HEALTH CARE PROCESS

PROCESS

 Series of planned actions or operations directed toward a particular result.

 Series of actions and operations that are goal directed, sequential, interrelated and dynamic.
 Series of steps of components leading to an achievement of a goal.
CHARACTERISTICS OF A PROCESS
1. Purpose: The goal or specific aim of the process.
2. Organization: Series of steps or components to achieve a goal.
3. Creativity: Continual development of the process itself.
 It is cyclical in nature.
 Steps are interrelated and interdependent; scientific method of problem solving.
HEALTH CARE PROCESS:
 A deliberate step by step approach in solving client’s problems.
 A method of organizing and delivering health care.
 Systematic method of planning and providing health care.
 Set of actions used to determine, plan, implement and evaluate health care.
 Application of the scientific method of problem solving in a progression of purposeful thoughts and actions with
the health worker employs in order to help her client cope with his problems arising from health-illness solutions.

PHASES OF THE HEALTH CARE PROCESS

I. ASSESSMENT
 First phase of the health care process
 Process of gathering, verifying and communicating date about a client’s health status.
 A continuous process carried out during all phases of the health care process.
 All phases of the health care process defend on the accurate and complete collection of data or information.
 Involves collecting, organizing, validating and recording data.
PURPOSE:
 Establish a data based about the client’s level of wellness, health practices, past illnesses, related experiences and
health care goals.
 The information contained in the data based is the basis for individualized client care.
 Collection of data would include history taking and physical examination.
HISTORY TAKING:
 Done through interview that is a planned communication or a conversation with a purpose.
Approaches to interview:
1. Directive/Structured: Elicits specific interview
 Interviewer establishes the purpose of the interview; usually to gather and to give information; utilizes close-
ended questions.
2. Non-directive / Unstructured:
 Client controls the purpose, subject matter and pacing; uses open- ended questions.
STEPS IN HISTORY TAKING
1. Find out the person’s identity. Personal profile.
Ex. Name, Address.
2. Ask what the main problem is.
“Why is he seeking consultation?
3. Ask about past and present history illness.
4. Ask questions what would reveal the details of illness.
Ex. If in pain description.
5. Ask about other complaints.
Ex. Any weight loss or gain.
6. Ask if any medication was taken for the condition.
Ex. What kind, who prescribed the medications, effect of the medicines.
7. Ask if the same problem had occurred before or if the same problem was/is experienced by the family or
neighborhood.

WHEN CONDUCTING THE INTERVIEW:

1. Keep the client comfortable during the interview.
2. Hold the interview in a private place.
3. Always treat the client as a person.
 Data collected during assessment should be descriptive, concise and complete and should not include
interpretative statements.

TYPES OF DATA
1. SUBJECTIVE DATA:
 Symptoms (covert data); apparent only to the person affected and can be described or verified only by that
person.
  Client perception about their health problems, comes from the client; non-observable.
Ex. Pain; itching; feelings of worry ‘I’m short of breath.”
 Subjective data include the client’s
1. Sensation
2. Opinion
3. Feelings
4. Attitudes
5. Values
6. Beliefs
7. Perception of personal health
8. Status and life situation
 Subjective data are obtained from the primary and secondary sources.
2. OBJECTIVE DATA:
 Signs; observable; observations or measurements made by the data collector.
 Detected by an observer or can be tested against an accepted standard. They can be seen, heard, felt or
smelled and they obtained by observation or physical examination.
 To observe is to gather data using the five senses.
A. Vision (Visual): Gait, posture, discoloration, respiration, amount of drainage, swelling, facial
expressions, behavioral responses to communication interaction.
B. Hearing (Auditory): Breath/heart sounds, bowel sounds, ability to communicate, sounds of
choking, gasping, coughing, language spoken.
C. Smell (Olfactory): Body or breath sounds, odor of drainage from a wound, odor of stool, odor
from cast.
D. Touch (Tactile): Skin temperature, muscle strength, pulse rate, palpatory lesions like lumps,
masses, nodules, texture, size of body organs.
E. Taste (Gustatory): Least common used sense for collecting information.

PHYSICAL EXAMINATION / PHYSICAL ASSESSMENT:

 Involves the gathering or objective, observable undistorted by clients perception.

1. INSPECTION:
 Visual examination of the client to determine normal, usual or abnormal conditions or responses.
 Focuses on specific behavior or physical features.
 Specific characteristics such as shape, size, position, color, texture and anatomical position and location.
2. PALPATION:
 The use of touch to determine the characteristics of body shape, texture, temperature, moisture, pulsation,
vibration, consistency and ability.
 Specific parts are used to assess particular characteristics:
♦ Back of the hands is assessing temperature.
♦ Fingertips to determine texture and size.
♦ Palmar surfaces are most sensitive to vibration.
 Used to examine all accessible parts of the body, using different parts of the body.

