PAMANTASAN NG LUNGSOD NG MARIKINA

J.P. Rizal St. Concepcion Uno, Marikina City

H.A. Handout 1

I. OVERVIEW OF THE NURSING PROCESS

Nursing – the diagnosis and treatment of human responses to actual or potential health

problems.

 Diagnosis and treatment are achieved through the nursing process.

Nursing Process – is a systematic problem solving method that has 5 steps.

1. Assessment
2. Nursing Diagnosis
3. Planning
4. Implementation or Intervention
5. Evaluation

 Nursing process is used to identify, prevent, and treat actual or potential health problems and
promote wellness.
 It provides a framework in which to practice nursing.
 It is a continuous, circular process that revolves around your patient (patient-centered)
 Characteristics of Nursing Process:
1. Dynamic and cyclic
2. Patient-centered
3. Goal directed
4. Flexible
5. Problem-oriented
6. Cognitive
7. Action-oriented
8. Interpersonal
9. Holistic
10. Systematic

ASSESSMENT:

 The process of collecting, validating, and clustering data.

 It is the first and most important step of the nursing process.
 It identifies the patient’s strengths, limitations and is performed not just once but
continuously throughout the nursing process.
NURSING DIAGNOSIS:

 Involves identifying and prioritizing actual or potential health problems or responses

 COLLECT → ANALYZE → IDENTIFY PROBLEM
 Actual Nursing Diagnosis identifies an occurring health problem for your patient.
 Potential Nursing Diagnosis identifies a high risk health problem that most likely will
occur unless preventive measures are taken.
 Possible Nursing Diagnosis is one that needs further data to support it.
 Collaborative Nursing Diagnosis a potential medical complication that warrants both
medical and nursing interventions.
 Wellness Diagnosis focuses on promoting or enhancing a patient’s level of wellness.
 Once nursing diagnosis are identified, prioritize in order to develop a plan of care.

PLANNING:

 Setting goals and outcomes.

 Establish goals and determine measurable outcomes.
 S. M. A. R. T. / STG & LTG

IMPLEMENTATION:

 Carrying out the plan to achieve goals and outcomes.

 “doing phase” of the nursing process; in which you actually implement the nursing
interventions in the plan.
 As the plan is implemented, continue to assess the patient’s responses and modify the
plan as needed.
 Document the care done.

EVALUATION:

 Determines the effectiveness of the plan

 Assess the patient again based on the criteria set for the outcome.
 May be goal met or partially met or not met → rethink, replan, and work through the
process again.

COMMUNICATION

 A process through which we convey our thoughts by the use of signs or symbols to achieve
understanding and changes in the behavior of a person or people.
 A process of sharing information and meaning; of sending and receiving messages.
 It can be verbal or nonverbal.
 Nonverbal Messages includes vocal cues, action cues or kinetics, object cues, personal space and
touch.
 Nonverbal behavior should be consistent with verbal messages.
1. Vocal cues / Paralinguistics – describe the quality of voice and its inflections, tone,
intensity, and speed when speaking.
 2. Action cues/ Kinetics – body movements that convey messages; posture, arm position,
hand gestures, body movements, facial expressions, and eye contact; may be relaxed
posture, tense posture, guarded posture, tripod posture.
3. Object cues – grooming and appearance; reflects also the nurse’s professionalism.
4. Personal space – the territory surrounding a person that she or he perceives as private; the
physical distance that needs to be maintained for the person to feel comfortable.
5. Touch – a means of communication; anger, caring, and protectiveness can be conveyed
through touch; it may also be seen as an invasion of one’s personal space or a threat.
 Verbal Messages involves the use of spoken words.
 Elements of Communication:
1. Sender/Encoder
2. Message
3. Receiver/Decoder
4. Feedback/Response

Active Listening – involves the use of all senses; requires energy and concentration.

- It involves paying attention to the total message, both verbal and nonverbal that
can modify what is spoken, and noting whether these communications are
congruent.
- It absorbs both the content and the feeling the person is conveying without
selectivity. This means that the listener does not select what he wants to hear
but on the needs of the speaker.

Ways to Convey Active Listening:

1. Face the other person squarely. “I’m available to you.”

2. Maintain good eye contact.
3. Lean toward the other. Leaning forward conveys involvement.
4. Maintain an open posture.
5. Remain relatively relaxed.

