Self-care deficit occurs when an individual is unable to perform Activities of Daily Living (ADLs) adequately. These activities encompass essential personal tasks such as feeding, bathing, hygiene, dressing, and toileting. Furthermore, self-care deficits can extend to Instrumental Activities of Daily Living (IADLs), which involve more complex tasks like managing finances or using communication devices. For individuals navigating life with multiple diagnoses, creating a robust Care Plan Living With Multiple Diagnosis is paramount to address these potential self-care challenges and promote overall well-being.
Nurses and healthcare professionals play a vital role in recognizing and evaluating the limitations patients face in meeting their basic needs. While some self-care deficits may be temporary, arising from situations like post-surgery recovery, others are long-term, often associated with chronic conditions or disabilities. The cornerstone of effective care lies in developing an adaptive environment that empowers patients to maintain maximum independence. This involves leveraging appropriate equipment, multidisciplinary therapies, and robust caregiver support systems, all integrated within a well-structured care plan living with multiple diagnosis.
Common Causes of Self-Care Deficits in Individuals with Multiple Diagnoses
Several factors can contribute to self-care deficits, particularly when managing multiple health conditions simultaneously:
- Weakness and Fatigue: Multiple diagnoses can often lead to compounded fatigue and physical weakness, making even simple ADLs challenging.
- Reduced Motivation: The burden of managing multiple chronic conditions can significantly impact motivation and enthusiasm for self-care activities.
- Mental Health Conditions: Depression and anxiety are frequently co-occurring conditions with chronic illnesses. These mental health challenges can severely impair the desire and ability to engage in self-care.
- Pain: Chronic pain, often a symptom across various diagnoses, can be a major barrier to performing physical tasks related to self-care.
- Cognitive Impairment: Certain medical conditions or their treatments can lead to cognitive decline, affecting the ability to plan and execute self-care tasks.
- Developmental Disabilities: Pre-existing developmental disabilities can be further complicated when combined with new or existing medical diagnoses, impacting self-care abilities.
- Neuromuscular Disorders: Conditions like multiple sclerosis or myasthenia gravis, which may coexist with other diagnoses, directly affect muscle function and coordination needed for self-care.
- Impaired Mobility: Reduced mobility, whether from arthritis, stroke, or other conditions common in individuals with multiple diagnoses, directly restricts the ability to perform many self-care tasks.
- Post-Surgical Recovery: Surgery to address one condition can temporarily exacerbate self-care deficits, especially when combined with the ongoing management of other diagnoses.
- Lack of Adaptive Equipment and Support: Insufficient access to assistive devices or inadequate caregiver support can significantly hinder an individual’s ability to manage self-care, particularly with complex health needs.
Recognizing Signs and Symptoms of Self-Care Deficit
Identifying self-care deficits is crucial for developing an effective care plan living with multiple diagnosis. Patients may exhibit an inability to complete various ADLs, including:
Self-Feeding
- Difficulty preparing meals, using kitchen appliances, or opening food packaging due to weakness or coordination issues arising from multiple conditions.
- Struggles with handling utensils effectively due to tremors, pain, or limited mobility.
- Problems picking up or holding cups and glasses, potentially due to muscle weakness or neurological issues.
- Chewing and swallowing difficulties, which can be exacerbated by certain medications or conditions common in multiple diagnoses.
Self-Bathing & Hygiene
- Challenges gathering and setting up bathing supplies, requiring careful planning within a care plan living with multiple diagnosis to ensure accessibility.
- Difficulty regulating water temperature, potentially due to sensory issues or cognitive impairments.
- Safety concerns transferring in and out of the shower or bathtub, particularly with mobility limitations from multiple conditions.
- Inability to raise arms to wash hair, often due to pain, weakness, or limited range of motion.
- Bending to wash lower body becomes problematic with mobility issues or pain from conditions like arthritis or neuropathy.
