Self-care deficit refers to a patient who is not adequately performing the activities of daily living (ADLs). This can include tasks related to feeding, bathing and hygiene practices, as well as getting dressed and completing toileting. Self-care deficits can also expand to more complex tasks, such as making phone calls or managing finances, which are referred to as Instrumental Activities of Daily Living (IADLs).
Nurses must be able to recognize and assess limitations of patients in their ability to carry out basic needs. Some self-care deficits will be temporary, such as recovering from surgery, while others will be long-term, such as a patient with paraplegia. The nurse’s role is to create an adaptive environment that allows the patient to maintain as much independence as possible while also ensuring their needs are met through equipment, multidisciplinary therapies, and caregiver support.
In this article:
- Causes (Related to)
- Signs and Symptoms (As evidenced by)
- Expected Outcomes
- Nursing Assessment
- Nursing Interventions
- Nursing Care Plans
- References
Causes (Related to)
The following are common causes of self-care deficit:
- Weakness/fatigue
- Decreased motivation
- Depression or anxiety
- Pain
- Cognitive impairment
- Developmental disabilities
- Neuromuscular disorders (multiple sclerosis, myasthenia gravis)
- Poor mobility
- Recent surgery
- Lack of adaptive equipment
Signs and Symptoms (As evidenced by)
Patients with a self-care deficit will present with an inability to complete any of the following ADLs:
Self-feeding
- Prepare food, use appliances, open packaging
- Handle utensils
- Pick up or hold drinkware
- Chew or swallow
Self-bathing & Hygiene
- Gather and set up supplies
- Regulate water temperature
- Safely transfer in and out of shower/bathtub
- Raise arms to wash hair
- Bend to wash lower body
- Manipulate a toothbrush
- Clean dentures
Self-dressing & Grooming
- Make appropriate clothing choices
- Fasten buttons, zip zippers
- Apply socks or shoes
- Manipulate comb or brush
- Handle razor
Self-toileting
- Transfer on and off toilet
- Recognize the urge for elimination
- Remove clothing to use toilet
- Complete hygiene following elimination
Expected Outcomes
The following are common nursing care planning goals and expected outcomes for self-care deficit:
- Patient will perform ADLs within their own level of ability.
- Patient will maintain independence with [specify ADL].
- Caregiver will demonstrate the ability to meet patient’s personal needs.
- Patient will demonstrate appropriate use of adaptive equipment where necessary.
Nursing Assessment
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In the following section, we will cover subjective and objective data related to self-care deficit.
1. Assess the degree of disabilities or impairments.
Assessing the extent of cognitive, developmental, or physical impairments will help the nurse to assist the patient in creating reasonable goals for self-care.
2. Assess the patient’s ability to safely complete self-care.
Is the patient able to safely feed themselves without aspirating? Can they safely ambulate to the bathroom? If there is doubt, it may be necessary to observe the patient perform tasks to evaluate their ability.
3. Assess barriers that prevent self-care.
Identifying issues that prevent participating in self-care helps the nurse develop appropriate measures to support the patient. Examples include a lack of information, a fear of embarrassment, or a lack of adaptive equipment.
4. Plan for resources at discharge.
Discharge planning begins at admission. The nurse can coordinate with the case manager when there is an expected need for home health or rehabilitation services once discharged from the acute care facility. Anticipating the patient’s needs creates a smooth transition of care.
5. Assess mental health challenges.
Patients with chronic illnesses are often affected by depression and lack of motivation from losing their independence. The nurse should remain non-judgmental and compassionate. A referral to a counselor or psychiatry consultant may be needed to get to the root of the problem before self-care can be reestablished.
Nursing Interventions
Nursing interventions and care are essential for the patients recovery. In the following section, you will learn more about possible nursing interventions for a patient with self-care deficit.
General Self-care Interventions
1. Implement resources to overcome barriers.
Use of translation services when the nurse and patient do not speak the same language or written prompts for patients who are hard of hearing may assist in communication necessary for ADLs.
2. Encourage participation in care.
Patients can become dependent on caregivers and support staff and should be encouraged to carry out as much of their own self-care as possible.
3. Offer (limited) choices.
Standing firm with completing tasks while offering the patient options will increase adherence. For example, allowing patients to choose between walking the hallway before or after lunch gives them autonomy without allowing pushback.
4. Incorporate family members and caregivers.
Involving family members, spouses, and other caregivers promotes a commitment and understanding of each person’s role in helping the patient manage their ADLs.
