M. Gordon in 1987. The model provides a comprehensive and systematic approach to nursing assessment to capture an individual’s holistic health status and promote health.

The theory defines 11 functional health patterns, organized into a standardized and universal format for ease of use.

Overview of Gordon’s Functional Health Patterns

When it comes to providing comprehensive and patient-centered care, nurses need a systematic approach to assessment that considers the whole person – their physical, psychological, and social needs.

This holistic perspective is at the heart of Gordon’s Functional Health Patterns, a widely recognized nursing model that serves as a valuable framework for assessment, diagnosis, and care planning.

What are Gordon’s functional health patterns? Definition

Developed by Marjory Gordon in the late 1970s, this model revolutionized the nursing process by introducing a novel concept: functional health patterns.

Unlike traditional medical models that focus solely on disease and dysfunction, Gordon’s approach emphasizes assessing an individual’s integrated patterns of behavior and their ability to meet basic human needs.

The 11 Functional Health Patterns At the core of Gordon’s model are eleven functional health patterns, each representing a crucial aspect of human functioning and well-being:

Health Perception/Health Management
Nutritional-Metabolic
Elimination
Activity-Exercise
Cognitive-Perceptual
Self-Perception/Self-Concept
Role-Relationship
Sexuality-Reproductive
Coping-Stress Tolerance
Value-Belief

These patterns are interconnected, and disturbances in one area can have ripple effects on others, underscoring the importance of a comprehensive assessment.

Gordon’s Functional Health Patterns Model

One vital aspect of Gordon’s model is its emphasis on culturally sensitive assessment.

Gordon recognized that an individual’s functional health patterns are influenced by their cultural background, beliefs, and values.
By incorporating cultural considerations into the assessment process, nurses can better understand their patients’ perspectives and tailor care plans accordingly.

The Nursing Process with Gordon’s Model Gordon’s Functional Health Patterns

The Nursing Process with Gordon’s Model Gordon’s Functional Health Patterns seamlessly integrates with the nursing process, providing a structured framework for the assessment, diagnosis, planning, implementation, and evaluation of care:

Assessment: Nurses collect data on each functional health pattern to identify actual or potential problems, strengths, and areas of concern.
Diagnosis: Based on the assessment findings, nurses formulate nursing diagnoses that capture the patient’s health status and needs.
Planning: Individualized care plans are developed, addressing identified problems and promoting optimal health patterns.
Implementation: Nursing interventions are carried out to address the patient’s needs and support their functional health patterns.
Evaluation: Nurses continuously evaluate the effectiveness of the care plan and make necessary adjustments

What are Gordon's functional health patterns? Definition

Gordon’s functional health patterns checklist

Health perception-health management pattern.

The health perception-health management pattern assesses an individual’s overall perception of their health status and their health management practices.

This pattern is crucial for understanding a patient’s health beliefs, attitudes, and behaviors, which can significantly influence their willingness to engage in health promotion activities and adhere to treatment plans.

Potential Questions for Nurses:

How would you describe your current health status?
What does being healthy mean to you?
What steps do you take to maintain or improve your health?
How do you manage any existing health conditions or concerns?

Potential Responses and Nursing Interventions:

Nurses can reinforce and encourage these practices if a patient exhibits a positive health perception and engages in health-promoting behaviors.
However, if a patient has a negative perception of their health or engages in risky behaviors, nurses may need education, counseling, and support to help them develop a more proactive approach to health management.
A prospective randomized controlled study aimed to investigate the effect of the application of Gordon’s Functional Health Patterns (FHP) model in the nursing care of symptomatic heart failure (HF) patients on the quality of life.
The study found that HF patients in the group receiving care developed based on Gordon’s FHP model were associated with significantly improved quality of life compared to the control group receiving standard nursing care.

Source: https://doi.org/10.1016/j.apnr.2020.151247

Nutritional-Metabolic Pattern

The nutritional-metabolic pattern focuses on assessing an individual’s dietary intake, eating habits, and metabolic processes.

This pattern is essential for identifying potential nutritional deficiencies or imbalances that may contribute to health problems or impede recovery.

Can you describe your typical daily food and fluid consumption?
How does your food and fluid intake compare to your estimated metabolic needs?
Do you have any dietary restrictions or preferences?
Have you experienced any changes in your weight, appetite, or digestion?

Based on the assessment findings, nurses may need to provide dietary counseling, recommend nutritional supplements, or collaborate with a dietitian to develop a personalized meal plan.

If a patient has specific metabolic disorders or conditions, such as diabetes or kidney disease, nurses can provide education and support to help manage these conditions through proper nutrition.

A quasi-experimental study was conducted to assess the effect of the application of Gordon’s FHP model on the nutritional-metabolic pattern in patients with chronic kidney disease.

The study found that patients in the intervention group, who received care based on Gordon’s model, had significantly improved dietary habits and better management of their nutritional needs compared to the control group receiving standard care.

source: https://pubmed.ncbi.nlm.nih.gov/32451005/

Elimination Pattern

The elimination pattern examines an individual’s ability to effectively excrete waste products from the body, including bowel and bladder function. This pattern is crucial for identifying potential issues such as constipation, incontinence, or other elimination problems that can impact overall health and well-being.

Can you describe your typical bowel and bladder habits?
Have you experienced any changes in your elimination patterns?
Do you have any difficulties or discomfort related to urination or bowel movements?
Are you taking any medications or supplements that may affect your elimination?

Potential Responses and Nursing Interventions: If a patient reports irregular or problematic elimination patterns, nurses can provide education on proper hydration, fiber intake, and bowel and bladder management strategies. In some cases, nurses may need to implement interventions such as scheduled toileting, catheter care, or bowel retraining programs. Collaboration with a physician or specialist may be necessary for more complex elimination issues.

Example: A study conducted at a school of nursing aimed to investigate the effect of Gordon’s FHP model on the elimination pattern in hospitalized patients.

The study found that patients receiving care based on Gordon’s model had significantly improved bowel and bladder function compared to the control group receiving standard care. The model helped nurses identify and address elimination issues early, leading to better patient outcomes and reduced complications.

Source: https://ncbi.nlm.nih.gov/pmc/articles/PMC5791974/

Activity-Exercise Pattern

The activity-exercise pattern assesses an individual’s level of physical activity, exercise habits, and functional abilities related to activities of daily living (ADLs). This pattern is crucial for identifying potential limitations or barriers to maintaining an active lifestyle, which can impact overall health and well-being.

Can you describe your typical daily activities and exercise routines?
Do you experience any difficulties or limitations in performing ADLs?
Have you noticed any changes in your energy levels or physical abilities?
What are your thoughts on the importance of physical activity for your health?

Based on the assessment findings, nurses can provide education and guidance on appropriate exercise programs, energy conservation techniques, or assistive devices to support ADLs.

For patients with mobility limitations or chronic conditions, nurses may need to collaborate with physical therapists or occupational therapists to develop tailored rehabilitation or exercise plans.

Example: A randomized controlled trial was conducted to evaluate the effect of Gordon’s FHP model on the activity-exercise pattern in primary care patients.

The study found that patients in the intervention group, who received care based on Gordon’s model, had significantly improved physical activity levels and better functional abilities compared to the control group receiving standard care.

The model helped nurses identify and address barriers to physical activity, leading to improved health outcomes.

Sleep-Rest Pattern

The sleep-rest pattern assesses an individual’s sleep habits, sleep quality, and ability to achieve restful and restorative sleep. This pattern is crucial for identifying potential sleep disturbances or disorders that can impact overall health, energy levels, and well-being.

Can you describe your typical sleep patterns and routines?
Do you experience any difficulties falling or staying asleep?
How rested do you feel upon waking up?
Do you engage in any activities or practices to promote better sleep?

Responses and Nursing Interventions:

If a patient reports sleep disturbances or poor sleep quality, nurses can provide education on sleep hygiene practices, such as maintaining a consistent sleep schedule, creating a conducive sleep environment, and avoiding stimulants before bedtime.

For more persistent sleep issues, nurses may need to collaborate with a physician or sleep specialist to explore potential underlying causes and appropriate interventions, such as medication management or cognitive-behavioral therapy.

Example: A study was conducted to compare Gordon’s FHP model with other nursing models in addressing the sleep-rest pattern in hospitalized patients.

The study found that patients receiving care based on Gordon’s model had significantly improved sleep quality and reduced sleep disturbances compared to those receiving care based on other models.

The comprehensive assessment approach of Gordon’s model helped nurses identify and address factors contributing to poor sleep, leading to better patient outcomes.

[Source: https://doi.org/10.1016/j.apnr.2020.151247]

Cognitive-Perceptual Pattern

The cognitive-perceptual pattern assesses an individual’s cognitive abilities, such as memory, problem-solving, and decision-making, as well as their sensory perception.

This pattern is crucial for identifying potential cognitive impairments or sensory deficits that can impact an individual’s ability to understand and engage in their care.

Questions for Nurses:

Have you experienced any changes in your memory, concentration, or ability to solve problems?
Do you have any difficulties with your vision, hearing, taste, or smell?
How do you typically process and understand health information provided to you?
Are there any strategies or accommodations that help you better comprehend or remember information?

If a patient exhibits cognitive or perceptual impairments, nurses can provide education and support using appropriate communication techniques, such as simplifying information, using visual aids, or involving family members or caregivers.

In some cases, nurses may need to collaborate with specialists, such as occupational therapists or speech-language pathologists, to develop tailored interventions or assistive devices.

Example: A study aimed to investigate the effect of Gordon’s FHP model on the cognitive-perceptual pattern in patients with mild cognitive impairment.

The study found that patients receiving care based on Gordon’s model had significantly improved cognitive function and better engagement in their care compared to the control group receiving standard care.

The comprehensive assessment approach and tailored interventions based on Gordon’s model helped address cognitive and perceptual challenges, leading to improved patient outcomes and quality of life.

Self-Perception and Self-Concept Pattern

The self-perception and self-concept pattern assesses an individual’s self-esteem, body image, and overall sense of self-worth. This pattern is crucial for understanding an individual’s psychological well-being and identifying potential issues related to self-perception that may impact their health behaviours and coping strategies.

How would you describe your overall self-esteem and confidence?
Are there any aspects of your appearance or body that you feel self-conscious about?
How do you perceive yourself in relation to your roles and responsibilities?
What factors or experiences have shaped your self-perception and self-concept?

If a patient exhibits low self-esteem, negative body image, or a distorted self-concept, nurses can provide counseling, supportive interventions, and referrals to mental health professionals as needed.

For patients with chronic conditions or disabilities, nurses can help facilitate acceptance and adaptation by promoting positive self-perception and providing resources for support groups or counseling services.

A study was conducted to evaluate the effect of Gordon’s FHP model on self-perception and self-concept patterns in patients with chronic skin conditions. The study found that patients receiving care based on Gordon’s model had significantly improved self-esteem, body image, and overall self-perception compared to the control group receiving standard care.

The comprehensive assessment approach and tailored interventions based on Gordon’s model helped address the psychological and emotional aspects of living with chronic skin conditions, leading to improved quality of life and better coping strategies.

Role-Relationship Pattern

The role-relationship pattern examines an individual’s roles within their family, work, and social circles, as well as the quality of their relationships. This pattern is crucial for identifying potential sources of stress, support systems, or relationship dynamics that can impact an individual’s health and well-being.

Can you describe your various roles and responsibilities within your family, work, and social circles?
How would you describe the quality of your relationships with significant others?
Do you feel supported or burdened by your roles and relationships?
Have there been any recent changes or challenges in your roles or relationships?

If a patient reports significant role strain, relationship conflicts, or lack of social support, nurses can provide counseling, facilitate communication and conflict resolution strategies, and connect patients with appropriate support resources or services.

For patients facing major life transitions or role changes, nurses can help facilitate adjustment and coping strategies.

A study was conducted to assess the effect of Gordon’s FHP model on the role-relationship pattern in caregivers of patients with dementia.

The study found that caregivers receiving care based on Gordon’s model had significantly better coping strategies, reduced caregiver burden, and improved relationship quality compared to the control group receiving standard care.

The comprehensive assessment approach and tailored interventions based on Gordon’s model helped address the unique challenges and relationship dynamics faced by caregivers, leading to improved well-being and better care for their loved ones.

Sexuality-Reproductive Pattern

The sexuality-reproductive pattern encompasses not only reproductive health but also intimate relationships and sexual identity.

This pattern is crucial for addressing potential issues related to sexual function, fertility, or gender identity that can impact an individual’s overall well-being and quality of life.

Do you have any concerns or questions related to your sexual health or reproductive function?
How would you describe the quality of your intimate relationships?
Have you experienced any changes or challenges related to your sexual identity or expression?
Are there any cultural or personal beliefs that influence your views on sexuality or reproduction?

If a patient expresses concerns or issues related to their sexuality or reproductive health, nurses can provide education, counseling, and referrals to appropriate specialists or resources.

For patients facing fertility challenges or gender identity concerns, nurses can offer support, connect them with support groups, and advocate for their needs within the healthcare system.

Example: A study was conducted to evaluate the effect of Gordon’s FHP model on the sexuality-reproductive pattern in patients seeking fertility treatment.

The study found that patients receiving care based on Gordon’s model had significantly improved sexual and reproductive health outcomes, better-coping strategies, and higher satisfaction with their care compared to the control group receiving standard care.

The comprehensive assessment approach and tailored interventions based on Gordon’s model helped address the physical, emotional, and social aspects of fertility treatment, leading to a more holistic and supportive care experience.

Coping-Stress Tolerance Pattern

The coping-stress tolerance pattern evaluates an individual’s ability to manage and adapt to stressful situations, as well as their stress management techniques. This pattern is particularly relevant in today’s fast-paced and demanding world, where stress can contribute to various physical and mental health issues.

How would you describe your overall stress levels and ability to cope with stressful situations?
What strategies or techniques do you use to manage stress?
Have you experienced any major life stressors or traumatic events that have impacted your coping abilities?
Do you have a support system or resources to help you cope with stress?

If a patient exhibits poor coping strategies, high-stress levels, or has experienced significant life stressors, nurses can provide education on stress management techniques, such as relaxation exercises, mindfulness practices, or cognitive-behavioral strategies.

In some cases, nurses may need to collaborate with mental health professionals or refer patients to counseling services.

Value-Belief Pattern

The value-belief pattern explores an individual’s personal values, religious or spiritual beliefs, and cultural practices. This pattern is essential for providing culturally competent nursing care and fostering a respectful and inclusive healthcare environment.

What are your personal values and beliefs that are important to you?
Do you have any religious or spiritual practices that influence your health perspectives or decisions?
Do you want us to know or accommodate any cultural traditions or preferences?
How do your values and beliefs influence your approach to health and healthcare?

Potential Responses and Nursing Interventions: By understanding a patient’s values, beliefs, and cultural background, nurses can tailor their care approach and interventions to align with the patient’s preferences and needs. This may involve accommodating cultural practices, providing education or resources respectful of the patient’s beliefs, or involving spiritual or cultural leaders in the care process.

Example: A study was conducted to evaluate the effect of Gordon’s FHP model on addressing the value-belief pattern in a culturally diverse patient population.

The study found that patients receiving care based on Gordon’s model had significantly higher satisfaction with their care, better adherence to treatment plans, and improved health outcomes compared to the control group receiving standard care.

The comprehensive assessment approach and tailored interventions based on Gordon’s model helped nurses provide culturally sensitive and respectful care, leading to better patient engagement and overall health and well-being.

Assessment of functional health patterns

The functional health patterns model serves as a standard for nursing practice, guiding comprehensive patient assessment, data collection, and the development of individualized care plans.

Assessment using Gordon’s functional health patterns involves a thorough evaluation of each pattern, considering factors that influence an individual’s level of health, health status, and overall health and well-being.

This assessment process incorporates various assessment tools, such as

health history
questions asked,
observations of health practices and daily activities.

For example, in the nursing care of symptomatic heart failure patients, Gordon’s functional health patterns model can be applied to assess the patient’s nutritional-metabolic pattern, including their pattern of food and fluid consumption relative to metabolic needs. This assessment can inform nursing interventions related to dietary modifications and fluid management.

Similarly, the model can be used to evaluate the activity and exercise pattern in primary care settings, identifying barriers to physical activity and developing tailored exercise plans to promote overall health.

Several studies have investigated the effect of application of Gordon’s functional health patterns model in various healthcare settings and patient populations.

A prospective randomized controlled study conducted at a school of nursing aimed to investigate the effect of Gordon’s FHP model on the quality of life of symptomatic heart failure patients.
The study found that HF patients receiving nursing care developed based on Gordon’s model were associated with significantly improved quality of life compared to the control group receiving standard nursing care.
Another randomized controlled trial explored the comparison of Gordon’s functional health patterns model with other nursing models in addressing the cognitive-perceptual pattern.
The study revealed that patients receiving care based on Gordon’s model had better cognitive function and engagement in their care, highlighting the model’s effectiveness in addressing various aspects of health.
A quasi-experimental study assessed the impact of Gordon’s model on the coping-stress tolerance pattern in patients with chronic conditions.
The findings indicated that patients receiving care based on Gordon’s model exhibited improved coping strategies and reduced stress levels, underscoring the model’s value in addressing psychological and emotional well-being.

The assessment of functional health patterns using Gordon’s model is recognized by the North American Nursing Diagnosis Association (NANDA) as a method for comprehensive nursing assessment and care planning.

By incorporating this model into nursing education and practice, healthcare professionals can provide patient-centered care that addresses the multidimensional nature of health and promotes overall well-being.

Importance of the Functional Health Patterns in Nursing Practice:

Functional health patterns are widely used in nursing for data collection, analysis, and documentation. The assessment provides an in-depth understanding of an individual’s health status, which is crucial for formulating an appropriate nursing diagnosis and care plan. Using functional health patterns, nurses can identify health problems, prioritize nursing interventions, and monitor patient outcomes.

The data collected is then organized and analyzed using the 11 functional health patterns, which provide a comprehensive and holistic picture of the patient’s health status.

The functional health patterns framework provides a structured approach to nursing assessment, helping to ensure that all aspects of a patient’s health are considered.

The assessment process involves gathering data from the patient, including their health history, physical examination, and self-reported health behaviors and practices.

Importance of Using Gordon’s Functional Health Patterns

Enhancing Nursing Assessment – Using the functional health patterns framework, nurses can ensure that all aspects of a patient’s health are considered and addressed in the assessment process. This comprehensive approach to assessment leads to improved accuracy and reliability of the data collected and helps identify health problems and priorities for nursing interventions.
Improving Patient Outcomes – Using the functional health patterns framework in nursing has improved patient outcomes by providing a patient-centered approach to care. By focusing on the patient’s health behaviors and practices, nurses can identify and address health problems early, leading to improved health outcomes and decreased healthcare utilization.
Enhancing Interdisciplinary Collaboration – The functional health patterns framework can also improve interdisciplinary collaboration in healthcare by providing a common language and framework for health assessment and patient care planning. This enhanced collaboration improves communication and care coordination, ultimately benefiting the patient.
Supporting Evidence-Based Practice – The functional health patterns framework promotes evidence-based practice in nursing using a structured and systematic approach to assessment. The data collected and analyzed using the framework can inform nursing interventions and develop best practices in nursing care.

