Self-Care Feeding Deficit
Inability (or unwilling) to†:
Bring food from a receptacle to the mouth
Complete a meal
Place food onto utensils
Handle utensils
Ingest food in a socially acceptable manner
Open containers
Pick up cup or glass
Prepare food for ingestion
Use assistive device
Self-Bathing Deficits (Include Washing Entire Body, Combing Hair, Brushing Teeth, Attending to Skin and Nail Care, and Applying Makeup)†
Inability (or unwilling) to†:
Access bathroom
Get bath supplies
Wash body
Dry body
Obtain a water source
Regulate bathwater
Self-Dressing Deficits (Including Donning Regular or Special Clothing, Not Nightclothes)†
Inability or unwillingness to†:
Choose clothing or put clothing on lower body
Put clothing on upper body
Put on necessary items of clothing
Maintain appearance at a satisfactory level
Pick up clothing
Put on shoes/remove shoes
Put on/remove socks
Use assistive devices
Use zippers
Fasten, unfasten clothing
Obtain clothing
Self-Toileting Deficits
Unable or unwillingness to†:
Get to toilet or commode
Carry out proper hygiene
Manipulate clothing for toileting
Rise from toilet or commode
Sit on toilet or commode
Flush toilet or empty commode
Instrumental Self-Care Deficits†
Difficulty using telephone
Difficulty accessing transportation
Difficulty laundering, ironing
Difficulty managing money
Difficulty preparing meals
Difficulty with medication administration
Difficulty shopping
Pathophysiologic
Related to lack of coordination secondary to (specify)
Related to spasticity or flaccidity secondary to (specify)
Related to muscular weakness secondary to (specify)
Related to partial or total paralysis secondary to (specify)
Related to atrophy secondary to (specify)
Related to muscle contractures secondary to (specify)
Related to visual disorders secondary to (specify)
Related to nonfunctioning or missing limb(s)
Related to regression to an earlier level of development
Related to excessive ritualistic behaviors
Related to somatoform deficits (specify)
Treatment Related
Related to external devices (specify: casts, splints, braces, intravenous [IV] equipment)
Related to postoperative fatigue and pain
Situational (Personal, Environmental)
Related to cognitive deficits
Related to fatigue
Related to pain
Related to decreased motivation
Related to confusion
Related to disabling anxiety
Maturational
Older Adult
Related to decreased visual and motor ability, muscle weakness
AUTHOR'S NOTESelf-care encompasses the activities needed to meet daily needs, commonly known as activities of daily living (ADLs), which are learned over time and become lifelong habits. Self-care activities involve not only what is to be done (hygiene, bathing, dressing, toileting, feeding), but also how much, when, where, with whom, and how (Miller, 2019).
In every individual, the threat or reality of a self-care deficit evokes panic. Many people report that they fear loss of independence more than death. A self-care deficit affects the core of self-concept and self-determination. For this reason, the nursing focus for self-care deficit should be not on providing the care measure, but on identifying adaptive techniques to allow the individual the maximum degree of participation and independence possible.
The diagnosis Total Self-Care Deficit once was used to describe an individual's inability to complete feeding, bathing, toileting, dressing, and grooming (*Gordon, 1982). The intent of specifying "Total" was to describe a person with deficits in several ADLs. Unfortunately, sometimes its use invites, according to Magnan (1987, personal communication), "preconceived judgments about the state of an individual and the nursing interventions required." The individual may be viewed as in a vegetative state, requiring only minimal custodial care. Total Self-Care Deficit has been eliminated because its language does not denote potential for growth or rehabilitation.
Currently not on the NANDA-I list, the diagnosis Self-Care Deficit Syndrome has been added here to describe an individual with compromised ability in all 5 self-care activities. For this individual, the nurse assesses functioning in each area and identifies the level of participation of which the individual is capable. The goal is to maintain current functioning, to increase participation and independence, or both. The syndrome distinction clusters all five self-care deficits together to enable grouping of interventions when indicated, while also permitting specialized interventions for a specific deficit.
The danger of applying a Self-Care Deficit diagnosis lies in the possibility of prematurely labeling an individual as unable to participate at any level, eliminating a rehabilitation focus. It is important that the nurse classify the individual's functional level to promote independence. Use this scale with the nursing diagnosis (e.g., Toileting Self-Care Deficit 2 = minimal help). Continuous reevaluation is also necessary to identify changes in the individual's ability to participate in self-care.
