Self-Care Deficit, Self-Care Deficit Nursing Assessment, Self-Care Deficit Nursing Interventions, and 4 Examples of Self-Care Deficit Nursing Care Plans

This guide is about Self-Care Deficit, Self-Care Deficit Nursing Assessment, Self-Care Deficit Nursing Interventions, and 4 Examples of Self-Care Deficit Nursing Care Plans.

This guide is about Self-Care Deficit, Self-Care Deficit Nursing Assessment, Self-Care Deficit Nursing Interventions, and 4 Examples of Self-Care Deficit Nursing Care Plans. It can be used to develop Self-Care Deficit nursing interventions for educational purposes.

Self-Care Deficit

What is Self-Care Deficit?

This guide is about Self-Care Deficit, Self-Care Deficit Nursing Assessment, Self-Care Deficit Nursing Interventions, and 4 Examples of Self-Care Deficit Nursing Care Plans.
What is Self-Care Deficit?

Self-care involves activities of daily living (ADLs) that involve the promotion and maintenance of personal well-being. These self-care tasks include feeding, bathing, toileting, grooming, and dressing. Activities of daily living or ADLs are defined as “the stuff we regularly do such as feeding ourselves, bathing, dressing, grooming, work, homemaking, and leisure. However, there are some that might have difficulties in performing self-care. Self-Care Deficit is a NANDA nursing diagnosis that defines a client’s inability to perform self-care on his/her own.

A client may experience a deficit in the ability to self-care after experiencing an accident or trauma such as fracture, a debilitating mental disorder such as major depression or schizophrenia, a progressive disease such as rheumatoid arthritis, dementia, or Alzheimer’s disease, or while on the recovery phase after surgery.

What is self-care by Dorothea Orem?

The nursing theorist Dorothea Orem developed the Self-Care Deficit Theory, a grand nursing theory that states that patients should be allowed to perform self-care to their best ability. It involves performing and achieving the self-care requisites of a patient, which are divided into 3 categories:

1. Universal Self-Care Requisites

  • Air
  • Water
  • Food
  • Elimination
  • Balance between Activity and rest
  • Balance between Social interaction and Solitude
  • Promotion of Normalcy and Human Functioning
  • Prevention of Hazards

2. Developmental Self-Care Requisites

  • Maintenance of developmental environment
  • Prevention and management of conditions that threaten normal development

3. Health Deviation Self-Care Requisites

  • Seeking appropriate medical assistance
  • Adherence to medical regimen
  • Awareness of potential problems
  • Promotion/ modification of self-image
  • Lifestyle adjustment to meet current health status and medical regimen
Orem identified five methods of helping a patient with self-care deficit:
  1. Acting for and doing for the client
  2. Guiding the client
  3. Supporting the patient
  4. Promoting personal development in relation to meet future demands
  5. Educating the patient

Self-Care Deficit Nursing Assessment

What is the nursing diagnosis of self-care deficit?

This guide is about Self-Care Deficit, Self-Care Deficit Nursing Assessment, Self-Care Deficit Nursing Interventions, and 4 Examples of Self-Care Deficit Nursing Care Plans.
Self-Care Deficit Nursing Assessment

Assessment is required in order to identify potential problems that may have lead to self-care deficit as well as name any episode that may happen during nursing care.

Nursing Assessment Rationales
Assess the patient’s strength to accomplish ADLs efficiently and cautiously on a daily basis using a proper assessment tool, such as the Functional Independence Measures (FIM). The patient may only need help with some self-care measures. FIM measures 18 self-care items related to eating, bathing, grooming, dressing, toileting, bladder and bowel management, transfer, ambulation, and stair climbing.
Determine the specific cause of each deficit (e.g., visual problems, weakness, cognitive impairment). Various etiological factors may need more explicit interventions to enable self-care.
Consider the patient’s need for assistive devices. Assistive devices improve confidence in performance of ADLs.
Recognize choice for food, personal care items, and other things. The patient will be eager to submit himself or herself to the treatment regimen that supports his or her individual preferences.
Evaluate gag reflex or the need for swallowing assessment by a speech therapist prior to initial oral feeding. Absence of gag reflex or inability to chew or swallow properly may lead to choking or aspiration.
Verify the need for home health care after discharge. Shortened hospital stay have resulted in patients being more debilitated on discharge and therefore requiring more assistance at home. Occupational therapists have access to a wide range of self-help devices.
Monitor impulsive behavior or actions indicative of altered judgment. This may imply the demand for supplementary interventions and management to guarantee safety or security.