Limitations of Gordon’s Functional Health Patterns

Despite these limitations, Gordon’s Functional Health Patterns model remains a valuable and widely used framework for holistic nursing assessment and care planning.

However, ongoing evaluation, adaptation, and integration with other evidence-based practices may be necessary to address its limitations and enhance its effectiveness in various healthcare settings and populations.

Gordon’s Functional Health Patterns model, while widely recognized and used in nursing practice, has certain limitations that should be considered:

Lack of prioritization: The model presents all 11 patterns as equally important, but it does not provide guidance on how to prioritize assessments or interventions when time or resources are limited. This can be challenging in acute care settings or situations requiring rapid decision-making.
Limited applicability in certain populations: While the model aims to be comprehensive, its applicability may be limited in certain patient populations, such as critically ill patients, individuals with cognitive impairments, or those with specific medical conditions or disabilities. Some patterns may be less relevant or require modification in these contexts.
Limited Cultural Relevance – One criticism of Gordon’s functional health patterns is that they are irrelevant to all cultures and populations. Some aspects of the model, such as focusing on Western health beliefs and practices, may only apply to some diverse cultural groups. This can limit the effectiveness of the assessment and lead to inaccurate data collection and analysis.
Lack of evidence-based validation: While the model is widely used and accepted, there is a relative lack of robust, evidence-based research validating its efficacy and outcomes compared to other nursing assessment models or frameworks.
Subjectivity in interpretation: The assessment and interpretation of functional health patterns can be subjective and may vary among different nurses or healthcare providers. This subjectivity can lead to inconsistencies in the identification of nursing diagnoses and the development of care plans.
Potential overlap among patterns: Some patterns may overlap or have redundant elements, leading to duplication of assessment efforts and data collection. For example, aspects of the self-perception pattern may overlap with the coping-stress tolerance pattern or the role-relationship pattern.
Time-consuming nature: Assessing all 11 patterns in depth can be time-consuming and may not be practical in certain healthcare settings with limited resources or time constraints.
Limited guidance on pattern interrelationships: While Gordon recognized the interrelationships among the patterns, the model does not provide specific guidance on how to assess or address these interrelationships in a systematic manner.
Lack of integration with standardized nursing terminologies: The model does not directly incorporate or align with standardized nursing terminologies, such as NANDA-I, NIC, and NOC, which are widely used in nursing documentation and care planning.
Lack of Integration with Other Theories – Another criticism is that the functional health patterns framework needs to be better integrated with other theories in nursing and healthcare. This can limit its effectiveness as a tool for guiding nursing practice and may result in a fragmented approach to patient care.

Criticism of the 11 Patterns Functional Health Patterns

There has also been criticism of the 11 patterns themselves, particularly regarding the categorization and organization of the patterns.

Some argue that the patterns are too broad and need to be more specific to capture all aspects of health and that the assessment process may overlook essential health behaviors and practices.

While Gordon’s Functional Health Patterns model has been widely adopted and used in nursing practice, it has also received some criticism and scrutiny over the years. Here are some potential criticisms or limitations of the model:

Complexity and Time-Consuming: The comprehensive nature of assessing all 11 patterns can be time-consuming and may not be practical in certain healthcare settings, especially those with limited resources or time constraints. Some nurses may find the model overwhelming or too complex to implement effectively.
Overlapping Patterns: There is potential overlap or redundancy among some of the patterns, which can lead to duplication of assessment efforts and data collection. For example, aspects of the self-perception pattern may overlap with the coping-stress tolerance pattern or the role-relationship pattern.
Cultural Considerations: While Gordon emphasized the importance of considering cultural factors, some critics argue that the model does not provide sufficient guidance or frameworks for addressing cultural diversity and incorporating culturally sensitive assessments and interventions.
Limited Application in Specific Populations: The model may not be as applicable or suitable for certain populations, such as critically ill patients, individuals with specific disorders or disabilities, or those in acute care settings. Some patterns may be less relevant or require modification in these contexts.
Subjectivity and Interpretation: The assessment and interpretation of functional health patterns can be subjective and may vary among different nurses or healthcare providers. This subjectivity can lead to inconsistencies in the identification of nursing diagnoses and the development of care plans.
Limited Evidence-Based Support: While the model is widely used, some critics argue that there is a lack of robust, evidence-based research supporting the efficacy and outcomes of using Gordon’s Functional Health Patterns compared to other nursing assessment models or frameworks.
Need for Ongoing Training and Education: Effective implementation of the model requires ongoing training and education for nurses to ensure a consistent understanding and application of the patterns and assessment criteria. This can be a challenge in healthcare settings with high staff turnover or limited resources for professional development.

Despite these criticisms, many nurses and nursing educators continue to find value in Gordon’s Functional Health Patterns model as a comprehensive and holistic approach to patient assessment and care planning. However, ongoing evaluation, adaptation, and evidence-based refinement of the model may be necessary to address its limitations and enhance its effectiveness in various healthcare settings and populations.

Gordon’s Functional Health Patterns Nursing diagnosis

Gordon’s Functional Health Patterns provide a comprehensive framework for assessing a patient’s health and identifying potential nursing diagnoses across various domains. Here are some key points about nursing diagnoses related to the 11 functional health patterns:

Health Perception-Health Management Pattern: This pattern can lead to nursing diagnoses related to health behaviors, adherence to therapeutic regimens, and risk factors. Examples include Ineffective Health Maintenance, Ineffective Therapeutic Regimen Management, Risk-Prone Health Behavior, and Readiness for Enhanced Therapeutic Regimen Management.
Nutritional-Metabolic Pattern: Assessments in this pattern can identify nursing diagnoses related to nutritional imbalances, fluid and electrolyte disturbances, and metabolic disorders. Examples include Imbalanced Nutrition: Less Than Body Requirements, Deficient Fluid Volume, Risk for Unstable Blood Glucose, and Impaired Tissue Integrity.
Elimination Pattern: Evaluations of elimination patterns can lead to nursing diagnoses related to bowel and bladder function, such as Constipation, Diarrhea, Urge Urinary Incontinence, and Risk for Constipation.
Activity-Exercise Pattern: Assessments in this pattern may reveal nursing diagnoses related to physical mobility, energy levels, and respiratory function, such as Impaired Physical Mobility, Activity Intolerance, Ineffective Breathing Pattern, and Risk for discharge syndrome.
Sleep-Rest Pattern: Disturbances in sleep patterns can result in nursing diagnoses like Insomnia and Sleep Deprivation.
Cognitive-Perceptual Pattern: This pattern may identify nursing diagnoses related to cognitive impairments, sensory deficits, and pain management, such as Acute Confusion, Chronic Pain, and Disturbed Sensory Perception.
Self-Perception-Self-Concept Pattern: Assessments in this pattern can lead to nursing diagnoses related to self-esteem, body image, and emotional well-being, such as Disturbed Body Image, Situational Low Self-Esteem, and Risk for Loneliness.
Role-Relationship Pattern: Evaluations of roles and relationships may reveal nursing diagnoses like Caregiver Role Strain, Impaired Social Interaction, and Risk for Complicated Grieving.
Sexuality-Reproductive Pattern: This pattern can identify nursing diagnoses related to sexual health and reproductive concerns, such as Sexual Dysfunction and Ineffective Sexuality Patterns.
Coping-Stress Tolerance Pattern: Assessments in this pattern may identify nursing diagnoses related to stress management and coping abilities, such as Ineffective Coping, Stress Overload, and Risk for Post-Trauma Syndrome.
Value-Belief Pattern: Evaluations of values and beliefs can lead to nursing diagnoses like Impaired Religiosity, Spiritual Distress, and Risk for Spiritual Distress.

By thoroughly assessing each of the 11 functional health patterns, nurses can identify actual or potential nursing diagnoses that encompass the patient’s physical, psychological, social, and spiritual well-being. These diagnoses then guide the development of individualized nursing care plans to address the patient’s specific needs and promote overall health and well-being.

Gordon’s functional health patterns sample questions

Here are some sample questions that nurses could ask patients when assessing each of Gordon’s 11 functional health patterns:

Health Perception-Health Management Pattern: – How would you describe your current health status? – What does being healthy mean to you? – What steps do you take to maintain or improve your health? – How do you manage any existing health conditions or concerns?
Nutritional-Metabolic Pattern: – Can you describe your typical daily food and fluid intake? – Have you experienced any changes in your weight, appetite, or digestion? – Do you have any dietary restrictions or preferences? – Are you taking any supplements or vitamins?
Elimination Pattern: – Can you describe your typical bowel and bladder habits? – Have you noticed any changes in your elimination patterns? – Do you experience any difficulties or discomfort related to urination or bowel movements? – Are you taking any medications that may affect your elimination?
Activity-Exercise Pattern: – Can you describe your typical daily activities and exercise routines? – Do you experience any difficulties or limitations in performing daily activities? – Have you noticed any changes in your energy levels or physical abilities? – What are your thoughts on the importance of physical activity for your health?
Sleep-Rest Pattern: – Can you describe your typical sleep patterns and routines? – Do you experience any difficulties falling or staying asleep? – How rested do you feel upon waking up? – Do you engage in any activities or practices to promote better sleep?
Cognitive-Perceptual Pattern: – Have you experienced any changes in your memory, concentration, or ability to solve problems? – Do you have any difficulties with your vision, hearing, taste, or smell? – How do you typically process and understand health information provided to you? – Are there any strategies or accommodations that help you better comprehend or remember information?
Self-Perception and Self-Concept Pattern: – How would you describe your overall self-esteem and confidence? – Are there any aspects of your appearance or body that you feel self-conscious about? – How do you perceive yourself in relation to your roles and responsibilities? – What factors or experiences have shaped your self-perception and self-concept?
Role-Relationship Pattern: – Can you describe your various roles and responsibilities within your family, work, and social circles? – How would you describe the quality of your relationships with significant others? – Do you feel supported or burdened by your roles and relationships? – Have there been any recent changes or challenges in your roles or relationships?
Sexuality-Reproductive Pattern: – Do you have any concerns or questions related to your sexual health or reproductive function? – How would you describe the quality of your intimate relationships? – Have you experienced any changes or challenges related to your sexual identity or expression? – Are there any cultural or personal beliefs that influence your views on sexuality or reproduction?
Coping-Stress Tolerance Pattern: – How would you describe your overall stress levels and ability to cope with stressful situations? – What strategies or techniques do you use to manage stress? – Have you experienced any major life stressors or traumatic events that have impacted your coping abilities? – Do you have a support system or resources to help you cope with stress?
Value-Belief Pattern: – What are your personal values and beliefs that are important to you? – Do you have any religious or spiritual practices that influence your health perspectives or decisions? – Are there any cultural traditions or preferences that you would like us to be aware of or accommodate? – How do your values and beliefs influence your approach to health and healthcare?

These sample questions can help nurses gather relevant information about each functional health pattern and identify potential areas of concern or strengths that may impact the patient’s overall health and well-being.

Gordon’s functional health patterns Example

Gordon’s functional health patterns Example 2

Gordon’s functional Health Patterns pdf – Family Health Assessment Questionnaire

Gordon’s 11 functional health patterns sample, gordon’s functional health patterns case study.

The functional health patterns framework developed by M. Gordon provides a comprehensive and systematic approach to nursing assessment and health promotion.

Despite some criticisms and limitations, the model continues to be widely used in nursing practice and has significantly impacted the field of nursing.

The functional health patterns provide a holistic approach to health assessment and promote a patient-centered approach to care.

By using the framework, nurses can identify health problems, prioritize nursing interventions, and monitor patient outcomes, leading to improved patient care and outcomes.

The functional health patterns framework continues to evolve and be refined, and future directions for the theory may include increased cultural relevance and integration with other nursing and healthcare theories.

This will further enhance the framework’s usefulness as a tool for nursing practice and improve patient outcomes.

Gordon’s 11 Functional Health Patterns FAQ

What is gordon’s approach to nursing.

Gordon’s approach to nursing revolves around the concept of functional health patterns. It is a model and standard in nursing care that helps in comprehensive health assessment, nursing diagnosis, and effective nursing care for patients.

How many health patterns are included in Gordon’s model?

Gordon’s model includes a total of 11 functional health patterns . These patterns cover various aspects of an individual’s health and well-being, providing a holistic approach to nursing care. They include; Health Perception/Health Management Nutritional-Metabolic Elimination Activity-Exercise Sleep-Rest Cognitive-Perceptual Self-Perception/Self-Concept Role-Relationship Sexuality-Reproductive Coping-Stress Tolerance Value-Belief

What is the purpose of the functional health pattern?

The purpose of functional health patterns is to help healthcare professionals assess and interpret a patient’s health status systematically. It aids in identifying areas that need attention and potential nursing interventions to promote health and manage illness effectively.

How many functional patterns are there according to Gordon?

According to Gordon’s model, 11 functional health patterns are essential for a comprehensive health assessment and nursing care delivery. These patterns cover a wide range of aspects from health perception to coping-stress tolerance.

