Diagnosis by Nursing Staff: Patient Diagnosed with Self-Care Deficit
Help required with Hygiene/Bathing; Feeding, Grooming/Dressing, Toileting
Nursing Outcomes Classifications (NOC)
Suggested Labels for NOCs
Self-Care Refers to:
Bathing
Dressing
Eating
General Hygiene
Grooming
Toileting
Nursing Interventions Classification (NIC)
Suggested Labels for NICs
Develop a nursing care plan for self care deficitthat includes the provision of assistance for the following self-care activities:
Bathing/hygiene
Eating
General assistance
Grooming
Management of own environment
Toileting
Definition of self-care deficit as provided by the North American Nursing Diagnosis Association (NANDA): Reduced ability on the patient’s part to complete or undertake everyday living tasks including bathing, dressing, feeding, and attending to one’s own toileting needs.
When developing a nursing care plan for self care deficit, it is possible that nurses will find patients with one or more self-care deficiencies in hospitals and in community settings. Some cases of this deficit can be short-term in nature i.e. impaired ability while recovering from some type of surgery. On the other hand, they can occur progressively over a period of time in a way that renders the patient unwilling or unable to undertake the tasks that are normally necessary to care for oneself. The patient’s condition will need to be carefully examined to ascertain that they are not neglecting to care for themselves due to a lack of resources or because it is difficultto arrange the living environment to accommodate a physical impairment or limitation on the part of the patient. It is the task of the nurse to coordinate all relevant or available services to provide the patient with maximum independence and to make sure the patient’s living environment is entirely safe and capable of supporting their specific needs.
A self-care deficit is defined by the following characteristics:
- A person is unable to bathe, groom, and undertake personal hygiene tasks on their own
- Person is unable to dress themselves
- Person is unable to feed themselves
- Person is unable to walk around from one place to another on their own
- Person is unable to undertake a variety of miscellaneous day-to-day tasks such as writing and/or making telephone calls by themselves
- Person is unable to transfer themselves from their bed to their wheelchair
- Person is unable to attend to their own toileting requirements
Anticipated Outcomes
- The patient safely performs self-care tasks to the best of his or her ability.
- The nurse identifies resources that help to optimize the patient’s level of independence and autonomy.
Ongoing Patient Assessment
An effective nursing care plan for self care deficit should make provision for the following assessments of the patient on an ongoing basis:
- Ability of patient to undertake the routine activities of daily living (ADLs) i.e. ambulate, bathe, dress, eat, groom, move, and transfer. The nurse determines the self-care activities the patient finds problematic. It is possible the patient will only need help with some ADLs.
- Assess exact cause of every instance of deficit (i.e. problems with vision, cognitive defects, weakness, etc.). Depending on the cause of the self-care deficit, some cases may need particular interventions to help the patient be able to care for themselves.
- Each patient’s needs should be assessed for devices that will assist them. These devices can improve the patient’s ability to undertake ADLs independently.
- Assess the patient’s need for home care upon discharge from hospital. Short stays in hospital can cause a greater level of debilitation and leave patients more in need of assistance upon discharge.
- The patient’s personal preferences in terms of food, personal hygiene products, and other similar items should be identified.
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Therapy Interventions
This self care deficit nursing care plan sample recommends the following therapeutic measures:
Dependence / Independence
Dependence / Independence- Help the patient accept they are dependent to some extent. Where the self-care deficit is the result of recent injury, illness, or disease, the patient might need a period of grieving before they can accept the possibility of dependence.
- Work with the patient to set some short-term goals. The setting of realistic and realizable goals will lessen the level of frustration.
- Encourage the patient to be independent, but provide intervention if or when the patient is unable to achieve targets. Injury from various activities can be prevented with appropriate levels of assistance and without the patient becoming frustrated.
- Devise consistent patterns and routines and give the patient enough time to complete each task. This can help the patient get organized and undertake self-care tasks.
- Provide the patient with positive encouragement and reinforcement for every activity they attempt, even when achievements are only partial. This gives patients an outside source of support and reinforcement.
