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 care
A. The patient will achieve the following goals:
B. Patient, family or significant other will teach back or demonstrate education topics and points:
- Education: Overview
- Education: Self Management
- Education: When to Seek Medical Attention
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.
- Implement appropriate environmental modifications, such as decluttering and rearranging room to allow wheelchair access.
- Promote use of recommended adaptive equipment, devices and orthoses.
- 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.
- Activity Assistance Provided
- Adaptive Equipment Use
- Self-Care Promotion
Education
Overview
risk factors
signs/symptoms
When to Seek Medical Attention
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
References
- Bulechek, G. M.; Butcher, H. K.; McCloskey-Dochterman, J. M.; Wagner, C. (2013). Nursing Interventions Classification (NIC). St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
- Foster, E. R.; Bedekar, M.; Tickle-Degnen, L. Systematic review of the effectiveness of occupational therapy - related interventions for people with Parkinson's Disease. American Journal of Occupational Therapy. 2014;68(1), 39-49. [Metasynthesis,Meta-analysis,Systematic Review]
- Legg, L.; Drummond, A.; Leonardi-Bee, J.; Gladman, J. R. F.; Corr, S.; Donkervoort, M.; Edmans, J.; Gilbertson, L.; Jongbloed, L.; Logan, P.; Sackley, C.; Walker, M.; Langhorne, P. Occupational therapy for patients with problems in personal activities of daily living after stroke: Systematic review of randomised trials. British Medical Journal. 2007;335(7626), 922-925. doi:10.1136/bmj.39343.466863.55 [Metasynthesis,Meta-analysis,Systematic Review]
- 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]
- National Guideline Clearinghouse (NGC). (2012, January). Guideline summary: Function-focused care (FFC) interventions. In Evidence-based geriatric nursing protocols for best practice. (Summary of a guideline from Hartford Institute for Geriatric Nursing) In: National Guideline Clearinghouse (NGC) [Web site]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ). [Quality Measures,Clinical Practice Guidelines]
- National Guideline Clearinghouse (NGC). (2014, January). Guideline summary: Occupational therapy practice guidelines for adults with neurodegenerative diseases. (Summary of a guideline from the American Occupational Therapy Association, Inc.) In: National Guideline Clearinghouse (NGC) [Web site]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ). [Quality Measures,Clinical Practice Guidelines]
- Pendleton, H. M.; Schultz-Krohn, W. (2013). Pedretti's occupational therapy: Practice skills for physical dysfunction. St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
- Pollock, A.; Baer, G.; Campbell, P.; Choo, P. L.; Forster, A.; Morris, J.; Pomeroy, V. M.; Langhorne, P. Physical treatment is effective in the promotion of functional recovery after stroke: Results of a Cochrane systematic review. Cerebrovascular Diseases. 2014;37, 30. doi:10.1159/000356349 [Metasynthesis,Meta-analysis,Systematic Review]
- 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]
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.