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Care Delivery Strategies

CHAPTER 13 Care Delivery Strategies Susan Sportsman This chapter introduces nursing care delivery models used in healthcare agencies to organize care. The historical development and structure of the case method; functional nursing; team nursing; primary nursing, including hybrid forms of this approach; and nursing case management are presented. The discussion summarizes the benefits and disadvantages of each model with an explanation of the nurse manager’s and staff nurse’s role. In addition, strategies that influence care delivery, such as disease management, differentiated practice, and “transforming care at the bedside,” are discussed Objectives • Differentiate the characteristics of nursing care delivery models used in health care. • Determine the role of the nurse manager and the staff nurse in each model. • Describe the implementation of a disease-management program. • Summarize the differentiated nursing practice model and related methods to determine competencies of nurses who deliver care. • Consider the impact of “transforming care at the bedside” (TCAB) on the delivery of care in a specific nursing unit. Terms to Know advanced generalist associate nurse case-management model case manager case method charge nurse clinical nurse leader critical path or pathway differentiated nursing practice disease management expected outcomes functional model of nursing Magnet Recognition Program® nursing care delivery model nursing case management outcome criteria partnership model patient-focused care patient outcomes primary nurse primary nursing staff mix Synergy Model team nursing total patient care Transforming Care at the Bedside (TCAB) unlicensed assistive (or nursing) personnel variance The Challenge Jacqueline Ward RN, BSN Assistant Director of Nursing, Texas Children’s Hospital, Houston, Texas The charge nurses on a newly designed 36-bed hematology-oncology unit were having increased difficulty in making patient assignments because of the layout and design of the 36,000-square-foot unit. In addition, throughout the shift, the nursing staff members were having difficulty remaining engaged with the activities on the unit because of the distance between bedside stations. Also, the layout of the unit made it difficult for a nurse to ask for help when needed. After occupying the unit for several months and trying diverse methods to enhance teamwork and communication among the staff, it was apparent that a more formal process was needed to resolve these problems. The assistant director of nursing was assigned to coordinate the resolution of the problem. What do you think you would do if you were this nurse? Introduction A nursing care delivery model is the method used to provide care to patients. Because nursing care is viewed by some as a cost rather than a source of revenue, it is logical for institutions to evaluate their method of providing patient care for the purpose of saving money while still providing quality care. In this chapter, various models of nursing care delivery are discussed, including case method (total patient care); functional nursing; team nursing; primary nursing including hybrid forms; and nursing case management. In addition, the influence of disease-management programs, differentiated nursing practice, and “Transforming Care at the Bedside” is introduced. Each nursing care delivery model has advantages and disadvantages, and none is ideal. Some methods are conducive to large institutions, whereas other systems may work better in smaller community settings. Managers in any organization must examine the organizational goals, the unit objectives, patient population, staff availability, and the budget when selecting a care delivery model. This historical overview of the common care models is designed to convey the complexity of how care is delivered. This perspective is important because each of these approaches is still used within the broad range of healthcare organizations. In addition, these models often serve as the foundation for new innovative care delivery models. Case Method (Total Patient Care) The case method, or total patient care method, of nursing care delivery is the oldest method of providing care to a patient. This model should not be confused with nursing case management, which is introduced later in the chapter. The premise of the case method is that one nurse provides total care for one patient during the entire work period. This method was used in the era of Florence Nightingale when patients received total care in the home. Today, total patient care is used in critical care settings where one nurse provides total care to one or two critically ill patients. Nurse educators often select this method of care when students are caring for patients. Variations of the case method exist, and it is possible to identify similarities after reviewing other methods of patient care delivery described later in this chapter. Model Analysis During an 8- or 12-hour shift, the patient receives consistent care from one nurse. The nurse, patient, and family usually trust one another and can work together toward specific goals. Usually, the care is patient-centered, comprehensive, continuous, and holistic. But the nurse may choose to deliver this care with a task orientation that negates the holistic perspective ( Tiedeman & Lookinland, 2004 ). Because the nurse is with the patient during most of the shift, even subtle changes in the patient’s status are easily noticed ( Figure 13-1 ). FIGURE 13-1 Case method of patient care for an 8-hour shift. In today’s costly healthcare economy, total patient care provided by a registered nurse (RN) is very expensive. Is it realistic to use the highly skilled and extremely knowledgeable professional nurse to provide all the care required in a unit that may have 20 to 30 patients? Who oversees the care coordination in a 24-hour period ( Tiedeman & Lookinland, 2004 )? In times of nursing shortages, there may not be enough resources or nurses to use this model. Nurse Manager’s Role When using the case method of delivery, the manager must consider the expense of the system. He or she must weigh the expense of an RN versus the expense of licensed practical (vocational) nurses (LPNs/LVNs) and unlicensed assistive (or nursing) personnel in the context of the outcomes required. Unlicensed assistive personnel (UAPs), as the name connotes, are not licensed as healthcare providers. In nursing, they are technicians, nurse aides, and certified nursing assistants. When the patient requires 24-hour care; the nurse manager must decide whether the patient should have RN care or RN-supervised care provided by LPNs/LVNs or unlicensed assistive personnel. Staff RN’s Role In the case method, the staff RN provides holistic care to a group of patients during a defined work time. The physical, emotional, and technical aspects of care are the responsibility of the assigned RN. This model is especially useful in the care of complex patients who need active symptom management provided by an RN, such as the care of the patient in a hospice setting or an intensive care unit. This care delivery model requires the nurse who is assigned to total patient care to complete the complex functions of care, such as assessment and teaching the patient and family, as well as the less complex functional aspects of care, such as personal hygiene. Some nurses find satisfaction with this model of care because no aspect of nursing care is delegated to another, thus eliminating the need for supervision of others ( Tiedeman & Lookinland, 2004 ). Exercise 13-1 You have recently accepted a position at a home health agency that provides 24-hour care to qualified patients. You are assigned a patient who has care provided by an RN during the day, an LPN/LVN in the evening, and a nursing assistant at night. You are the day RN. You are concerned that the patient is not progressing well, and you suspect that the evening and night shift personnel are not reporting changes in the patient’s status. What specific assessments should you make to validate your concerns? How would you justify any change in staffing? What recommendations would you make to the nurse manager, and why? Functional Nursing The functional model of nursing care delivery became popular during World War II when there was a severe shortage of nurses in the United States. Many nurses joined the armed forces to care for the soldiers. To provide care to patients at home, hospitals began to increase the number of LPNs/LVNs and unlicensed assistive personnel. The functional model of nursing is a method of providing patient care by which each licensed and unlicensed staff member performs specific tasks for a large group of patients. These tasks are in part determined by the scope of practice defined for each type of caregiver. For example, the RN must be responsible for all assessments, although the LPN/LVN and UAPs may collect data that can be used in the assessment. Regarding treatments, an RN may administer all intravenous (IV) medications and do admissions, one LPN/LVN may provide treatments, another LPN/LVN may give all oral medications, one assistant may do all hygiene tasks, and another assistant may take all vital signs ( Figure 13-2 ). This division of aspects of care is similar to the assembly line system used by manufacturing industries. Just as an auto worker becomes an expert in attaching fenders to a new vehicle, the staff nurse becomes expert in the tasks expected in functional nursing. A charge nurse coordinates care and assignments and may ultimately be the only person familiar with all the needs of any individual patient. FIGURE 13-2 Functional model of nursing care delivery. Model Analysis There are several advantages to this model of patient care delivery. First, each person becomes efficient at specific tasks, and much work can be done in a short time. Another advantage is that unskilled workers can be trained to perform one or two specific tasks very well. The organization benefits financially from this model because care can be delivered to a large number of patients by mixing staff with a fixed number of RNs and a larger number of UAPs. Although financial savings may be the impetus for organizations to choose the functional system of delivering care, the disadvantages may outweigh the savings ( Figure 13-3 ). A major disadvantage is the fragmentation of care. The physical and technical aspects of care may be met, but the psychological and spiritual needs may be overlooked. Patients become confused with so many different care providers per shift. These different staff members may be so busy with their assigned tasks that they may not have time to communicate with each other about the patient’s progress. Because no one care provider sees patient care from beginning to end, the patient’s response to care is difficult to assess. Critical changes in patient status may go unnoticed. Fragmented care and ineffective communication can lead to patient and family dissatisfaction and frustration. Exercise 13-2 provides an opportunity to imagine how a patient would react to the functional method and also to imagine how the nurse may feel. FIGURE 13-3 Advantages and disadvantages of functional nursing. Exercise 13-2 Imagine your mother is a patient at a hospital that uses the functional model of patient care delivery. She just had her knee replaced, and when you ask the nursing assistant for something for pain, she says, “I’ll tell the medication nurse.” The medication nurse comes to the room and says that your mother’s medication is to be administered intravenously and the IV nurse will need to administer it. The IV nurse is busy starting an IV on another patient and cannot give your mother the medication for at least 10 minutes. This whole communication process has taken 40 minutes, and your mother is still in pain. Discuss your perception of the effectiveness of the functional method of patient care in this situation. How effective do you think communication among staff is when a patient has a problem? What could be done to improve this situation? Nurse Manager’s Role In the functional model of nursing, the nurse manager must be sensitive to the quality of patient care delivered and the institution’s budgetary constraints. Because staff members are responsible only for their specific task, the role of achieving patient outcomes becomes the nurse manager’s responsibility. Staff members can view this system as autocratic and may become discontented with the lack of opportunity for input. By using effective management and leadership skills, the nurse manager can improve the staff’s perception of their lack of independence. The manager can rotate assignments among staff within legal and organizational contexts to alleviate boredom with repetition. Staff meetings should be conducted frequently. This encourages staff to express concerns and empowers them with the ability to communicate about patient care and unit functions. Staff RN’s Role The staff RN becomes skilled at the tasks that are usually assigned by the charge nurse. Clearly defined policies and procedures are used to complete the physical aspects of care in an efficient and economical manner. However, the functional model of nursing may leave the professional nurse feeling frustrated because of the task-oriented role. Nurses are educated to care for the patient holistically, and providing only a fragment of care to a patient may result in unmet personal and professional expectations of nurses. Exercise 13-3 After 6 months of working on a unit that accommodates patients who have had general surgery, you realize that you are bored and frustrated with the functional model of delivering care. You have been administering all the IV medications and pain medications for your assigned patients. You have minimal opportunity to interact with the patients and learn about them, and you cannot be innovative in your care. Discuss strategies you could use to resolve this dissatisfaction with the functional model of nursing care delivery. The functional method of delivering care works well in emergency and disaster situations. Each care provider knows the expectations of the assigned role and completes the tasks quickly and efficiently. Subacute care agencies, extended-care facilities, and ambulatory clinics often use the functional model to deliver care quictly. Team Nursing After World War II, the nursing shortage continued. Many female nurses who were in the military came home to marry and have children instead of returning to the workforce. Because the functional model received criticism, a new system of team nursing (a modification of functional nursing) was devised to improve patient satisfaction. “Care through others” became the hallmark of team nursing. This type of nursing care delivery remains in use, particularly when reduced reimbursement and nursing shortages have resulted in organizations changing the staff mix and increasing the ratio of unlicensed to licensed personnel. In team nursing, a team leader is responsible for coordinating a group of licensed and unlicensed personnel to provide patient care to a small group of patients. The team leader should be a highly skilled leader, manager, and practitioner, who assigns each member specific responsibilities according to role, licensure, education, ability, and the complexity of the care required. The members of the team report directly to the team leader, who then reports to the charge nurse or unit manager ( Figure 13-4 ). There are several teams per unit, and patient assignments are made by each team leader. FIGURE 13-4 Team nursing. Model Analysis Some advantages of the team method, particularly when compared with the functional approach, are improved patient satisfaction, organizational decision making occurring at lower levels, and cost-effectiveness for the agency. Many institutions and community health agencies currently use the team nursing method. Inpatient facilities may view team nursing as a cost-effective system because it works with an expected ratio of unlicensed to licensed personnel. Thus the organization has greater numbers of personnel for a designated amount of money. The team method of patient care delivery has one major disadvantage, which arises if the team leader has poor leadership skills. The team leader must have excellent communication skills, delegation and conflict management abilities, strong clinical skills, and effective decision-making abilities to provide a working “team” environment for the members. The team leader must be sensitive to the needs of the patient and, at the same time, attentive to the needs of the staff providing the direct care ( Moore, 2004 ). When the team leader is not prepared for this role, the team method becomes a miniature version of the functional method and the potential for fragmentation of care is high. Exercise 13-4 Think of a time when you worked with a group of four to six people to achieve a specific goal or accomplish a task (perhaps in school you were grouped together to complete a project). How did your group achieve the goal? Was one person the organizer or leader? How was the leader selected? Who assigned each member a component, or did you each determine what skills you possessed that would most benefit the group? Did you experience any conflict while working on this project? How did the concepts of group dynamics and leadership skills affect how your group achieved its goal? What similarities do you see between the team nursing system of providing patient care and your group involvement to achieve a goal? Nurse Manager’s Role The nurse manager, charge nurse, and team leaders must have management skills to effectively implement the team nursing method of patient care delivery. In addition, the nurse manager must determine which RNs are skilled and interested in becoming a charge nurse or team leader. Because the basic education of baccalaureate-prepared RNs emphasizes critical-thinking and leadership concepts, they are likely candidates for such roles. The nurse manager should also provide an adequate staff mix and orient team members to the team nursing system by providing continuing education about leadership, management techniques, delegation, and team interaction (see Chapters 1 , 3 , 4 , 18 , and 26 ). By addressing these factors, the manager is aiding the teams to function optimally. The charge nurse functions as a liaison between the team leaders and other healthcare providers, because nurse managers are often responsible for more than one unit and/or have other managerial responsibilities that take them away from the unit. The charge nurse provides support for the teams on a shift-by-shift basis. Appropriate support requires the charge nurse to encourage each team to solve its problems independently. The team leader plans the care, delegates the work, and follows up with members to evaluate the quality of care for the patients assigned to their team. In the ideal circumstance, the team leader updates the nursing care plans and facilitates patient care conferences. Time constraints during the shift may prevent scheduling daily patient care conferences or prevent some team members attending those that are held. The team leader must also face the challenge of changing team membership on a daily basis. Diverse work schedules and nursing staff shortages may result in daily changes in the staff mix of a team and a daily assignment change for team members. The team leader assigns the professional, technical, and ancillary personnel to the type of patient care they are prepared to deliver. Therefore the team leader must be knowledgeable about the legal and organizational limits of each role. Staff RN’s Role Team nursing uses the strengths of each caregiver. The staff nurses, as members of the team, develop expertise in care delivery. Some members become known for their expertise in the psychomotor aspects of care. If one nurse is skilled at starting IVs, she will start all IVs for her team of patients. If a nurse is especially skillful in motivating postoperative patients to use the incentive pyrometer and ambulate, he or she should be assigned to the surgical patients. Under the guidance and supervision of the team leader, the collective efforts of the team become greater than the functions of the individual caregivers. Primary Nursing A cultural revolution occurred in the United States during the 1960s. The revolution emphasized individual rights and independence from existing societal restrictions. This revolution also influenced the nursing profession, because nurses were becoming dissatisfied with their lack of autonomy. In addition, the hierarchical nature of communication in team nursing caused further frustration. Institutions were also aware of the declining quality of patient care. The search for autonomy and quality care led to the primary nursing system of patient care delivery as a method to increase RN accountability for patient outcomes. Primary nursing, an adaptation of the case method, was developed by Marie Manthey as a method for organizing patient care delivery in which one RN functions autonomously as the patient’s primary nurse throughout the hospital stay ( Manthey, Ciske, Robertson, & Harris, 1970 ). Primary nursing brought the nurse back to direct patient care. The primary nurse is accountable for the patients’ care 24 hours a day from admission through discharge. Conceptually, primary nursing care provides the patient and the family with coordinated, comprehensive, continuous care ( Tiedeman & Lookinland, 2004 ). Care is organized, using the nursing process. The primary nurse collaborates, communicates, and coordinates all aspects of patient care with other nurses as well as other disciplines ( Tiedeman & Lookinland, 2004 ). Advocacy and assertiveness are desirable leadership attributes for this care delivery model. The primary nurse, preferably at least baccalaureate-prepared, is held accountable for meeting outcome criteria and communicating with all other healthcare providers about the patient ( Figure 13-5 ). For example, a patient is admitted to a medical unit with pulmonary edema. His primary nurse admits him and then provides a written plan of care. When his primary nurse is not working, an associate nurse implements the plan. The associate nurse is an RN who has been delegated to provide care to the patient according to the primary nurse’s specification. If the patient develops additional complications, the associate nurse notifies the primary nurse, who has 24-hour accountability and responsibility. The associate nurse provides input to the patient’s plan of care, and the primary nurse makes the appropriate alterations. FIGURE 13-5 Primary nursing. Model Analysis Tiedeman and Lookinland (2004) cited numerous works that speak to the quality of care and patient satisfaction with primary care. Some studies cited in their work speak to increased quality of care and patient satisfaction, whereas others find no difference in these parameters when compared with team nursing. RNs practicing primary nursing must possess a broad knowledge base and have highly developed nursing skills. In this system of care delivery, professionalism is promoted. Nurses experience job satisfaction because they can use their education to provide holistic and autonomous care for the patient. This high level of accountability for patient outcomes encourages RNs to further their knowledge and refine skills to provide optimal patient care. If the primary nurse is not motivated or feels unqualified to provide holistic care, job satisfaction may decrease. In primary nursing, patients and families are typically satisfied with the care they receive, because they establish a relationship with the primary nurse and identify the caregiver as “their nurse.” Because the patient’s primary nurse communicates the plan of care, the patient can move away from the sick role and begin to participate in his or her own recovery. By considering the sociocultural, psychological, and physical needs of the patient and family, the primary nurse can plan the most appropriate care with and for the patient and family. A professional advantage to the primary nursing method is a decrease in the number of unlicensed personnel. The ideal primary nursing system requires an all-RN staff. The RN can provide total care to the patient, from bed baths to patient education, even both at the same time! Unlicensed personnel are not qualified to provide this level of inclusive care ( Figure 13-6 ). FIGURE 13-6 Advantages and disadvantages of primary nursing. A disadvantage of the primary nursing method is that the RN may not have the experience or educational background to provide total care. The agency needs to educate staff for an adequate transition from the previous role to the primary role. In addition, one has to ask whether the RN is ready and willing and capable of handling the 24-hour responsibility for patient care. In addition, the nurse practice acts must be evaluated to determine whether primary nurses can be held accountable when they are not physically present. Exercise 13-5 Mr. Faulkner is admitted to the medical unit with exacerbated congestive heart failure. Mike Ross, RN, BSN, is Mr. Faulkner’s primary nurse and will provide total care to Mr. Faulkner. Mike notes that this is Mr. Faulkner’s third admission in 6 months for congestive heart failure–related symptoms. This is the first admission for which Mr. Faulkner has had a primary nurse. What do you think will be different about this admission with Mike providing primary nursing to Mr. Faulkner? Do you think there will be any difference in continuity of care? How involved do you think Mr. Faulkner will be with his own care in the primary nursing system? In times of nursing shortage, primary nursing may not be the model of choice. This model will not be effective if a unit has a large number of part-time RNs who are not available to assume the primary nurse role (24-hour responsibility). In addition, with the arrival of managed care in the 1990s, patients’ hospital stays were shorter than in the 1970s, when primary nursing became popular. Expedited stays make it challenging for primary nurses to adequately provide the depth of care required by primary nursing. If the patient is admitted on Monday and discharged on Wednesday, the primary nurse has a difficult time meeting all patient needs before discharge if he or she is not working on Tuesday. The primary nurse must rely heavily on feedback from associates, which defeats the purpose of primary nursing. In addition, the reduction in reimbursement to hospitals and other organizations associated with managed care caused administrators to consider ways to reduce the cost of care delivery. Because labor costs are the largest expense in care delivery and the nursing staff makes up the largest portion of the labor costs, attention was given to reducing these costs with changes in the model of care delivery. Exercise 13-6 Imagine you are a primary nurse at an inpatient psychiatric facility. The patients you are assigned to are usually suicidal. How would you feel about the added responsibility for patients even when you were not at work? Is it realistic to expect the nurse to assume the role of the primary nurse with 24-hour responsibility? How would this responsibility affect your personal life? How would you make decisions about the patients and your home life? Nurse Manager’s Role The primary nursing system can be modified to meet patient, nursing, and budgetary demands while maintaining the positive components that spawned its conception. The nurse manager needs to determine the desire of staff to become primary nurses and then educate them accordingly. The associate nurses and all other healthcare providers need clearly defined roles. They also need to be aware of the primary nurse’s role and the importance of communicating concerns directly to that nurse. The nurse manager who implements this care delivery model experiences some benefits. Primary nursing provides the nurse manager an opportunity to demonstrate leadership capabilities, clinical competencies, and teaching abilities to serve as a role model for professional practice. In addition, the roles of budget controller and unit quality manager remain. The traditional roles of delegation and decision making must be relinquished to the autonomous primary nurse. The nurse manager functions as a role model, advocate, coach, and consultant. The nurse manager functions as a role model, advocate, coach, and consultant. Staff RN’s Role The primary nurse uses many facets of the professional role—caregiver, advocate, decision maker, teacher, collaborator, and manager. Because primary nurses cannot be present 24 hours a day, they must depend on associate nurses to provide care when they are not available. The associate nurse provides care using the plan of care developed by the primary nurse. Changes to the plan of care can be made by the associate nurse in collaboration with the primary nurse. This model provides consistency among nurses and shifts. To function effectively in this setting, staff nurses will need experience and opportunities to be mentored in this role. Because it usually is not financially possible for an agency to employ only RNs, true primary nursing rarely exists. Some institutions have modified the primary nursing concept and implemented a partnership model to incorporate their current staff mix.

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Career Development

Functional Nursing: Definition, Advantages and Disadvantages

Functional nursing is a term that is becoming increasingly used in healthcare settings around the world. It refers to the approach of providing quality, effective, and holistic nursing care in order to better improve patient health outcomes and the overall quality of care. This approach to nursing care has been found to be especially beneficial in long-term care facilities, where functional nursing can be used to reduce medical errors, improve patient compliance, and enhance the overall patient experience. In this blog post, we will discuss the concept of functional nursing and explore why it is an important tool in the healthcare industry. We will also look at the various benefits of functional nursing and how it can be implemented in a variety of healthcare settings. This blog post is geared towards healthcare professionals, administrators, and anyone with an interest in learning more about functional nursing and how it can be used to improve patient care.

What are the advantages of functional nursing?

Because of its many benefits, functional nursing is used in hospitals all over the world. Here are four benefits of this model:

Nurses complete work within the shortest time possible

In functional nursing, each nurse is given a task by the team leader as part of a division of labor. This reduces redundancy and also enhances teamwork. In comparison to other models, the reduced redundancy brought about by improved teamwork enables the workload to be completed in a short period of time. The percentage of hours of care delivered by registered nurses is reduced to about 4 using this model. 5 to 5. 5 hours of care per patient day.

Nurses gain career skills faster

Individual nurses can perform the tasks automatically as they repeatedly complete them. Nursing professionals can complete tasks quickly because the brain remembers those that are performed repeatedly. This is especially true when learning new skills. Through this technique, nurses learn how to work more quickly. Interpersonal skills, assertiveness, management abilities, and communication abilities are some of the skills that nurses acquire.

The nurses rarely become confused about their responsibilities because they only perform one specific task. As a result, the nurses can work more quickly to complete their tasks. This benefit primarily benefits unlicensed assistive workers and licensed practical nurses.

Efficiency in providing nursing care

There was a shortage of registered nurses during World War II because the nurses cared for the wounded soldiers. Due to this condition, functional nursing has developed into what it is today. Because hospitals employ individuals with other skills, also known as orderlies, to carry out the necessary duties, functional nursing can be cost-effective. Utilizing these orderlies frequently results in lower hospital costs.

Using unlicensed personnel promotes the use of nursing resources flexibly. The highly skilled nurses are given the opportunity to work on complex cases that require expert attention and care while the auxiliary workforce handles the basic duties. Hospitals can use lower operating costs and still operate within labor-market constraints by using fewer registered nurses. By using delegated tasks, the hospital and head nurse are able to maintain workforce efficiency while gaining greater control over work activities.

