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 engaging in self-care , or it can be out of their control, such as with cognitive impairment. A patient displaying poor health maintenance 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. It is important that the nurse explores the root causes of ineffective health maintenance. 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. However, the patient must play an active role in maintaining or improving their health status.
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 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)
Signs and Symptoms (As evidenced by)
The following are common signs and symptoms of ineffective health maintenance. They are categorized into subjective and objective data based on patient reports and assessment by the nurse.
Subjective: (Patient reports)
- Expressed disinterest in improving health
- Expressed lack of knowledge or knowing where to start
- Describes barriers to effective health maintenance
Objective: (Nurse assesses)
- 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
Expected Outcomes
The following are common nursing care planning goals and expected outcomes for 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.
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 ineffective health maintenance.
1. Assess conditions that prevent health maintenance.
Physical impairments (Parkinson’s disease, stroke, paralysis) and cognitive impairments (dementia, mental illness or developmental delays) 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 have barriers to appropriate health maintenance.
3. Assess for family support.
A lack of family or social support systems can be detrimental and can reduce a person’s ability to engage in effective health maintenance, regardless of physical or mental capabilities. However, 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, or changes in finances, can cause stress and prevent the patient from focusing on maintaining their health.
6. Assess living environment and access to resources.
A patient who is unhoused or living in a rural area may not have access to community resources for healthcare providers. It is important to assess the patient’s current living situation to assess for barriers.
7. Assess interest and desire to improve health.
Before presenting the patient with information or resources or assuming interest, the nurse should assess for patient 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.
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 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, discuss with the provider ways to increase adherence by suggesting once-daily pills instead of divided doses or 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 as necessary to support effective health maintenance.
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. It is important that the nurse provides accurate health information without shaming the patient.
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 who 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.
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 such as social workers or home health nurses 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 who 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 misuse or smoking cessation.
A patient who 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.
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 ineffective health maintenance.
Care Plan #1
Diagnostic statement:
Ineffective health maintenance related to lack of resources as evidenced by lack of transportation and living in a rural area
Expected outcomes:
- Patient will identify and use available or alternative resources in the rural area.
- Patient will assume responsibility for their healthcare needs within their ability.
Assessment:
1. Determine whether the required health maintenance facilities are available to the patient.
Unequal geographical distribution of healthcare facilities is still prevalent, and people residing in rural areas are the ones who are mostly impacted. Maximizing what is available and knowing resources that could be improvised could help fill the poor health maintenance gap.
2. Assess financial problems that present a barrier to maintaining healthy behaviors.
Patients without insurance experience the burden of out-of-pocket expenses. Money is a resource required to afford quality health services. Assess for financial instability that may be contributing to ineffective health maintenance.
3. Ascertain the patient’s willingness to acquire needed resources and manage health.
Aside from the availability of resources, determine if the patient is motivated to acquire these resources to maintain health. Successful and unsuccessful efforts to obtain resources should be ascertained to plan what other possible means the patient and family can do to acquire the needed resources.
Interventions:
1. Assist patient with means of contacting healthcare provider (e.g., telehealth, payphone, help of family member).
Distance to the healthcare facility is a barrier that inhibits the patient from seeking care. Patients may lack time, need to sacrifice work, may not be able to afford to travel, and all other factors that need to be considered before traveling. Telehealth or other means of communication would help to close the distance and ease the burden of traveling far. There may also be programs that the patient could apply for with the help of a social worker to support their care.
2. Assist in creating a schedule of clinic visits considering the limited transportation availability and financial resources.
If transportation is limited, clinic visits or procedure schedules, if necessary, should be aligned to the availability of transport vehicles. Care should always be adjusted based on the best interest of the patient.
3. Present alternative and affordable options for health maintenance
Exploring cheaper generic medications, or complementary and alternative medical practices, with the advice of a healthcare provider, may be considered as complementary care.
4. Explain the importance of adequate health maintenance and the possible risks of non-compliance.
Helping the patient and family realize the importance of these resources to maintain their health would mobilize them to take the necessary course of action.
Care Plan #2
Diagnostic statement:
Ineffective health maintenance related to misinterpretation of information, as evidenced by a lack of knowledge of best health practices.
Expected outcomes:
- Patient will demonstrate positive health maintenance behaviors as evidenced by:
- Attending scheduled appointments
- Participating in lifestyle modification health programs
- Complying with the therapeutic regimen
- Patient will identify areas that need further education.
- Patient will verbalize increased knowledge of the condition and the best health practices to manage it.
Assessment:
1. Assess misconceptions about condition and management that need to be corrected.
Misinterpreted information may come from misconceptions. Targeting the degree of misunderstanding known will have a baseline for education sessions.
2. Assess the client’s ability and desire to learn and meet health maintenance needs.
This determines the beginning point for planning and interventions to assist the patient in addressing their needs.
3. Determine barriers to learning (e.g., literacy, spoken language is different, depression, grief or stress, lack of interest in the subject).
Barriers should be addressed first before the teaching session. The patient may not be physically, emotionally, or mentally capable because of interfering factors. It is important to identify and mitigate these factors prior to initiating teaching.
Interventions:
1. Educate about the condition and the management.
Increasing the knowledge about the condition and best health practices would promote empowerment for the patient to maintain their health.
2. Use plain language as much as possible.
Medical jargon is commonly misunderstood by patients. Therefore it is important to use plain language whenever possible. The nurse can also explain things multiple ways and ask the patient to engage in “teach back” to ensure their understanding.
3. Allow the patient to ask questions.
Questions stimulate open communication. They provide avenues for correction and understanding verification.
4. Use visual aids to explain the information.
Information about health conditions and treatments are often complex, especially those who do not have any medical background. Pictures will provide a visual representation of the topic.
5. Involve the family in health planning conferences.
Illness and hospitalization often have a direct impact on the patient’s family. Increasing their knowledge about the treatment and disease will help them all work together to adapt to the changes caused by the illness.
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.
- Coombs, N.C., Campbell, D.G. & Caringi, J. (2022). A qualitative study of rural healthcare providers’ views of social, cultural, and programmatic barriers to healthcare access. BMC Health Serv Res, 22(438). https://doi.org/10.1186/s12913-022-07829-2
- 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.
- Gulanick, M. & Myers, J.L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes (8th ed.). Elsevier.
- Hartney, E. (2021, May 30). What Is Motivational Interviewing? Verywell Mind. https://www.verywellmind.com/what-is-motivational-interviewing-22378
- 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