Ways to Improve Listening Skills:

1. Be mentally and physically prepared to listen.

2. Think about the topic in advance when possible.
3. Listen in a courteous and attentive manner.
4. Determine the personal value of the topic for you. Is there anything you can use?
5. Listen and evaluate the content of the message, instead of judging the speaker’s appearance or
delivery.
6. Hear the speaker out before you judge him.
7. Listen for main ideas, principles, or concepts.
8. Use varied note-taking techniques.
9. Practice listening to difficult expository materials.
10. Build your vocabulary.
 11. Be flexible in your views.
12. When possible, eliminate distractions to improve your listening environment.
13. Control your reaction to emotion-laden words, stay “tuned-in”.
14. Compensate for ideas which are contrary to your prejudices, conviction.
15. Do not relax and fake attention. Remember that good listening requires full attention.
16. Concentrate, instead of letting your thoughts wander, differentiate between speech rate and
thought speed to improve you listening ability.

Responding Therapeutically:
- Nurses need to respond not only to the verbal content of a patient’s message
but also to the feelings expressed.
- Interpersonal skills used in a healing way to help patient (therapeutic use of
self)

1. Paraphrasing – also called restating. Involves listening to the message and then repeating
thoughts or feelings in similar words.
2. Clarifying – a method of making the person’s message more understandable.
3. Using open-ended questions and statements
4. Focusing – is used when the person’s communication is vague or when the person is talking
about numerous things.
5. Being specific, tentative, and informative.
“You dropped your glasses.” – specific
“You are clumsy.” – general
“You seem unconcerned about your daughter.” -Tentative
“You don’t care about you daughter.” – Absolute
“I haven’t finished my statement.” - Informative
“Don’t interrupt me.” - Authoritarian

6. Using touch
7. Using silence – when people are ill, they find it difficult to talk about how they feel.
8. Clarifying reality, time, and sequence.
9. Providing general leads. Ex: “My chest feels tight.” Encourage to verbalize.
10. Affirmation – acknowledge your patient’s response through verbal and nonverbal
communication.
11. Reflection – “echoing back” in a form of question; acknowledges your patient’s feelings i.e. if
she is afraid of having surgery.
12. Humor – can be therapeutic when used in the right context.
13. Redirecting
14. Identifying themes – recurrent themes may help your patient make a connection and focus
15. Suggesting – presenting alternative ideas gives the patient options
16. Summarizing – it allows the patient to clarify misconceptions you may have

Non-Therapeutic Responses:
1. Failing to listen
 2. Unwarranted reassurance
3. Judgmental Responses
4. Approval and Disapproval
5. Common advice
6. Stereotypes – generalized and oversimplified beliefs one holds about various groups of people
which are based upon experiences too limited to valid. Ex: “Women complain more than men” or
“Men are not supposed to cry.”
7. Defensive responses
8. Agreement and Disagreement – can cause defensiveness
9. Probing, Testing, and Challenging Responses
Probing – asking for information out of curiosity.
Testing – questioning by someone to make the person admit to something.
Challenging – giving a response that makes a person prove his statement or point of view.

Qualities in Establishing Nurse-Patient Relationship:

1. Genuineness – be open, honest, and sincere to your patient.
2. Respect – be nonjudgmental in your approach; everyone needs to feel accepted as a unique
individual.
3. Empathy – knowing what your patient means and understanding how she feels.
- Acknowledges your patient’s feelings, shows acceptance, care, and concern
and fosters open communication.

Special Considerations:
1. Elderly clients may have one or more communication barriers that may readily be removed once
discovered; dentures, hearing aids, and glasses should be acquired if possible.
2. With increasing age, a client’s speech and comprehension may be slowed, requiring more time
for communication.
3. A child may perceive sudden body movements by an adult as threatening; approach slowly after
informing the child of your intentions.
4. When communicating with a child, consider developmental stage.
5. Interacting with an anxious client:
- Maintain quiet, calm environment
- Keep messages simple, concrete, and brief
- Repeat messages often
- Minimize need for extensive decision making
- Monitor anxiety level
6. Interacting with angry client:
- Use careful, unhurried, deliberate body movements
- Provide an open non-threatening environment
- Clear area of anger-provoking stimuli
- Maintain a nonthreatening demeanor, using open body language, soft voice
tones
7. Interacting with a depressed client
- Allow additional time for interactions
- Emphasize use of physical attending
- Avoid giving client time-limited tasks due to slowed reflexes
- Monitor closely for cues of self-destructive tendencies
- Keep messages simple, concrete, and brief
8. Silent Patient
- Give brief encouragement
- Watch for nonverbal cues
9. Talkative patient
- Try to focus on what seems most important to the patient
- Interrupt courteously
10. Crying patient
- Allow the patient to cry; quiet acceptance of the patient’s distress or pain
11. Confusing Patient – focus on the meaning or function of the symptom and guide the interview
into a psychosocial assessment.
12. Patient with Language Barrier
13. Patient with Reading problems – assess ability to read
14. Patient with Impaired Hearing – find out the patient’s preferred method of communicating
15. Patient with Impaired Vision – use words when responding