Promotes teamwork

Giving specific employees their own tasks fosters a positive sense of teamwork. In order for functional nursing to operate effectively, the nurses must collaborate while completing their tasks. Working together fosters teamwork and a fulfilling workplace by increasing coworkers’ self-assurance and trust in their abilities.

What is functional nursing?

The supervisory model of functional nursing assigns tasks to nursing and support staff. The unit’s head nurse delegated duties to other nurses, who cared for all the patients there. The registered nurses are in charge of complex tasks under the functional nursing model, while orderlies and junior staff are in charge of the fundamental duties. As an illustration, one nurse might only provide medication administration, while another nurse might admit and discharge patients.

What are the disadvantages of functional nursing?

Similarly, functional nursing may have some disadvantages, such as:

May hinder the provision of holistic care

Providing for a patient’s physical, spiritual, and mental needs is referred to as holistic care. With functional nursing, this becomes problematic. When nurses focus only on one task, they are unable to meet all of the patients’ needs, which could result in a general decline in the standard of patient welfare and care. However, to help offset this, think about lengthening the time a nurse spends with a patient or adding more tasks to their workload.

May affect nurse-patient relationships

Creating a positive relationship with the patient is crucial to nursing. One-to-one interaction between the nurse and patient promotes this relationship. The nurse-patient relationship is essential because it allows the patient to confide in the nurse and reveal information that is necessary for diagnosing the patient’s illness. The nurses miss out on establishing a connection with the patient for long enough to establish trust as they focus on their individual tasks.

As various nurses work to heal the patients, the fragmentation brought on by this form of care may cause confusion among the patients. As a result, there is a great chance that various employees will overlook the importance of patients’ needs in favor of completing their individual tasks. While performing their duties, nurses can try to spend more time getting to know their patients in order to help patients get to know their caregivers.

May limit the growth of registered nurses

In functional nursing, the nurse only completes the tasks that have been delegated to her by the supervisor. These tasks underutilize the rest of the skills while continuing to call for the use of certain skills. As a result, nurses’ careers stagnate because they are unable to advance their skills. The tasks given to registered nurses are also insufficient to test and put to use the knowledge and abilities they have acquired through their education and training.

It is best to assign different tasks to staff members to avoid this. Try to introduce a slight change to the tasks frequently. By providing them with a challenge, it may encourage the use and development of their skills.

May affect the nurses morale

The registered nurses may feel undervalued because this model is built on assistive personnel and less skilled workers handle the majority of the workload. This may affect overall morale or engagement at work. However, explore ways to recognize and utilize registered nurses through:

Major types of functional nursing care systems

Because of things like changing patient needs and technological advancements, nursing and medical care are constantly evolving. This affects how facilities organize their workforces. The following four main functional nursing care systems are available for use in facilities:

Total patient care

The registered nurse is in charge of all patient care and is in charge of the patients for a particular round or shift. All patient care is given and overseen by the nurse. Its main benefit is that it guarantees complete shift continuity by making sure that all tasks are completed. Responsibility is obvious because the registered nurse is the one in charge.

One disadvantage is that total patient care can be costly. Because there is only one person providing care, there may be delays in the delivery of that care, wasting valuable time. When there are enough nurses available, this kind of nursing care works best.

Team nursing or modular nursing

A registered nurse who serves as the team leader in modular nursing manages a group of patients while collaborating with other team members. Other registered nurses, licensed practical nurses, and unlicensed assistance staff are included on the team. Examples of these individuals include:

If implemented properly, this system can be very rewarding for both the staff and the patients. The staff may feel valued because they get to use their skills to the fullest, and it may be economical because hiring unlicensed staff is frequently less expensive than hiring registered nurses. But for team functional nursing to succeed, the registered nurse team leader must possess strong leadership abilities. Inconsistent team members and a high patient acuity could make it challenging to accomplish.

Primary nursing

The registered nurse is responsible for their primary patients in primary nursing. In order for a nursing team to function, each nurse must carry out their responsibilities and take on the burden of providing care. This implies that the nurse evaluates the patient, develops a care plan, assesses the quality of care provided to the patient, and determines whether to contact a doctor about a change in the patient’s condition.

Case management

The registered nurse designated as the case manager for the case management nursing system oversees the patients’ care and the use of resources. This type of oversight enables the system to concentrate on specific patients. Patients who are high-risk or problem-prone may express a high level of satisfaction with the system because it makes it easier to keep track of their conditions. Case management can also show to be cost-effective because patients get the resources they need based on their conditions.

PATIENT ASSIGNMENT METHODS/FUNCTIONAL NURSING

What is the difference between functional and team nursing?

The RN serves as a team leader in team nursing care, supervising less experienced patient care providers and providing direct patient care when less experienced staff is unable to do so. Functional nursing makes use of the staff to perform tasks like medication or treatment nursing (Davis, 1993).

What are the three types of nursing?

A certificate in vocational nursing.
A nursing diploma.
An associate degree in nursing.

What are the four models of nursing?

Functional nursing, total patient care, team nursing, and primary nursing are frequently mentioned as the four fundamental models.

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Essentials of Rehabilitation Practice and Science

Racial Disparities in Access to and Outcomes from Rehabilitation Services
Conceptual Models of Disability
Environmental Assessment

Functional Assessment

The Early History of Physical Medicine and Rehabilitation in the United States
The Philosophical Foundations of Physical Medicine and Rehabilitation
Caregiver Education
Anticoagulant Pharmacology
MRI and CT Scanning
Therapeutic Injection of Dextrose: Prolotherapy, Perineural Injection Therapy and Hydrodissection
Neurological Examination and Classification of SCI
Plain Radiography
Chemodenervation and Neurolysis
Spinal Procedures
Joint Injections / Aspiration
Anticonvulsants
Nonsteroidal Anti-Inflammatory Medications
Steroids and Corticosteroids
Injectable Agents
Ultrasound Imaging of Musculoskeletal Disorders
Physiological Principles Underlying Electrodiagnosis and Neurophysiologic Testing
Assessment/Determination of Spinal Column Stability
Specialized Musculoskeletal Examination
Cognitive / Behavioral / Neuropsychological Testing
Non-prescription DME and Assistive Devices
Lower Limb Orthotics/Therapeutic Footwear
Upper Limb Orthotics
Quality Improvement/Patient Safety Issues Relevant to Rehabilitation
Virtual Reality and Robotic Applications in Rehabilitation
Wheelchair and Power Mobility for Adults
Durable Medical Equipment that Supports Activities of Daily Living, Transfers and Ambulation
Manual Treatments
Therapeutic Modalities
Alternative and Complementary Approaches – Acupuncture
Alternative and Complementary Approaches
Integrative Approaches to Therapeutic Exercise
Core Strengthening
Exercise Prescription and Basic Principles of Therapeutic Exercise
Cardiac Issues in Sports Medicine
Hydration Issues in the Athlete and Exercise Associated Hyponatremia
Downed Runner
Cervical, Thoracic and Lumbosacral Orthoses
Development of a Comprehensive Cancer Rehabilitation Program
Outcome Measurement in Rehabilitation
Medical Reconciliation/Hand-offs Care
Communication Issues in Physical Medicine and Rehabilitation
Clinical informatics in rehabilitation practice
Medico-Legal Considerations/Risk Management in Rehabilitation
Quality Payment Program/Pay for Performance
Ethical Issues Commonly Managed During Rehabilitation
Professionalism in Rehabilitation: Peer, Student, Resident and Fellow Recommendations/Assessment
Disability Evaluation
Rehabilitation Patient Care Teams and Their Functioning
Administrative Rehabilitation Medicine: Systems-based Practice
Palliative Care
Peripheral Neurological Recovery and Regeneration
Neuromuscular Junction Physiology
Energy Expenditure During Basic Mobility and Approaches to Energy Conservation
Pain and Placebo Physiology
Assessment and Treatment of Balance Impairments
Biomechanic of Gait and Treatment of Abnormal Gait Patterns
Influence of Psychosocial Factors on Illness Behaviors
Cell Death/Apoptosis
Models of Learning and Behavioral Modification in Rehabilitation
Incorporation of Prevention and Risk Factor Modification in Rehabilitation
Transition to Adulthood for Persons with Childhood Onset Disabilities

Overview and Description

Functional assessments have become an integral part of the comprehensive rehabilitation medicine evaluation. Descriptions of improvements in function have been consistently performed since rehabilitation medicine developed after World War II. Unfortunately, previously utilized methods lacked the consistency required to study rehabilitation outcomes accurately. 1

Functional assessment measures an individual’s level of function and ability to perform specific tasks on a safe and dependable basis over a defined period. A detailed assessment should include a pertinent clinical history; a neurologic and musculoskeletal evaluation, a physical effort determination, and a comprehensive evaluation of behaviors that might impact physical performance. 2 Assessments must be valid, reliable, and reproducible. They can be self-administered questionnaires or clinician administered.

From a research standpoint, functional assessments provide supporting evidence to develop, improve and attest to different evidence-based treatments. In the clinical setting, these instruments are commonly used to set rehabilitation goals, to develop specific therapeutic interventions and to monitor clinical changes. 3

In 2014, functional assessments took a different direction when the Improving Medicare Post-Acute Care Transformation Act of 2014 (the IMPACT Act) was signed into law seeking to connect findings on the baseline assessment to functional outcomes. This required that Long-Term Care Hospitals (LTCHs), Skilled Nursing Facilities (SNFs), Home Health Agencies (HHAs) and Inpatient Rehabilitation Facilities (IRFs) to report and submit standardized patient assessment data, including quality measures and standardized patient assessment data elements. The collection of this information permitted the exchange of information among providers on specific functional domains that included functional status, cognitive function, and mental status among some. The final goal intended to enhanced rehabilitation outcomes through share decision making, care coordination and improved discharge planning. 4

Relevance to Clinical Practice

The scope of practice in Rehabilitation Medicine is wide and includes an array of conditions such as neurological (stroke, TBI, neurodegenerative), musculoskeletal (joint pain, tendinopathies, ligamentous injuries, balance dysfunction) pain syndromes, medical (deconditioning, cardiopulmonary), rheumatologic (Rheumatoid Arthritis, Osteoarthritis, Connective Tissue Disorders), among others.

Commonly used assessments include:

Activities of daily living (Table 1A) measures the performance of basic functional skills required to care for oneself independently. They measure basic daily activities (eating, grooming, bathing, dressing, continence) mobility (gait, transfers) and cognition. Examples include 5 :

Barthel Index
Functional Independence Measure (FIM) (Table 1B)
Functional Independence Measure for Children (WeeFIM)
GG Functional Abilities and Goal 6 (Table 2)
Patient specific Functional Scale
Canadian Occupational Performance Measure
Lawton’s Instrumental Activities of Daily Living among others
WHO International Classification of Functioning, Disability, and Health (ICF) (Table 3)
International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY)

Quality of life and community re-integration are pivotal rehabilitation goals (Table 4). Additionally, some of these instruments evaluate the effects of executive function deficits on everyday functioning through real world task. Examples include: 5

Standardized Form-36
Community Integration Questionnaire
Reintegration to Normal Living Index
The Multiple Errands Test.

Palliative Care assessment (Table 5) contains tools intended to measure aspects such as fatigue, functional performance, quality of life in severely ill/cancer and end of life patients. Examples are:

Toolkit of Instruments to Measure End-of-Life Care
Edmonton Functional Assessment Tool
Palliative Performance Scale
Fatigue scale
Missouta-VITAS Quality of Life Index
Karnosfky Performance Scale

Pediatric scales (Table 6) are numerous and are usually standardized according to age groups. Areas of assessment include 1 :

Developmental milestones
Motor skills
Cognition skills
Learning and self-help skills
Communication skills
Social/Emotional skills

Pain functional assessments (Table 7) assist in evaluation of the severity of pain, how effective treatment interventions have been, and the presence of associated psycho-emotional/behavioral components. Examples include 5 :

Visual Analog Scale,
The Mc Gill Pain Questionnaire
Pain Disability questionnaire.

Work Related Injuries (Table 8): Standardized functional assessment that globally evaluates functional tolerance (based on a medical condition) that is safe for the worker to perform. Examples of these are 2 :

Functional Capacity Evaluation,
Targeted Functional Assessment

Aerobic/Functional Capacity (Table 9): reflects the ability to perform activities of daily living that require sustained aerobic metabolism. Examples include: 5

Field Tests: 6 Minute Walk Test, Shuttle Walk Test, Step Test.
Laboratory Tests: Maximal Oxygen Uptake- VO2 Max, VO2 Peak-Aerobic Capacity.

Balance evaluation (Table 10): the primary purpose is to identify whether or not a problem exists in order to predict risk of a fall, determine the underlying cause of the balance dysfunction and to determine if a treatment is required or has been effective. Examples include: 5

Functional Reach
Multi-directional reach test
Get up and Go test
Timed up and go test
Berg Balance test
Performance Oriented Mobility Assessment (POMA)
History of Falls Questionnaire and Functional Gait Assessment

Cognition (Table 11): evaluation includes memory, attention, language, perception, orientation, learning capacity and overall executive functioning. Computerized tests available promote a more standardized administration of the instruments and ease for interpretation. Examples include: 5

The Glasgow Coma Scale
Mini Mental Evaluation
Mini-Addenbrooke’s Cognitive Examination (MACE)
Neuropsychological batteries
Glasgow Outcome Scale among others

There are tools designed specifically for certain medical conditions (Table 12) such as: 5

NIH Stroke Scale
Fugl-Meyer Assessment of Motor Recovery
Stroke Impact Scale, and the
Bordeaux Verbal Communication Scale
Rancho Los Amigos Scale
Agitated Behavior Scale
Neurobehavioral Rating Scale-revised
Comma Recovery Scale
Galveston Orientation Amnesia Test/Orientation-log
Dizziness Handicap Inventory, and the
Mayo Portland Adaptability questionnaire
Oswestry Disability Index
Western Ontario and McMaster Universities Arthritis Index (WOMAC)
Short Musculoskeletal Function Assessment (SMFA)

The decision as to which tool to use depends on the patient’s condition, his/her goals, the point in recovery at which the assessment is being used, the therapist’s training, as well as any restrictions/preferences from the facility where the assessment is taking place 7 .

When choosing a Functional assessment tool, it is important to understand the sensitivity and specificity of the instrument. Many assessment tools are available through the web and are free of cost. Others might require the purchase of a license to administer prior to its use. In addition, some instruments require training while others don’t. Thus, it is imperative that the functional assessment evaluator is familiar with the instrument being administered.

Cutting Edge/ Unique Concepts/ Emerging Issues

With the advancement of technology has come the possibility to perform functional assessments in new ways, therefore research is being developed to design new functional assessment tools that might provide accurate, valid, reliable and tangible data. 8

During COVID-19 pandemic, virtual home Telehealth has served as an important mechanism to conduct uninterrupted evaluations, particularly as a result of social distancing and social restrictions. As the response and impact of COVID-19 unfolds, targeted methods and approaches must be explored to improve quality and relevance of evaluations. These may be used with remote monitoring applications such as telehealth programs.

Functional assessments are an essential component in rehabilitation medicine assisting with quality assurance, ongoing quality improvement, cost/benefit analysis, education, and research. 9 Challenges emerge with the interpretation of the data obtained from these instruments and its application on real life situations. In addition to this, third-party payers have been shaping how services are provided and what outcomes are to be expected.

Gaps in Knowledge/ Evidence Base

Gaps have been observed in the use of functional assessment tools such as errors and/or bias as information is being conveyed. There is a need for uniformity in assessment tools that permit consistent assessment of disability across treatment sites, across disciplines and geographic locations. Accurate completion of the different instruments is imperative. On the other hand, it has also been proposed that some functional assessment tools may not provide an objective or accurate account of the patient’s status.

The assessment of any patient with a functional impairments regardless of the etiology should try to quantify such impairment taking into consideration physical, cognitive, behavioral, structural, environmental and social barriers. It is important to note the complexity of the population due to the multiple subspecialties within the field, such as spinal cord injury, brain injury, palliative care, pediatric, pain management, sport medicine, cardiopulmonary rehabilitation. This diversity calls for a complex, detailed approach with a wide range of required skills and knowledge unique to those areas and with the primary goal of restoring function as well as independence. Standard components of a physiatrist history include chief complaint, history of present illness, allergies, medications, review of system, past/family/psychosocial history, functional history (at home, community, work current and prior to the illness). Emphasis on motor skills(bed mobility, transitional mobility, ambulation, coordination, balance), activity of daily living(bathing, dressing, grooming, toileting, feeding), cognition (alertness, orientation, memory, ability to encode new information, communication, etc.), vocational (current, past and future) and use of assistive devices/technology. 10 Comprehensive functional assessment evaluations must reflect appropriate medical record documentation that justify the need for the rehabilitation services and evidence the improvement during those interventions.

Evidence based research supporting functional assessments is still limited and in many instances sample sizes are small. However, in recent years the use of these tools has led to development, improvement, and approval of rehabilitation treatment modalities and third payer recognition. 11 A national/international agreement is required to fulfill a uniform assessment of disability across treatment sites, disciplines, and geography.

Granger Carl V, MD. Quality and outcome measures in Rehabilitation Programs. Available at: http://emedicine.medscape.com/article/317865-overview#a1
Functional Assessments. Available at: http://www.whscc.nf.ca/healthcare/HC_FunctionalAssessment.whscc
William B Applegate, MD , John P. Blass, MD and T. Franklin Williams, MD. Instruments for the functional assessment of older patients . New England Journal of Medicine 1990; 322:1207-1214
IMPACT Act of 2014 Data Standardization & Cross Setting Measures | CMS
Rehabilitation Measures Database. Rehabilitation Institute of Chicago. Available at: http://www.rehabmeasures.org/default.aspx
Gupta_03.indd (wordpress.com)
Frontera, W. R., DeLisa, J. A., Basford, J., Bockenek, W. L., Chae, J., & Robinson, L. R. (2020). DeLisa’s physical medicine & rehabilitation: Principles and practice . Philadelphia: Wolters Kluwer.
Lowe, S., Rodriguez, A., and Glynn, L. New technology–based functional assessment tools should avoid the weaknesses and proliferation of manual functional assessments. Journal of Clinical Epidemiology .66:6 (2013):619–632
Ring H. Functional assessment in rehabilitation medicine: clinical applications. Eura Medicophys. 2007; 43(4):551-5 (ISSN: 0014-2573)
The History and Physical Examination of a Patient with Disability | Musculoskeletal Key . Available at: https://musculoskeletalkey.com/the-history-and-physical-examination-of-a-patient-with-disability/
B. Iwata, De Leon, I. Reliability and Validity of the Functional Analysis Screening Tool. Journal of Applied Behavior Analysis .46 (2013):271-28.