Light Palpation: Used to examine most of the body parts. Gentle pressure is exerted while the hands in a circular
motion.

Deep Palpation: Effective when examining the abdomen to locate organs or identify unusual masses. It require
both hands, one for pressure and the other one for sensor.

Put the dominant hand on the area to be palpated and the other hand is placed on the top the other
to apply pressure.
Deep palpation of the abdomen should be used with caution, because prolonged deep pressure
cause internal injury.
3. PERCUSSION:
 Involves the stroking of a body surface with a finger or fingers to produce sounds.
 Tapping of a body surface with a small rubber tipped mallet or with the fingers.
 Determined size, density, organ boundaries and location.
TWO METHODS:
1. DIRECT METHOD
 Body surface is struck directly with one or two fingers (direct tapping of body surfaces with one or more
fingers of one hand); often used to define the cardiac border
2. INDIRECT METHOD
 Index or middle finger of one hand firmly on the skin and strike with the middle finger of the other hand.
 Middle finger of non-dominant hand is placed firmly against a body surface end the tip of the middle
finger or the dominant hand strikes the base of the distal joint of the pleximeter, with a quick stroke.
The sound maybe describes as
1. Flat Sounds: Low pitched and abrupt and are produced when the muscle or bone is percussed.
2. Dull Sounds: Medium pitched, thudding, and maybe heard over and spleen.
 3. Resonance: Clear hollow sounds produced over a normal air filled lungs.
4. Tympany: Loud high pitched sound heard over a gas filled stomach or pulled out cheek.
4. AUSCULATION
 Involves listening to sounds produced by the body at different steps by aid of the stethoscope.
1. DIRECT AUSCULATION:
 Uses the ear without any other tool.
2. INDIRECT AUSCULATION:
 Uses a stethoscope: used to determine the characteristic of lungs, heart and bowel sounds.
 Identify the frequency, intensity, quality and direction of auscultated sounds.
Four Characteristics of Sounds:
1. Pitch: From high to low
2. Loudness: Soft to loud
3. Quality: Described as blowing, swishing and gurgling.
4. Duration: From short to medium to long

ORDER OF EXAMINATION
 The physical examination is carried out in a systematic manner in order to avoid omissions.
A. Cephalocaudal Approach: (Head to toe) Begins at the head and ends at the toes
B. Body System Approach:
C. Maslow’ Hierarchy of Needs:
 Any methodical, thorough approach is acceptable as long as it meets the need to gather relevant data that helps to identify
health problems requiring intervention.
1. Begin with data on the client’s height, weight and vital signs.
2. Next, write a general statement of the client’s level of health and about perception of the client general
survey. (Includes information about mental status, body development, nutritional status, sex & race
appearance and speech, chronological versus apparent age

WHEN CONDUCTING THE PHYSICAL EXAMINATION

1. Keep the client comfortable. Explain each step in the examination before doing it.
 Ask client to empty bladder or bowel if needed.
 Be sure client is dressed and draped properly.
 Position client appropriately for different parts of the physical assessment.
 Take special care when positioning the client during the examination. Positions:
1. Sitting
2. Sim’s
3. Prone
4. Knee-Chest (Genopectoral)
5. Supine
6. Dorsal recumbent
7. Lithotomy
2. Begin by explaining in general terms the purpose of the examination and how it will be performed.
 Tell client to feel free to ask any questions and provide an opportunity for those questions.
 As you examine each body system, explain the procedure in detail.
3. Monitor client’s emotional responses throughout the examination. (for through facial expression, tension through body
movements)
 Do not force if client is afraid, postpone until client is relaxed and cooperative.
4. Do the examination in a well-lighted, well-ventilated room.
5. A close relative should be present in the room when:
 A female client is to be examined by a male health worker
 A male client is to be examined by a female health worker
6. Preparation of equipment
 Avoid, prolonging examination by having all equipment ready
 Any equipment that will touch the client should be warned well
 Be sure all-equipment is functioning properly.

THE EXAMINATION BEGINS WITH

A. General survey which includes observations of general approaches and behavior like:
1. Gender and race
2. Signs of distress (anxiety, difficulty in breathing, pain)
3. Body type (size)
4. Posture (erect, bent, stoop)
5. Gait
6. Body movement
7. Age
8. Hygiene and grooming
9. Dress, culture, lifestyle
10. Body odor
 11. Affect and mood (feelings)
12. Speech
13. Assessing the skin while body system are examined
B. Taking height and weight
C. Taking Vital Signs
Vital Signs: Cardinal Signs Temperature, pulse, respiration, and blood pressure, which are
indication of health status.
Vital Signs are measure To provide baseline data to determine a client’s response to
physiologic or psychological stress or to therapy.

