Mental or physical challenges can be the cause of people not being able to take care of themselves adequately. Nurses may use this care plan in any setting with patients dependent on personal care and hygiene.
Self- Care Deficit is the inability to perform feeding, bathing, dressing, and toileting activities by oneself and therefore depend on others for routine activities.
The self-care deficit theory by Dorothea Orem talks about precisely that: encouraging the patient to participate in activities of daily living as much as possible.
- Body injuries
- Mental health problems such as dementia
- Degenerative body functions
- Lack of interest
- Lack of knowledge
- Lack of resources
Signs and Symptoms…
- Verbalization of lack of self-care abilities
- Body odor
- Inability to perform self-care tasks
- Weight loss
- Unkempt appearance
- Skin breakdown
- The patient will perform activities of daily living as independently as possible
- The patient will perform ADLs safely and recognize when he or she needs assistance
- The patient will name available resources to continue to improve building independence
|Subjective data: patients might say…|
“I need help getting ready for the day.”
“Since my car accident, I need help standing up.”
|Objective data: you might find the following during your assessment… |
The patient is unable to reach the entire body when washing.
The patient is unable to bring food to the mouth.
The patient has a stage one ulcer on the sacrum.
Nursing Interventions for Self-Care Deficit
|Observe self-care tasks.|
This provides a baseline about how dependent the patient is and how much help the patient needs. From there, the nurse may create an individualized care plan that focuses on maximum independence for the patient.
|Involve the patient in the development of the care plan.|
Including the patient in the plan of care provides a sense of autonomy. The patient is also more likely to comply if he or she helped work on the plan.
|Assess the reason for the patient’s impaired self-care.|
The reason for the deficient self-care builds the foundation of the care plan. Knowing why the patient is unable to care for himself or herself allows the nurse to focus on the cause and improve it. For example, mental health problems such as dementia or schizophrenia can be medically treated, and therefore the self-care process improved.
|Establish a routine with the patient |
Routines provide a sense of security. The patient feels much more confident knowing repetitive individual steps of a specific process.
|Encourage the patient to verbalize thoughts, fear, and frustration |
The patient might be in a new situation or a worsening condition that requires adjustment. An opportunity to express negative feelings could give the patient relief and allow for the healing process to begin.
Inquire about a swallow screen and evaluation before feeding the patient -diet recommendation.
Speech therapy can assess the patient’s ability to swallow different types of liquids and foods and also different consistencies. Sometimes staff has to thicken fluids, puree food, or crush medications so that the patient can safely consume food and medicines.
|Ask the patient about food preferences.|
Patients are much more inclined to eat the food that they like. Nutrition is a vital part of the healing process. It is also essential to consider the patient’s cultural beliefs. Some religions restrict the consumption of certain foods. If the healthcare team considers all these factors, the patient is more likely to comply with eating and, therefore, heals more quickly.
|Ask the patient about the use of modified utensils.|
Patients with physical limitations might need special utensils that make eating easier and more enjoyable for them. Some might already use specific tools at home. Have someone bring them to the patient during the hospital stay. However, suppose the patient experiences a new physical challenge. In that case, you have to get physical therapy to evaluate the patient’s baseline and skills so that the healthcare team can provide the necessary equipment for this new situation. The patient is more motivated when he or she has assistance to do so.
|Encourage the patient to use proper body alignment and mechanics |
Proper body mechanics during eating is safer for the patient. It helps prevent food from entering the wrong place. Sitting up straight to the best of the patient’s ability reduces the risk of choking greatly and benefits with proper digestion.
|Allow enough time between bites.|
When assisting with feeding, it is crucial to adjust to the patient’s pace. If the patient feels rushed or senses that you are in a hurry, it is more likely for the patient not to chew his or her food properly. Frequently, tell the patient to allow enough time to chew the food thoroughly.
|Encourage sips of water/fluids between food.|
Sips of fluids between bites allow the patient to clear his or her mouth from food and prevent food from getting stuck. It also prevents the patient from pocketing food and his or her mouth or accumulating too much food that will be difficult to swallow.
|Inquire feedback about usage of new methods and utensils.|
The most important thing is that your patient feels like newly implemented strategies are working. This feedback allows the healthcare team to make adjustments to the care plan throughout the process and personalize these strategies.
|Assist the patient with other deficits such as dentures, and glasses.|
Dentures and glasses will make eating a more comfortable and pleasant experience. Seeing the food makes it more appealing, and the patient will require the least assistance during meals. Dentures will facilitate the chewing process. These aides will help increase independence.
Assess the patient’s ability to bathe on his or her own.
This provides information about how much help the patient needs. Sometimes patients need more than one person or even devices to transfer them safely.
|Let the patient decide what time he or she wants to bathe.|
If patients can make some decisions about their care, it gives some degree of autonomy and lets them participate in their care.
|Assist with places that are difficult to reach.|
You want to assist patients in things they cannot do for themselves but promote independence at the same time.
Always show that you respect the patient’s privacy as much as you can. This fosters trust in the relationship between the patient and the healthcare staff.
|Dressing and grooming: Adapt to the pace of the patient.|
It’s easy to jump ahead and do things for the patient when dressing and grooming. However, the most beneficial way for the patient is to give him or her enough time to perform all these tasks. This ensures that the patient has assistance available if needed but also can be as independent as he or she is able.
|Let the patient select clothes and accessories.|
This is a great way to normalize the situation as much as possible. The patient feels included in the care and more motivated to participate in the plan of care.
|Encourage to wear comfortable clothes such as jogging pants. |
Whether the setting is in a long term care facility or at the hospital, patients don’t feel their best and sometimes have equipment attached to them. Some patients have foley catheters and other things that can make it difficult to put clothes on. Some patients use wheelchairs most of the day. Comfortable, wider clothing facilitates these challenges.
Use appropriate equipment for the safety of all parties involved.
Using the right equipment when transferring patients is safer and more comfortable for the patient.
|Regularly reevaluate the need for the use of the same mechanical aides.|
Some patients might deteriorate during their hospital stay or while in the nursing home and require equipment that is more suited for a more dependent patient. The patient might get better and not need the transfer aid anymore. Either way, frequent evaluation keeps everyone safe.
|Allow enough time to prepare for transfer.|
It takes time for the patient to get situated and ready to stand up or transfer.
|Always let the patient know about the next move.|
Ongoing communication between the patient and the person assisting allows for a smooth process of transferring. The patient feels safer and has the chance to prepare and help without feeling caught off guard.
|Align pain medication administration before moving the patient extensively.|
Depending on the patient’s condition, it is good to provide the patient with pain relief before transferring or other activities of daily living. If the patient is pain-free, ADLs will be more manageable.
Respecting the patient’s need for privacy builds trust and allows for ongoing open communication with the healthcare team.
|Ask about previous routines about transfer.|
Maintaining a routine as much as possible gives patients confidence and makes transfers easier because they know what to expect.
More Care Plans:
Ackley, B., & Ladwig, G. (2014). Nursing diagnosis handbook (10th ed.). Maryland Heights: Mosby Elsevier.
Gulanick, M., & Myers, J. (2014). Nursing care plans (8th ed.). Elsevier.