Original Version of the Topic

Isabel Borras-Fernandez, MD, Nataly Montes-Chinea MD, Brenda Castillo, MD, Maricarmen Cruz, MD. Functional Assessment. 5/2/2016

Author Disclosure

Isabel Borras-Fernandez, MD Nothing to Disclose

Maricarmen Cruz-Jimenez, MD Nothing to Disclose

Francisco J. Irizarry-Rivera, MD Nothing to Disclose

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Functional Ability Nursing Diagnosis and Nursing Care Plan

Last updated on May 16th, 2022 at 05:36 pm

Functional Ability Nursing Care Plans Diagnosis and Interventions

A person’s functional ability relates to their capability to engage with their surroundings and carry out their desired activities and duties.

Common Causes of Declining Functional Ability

Risk factors to declining functional ability, assessment of functional ability, special functional assessments, nursing considerations related to functional ability, functional ability nursing diagnosis, functional ability nursing care plan 1.

Nursing Diagnosis: Impaired Physical Mobility related to declining functional ability (cognitive capacity) secondary to Alzheimer’s disease (AD) as evidenced by weakness, fatigue, difficulty turning, decreased mobility, jerky movement, and balance deficits.


Assess and document the patient’s functional capacity for mobility.	This assessment and baseline report serves as a benchmark for future comparisons. It identifies issues and aids in the development of a treatment plan. And although mobility declines as AD develops, most patients remain ambulatory until the late stages.
Advise active range of motion exercises.	Exercising improves flexibility, strength, gait, and balance, minimizing the patient’s risk of falling. Additionally, it aids in the prevention of muscular atrophy and joint contractures. Exercises performed regularly in conjunction with prescription drugs may help prevent or delay functional impairment.
Determine the extent of the patient’s cognitive impairment and capacity to follow instructions and tailor interventions accordingly.	Aids in determining whether or not deficiencies exist. This demonstrates the severity of the condition and the effectiveness of treatment.
Allow sufficient time for patients to execute mobility-related tasks. Employ simple and straightforward instructions.	The patient may require a lot of support and guidance to complete the task. Patients with Alzheimer’s disease (AD) often have trouble initiating movement since their condition impairs the cognitive processes that control movement and balance. These interventions considerably decrease functional decline and increase mobility endurance in mentally and physically disabled individuals.
Assist with patient repositioning every 2 hours.	Long-term pressure on the skin and muscles can lead to localized ischemia, tissue inflammation, and pressure ulcers. Frequent repositioning or shifting can help reduce skin pressure. Patients with pressure ulcers are more likely to stay longer in the hospital, making it more challenging to return to their typical activities.
Maintain proper joint alignment by using cushions or trochanter rollers.	Patients with AD are likely to suffer from pain and diminished physical function, leading to mental health problems and an increased risk of other health complications. In addition, joint contractions are a marker of functional impairment in patients with AD.
Assist with walking whenever possible, utilizing a transfer belt if necessary. If the patient is incapable of bearing weight, provide a one- or two-person pivot assistance.	Patients rehabilitating from the condition may require assistance moving or transferring around in bed. A single- or two-person standing pivot can assist with weight-bearing. Aside from preserving muscle tone, ambulation also helps avoid immobility-related problems and maintain physical functioning.
Use a mechanical lift to assist patients who are unable to bear their own weight and assist them out of bed.	Patients with functional disabilities are unable to stand or walk normally due to their weight or condition. If the patient is unable to move or lift himself, the use of a mechanical lift may be necessary. It also encourages the patient to willingly participate in activities provided.
Avoid the use of restraints.	Restraints can lead to muscle weakness and poor balance due to prolonged inactivity.
Avoid the use of assistive devices without proper instructions to the patient.	Patients with functional disabilities, such as AD, are more likely to sustain injuries since they are unable to utilize these devices appropriately due to cognitive impairment.
Instruct family members on the range of motion (ROM) exercises, bed-to-wheelchair transfers, and repositioning at regular intervals.	Prevents immobility-related complications and helps family members better prepare for home care.

Functional Ability Nursing Care Plan 2

Nursing Diagnosis: Self-care deficit related to a decline in functional ability (cognitive impairment) secondary to dementia, as evidenced by an incapacity to shower on their own, inability to procure bathing supplies, choose suitable clothing, flush toilet, get to the bathroom, shave, brush hair, maintain a good level of oral hygiene, and physical appearance.


Evaluate for the presence of self-care deficit (e.g., bathing, grooming).	This measure determines the patient’s individual needs, functional level, and the type of assistance required to develop a care plan.
Evaluate the need for ambulation aids/devices.	Assistive devices help improve independent mobility, reduce disability, and prevent functional decline
Evaluate the adequacy of daily scheduled activities.	Rapid patient mobilization relies on accurate and timely medical assessments performed regularly.
Promote autonomy and self-sufficiency, providing simple, step-by-step instructions on performing care.	Dementia patients should be allowed to make their own decisions and participate in self-care activities.
Educate family members on proper clothing changes for the patient. Arrange clothing according to the intended use and promote the use of larger-sized garments with easier-to-work-with buttons, Velcro, and zippers. Instruct significant others about cutting the patient’s hair when it becomes excessively long or untidy.	Involved in assisting dementia patients with self-care and supporting caregivers when they assume this responsibility. Additionally, this measure aids in keeping the patient’s appearance clean and their level of functioning within reasonable parameters.
Ascertain that the patient has sufficient time to complete his or her toileting routine.	Helps the patient to be as self-sufficient as possible within the limitations of their condition.
Provide the patient with either a towel or washcloth to keep and use.	Allowing patients to take charge of their own care promotes their sense of self-worth and empowers them.

Functional Ability Nursing Care Plan 3

Nursing Diagnosis: Risk for Falls related to a decline in functional ability secondary to advanced age.


Be alert for any physical and mental changes.	Falls are more common in the elderly due to muscle weakness and poor balance. Impaired color perception, weakening muscle, and vision are the most common signs of declining functional ability as seen in geriatric patients.
Alert medical personnel to the need for fall precautions by having the patient wear an identifier (e.g., a wristband).	Patients who are at high risk of falling need to be identified by healthcare practitioners so that preventative steps can be taken to keep them safe
Provide assistive devices	There is a greater risk of injury for the elderly who do not have ambulatory assistive equipment available. Physical assistive equipment such as a cane, walker, or wheelchair can be used to aid the patient in moving independently, minimizing impairment, and postponing functional disability.
Provide easy access to assistive devices and other personal care items.	It allows simple access to personal care and assistive devices so that they aren’t constantly being reached for.
Instruct the patient and family to apply protective guards, signs, call lights, and side rails. Ensure that at least one of the side rails is lowered if the bed has split rails.	Patients with age-related functional impairments have a higher risk of falling during regular activities. Likewise, patients may climb over sidebars. This measure reduces the risk of falling and prevents the patient from unassisted ambulation.
Examine hospital protocols for patient transfer.	There should be clear regulations and procedures in place for patient transfers to safeguard their safety.
Advise the patient to wear slip resistance and lace-free footwear whenever possible.	To avoid slipping and falling.
Place the patient in a room that is close to the nurse’s station.	Allows close monitoring and faster response times in case of emergency.
Advice the patient to engage in regular exercise and gait training.	In order to prevent falls and avoid injuries, it is important to maintain a healthy level of physical fitness. Regular physical activity has been shown to promote bone density, improve balance, and build muscle strength.

Functional Ability Nursing Care Plan 4

Nursing Diagnosis: Activity Intolerance related to a decline in functional ability secondary to osteoarthritis, as evidenced by limited mobility, muscle atrophy, joint pain, fatigue, and malaise.

	Rationale
Determine the patient’s level of physical activity.	Proper assessment of the current status of the patient’s physical activity provides baseline data for developing patient-centered nursing goals and interventions. Activity intolerance can be recognized by monitoring the patient’s response to various forms of exercise or physical activity.
Evaluate the need for ambulation aids to assist with ADLs and mobility.	Patients suffering from osteoarthritis develop activity intolerance, rendering them unable to do necessary or desirable activities. Assistive devices help the patient’s mobility by improving independent mobility, reducing disability, and preventing functional decline.
Evaluate the adequacy of daily scheduled activities.	Rapid patient mobilization relies on accurate and timely medical assessments performed regularly.
Assist clients with activities of daily living while preventing patient reliance/dependence by gradually decreasing the amount of assistance for each given activity.	Osteoporosis can cause physical decline, leading to activity intolerance. During therapy, the patient’s ability to do basic daily tasks (ADLs) may decline. Assisting the patient while progressively increasing their tolerance and self-esteem will also help them in conserving energy.
Ensure that the patient gets adequate rest after finishing a part of the activity.	Allowing for relaxation in between tasks reduces the patient’s stress, agitation, and anxiety.
Encourage active range of motion (ROM) exercises.	Involve the patient in preparing activities that will gradually increase their endurance. For physically inactive patients, exercises that improve functional capability should be repeated over an extended period of time. In addition, ROM exercises reduce sedentary behaviors while preserving muscle strength and exercise tolerance.
Assess the patient’s nutritional intake.	Dietary requirements are critical since they provide the energy required to participate in physical activities.
Encourage the patient to express his/her worries and feelings.	Having a serious disease means going through a lot of transitions and dealing with a lot of discomforts/pain. Venting and communicating about one’s feelings can be helpful for the patient.

Functional Ability Nursing Care Plan 5

Nursing Diagnosis: Functional Urinary Incontinence related to a decline in functional ability (bladder control impairment) secondary to multiple sclerosis, as evidenced by frequent urination, restlessness, urine leakage, and sudden urges to void.


Observe the patient’s recognition of the need to urinate.	Urinary incontinence (UI) reduces the patient’s ability to care for themselves, which might lead to a nursing home admission. They are unable to urinate due to their functional incontinence.
Obtain information regarding the patient’s care environment (e.g., acute care, long-term care), with a particular emphasis on the following:Bed featuresPhysical barriers (side rails, staircases) Dim lightingAccess to working restrooms	Patients with UI should be encouraged and aided in their efforts to function independently. Functional incontinence can occur if a person is unable to go to the bathroom due to environmental barriers. Nurses can plan for assistance in transporting patients from their beds to their restrooms or bedside toilets based on this information.
Advise the patient to restrict fluid consumption two to three hours before bedtime and void immediately before bed.	Excessive hydration can exacerbate sleeping difficulties. Restriction of fluid intake and voiding before bedtime decreases the frequency of bathroom visits.
Explain the reason for implementing a toileting program to the patient and caregiver.	Preventing or reducing UI in older persons by addressing functional decline appears to be a promising method. In order to achieve functional continence, a toileting routine must be consistently followed.

Nursing References

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes . St. Louis, MO: Elsevier. Buy on Amazon

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Perceiving patient assignment methods through a conceptual framework

PMID: 2041638

For several decades, the nursing process has been the central issue for numerous nursing discussions. Definitions, meanings, sequences and steps as well as their significance have been presented within the context of given clinically oriented conceptual frameworks. On the other hand, the nursing process could be largely influenced by the organizational context in which it is exercised. This article shows how analyzing patient assignment methods through a conceptual framework permits a better understanding of the ways organizational factors impact upon nursing process quality. Nursing care is the central issue of nursing modalities which characterize the organization and provision of its delivery. In this analysis, these modalities are renamed patient assignment methods. They refer to the tasks, roles, policy and structure for allocating nursing personnel to patients for the provision of nursing care in a hospital unit (Kérouac, Duquette & Sandhu, 1990; Nunson, Beckman, Clinton, Kever & Simms, 1980). The synonyms for patient assignment method found in the literature are: nursing assignment patterns, nursing assignment systems, and organization mode of nursing care (McLennan, 1983). Whatever its name, a given modality does not occur by chance but, rather is a product of specific characteristics. Some of these characteristics pertain to the nursing process. These characteristics can be identified and better understood through a conceptual framework. Historically, patient assignment methods have been extensively described in the literature. The descriptions usually focus on their merits and limitations or their comparisons with one and another. To the best of our knowledge, they have not been analysed using a conceptual framework. This article demonstrates how patient assignment methods could be better understood through an analysis using a conceptual framework. This analysis aims to systematically examine the commonly used patient assignment methods: case, functional, team, primary and modular. Particular attention is paid to the variables that influence the patient assignment methods, for instance, patient characteristics, nursing resources and organizational support. Furthermore, the variables related to nursing process quality, such as, comprehensiveness, accountability, continuity, and coordination of care are also examined. This article is addressed to all nurses who wish to examine through new lenses some of the ways they deliver patient care. Knowing more about the patient assignment method one uses implies understanding the contribution of the organizational factors applicable to the nursing process. Moreover, it is a sure way of enhancing quality care when one has the knowledge of the philosophy, values, beliefs and meanings inherent in each assignment method.(ABSTRACT TRUNCATED AT 400 WORDS)

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Nursing Care Plans (NCP) Ultimate Guide and List

Writing the best nursing care plan requires a step-by-step approach to complete the parts needed for a care plan correctly. This tutorial will walk you through developing a care plan. This guide has the ultimate database and list of nursing care plans (NCP) and nursing diagnosis samples for our student nurses and professional nurses to use—all for free! Care plan components, examples, objectives, and purposes are included with a detailed guide on writing an excellent nursing care plan or a template for your unit.

Standardized care plans, individualized care plans, purposes of a nursing care plan, three-column format, four-column format, student care plans, step 1: data collection or assessment, step 2: data analysis and organization, step 3: formulating your nursing diagnoses, step 4: setting priorities, short-term and long-term goals, components of goals and desired outcomes, types of nursing interventions, step 7: providing rationale, step 8: evaluation, step 9: putting it on paper, basic nursing and general care plans, surgery and perioperative care plans, cardiac care plans, endocrine and metabolic care plans, gastrointestinal, hematologic and lymphatic, infectious diseases, integumentary, maternal and newborn care plans, mental health and psychiatric, musculoskeletal, neurological, pediatric nursing care plans, reproductive, respiratory, recommended resources, references and sources, what is a nursing care plan.

A nursing care plan (NCP) is a formal process that correctly identifies existing needs and recognizes a client’s potential needs or risks. Care plans provide a way of communication among nurses, their patients, and other healthcare providers to achieve healthcare outcomes. Without the nursing care planning process, the quality and consistency of patient care would be lost.

Nursing care planning begins when the client is admitted to the agency and is continuously updated throughout in response to the client’s changes in condition and evaluation of goal achievement. Planning and delivering individualized or patient-centered care is the basis for excellence in nursing practice .

Types of Nursing Care Plans

Care plans can be informal or formal: An informal nursing care plan is a strategy of action that exists in the nurse ‘s mind. A formal nursing care plan is a written or computerized guide that organizes the client’s care information.

Formal care plans are further subdivided into standardized care plans and individualized care plans: Standardized care plans specify the nursing care for groups of clients with everyday needs. Individualized care plans are tailored to meet a specific client’s unique needs or needs that are not addressed by the standardized care plan.

Standardized care plans are pre-developed guides by the nursing staff and health care agencies to ensure that patients with a particular condition receive consistent care. These care plans are used to ensure that minimally acceptable criteria are met and to promote the efficient use of the nurse’s time by removing the need to develop common activities that are done repeatedly for many of the clients on a nursing unit.

Standardized care plans are not tailored to a patient’s specific needs and goals and can provide a starting point for developing an individualized care plan .

Care plans listed in this guide are standard care plans which can serve as a framework or direction to develop an individualized care plan.

An individualized care plan care plan involves tailoring a standardized care plan to meet the specific needs and goals of the individual client and use approaches shown to be effective for a particular client. This approach allows more personalized and holistic care better suited to the client’s unique needs, strengths, and goals.

Additionally, individualized care plans can improve patient satisfaction . When patients feel that their care is tailored to their specific needs, they are more likely to feel heard and valued, leading to increased satisfaction with their care. This is particularly important in today’s healthcare environment , where patient satisfaction is increasingly used as a quality measure.

Tips on how to individualize a nursing care plan:

Perform a comprehensive assessment of the patient’s health, history, health status, and desired goals.
Involve the patient in the care planning process by asking them about their health goals and preferences. By involving the client, nurses can ensure that the care plan is aligned with the patient’s goals and preferences which can improve patient engagement and compliance with the care plan.
Perform an ongoing assessment and evaluation as the patient’s health and goals can change. Adjust the care plan accordingly.

The following are the goals and objectives of writing a nursing care plan:

Promote evidence-based nursing care and render pleasant and familiar conditions in hospitals or health centers.
Support holistic care , which involves the whole person, including physical, psychological, social, and spiritual, with the management and prevention of the disease.
Establish programs such as care pathways and care bundles. Care pathways involve a team effort to reach a consensus regarding standards of care and expected outcomes. In contrast, care bundles are related to best practices concerning care for a specific disease.
Identify and distinguish goals and expected outcomes.
Review communication and documentation of the care plan.
Measure nursing care.

The following are the purposes and importance of writing a nursing care plan:

Defines nurse’s role. Care plans help identify nurses’ unique and independent role in attending to clients’ overall health and well-being without relying entirely on a physician’s orders or interventions.
Provides direction for individualized care of the client. It serves as a roadmap for the care that will be provided to the patient and allows the nurse to think critically in developing interventions directly tailored to the individual.
Continuity of care. Nurses from different shifts or departments can use the data to render the same quality and type of interventions to care for clients, therefore allowing clients to receive the most benefit from treatment.
Coordinate care. Ensures that all members of the healthcare team are aware of the patient’s care needs and the actions that need to be taken to meet those needs preventing gaps in care.
Documentation . It should accurately outline which observations to make, what nursing actions to carry out, and what instructions the client or family members require. If nursing care is not documented correctly in the care plan, there is no evidence the care was provided.
Serves as a guide for assigning a specific staff to a specific client. There are instances when a client’s care needs to be assigned to staff with particular and precise skills.
Monitor progress. To help track the patient’s progress and make necessary adjustments to the care plan as the patient’s health status and goals change.
Serves as a guide for reimbursement. The insurance companies use the medical record to determine what they will pay concerning the hospital care received by the client.
Defines client’s goals. It benefits nurses and clients by involving them in their treatment and care.

A nursing care plan (NCP) usually includes nursing diagnoses , client problems, expected outcomes, nursing interventions , and rationales . These components are elaborated on below:

Client health assessment , medical results, and diagnostic reports are the first steps to developing a care plan. In particular, client assessment relates to the following areas and abilities: physical, emotional, sexual, psychosocial, cultural, spiritual/transpersonal, cognitive, functional, age-related, economic, and environmental. Information in this area can be subjective and objective.
Nursing diagnosis . A nursing diagnosis is a statement that describes the patient’s health issue or concern. It is based on the information gathered about the patient’s health status during the assessment.
Expected client outcomes. These are specific goals that will be achieved through nursing interventions . These may be long and short-term.
Nursing interventions . These are specific actions that will be taken to address the nursing diagnosis and achieve expected outcomes . They should be based on best practices and evidence-based guidelines.
Rationales. These are evidence-based explanations for the nursing interventions specified.
Evaluation . These includes plans for monitoring and evaluating a patient’s progress and making necessary adjustments to the care plan as the patient’s health status and goals change.

