Gordon's 11 Functional Pattern
Pattern
Description
Health Perception
and Health
Management
Describe the clients’
Formulated Questions
1.
perceived health & wellbeing and how health is
Do you consider yourself healthy? What is
“healthy” for you?
2.
managed.
What prescription and non-prescription
medications do you take?
3.
Do you visit the doctor on a regular basis or
have annual check-ups?
4.
When was the last time you visited the
doctor for a check-up?
5.
Do you smoke? Do you drink alcohol? Do
you take or have you taken any illegal
substances? (For medical purposes only) (If
the client does any of these) How often do
you do this? How much would you say you
consume on an average?
6.
When there is something wrong with your
body or whenever you feel sick, what do you
first do? Who and where do you seek help?
7.
Any health issues that may affect general
health?
8.
Have you experienced colds in the past year?
9.
Any circumstances that may have required
you to skip work/school recently?
10. In the past, has it been easy to carry out
doctor’s or nurse’s suggestions?
11. Most important thing you do to stay healthy?
12. Have you ever used home remedies-folk
remedies?
Nutrition and
Metabolic
Describes the food and
1.
fluid consumption relative
to metabolic need and
Vegetarian, etc.)
2.
pattern indicators of local
nutrient supply.
What is your diet? (Omnivore, Keto, Vegan,
What is your typical meal composed of?
(Proportion of carbs., protein, fat)
3.
What are your food preferences?
4.
Do you have any dietary restrictions?
(Restrictions including voluntary, because of
beliefs/religion, as instructed by doctor,
intolerances)
5.
What is your typical food, snack, drink
intake?
6.
How do you typically prepare your food?
(Fried, baked, raw, steamed, grilled, etc.)
7.
How often do you drink water in a day? How
much water do you drink?
8.
Do you take any vitamins or food
supplements?
9.
Do you have any food allergies?
10. How often do you eat junk food or eat in a
fast-food chain?
11. May I ask for a diet recall for 7 days from
this day?
12. Do you have an eating schedule to follow?
13. Can you tell me about the time interval of
your meals? including snacks
14. Who prepares your food?
15. Do you have any discomfort upon
swallowing, chewing, and drinking?
16. Aware of any stomach or intestinal
problems? or a problem with metabolism?
17. Problems toward appetite?
18. Do you have dental problems?
Elimination Pattern
Describes the pattern of
1.
excretory function (bowel,
How often is your bowel movement in a
week?
bladder, skin). Through
2.
Do you notice any changes in your bowel?
this pattern the nurse is
3.
Do you experience pain or discomfort
able to determine
regularity, quality, and
during excretion/pooping?
4.
quantity of stool and
urine.
Do you experience any difficulty in
peeing/urinating?
5.
What color does your pee/urine normally
look like?
6.
How often do you urinate in a day?
7.
Do you notice if your urine has any strong
odor? Foul odor perhaps?
Skin & Perspiration
8.
Are there any alarming changes in your skin
color or texture?
9.
Do you have an issue towards sweating?
May it be too excessive?
10. Have you noticed any concerning odors
from yourself recently?
Bowel Excretion
11. Typically, how long does it take for you to feel
the urge of bowel excretion?
12. May I know how frequently you take bowel
excretion in a day?
13. Have you taken any laxatives to help with
your bowel movement?
14. Do you experience any problems regarding
bowel excretion such as discomfort on
abdomen, anus, or anywhere?
15. If I may ask, do you take any medication
when facing pain correlating to your bowel
movement?
Bladder Excretion
16. Typically, how long does it take for you to
feel the urge to pee?
17. How often do you urinate in a day?
18. Is there any alarming discomfort, odor,
appearance, frequency regarding bladder
excretion?
19. Do you have any issues toward controlling
bladder excretion?
Activity-Exercise
This pattern describes
1.
Do you exercise regularly?
activity level, exercise
2.
What type of exercises do you do? Do you
program, and leisure
activities.
follow any exercise plan?
3.
Are there any restrictions in your exercise?
(such as duration, type of exercise)
4.
What activities do you engage in during
your leisure and recreation time?
5.
How often do you engage in strenuous
activities?
6.
Every time you exercise, do you experience
any body pain?
7.
Are you having any problems in exerting
energy for certain activities?
8.
Have you been exposed to any work-related
health hazards?
Sleep and Rest
Describe the patterns of
1.
Do you use any aids to help you sleep?
sleep, rest, and relaxation
2.
What time do you usually sleep?
3.
What time do you usually wake up?
4.
If you were to assess yourself, how long do
you think you usually sleep and rest in a
day?
5.
Do you experience disturbance in the
middle of your sleep?
6.
Do you have difficulty falling asleep?
7.
Do you find it hard to go back to sleep if
you are suddenly awoken?
8.
Do you take naps within the day? When do
you usually take naps? How long are your
naps?
9.
Do you have any sleep disorder/s? If yes,
what is/are this/these?
10. On a daily basis, how many hours of sleep
do you get?
11. What time do you go to bed?
12. What time do you get up?
13. Do you take any sleep-inducing pills/drinks?
14. How often do you get disturbed and wake
up at night?
15. Do you have a routine before sleeping?
16. Do you take naps during the day?
17. How long do your naps usually take?
18. Do you often experience nightmares?
Cognitive-Perceptual
Describes the ability of the
1.
individual to understand
and follow directions,
Do you have difficulty learning due to visual
or auditory distraction/s?
2.
retain information, make
Do you tend to forget things quickly? Have
you experienced memory gaps recently?
decisions, solve problems
3.
Do you easily get distracted?
and also assess the five
4.
Are there any changes in your mental
senses
status?
5.
Do you wear eyeglasses? Are they
prescribed or not?
(If the client wears eyeglasses) How long
have you had them? When was your last eye
check-up? Do you change your eyeglasses
regularly?
