Decline in competence associated with performing elimination tasks independently

• Anxiety
• Decreased activity tolerance
• Decreased motivation
• Impaired physical comfort
• Impaired physical mobility
• Impaired postural balance
• Impaired transfer ability
• Muscle hypotonia
• Pain
• Prolonged inactivity
• Unaddressed environmental constraints
• Weakness

• Mental disorders
• Musculoskeletal impairment
• Neuromuscular diseases
• Significant comorbidity
• Stroke
• Wounds and injuries

• Age
• History of neurologic, sensory, psychological, or musculoskeletal impairment
• Self-care abilities, including knowledge and use of adaptive equipment, preparation of equipment and supplies, and technical or mechanical skills
• Musculoskeletal status, including coordination; functional ability; gait; mechanical restriction (such as cast, splint, and traction); muscle tone, size, and strength; range of motion; and tremors
• Neurologic status, including cognition, communication ability, insight or judgment, level of consciousness, memory, motor and sensory ability, and orientation
• Psychosocial status, including coping mechanisms, family members, lifestyle, patient's perceptions of health problem and self, and personality

• Difficulty flushing toilet
• Difficulty manipulating clothing for toileting
• Difficulty reaching toilet
• Difficulty rising from toilet
• Difficulty sitting on toilet

• Patient will have toileting self-care needs met.
• Patient will have few, if any, complications.
• Patient will communicate feelings about limitations.
• Patient and family members will demonstrate correct use of assistive devices.
• Patient and family members will carry out toileting program daily.
• Patient and family members will identify resources to help cope with problems and discharge from facility.

Suggested NOC Outcomes

• Observe patient's functional, perceptual, and cognitive level every shift; document and report any changes. Careful observation helps you adjust nursing actions to meet patient's needs.
• Perform the prescribed treatment for the underlying condition. Monitor patient's progress, reporting favorable and adverse responses to treatment. Applying therapy consistently aids patient's independence.
• Encourage patient to voice feelings and concerns about self-care deficits to help patient achieve the highest functional level possible.
• Monitor intake and output and skin condition; record episodes of incontinence. Accurate intake and output records can identify potential imbalances.
• Use assistive devices, as needed, such as an external catheter at night, a bedpan or urinal every 2 hours during the day, and adaptive equipment for bowel care. Instruct on use. As control improves, reduce the use of assistive devices. Assisting at an appropriate level helps maintain patient's self-esteem.
• Assist with toileting only if needed. Allow patient to perform independently as much as possible to promote independence.
• Instruct patient and family members in toileting routine (you can give family members written instructions). Have patient and family members demonstrate toileting routine under supervision. Return demonstration identifies problem areas and increases patient's self-confidence.
• Provide positive, constructive feedback when assisting with toileting. Reinforcement and rewards may enhance self-esteem.
• Assist with toileting, giving simple instructions one at a time, to aid comprehension.
• Complete urinary and bowel care if patient can't do so. Follow urinary and bowel elimination plans. Monitoring success or failure of toileting plans helps identify and resolve problem areas.
• As needed, refer patient to a psychiatric liaison nurse, support group, or home health care agency. Extra resources reinforce activities planned to meet patient's needs.

Suggested NIC Interventions

• Patient meets toileting self-care needs.
• Patient accepts help from staff if needed.
• Patient and family members express feelings about self-care deficit. If unable to meet own needs, patient seeks assistance from family member or staff within 24 hours.
• Patient and family members demonstrate appropriate use of assistive devices.
• Patient follows toileting program daily. Family members assist, as needed.
• Patient and family members identify and contact available support resources, as needed.

• Patient's expression of feelings and concerns about self-care limitations and their impact on body image and lifestyle
• Patient's willingness to participate in self-care
• Observations of patient's ability to perform toileting routine and patient's response to treatment
• Patient's intake and output
• Interventions to provide supportive care
• Instructions given to patient and family members, their understanding of instructions, and their demonstrated skill in carrying out self-care functions
• Patient's response to nursing interventions
• Evaluations for expected outcomes

• Imanishi, M., Tomohisa, H., & Higaki, K. (2017). Impact of continuous in-home rehabilitation on quality of life and activities of daily living in elderly clients over 1 year. Geriatrics & Gerontology International, 17(11), 1866-1872. doi:10.1111/ggi.12978
• King, E. C., Holliday, P. J., & Andrews, G. J. (2018). Care challenges in the bathroom: The views of professional care providers working in clients' homes. Journal of Applied Gerontology, 37(4), 493-515. doi:10.1177/0733464816649278
• Rojas, J., Joseph, J., Liu, B., Srikumaran, U., & McFarland, E. G. (2018). Can patients manage toileting after reverse total shoulder arthroplasty? A systematic review. International Orthopaedics, 42(10), 2423-2428. doi:10.1007/s00264-018-3900-4