Self-care deficit refers to the patient that is limited in performing activities of daily living (ADLs). This can include tasks related to feeding, bathing and hygiene practices, as well as getting dressed and completing toileting. Self-care deficits can also expand to more complex tasks such as making phone calls or managing finances, which are referred to as Instrumental Activities of Daily Living (IADLs).
Nurses must be able to recognize and assess for limitations of patients in their ability to carry out basic needs. Some self-care deficits will be temporary, such as recovering from surgery, while others will be long-term, such as a patient with paraplegia. The nurse’s role is to create an adaptive environment that allows the patient to maintain as much independence as possible while also ensuring their needs are met through equipment, multidisciplinary therapies, and caregiver support.
Causes: (Related to)
- Weakness/fatigue
- Decreased motivation
- Depression and anxiety
- Pain
- Cognitive impairment
- Developmental disabilities
- Neuromuscular disorders (multiple sclerosis, myasthenia gravis)
- Poor mobility
- Recent surgery
- Lack of adaptive equipment
Signs and Symptoms (As evidenced by)
Patients with a self-care deficit will present with an inability to complete the following ADLs:
Self-feeding:
- Prepare food, use appliances, open packaging
- Handle utensils
- Pick up or hold drinkware
- Chew or swallow
Self-bathing & hygiene:
- Gather and set up supplies
- Regulate water temperature
- Safely transfer in and out of shower/bathtub
- Raise arms to wash hair
- Bend to wash lower body
- Manipulate toothbrush
- Clean dentures
Self-dressing & grooming:
- Make appropriate clothing choices
- Fasten buttons, zip zippers
- Apply socks or shoes
- Manipulate comb or brush
- Handle razor
Self-toileting:
- Transfer on and off toilet
- Recognize the urge for elimination
- Remove clothing to use toilet
- Complete hygiene following elimination
Expected Outcomes:
- Patient will perform ADLs within their own level of ability
- Patient will maintain independence with [specify ADL]
- Caregiver will demonstrate the ability to meet patient’s personal needs
- Patient will demonstrate appropriate use of adaptive equipment
Nursing Assessment for Self-Care Deficit
| Assessment | Rationale |
| Assess the degree of disabilities or impairments | Assessing the extent of cognitive and developmental impairments as well as physical disabilities will help create reasonable goals for self-care. |
| Assess ability to safely complete self-care | Is the patient able to safely feed themselves without aspirating? Can they safely ambulate to the bathroom? If there is doubt, it may be necessary to observe the patient perform tasks to evaluate their ability. |
| Assess barriers that prevent self-care | Identifying issues that prevent participating in self-care helps the nurse develop appropriate measures to support the patient. Examples include lack of information, fear of embarrassment, and cultural differences. |
| Plan for resources at discharge | Discharge planning begins at admission. The nurse can coordinate with the case manager when there is an expected need for home health or rehabilitation services once discharged from the acute care facility. Anticipating the patient’s needs creates a smooth transition of care. |
| Assess mental health challenges | Patients with chronic illnesses are often affected by depression and lack of motivation from losing their independence. The nurse should remain non-judgmental and compassionate with a listening attitude. A referral to a counselor or psych consult may be needed to get to the root of the problem before self-care can be reestablished. |
Nursing Interventions for Self-Care Deficit
| Interventions | Rationale |
| General self-care interventions | |
| Implement resources to overcome barriers | Use of language lines may be necessary for language barriers or hearing aids for hard-of-hearing patients. These are simple barriers to overcome that allow nurse-patient communication to complete ADLs. |
| Encourage participation in care | Patients can become dependent on caregivers and support staff and should be encouraged to carry out as much of their self-care as possible. |
| Offer (limited) choices | Standing firm with completing tasks while offering the patient options will increase adherence. For example, allowing the patient to choose between walking the hallway before or after lunch gives them autonomy without allowing pushback. |
| Incorporate family members and caregivers | Involving family members, spouses, and other caregivers promotes a commitment and understanding of each person’s role to success. |
