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Chapter 16 Identifying health problems
THE PROCESS OF IDENTIFYING
HEALTH PROBLEMS
During the phase of identifying a health problem you
should, wherever possible, include the person and family or
significant others in all aspects of the process. To ensure that
the identification of the health problem is accurate and
person-centred, feedback is sought from the person to
encourage participation in the decision-making process
relating to their care. Health problems cannot be reliably
identified without the person’s input. In certain circum-
stances a person being cared for will not be able to
participate in this process due to unconsciousness, critical
illness or an illness that impairs cognitive abilities. When
this situation occurs, family or significant others will need to
be consulted. Minors, such as children, have the right to par-
ticipate in the decision making at the level of their cognition.
However, parents and guardians remain the primary carers
when a child is in hospital and have the responsibility and
rights to be involved in the child’s care.
In order for all potential health problems to be identified,
it is imperative that the health assessment process described
in Chapter 15 be as rigorous as possible as not all health
problems are immediately obvious. Conducting a review of
the assessment findings will help to ensure all possible
health problems are identified (Box 16-1).
The focus of the problem identification phase of the
process of person-centred care is the nurse or midwife’s
unique concern for the person (i.e. what it is about the
person that gives rise to the need for care, as opposed to the
need for medicine or for physiotherapy). The
identified
health problem
is defined to help create care strategies that
will be implemented to address the problem. Interpretation
and analysis of health data may identify a health problem
that is better treated by a doctor (
medical diagnosis
) or in
conjunction with other healthcare providers (
collaborative
problem
). In such a case the findings are reported to the
doctor or other appropriate healthcare providers and you
will work collaboratively with them to resolve the issues.
Box 16-2 outlines key nursing and midwifery responsibili-
ties within a collaborative framework.
Clinical reasoning and an identified
health problem
Clinical reasoning is explained in Chapter 14. The clinical
reasoning process includes a focus on identifying a health
problem and the reason for the problem. This hypothesis-
Identifying health problems
• Accurately identifying current
problems
• Predicting potential health problems
• Identifying risk factors
• Identifying resources and strengths
Assessment
• Gathering
• Validating data
• Organising data
• Identifying cues and making inferences
• Reporting/recording data
Interpreting data
(analysis and
synthesis)
Identifying health problems is a pivotal point in the process of care for three reasons:
1.
The accuracy and relevancy of the entire plan depends on your ability to clearly and specifically identify both the
problems and what is causing them.
Incorrectly identifying problems and what is causing them is likely to send you and
everyone else in the wrong direction, resulting in inefficient, perhaps even dangerous care. For example, imagine what
could happen if you decide someone’s left shoulder pain is related to arthritis when the pain is actually related to cardiac
problems.
2.
Creating a proactive plan that promotes health and prevents problems before they begin depends on your ability to
recognise risk factors (things that we know cause problems, such as sedentary lifestyle).
Even when there are no
problems, you must ask, ‘Are there risk factors that need to be addressed?’ For example, you assess an overweight
person and learn that both his parents had hypertension. Knowing that obesity and family history of hypertension are
risk factors for hypertension, you stress the importance of preventing hypertension through exercise, weight control and
decreased salt intake. Detailed information (printed material or websites) should be provided to the person on how to
prevent the risk factors—that is, knowing the correct weight for height, appropriate exercise regimens, the constituents of
a healthy diet and the recommendation for daily salt intake.
3.
The resources and strengths you identify are the key to reducing costs and maximising efficiency.
Be sure you identify and use
one of your most valuable resources: the person requiring care and the person’s network of support. For example, in the case of
a person with diabetes, you may have time only to do the minimally acceptable amount of teaching and follow-up. But if you
take a few moments to motivate the person to get involved with the local Diabetes Association to learn more and if you provide
the appropriate phone numbers to call, the person is likely to expand and reinforce what has been learnt.
Figure 16-2
From assessment to identifying health problems: a pivotal point
