Ineffective Health Maintenance Nursing Diagnosis and Nursing Care Plan

Ineffective Health Maintenance

Ineffective Health Maintenance Nursing Diagnosis and Nursing Care Plan

This guide is about ineffective health maintenance, ineffective health maintenance nursing diagnosis, and ineffective health maintenance care plan. It can be used to develop ineffective health maintenance care plans for educational purposes.

What is ineffective health maintenance?

Ineffective Health Maintenance Nursing Diagnosis and Nursing Care Plan
Health Maintenance

Ineffective Health Maintenance is a NANDA nursing diagnosis that refers to the changes in one’s ability to maintain or manage his or her healthcare requirements, whether they may be physical, mental, social, or spiritual needs. This can be a result of the patient’s lack of ownership of their health or it can be out of their control, such as cognitive impairment.

Ineffective health maintenance incorporates components of related nursing diagnoses. Specific diagnoses such as impaired communication, confusion, grieving, hopelessness, spiritual distress, and many others can correlate to ineffective health maintenance. Regardless of the reason, it prevents the patient from identifying, managing, or seeking help to maintain their health.

Ineffective health maintenance can be the result of a patient’s lack of ownership of their health or it can be out of their control, such as with cognitive impairment. A patient displaying poor health due to lifestyle choices or disinterest in making changes presents a different challenge than a patient who attempts to improve their health but lacks finances or family support. In many instances, the nurse can present information and resources, support and empower the patient in making a plan or setting goals, and continue to follow-up, but the patient must play an active role in maintaining or improving their health status.

What causes ineffective health maintenance?

  • Inability to make appropriate judgments
  • Cognitive impairment
  • Developmental delay
  • Lack of motor skills to perform tasks (opening pill bottles)
  • Ineffective coping
  • Lack of psychosocial support
  • Complicated family dynamics
  • Insufficient finances
  • Lack of access to resources
  • Lack of motivation
  • Poor adherence
  • Depression
  • Deficient knowledge
  • Poor lifestyle choices (substance abuse, smoking, poor diet)

What are the Signs and Symptoms of ineffective health maintenance? (As evidenced by) 

Subjective: (Patient reports) 

  • Expressed disinterest in improving health
  • Expressed lack of knowledge or knowing where to start

Objective: (Nurse assessments) 

  • Worsening of health status
  • Demonstrated lack of knowledge
  • Demonstrated lack of adherence
  • History of lack of health-seeking behaviors
  • Lack of motivation due to depression, grieving, hopelessness, etc.
  • Inability to make decisions due to cognitive functioning
  • Inability to perform health maintenance behaviors due to physical impairment

What are the expected outcomes of diagnosing ineffective health maintenance?

  • Patient will verbalize factors contributing to current health status/preventing improved health status
  • Patient will adopt lifestyle changes to support health goals (example: Patient will stop smoking by the end of the year to prevent worsening of asthma.)
  • Patient will identify resources necessary to support health maintenance

 Ineffective Health Maintenance Nursing Diagnosis

Ineffective Health Maintenance Nursing Diagnosis and Nursing Care Plan
Ineffective Health Maintenance Nursing Diagnosis

How do you diagnose for ineffective health maintenance?

1. Assess conditions that prevent health maintenance.
Physical impairments (Parkinson’s disease, stroke, paralysis) and cognitive impairments (dementia, mental retardation) may prevent the patient from making appropriate decisions or completing tasks without the help of others.

2. Assess for religious and cultural beliefs.
Patients who have strong religious or cultural beliefs (not receiving blood products, distrust in Western medicine) may present as barriers to appropriate health maintenance.

3. Assess for family support.
A lack of family or social support systems can be detrimental to all patients, regardless of physical or mental capabilities. Family and friends can also influence poor decisions.

4. Evaluate for substance abuse.
Without judging, the nurse evaluates the use of harmful substances and the role played in the patient’s life and health. People often use addictive substances (even caffeine) to cope.

5. Note recent losses or life changes.
Grieving the loss of a loved one, loss of independence, and changes in finances, causes stress and prevent the patient from focusing on maintaining their health.