Feeding
Feeding
- Patients should be encouraged to self-feed at the earliest possible opportunity (using, where appropriate, a hand that remains unaffected). Help with setting up should be provided as required. In cases where upper extremity is involved, it is likely the patient’s dominant or “normal” hand will be the hand that is affected.
- Where needed, make sure the patient wears eyeglasses and dentures. A deficit can be made worse where other strengths or senses are functioning at a reduced level.
- Make sure the consistency of food/diet is suitable for how well the patient is able to chew and to swallow, which a speech specialist will assess. A patient’s eating ability may be restricted or prohibited by mechanical difficulties.
- Patients should be provided with suitable utensils such as food guards, non-slip place mats, drinking straws, rocking knives, etc. to help them feed themselves. Items like these improve the chances of success.
- Patients should be placed in the best feeding position. Preferably, this is seated upright in a suitable chair with support provided for wrists, elbows, and arms as required.
- Consider the best setting for eating – one that provides the patient with support and assistance but will not cause them embarrassment. Being afraid of food spillage or causing embarrassment can hamper a patient’s efforts to feed themselves.
- Patients with sight problems should be advised about how and where food is placed on a plate. After CVA (i.e. stroke) treatment, a patient may suffer unilateral or spatial neglect and ignore some or half a plate.
Getting Dressed/Grooming
Getting Dressed/Grooming- Privacy should be provided for dressing. Dressing can take longer for a patient with self-care deficit and they may fear that their privacy will be breached.
- Patients should be frequently helped and encouraged (as required) when it comes to dressing. This helps them save energy and it reduces frustration.
- Suitable devices should be provided to help with dressing according to assessment by occupational therapists and nurses. Button hooks or clothes with loop and pile closure mechanisms can enable patients to continue dressing independently.
- Daily tasks and activities should be planned to allow the patient to rest before each activity.
- Patients should be placed in stationary chairs or wheelchairs. These can provide support while dressing, which can be tiring.
- The use of clothes that are a size bigger should be encouraged for comfort and to make dressing easier.
- In this self care deficit nursing care plan sample, we recommend the use of half-slips and brassieres with front openings. These are often easier to put on and manage.
- We also recommend elasticized shoelaces and/or shoes with loop and pile closing mechanisms. These remove the effort of tying.
- Provide a mirror for applying make-up. Help the patient as required. Activities that require fine motor skills can mean greater coordination and might not be within the patient’s capabilities.
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Hygiene Activities/Bathing
Hygiene Activities/Bathing- Privacy should be provided for bathing where appropriate. This is essential for the majority of patients.
- Make sure that any utensils that are needed are nearby. This makes the process safer and helps conserve the patient’s energy.
- Patients should be instructed to choose bathing times when they are rested and not in a hurry. The latter can lead to accidentsand this activity can require substantial energy.
- Patients should be provided with suitable devices to assist with bathing e.g. safety (non-slip) floor mats, shower chairs, bath sponges with long handles, shower or bath grab bars. These help with bed baths.
- Patients should be encouraged to brush/comb their own hair, which is a task that only requires one hand. Recommend low-maintenance hair styles. This will help a patient be autonomous for however long is possible.
- Patients should be encouraged to undertake a minimal amount of facial and/or oral hygiene as soon as possible after waking/getting up. Help with shaving and teeth cleaning as required.
- Patients should be helped with finger and toenail care as needed. Some patients may need podiatric treatment/care to prevent their feet being injured while their nails are being trimmed or because the process of cutting nails requires the use of special tools.
- Patients should be given regular encouragement since they often find it difficult to see progress.
Help with Toileting
Help with Toileting- Assess and record current and previous toileting routines/patterns. Implement a schedule or program for toileting that takes account of these patterns. Bladder and bowel programs will be more effective where respect is shown to the patient’s personal and natural patterns.
- The patient should be given privacy while toileting. The ability to evacuate bladder and bowel can be inhibited where there is an absence of privacy.
- Call lights should be kept within the patient’s reach and they should be instructed to use these as early as they possibly can. This gives staff time to help patients transfer to a toilet or commode.
- Patients should be helped to replace or remove any clothing that needs to be replaced or removed. A person’s continence levels can be compromised by clothes that are difficult to put on/take off.
