Careplan

    Self-Care Deficit, Adult

    Oct.01.2020

    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:
    • Improved Ability to Complete Activities of Daily Living

    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

    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]
    • Haugen, N.; Galura, S. (2020). Ulrich and Canale's Nursing Care Planning Resource-E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health. St. Louis: Saunders, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
    • 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.

    Logo pequeno da Elsevier

    Cookies são usados neste site. Para recusar ou saber mais, visite nosso conheça nosso aviso de cookies.


    Copyright © 2024 Elsevier, its licensors, and contributors. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

    Logo pequeno da Elsevier
    RELX Group