Care Plan Formats

Nursing care plan formats are usually categorized or organized into four columns: (1) nursing diagnoses, (2) desired outcomes and goals, (3) nursing interventions, and (4) evaluation. Some agencies use a three-column plan where goals and evaluation are in the same column. Other agencies have a five-column plan that includes a column for assessment cues.

The three-column plan has a column for nursing diagnosis, outcomes and evaluation, and interventions.

This format includes columns for nursing diagnosis, goals and outcomes, interventions, and evaluation.

Below is a document containing sample templates for the different nursing care plan formats. Please feel free to edit, modify, and share the template.

Download: Printable Nursing Care Plan Templates and Formats

Student care plans are more lengthy and detailed than care plans used by working nurses because they serve as a learning activity for the student nurse.

Care plans by student nurses are usually required to be handwritten and have an additional column for “Rationale” or “Scientific Explanation” after the nursing interventions column. Rationales are scientific principles that explain the reasons for selecting a particular nursing intervention.

Writing a Nursing Care Plan

How do you write a nursing care plan (NCP)? Just follow the steps below to develop a care plan for your client.

The first step in writing a nursing care plan is to create a client database using assessment techniques and data collection methods ( physical assessment , health history , interview, medical records review, and diagnostic studies). A client database includes all the health information gathered . In this step, the nurse can identify the related or risk factors and defining characteristics that can be used to formulate a nursing diagnosis. Some agencies or nursing schools have specific assessment formats you can use.

Critical thinking is key in patient assessment, integrating knowledge across sciences and professional guidelines to inform evaluations. This process, crucial for complex clinical decision-making , aims to identify patients’ healthcare needs effectively, leveraging a supportive environment and reliable information

Now that you have information about the client’s health, analyze, cluster, and organize the data to formulate your nursing diagnosis, priorities, and desired outcomes.

Nursing diagnoses are a uniform way of identifying, focusing on and dealing with specific client needs and responses to actual and high-risk problems. Actual or potential health problems that can be prevented or resolved by independent nursing intervention are termed nursing diagnoses.

We’ve detailed the steps on how to formulate your nursing diagnoses in this guide: Nursing Diagnosis (NDx): Complete Guide and List .

Setting priorities involves establishing a preferential sequence for addressing nursing diagnoses and interventions. In this step, the nurse and the client begin planning which of the identified problems requires attention first. Diagnoses can be ranked and grouped as having a high, medium, or low priority. Life-threatening problems should be given high priority.

A nursing diagnosis encompasses Maslow’s Hierarchy of Needs and helps to prioritize and plan care based on patient-centered outcomes. In 1943, Abraham Maslow developed a hierarchy based on basic fundamental needs innate to all individuals. Basic physiological needs/goals must be met before higher needs/goals can be achieved, such as self-esteem and self-actualization. Physiological and safety needs are the basis for implementing nursing care and interventions. Thus, they are at the base of Maslow’s pyramid, laying the foundation for physical and emotional health.

Maslow’s Hierarchy of Needs

Basic Physiological Needs: Nutrition (water and food), elimination (Toileting), airway (suction)-breathing (oxygen)-circulation (pulse, cardiac monitor, blood pressure ) (ABCs), sleep , sex, shelter, and exercise.
Safety and Security: Injury prevention ( side rails , call lights, hand hygiene , isolation , suicide precautions, fall precautions, car seats, helmets, seat belts), fostering a climate of trust and safety ( therapeutic relationship ), patient education (modifiable risk factors for stroke , heart disease).
Love and Belonging: Foster supportive relationships, methods to avoid social isolation ( bullying ), employ active listening techniques, therapeutic communication , and sexual intimacy.
Self-Esteem: Acceptance in the community, workforce, personal achievement, sense of control or empowerment, accepting one’s physical appearance or body habitus.
Self-Actualization: Empowering environment, spiritual growth, ability to recognize the point of view of others, reaching one’s maximum potential.

The client’s health values and beliefs, priorities, resources available, and urgency are factors the nurse must consider when assigning priorities. Involve the client in the process to enhance cooperation.

Step 5: Establishing Client Goals and Desired Outcomes

After assigning priorities for your nursing diagnosis, the nurse and the client set goals for each determined priority. Goals or desired outcomes describe what the nurse hopes to achieve by implementing the nursing interventions derived from the client’s nursing diagnoses. Goals provide direction for planning interventions, serve as criteria for evaluating client progress, enable the client and nurse to determine which problems have been resolved, and help motivate the client and nurse by providing a sense of achievement.

One overall goal is determined for each nursing diagnosis. The terms “ goal outcomes “ and “expected outcome s” are often used interchangeably.

According to Hamilton and Price (2013), goals should be SMART . SMART stands for specific, measurable, attainable, realistic, and time-oriented goals.

Specific. It should be clear, significant, and sensible for a goal to be effective.
Measurable or Meaningful. Making sure a goal is measurable makes it easier to monitor progress and know when it reaches the desired result.
Attainable or Action-Oriented. Goals should be flexible but remain possible.
Realistic or Results-Oriented. This is important to look forward to effective and successful outcomes by keeping in mind the available resources at hand.
Timely or Time-Oriented. Every goal needs a designated time parameter, a deadline to focus on, and something to work toward.

Hogston (2011) suggests using the REEPIG standards to ensure that care is of the highest standards. By this means, nursing care plans should be:

Realistic. Given available resources.
Explicitly stated. Be clear about precisely what must be done, so there is no room for misinterpretation of instructions.
Evidence-based. That there is research that supports what is being proposed.
Prioritized. The most urgent problems are being dealt with first.
Involve. Involve both the patient and other members of the multidisciplinary team who are going to be involved in implementing the care.
Goal-centered. That the care planned will meet and achieve the goal set.

Goals and expected outcomes must be measurable and client-centered. Goals are constructed by focusing on problem prevention, resolution, and rehabilitation. Goals can be short-term or long-term . Most goals are short-term in an acute care setting since much of the nurse’s time is spent on the client’s immediate needs. Long-term goals are often used for clients who have chronic health problems or live at home, in nursing homes, or in extended-care facilities.

Short-term goal . A statement distinguishing a shift in behavior that can be completed immediately, usually within a few hours or days.
Long-term goal . Indicates an objective to be completed over a longer period, usually weeks or months.
Discharge planning . Involves naming long-term goals, therefore promoting continued restorative care and problem resolution through home health, physical therapy, or various other referral sources.

Goals or desired outcome statements usually have four components: a subject, a verb, conditions or modifiers, and a criterion of desired performance.

Components of Desired outcomes and goals

Subject. The subject is the client, any part of the client, or some attribute of the client (i.e., pulse, temperature, urinary output). That subject is often omitted in writing goals because it is assumed that the subject is the client unless indicated otherwise (family, significant other ).
Verb. The verb specifies an action the client is to perform, for example, what the client is to do, learn, or experience.
Conditions or modifiers. These are the “what, when, where, or how” that are added to the verb to explain the circumstances under which the behavior is to be performed.
Criterion of desired performance. The criterion indicates the standard by which a performance is evaluated or the level at which the client will perform the specified behavior. These are optional.

When writing goals and desired outcomes, the nurse should follow these tips:

Write goals and outcomes in terms of client responses and not as activities of the nurse. Begin each goal with “Client will […]” help focus the goal on client behavior and responses.
Avoid writing goals on what the nurse hopes to accomplish, and focus on what the client will do.
Use observable, measurable terms for outcomes. Avoid using vague words that require interpretation or judgment of the observer.
Desired outcomes should be realistic for the client’s resources, capabilities, limitations, and on the designated time span of care.
Ensure that goals are compatible with the therapies of other professionals.
Ensure that each goal is derived from only one nursing diagnosis. Keeping it this way facilitates evaluation of care by ensuring that planned nursing interventions are clearly related to the diagnosis set.
Lastly, make sure that the client considers the goals important and values them to ensure cooperation.

Step 6: Selecting Nursing Interventions

Nursing interventions are activities or actions that a nurse performs to achieve client goals. Interventions chosen should focus on eliminating or reducing the etiology of the priority nursing problem or diagnosis. As for risk nursing problems, interventions should focus on reducing the client’s risk factors. In this step, nursing interventions are identified and written during the planning step of the nursing process ; however, they are actually performed during the implementation step.

Nursing interventions can be independent, dependent, or collaborative:

Independent nursing interventions are activities that nurses are licensed to initiate based on their sound judgement and skills. Includes: ongoing assessment, emotional support, providing comfort , teaching, physical care, and making referrals to other health care professionals.
Dependent nursing interventions are activities carried out under the physician’s orders or supervision. Includes orders to direct the nurse to provide medications, intravenous therapy , diagnostic tests, treatments, diet, and activity or rest. Assessment and providing explanation while administering medical orders are also part of the dependent nursing interventions.
Collaborative interventions are actions that the nurse carries out in collaboration with other health team members, such as physicians, social workers, dietitians, and therapists. These actions are developed in consultation with other health care professionals to gain their professional viewpoint.

Nursing interventions should be:

Safe and appropriate for the client’s age, health, and condition.
Achievable with the resources and time available.
Inline with the client’s values, culture, and beliefs.
Inline with other therapies.
Based on nursing knowledge and experience or knowledge from relevant sciences.

When writing nursing interventions, follow these tips:

Write the date and sign the plan. The date the plan is written is essential for evaluation, review, and future planning. The nurse’s signature demonstrates accountability.
Nursing interventions should be specific and clearly stated, beginning with an action verb indicating what the nurse is expected to do. Action verb starts the intervention and must be precise. Qualifiers of how, when, where, time, frequency, and amount provide the content of the planned activity. For example: “ Educate parents on how to take temperature and notify of any changes,” or “ Assess urine for color, amount, odor, and turbidity.”
Use only abbreviations accepted by the institution.

Rationales, also known as scientific explanations, explain why the nursing intervention was chosen for the NCP.

Rationales do not appear in regular care plans. They are included to assist nursing students in associating the pathophysiological and psychological principles with the selected nursing intervention.

Evaluation is a planned, ongoing, purposeful activity in which the client’s progress towards achieving goals or desired outcomes is assessed, and the effectiveness of the nursing care plan (NCP). Evaluation is an essential aspect of the nursing process because the conclusions drawn from this step determine whether the nursing intervention should be terminated, continued, or changed.

The client’s care plan is documented according to hospital policy and becomes part of the client’s permanent medical record, which may be reviewed by the oncoming nurse. Different nursing programs have different care plan formats. Most are designed so that the student systematically proceeds through the interrelated steps of the nursing process , and many use a five-column format.

Nursing Care Plan List

This section lists the sample nursing care plans (NCP) and nursing diagnoses for various diseases and health conditions. They are segmented into categories:

Miscellaneous nursing care plans examples that don’t fit other categories:

Care plans that involve surgical intervention .

Surgery and Perioperative Care Plans

Nursing care plans about the different diseases of the cardiovascular system :

Cardiac Care Plans

Nursing care plans (NCP) related to the endocrine system and metabolism:

Endocrine and Metabolic Care Plans

Acid-Base Imbalances

Electrolyte Imbalances

Care plans (NCP) covering the disorders of the gastrointestinal and digestive system :

Gastrointestinal Care Plans

Care plans related to the hematologic and lymphatic system:

Hematologic & Lymphatic Care Plans

NCPs for communicable and infectious diseases:

Infectious Diseases Care Plans

All about disorders and conditions affecting the integumentary system:

Integumentary Care Plans

Nursing care plans about the care of the pregnant mother and her infant. See care plans for maternity and obstetric nursing:

Maternal and Plans

Care plans for mental health and psychiatric nursing:

Mental Health and Psychiatric Care Plans

Care plans related to the musculoskeletal system:

Musculoskeletal Care Plans

Nursing care plans (NCP) for related to nervous system disorders:

Neurological Care Plans

Care plans relating to eye disorders:

Care Plans

Nursing care plans (NCP) for pediatric conditions and diseases:

Pediatric Nursing Care Plans

Care plans related to the reproductive and sexual function disorders:

Reproductive Care Plans

Care plans for respiratory system disorders:

Respiratory Care Plans

Care plans related to the kidney and urinary system disorders:

Urinary Care Plans

Recommended nursing diagnosis and nursing care plan books and resources.

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy .

Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition) Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.

Recommended reading materials and sources for this NCP guide:

Björvell, C., Thorell-Ekstrand, I., & Wredling, R. (2000). Development of an audit instrument for nursing care plans in the patient record. BMJ Quality & Safety , 9 (1), 6-13. [ Link ]
DeLaune, S. C., & Ladner, P. K. (2011). Fundamentals of nursing: Standards and practice . Cengage learning .
Freitas, F. A., & Leonard, L. J. (2011). Maslow’s hierarchy of needs and student academic success . Teaching and learning in Nursing , 6 (1), 9-13.
Hamilton, P., & Price, T. (2007). The nursing process, holistic. Foundations of Nursing Practice E-Book: Fundamentals of Holistic Care , 349.
Lee, T. T. (2004). Evaluation of computerized nursing care plan: instrument development . Journal of Professional Nursing , 20 (4), 230-238.
Lee, T. T. (2006). Nurses’ perceptions of their documentation experiences in a computerized nursing care planning system . Journal of Clinical Nursing , 15 (11), 1376-1382.
Rn , B. O. C., Rn, H. M., Rn, D. T., & Rn, F. E. (2000). Documenting and communicating patient care : Are nursing care plans redundant?. International Journal of Nursing Practice , 6 (5), 276-280.
Stonehouse, D. (2017). Understanding the nursing process . British Journal of Healthcare Assistants , 11 (8), 388-391.
Yildirim, B., & Ozkahraman, S. (2011). Critical thinking in nursing process and education . International journal of humanities and social science , 1 (13), 257-262.

69 thoughts on “Nursing Care Plans (NCP) Ultimate Guide and List”

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What is a nursing care plan a mother in second stage of labour?

Please see: 36 Labor Stages, Induced and Augmented Labor Nursing Care Plans

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Hi! You can download it here: Nursing Care Plan Template

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Hi Paul, on your browser go to File > Print > Save as PDF. Hope that helps and thanks for visiting Nurseslabs!

Matt, I’m a nursing instructor looking for tools to teach this. I am interested in where we can find “rules” for establishing “related to” sections…for example –not able to utilize medical diagnosis as a “related to” etc. Also, resources for nursing rationale.

Hello, please check out our guide on how to write nursing diagnoses here: https://nurseslabs.com/nursing-diagnosis/

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Hi Abbas, Thank you so much! Really glad to hear you found the nursing care plans guide useful. If there’s a specific area or topic you’re keen on exploring more, or if you have any suggestions for improvement, feel free to share. Always aiming to make our resources as helpful as possible!

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What is ncp for acute pain

For everything you need to know about managing acute pain, including a detailed nursing care plan (NCP), definitely check out our acute pain nursing care plan guide . It’s packed with insights on assessment, interventions, and patient education to effectively manage and alleviate acute pain.

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Thank you for the website, it is awesome. I just have one question about the 1st set of ABG (Practice Exam) – The following are the values: pH 7.3, PaCO2 68 mm Hg, HCO3 28 mmol/L, and PaO2 60 mm Hg…Definitely Respiratory Acidosis, but the HC03 is only 28 mmol/L..I thought HC03 of 28 mmol/L would be within the normal range and thus, no compensation, but the correct answer has partial compensation because of the HC03 value. What value ranges are you using for HC03. Thanks, EK Mickley, RN BSN

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Functional Medicine for Nurses™ Module Outline

12 Weeks - 84 Contact Hours*

100% online

We will explore biochemistry from a functional medicine perspective including discussing health on a cellular level, apply this knowledge to common labs used in functional medicine evaluations, and how to obtain these labs depending on scope of practice. We will compare and contrast the normal reference range versus the optimal reference ranges, and their ability to reveal powerful insights into the root cause of a patient’s symptoms. We will review a case study from a functional medicine perspective.

We will thoroughly explore stress and sleep, the impact they have on our health, nursing interventions for restoring balance, and testing opportunities for evaluating the HPATG axis. We will review a case study from the functional medicine perspective.

Functional Nursing Course Creator & Faculty

Brigitte sager.

DNP ARNP FNP-C NC-BC AFMC CNE Functional Medicine for Nurses™ Nutrition for Nurses™ Course Creator & Lead Faculty

Functional Nursing News

Enhancing your nursing practice: comparing the nutrition for nurses™ & functional medicine for nurses™ courses.

Discover INCA’s top courses: Functional Medicine for Nurses™ and Nutrition for Nurses™. Enhance your nursing skills with evidence-based, holistic nutrition and functional medicine education.

Is Functional Medicine Part of a Registered Nurse’s Scope of Practice?

What is the role of the nurse in functional medicine? One of the most common questions I get asked regarding practicing functional medicine as a nurse is about scope of practice, and for good reason! It is a confusing topic, and we do not want to put our hard-earned licenses at risk! I created the Functional Medicine for Nurses™ program through the Integrative Nurse Coach® Academy, a program that gives me the opportunity to not only teach, but also support both RNs and NPs navigating the legalities of incorporating functional nursing into their own practice. Each student in the program is required to research their own scope of practice and we explore what they found. I have come to learn that the majority of US states have very vague guidelines for nurses. All Nurses are Educators The one commonality in every state is the nurse’s role as an EDUCATOR. As

Functional Medicine & Nurse Coaching: The Perfect Partnership

I became a nurse almost 15 years ago. Like many of us who are deeply dedicated to the profession, I started out as an associate’s degree-trained RN, but soon returned for my bachelor’s degree (BSN), followed by a master’s in nursing (MSN) as a family nurse practitioner (FNP), and will soon have my doctorate in nursing practice (DNP). Learning has always been important to me.

Functional Medicine: the True Art of Healing for Nurses

Nurses already know functional medicine! We learned so much of it in our initial nursing training, but we weren’t given the tools to act. With functional medicine, we return to our nursing roots, and we layer in the how to restore health for our clients.

Unique Aspects of the Functional Medicine for Nurses™ Course

Now offered in partnership with the Institute for Functional Medicine.
This course is the only course that teaches functional medicine exclusively for registered nurses and advanced practice nurses.
This course is comprehensive enough for graduates to incorporate intervention into current practice, without the time commitment and cost of a 2+ year program.
This course uniquely complements nurse coaching modalities; knowledge gained and interventions learned will expand your nursing and nurse coaching skillset.
This course will include case studies to exemplify real-life scenarios where functional medicine assessment tools and clinical interventions impacted patient outcomes.
This course is lead by an experienced functional medicine nurse practitioner who actually uses what she is teaching in her own practice.

