Inability to eat independently

Difficulty bringing food to mouth

Difficulty chewing food

Difficulty getting food onto utensil

Difficulty handling utensils

Difficulty manipulating food in mouth

Difficulty opening containers

Difficulty picking up cup

Difficulty preparing food

Difficulty self-feeding a complete meal

Difficulty self-feeding in an acceptable manner

Difficulty swallowing food

Difficulty swallowing sufficient amount of food

Difficulty using assistive device

Anxiety

Cognitive dysfunction

Decreased motivation

Discomfort

Environmental constraints

Fatigue

Neurobehavioral manifestations

Pain

Weakness

Musculoskeletal impairment

Neuromuscular disease

Refer to Self-Care Deficit Syndrome for additional related factors.

AUTHOR'S NOTE

This diagnosis is appropriate for an individual who has difficulty with the activities of self-feeding. Individuals who have difficulty chewing and ingesting sufficient calories need an additional diagnosis of Imbalanced Nutrition.

Level 1 Fundamental Focused Interventions (all settings)

Use the Following Scale to Rate the Individual's Ability to Perform. Add the Number to the Individual's Nursing Diagnosis as Feeding 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

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 feed self or report that he or she needs assistance, as evidenced by the following indicators:

• Demonstrates ability to make use of adaptive devices, if indicated.
• Demonstrates increased interest and desire to eat.
• Describes rationale and procedure for treatment.
• Describes causative factors for feeding deficit.

Level 2 Extended Focused Interventions (all settings)

Assess 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:Motivational interviewing 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).

CARP'S CUES

The 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 ill and well individuals.

Provide Opportunities to Relearn or Adapt to Activity

Common Nursing Interventions for Feeding

• Ascertain what foods the individual likes or dislikes.
• Provide meals in the same setting with pleasant surroundings that are not too distracting.
• Maintain correct food temperatures (hot foods hot, cold foods cold).
• Provide pain relief because pain can affect appetite and ability to feed self.
• Provide good oral hygiene before and after meals.
• Encourage the individual to wear dentures and eyeglasses.
• Assist the individual to the most normal eating position suited to his or her physical disability (best is sitting in a chair at a table).
• Provide social contact during eating.

R:These strategies attempt to normalize mealtime to increase participation and intake.

Specific Interventions for People with Sensory/Perceptual Deficits

• Encourage the individual to wear prescribed corrective lenses.
• Describe the location of utensils and food on the tray or table.
• Describe food items to stimulate appetite.
• For perceptual deficits, choose different-colored dishes to help distinguish items (e.g., red tray, white plates).
• Ascertain usual eating patterns and provide food items according to preference (or arrange food items in clock-like pattern); record on the care plan the arrangement used (e.g., meat, 6 o'clock; potatoes, 9 o'clock; vegetables, 12 o'clock).
• Encourage eating of "finger foods" (e.g., bread, bacon, fruit, hot dogs) to promote independence.
• Avoid placing food to the blind side of the individual with field cut until visually accommodated to surroundings; then encourage him or her to scan the entire visual field.

R:Enhancing an individual's self-care abilities can increase his or her sense of control and independence, promoting overall well-being.

Specific Interventions for People with Missing Limbs

• Provide an eating environment that is not embarrassing; allow sufficient time for eating.
• In group dining rooms, have individual face away from the majority of diners.
• Provide only the supervision and assistance necessary for relearning or adaptation.
• To enhance independence, provide necessary adaptive devices:
  • Plate guard to avoid pushing food off the plate
  • Suction device under the plate or bowl for stabilization
  • Padded handles on utensils for a more secure grip
  • Wrist or hand splints with clamp to hold eating utensils
  • Special drinking cup
  • Rocker knife for cutting
• Assist with setup if needed by opening containers, napkins, condiment packages; cutting meat; and buttering bread.
• Arrange food so there is enough space to perform the task of eating.

R:Assistive devices can improve self-care abilities.

Specific Interventions for People with Cognitive Deficits

• Provide an isolated, quiet atmosphere until the individual can attend to eating and is not easily distracted from the task.
• Supervise the feeding program until there is no danger of choking or aspiration.
• Orient the individual to location and purpose of feeding equipment.
• Avoid external distractions and unnecessary conversation.
• Position the individual in the most normal eating position he or she can physically assume.
• Encourage the individual to attend to the task, but be alert for fatigue, frustration, or agitation.
• Provide one food at a time in the usual sequence of eating until the individual can eat the entire meal in the normal sequence.
• Encourage the individual to eat in small amounts and to put food in the unaffected side of the mouth if paresis or paralysis is present.
• Check for food in cheeks.
• Refer to Impaired Swallowing for additional interventions.

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

Initiate Health Teaching and Referrals, as Indicated

• Ensure that both the individual and family understand the reason and purpose of all interventions.
• Proceed with teaching as needed.
• Maintain safe eating methods.
• Prevent aspiration.
• Use appropriate eating utensils (avoid sharp instruments).
• Test the temperature of hot liquids and wear protective clothing (e.g., paper bib).
• Teach the use of adaptive devices.

R:Eating has physiologic, psychological, social, and cultural implications. Increasing one's control over meals promotes overall well-being.