5. Promote energy-saving tactics.
Patients with weakness or conditions such as chronic obstructive pulmonary disease (COPD) cannot tolerate standing or moving for long periods of time. Encourage sitting when possible and performing tasks when they have the most energy available.
6. Pain management.
If self-care deficits stem from acute or chronic pain, the patient will not want to participate in activities that trigger pain. The nurse will need to first administer pain medications as ordered or consult with the physician if the pain is not controlled.
Self-feeding Interventions
1. Offer appropriate time and setting for eating.
Patients should not be rushed during mealtimes in order to prevent aspirating and ensure adequate nutritional intake. Position the patient in the bed or chair at high as possible, and clean hands and mouth to promote readiness to eat with all utensils. Ensure the patient is not interrupted by support staff.
2. Involve speech therapy if needed.
If coughing, pocketing of food, or drooling is observed, it may be necessary to alert the physician of the need for a speech evaluation to prevent a possible aspiration.
3. Delegate feeding to the nursing assistant if needed.
A patient who is not eating or consuming only small amounts may need assistance. Delegate to support staff to assist the patient in eating to ensure they meet their nutritional and hydration needs.
4. Consult with occupational therapy.
If a patient cannot hold eating utensils/get utensils up to their mouths, or suffers from tremors, they may need adaptive utensils or assessment by OT to make feeding easier.
Self-bathing Interventions
1. Allow the patient to help as much as possible.
If the patient is bed-bound or has decreased strength but is able to wipe their face and hands, encourage them to perform as much as possible to maintain independence.
2. Evaluate equipment needs.
Whether in the hospital or at home, there may be accessibility requirements the patient may need. For example, the patient may need a shower chair, grab bars, or a handheld showerhead to complete bathing safely.
3. Consider rehabilitation and exercise programs.
If strength, transferring, or range of motion are preventing the completion of ADLS, the patient may benefit from stretching and exercise programs to improve flexibility and strength.
Self-dressing Interventions
1. Suggest adapted clothing options.
Patients may need to shift their wardrobes to pullover sweaters and shirts, pants with elastic waistbands, and shoes with velcro in order to dress themselves.
2. Layout clothing options beforehand.
Patients with dementia may become easily distracted while dressing if presented with an entire closet. They may also wear soiled or dirty clothing they were not aware was already worn. Laying out an exact outfit takes away the confusion and frustration of dressing while promoting independence.
3. Evaluate tools for grooming.
The patient may need adaptive tools for hair brushing, shaving, and applying makeup. Feeling confident in one’s appearance is important to maintaining hygiene.
Self-toileting Interventions
1. Establish a voiding schedule.
Certain conditions, such as a neurogenic bladder, prevent proper bladder control. Establishing a voiding schedule means setting times (every 2 hours or so) to urinate. This helps with muscle control in holding urine and emptying the bladder and gives the patient control over their toileting.
2. Provide privacy.
Everyone expects privacy with toileting. Once the patient’s safety is ensured, allow privacy and time for them to complete elimination.
3. Provide commodes or toilet risers.
If transferring or ambulation is a concern, a bedside commode can help with toileting in the middle of the night. If sitting and rising are difficult, a toilet riser placed over a regular toilet can assist the patient in transferring.
4. Anticipate toileting needs.
If a patient is nonverbal or can’t recognize the urge to eliminate, it may be best to offer them the bedpan or assist them to the bathroom at certain intervals, such as after meals or before bedtime to prevent incontinence episodes, soiling or clothing or bed linens, and preserving their dignity.
Nursing Care Plans
Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for self-care deficit.
Care Plan #1
Diagnostic statement:
Self-care deficit related to a lack of coordination secondary to stroke as evidenced by an inability to toilet without assistance and put clothing on the lower body.
Expected outcomes:
- Patient will demonstrate safe and independent toileting and clothing methods.
- Patient will report improved motor coordination.
Assessment:
1. Assess the degree of impairment and functional level.
This information will determine the level and kind of assistance to be given.
2. Assess the need for assistive devices or home health care after discharge.
Assistive devices promote independence. Thus, they empower the patient to take control of health and increase self-worth. It may also be helpful for home health nurses to check in the patient after discharge. Occupational therapy may be consulted if home modifications are needed for the patients to maintain independence.
3. Assist the patient in accepting the necessary amount of help.
Patients may experience grief for losing independence and may have difficulty accepting that help is necessary. Patients may need help determining the safe limits of independence versus asking for help when needed.
Interventions:
1. Perform or assist with meeting patient’s needs.
Personal care assistance while promoting self-care independence is part of routine nursing care duty.
