Fundamentals of Nursing and Midwifery 2e

Chapter 16 Identifying health problems

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Identifying health problems

Assessment

• Accurately identifying current problems • Predicting potential health problems • Identifying risk factors • Identifying resources and strengths

• 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

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-