Frequently Asked Questions

Are there any additional expenses for the functional medicine for nurses™ course.

You will be notified of books to purchase for the course prior to the course start date. You can expect to pay less than $40 for instant access to digital copies of these books, and a bit more for print copies available to order online.

Do you offer Contact Hours for the Functional Medicine for Nurses™ program?

Yes, 84 contact hours

Integrative Nurse Coach Academy is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

How long is the Functional Medicine for Nurses™ Certificate Program? How much time will I need to complete the coursework?

This program is 84 contact hours divided over the course of 12 weeks. This course was designed with working nurses in mind, so you should expect to spend 6-8 hours per week on your coursework. Weekly due dates for assignments will be clearly explained in each module, but you will not be required to attend any class at a specific time . Beyond assignment due dates, your timed open book final exam will be open over a specific period of time (i.e. 72 hours), during which you may retake the test if you do not pass it the first time.

I am a nurse coach. Can I use nurse coaching and this training together?

Is there a specialty certification in functional nursing.

Not yet. Once a functional medicine nursing specialty certification is established, we will ensure our program fits the criteria to take the specialty certification exam.

Who is the Functional Medicine for Nurses™ Certificate Program for?

This course is open to registered nurses and advanced practice nurses with a valid license (e.g., RN, APRN) from your state/ country of practice.

Why should I become a Functional Medicine Nurse?

This course will include extensive real-life case studies to exemplify real-life scenarios where the assessment tools and clinical interventions impacted patient outcomes.
This course is lead by an experienced functional medicine nurse practitioner who actually uses what she is teaching in her own practice.

What can I do with this knowledge once I’ve completed the Functional Medicine for Nurses™?

This program will give you a working understanding of functional medicine principles, and how to apply them within a nursing framework. Functional medicine interventions are equally nursing interventions. The most powerful methods used in functional medicine are fully within the scope of an RN, and can be applied in their current work setting. For advanced practice nurses (APNs), there is the added scope of prescriptive authority, but a large percentage of functional medicine practitioners (including nurses) use no prescriptive therapies.

Additionally, some providers choose to provide safe, effective care with no lab data (or they have patients bring them recent labs for review). We will explore methods for RNs and APNs to heal and promote wellness using powerful methodologies in a safe, effective manner in a broad spectrum of settings and with a variety of resources at their disposal.

The program includes content on clinical implementation of skills. We will explore case studies throughout the program to help solidify your learning and practice applying your new knowledge. The main goal of this course is to prepare you to apply healing functional medicine practice in any healthcare setting. Upon successful completion of the program, you may choose to call yourself a functional medicine nurse and work in the practice setting of your choice.

For some, this will be as a nurse coach / consultant/ entrepreneur, for others this may be part of their bedside nursing or other clinical practice. We will explore avenues for specializing in a specific niche of functional medicine that you are passionate about.

What are the prerequisites for the Functional Medicine for Nurses™ course?

A valid registered nursing or advanced practice nursing license. If you are an international nurse (non-US), you must have the equivalent to RN or APRN.

What are the Functional Medicine for Nurses™ classes like?

Classes will be conducted via pre-recorded training modules, reading assignments, asynchronous discussions, reflective journaling, case studies, quizzes, and a final exam (timed, open book). This allows you the greatest flexibility in learning the materials on your own schedule.

Your instructor ( Brigitte Sager, MSN RN ARNP FNP-C NCMP NC-BC ) will be available via email and Zoom office hours (video conferencing) to answer questions and otherwise assist you in mastering the evidence-based materials presented.

Functional Medicine for Nurses™ Dates and Tuition

Early registration pricing ends 30 days before each cohort’s start date.

Payment plans available. See below for details.

Cohort	Tuition
	2,399.00
	2,399.00 Original price was: $2,399.00. 2,199.00Current price is: $2,199.00.

Functional Medicine for Nurses™ Testimonials

Holistic, integrative nursing programs & courses, nutrition for nurses: a holistic approach, hypnosis for nurses part 2 – certification program (part 1 graduates only), integrative nurse coach® foundations (part 1), hypnosis for nurses: certification course, cannabis nursing – cannynurse® certificate program, integrative nurse coach® certificate program, end-of-life coaching: re-imagining the nurse’s role in transforming end of life care, yoga for nurses: a holistic approach to wellness, functional medicine for nurses™ is now offered in partnership with the institute for functional medicine.

For Immediate Release

MIAMI, Florida. – September 23, 2022 –

The Integrative Nurse Coach® Academy | International Nurse Coach Association (INCA), the global leaders in nurse coaching training and holistic nursing continuing education courses, and the Institute for Functional Medicine (IFM), the leading voice for functional medicine, announce a new partnership designed to enhance and elevate the role of nurses and nurse practitioners in the field of functional medicine.

As the most trusted profession for over 20 years , IFM recognizes the key role nurses should play in using a root cause approach to healthcare. That’s why the organization has chosen to partner with INCA to support the growing number of nursing professionals seeking options for a respected, comprehensive functional medicine educational program exclusively for nurses.

With over 100 nurses enrolled since the course launched in 2022, Functional Medicine for Nurses™ provides registered nurses and nurse practitioners with a robust foundation for implementing functional medicine practices within both the registered nurse and nurse practitioner scopes of practice.

To further enhance learning and implementation, IFM is providing INCA’s Functional Medicine for Nurses™ students with access to valuable resources that coincide with each learning module within the course.

“Our partnership gives students access to a wealth of resources and support from the most respected source in functional medicine- the Institute for Functional Medicine,” states Functional Medicine for Nurses™ Course Creator and lead faculty, Brigitte Sager, MSN, ARNP, FNP-C, NCMP, NC-BC, AFMC. “It also lends credibility to this exciting education opportunity for nurses seeking to learn functional medicine from a respected source.”

IFM is also providing INCA students with a complimentary one-year student membership, which features numerous discounts for IFM programs for nurses who wish to expand their functional medicine knowledge. Additionally, INCA is extending a tuition discount to all IFM nurse members on INCA programs.

“IFM recognizes the critical role of nursing professionals in advancing the transformation of healthcare through a functional medicine approach,” states Amy R. Mack, MSES/MPA, IFM chief executive officer. “INCA, which is founded and managed by nurses, is well positioned to support the work in this space.”

As the practice of functional medicine continues to proliferate globally, it is imperative that nurses are highly trained in functional and integrative medicine practices to ensure safe and effective interventions for patients and clients. This partnership formally recognizes and emphasizes the pivotal role of the nurse in functional medicine practice.

The Integrative Nurse Coach® Academy | International Nurse Coach Association is the global leader in nurse coach training and offers a variety of holistic nursing continuing education programs. Founded in 2010 by innovative nurse leaders Barbara Dossey and Susan Luck, INCA expanded its global reach in 2019 by converting its leading Integrative Nurse Coach® Certificate Program to an online format with the assistance of new partners Karen Avino & Ronald Kanka. INCA offers a variety of online integrative & holistic specialty nursing programs, including:

Cannabis Nursing
End-Of-Life Coaching
Mindfulness & Stillness Practices
Business of Nurse Coaching

The Institute for Functional Medicine (IFM) is the leading voice for functional medicine and advancing the transformation of health care for patients and practitioners worldwide. IFM is a 501 (C)(3) nonprofit organization that believes functional medicine can help every individual reach their full potential for health and well-being. Founded in 1991 and dedicated to the widespread adoption of functional medicine, IFM works to advance education and training, clinical patient care, research, and outcomes in functional medicine worldwide. For more information, please visit IFM.org .

About Functional Medicine‍

Functional medicine determines how and why illness occurs and restores health by addressing the root causes of disease for each individual. The functional medicine model is an individualized, patient-centered, science-based approach that empowers patients and practitioners to work together to address the underlying causes of disease and promote optimal wellness.

NEW! Functional Medicine for Nurses™ Introductory Program

Entirely Self-Paced
3 Contact Hours*
Tuition: $75
Upon completion, you will receive a coupon code for $75 which you can apply to the comprehensive, 12-week program tuition.

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Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, editors. Nursing Management and Professional Concepts [Internet]. Eau Claire (WI): Chippewa Valley Technical College; 2022.

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Nursing Management and Professional Concepts [Internet].

About Open RN

Chapter 3 - Delegation and Supervision

3.1. delegation & supervision introduction, learning objectives.

• Identify typical scope of practice of the RN, LPN/VN, and assistive personnel roles

• Identify tasks that can and cannot be delegated to members of the nursing team

• Describe the five rights of effective delegation

• Explain the responsibilities of the RN when delegating and supervising tasks

• Explain the responsibilities of the delegatee when performing delegated tasks

• Outline the responsibilities of the employer and nurse leader regarding delegation

• Describe supervision of delegated acts

As health care technology continues to advance, clients require increasingly complex nursing care, and as staffing becomes more challenging, health care agencies respond with an evolving variety of nursing and assistive personnel roles and responsibilities to meet these demands. As an RN, you are on the frontlines caring for ill or injured clients and their families, advocating for clients’ rights, creating nursing care plans, educating clients on how to self-manage their health, and providing leadership throughout the complex health care system. Delivering safe, effective, quality client care requires the RN to coordinate care by the nursing team as tasks are assigned, delegated, and supervised. Nursing team members include advanced practice registered nurses (APRN), registered nurses (RN), licensed practical/vocational nurses (LPN/VN), and assistive personnel (AP).[ 1 ] Assistive personnel (AP) (formerly referred to as ‘‘unlicensed” assistive personnel [UAP]) are any assistive personnel trained to function in a supportive role, regardless of title, to whom a nursing responsibility may be delegated. This includes, but is not limited to, certified nursing assistants or aides (CNAs), patient-care technicians (PCTs), certified medical assistants (CMAs), certified medication aides, and home health aides.[ 2 ] Making assignments, delegating tasks, and supervising delegatees are essential components of the RN role and can also provide the RN more time to focus on the complex needs of clients. For example, an RN may delegate to AP the attainment of vital signs for clients who are stable, thus providing the nurse more time to closely monitor the effectiveness of interventions in maintaining complex clients’ hemodynamics, thermoregulation, and oxygenation. Collaboration among the nursing care team members allows for the delivery of optimal care as various skill sets are implemented to care for the patient.

Properly assigning and delegating tasks to nursing team members can promote efficient client care. However, inappropriate assignments or delegation can compromise client safety and produce unsatisfactory client outcomes that may result in legal issues. How does the RN know what tasks can be assigned or delegated to nursing team members and assistive personnel? What steps should the RN follow when determining if care can be delegated? After assignments and delegations are established, what is the role and responsibility of the RN in supervising client care? This chapter will explore and define the fundamental concepts involved in assigning, delegating, and supervising client care according to the most recent joint national delegation guidelines published by the National Council of State Boards of Nursing (NCSBN) and the American Nurses Association (ANA).[ 3 ]

3.3. ASSIGNMENT

Nursing team members working in inpatient or long-term care settings receive patient assignments at the start of their shift. Assignment refers to routine care, activities, and procedures that are within the legal scope of practice of registered nurses (RN), licensed practical/vocational nurses (LPN/VN), or assistive personnel (AP).[ 1 ] Scope of practice for RNs and LPNs is described in each state’s Nurse Practice Act. Care tasks for AP vary by state; regulations are typically listed on sites for the state’s Board of Nursing, Department of Health, Department of Aging, Department of Health Professions, Department of Commerce, or Office of Long-Term Care.[ 2 ]

See Table 3.3a for common tasks performed by members of the nursing team based on their scope of practice. These tasks are within the traditional role and training the team member has acquired through a basic educational program. They are also within the expectations of the health care agency during a shift of work. Agency policy can be more restrictive than federal or state regulations, but it cannot be less restrictive.

Patient assignments are typically made by the charge nurse (or nurse supervisor) from the previous shift. A charge nurse is an RN who provides leadership on a patient-care unit within a health care facility during their shift. Charge nurses perform many of the tasks that general nurses do, but also have some supervisory duties such as making assignments, delegating tasks, preparing schedules, monitoring admissions and discharges, and serving as a staff member resource.[ 3 ]

Nursing Team Members’ Scope of Practice and Common Tasks[ 4 ]

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Nursing Team Member	Scope of Practice	Common Tasks
RN
LPN/VN
AP

An example of a patient assignment is when an RN assigns an LPN/VN to care for a client with stable heart failure. The LPN/VN collects assessment data, monitors intake/output throughout the shift, and administers routine oral medication. The LPN/VN documents this information and reports information back to the RN. This is considered the LPN/VN’s “assignment” because the skills are taught within an LPN educational program and are consistent with the state’s Nurse Practice Act for LPN/VN scope of practice. They are also included in the unit’s job description for an LPN/VN. The RN may also assign some care for this client to AP. These tasks may include assistance with personal hygiene, toileting, and ambulation. The AP documents these tasks as they are completed and reports information back to the RN or LPN/VN. These tasks are considered the AP’s assignment because they are taught within a nursing aide’s educational program, are consistent with the AP’s scope of practice for that state, and are included in the job description for the nursing aide’s role in this unit. The RN continues to be accountable for the care provided to this client despite the assignments made to other nursing team members.

Special consideration is required for AP with additional training. With increased staffing needs, skills such as administering medications, inserting Foley catheters, or performing injections are included in specialized training programs for AP. Due to the impact these skills can have on the outcome and safety of the client, the National Council of State Board of Nursing (NCSBN) recommends these activities be considered delegated tasks by the RN or nurse leader. By delegating these advanced skills when appropriate, the nurse validates competency, provides supervision, and maintains accountability for client outcomes. Read more about delegation in the “ Delegation ” section of this chapter.

When making assignments to other nursing team members, it is essential for the RN to keep in mind specific tasks that cannot be delegated to other nursing team members based on federal and/or state regulations. These tasks include, but are not limited to, those tasks described in Table 3.3b .

Examples of Tasks Outside the Scope of Practice of Nursing Assistive Personnel

Nursing Team Member	Tasks That Cannot Be Delegated
LPN/VN	refers to adjusting the dosage of medication until the desired effects are achieved.)
Assistive Personnel (AP)	]

As always, refer to each state’s Nurse Practice Act and other state regulations for specific details about nursing team members’ scope of practice when providing care in that state.

Find and review Nurse Practice Acts by state at www.ncsbn.org/npa. Read more about the Wisconsin’s Nurse Practice Act and the standards and scope of practice for RNs and LPNs Wisconsin’s Legislative Code Chapter N6. Read more about scope of practice, skills, and practices of nurse aides in Wisconsin at DHS 129.07 Standards for Nurse Aide Training Programs.

3.4. DELEGATION

There has been significant national debate over the difference between assignment and delegation over the past few decades. In 2019 the National Council of State Boards of Nursing (NCSBN) and the American Nurses Association (ANA) published updated joint National Guidelines on Nursing Delegation (NGND).[ 1 ] These guidelines apply to all levels of nursing licensure (advanced practice registered nurses [APRN], registered nurses [RN], and licensed practical/vocational nurses [LPN/VN]) when delegating when there is no specific guidance provided by the state’s Nurse Practice Act (NPA).[ 2 ] It is important to note that states have different laws and rules/regulations regarding delegation, so it is the responsibility of all licensed nurses to know what is permitted in their jurisdiction.

The NGND defines a delegatee as an RN, LPN/VN, or AP who is delegated a nursing responsibility by either an APRN, RN, or LPN/VN, is competent to perform the task, and verbally accepts the responsibility.[ 3 ] D elegation is allowing a delegatee to perform a specific nursing activity, skill, or procedure that is beyond the delegatee’s traditional role and not routinely performed, but the individual has obtained additional training and validated their competence to perform the delegated responsibility.[ 4 ] However, the licensed nurse still maintains accountability for overall client care. Accountability is defined as being answerable to oneself and others for one’s own choices, decisions, and actions as measured against a standard. Therefore, if a nurse does not feel it is appropriate to delegate a certain responsibility to a delegatee, the delegating nurse should perform the activity themselves.[ 5 ]

Delegation is summarized in the NGND as the following[ 6 ]:

A delegatee is allowed to perform a specific nursing activity, skill, or procedure that is outside the traditional role and basic responsibilities of the delegatee’s current job.
The delegatee has obtained the additional education and training and validated competence to perform the care/delegated responsibility. The context and processes associated with competency validation will be different for each activity, skill, or procedure being delegated. Competency validation should be specific to the knowledge and skill needed to safely perform the delegated responsibility, as well as to the level of the practitioner (e.g., RN, LPN/VN, AP) to whom the activity, skill, or procedure has been delegated. The licensed nurse who delegates the “responsibility” maintains overall accountability for the client, but the delegatee bears the responsibility for completing the delegated activity, skill, or procedure.
The licensed nurse cannot delegate nursing clinical judgment or any activity that will involve nursing clinical judgment or critical decision-making to AP.
Nursing responsibilities are delegated by a licensed nurse who has the authority to delegate and the delegated responsibility is within the delegator’s scope of practice.

An example of delegation is medication administration that is delegated by a licensed nurse to AP with additional training in some agencies, according to agency policy. This task is outside the traditional role of AP, but the delegatee has received additional training for this delegated responsibility and has completed competency validation in completing this task accurately.

An example illustrating the difference between assignment and delegation is assisting patients with eating. Feeding patients is typically part of the routine role of AP. However, if a client has recently experienced a stroke (i.e., cerebrovascular accident) or is otherwise experiencing swallowing difficulties (e.g., dysphagia), this task cannot be assigned to AP because it is not considered routine care. Instead, the RN should perform this task themselves or delegate it to an AP who has received additional training on feeding assistance.

