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    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.

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