| Promote energy-saving tactics | Patients with weakness or conditions such as COPD cannot tolerate standing or moving for long periods of time. Encourage sitting when possible and performing tasks when they have the most energy available. |
| Pain management | If self-care deficits stem from acute or chronic pain the patient will not want to participate in activities that trigger pain. The nurse will need to first administer pain medications as ordered or consult with the physician if pain is not controlled. |
| Self-feeding Interventions | |
| Offer appropriate time and setting for eating | Patients should not be rushed during mealtimes in order to prevent aspirating and ensure adequate nutritional intake. Position the patient in the bed or chair at high as possible, and clean hands and mouth to promote readiness to eat with all utensils. Ensure the patient is not interrupted by support staff. |
| Involve speech therapy if needed | If coughing, pocketing of food, or drooling is observed it may be necessary to alert the physician to the need for a speech evaluation for possible aspiration. |
| Delegate feeding to the nursing assistant if needed | A patient who is not eating or consuming only small amounts may need assistance. Delegate to support staff to assist the patient in eating to ensure they are meeting their nutritional and hydration needs. |
| Consult with occupational therapy | If a patient is unable to hold eating utensils, get utensils up to their mouths or suffer from tremors, they may need adaptive utensils or assessment by OT to make feeding easier. |
| Self-bathing Interventions | |
| Allow the patient to help as much as possible | If the patient is bed-bound or has decreased strength but is able to wipe their face and hands, encourage them to perform as much as possible to maintain independence. |
| Evaluate equipment needs | Whether in the hospital or at home, the patient may need a shower chair, grab bars, or a handheld showerhead to complete bathing. |
| Consider rehabilitation and exercise programs | If strength, transferring, and range of motion are preventing washing hair or reaching feet, the patient may benefit from stretching and exercise programs to improve flexibility. |
| Self-dressing Interventions | |
| Suggest easier clothing options | Patients may need to shift their wardrobes to pullover sweaters and shirts, pants with elastic waistbands, and shoes with velcro in order to dress themselves. |
| Layout clothing options beforehand | Patients with dementia may become easily distracted while dressing if presented with an entire closet. They may also wear soiled or dirty clothing they were not aware was already worn. Laying out an exact outfit takes away the confusion and frustration of dressing. |
| Evaluate tools for grooming | The patient may need adaptive tools for hair brushing, shaving, and applying makeup. Feeling confident in one’s appearance is important to maintaining hygiene. |
| Self-toileting Interventions | |
| Establish a voiding schedule | Certain conditions, such as a neurogenic bladder, prevent proper bladder control. Establishing a voiding schedule means setting times (every 2 hours or so) to urinate. This helps with muscle control in holding urine and emptying the bladder and gives the patient control over their toileting. |
| Provide privacy | Everyone expects privacy with toileting. Once the patient’s safety is ensured, allow privacy and time for them to complete elimination. |
| Provide commodes or toilet risers | If transferring or ambulation is a concern, a bedside commode can help with toileting in the middle of the night. If sitting and rising are difficult, a toilet riser placed over a regular toilet can assist the patient in transferring. |
| Anticipate toileting needs | If a patient is nonverbal or can’t recognize the urge to eliminate, it may be best to offer them the bedpan or assist to the bathroom at certain intervals, such as after meals or before bedtime to prevent incontinence episodes, soiling or clothing or bed linens, and preserving their dignity. |
References and Sources
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
- Mlinac, M. E., & Feng, M. C. (2016, September). Assessment of Activities of Daily Living, Self-Care, and Independence. Archives of Clinical Neuropsychology, 31(6), 506-516. https://academic.oup.com/acn/article/31/6/506/1727834
- Regis College. (n.d.). The Pivotal Role of Orem’s Self-Care Deficit Theory. Regis College. https://online.regiscollege.edu/blog/the-pivotal-role-of-orems-self-care-deficit-theory/
- What is Neurogenic Bladder? (2021, September). Urology Care Foundation. https://www.urologyhealth.org/urology-a-z/n/neurogenic-bladder