Self-Care Deficit Nursing Interventions

What are the Nursing Interventions for Self-Care Deficit?

This guide is about Self-Care Deficit, Self-Care Deficit Nursing Assessment, Self-Care Deficit Nursing Interventions, and 4 Examples of Self-Care Deficit Nursing Care Plans.
Self-Care Deficit Nursing Interventions

The following are the therapeutic nursing interventions for self-care deficit:

Nursing Interventions Rationales
Establish short-term goals with the patient. Helping the patient with setting realistic goals will reduce frustration.
Guide the patient in accepting the needed amount of dependence. Patient may require help in determining the safe limits of trying to be independent versus asking for assistance when necessary.
Present positive reinforcement for all activities attempted; note partial achievements. External resources of positive reinforcement may promote ongoing efforts. Patients often have difficulty seeing progress.
Render supervision for each activity until the patient exhibits the skill effectively and is secured in independent care; reevaluate regularly to be certain that the patient is keeping the skill level and remains safe in the environment. The patient’s ability to perform self-care measures may change often over time and will need to be assessed regularly.
Implement measures to promote independence, but intervene when the patient cannot function. An appropriate level of assistive care can prevent injury from activities without causing frustration. Nurses can be key in helping patients accept both temporary and permanent dependence.
Boost maximum independence. The goal of rehabilitation is one of achieving the highest level of independence possible.
Apply regular routines, and allow adequate time for the patient to complete task. An established routine becomes rote and requires less effort. This helps the patient organize and carry out self-care skills.
Feeding
Allow the patient to feed himself or herself as soon as possible (using the unaffected hand, if appropriate). Assist with setup as needed. It is possible that the dominant hand will also be the affected hand if there is upper extremity involvement.
Ensure the patient wears dentures and eyeglasses if required. Deficits may be exaggerated if other senses or strengths are not functioning optimally.
Place the patient in a comfortable position for feeding. Proper positioning can make the task easier while also reducing the risk for aspiration.
Provide patient with proper utensils (e.g., wide-grip utensils, rocking knife, plate guard, drinking straw) to aid in self-feeding. These things expand possibilities of success.
Assure that the consistency of diet is suitable for the patient’s ability to chew and swallow, as assessed by the speech therapist. Thickened semisolid foods such as pudding and hot cereal are most easily swallowed and less likely to be aspirated.
If vision is affected, guide the patient about the placement of food on the plate. After a CVA, patients may have unilateral neglect and may ignore half of the plate.
Provide an appropriate setting for feeding where the patient has supportive assistance yet is not embarrassed. Embarrassment or fear of spilling food on self may prevent the patient’s effort to feed self.
Dressing/grooming
Provide privacy during dressing. The need for privacy is fundamental for most patients. Patients may take longer to dress and may be fearful of breaches in privacy.
Use appropriate assistive devices for dressing as assessed by the nurse and occupational therapist. The use of buttonhook or loop-and-pile closures on clothes may make it possible for a patient to continue independence in this self-care activity.
Suggest elastic shoelaces or Velcro closures on shoes. The closures eliminate tying, which can add to frustration.
Give frequent encouragement and aid with dressing as needed. Assistance can reduce energy expenditure and frustration. However, care needs to be taken so the care provider does not rush through tasks, negating the patient’s attempts.
Utilize wheelchair or stationary chair. Dressing requires energy. A chair that provides more support for the body than sitting on the side of the bed saves energy when dressing.
Establish regular activities so the patient is rested before activity. A plan that balances periods of activity with periods of rest can help the patient complete the desired activity without undue fatigue and frustration.
Consider the use of clothing one size larger. A large size guarantees easier dressing and comfort.
Recommend a front-opening brassiere and half-slips. Clothing that is easier to put on and remove enhances self-care with dressing.
Transferring/Ambulation
For moderate assistance, the caregiver places arms beneath both patient’s armpits with the caregiver’s hands on the patient’s back. This method forces the patient to maintain his or her weight forward.
For patients needing maximal assistance, use a gait belt.

