Inability to independently put on or remove clothing

Difficulty choosing clothing

Difficulty fastening clothing

Difficulty gathering clothing

Difficulty maintaining appearance

Difficulty picking up clothing

Difficulty putting clothing on lower body

Difficulty putting clothing on upper body

Difficulty putting on various items of clothing

Difficulty removing clothing item

Difficulty using assistive device

Difficulty using zipper

Anxiety

Cognitive dysfunction

Decreased motivation

Discomfort

Environmental constraints

Fatigue

Neurobehavioral manifestations

Pain

Weakness

Musculoskeletal impairment

Neuromuscular diseases

AUTHOR'S NOTE

Refer to Self-Care Deficit Syndrome.

Level 1 Fundamental Focused Assessments

Use the Following Scale to Rate the Individual's Ability to Perform. Add the Number to the Individual's Nursing Diagnosis as Dressing Self-Care Deficit (3)

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

R:This coding allows for establishing a baseline from which to evaluate progress.

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).

The individual will demonstrate increased ability to dress self or report the need to have someone else assist him or her to perform the task, as evidenced by the following indicators:

• Demonstrates ability to use adaptive devices to facilitate independence in dressing.
• Demonstrates increased interest in wearing street clothes.
• Describes causative factors for dressing deficits.
• Relates rationale and procedures for treatments.

Level 1 Fundamental Interventions (all settings)

Assess for Causative Factors

Refer to Related Factors.

Engage in Motivational Interviewing Interactions (Pignataro, 2018)

Techniques used in 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 changes (Ibid).

General Nursing Interventions for Self-Dressing

• Obtain clothing that is larger-sized and easier to put on, including clothing with elastic waistbands, wide sleeves and pant legs, dresses that open down the back for women in wheelchairs and Velcro fasteners or larger buttons.
• Encourage to wear prescribed corrective lenses or hearing aid.
• Promote independence in dressing through continual and unaided practice.
• Provide dressing aids as necessary (some commonly used aids include dressing stick, Swedish reacher, zipper pull, buttonhook, long-handled shoehorn, and shoe fasteners adapted with elastic laces).

R:Inability to care for oneself produces feelings of dependency and poor self-concept. With increased ability for self-care, self-esteem increases. Optimal personal grooming promotes psychological well-being.

Specific Dressing Interventions for People with Visual Deficits

• Allow the individual to select the most convenient location for clothing, and adapt the environment to accomplish the task best (e.g., remove unnecessary barriers).
• Announce yourself before entering or leaving the dressing area.
• If the individual has a field cut, avoid placing clothing to the blind side until he or she is visually accommodated to the surroundings; then encourage him or her to turn the head to scan the entire visual field.

R:Strategies used include consistent placement of items needed for dressing.

Specific Dressing Interventions for People with Cognitive Deficits (Miller, 2019)

• Keep verbal communication simple. Call the individual by name.
• Ask yes/no questions.
• Use one-step requests (e.g., "put your sock on").
• Praise after each step.
• Use the same word for the same thing (e.g., "shirt").
• Dress the bottom half, and then the top half.
• Prepare an uncluttered environment.
• Lay clothes face down.
• Place clothes in the order that they will be used.
• Allow a choice from only two pieces.
• Place matching clothes together on hangers.
• Remove dirty clothes from the dressing area.
• Provide nonverbal cues.
• Hand one clothing item at a time in correct order.
• Place shoes beside the correct foot.
• Point or touch the body part to be used.
• If the individual cannot complete all the steps, always allow him or her to finish the dressing step, if possible—zipper pants, buckle belt.
• Decrease assistance gradually.

R:Strategies are needed to reduce environmental distractions and to increase attention to the task.

Initiate Health Teaching and Referrals, as Indicated

Access a home health nurse for an in-home evaluation.