Marjorie Gordon (1987) proposed functional health patterns as a guide for establishing a comprehensive nursing data base. A family’s functional health patterns evolve from a client_enviromental interaction. Each pattern is a expression of biopsychosocial integration.There is no one pattern which can be understood without the knowledge of other patterns. Functional health patterns are influenced by biological, developmental, cultural, social, and spiritual factors.A functional pattern represents a healthy set of behaviors.The judgement of whether a pattern is functional or dysfunctional is made by comparing assessment data. These 11 categories make possible a systematic and standardized approach to data collection, and enable the nurse to determine the different aspects of health and human function. This paper will discuss the nurse’s role in family assessment and how this task is performed by the use of family focused open ended questions. Using Gordon’s functional health patterns, this paper will summarize the findings of each health pattern as well as the family based nursing diagnosis of each assessment. SUMMARY OF THE FAMILY
To assess the family using the Gordon’s 11 functional health pattern the author has chosen a joint Indian family.The head of the family is Abraham who is 70yrs.He lives with his wife Mary 62yrs,son Jacob 38yrs,his wife Alice 34yrs and two children’s Annie 14yrs,Ashley11yrs.
Using Gordon’s 11 functional assessment open ended question the author was able to get a idea of different aspect of their health and was able to compare it.
1.Health Perception-Health Management Pattern:The family states they are healthy except for Abraham and his wife who are diabetic since 10yrs.Both of them go for periodic educational classes for diabetes and do periodic blood screenings for risk of other health conditions related to diabetes and follow instructions given by their health provider.Jacob showed a little bit concern about inheriting diabetes from his parents so he maintains his health and weight by eating healthy and doing exercise.All the immunization for the children’s were completed and were in good health.Alice mentioned that she does maintain her health by going for Gyn periodic checkups and is healthy. No one in the family smokes or drinks alcohol and they believe in prevention and promotion of health by following health and safety practices.The family seems to be happy and knowledgable about maintaining their health.
2.Nutritional-Metabolic Pattern:The family mainly eats home made cook food. And there is a family practice of having atleast one meal of the day together with all members present on the table .The family eats healthy and includes lot of vegetables and fruits. . Even though their cultural habits are on eating lot of carbohydrates they have controlled that and started eating healthy.Abraham and Mary strictly follows diabetic diet and understand the importance of it.There was a little concern about the fluid intake but gave ideas how to add fenugreek seeds in boiling water and makes the water taste better. Jacob has concerns about his weight and gave advice on healthy eating habits and not to eat too late in the night.Alice brought up concerns about the childrens trying to avoid breakfast.
3.Elimination Pattern: Abraham has some concerns of constipation .Health education was given on fibre rich healthy diabetic diet and to increase his fluid intake.Rest of the family members had normal elimination pattern.
4.Activity-Exercise Pattern: Family has the knowledge on importance of exercise .The elderly parents walk every morning and evening.Due to the busy time schedule Jacob and Alice could go to the gym only twice a week but they try to remain active as much as they can. They also mention they send their children’s for dance classes to remain active so that they would send less time in front of the TV and computer.They also participate in after school activities.
5.Sleep-Rest Pattern: The whole family has a habit of going to bed early and getting enough rest so that the day is fresh.They also mention it was a custom in the family that each member before going to bed have a glass of warm milk which aids to sleep well.
6.Cognitive-Perceptual Pattern: The parents has glasses for reading and they go for regular follow up.
7.Self-Perception – Self-Concept Pattern: Alice was grieving on loss of her mother in India. She was feeling better with the comfort of her mother-in law being as a mother to her and with the support of her family.
8.Roles-Relationships Pattern: This family is a joint famiy. Their children’s grow in a well disciplined manner under the able guidance of the grandfather, grandmother and other elders as they have more experience of various aspects of life. In this family all the family members sit together and discuss their own problems with the family members. They take part in social activities with other friends and families.
9.Sexuality-Reproductive Pattern: Jacob and Alice had normal sexual life. The menstrual cycle for Alice and Annie were normal.
10.Coping-Stress Tolerance Pattern: Jacob and Alice had tough times last year because of the layoff from their jobs due to the bad economy throughout the country. Since they being the bread winners for the family the whole family was affected. But as a team they overcome through it. They both have new jobs and are trying to cope of with the new changes. Alice has mentioned the anxiety about the daughters being teenagers and parenting them.
11.Values-Beliefs Pattern: The religion of this family is catholic Christian. They go to church once a week. They are strong believers in God and whatever happens in life is the will of the Lord. The grandparents follow the cultural traditions and try to instill them to their grandchildrens. All they expect is happiness, peace, and a healthy family.

Wellness Diagnosis Based On Family Assessment
A wellness diagnosis is used to describe an aspect of the client which is at a high level of wellness. A wellness diagnosis describes human responses to levels of wellness in an individual, family or community that have the potential for enhancement to a higher state. The role of the nurse is basically to facilitate healthy responses in order to reach a higher level of health oriented goals. There is a progression from one level of wellness to a higher level of wellness. For example, the nurse can help clients to complete transitions, to achieve higher levels of wellness or to attain wellness status. Health promotion plays a significant role.
1.Readiness for Enhanced Bowel Elimination Pattern Risk Diagnosis Actual Diagnosis Risk for constipation Altered bowel Elimination
Education should be given on eating habits and increasing the amount of fibers and fluids.The best way of adding fiber to the diet is increasing the quantity of fruits and vegetables that are eaten. This means a minimum of five servings of fruits or vegetables every day. For many people, however, the amount of fruits and vegetables that are necessary may be inconveniently large or may not provide adequate relief from constipation. In this case, fiber supplements can be useful. 2. Readiness for Enhanced Nutritional Metabolic Pattern.
Risk Diagnosis Actual Diagnosis
Risk of imbalanced fluid volume Fluid volume deficit
The importance of fluid intake should be explained to prevent dehydration. Two litres of fluid intake per day is needed as the body eliminates this quantity of fluid every day through the skin, lungs, bladder and intestines. Achieving an optimal fluid balance can have a decisive factor on an individual's well being and performance. It affects both physical and mental ability. 3.Readiness for Enhanced Parenting Risk Diagnosis Actual Diagnosis
Risk of impaired parent Parental role conflict

The parents should be educated when they consider that the teen years are a period of intense growth, not only physically but morally and intellectually, it's understandable that it's a time of confusion and upheaval for many families.Despite some adults' negative perceptions about teens, they are often energetic, thoughtful, and idealistic, with a deep interest in what's fair and right. So, although it can be a period of conflict between parent and child, the teen years are also a time to help kids grow into the distinct individuals they will become. Conclusion.
The author was able to understand Gordon’s 11 functional pattern and was able to use open ended question in the family assessment, nursing wellness diagnosis and educate health promotion for Abraham’s family.

References

Gordon, M. Nursing Diagnosis: Process and application, Third Edition. St. Louis: Mosby, 1994.

Stolte, K.M. (1996). Wellness: Nursing diagnosis for health promotion. Philadelphia: J.B. Lippincott.