* *This diagnosis is not currently on the NANDA-I list but has been included by the author for clarity and usefulness.

Impaired ability to perform certain activities or access certain services essential for managing a household

Observed or reported difficulty with one or more of the following:

Using a telephone

Accessing transportation

Laundering and ironing

Preparing meals

Shopping (food, clothes)

Managing money

Administering medication

Refer to Self-Care Deficit Syndrome.

AUTHOR'S NOTE

Instrumental Self-Care Deficit is currently not on the NANDA-I list but has been added here for clarity and usefulness. This diagnosis describes problems with performing certain activities or accessing certain services include housekeeping, preparing and procuring food, shopping, laundering, ability to self-medicate safely, ability to manage money, and access to transportation (Miller, 2019). Instrumental ADLs require more complex tasks than ADLs. This diagnosis is important to consider when planning transition and during home visits by community nurses.

The individual or family will report satisfaction with household management, as evidenced by the following indicators:

• Demonstrates use of adaptive devices (e.g., telephone, cooking aids).
• Describes a method to ensure adherence to medication schedule.
• Reports ability to make calls and answer the telephone.
• Reports regular laundering by self or others.
• Reports daily intake of at least two nutritious meals.
• Identifies transportation options to stores, physician, house of worship, and social activities.
• Demonstrates management of simple money transactions.
• Identifies people who will assist with money matters.

Level 1 Extended Focused Assessment (rehabilitation, community)

Use a standard Assessment Instrument to assess their ability to (*Lawton & Brody, 1969):

• Use telephone
• Shop
• Prepare foods
• Do housekeeping
• Do laundry
• Utilize a mode of transportation
• Assume responsibility for own medication
• Handle finances

Interventions

Assess for Causative and Contributing Factors

Refer to Related Factors.

Ensure an occupational therapist is consulted and an in-home assessment planned.

Evaluate the Individual's Ability to Select, Procure, and Prepare Nutritious Food Daily

• Prepare a permanent shopping list with cues for essential foods and products.
• Teach to review the list before shopping, check items needed, and, in the store, check off items selected. (Use a pencil that can be erased to reuse list.)
• Teach how to shop for single-person meals (refer to Imbalanced Nutrition for specific techniques).
• If possible, teach the individual to use a microwave to reduce the risk of heat-related injuries or accidents.

Offer Hints to Improve Adherence to Medication Schedule

• Have someone place medications in a commercial pill holder divided into 7 days.
• Take out the exact amount of pills for the day. Divide them in small cups, each labeled with time of day.
• If needed, draw a picture of the pills and the quantity on each cup.
• Teach to transfer the pills from cup to small plastic bag when planning to be away from home.
• Tell the individual whom to call for instructions if he or she misses a dose.

Initiate Health Teaching and Referrals, as Indicated

• Ensure a home assessment is scheduled, e.g., nursing, social services, occupational therapy, and/or physical therapy.

Determine Available Sources of Transportation (Neighbors, Relatives, Community Centers)

Refer to community agencies for assistance/respite care (e.g., Department of Social Services, area agency on aging, senior neighbors, public health nursing, Meals on Wheels).

R:Community resources, neighbors, religious groups, or all three can assist the individuals when caregivers are unavailable or nonexistent (Miller, 2019).