- Manipulating a toothbrush and maintaining oral hygiene can be challenging due to fine motor skill deficits or fatigue.
- Cleaning dentures can be difficult due to dexterity issues or cognitive decline.
Self-Dressing & Grooming
- Making appropriate clothing choices can be affected by cognitive impairments or sensory sensitivities that might be part of their multiple diagnoses.
- Fastening buttons and zippers becomes difficult with fine motor skill problems or arthritis.
- Putting on socks and shoes can be challenging due to limited mobility or balance issues.
- Manipulating a comb or brush requires dexterity and arm strength, which may be compromised.
- Handling a razor for shaving presents safety concerns with tremors, cognitive issues, or coordination problems.
Self-Toileting
- Transferring on and off the toilet is a major challenge for individuals with mobility impairments or balance issues, requiring careful consideration in a care plan living with multiple diagnosis.
- Difficulty recognizing the urge to urinate or defecate, possibly due to neurological conditions or cognitive decline.
- Removing clothing to use the toilet can be problematic with mobility or dexterity limitations.
- Completing hygiene after elimination requires coordination and range of motion, which may be affected by multiple diagnoses.
Setting Expected Outcomes in a Care Plan for Multiple Diagnoses
When creating a care plan living with multiple diagnosis, setting realistic and achievable goals is crucial. Common nursing care planning goals and expected outcomes for self-care deficit include:
- The patient will perform ADLs to the maximum extent of their ability, acknowledging the limitations imposed by their multiple diagnoses.
- The patient will maintain independence with specific ADLs (e.g., self-feeding with adaptive equipment) as defined in their personalized care plan.
- Caregivers will demonstrate the skills and understanding necessary to effectively support the patient’s personal care needs within the context of their multiple diagnoses.
- The patient will demonstrate the proper and safe use of adaptive equipment to enhance their independence in self-care, as outlined in their care plan living with multiple diagnosis.
Nursing Assessment: A Holistic Approach for Multiple Diagnoses
A thorough nursing assessment is the foundation of an effective care plan living with multiple diagnosis. This involves gathering comprehensive physical, psychosocial, emotional, and diagnostic data.
1. Evaluate the Extent of Disabilities and Impairments: Assess the degree of cognitive, developmental, and physical impairments resulting from each diagnosis and their combined effect on self-care abilities. This comprehensive understanding is vital for setting realistic goals within the care plan.
2. Assess Safe Self-Care Capacity: Determine the patient’s ability to perform self-care tasks safely, considering the potential risks associated with their multiple diagnoses. For example, can they safely swallow food without aspiration, especially if they have conditions affecting swallowing? Can they safely navigate to the bathroom given mobility challenges from various conditions? Observational assessments may be necessary to evaluate their functional abilities.
3. Identify Barriers to Self-Care: Pinpoint specific obstacles preventing participation in self-care. These barriers could be physical, psychological, environmental, or related to the complexities of managing multiple medications and treatments. Examples include lack of information about adaptive strategies, fear of accidents or embarrassment, or insufficient access to necessary adaptive equipment or home modifications.
4. Plan for Resource Needs at Discharge: Discharge planning, an integral part of a care plan living with multiple diagnosis, should begin at admission. Anticipate the patient’s needs for ongoing support at home, considering the long-term management of their multiple conditions. Coordinate with case managers to arrange for home health services, rehabilitation, or community-based support systems to ensure a seamless transition of care and continued self-care support.
5. Assess Mental Health and Emotional Well-being: Recognize the significant emotional and psychological impact of living with multiple chronic illnesses and associated self-care deficits. Patients may experience depression, anxiety, and loss of motivation due to decreased independence. A non-judgmental and compassionate approach is crucial. Referral to mental health professionals (counselors, psychiatrists) may be necessary to address underlying emotional issues that are hindering self-care re-establishment. This mental health support should be integrated into the overall care plan living with multiple diagnosis.