- Patients should be encouraged to use a toilet or commode at the earliest possible time. Evacuating the bladder and bowel can be undertaken more effectively when seated on a toilet or commode. Some people find bedpans impossible for toileting purposes.
- Patients should be placed on a toilet or offered a bedpan at hourly or hour-and-a-half periods during the day and on three occasions throughout the night. It should be possible to lengthen these intervals when a patient starts requesting the use of a toilet of their own accord.
- Patients should be monitored for falls or balance problems. A commode and tissue should be kept close to the patient’s bedside for use at night. It is possible that patients will hurry to a commode or toilet at night out of fear or to avoid soiling and the process of hurrying can cause them to fall.
Moving/Transferring
Moving/TransferringAn effective self care deficit nursing care plan should include teaching or training sessions for walking and/or transfer. These should be planned to take place when a patient is feeling rested. A certain amount of energy is needed for each task. A tired patient can find tasks more difficult and this can unnecessarily cause feelings of frustration.
Take the following steps to help with getting in/out of bed:
- Patient should be encouraged to use their strongest side (where this is appropriate) to the best of their ability. The dominant limbs or side are often weakened in patients who experience strokes. Hence, there is a need for patients to develop coordination and make the muscles stronger on their strongest side.
- Patients should be allowed to train or work at their own pace. Each patient’s pace and ability to ambulate freely is influenced by several factors, and each factor needs to be taken into account when teaching/developing a training plan for a new self-care system. Patients will require time to learn and acquire the confidence in their own ability to undertake new methods of self-care.
- Patients should be instructed not to tug or pull on their caregiver when sitting up at their bedside. This can lead to the carer losing their balance and falling. This instruction prevents pressure sores, weakening of muscles, and contractures that cause disablement from occurring.
- Wheelchairs should always be placed on the patient’s best or strongest side - with lock brakes and bed at a small angle - when transferring the patient to the chair. The patient will bear their weight on their strongest side.
- Where a patient needs only a minimal amount of assistance, the nurse or carer should stand on the patient’s weaker side and place their hand beneath the patient’s weakest arm. (Note: nurse orcaregiver should keep their feet a good distance apart, and lift with their legs rather than their back to avoid straining the latter.)
- Where a moderate amount of help is needed, the caregiver should place their arms under each of the patient’s armpits with their hands on the patient’s back. This action forces the patient’s weight forward.
- Where a patient needs a maximum amount of help, the caregiver should place his or her right knee up against the strongest knee of the patient, clasp both their arms around the waist of the patient, and pull them forward. Patients should be encouraged to weight-bear on their strongest side. This action gives the patient maximum support and protects the caregiver from injuring their back.
- Help the patient with movement. Teach patients how to use movement devices, e.g., crutches, canes, walkers, and so on.
- The caregiver should stand on the patient’s weakest side. This position enhances the safety of the patient.
- Where a cane is being used, this should be placed in the strongest hand of the patient while making sure the cane-foot sequence is correct. This helps with support and balance.
Miscellaneous Help/Skills
Miscellaneous Help/Skills- Telephone assistance: Evaluate via the therapy department if the patient needs any adaptive or special equipment such as larger numbers on a phone, higher volume, or phone with pushbuttons). Each patient will need an effective device at home to communicate their needs.
- Writing materials: Patients should be supplied with pens with felt tips. These are easy to use and they mark without much pressure. Assess if the patient needs a splint on the hand they write with. This helps with holding a pen or other writing tool.
- Each individual activity should be supervised until such time as the patient is able to perform a task competently and they are safe caring for themselves independently. Undertake regular evaluations to ensure the patient’s level of skill is being maintained and that their environment continues to be safe. The ability to undertake self-care tasks can change frequently as time passes so this needs to be regularly assessed.
- The patient should be encouraged to maintain maximum levels of independence.
Patient Education and Ongoing Care
Patient Education and Ongoing Care- Teaching/training sessions should be planned so that the patient has sufficient time to practice various tasks.
- Patients should be taught to use aids and help devices where appropriate.
- Caregivers and family members should be taught to foster a culture of independence. They should use interventions when the patient gets tired, cannot undertake a task, or gets very frustrated. This approach shows concern and care without interfering with the patient’s desire or effort to be as independent as possible.
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