Level 1 Extended Assessment (all settings)
Evaluate Each ADL Using the Following Scale:
0 = Is completely independent
1 = Requires use of assistive device
2 = Needs minimal help
3 = Needs assistance and/or some supervision
4 = Needs total supervision
5 = Needs total assistance or unable to assist with the activity
Observe strength, flexibility, endurance, coordination, and/or balance. Ask the individual what self-care activities are most important to them to improve.
R:Determining the individual's goals as a starting point helps the provider establish credibility and lays the foundation for a trusting relationship built on a strong sense of collaboration. This is a dramatic shift from traditional models of care that employ a hierarchical, paternalistic approach toward providing advice and presuming adherence (Pignataro, 2018).
NOCSee Bathing, Feeding, Dressing, Toileting, and/or Instrumental Self-Care Deficit
The individual will participate in feeding, dressing, toileting, and bathing activities, as evidenced by the following indicators (specify what the individual can perform with assistance and unassisted):
- Identifies preferences in self-care activities (e.g., time, products, location).
- Demonstrates optimal hygiene after assistance with care.
NICRefer to NIC under each Self-Care Deficit Nursing Diagnosis
Level 2 Extended Focused Interventions (nonacute setting)
Dressing, Toileting, and/or Instrumental Self-Care Deficit
Engage in Motivational Interviewing Interactions (Pignataro, 2018)
Techniques used in motivational interviewing (MI) often are represented by the acronym OARS:
O: Ask open-ended questions. > What activity do you want to improve your ability to do?
A: Use affirmations, or positive statements, that demonstrate an authentic interest in the patient's own perspectives. > I am pleased that you are very interested in improving your . . . .
R: Reflective listening reinforces this interest and offers opportunities to clarify information or make inferences that invite the individual to continue to share his or her thoughts and opinions.
What can increase your ability to (identify self-care activity, such as using the toilet)?
S: The provider can pause the conversation to summarize information, pulling together pieces of the dialogue in a way that inspires action. > So you are interested in (summarize the activities that the individual has expressed interest in improving).
R:MI is an evidence-based, patient-centered form of communication that has been used effectively to encourage a broad range of healthy behaviors, such as vaccinations, preventive screenings, exercise, weight management, and tobacco cessation (Pignataro, 2018). MI can foster initiation, rapport, create transformative dialogues, enhance adherence, and inspire successful lifestyle change (Ibid).
Assess for Causative or Contributing Factors
CARP'S CUESThe concept of self-care emphasizes each individual's right to maintain individual control over his or her own pattern of living. This applies to both the ill and the well individuals.
Refer to Related Factors.
When indicated, request a physical/occupational therapist for an evaluation of the individual's present level of participation and for a plan.
Promote Self-Esteem and Self-Determination
- Determine preferences for:
- Schedule
- Products
- Methods
- Clothing selection
- Hair styling
- During self-care activities, provide choices and request preferences.
- Do not focus on disability.
- Offer praise for independent accomplishments.
R:Inability to care for oneself produces feelings of dependency and poor self-concept. With increased ability for self-care, self-esteem increases.
Evaluate Their Ability to Participate in Each Self-Care Activity (Feeding, Dressing, Bathing, Toileting); Promote Optimal Participation.
- Determine areas for potentially increased participation in each self-care activity.
- Explore the goals, and determine what the individual perceives as his or her own needs.
- Compare what the nurse assesses are the needs and goals, and then work to establish mutually acceptable goals.
- Allow ample time to for the individual to complete activities without help. Promote independence but assist when the client cannot perform an activity.
R:Offering choices and including the individual in planning care reduces feelings of powerlessness; promotes feelings of freedom, control, and self-worth; and increases his/her willingness to comply with therapeutic regimens. Optimal education promotes self-care.
Reassess Ability Frequently and Revise Code as Appropriate
R:Coding each self-care ability provides a baseline to evaluate progress.
Refer to Interventions under Each Diagnosis—Feeding, Bathing, Dressing, Toileting, and Instrumental Self-Care Deficit—as Indicated
R:Enhancing self-care abilities can increase his or her sense of control and independence, promoting overall well-being.