  • Raise the bed to the tallest height that still allows the patient’s feet to be flat on the floor.
  • Grasp the gait belt with both arms, and pull the patient forward.
  • Place a knee against the patient’s weak knee (if applicable), and encourage the patient to put weight on the strong side during the transfer.
  • Encourage the patient to use his or her arms to assist, as able, and to place them on the caregiver’s forearms.
This method maximizes patient support while protecting the care provider from injury.
Aid with ambulation; direct the use of ambulation devices such as canes, walkers, and crutches.

  • Stand on the patient’s weak side.
  • If using a cane, place the cane in the patient’s strong hand and ensure proper foot-cane sequence.
These methods promote patient safety and aid with balance and support.
Miscellaneous skills:
Telephone: Evaluate need for adaptive equipment through the therapy department (e.g., increased volume, larger numbers, pushbutton phone). Patients will need a useful tool for communicating needs from home.
Writing: Provide the patient with felt-tip pens. Assess the demand for a support or splint on the writing hand. Felt-tip pens mark with little pressure and are easier to use. Splints assist in holding the writing device.
Toileting
Assess and note prior and present patterns for toileting; introduce a toileting routine that factors these habits into the program. The efficacy of the bowel or bladder program will be improved if the natural and personal patterns of the patient are taken into consideration.
Assess patient’s ability to verbalize necessitate to void and/or capacity to use urinal, bedpan. Bring patient to the bathroom at regular or intermittent intervals for voiding if suitable. Patient may have neurogenic bladder, is lacking concentration, or be able to verbalize needs in acute recovery phase, but often is able to recover independent control of this function as recovery develops.
Provide privacy while patient is toileting. Lack of privacy may reduce the patient’s ability to empty bowel and bladder.
Give bedpan or put patient on toilet every 1 to 1½ hours throughout day and three times throughout night. This eradicates incontinence. Time intervals can be prolonged as the patient starts to verbalize the need to toilet on demand.
Give suppositories and stool softeners. May be essential at first to help in instituting normal bowel function.
Observe closely patient for loss of balance or fall. Maintain commode and toilet tissue close to the bedside for nighttime utilization. Patients may hurry readiness to ambulate to the toilet or commode throughout the night due to fear of soiling themselves and may fall in the procedure.
Keep call light within reach and teach patient to call as prompt as possible. This facilitates staff members to have ample time to help with transfer to commode or toilet.
Aid patient in eliminating or changing unnecessary clothing. Clothing that is not easy to get in and out of may compromise a patient’s capability to be continent.
Consider utilization of commode or toilet as early as possible. Patients are more successful in emptying bowel and bladder when sitting on a commode. A number of patients find it unfeasible to toilet on a bedpan.
Recognize prior bowel habits and restore normal regimen. Increase bulk in diet, fluid intake, and activity. Supports in progression of retraining program and helps in avoiding constipation and impaction.
More Interventions
Educate family and significant others to promote autonomy and to intervene if the patient becomes tired, not capable of carrying out task, or become extremely aggravated. This displays caring and concern but does not hinder with patient’s efforts to attain autonomy.
Inform family members to allow the patient perform self-care measures as much as possible. Reinstitutes feeling of independence and promotes self-esteem and improves rehabilitation process. Note: This may be very hard and discouraging for the significant other or caregiver, depending on extent of disability and time needed for the patient to accomplish activity.
Promote independence, but intervene when the patient is not able to carry out self-care activities. A suitable level of assistive care can avoid harm with activities without causing disappointment.
Entertain patient input in planning schedule. Patient’s worth of life is improved when wishes or likes are taken into consideration in daily activities.
Consider or use energy-conservation techniques. This saves energy, decreases fatigue, and improves patient’s capability to execute tasks.