HEALTH HISTORY GUIDELINES

INTERVIEW – health history interview is a conversation with a purpose

Purpose:
1. To establish a trusting and supportive relationship
2. To gather information
3. To offer information

Types:
1. Directive interviews – are structured with specific questions and are controlled by the nurse;
effective for obtaining factual data.
2. Nondirective interviews – controlled by the patient although the nurse often needs to summarize
and clarify the data; helps the nurse to identify what is important to the patient.

Types of Questions:
1. Closed questions – effective for factual data
2. Open questions – elicit the patient’s perceptions

Phases of the Interview:

1. Introductory/Orientation Phase
 - Time to introduce self, put her at ease and explain the purpose of the interview and the time
frame needed to complete it.
2. Working Phase
- Data collection takes place
- The longest phase and is very structured
3. Termination Phase
- Summarize and restate findings
- Provides opportunity to clarify data and share findings with the patient.

Considerations:
1. Taking time for self-reflection – brings a deepening personal awareness to our work with patients
2. Reviewing the chart
3. Setting goals for the interview
4. Reviewing behavior and appearance
5. Improving the environment
6. Taking Notes

Techniques:
1. Introduce yourself.
2. Don’t rush. Allow enough time for the interview.
3. Explain that the information from the interview is confidential.
4. Work at the same level as your patient.
5. Don’t invade you patient’s personal space. Two to four feet away is a comfortable distance.
6. Begin with nonsensitive issues. Leave more sensitive topics until the end.
7. Consider your patient’s cultural background and developmental level.
8. Don’t become preoccupied with writing.
9. Avoid “why” questions; they tend to put the patient on the defensive side.
10. Never pass up an opportunity to teach.
11. Be honest.
12. Be respectful.
13. Provide reassurance and encouragement – accepting and identifying the patient’s feelings is the
first step to effective reassurance.

Interview Pitfalls:
1. Leading the patient.
2. Biasing yourself.
3. Letting family members answer for the patient.
4. Asking more than one question at a time.
5. Not allowing enough response time.
6. Using medical jargon.
7. Assuming rather than clarifying and validating
8. Taking the patient’s responses personally.
9. Using clichēs – used when the nurse is unsure of the answer when asked.
10. Offering false reassurance.
 11. Changing the subject when the topic is uncomfortable.
12. Taking things literally – “I get crazy when . . .”
13. Jumping to conclusions.

HEALTH HISTORY:

- provides the subjective database for your assessment.

- is the first major interaction with the patient

Purpose:
1. Provide the subjective data base.
2. Identify patient strengths.
3. Identify patient health problems, both actual and potential.
4. Identify supports.
5. Identify teaching needs.
6. Identify discharge needs.
7. Identify referral needs.

Types:

Complete Health History Focused Health History

Biographical data Biographical data

Reason for seeking care Reason for seeking care

Current health status and symptom analysis if Current health status and symptom analysis
indicated
Past health history Past health history only as it relates to specific
reason for seeking care

Check for history of the most prevalent diseases:

heart disease, hypertension, cancer, diabetes, and
alcoholism.

Family history Family history only as it relates to specific reason

for seeking care

Review of systems Review of systems only as it relates to specific

reason for seeking care

Psychosocial profile Psychosocial profile only as it relates to specific

reason for seeking care
Developmental considerations Developmental considerations only as they would
affect the acute problem

Ethnic considerations Ethnic considerations only as they would affect the

acute problem
  Decide when to use both types. It depends on the condition of the patient and the amount of
time needed to do the health history taking.

