Careplan
Self-Care Deficit, Adult
Self-Care Deficit (Adult Inpatient)
Clinical Description
- Care of the hospitalized patient experiencing limitations in the safe and independent performance of activities of daily living.
Key Information
- It is important to consider the patient’s cultural norms, along with individual priorities and preferences when promoting self-care performance.
- Early rehabilitation and care aimed at increasing self-care abilities are important to help prevent loss of independence and associated negative health outcomes.
Clinical Goals
By transition of careA. The patient will achieve the following goals:
Improved Ability to Complete Activities of Daily Living
- Education: Overview
- Education: Self Management
- Education: When to Seek Medical Attention
Correlate Health Status
Correlate health status to:
- history, comorbidity
- age, developmental level
- sex, gender identity
- baseline assessment data
- physiologic status
- response to medication and interventions
- psychosocial status, social determinants of health
- barriers to accessing care and services
- health literacy
- cultural and spiritual preferences
- safety risks
- family interaction
- plan for transition of care
Self-Care Deficit
Signs/Symptoms/Presentation
- active movement limitation
- bathing ability limited
- dressing ability limited
- grooming ability limited
- inability to complete BADLs (basic activities of daily living)
- inability to complete IADLs (instrumental activities of daily living)
- laundry performance ability limited
- limited endurance
- meal preparation ability limited
- medication management ability limited
- muscle weakness
- pain limits activity
- personal hygiene care ability limited
- reluctance to perform self-care
- requires prompting to perform self-care
- requires assistance with self-care
- self-feeding ability limited
- shortness of breath
- toileting ability limited
Problem Intervention
Promote Activity and Functional Independence
- Evaluate ability to perform and complete BADLs (basic activities of daily living) and IADLs (instrumental activities of daily living) safely and independently.
- Identify patient’s preferences for clothing, food and personal care items; offer and honor patient choice when possible.
- Provide therapeutic interventions, such as modifications or adaptations to personal care tasks or routines to maximize independence and safety.
- Encourage active participation and independence in daily activity; provide level of assistance required for safety.
- Promote use of recommended adaptive equipment, devices and orthoses.
- Implement appropriate environmental modifications, such as decluttering and rearranging room to allow wheelchair access.
- Maintain patient’s preferred routines and habits; respect privacy and personal space.
- Schedule self-care activities when pain and fatigue are at a minimum to encourage optimal performance.
- Pace activity; allow adequate time and rest periods to conserve energy.
- Provide frequent encouragement, along with prompting and assistance as needed.
- Provide set-up of items if patient is unable to retrieve; store personal care items in accessible location.
- Individualize instructions and prompts to patient’s cognitive status to promote effective communication; simplify verbal directions, give encouragement and provide demonstrated cues as needed.
- Position the patient for optimal performance, such as sitting in a chair for meals or performing hygiene at sink.
Associated Documentation
- Activity Assistance Provided
- Adaptive Equipment Use
- Cognitive Support Measures
- Self-Care Promotion
Education
CPG-Specific Education Topics
Overview
risk factors
signs/symptoms
Self Management
self-care
When to Seek Medical Attention
unresolved/worsening symptoms
General Education Topics
General Education
admission, transition of care
orientation to care setting, routine
advance care planning
diagnostic tests/procedures
diet modification
opioid medication management
oral health
medication management
pain assessment process
safe medication disposal
tobacco use, smoke exposure
treatment plan
Safety Education
call light use
equipment/home supplies
fall prevention
harm prevention
infection prevention
MDRO (multidrug-resistant organism) care
personal health information
resources for support
References
- (2018). Butcher, H. K.; Bulecheck, G. M.; Dochterman, J. M.; Wagner, C. M. (Eds.), Nursing interventions classifications (NIC). St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
- Chan, E. Y.; Samsudin, S. A.; Lim, Y. J. Older patients’ perception of engagement in functional self-care during hospitalization: A qualitative study. Geriatric Nursing. 2019;, 1-8. doi:10.1016/j.gerinurse.2019.11.009 Source[Expert/Committee Opinion]
- Edemekong, P. F.; Bomgaars, D. L.; Levy, S. B.. (2020). Activities of daily living. Treasure Island, FL: StatPearls. doi:10.1016/j.apnr.2019.151189 Source[Expert/Committee Opinion]
- Fan, B. J.; Wong, R. Y. Effect of cognitive training on daily function in older people without major neurocognitive disorder: A systematic review. Geriatrics. 2019;4(3), 44. doi: 10.3390/geriatrics4030044 Source[Systematic Review]
- Freedman, V. A.; Kasper, J. D.; Spillman, B. C. Successful aging through successful accommodation with assistive devices. The Journals of Gerontology: Series B. 2017;72(2), 300-309. doi:10.1093/geronb/gbw102 Source[Review Articles]
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- Hopkins, R. O.; Suchyta, M. R.; Kamdar, B. B.; Darowski, E.; Jackson, J. C.; Needham, D. M. Instrumental activities of daily living after critical illness: A systematic review. Annals of the American Thoracic Society. 2017;14(8), 1332-1343. doi:10.1513/AnnalsATS.201701-059SR [Systematic Review]
- Lim, Y. M.; Kim, H.; Cha, Y. J. Effects of environmental modification on activities of daily living, social participation and quality of life in the older adults: A meta-analysis of randomized controlled trials. Disability and Rehabilitation: Assistive Technology. 2020;15(2), 132-140. doi:10.1080/17483107.2018.1533595 [Meta-analysis]
- Martínez-Velilla, N.; Cadore, E. L.; Casas-Herrero, Á.; Idoate-Saralegui, F.; Izquierdo, M. Physical activity and early rehabilitation in hospitalized elderly medical patients: Systematic review of randomized clinical trials. Journal of Nutrition, Health and Aging. 2016;20(7), 738-751. doi:10.1007/s12603-016-0683-4 [Metasynthesis,Meta-analysis,Systematic Review]
- Pendleton, H. M.; Schultz-Krohn, W. (2018). Pedretti's occupational therapy: Practice skills for physical dysfunction. St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
- Registered Nurses' Association of Ontario. (2015). Person- and family-centred care. Source[Quality Measures,Clinical Practice Guidelines]
- Roberts, C. E.; Phillips, L. H.; Cooper, C. L.; Gray, S.; Allan, J. L. Effect of different types of physical activity on activities of daily living in older adults: Systematic review and meta-analysis. Journal of Aging and Physical Activity. 2017;25(4), 653-670. doi:10.1123/japa.2016-0201 Source[Meta-analysis,Systematic Review]
- Swearingen, P. L.; Wright, J. (2019). All-in-One Nursing Care Planning Resource-E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health. Philadelphia: Elsevier Health Sciences. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
- Vining Radomski, M.; Trombly Latham, C. A. (2014). Occupational therapy for physical dysfunction. Baltimore: Wolters Kluwer/Lippincott Williams & Wilkins. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
- Wang, D. X.; Yao, J.; Zirek, Y.; Reijnierse, E. M.; Maier, A. B. Muscle mass, strength, and physical performance predicting activities of daily living: A meta‐analysis. Journal of Cachexia, Sarcopenia and Muscle. 2019;11(1), 3-25. doi:10.1002/jcsm.12502 Source[Meta-analysis]
Disclaimer
Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.