Alt Text: Individual utilizes adaptive utensils for independent eating, showcasing assistive technology for self-care.
Nursing Interventions: Tailoring Care for Multiple Diagnoses
Nursing interventions are crucial for supporting patients with self-care deficits, particularly when developing a care plan living with multiple diagnosis.
General Self-Care Interventions
1. Implement Resources to Address Barriers: Proactively address identified barriers to self-care. This may involve utilizing translation services for communication challenges, providing written prompts for patients with hearing impairments, or securing necessary adaptive equipment.
2. Encourage Active Participation in Care: Combat potential dependency by actively encouraging patients to participate in their self-care to the fullest extent possible. This fosters a sense of control and promotes independence within the limitations of their multiple diagnoses.
3. Offer Limited Choices to Enhance Autonomy: While ensuring necessary tasks are completed, offer patients limited choices to promote autonomy and adherence. For example, allow them to choose the time of day for bathing or dressing, giving them a sense of control within their care routine.
4. Involve Family and Caregivers: Actively involve family members, spouses, and other caregivers in the care plan. This collaborative approach fosters shared understanding and commitment to supporting the patient’s ADLs, ensuring a cohesive care plan living with multiple diagnosis.
5. Promote Energy Conservation Strategies: Teach and implement energy-saving techniques, especially for patients experiencing fatigue from multiple conditions or respiratory issues like COPD. Encourage sitting during tasks, pacing activities, and scheduling self-care during periods of peak energy levels.
6. Pain Management is Paramount: Address pain effectively, as it can be a significant deterrent to self-care participation. Administer prescribed pain medications promptly and advocate for adjustments to pain management strategies if pain remains uncontrolled. Effective pain management is an essential component of a successful care plan living with multiple diagnosis.
Self-Feeding Interventions
1. Create a Conducive Eating Environment: Ensure a relaxed and unhurried mealtime to prevent aspiration and promote adequate nutrition. Position the patient upright, ensure clean hands and mouth, and minimize interruptions during meals.
2. Involve Speech Therapy When Necessary: If signs of swallowing difficulties (coughing, food pocketing, drooling) are observed, promptly consult with a speech therapist for evaluation and intervention to prevent aspiration and ensure safe eating.
3. Delegate Feeding Assistance Appropriately: When patients are unable to eat adequately independently, delegate feeding assistance to trained nursing assistants or caregivers to ensure nutritional and hydration needs are met.
4. Occupational Therapy Consultation for Adaptive Equipment: If patients struggle with utensil use due to weakness, tremors, or coordination problems, consult with occupational therapy for assessment and provision of adaptive utensils and feeding aids.
Self-Bathing Interventions
1. Maximize Patient Involvement in Bathing: Encourage patients to participate actively in bathing to the extent of their ability. Even if bed-bound, they may be able to wash their face and hands, promoting a sense of independence.
2. Evaluate and Provide Necessary Equipment: Assess the need for assistive bathing equipment both in the hospital and at home. This may include shower chairs, grab bars, handheld showerheads, and bath lifts to enhance safety and accessibility. Ensure these are incorporated into the care plan living with multiple diagnosis for home use.
3. Consider Rehabilitation and Exercise Programs: For patients whose self-care deficits are related to weakness, transfer difficulties, or limited range of motion, recommend rehabilitation and exercise programs to improve strength, flexibility, and functional mobility.
Self-Dressing Interventions
1. Suggest Adaptive Clothing Options: Recommend clothing modifications that simplify dressing, such as pullover garments, elastic waistbands, Velcro closures, and front-fastening bras.
2. Prepare Clothing in Advance: For patients with cognitive impairments or dementia, simplify dressing by laying out clothing choices in advance. This reduces confusion and promotes independence by streamlining the decision-making process.
3. Evaluate and Provide Grooming Aids: Assess the need for adaptive grooming tools, such as long-handled combs, adapted razors, and specialized makeup applicators, to facilitate hygiene and maintain self-esteem.
