Open Source Handbook of Nursing/Health Perception and Management
Health Perception and management
The principle of wellness has been ingrained in nursing theory since Dorothea Orem published her work on self care. The nurses perception of the clients health status and the clients perception of their own health are not identical. For example, the client may have been born with a major disability but regard this as normal for them. Consequently some clients seek nursing attention far more or less readily than health professionals might expect.
Health management refers to the clients behavior in relation to their own health. Some clients will seek nursing attention at the slightest excuse because they view health issues with great concern. Other clients at the other end of the extreme will avoid nursing attention at all cost (e.g. clients with paranoid tendencies will regard health assessment as invasive). The bulk of nursing contacts will be in between these extremes, but clients health-seeking behavior needs to be respected throughout the nursing relationship.
The first contact between nurse and client is often during the initial interview when the nurse will obtain a history from the client and collateral data from other sources such as relatives, existing records and allied agencies. The following questions could be asked by the nurse to provide an overview of the individuals subjective health history and health practices that are used to reach the current level of health or wellness. Generally well? Regular exercise? Any absences from work/school? Important things to keep healthy? Use drugs (eg Caffeine, nicotine) Perform self exams at intervals i.e. Breast/testicular self-examination? Accidents? What do you think caused current illness? Why have you asked for an assessment? What actions have you taken since symptoms started? Does anything alleviate the symptom or make it worse?
A client with optimal health seeking behavior will take steps to maintain their own health status, such as safe sex practices, personal protective equipment, retire early to bed and so on. A more specific health assessment is used to pinpoint the nature and extent of the clients complaint once an initial impression has been formed. Then the nurse can ask more probing questions and collect objective data relevant to the disturbed functional health pattern.
Principles for prioritizing care
Nola Pender is synonymous with nursing care of populations and her theory underpins the practice of nursing in primary care settings such as health promotion, public health and community care roles.
One way of organizing care is to order priority by principles of justice, which goes something like this.
- Principle one: All the nursing resources available should be distributed to clients except where this impinges on principle two and principle three
- Principle two: The available nursing resources should be distributed to clients who request it, except where this impinges on principle three
- Principle three: All the nursing resources available should be distributed to clients who need it.
In the acute clinical setting, many nurses will be delivering care to groups of clients whom they come to know personally and the priority becomes more individual: usually by assigning acuity. Acuity can be a subjective or digitally scored system for assigning the amount of nursing the clients require. In other words a means of gauging whether a client group is more or less sick than usual for the conditions. Some organizations have elaborate computer software programs for tallying acuity predictions to help manage staffing.
Another system for deciding care priority is the triage scale. In some settings the triage scale is used to decide how long the client can wait without injury. Triage can also be used to decide whether the client requires nursing care or collaborative care with another health professional, such as a physiotherapist or continence advisor. Most countries use a triage scale with degree of urgency ranging from least urgent for primary care issues such as recurrent treatment for known conditions (eg. dressing) to most urgent, such as cardiac arrest.