Self-Care Deficit Nursing Care Plans

What Nursing Care Plans are Available for patients suffering from Self-Care Deficit?

Nursing Care Plan 1

Fracture

Nursing Diagnosis: Self-Care Deficit related to musculoskeletal impairment and physical limitations due to immobilizer secondary to arm fracture as evidenced by inability to bathe, get dressed, and perform toileting activities as normal

Desired Outcome: The patient will be able to demonstrate optimal performance of ADLs or activities of daily living.

Intervention Rationale
Assess the patient’s limitations to self-care by asking open-ended questions. To explore the patient’s self-care limitations and needs while allowing him/her to express his/her personal thoughts and feelings related to ADLs.
Offer appropriate pain medication as prescribed at least 30 minutes before the patient performs self-care activities. Pain might discourage the patient to mobilize and carry out self-care activities.
Educate the patient’s carer or significant other on providing appropriate assistance to the patient while he/she performs self-care tasks. To provide learning to the carer or significant other and to ensure that the patient has a good amount of support while doing ADLs at home. Skilled home services might be needed if there is no available significant other to care for the patient.
Refer the patient to occupational therapist. Occupational therapists are skilled professionals in helping clients achieve optimal performance in their daily activities like bathing, dressing, and personal hygiene tasks.
Coordinate with the physical therapy team on how to create and initiate an exercise program for the patient. A customized exercise plan can help the patient in terms of increasing his/her endurance and strength which he/she will need when doing self-care activities.
Encourage the patient to use assistive devices and grooming aids as needed. To promote autonomy when performing self-care activities.

Nursing Care Plan 2

Depression

Nursing Diagnosis: Self-Care Deficit related to perceptual or cognitive impairment with anergia and severe anxiety secondary to major depression, as evidenced by unwashed hair, foul body odor, weight loss, constipation, persistent hypersomnia or insomnia, and inability to bathe, get dressed, and perform toileting activities as normal

Desired Outcome: The patient will be able to demonstrate optimal performance of ADLs or activities of daily living as well as gradual return to normal BMI with the assistance of family, nurse, or carer.

Intervention Rationale
Assess the patient’s limitations to self-care by asking open-ended questions. To explore the patient’s self-care limitations and needs while allowing him/her to express his/her personal thoughts and feelings related to ADLs.
 Assist the patient to use toiletries and hygiene aids such as soap, shampoo, wash cloth, toothbrush, and shaver. Encourage the patient to perform self-care and offer help as needed. To promote the patient’s autonomy and increase his/her self-esteem.
Provide gentle instructions to the patient using a step-by-step method. For example: When bathing: “damp your face first using a washcloth, lather soap on hands and gently apply on the face.” Insomnia or hypersomnia as well as having major depression in general can decrease the level of concentration and cognition for the patient, so breaking down tasks into simple steps can help organize thoughts and actions.
Encourage the patient to increase oral fluid intake to reach 8 to 10 glasses a day, and to increase high calorie and fiber-rich foods. Monitor the patient’s intake and output and bowel movements daily. Perform weekly weight checks. Many patients with clinical major depression suffer from constipation and weight loss. Increased fluid intake and fibre-rich foods can help resolve constipation.
Ensure that the patient takes medications on time and as prescribed. To ensure adherence to medical regimen.
Educate the patient’s carer or significant other on providing appropriate assistance to the patient while he/she performs self-care tasks. To provide learning to the carer or significant other and to ensure that the patient has a good amount of support while doing ADLs at home. Skilled home services might be needed if there is no available significant other to care for the patient.
Encourage the patient to perform activities like crafts and games during the day and discourage sleeping during the day. Sleeping during the day can make the patient less sleepy at night, which can cause insomnia. Encouraging socialization can help the patient cope with depression.