 Vital signs are a quick and efficient way of monitoring a condition or identifying the presence of a problem.
Their values are so constant that any marked deviation from normal indicates person’s state of health.

COMMON SIGNS/SYMPTOMS AND CHARACTERISTICS

1. Cough and colds:
 Are infections of the upper respiratory tract
 Commonly occurs during rainy season or during changes in weather.
 Spread easily from person to person through sneezing.

2. Fever:
 An increase in the body’s temperature
 Not a disease but a sign of many diseases
 A signal that the body is ill
 Usually caused by microbes entering the body
 Fever makes a person lose a lot of water and salt by making the client dehydrated.
3. Diarrhea
 Frequent passing out of loose watery stools
 Caused by harmful that enters the body through the mouth, causes dehydration.

4. Abdominal pain:
 Maybe caused by certain diseases such as diarrhea, intestinal worm or excess gas in the stomach etc.
 A person who complains of abdominal pain may have a serious disease if, if started a few minutes or after a few
hours and getting worse; is accompanied by committing abdomen is very hard and painful when touched; client
does not want to move because of severe pain.

II. HEALTH PROBLEM IDENTIFICATION: DIAGNOSIS

 Describes a continuum of health status.
 Statement of client’s problem.
 Because diagnosing involves problem identification, it is important and to be able to differentiate problem from
other phenomena.
 In the diagnostic process analyzing involves the following steps:
1. Compare data against standards. (Identify significant cues.)
 Compares client’s data to a wide range of standards (health patterns, normal vital signs,
laboratory values, basic food groups, growth and development)
 Uses personal knowledge and experience when comparing data.
 Comparing client’s data against standards helps to identify significant and relevant cues.
2. Cluster data (Generate tentative diagnosis)
 Clustering or grouping data is a process of determining the relatedness of facts and
finding patterns in the facts. This is the beginning of synthesis.
 One examines data to determine whether any patterns are present, whether the data
represent isolated incidents and whether the data are significant.
 Data clustering involves making inferences about the data.
3. Identify gaps and inconsistencies
 Skillful assessment minimize gaps and inconsistencies in data
 Gaps: missing information needed to determine a data pattern
 Inconsistencies: conflicting data.
 Data analysis should include a final check to ensure data are complete and correct.
STEPS IN DATA ANALYSIS
1. Sort data.
2. Classifying / grouping data
3. Relating them to each other
4. Compare data with norms
5. Determine patterns or relationships
6. Interpret results of comparison
7. Making inferences, drawing conclusions
 After data are analyzed, strengths and problems are identified.
  For health problems to have a successful outcome, the client must acknowledge that the problem exists. The
health worker determines whether client needs help dealing with the problem.
 HEALTH PROBLEM is recognized by the following characteristics:
 A human response to a life process, event or stressor.
 Health related condition that both client and health and wealth worker wish to change.
 Requires intervention in order to prevent or resolve illness or to facilitate coping.
 Involves or results in ineffective coping/ adaptation that is not satisfying to the client.
 Undesirable client state.
HEALTH PROBLEM:
 It is a situation or condition which interferes with the promotion and or maintenance of
health and recovery from illness or injury.
1) ACTUAL HEALTH PROBLEM:
 Perceived or experienced by the client at that moment.
Ex. Fever, headache
2) POTENTIAL HEALTH PROBLEM:
 One for which the client is at risks
 Presence or risk factors that predispose one to health problems.

Risk Factor: a phenomenon that increases a person’s chance of acquiring a specific disease.
Ex. Overweight ----- heart disorders

CATEGORIES OF HEALTH PROBLEMS

1. WELLNESS STATE
 Condition wherein client is capable of performing current competencies or has the desire to achieve
wellness to higher level.
2. HEALTH DEFICIT:
 When there is a gap between actual and achievable health status and instances of failure in health
maintenance.
3. HEALTH THREATS:
 Conditions that promote disease or illness / injury and prevent people from realizing their potential.
4. FORSEABLE CRISIS:
 Stressful occurrences or anticipated periods of unusual demand on the individual in terms of
adjustments or family resources. Ex. Adoption, marriage

STATEMENT OF THE HEALTH PROBLEM

 Actual problems of the client are to be stated. The problem and symptom are to be written.