THE FORMAT OF THE COMPREHENSIVE HEALTH HISTORY (Sample)

Identifying Data
Source and Reliability of History
Chief Complaint
History of Present Illness
Medications, Allergies, Tobacco, Alcohol and Drugs
Past History
Childhood Illness
Adult Illness: Medical, Surgical, Ob/Gyn, Psychiatric, Health Maintenance
Family History
Personal and Social History
Review of Systems

COMPONENTS OF THE HEALTH HISTORY

1. Biographical Data – provide you with direct information related to a current health problem, alert
you to risk factors for health problems, and point out the need for referrals. The patient’s ability
to provide biographical data accurately reflects his mental status.
2. Reason for seeking healthcare – the chief complaint gives you the patient’s perspective on the
problem, a view of the problem through his own eyes.
3. Current Health Status or Present Health History (Acute problem: Symptom Analysis) – state of
health, any major health problems, usual patterns of healthcare, any health concerns.
4. Past Health History – assesses childhood illnesses, hospitalizations, surgeries, serious injuries,
adult medical problems, immunizations, allergies, medications, travel, and military service. The
purpose is to identify any health factors from the past that may have direct relationship to the
current health status. Ask for dates, name of physician and hospitals and reason for
hospitalization or surgery.
5. Family History – provides clues for genetically linked or familial diseases that may be risk factors
for the patient. Ask about the health status and ages of family members. A family tree or
genogram can be used. Use symbols to represent family members and include a key to explain the
symbols and abbreviation.
6. Psychosocial History – focuses on health promotion, protective patterns, and roles and
relationships. May include health practices and beliefs, typical day, nutritional patterns, activity
and exercise patterns, recreation, hobbies, pets, sleep/rest patterns, personal habits (tobacco,
alcohol, caffeine, drugs), occupational health patterns, socioeconomic status, environmental
health patterns, etc.

MENTAL STATUS ASSESSMENT

If indicated and not done during the interview, assess the patient’s orientation, mood, thought process,
thought content, abnormal perceptions, insight and judgment, memory and attention, information and
vocabulary, calculating abilities, abstract thinking, and constructional ability.
1. Observe level of consciousness. Use the Glasgow coma scale for patients at risk of developing
nervous system deterioration.
2. Observe posture and body movements. The client appears relaxed with shoulders and back erect
when standing or sitting.
3. Observe dress grooming and hygiene.
4. Observe facial expressions.
5. Observe speech. Speech is largely influenced by experience, level of education and culture.
6. Observe mood, feelings and expressions.
7. Observe for thought processes and perceptions. Check first the vision and hearing of older clients
when assessing the mental status.
8. Observe cognitive abilities; orientation, concentration, recent memory, remote memory, use of
memory to learn new information, abstract reasoning, judgment, visual perceptual and constructional
ability.

Recent – “ What did you eat for breakfast?”

Remote – “When is your birthday?”
New information – Recall words correctly after 5-, 10-, 30 minute period
Abstract reasoning – client explains similarities and differences of objects
Judgment – “What do you do if you have pain?”
Visual perception and constructional ability – ask patient to draw the face of a clock or copy simple
figure.

FUNCTIONAL ASSESSMENT

A. Physical Activities of Daily Living

Bathing continence
Dressing feeding
Toileting managing money
Transfers
B. Instrumental Activities of Daily Living
Using the telephone
Shopping
Preparing food
Housekeeping
Laundry
Transportation
Taking medicine

 Assess if the patient can do these activities independently, with assistance, or total
dependence.

FUNCTIONAL ASSESSMENT TESTS

A. APGAR Scoring for Newborns

0 1 2
Heart rate absent < 100 > 100
Respiratory Absent Slow, Good,
 effort irregular,wea strong cry
k cry
Muscle tone flaccid Some flexion Well flexed
Reflex No response grimace Cough,
irritability sneeze
Color Blue, pale acrocyanosis pink