Self-Toileting Interventions
1. Establish a Voiding Schedule: For patients with bladder control issues (e.g., neurogenic bladder), implement a structured voiding schedule to improve bladder control and reduce incontinence episodes.
2. Ensure Privacy During Toileting: Respect the patient’s need for privacy during toileting. Once safety is ensured, allow them to toilet independently and discreetly.
3. Provide Commodes and Toilet Risers: For patients with mobility limitations, provide bedside commodes for nighttime toileting and toilet risers to facilitate safe transfers on and off the toilet.
4. Anticipate Toileting Needs Proactively: For patients who are nonverbal or have difficulty recognizing toileting urges, anticipate their needs by offering bedpans or assistance to the bathroom at regular intervals (e.g., after meals, before bed) to prevent incontinence and maintain dignity. This proactive approach is especially important in a care plan living with multiple diagnosis where other conditions may complicate toileting needs.
Alt Text: Nurse supports patient during ambulation, illustrating assistance with mobility as part of comprehensive care.
Nursing Care Plan Examples: Addressing Self-Care Deficits
Nursing care plans provide a structured framework for prioritizing assessments and interventions, guiding both short-term and long-term care goals within a care plan living with multiple diagnosis.
Care Plan #1: Self-Care Deficit related to Stroke and Multiple Diagnoses
Diagnostic Statement:
Self-care deficit related to impaired coordination secondary to stroke, complicated by pre-existing arthritis and diabetes, as evidenced by difficulty toileting independently and dressing the lower body.
Expected Outcomes:
- The patient will demonstrate safe and increasingly independent toileting and dressing techniques, adapted to their physical limitations from stroke, arthritis, and diabetes.
- The patient will report improved motor coordination and confidence in performing self-care tasks.
Assessment:
1. Assess the Degree of Impairment and Functional Level: Evaluate the specific impact of stroke, arthritis, and diabetes on the patient’s coordination, mobility, sensation, and overall functional abilities related to self-care. This detailed assessment guides the level and type of assistance required.
2. Assess Need for Assistive Devices and Home Health Care: Determine the need for assistive devices (e.g., reachers, dressing sticks, grab bars) and home health support, considering the combined challenges of stroke, arthritis, and diabetes. Occupational therapy consultation is crucial for home modifications to maximize independence.
3. Facilitate Acceptance of Necessary Assistance: Address potential emotional distress related to loss of independence due to multiple health conditions. Help the patient accept necessary assistance while focusing on maximizing their remaining abilities and promoting self-worth.
Interventions:
1. Provide Personal Care Assistance While Promoting Independence: Assist with personal care tasks while actively encouraging the patient to participate to their fullest capacity, focusing on regaining and maintaining independence within the context of their multiple diagnoses.
2. Promote Patient Involvement in Care Planning and Decision-Making: Engage the patient in identifying problems, setting goals, and making decisions related to their care plan. This collaborative approach enhances commitment, optimizes outcomes, and supports recovery and health promotion despite multiple health challenges.
3. Assist with Dressing, Using Adaptive Techniques: Provide assistance with dressing, adapting techniques based on the patient’s specific limitations from stroke, arthritis, and diabetes. This may include adapted methods for putting on shoes and socks or managing fasteners.
4. Utilize Adaptive Clothing: Recommend and provide adaptive clothing (e.g., front closures, wide openings, Velcro) to facilitate easier dressing, considering the patient’s limited mobility and fine motor skills.
5. Teach Dressing Techniques for Affected Side: Instruct the patient in techniques for dressing the affected side first, then the unaffected side, to promote independence despite hemiparesis from stroke.
6. Collaborate with Rehabilitation Professionals: Work closely with physical and occupational therapists to obtain assistive devices, mobility aids, and home modifications tailored to the patient’s needs arising from stroke, arthritis, and diabetes. Rehabilitation professionals play a vital role in maximizing the patient’s functional capabilities and promoting independence in the face of multiple diagnoses.