III. PLANNING:
 Identification of client’s problems serves as basis for planning the health care.
 The product of this phase is a health care plan.
 The planning process:
SETTING PRIORITIES
ESTABLISHING GOALS/OBJECTIVES
SELECTING STRATEGIES
DEVELOPING CARE PLAN
 The health worker does not plan for the client but to encourage client to participate actively to the extend possible.
A. ESTALISHING PRIORITIES:

♦ Faced with so many health problems, the health worker must rank the problems into the priorities.
♦ Priority Setting:
 Process of establishing a preferential order for strategies.
 Decides which health problems require attention first.

Ex. The tool to be used: “Scale of Ranking Health Problem”

FOUR CRITERIA TO DETERMINE PRIORITIES

1. NATURE OF THE PROBLEM PRESENTED:
 Categorize as to wellness state, health deficit, health threat, and foreseeable crisis.
2. MODIFIABILITY OF THE PROBLEM:
 Refers to the probability of success in minimizing, alleviating or totally eradicating the problem through
intervention.
 The following factors are considered in determining modifiability.
1. Current knowledge, technology and interventions to manage the problem.
2. Resources of the family: physical, financial and manpower.
3. Resources of the health worker: knowledge, skills the time.
4. Resources of the community: facilities and community organization.
3. PREVENTIVE POTENTIAL:
  Refers to the nature and magnitude of future problems that can be minimized or totally prevented if
intervention is done on the problem under consideration.
4. SALIENCE:
 Refers to the family’s perception and evaluation of the problem in terms of seriousness and urgency of
the attention needed.
 The health worker evaluates family’s perception of a problem. As a general rule, the family’s concerns
and felt needs require priority attention.

TO DECIDE PREVENTIVE POTENTIAL:

1. GRAVITY OR SEVERITY OF THE PROBLEM:
 Refers to the progress of the problem (Extent of damage on client and family, indicates prognosis,
reversibility, etc.
 The more severe or advanced the problem, the lower the preventive potential.
2. DURATION OF THE PROBLEM:
 Length of time the problem has been existing
 Has direct relationship to gravity and to preventive potential.
3. CURRENT MANAGEMENT:
 Refers to the presence and appropriateness of intervention measures instituted to remedy the problem.
 The institution of appropriate intervention increases the problem’s preventive potential.
4. EXPOSURE OF ANY HIGH RISK GROUP.
 Decreases preventive potential of a problem.
SCALE FROR RANKING HEALTH CONDITIONS AND PROBLEMS
ACCORDING TO PRIORITIES

CRITERIA WEIGHT

1. Nature of the problem

Scale : Wellness state 3 1
Health deficit 3
Health threat 2
Foreseeable crisis 1

2. Modifiability of the problem 2

Scale : Easily modifiable 2
Partially modifiable 1
Not modifiable 0

3. Preventive potential 1
Scale: High 3
Moderate 2
Low 1

4. Salience 1
Scale: A condition or a problem 2
needing immediate attention 5

A condition or a problem not 1

needing immediate attention

Not perceived as a problem or 0

condition needing change

Scoring:

1. Decide on score for each criteria.

2. Divide the score by the highest possible score and multiply by weight.
(Score/Highest score) x Weight
3. Sum up the scores for all the criteria. The highest score is ‘5

The higher the score of a given problem the more likely it is taken as priority.

B. OBJECTIVE SETTING/ ESTABLISHING GOALS/EXPECTED OUTCOME

Goal
♦ Desired outcome or change in client’s behavior.
♦ A declaration of purpose or intent that gives essential directions to action.
 ♦ Specific objectives of care are made with the individual family in terms of activities of daily living, adoptive
functioning based on remaining capabilities resulting from these conditions and capability to cope with stress
associated with his disease condition or environment.
♦ Objectives are stated in behavioral terms. They should be SPECIFIC, MEASURABLE ATTAINABLE,
REALISTIC & TIME BOUNDED.
♦ Goals are broad statements about the effects of strategies. It maybe long term or short term.

Expected outcomes
♦ More specific, measurable, criteria used to evaluate whether the goal has been met.

OBJECTIVE FORMULATION:
A. ACTOR (CLIENT)
B. BEHAVIOR (WHAT IS EXPECTED)
C. CONDITION (SITUATION WHERE YOU SUBJECT THE ACTOR)
D. DETERMINANT (HOW THE ACTOR WILL PERFORM)

EXPECTED OUTCOME:
Client Behavior + Criteria of Performance + Time + Condition

Ex. Client will defecate with ease 24 hours after intake of foods high in roughage and exercise.