6. Assess living environment and access to resources.
A patient that is homeless or living in a rural area may not have access to community resources or healthcare providers.

7. Assess interest and desire to improve health.
Before presenting the patient with information or resources or assuming interest the nurse should assess for readiness. The patient may not be motivated or have a thorough understanding of the need to improve health behaviors.

8. Assess prior attempts to change and their understanding of the situation.
It may help the nurse to better understand steps the patient took in the past to improve their health and what didn’t work. The nurse may be able to present information in a better way or help them implement more appropriate interventions.

Ineffective Health Maintenance Nursing Care Plan

Ineffective Health Maintenance Nursing Diagnosis and Nursing Care Plan
Ineffective Health Maintenance Nursing Care Plan

What are the nursing interventions for ineffective health maintenance?

1. Incorporate the patient in their health goals.
A patient who does not understand the reason for changing or is not interested/ready to change will not do so. The nurse must meet the patient where they are in their health journey and focus on what is important to them and their current capabilities.

2. Simplify their treatment plan.
If medication adherence is an issue or completing appointments discuss with the provider ways to increase adherence by suggesting once-daily pills instead of divided doses and telehealth visits when appropriate.

3. Coordinate resources.
The nurse is vital in advocating and coordinating on behalf of the patient. Patients who lack knowledge of available resources or how to set them up will benefit from support. The nurse can begin communication with community resources such as food pantries, free dental clinics, or patient assistance programs.

4. Offer mental health support.
Patients struggling with coping with their illnesses, instances of abuse, depression, or complicated grief may require mental health intervention. Patients cannot focus on health maintenance activities if they do not feel safe or mentally well.

5. Educate about the detriment of health behaviors.
Patients may not understand the consequences of certain behaviors. Without instilling unnecessary fear, the nurse can present facts that the patient may have been unaware of. For example, a pregnant patient that has multiple sexual partners may not understand the risk of sexually transmitted diseases that can be transmitted to her child.

6. Help the patient see a trend when making positive changes.
For patients that may need visual reminders, the nurse can suggest keeping a log or journal. A patient that can visualize their blood pressure normalizing or staying on track with their diet is more likely to continue and create a positive habit.

7. Use motivational interviewing.
MI is an evidence-based approach to behavior change. The nurse can use the acronym OARS to help explore the patient’s thoughts and feelings.

  • O – Open-ended questions (Encourages the patient to think deeper)
  • A – Affirmations (Build the patient’s confidence and their ability to succeed)
  • R – Reflective listening (Show the patient you are listening and give them a chance to correct or elaborate)
  • S – Summarize – (Tie up the plan, goals, and next steps)

8. Involve family as applicable.
Patients may not want family members involved or they may lack support. Some family members may also lack an understanding or awareness of the severity of a situation. In this case, the nurse can invite family members to appointments or have conferences to support positive health maintenance.

9. Refer to social workers or home health.
The nurse can request referrals to other clinicians for continued follow-up. These professionals may be able to assess for further barriers at home and make recommendations.

10. Consider alternatives and get creative.
Nurses can think outside the box to overcome barriers. A bed-bound patient may require virtual care or home visits by a provider. A patient that lacks transportation may need their medications delivered. Patients with memory loss or who miss appointments frequently can be sent text reminders.

11. Discuss programs for substance abuse or smoking cessation.
A patient that appears interested in overcoming addiction may seek out help. Offer phone numbers to Narcotics/Alcoholics Anonymous or programs that support smoking cessation.

12. Assist in setting up appointments for preventive health.
The best health maintenance begins with prevention. Remind and if necessary, set up appointments for breast cancer screenings, pap smears, and vaccinations. Make sure the patient understands the reasoning and importance for better adherence.

Ineffective Health Maintenance Nursing Diagnosis and Nursing Care Plan Examples

Ineffective Health Maintenance Nursing Care Plan 1

Pressure Ulcer

Nursing Diagnosis: Risk for Ineffective Health Maintenance secondary to Pressure Ulcer related to the need for long term pressure ulcer management

Desired Outcome: The patient and the caregiver will demonstrate understanding of the following aspects of care related to pressure ulcer management: relief of pressure, wound care, nutrition, and incontinence management.