2. Promote patient participation in problem identification and desired goals and decision-making.
This strategy enhances commitment to plan, optimize outcomes, and support recovery and health promotion.
3. Dress the client or assist with dressing, as indicated.
The patient may need assistance putting on or removing clothing (e.g., shoes and socks or over-the-head shirt) or may require partial or complete assistance with fasteners (e.g., buttons, snaps, zippers, shoelaces).
4. Use adaptive clothing as indicated (e.g., clothing with front closure, wide sleeves, pant legs, Velcro, or zipper closures).
These may be helpful for a patient with limited arm or leg movement, impaired fine motor skills, or a cognitively impaired person who desires to dress but cannot do so with regular clothing fasteners.
5. Teach the patient to dress the affected side first, then the unaffected side.
This promotes independence in patients with paralysis or injury to one side of the body.
6. Collaborate with rehabilitation professionals.
Collaborate with rehabilitation professionals to identify and obtain assistive devices, mobility aids, and home modification, as necessary. Physical or occupational therapists enhance the patients’ capabilities and promote independence.
Care Plan #2
Diagnostic statement:
Self-care deficit related to disabling anxiety as evidenced by difficulty accessing transportation, telephone use, and shopping.
Expected outcomes:
- Patient will verbalize feelings of anxiety.
- Patient will report decreased feelings of anxiety.
- Patient will perform self-care activities within the level of ability.
Assessment:
1. Assess cognitive functioning (e.g., memory, concentration, ability to attend to the task).
This helps to determine the patient’s ability to participate in care and the potential to return to normal functioning or to learn/relearn tasks.
2. Assess for potential triggers for the anxiety
Understanding the underlying causes of anxiety may allow the patient to create routines or strategies to address the trigger before they are so anxious that they can’t perform a task.
3. Assess the patient’s ability to perform ADLs effectively and safely daily.
Assessment tools such as Functional Independence Measure (FIM) can assess individual functional status based on the most necessary level of assistance.
4. Assess factors contributing to anxiety.
Addressing anxiety will consequently motivate the patient to perform ADLs.
Interventions:
1. Assist with personal care.
Nursing involves ensuring that the patient meets their self-care needs. However, the nurse should integrate and promote independence gradually.
2. Engage the patient and family in the formulation of the plan of care.
Involving the patient and family in setting goals and strategies to promote self-care will ensure their commitment to attaining the goals.
3. Use consistent routines, and allow adequate time to accomplish tasks.
Established routines require less effort and stress. They help the patient organize and carry out self-care skills.
4. Provide positive reinforcement for all activities attempted; note partial achievements.
External sources of positive reinforcement promote ongoing efforts. Patients often have difficulty seeing progress if it’s incremental, so a nurse can help remind the patient of progress.
5. Create a schedule of properly spaced activities.
Patients with anxiety may feel fatigued and disinterested in performing usual tasks. A balanced rest and activity schedule can help the patient complete the desired activity without undue fatigue and frustration.
References
- Ackley, B.J., Ladwig, G.B.,& Makic, M.B.F. (2017). Nursing diagnosis handbook: An evidence-based guide to planning care (11th ed.). Elsevier.
- Carpenito, L.J. (2013). Nursing diagnosis: Application to clinical practice (14th ed.). Lippincott Williams & Wilkins.
- Doenges, M.E., Moorhouse, M.F., & Murr, A.C. (2019). Nursing care plans Guidelines for individualizing client care across the life span (10th ed.). F.A. Davis Company.
- Gulanick, M. & Myers, J.L. (2014). Nursing care plans Diagnoses, interventions, and outcomes (8th ed.). Elsevier.
- Mlinac, M. E., & Feng, M. C. (2016, September). Assessment of Activities of Daily Living, Self-Care, and Independence. Archives of Clinical Neuropsychology, 31(6), 506-516. https://academic.oup.com/acn/article/31/6/506/1727834
- National Institute of Neurological Disorders and Stroke. Amyotrophic Lateral Sclerosis (ALS). https://www.ninds.nih.gov/health-information/disorders/amyotrophic-lateral-sclerosis-als
- Regis College. (n.d.). The Pivotal Role of Orem’s Self-Care Deficit Theory. Regis College. https://online.regiscollege.edu/blog/the-pivotal-role-of-orems-self-care-deficit-theory/
- What is Neurogenic Bladder? (2021, September). Urology Care Foundation. https://www.urologyhealth.org/urology-a-z/n/neurogenic-bladder