P: Expected or desired change in client’s behavior which intervention seeks to bring about.
C: Conditions under which such behavior will occur.
S: Performance criteria against which such behavior will be deemed as achieving or
approximating desired outcome.

PURPOSE OF GOALS/EXPECTED OUTCOMES

1. Provide direction for planning interventions that will achieve the changes in the client.
2. Provide a time span for planned activities.
3. Serves as criteria for evaluation of client’s progress.
4. Enable the client and health worker to determine when the client’s problem has been resolved.
5. Help motivate the client and health worker by providing a sense of achievement.
GUIDELINES FOR WRITING GOALS
1. Write goals and outcome criteria in terms of client behavior. Outcome criteria should focus on what the client will
accomplish not what the health worker will do.
2. Make sure the goal statement is appropriate for the identified health problem.
3. Be sure that the outcomes are realistic for the client’s, capabilities, limitations and designated time span, if it is
indicated.
4. Make sure the client considers the goal outcomes important and values them.
5. Ensure that goals and expected outcomes are compatible with the work and therapies of other professionals.
6. Make sure that each goal derived from only one health problem.
7. Use observable terms. Avoid words that are vague-and require interpretation or judgment by the observer.

C. STRATEGIES:
 Interventions, activities related to the identified health problem that a health worker critics to achieve client’s goal.
 Strategies chosen should focus on eliminating or reducing the etiology or cause and to reduce the client’s risk factors.

D. DETERMINING HEALTH CARE STRATEGIES AND INTERVENTION

1. PREVENTIVE:
♦ Activities that seek to protect client from potential or actual health threats and their harmful consequences.
2. PROMOTIVE:
♦ Activities directed towards developing the resources of client’s that maintain or enhance well-being.
♦ Usually non-specific, geared towards, raising the general level of health and well-being of an individual,
family and community.
♦ Activities include stress management, nutrition education, weight control, lifestyle modification and
organized physical activity programs.
3. CURATIVE:
♦ Activities are directed towards treating the illness as well as diagnosing.
4. REHABILITATION:
♦ Activities are directed towards restoring people to their previous level of health.

E. DEVELOPING A CARE PLAN:

Health Care Plan:

 Written guide that organizes information about a client’s care, includes the actions healthy worker must take to
address client’s problems and meet the stated goals.
PURPOSE:
1. To provide direction for individualized care of the client. It is organized to each client’s needs.
 2. To provide continuity of care.
IV. IMPLEMENTATION:

 Carrying out procedures which are consistent with the plan of care.
 Doing phase, putting the care plan into action.
 Involve the client and his family in the care provided in order to motivate them to assume responsibility of their
care and to be able to reach and maintain a desired level of functioning at a specified time.

Preventive / Promotive Health Care

1. Nutrition and Malnutrition

2. Maternal and Child Care (Pre-Natal Care, Post Natal Care, Breastfeeding, Immunization)
3. Family Planning/Responsible Parenthood
4. Personal-Hygiene
5. Environmental Sanitation
6. Dental Care
7. Rational Drug Use
8. Herbal Medicare

Managing Common Illnesses in the Community

 Simple coughs, colds, asthma, tuberculosis, diarrhea; intestinal worms

Common Childhood Diseases

 Ear infection, sore throat, measles; german measles; chicken pox, mumps, polio, diarrhea, whooping cough
 Skin disease; headache/chest pains, stomach aches, muscle-joint pains, hypertension
First Aid
 Fever & convulsion; CPR stocks; loss of consciousness, drowning, poisoning, wounds, bleeding fractures/
discolorations, animal bites, how to move an injure person, assisting emergency childbirth.

Specific Health Care Interventions

1. Hygiene & Comfort
2. Interventions promoting healthy nutritional status
3. Exercise, Sleep and Rest Interventions
4. Turning/Transferring Clients
5. Aseptic Technique
6. Traditional Medicines
7. First Aid/Emergency Care
8. Intervening for common signs/symptoms

Family Health Care Strategies

1. Assisting in pre natal/natal care
2. Care of the Newborn
3. Parenting
4. Health Education
5. Environmental Care/Sanitation

V. EVALUATION

 To judge or to appraise; to identify whether, or to what degree the client’s goal has been met.

FIVE COMPONENTS

1. Identify the outcome criteria that will be used to measure achievements of goals
2. Gather data related to the identified criteria.
3. Compare data collected with the identified criteria and judging whether the goals have been attained.
4. Relate actions to the outcome.
5. Reexamining the client’s care plan.
6. More care plan

EVALUATE STATEMENT: GOAL MET & CLIENT BEHAVIOR + CP.