Care Plan #2: Self-Care Deficit related to Anxiety and Multiple Diagnoses
Diagnostic Statement:
Self-care deficit related to disabling anxiety, exacerbated by the challenges of managing COPD and heart failure, as evidenced by difficulty with transportation, telephone use, and shopping.
Expected Outcomes:
- The patient will verbalize and acknowledge feelings of anxiety related to managing their health and self-care.
- The patient will report a decrease in anxiety levels, enabling them to engage more effectively in self-care activities.
- The patient will perform self-care activities to the best of their ability, with reduced anxiety as a barrier.
Assessment:
1. Assess Cognitive Functioning: Evaluate memory, concentration, and ability to focus on tasks, as anxiety can significantly impact cognitive function. This assessment helps determine the patient’s capacity to participate in care and learn or relearn self-care tasks amidst anxiety and the complexities of COPD and heart failure management.
2. Identify Anxiety Triggers: Explore potential triggers for the patient’s anxiety, particularly those related to managing COPD, heart failure, and their combined impact on daily life and self-care. Understanding triggers allows for proactive strategies to mitigate anxiety.
3. Assess ADL Performance and Safety: Evaluate the patient’s ability to perform ADLs safely and effectively, considering the limitations imposed by anxiety, COPD, and heart failure. Utilize assessment tools like the Functional Independence Measure (FIM) to quantify functional status and identify specific areas of difficulty.
4. Assess Contributing Factors to Anxiety: Investigate factors contributing to anxiety, such as breathlessness from COPD, fear of heart failure exacerbation, social isolation, or concerns about managing multiple medications. Addressing these underlying factors is crucial for reducing anxiety and improving self-care motivation.
Interventions:
1. Provide Personal Care Support with Gradual Independence: Offer personal care assistance while gradually encouraging and promoting independence as the patient’s anxiety decreases and their confidence grows.
2. Engage Patient and Family in Care Plan Development: Involve the patient and their family in formulating the care plan living with multiple diagnosis, including setting goals and strategies for promoting self-care. This collaborative approach ensures their active participation and commitment to achieving goals.
3. Establish Consistent Routines and Allow Adequate Time: Implement consistent daily routines for self-care activities. Predictability and structure can reduce anxiety. Allow ample time for task completion, minimizing pressure and promoting a sense of control.
4. Provide Positive Reinforcement and Acknowledge Progress: Offer consistent positive reinforcement for all self-care attempts, acknowledging even partial achievements. Highlighting incremental progress helps build confidence and motivation, especially when anxiety makes it difficult to perceive improvement.
5. Create a Balanced Activity Schedule: Develop a schedule that balances rest and activity, considering the patient’s fatigue levels from COPD and heart failure, as well as anxiety-related exhaustion. A structured schedule prevents overexertion and frustration, facilitating better participation in self-care.
References
- Ackley, B.J., Ladwig, G.B.,& Makic, M.B.F. (2017). Nursing diagnosis handbook: An evidence-based guide to planning care (11th ed.). Elsevier.
- Carpenito, L.J. (2013). Nursing diagnosis: Application to clinical practice (14th ed.). Lippincott Williams & Wilkins.
- Doenges, M.E., Moorhouse, M.F., & Murr, A.C. (2019). Nursing care plans Guidelines for individualizing client care across the life span (10th ed.). F.A. Davis Company.
- Gulanick, M. & Myers, J.L. (2014). Nursing care plans Diagnoses, interventions, and outcomes (8th ed.). Elsevier.
- 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
- National Institute of Neurological Disorders and Stroke. Amyotrophic Lateral Sclerosis (ALS). https://www.ninds.nih.gov/health-information/disorders/amyotrophic-lateral-sclerosis-als
- 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