B. MMDST for Infants and children

METRO MANILA DEVELOPMENT SCREENING TEST

• Screening is a presumptive identification of unrecognized disease or defect
• Early detection model
• Test children with problem
• Facilitates early referral and treatment
• Detection of developmental disabilities
• Children 6 ½ years and below
What then is MMDST?
• Simple and clinically useful tool
• To determine early serious developmental delays
• Developed by Dr. William K. Frankenburg (Denver Test)
• Modified and standardized by Dr. Phoebe D. Williams DDST to MMDST
• Developed for health professionals (MDs, RNs, etc)
• It is not an intelligence test
• It is a screening instrument to determine if child’s development is within normal
• Purposes:
• Measures developmental delays
• Evaluates 4 aspects of development
• Aspects of development :
1. Personal-social
2. Fine-motor adaptive
3. Language
4. Gross motor behavior
• MMDST Kit
1. Manual
2. Sample test form
3. Test materials
4. MMDST bag
• Test materials
1. A bright red yarn pom-pom
2. A rattle with narrow handle
3. Eight 1-inch colored wooden blocks (red, yellow, blue green)
4. Test materials
5. A small clear glass/bottle with 5/8 inch opening
6. A small bell with 2 ½ inch-diameter mouth
7. Test materials
8. A rubber ball 12 ½ inches in circumference
9. Cheese curls
10. A pencil
11. Cheese curls
• Important considerations
1. Child’s age is crucial= initial step in test administration
2. Test items will be dependent on age of child
3. Age = guide the selection of test items and subsequent interpretation of results
• Scoring the Test
1. Passed
2. Failed
3. Refused, or
4. No opportunity
• Failure of an item that is completely to the left of the child’s age is considered a
developmental delay
• The Test Form
• Made of 105 items written in the range of development of children between birth and six
years of age
• Four Sectors
• Personal-Social – tasks which indicate the child’s ability to get along with people and to
take care of himself
• Four Sectors
• Fine-Motor Adaptive – tasks which indicate the child’s ability to see and use his hands to
pick up objects and to draw
• Four Sectors
• Language – tasks which indicate the child’s ability to hear, follow directions and to
speak; and
• Four Sectors
• Gross-Motor – tasks which indicate the child’s ability to sit, walk and jump
• Test Directions
1. Try to get the child to smile by smiling, talking or waving to him. Do not touch him.
2. When the child is playing with toy, pull it away from him. Pass if he resists.
3. Child does not have to be able to tie shoes or button in the back
4. Move yarn slowly in an arch from one side to the other, about 6” above child’s face. Pass
if the eyes follow 90o to midline. (past midline; 180o)
5. Pass if the child grasps rattle when it is touched to the backs or tips of fingers
6. Pass if the child continues to look where yarn disappeared or tries to see where it went.
Yarn should be dropped quickly from sight from tester’s hand without arm movement
7. Pass if the child picks up cheese curl with any part of the thumb and finger
8. Pass if child picks up cheese curl with the ends of thumb and index finger using an over
hand approach
9. Pass any enclosed form. Fail continuous round motion.
10. Which line is longer (not bigger). Turn the paper upside down an repeat (3/3 or 5/6)
11. Pass any crossing line
12. Have child copy first. If failed, demonstrate
• Note
– When giving items 9, 11 and 12, do not name the forms. Do not demonstrate 9
and 11
13. When scoring, each pair (2 arms, 2 legs, etc) counts as one part
14. Point to picture and have the child name it. (No credit is given for sounds only)
15. Tell the child to: give block to mommy; put block on table; put block on floor. Pass 2 of
3. (Do not help child by pointing, moving head or eyes.)
16. Ask child: What do you do when you are cold? Hungry? Tired? Pass 2 of 3.
17. Tell child to: Put block on table; under table; in front of chair, behind chair. Pass 3 of 4.
(Do not help child by pointing, moving head or eyes.)
18. Ask child: If fire is hot, ice is? Mother is a woman, Dad is a?, a horse is big, a mouse is ?
Pass 2 of 3.
19. Ask child: What is a ball? River? Desk? House? Banana?, Curtain? Roof? Fence? Street?
Pass if defined in terms of use, shape, what is it made of or its general category (such as
banana is a fruit, not just yellow). Pass 6 of 9.
20. Ask child: What is a spoon made of? A shoe made of? A door made of? (no other objects
can be substituted.) Pass 3 of 3.
21. When placed on stomach, child lifts chest off table with support of forearms and/or
hands.
22. While child is on back, grasp his hands and pull him to sitting. Pass if head does not
hang back
23. Child may use wall or rail only, not person. May not crawl.
24. Child must throw ball overhead 3 feet to within arm’s reach of tester
25. Child must perform standing broad jumps over width of test sheet (8 ½ inches)
26. Tell child to walk forward, heel within 1 inch of toe. Tester may demonstrate. Child
must walk 4 consecutive steps, 2 out of 3 trials.