Ineffective Health Maintenance Nursing Interventions Rationale
Assess the patient and the home caregiver’s knowledge of and ability to provide local wound care. The patient may need to have long-term care after being discharged from the hospital, therefore the need for local wound care may continue at home for weeks to months. Assessing the caregiver and the patient’s knowledge will provide baseline information on how to educate the patient and the caregiver in managing pressure ulcer wounds.
Assess the patient and the caregiver’s understanding of and ability to provide a high-calorie, high-protein diet throughout the course of healing. Nutrition is a vital part of the wound healing process. Assessment of the patient and caregiver’s knowledge on diet and nutrition will provide a better meal plan for the patient, thus, promoting fast recovery and healing from pressure ulcers.
Teach the client and the caregiver to observe: report the signs of wound infection: fever or high temperature, general malaise, malaise, chills, foul-smelling odor, purulent drainage.  Early detection of the signs and symptoms of an impending infection would prompt immediate intervention to avoid complications and further tissue injury.
Educate the patient and the caregiver on the importance of pressure reduction and relief (e.g., turning schedule, use of specialty beds, use of relief surface where the client sits). Providing information to the caregiver and the patient will enhance adherence to pressure ulcer treatment guidelines.  Proper education of Interventions will promote relief and will help in fast wound recovery.
Educate the patient and the caregiver regarding local wound care, and allow for a return demonstration. The teach-back method is the most effective way to measure the patient and caregiver’s knowledge, thus enhancing retention. Immediate feedback allows the learner to make corrections in real-time.

Ineffective Health Maintenance Nursing Care Plan 2

Terminal or End-stage Cancer

Nursing Diagnosis: Risk for Ineffective Health Maintenance related to anxiety secondary to terminal cancer.

Desired Outcome: The patient will demonstrate the ability to cope adequately with the existing condition and adopt lifestyle changes to support health goals.

Ineffective Health Maintenance Nursing Interventions Rationale
Discuss with the patient any anxiety towards his or her condition. Offer available help to control anxiety levels. It is important to recognize the patient’s anxiety level in relation to the condition as this may determine the reason behind ineffective health maintenance. Initiating intervention would be effective since the patient will cooperate in the plan of care if the anxiety levels are understood and addressed.
Communicate with the patient using easy-to-understand words and b brief statements Avoid using medical jargon, or explain what the medical term/s mean. Simplifying the patient’s treatment plan and instruction using easy-to-understand words and brief statements s would yield increase adherence to the therapy regimen especially when the patient is experiencing moderate to severe anxiety.
Incorporate the patient in their health goals and recognize the patient for achieving goals. Involving the patient in planning self-care will enhance independence and improve self-awareness. Compliments and achievements raise motivation and reinforce that the actions taken are appropriate thus, reducing anxiety.
Introduce anxiety-reducing skills to the patient and demonstrate as needed (e.g., relaxation, deep breathing, positive visualization, and reassuring self-statements). Stress management with the patient having a terminal illness such as end-stage cancer may be difficult. Helping the patient discover new coping methods provides the patient with a variety of ways to manage anxiety.
Discuss with the patient all the parts of his or her treatment plan and procedures by utilizing non-medical terms, as well as a  calm tone of voice and slow speech. Verify the patient’s understanding by asking questions. Providing clear explanations in a non-threatening way may motivate the patient to adhere to activities that promote health. Mirroring the patient’s pace and validating knowledge of the procedure decreases anxiety.

 


References and Sources

  1. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
  2. Hartney, E. (2021, May 30). What Is Motivational Interviewing? Verywell Mind. https://www.verywellmind.com/what-is-motivational-interviewing-22378
  3. Canadian Institute for Substance Use Research. (2017). Understanding Substance Use: A health promotion perspective. Here to Help. https://www.heretohelp.bc.ca/infosheet/understanding-substance-use-a-health-promotion-perspective#applies

Ineffective Health Maintenance Nursing Diagnosis and Nursing Care Plan

Ineffective Health Maintenance Nursing Diagnosis and Nursing Care Plan

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