6.
Did you experience any traumatic
accident/situation that affects your wellbeing?
7.
Do you find it hard to recall information?
recognize people and objects? differentiate
people and objects?
8.
Experienced any difficulties or discomfort on
your ear? Do you wear hearing aids?
9.
Do you have trouble with your vision? wear
glasses?
10. How often do you find it difficult to
memorize a certain thing?
11. Do you find it easy/difficult to make an
important decision in life?
12. Any kind of speech problems?
13. How would you describe your ability to be
attentive?
14. Is there an easiest way for you to learn
things? If so, in what ways do you tend to
do it?
Self-Perception/ Selfconcept
Describes the client’s self-
1.
Do you constantly feel angry and/or sad?
worth, comfort, body
2.
Do you feel positive or negative about your
image, feeling state
current health, financial, and educational
status?
3.
Do you feel confident in your body? Are
there things that you don’t like about your
body?
4.
Are you able to control things in your
surroundings?
5.
Do you feel like your body is the main
source of your problems?
6.
Do you ever feel like you lose hope in
things?
7.
Are you aware of your self-worth? How
would you describe it?
8.
Are you experiencing an identity crisis?
9.
How do you feel and think about yourself
lately?
10. Do you feel good about your whole being?
11. If I may ask, was there a time that you may
have been conscious of yourself?
12. Does it ever occur to you to lose hope?
13. If it’s okay, may I ask what changes in your
body that affects the things you can do?
14. Do you do selfcare? If so, how?
Role-Relationship
Client's pattern of role
1.
Do you live alone or are you living with
engagements and
anybody? (With partner and/or family
relationships.
member/s)
2.
(if living with someone) What is your role in
the household? If you are admitted, who will
do your responsibilities/duties/chores?
3.
Can you describe your relationship with your
family? What is your role in your family?
4.
Is there anyone we can contact in case of an
emergency?
5.
Do you have friends/peers? Can you
describe your relationship with them?
6.
How often do you see your friends?
7.
Are you a member of any social groups or
organizations? How is your relationship with
the members?
8.
Can you describe your experience in school
or workplace?
9.
Can you describe your relationship with your
co-workers/colleagues (if working) or
classmates and teachers (if student)? (If
both, ask for both)
10. What is it like growing up in your family?
How would you describe your role in your
family?
11. Do you have any other relatives living with
you?
12. Family or others depend on you generally?
(emotionally, financially, spiritually, etc.)
SexualityReproductive
Patterns of satisfaction
1.
Are you in a sexual relationship right now?
and dissatisfaction with
2.
If I may ask, are you sexually active?
sexuality pattern;
3.
If you do not mind me asking, when was the
reproductive pattern.
last time you had sexual intercourse with
your partner?
4.
Not to offend you, but if I may ask besides
your partner, do you engage in sexual
intercourse with other people?
5.
How many times did you engage yourself in
sexual intercourse with other people?
6.
When was the last time you had sexual
intercourse with other people?
7.
How do you identify your sexual
orientation?
8.
Do you use any contraceptives?
9.
For females - Are you using birth control? Is
this prescribed by your doctor/ OB-GYN, or
do you take this voluntarily?
10. For females - When was your last period?
11. For females - Is there a chance that you are
currently pregnant?
12. For females - Do you mind if I ask about
whether or not you had a miscarriage?
13. For males - Do you have any concerns or
problems with regards to your sexuality?
14. How should I address you? May I also know
about your sexual orientation?
15. Are you currently in a relationship with
someone? Is it possible that you may have
engaged with sexual activities with your
partner?
16. Are you experiencing or feeling any
problems in your body after participating in
a sexual activity?
17. Have you used any medications recently,
such as contraceptives, viagra, and if you
noticed some side effects after using them?
Coping-Stress
Describes the client’s
1.
feelings, comfort and
discomfort.
What stresses you? / How do you recognize
stress in daily life?
2.
How do you cope with stress?
3.
How does stress affect you?
4.
When feeling stressed, how do you feel
physically?
5.
Have you been under stress recently?
6.
Are you quick tempered? Did you do
anything to manage this? / How do you
ease your anger?
7.
Do you receive any treatment for emotional
distress?
8.
How often do you get the emotional
support you need? From who/what?
9.
Who are the people you can talk to about
your stress?
10. Has anything been bothering you lately or
causing stress?
11. Do you have any sort of activities that keep
you relaxed?
12. How do you deal with setbacks in life?
13. In what area of your life, makes you sensitive
and feel some kind of emotions ragingly?
14. Feeling unable to control emotions? How do
you cope when things don't go your way?
15. Things that frequently make you angry?
Annoyed? Fearful? Anxious? Depressed?
Work, School, Family, Health Issues,
Personal Things
16. For you, Who is the most helpful in talking
things over?
17. Use of any medicine for emotional/mental
issues?
Values and Belief
Describes the patterns of
values, beliefs (including
spiritual), and goals that
1.
Do you think that herbal/alternative
medicines work on your body when you
guides the client’s choices
take it? When and where did you know
or decisions.
about these herbal/alternative medicines?
2.
Are you subject to any medical aid
restrictions? (i.e., blood transfusion)
3.
Are there any restrictions that can violate
your beliefs that I/we should be aware of?
4.
Do you believe that your life has purpose or
meaning?
5.
Are you experiencing spiritual distress?
6.
Would you say that your faith and hope is
uncompromised?
7.
What religion or sources of hope, strength,
comfort, and peace do you practice?
8.
Is there anything specific about your culture,
beliefs, or religious practices that I should be
aware of?
9.
Have your beliefs had an impact on how you
care for yourself?
10. Is there any matter regarding your belief
you may need to disclose that may affect
your health care you receive from us?