Concept 2

Functional Ability

Lesson 2.1

Objectives

  1. Define and describe the concept of functional ability.

  2. Notice situations and factors that increase the risk for functional impairment.

  3. Recognize when functional impairment exists.

  4. Provide appropriate interventions to optimize functional ability and minimize complications.

Define and Describe the Concept of Functional Ability

Definition

  • Functional ability is defined as:
      - The cognitive, social, physical, and emotional ability to carry out the normal activities of life.

Related Terms:

  • Functional performance: Measures the ability of a person to perform necessary tasks.

  • Functional impairment: Refers to limitations in performing daily activities.

  • Function: The action of an individual in various contexts.

  • Disability: A condition that limits an individual's movements, senses, or activities.

Scope of Functional Ability

  • Functional ability exists on a continuum from full function to disability.

Types of Activities:

  1. Basic Activities of Daily Living (BADLs): Essential tasks required for personal care and basic functioning.

  2. Instrumental Activities of Daily Living (IADLs): More complex activities needed for independent living, including managing finances, using transportation, and preparing meals.

Lifespan Considerations

  • Functional ability varies across the lifespan and is influenced by several factors:
      - Developmental stage: Achievement of developmental milestones indicates levels of functional ability.
      - Physical health: Overall wellness impacts functional capacity.
      - Psychosocial health: Emotional wellbeing is essential for functioning.
      - Cognitive ability: Mental acuity and memory capabilities influence daily activities.
      - Social and cultural factors: Social interactions and cultural expectations affect the perception and enactment of functional abilities.

Attributes and Criteria of Functional Capacity

Attributes:

  • Capacity to perform specific functional abilities: The inherent potential to carry out activities.

  • Actual or required performance: The extent to which these abilities are realized in practice.

Antecedents of Functional Capacity:

  • Development of physiological processes: Neural, endocrine, musculoskeletal, and metabolic developments are crucial.

  • Acquisition of developmental milestones and skills: Skills must be developed over time to enhance functional ability.

Theoretical Links

  • The Roper-Logan-Tierney Model of Nursing emphasizes:
      - 12 key activities of daily living that are central to life.
      - Focuses on ongoing patient assessment to facilitate independence.

  • International Classification of Functioning, Disability, and Health (ICF):
      - Describes a dynamic (non-linear) process between functional ability and disability.

Notice Situations That Increase the Risk for Functional Impairment

Risk Recognition (1 of 2)

  • Various risk factors contribute to impaired functional ability:
      - Developmental abnormalities: Any genetic or developmental defect causing limitations.
      - Trauma: Physical or psychological impact leading to impairment.
      - Disease: Both acute and chronic conditions create challenges for functioning.
      - Social and cultural factors: Societal expectations and cultural beliefs can obstruct functional performance.
      - Beliefs and perceptions of health: How individuals view their health can impact their functionality.
      - Medications: Side effects from prescriptions can impair functional abilities.
      - Physical environment: Accessibility and safety of one’s surroundings affect daily living tasks.
      - Cognitive function: Any decline in cognitive capabilities may hinder daily function.
      - Mental health issues: Conditions such as depression significantly impair one's ability to function effectively.

Risk Recognition (2 of 2)

  • Early recognition of these risk factors is crucial for timely identification of functional deficiencies.

  • Identifying functional deficits early can lead to better health outcomes.

  • Optimal functional ability is linked to improved overall health outcomes.

Reducing Risk

  • Educating patients and families about factors associated with maintaining high levels of functional ability is essential.

Key Factors Include:

  1. Well-balanced nutrition: Good dietary practices support physical and cognitive health.

  2. Regular physical activity: Encourages bodily mobility and wellness.

  3. Routine health checkups: Preventive care aids in early detection of potential health issues.

  4. Stress management: Managing stress positively impacts mental health and functionality.

  5. Regular participation in meaningful activity: Engages individuals in social and mental stimulation.

  6. Fall prevention measures: Safety strategies reduce the risk of physical injuries.

  7. Avoidance of tobacco and other substances: Reduces health risks linked to substance abuse.

Recognize When Functional Impairment Exists

Functional Assessment

  • A comprehensive functional assessment is labor-intensive and best accomplished as an interprofessional effort.

Indications for Assessment Include:

  • Children showing delays in developmental milestones.

  • Adults experiencing loss in functional ability, changes in mental status, or those with multiple health conditions, particularly in frail elderly persons.

Functional Assessment Components

  • Comprehensive evaluation involves several components:

  1. Vision: Assessing visual capabilities.

  2. Hearing: Evaluating auditory function.

  3. Mobility: Determining physical movement capabilities.

  4. Fall History: Documenting any past incidents of falls.

  5. Continence: Assessing bladder and bowel control.

  6. Nutrition: Evaluating dietary intake and nutritional status.

  7. Cognition: Measuring cognitive function and mental acuity.

  8. Affect: Understanding emotional regulation and mental health status.

  9. Home Environment: Evaluating the safety and accessibility of the living environment.

  10. Social Participation: Assessing engagement in social interactions.

  11. BADLs: Measuring ability in basic activities of daily living.

  12. IADLs: Assessing ability to conduct instrumental activities of daily living.

Functional Assessment Approaches

Self-reporting tools

  • Advantages: Allow for personal insights and experiences related to functional ability.

  • Disadvantages: Subjectivity may limit accuracy.

Performance-based tools

  • Advantages: Provide objective measures of ability through task performance.

  • Disadvantages: May not capture all nuances of patient experiences.

Functional Assessment Conclusions

  • Determine the level of assistance or dependency:
      - No assistance: Clients are fully independent.
      - Partial assistance: Clients require some help in specific areas.
      - Total assistance: Clients rely entirely on assistance for daily functioning.

  • Determine the level of difficulty:
      - No difficulty: Activities can be performed without challenges.
      - Some difficulty: Minor struggles with performing certain activities.
      - Unable to perform: Complete inability to conduct activities.

Provide Appropriate Interventions to Optimize Functional Ability and Minimize Complications

Care Delivery

  • The primary goal of care delivery is to:
      - Maintain optimal independent functioning and prevent functional decline, enhancing health-related quality of life.

  • To achieve this goal, it is important to:
      - Reduce risk: Identify and mitigate factors that contribute to functional impairment.
      - Early detection and screening: Timely assessments can help prevent complications.
      - Management of functional activity impairment: Involves multidisciplinary interventions tailored to individual needs.

Interventions to Manage Functional Impairment

  • A multidisciplinary approach is essential:
      - Emphasizes interprofessional collaborative practice, where various healthcare disciplines contribute based on their expertise.

  • Interventions vary depending on the underlying cause of impairment including:
      - Visual impairments, mobility issues, cognitive decline, or mental health challenges.

Nursing Interventions to Manage Functional Impairment

  • Nurses can implement various strategies to aid clients in maintaining functional ability, including:
      - Self-care assistance for BADLs and IADLs: Support in dressing, toileting, bathing, ambulating, shopping, cooking, and eating.
      - Fall prevention strategies: Implementing measures to minimize risk of falls.
      - Exercise therapy: Encouraging physical activity tailored to individual needs.
      - Teaching safe use of assistive devices: Ensuring proper utilization of devices like walkers or canes to enhance mobility.

Featured Exemplars

  • Cerebral Palsy

  • Autism Spectrum Disorder

  • Alzheimer's Disease

  • Rheumatoid Arthritis

  • Parkinson's Disease