NANDA-I Definition: Inability to independently maintain a safe growth-promoting immediate environment.
Nursing Diagnosis: Impaired Home Maintenance
- Lack of financial resources
- Physical impairment
- Inadequate or no support system
- Substance abuse
- Lack of knowledge
- Acuity of illness
- Cognitive or emotional impairment
- Sudden change in the caregiver role
- Inadequate planning and organization
Subjective Data: patient’s feelings, perceptions, and concerns. (Symptoms)
- Expresses difficulty in maintaining a comfortable home environment
- Reports a drastic change in the home environment such as the loss of a family member or caregiver
- Reports financial strain
- Requests help with household maintenance
Objective Data: assessment, diagnostic tests, and lab values. (Signs)
- Poor hygiene and unkempt appearance; body odor
- Chaotic household
- Lack of necessary tools such as for cooking and cleaning
- Physically and emotionally strained caregiver
- Lacking clothes, linen, and other essential items
- Illnesses, infections, and disorders deriving from lack of hygiene
- The patient will use available resources to maintain a healthy and safe home environment
- The patient will be able to identify appropriate resources
- The patient will demonstrate the ability to maintain a healthy home environment
|Assess the patient’s cognitive and emotional fitness to change. |
This information provides a baseline and directs the treatment plan. A patient has to be ready and make changes or tolerate changes before a plan can be established.
|Assess the patient’s ability to care for self. |
This information will guide the necessary interventions. For example, the patient might not eat very much and rarely prepare food because they cannot tolerate long hours of standing up.
|Evaluate the caregiver’s preparedness to care for the patient adequately. |
Most family members and some caregivers don’t receive official training in patient care. Without training and support, the situation can become very overwhelming. Once the lacking skills have been identified, adjustments can dramatically increase the patient’s quality of care.
|Pay a home visit and assess the patient’s home environment. |
Assess for basic functions of the home such as
Assess the availability of necessary amenities such as
Functionality of heat and airconditioning
The condition of the home provides for a starting point. This inspection will give a guideline of all issues that need to be addressed.
|Ask the caregiver and family about the patient’s living situation.|
Families and caregivers can provide valuable and unique information about the current home situation and their concerns. The family and caregiver have a different perspective of the problem and report issues that the patient might not be aware of.
|Assess financial resources. |
The patient or family might not have enough money to afford necessities, such as paying the rent, utility, groceries, and other financial responsibilities. Community funds and government assistance can sometimes help relieve financial strain.
|Assess if the patient has the necessary equipment to maintain a healthy home. |
To perform specific tasks, the patient might need assistive devices or other equipment.
Nursing Interventions for Impaired Home Maintenance
|Initiate discharge planning after the patient has been admitted and involve all immediate family members and caregivers. |
Due to a possible change in the patient’s health status, the home conditions might have to be adjusted. The patient might need more attention and increased care than before the hospital stay.
|Plan to visit the home before discharge. |
The patient’s new condition might require many further adjustments around the home. Careful planning before the patient returns home will ensure a more smooth and successful transition.
|Obtain the equipment needed for the living situation at home. |
The patient might rely on new equipment that needs to be installed in the home. Improved devices and increased support might keep the patient away from repeated hospital admissions.
|Teach the family, primary caregiver, and friends about the use of new equipment. |
Before using new equipment, every person should be trained in safe usage to avoid injury.
|Educate the family members and the primary caregiver about the importance of taking time off to recover. |
Many primary caregivers are available to the patient around the clock and forget to take care of themselves. However, it is not beneficial for the patient or the caregiver if there is no relief or support.
|Help the family establish a relief system for taking care of the patient. |
Mobilizing family members and friends to help out with patient care might alleviate the primary caregivers’ workload.
|Educate the family and caregivers about proper patient care. |
A consistent standard of care will benefit the patient. Caregivers can take care without a compromise in quality of care.
|Consult a social worker. |
The patient might not be aware that they can use various services such as financial assistance, home care services, and treatment programs for substance abuse.
|Collaborate with physical therapy, occupational therapy, the dietitian, and home health services to continue care at home. |
These services help transition from hospital care to home care and enable the patient to receive care at home, not in the hospital.
|Assist in making community services such as Meals on Wheels, transportation, and other services available. |
The use of community agencies will enable the patient to live at home with assistance for as long as possible. Access to these service providers improves the patient’s overall well being.
|Assist with finding a permanent home in a group home or nursing facility if the family cannot continue care at home.|
The patient’s care that is required might be too complicated and need a professional level of care.
|Introduce the family and caregiver to support groups in the community. |
Caregiver groups can be helpful with emotional support. The participants can benefit from hearing similar experiences and talk about their thoughts and feelings. The caregiver can decompress and recharge.
|Provide the option of counseling services. |
Caregivers with sudden changes might need professional help to process their new situation. For example, if someone’s significant other suffered from a stroke and now requires total patient care can be emotionally overwhelming. Professional help can assist with adjustments.
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