Nursing Care Plan 3

Alzheimer’s Disease

Nursing Diagnosis: Self-Care Deficit (Toileting) related to cognitive impairment with secondary to Alzheimer’s disease, as evidenced by foul body odor, constipation, and inability to perform toileting activities as normal

Intervention Rationale
Assess the patient’s limitations to self-care by asking open-ended questions. Observe the patient’s cognitive and functional ability to perform self-care activities, especially toileting. To explore the patient’s self-care limitations and needs while allowing him/her to express his/her personal thoughts and feelings related to ADLs.
Allow sufficient time for the patient to perform his/her toileting routine without interrupting or rushing but offering help whenever it is needed. To promote the patent’s autonomy and independence while ensuring patient’s safety and support by the nurse or carer’s presence. Avoiding to rush the patient when doing self-care routines or rituals can help prevent mental stress to the Alzheimer’s disease patient.
Educate the patient’s carer or significant other on providing appropriate assistance to the patient while he/she performs self-care tasks. To provide learning to the carer or significant other and to ensure that the patient has a good amount of support while doing ADLs at home. Skilled home services might be needed if there is no available significant other to care for the patient.
Create a urinary and bowel routine care program with the patient’s carer if he/she is not able to complete toileting on his/her own. This may include toilet training by taking the patient to the bathroom every 2 to 3 hours. To help identify problems in urinary and bowel care and resolve these issues through careful planning and monitoring.
Note any sudden changes in urinary or bowel status. Incontinence, diarrhea, and/or constipation are common in patients with AD.
Administer laxatives or stool softeners as needed. To relieve constipation.
Ensure that the patient takes medications on time and as prescribed. To ensure adherence to medical regimen.
Encourage the patient to use assistive devices and grooming aids as needed. To promote autonomy when performing self-care activities.

Nursing Care Plan 4

Rheumatoid Arthritis

Nursing Diagnosis: Self-Care Deficit related to musculoskeletal impairment and physical limitations secondary to rheumatoid arthritis as evidenced by inability to bathe, get dressed, and perform toileting activities as normal, pain triggered by movement, and decreased level of strength and endurance

Desired Outcome: The patient will be able to demonstrate optimal performance of ADLs or activities of daily living.

Intervention Rationale
Observe the patient’s cognitive and functional ability to perform self-care activities, especially toileting. Use functioning assessment (from 0 to 4) scale. To determine the functional capability of the patient.
Assess the patient’s limitation and barriers to self-care by asking open-ended questions. To explore the patient’s self-care limitations and needs while allowing him/her to express his/her personal thoughts and feelings related to ADLs.
Offer appropriate pain medication as prescribed at least 30 minutes before the patient performs self-care activities. Pain might discourage the patient to mobilize and carry out self-care activities.
Ensure that the patient takes medications on time and as prescribed. To ensure adherence to medical regimen.
Allow the patient to have sufficient time to complete activities of daily living. Advise the patient to be patient with one’s self when performing self-care. To build patient’s confidence and allow him/her to have a greater sense of self-worth.
Refer the patient to occupational therapist. Occupational therapists are skilled professionals in helping clients achieve optimal performance in their daily activities like bathing, dressing, and personal hygiene tasks.
Encourage the patient to use assistive devices and grooming aids as needed. To promote autonomy when performing self-care activities.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.

This guide is about Self-Care Deficit, Self-Care Deficit Nursing Assessment, Self-Care Deficit Nursing Interventions, and 4 Examples of Self-Care Deficit Nursing Care Plans.

 

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