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Acta Paulista de Enfermagem

Print version ISSN 0103-2100

Acta paul. enferm. vol.24 no.6 São Paulo  2011 



Importance of using a nursing framework for clinical reasoning



Based on research and practice journals of the United States (U.S.) and other countries, a generalization can be made that nurse researchers implement the principle: nursing theories, models, or conceptual frameworks are needed to guide nursing research. This principle has not yet been widely implemented, however, by nurses in clinical practice. Descriptions of nursing assessment frameworks for clinical practice have been in the literature since the 1970s, yet many health care agencies continue to use the biosystems framework instead of a nursing framework for assessment. The purpose of this editorial is to revisit the importance of using a nursing framework for nursing assessments, the foundation of clinical reasoning.

A nursing framework for assessment is necessary to generate the relevant patient data for accurate nursing diagnoses, nursing-sensitive patient outcomes, and appropriate nursing interventions. For example, the NANDA-International(1) contains a case study of a nurse's assessment with a healthy person, generated with use of the Functional Health Pattern (FHP) nursing framework. Nursing plans of care for health promotion, health protection, and/or health restoration cannot be developed using the biosystems framework currently being used by many health care agencies because data on the structural and functional status of biological systems are insufficient to identify a broad range of human responses. Data collection using biological systems as the framework does not generate a sufficient amount of holistic data for nursing plans of care. In contrast, nursing frameworks such as FHPs assist nurses to identify health and illness issues of concern to nurses.

The FHP nursing framework has been shown to successfully generate the data needed by nurses for effective plans of care and documentation(2). The FHP framework reflects the interaction of biological, psychological, social, cultural, spiritual and other dimensions of human beings. It enables nurse users to make nursing diagnoses by considering the interactions of these dimensions. The FHP framework for nursing assessment reflects the type of data that are needed to accurately diagnose human responses to health problems and life processes(1). Ideally, nursing practice worldwide should be guided by a universal assessment framework, just as the biosystems framework is universal for medicine.

The Functional Health Pattern screening tool (FHPAST) can be used by all agencies worldwide because it has been tested and found to have satisfactory psychometric properties(3). This screening tool is a self report assessment by patients, which, when combined with further health history as needed and a physical examination, enables nurses to select accurate nursing diagnoses.

Because I have been using the FHPs for decades, I cannot address the value of other nursing frameworks for assessment, but it is clear that a nursing framework is needed to guide nurses' clinical reasoning in the nursing process. My hope is that international nursing organizations will soon sponsor nurses' adoption of a universal framework for nursing assessment, one that enables assessment processes that yield sufficient data to diagnose human responses and experiences to health problems and life processes.



1. Lunney, M (2009). Case study example. In TH Heardman (Ed)., Nursing diagnoses: Definitions and classifications, 2009-2011 (pp. 12-16). Ames, IA: Wiley Blackwell.         [ Links ]

2. Thoroddsen, A & Enfors, M (2007). Putting policy into practice: Pre and post tests of implementing standardized languages for nursing documentation. Journal of Clinical Nursing, 16, 1826-1838.         [ Links ]

3. Barros, ALBL, Michel, JLM, & Nobrega, ML (2003), Translation, utilization, and psychometric properties of the Functional Health Pattern Assessment screening tool with patients in Brazil. International Journal of Nursing Terminologies and Classifications, 14 (4S), 17.         [ Links ]

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