27. Bounce ball to child who should stand 3 feet away from tester. Child must catch ball
with hands, not arms, 2 out of 3 trials.
28. Tell child to walk backward toe within 1 inch of heel. Tester may demonstrate. Child
must walk 4 consecutive steps, 2 out of 3 trials.
• Important
• Date and Behavioral Observations
 – How child feels at time of test, relations to tester, attention span, verbal behavior,
self-confidence, etc)
• The Test Form
• Across the top and bottom of form are age scales
• Age is marked in months 1-24, and age in years from 2 ½ to 6.
• Each item is represented in the test form by a bar
• The bar is placed along the age scale to show when 25%, 50% (indicated by the hatch
mark) 75% and 90% of the normal children are able to pass the item.
• Some items have a small footnote number at the left end of the bar
• Footnote indicates corresponding instruction for administering the item found at the test
form
• Some items may be passed by report of the parent (R)
• Only items with an R on the form can be passed by report
• However, whenever possible tester should observe what the child can perform
• The item, equal movements, has an asterisk (*) at the right end of its bar
• Indicates 100% of normal children pass this item at birth
• It is the only item with an * (fine-motor adaptive sector
• 9 items have arrows ( ) at the right end of these bars
• This includes the items, defines words and composition of __.
• Arrows indicate that normal children may pass these items even beyond 6 ½ y.o.
• Drawing the Age Line
• Use age scale shown at the top and bottom of the form
• Mark the age and draw a line through all four sectors
• Show acetate
• Location of age must be accurate interpretation depends on correct placement of the line
• Space between age –-- 2 weeks until 14 mos, 1 mo from 14 to 24 mos
• From 24 mos to 5 yrs spaces between represent 3 mos and thereafter 6 mos
• Adjusting for Prematurity
• Prematurity affect ability to perform that normal child pass at the same age
• Adjust for children 2 years or younger
• After 2 years, it is no longer necessary to compensate (Frankenburg, et al)
• No adjustment is made on postterm
• Ask mother if child was born prematurely
• For two or three weeks earlier, subtract the number of weeks from actual age
• Draw age line based on adjusted age
• Selecting Items to be administered
• Administer first those through which child’s chronological age line passes
• If failure occurs in any items, proceed to administer items to the left of the age line until
you obtain 3 passes then stop
• WHAT TO KEEP IN MIND!!!!!
• Selecting Items to be administered
 • All items crossing the age line should be administered
• Child should have a minimum of three passes to the left of any failure; and
• Each sector should have at least 3 passes and three failures
• The Test Procedure
• Preliminary Phase
– Establish rapport
– Make the child as comfortable as possible
• If infant…on mother’s lap
• Materials should be accessible
• If child is one year older, put child at ease
– Show toys…etc
• Start with Personal-social sector
• Gives child chance to get used to tester
• Gives tester chance ask parents which can be scored based on report and can also directly
observe it
• Fine motor-adaptive sector follows
• Child can perform tasks even without having to directly talk to tester
• Filipino child…..warming up
• Third is, language sector
• This time child is more comfortable with you (tester)
• Will talk as much to you
• Lastly, gross-motor sector
• Many children are too shy at the beginning of the test
• WHAT MAY NOT BE CHANGED?
• Manner in which each test is administered
• Words or direction may not be changed

C. Adults
1. Barthel Index - The Barthel Index consists of 10 items that measure a person's daily
functioning specifically the activities of daily living and mobility. The items include
feeding, moving from wheelchair to bed and return, grooming, transferring to and from a
toilet, bathing, walking on level surface, going up and down stairs, dressing, continence
of bowels and bladder.

How is the Barthel Index used?

The assessment can be used to determine a baseline level of functioning and can be used to
monitor improvement in activities of daily living over time. The items are weighted according to
a scheme developed by the authors. The person receives a score based on whether they have
received help while doing the task. The scores for each of the items are summed to create a total
score. The higher the score, the more "independent" the person. Independence means that the
person needs no assistance at any part of the task.   If a person’s does about 50% independently
then the "middle" score would apply.

2. Katz Index – commonly used tool for measuring ability to perform basic personal tools
such as bathing, dressing, toileting, transferring, and eating.
3. Gordon’s Functional Health Patterns - Organizes data into 11 functional groups that
contribute to a person’s overall health and well-being, quality of life, and attainment of human
potential.