The delegation process is multifaceted. See Figure 3.2 [ 7 ] for an illustration of the intersecting responsibilities of the employer/nurse leader, licensed nurse, and delegatee with two-way communication that protects the safety of the public. “Delegation begins at the administrative/nurse leader level of the organization and includes determining nursing responsibilities that can be delegated, to whom, and under what circumstances; developing delegation policies and procedures; periodically evaluating delegation processes; and promoting a positive culture/work environment. The licensed nurse is responsible for determining client needs and when to delegate, ensuring availability to the delegatee, evaluating outcomes, and maintaining accountability for delegated responsibility. Finally, the delegatee must accept activities based on their competency level, maintain competence for delegated responsibility, and maintain accountability for delegated activity.”[ 8 ]

Multifaceted Delegation Process

Five Rights of Delegation

How does the RN determine what tasks can be delegated, when, and to whom? According to the National Council of State Boards of Nursing (NCSBN), RNs should use the five rights of delegation to ensure proper and appropriate delegation: right task, right circumstance, right person, right directions and communication, and right supervision and evaluation[ 9 ]:

Right task: The activity falls within the delegatee’s job description or is included as part of the established policies and procedures of the nursing practice setting. The facility needs to ensure the policies and procedures describe the expectations and limits of the activity and provide any necessary competency training.
Right circumstance: The health condition of the client must be stable. If the client’s condition changes, the delegatee must communicate this to the licensed nurse, and the licensed nurse must reassess the situation and the appropriateness of the delegation.[ 10 ]
Right person: The licensed nurse, along with the employer and the delegatee, is responsible for ensuring that the delegatee possesses the appropriate skills and knowledge to perform the activity.[ 11 ]
Right directions and communication: Each delegation situation should be specific to the client, the nurse, and the delegatee. The licensed nurse is expected to communicate specific instructions for the delegated activity to the delegatee; the delegatee, as part of two-way communication, should ask any clarifying questions. This communication includes any data that need to be collected, the method for collecting the data, the time frame for reporting the results to the licensed nurse, and additional information pertinent to the situation. The delegatee must understand the terms of the delegation and must agree to accept the delegated activity. The licensed nurse should ensure the delegatee understands they cannot make any decisions or modifications in carrying out the activity without first consulting the licensed nurse.[ 12 ]
Right supervision and evaluation: The licensed nurse is responsible for monitoring the delegated activity, following up with the delegatee at the completion of the activity, and evaluating client outcomes. The delegatee is responsible for communicating client information to the licensed nurse during the delegation situation. The licensed nurse should be ready and available to intervene as necessary. The licensed nurse should ensure appropriate documentation of the activity is completed.[ 13 ]

Simply stated, the licensed nurse determines the right person is assigned the right tasks for the right clients under the right circumstances. When determining what aspects of care can be delegated, the licensed nurse uses clinical judgment while considering the client’s current clinical condition, as well as the abilities of the health care team member. The RN must also consider if the circumstances are appropriate for delegation. For example, although obtaining routine vitals signs on stable clients may be appropriate to delegate to assistive personnel, obtaining vitals signs on an unstable client is not appropriate to delegate.

After the decision has been made to delegate, the nurse assigning the tasks must communicate appropriately with the delegatee and provide the right directions and supervision. Communication is key to successful delegation. Clear, concise, and closed-loop communication is essential to ensure successful completion of the delegated task in a safe manner. During the final step of delegation, also referred to as supervision , the nurse verifies and evaluates that the task was performed correctly, appropriately, safely, and competently. Read more about supervision in the following subsection on “ Supervision .” See Table 3.4 for additional questions to consider for each “right” of delegation.

Rights of Delegation[ 14 ]

Rights of Delegation	Description	Questions to Consider When Delegating
Right Task	A task that can be transferred to a member of the nursing team for a specific client.
Right Circumstances	The client is stable.
Right Person	The person delegating the task has the appropriate scope of practice to do so. The task is also appropriate for this delegatee’s skills and knowledge.
Right Directions and Communication	The task or activity is clearly defined and described.
Right Supervision and Evaluation	The RN appropriately monitors the delegated activity, evaluates client outcomes, and follows up with the delegatee at the completion of the activity.

Keep in mind that any nursing intervention that requires specific nursing knowledge, clinical judgment, or use of the nursing process can only be delegated to another RN. Examples of these types of tasks include initial preoperative or admission assessments, client teaching, and creation and evaluation of a nursing care plan. See Figure 3.3 [ 15 ] for an algorithm based on the 2019 National Guidelines for Nursing Delegation that can be used when deciding if a nursing task can be delegated.[ 16 ]

Delegation Algorithm

Responsibilities of the Licensed Nurse

The licensed nurse has several responsibilities as part of the delegation process. According to the NGND, any decision to delegate a nursing responsibility must be based on the needs of the client or population, the stability and predictability of the client’s condition, the documented training and competence of the delegatee, and the ability of the licensed nurse to supervise the delegated responsibility and its outcome with consideration to the available staff mix and client acuity. Additionally, the licensed nurse must consider the state Nurse Practice Act regarding delegation and the employer’s policies and procedures prior to making a final decision to delegate. Licensed nurses must be aware that delegation is at the nurse’s discretion, with consideration of the particular situation. The licensed nurse maintains accountability for the client, while the delegatee is responsible for the delegated activity, skill, or procedure. If, under the circumstances, a nurse does not feel it is appropriate to delegate a certain responsibility to a delegatee, the delegating nurse should perform the activity.[ 17 ]

The licensed nurse must determine when and what to delegate based on the practice setting, the client’s needs and condition, the state’s/jurisdiction’s provisions for delegation, and the employer’s policies and procedures regarding delegating a specific responsibility. The licensed nurse must determine the needs of the client and whether those needs are matched by the knowledge, skills, and abilities of the delegatee and can be performed safely by the delegatee. The licensed nurse cannot delegate any activity that requires clinical reasoning, nursing judgment, or critical decision-making. The licensed nurse must ultimately make the final decision whether an activity is appropriate to delegate to the delegatee based on the “Five Rights of Delegation.”

Rationale: The licensed nurse, who is present at the point of care, is in the best position to assess the needs of the client and what can or cannot be delegated in specific situations.[ 18 ]

The licensed nurse must communicate with the delegatee who will be assisting in providing client care. This should include reviewing the delegatee’s assignment and discussing delegated responsibilities, including information on the client’s condition/stability, any specific information pertaining to a certain client (e.g., no blood draws in the right arm), and any specific information about the client’s condition that should be communicated back to the licensed nurse by the delegatee.

Rationale: Communication must be a two-way process involving both the licensed nurse delegating the activity and the delegatee being delegated the responsibility. Evidence shows that the better the communication between the nurse and the delegatee, the more optimal the outcome. The licensed nurse must provide information about the client and care requirements. This includes any specific issues related to any delegated responsibilities. These instructions should include any unique client requirements. The licensed nurse must instruct the delegatee to regularly communicate the status of the client.[ 19 ]

The licensed nurse must be available to the delegatee for guidance and questions, including assisting with the delegated responsibility, if necessary, or performing it themselves if the client’s condition or other circumstances warrant doing so.

Rationale: Delegation calls for nursing judgment throughout the process. The final decision to delegate rests in the hands of the licensed nurse as they have overall accountability for the client.[ 20 ]

The licensed nurse must follow up with the delegatee and the client after the delegated responsibility has been completed.

Rationale: The licensed nurse who delegates the “responsibility” maintains overall accountability for the client, while the delegatee is responsible for the delegated activity, skill, or procedure.[ 21 ]

The licensed nurse must provide feedback information about the delegation process and any issues regarding delegatee competence level to the nurse leader. Licensed nurses in the facility need to communicate to the nurse leader responsible for delegation any issues arising related to delegation and any individual whom they identify as not being competent in a specific responsibility or unable to use good judgment and decision-making.

Rationale: This will allow the nurse leader responsible for delegation to develop a plan to address the situation.[ 22 ]

The decision of whether or not to delegate or assign is based on the RN’s judgment concerning the condition of the client, the competence of the nursing team member, and the degree of supervision that will be required of the RN if a task is delegated.[ 23 ]

Responsibilities of the Delegatee

Everyone is responsible for the well-being of clients. While the nurse is ultimately accountable for the overall care provided to a client, the delegatee shares the responsibility for the client and is fully responsible for the delegated activity, skill, or procedure.[ 24 ] The delegatee has the following responsibilities:

The delegatee must accept only the delegated responsibilities that they are appropriately trained and educated to perform and feel comfortable doing given the specific circumstances in the health care setting and client’s condition. The delegatee should confirm acceptance of the responsibility to carry out the delegated activity. If the delegatee does not believe they have the appropriate competency to complete the delegated responsibility, then the delegatee should not accept the delegated responsibility. This includes informing the nursing leadership if they do not feel they have received adequate training to perform the delegated responsibility, do not perform the procedure frequently enough to do it safely, or their knowledge and skills need updating.

Rationale: The delegatee shares the responsibility to keep clients safe, and this includes only performing activities, skills, or procedures in which they are competent and comfortable doing.[ 25 ]

The delegatee must maintain competency for the delegated responsibility.

Rationale: Competency is an ongoing process. Even if properly taught, the delegatee may become less competent if they do not frequently perform the procedure. Given that the delegatee shares the responsibility for the client, the delegatee also has a responsibility to maintain competency.[ 26 ]

The delegatee must communicate with the licensed nurse in charge of the client. This includes any questions related to the delegated responsibility and follow-up on any unusual incidents that may have occurred while the delegatee was performing the delegated responsibility, any concerns about a client’s condition, and any other information important to the client’s care.

Rationale: The delegatee is a partner in providing client care. They are interacting with the client/family and caring for the client. This information and two-way communication are important for successful delegation and optimal outcomes for the client.[ 27 ]

Once the delegatee verifies acceptance of the delegated responsibility, the delegatee is accountable for carrying out the delegated responsibility correctly and completing timely and accurate documentation per facility policy.

Rationale: The delegatee cannot delegate to another individual. If the delegatee is unable to complete the responsibility or feels as though they need assistance, the delegatee should inform the licensed nurse immediately so the licensed nurse can assess the situation and provide support. Only the licensed nurse can determine if it is appropriate to delegate the activity to another individual. If at any time the licensed nurse determines they need to perform the delegated responsibility, the delegatee must relinquish responsibility upon request of the licensed nurse.[ 28 ]

Responsibilities of the Employer/Nurse Leader

The employer and nurse leaders also have responsibilities related to safe delegation of client care:

The employer must identify a nurse leader responsible for oversight of delegated responsibilities for the facility. If there is only one licensed nurse within the practice setting, that licensed nurse must be responsible for oversight of delegated responsibilities for the facility.

Rationale: The nurse leader has the ability to assess the needs of the facility, understand the type of knowledge and skill needed to perform a specific nursing responsibility, and be accountable for maintaining a safe environment for clients. They are also aware of the knowledge, skill level, and limitations of the licensed nurses and AP. Additionally, the nurse leader is positioned to develop appropriate staffing models that take into consideration the need for delegation. Therefore, the decision to delegate begins with a thorough assessment by a nurse leader designated by the institution to oversee the process.[ 29 ]

The designated nurse leader responsible for delegation, ideally with a committee (consisting of other nurse leaders) formed for the purposes of addressing delegation, must determine which nursing responsibilities may be delegated, to whom, and under what circumstances. The nurse leader must be aware of the state Nurse Practice Act and the laws/rules and regulations that affect the delegation process and ensure all institutional policies are in accordance with the law.

Rationale: A systematic approach to the delegation process fosters communication and consistency of the process throughout the facility.[ 30 ]

Policies and procedures for delegation must be developed. The employer/nurse leader must outline specific responsibilities that can be delegated and to whom these responsibilities can be delegated. The policies and procedures should also indicate what may not be delegated. The employer must periodically review the policies and procedures for delegation to ensure they remain consistent with current nursing practice trends and that they are consistent with the state Nurse Practice Act. (Institution/employer policies can be more restrictive, but not less restrictive.)

Rationale: Policies and procedures standardize the appropriate method of care and ensure safe practices. Having a policy and procedure specific to delegation and delegated responsibilities eliminates questions from licensed nurses and AP about what can be delegated and how they should be performed.[ 31 ]

The employer/nurse leader must communicate information about delegation to the licensed nurses and AP and educate them about what responsibilities can be delegated. This information should include the competencies of delegatees who can safely perform a specific nursing responsibility.

Rationale: Licensed nurses must be aware of the competence level of staff and expectations for delegation (as described within the policies and procedures) to make informed decisions on whether or not delegation is appropriate for the given situation. Licensed nurses maintain accountability for the client. However, the delegatee has responsibility for the delegated activity, skill, or procedure.

In summary, delegation is the transfer of the nurse’s responsibility for a task while retaining professional accountability for the client’s overall outcome. The decision to delegate is based on the nurse’s judgment, the act of delegation must be clearly defined by the nurse, and the outcomes of delegation are an extension of the nurse’s guidance and supervision. Delegation, when rooted in mutual respect and trust, is a key component to an effective health care team.

3.5. SUPERVISION

The licensed nurse has the responsibility to supervise, monitor, and evaluate the nursing team members who have received delegated tasks, activities, or procedures. As previously noted, the act of supervision requires the nurse to assess the staff member’s ability, competency, and experience prior to delegating. After the nurse has made the decision to delegate, supervision continues in terms of coaching, supporting, assisting, and educating as needed throughout the task to assure appropriate care is provided.

The nurse is accountable for client care delegated to other team members. Communication and supervision should be ongoing processes throughout the shift within the nursing care team. The nurse must ensure quality of care, appropriateness, timeliness, and completeness through direct and indirect supervision. For example, an RN may directly observe the AP reposition a client or assist them to the bathroom to assure both client and staff safety are maintained. An RN may also indirectly evaluate an LPN’s administration of medication by reviewing documentation in the client’s medical record for timeliness and accuracy. Through direct and indirect supervision of delegation, quality client care and compliance with standards of practice and facility policies can be assured.

Supervision also includes providing constructive feedback to the nursing team member. Constructive feedback is supportive and identifies solutions to areas needing improvement. It is provided with positive intentions to address specific issues or concerns as the person learns and grows in their role. Constructive feedback includes several key points:

Was the task, activity, care, or procedure performed correctly?
Were the expected outcomes involving delegation for that client achieved?
Did the team member utilize effective and timely communication?
What were the challenges of the activity and what aspects went well?
Were there any problems or specific concerns that occurred and how were they managed?

After these questions have been addressed, the RN creates a plan for future delegation with the nursing team member. This plan typically includes the following:

Recognizing difficulty of the nursing team member in initiating or completing the delegated activities.
Observing the client’s responses to actions performed by the nursing team member.
Following up in a timely manner on any problems, incidents, or concerns that arose.
Creating a plan for providing additional training and monitoring outcomes of future delegated tasks, activities, or procedures.
Consulting with appropriate nursing administrators per agency policy if the client’s safety was compromised.

3.6. SPOTLIGHT APPLICATION

You are an RN and are reporting to work on a 16-bed medical/renal unit in a county hospital for the 0700 – 1500 shift today. The client population is primarily socioeconomically disadvantaged. Staff for the shift includes four RNs, one LPN/VN, and two AP.

You are a new RN graduate on the unit, and your orientation was completed two weeks ago. The LPN/VN has been working on the unit for ten years. Both AP have been on the unit for six months and are certified nursing assistants after completing basic nurse aide training. You, as one of four RNs on the unit, have been assigned four clients. You share the LPN with the other RNs, and there is one AP for every two RNs.

The charge nurse has assigned you the following four clients. Scheduled morning medications are due at 0800 and all four require some assistance with their ADLs.

Client A: An obese 52-year-old male with hypertension and diabetes requiring insulin therapy. He has been depressed since recently being diagnosed with end-stage renal disease requiring hemodialysis. He needs his morning medications and assistance getting dressed for transport to hemodialysis in 30 minutes.
Client B: A 83-year-old female client with acute pyelonephritis admitted two days ago. She has a PICC line in place and is receiving IV vancomycin every 12 hours. The next dose is due at 0830 after a trough level is drawn.
Client C: A 78-year-old male recently diagnosed with bladder cancer. He has bright red urine today but reports it is painless. He has surgery scheduled at 0900 and the pre-op checklist has not yet been completed.
Client D: A malnourished 80-year-old male client admitted with dehydration and imbalanced electrolyte levels. He is being discharged home today and requires patient education.

Reflective Questions

At the start of the shift, you determine which tasks, cares, activities, and/or procedures you will delegate to the LPN and AP. What factors must you consider prior to delegation?

What tasks will you delegate to the LPN/VN?

What tasks will you delegate to the AP?

3.7. LEARNING ACTIVITIES

Learning activities.

(Answers to “Learning Activities” can be found in the “Answer Key” at the end of the book. Answers to interactive activities are provided as immediate feedback.)

Review the following case studies regarding nurse liability associated with inappropriate delegation:

Nurse Case Study: Wrongful delegation of patient care to unlicensed assistive personnel
Nurse Video Case Study: Failure to assess and monitor

Reflective Questions: What delegation errors occurred in each of these scenarios and what were the repercussions of these errors for the nurses involved?

	Right Person	Right Task	Right Circumstance	Right Direction and Communication	Right Supervision and Evaluation
Directs the AP to assess the pain level of a client who is post-op Day 3 after a hip replacement and report back the finding.
Directs the LPN to give 1 mg IV push morphine to a patient who is 2-hours post total left knee replacement and ensure documentation.
Assigns the AP to collect blood pressures on all clients on the unit by 0800. Assumes the AP will report back any abnormal blood pressures.
Directs a new AP to ambulate a patient who is post-op Day 2 from a shoulder replacement who needs the assistance of one person and an adaptive walker. The AP voices concerns about never having used an adaptive walker before. The RN directs the AP to get another AP to help.

III. GLOSSARY

Being answerable to oneself and others for one’s own choices, decisions, and actions as measured against a standard.

Routine care, activities, and procedures that are within the authorized scope of practice of the RN, LPN/VN, or routine functions of the assistive personnel.

Any assistive personnel (formerly referred to as ‘‘unlicensed” assistive personnel [UAP]) trained to function in a supportive role, regardless of title, to whom a nursing responsibility may be delegated. This includes, but is not limited to, certified nursing assistants or aides (CNAs), patient-care technicians (PCTs), certified medical assistants (CMAs), certified medication aides, and home health aides. [1]

A process that enables the person giving the instructions to hear what they said reflected back and to confirm that their message was, in fact, received correctly.

Supportive feedback that offers solutions to areas of weakness.

An RN, LPN/VN, or AP who is delegated a nursing responsibility by either an APRN, RN, or LPN/VN who is competent to perform the task and verbally accepts the responsibility.

Allowing a delegatee to perform a specific nursing activity, skill, or procedure that is beyond the delegatee’s traditional role but in which they have received additional training.

An APRN, RN, or LPN/VN who requests a specially trained delegatee to perform a specific nursing activity, skill, or procedure that is beyond the delegatee’s traditional role.

Right task, right circumstance, right person, right directions and communication, and right supervision and evaluation.

Advanced practice registered nurses (APRN), registered nurses (RN), licensed practical/vocational nurses (LPN/VN), and assistive personnel (AP).

Procedures, actions, and processes that a health care practitioner is permitted to undertake in keeping with the terms of their professional license.

Appropriate monitoring of the delegated activity, evaluation of patient outcomes, and follow-up with the delegatee at the completion of the activity.

Making adjustments to medication dosage per an established protocol to obtain a desired therapeutic outcome.

Licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/ .

Cite this Page Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, editors. Nursing Management and Professional Concepts [Internet]. Eau Claire (WI): Chippewa Valley Technical College; 2022. Chapter 3 - Delegation and Supervision.
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SUPERVISION
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