Nursing Care Plan: Self-Care deficit related to depression, discouragement, loss of mobility, energy deficit, general debilitation and perceptual/cognitive impairment.

Scientific Basis:

The nurse may encounter the patient with a self-care deficit in the hospital or in the community. The deficit may be the result of transient limitations, such as those one might experience while recuperating from surgery, or the result of progressive deterioration that erodes the individual’s ability or willingness to perform the activities required to care for himself or herself. Careful examination of the patient’s deficit is required in order to be certain that the patient is not failing at self-care because of a lack in material resources or a problem with arranging the environment to suit the patient’s physical limitations. The nurse coordinates services to maximize the independence of the patient and to ensure that the environment the patient lives in is safe and supportive of his or her special needs.

Alteration in physical ability may interfere with the individual’s performance of activities of daily living. Patients who are unable to participate on their own are dependent upon others to meet basic needs and are at risk for problems such as poor hygiene.

Self-care refers to those activities of an individual performs independently throughout the life to maintain personal well-being. Most adults care for themselves, whereas a person weakened by illness or disability require assistance with self-care activities.

Kozier, 2007; Gulanick, 2007; Neal, 2004



Intervention and Rationale

I: Determine current capabilities (0–4 scale) and barriers to participation in care.
R: Identifies need for/level of interventions required.

I: Assess ability to carry out ADL’s on regular basis. Determine the aspects of self care that are problematic to the client.
R: The client may only require assistance with some self-care measures.

I: Assess specific cause of each deficit (e.g., weakness, visual problems, cognitive impairment).
R: Different etiologic factors may require more specific interventions to enable self care.

I: Encouraging independence, but intervene when client cannot perform.
R: To decrease frustration.

I: Use consistent routines and allow adequate time for client to complete the tasks
R: This helps client organize and carry out self-care skills.

I: Provide positive reinforcement for all activities attempted; no partial achievements.
R: This provides the client with an external source of positive reinforcement.

I: Encouraged client to comb own hair. Suggested hairstyles that are low maintenance.
R: To enable the client to maintain autonomy for as long as possible.

I: Involve client in formulation of plan of care at level of ability.
R: Enhances sense of control and aids in cooperation and maintenance of independence.

I: Encourage self-care. Work with present abilities; do not pressure client beyond capabilities. Provide adequate time for client to complete tasks. Have expectation of improvement and assist as needed.
R: Doing for oneself enhances feeling of self-worth. Failure can produce discouragement and depression.

I: Provide and promote privacy, including during bathing/ showering.
R: Modesty may lead to reluctance to participate in care or perform activities in the presence of others.

I: Shampoo/style hair as needed. Provide/assist with manicure.
R: Aids in maintaining appearance. Shampooing may be required more/less frequently than bathing schedule.

I: Acquire clothing with modified fasteners as indicated.
R: Use of Velcro instead of buttons/shoelaces can facilitate process of dressing/undressing.

I: Encourage/assist with routine mouth/teeth care daily.
R: Reduces risk of gum disease/tooth loss; promotes proper fitting of dentures.

I: Provided supervision for each activity until client performed skill competently and is safe in independent care; evaluated regularly making sure that client is maintaining skill level and remains safe in environment.
R: The client’s ability to perform self-care measures may change often over time and will need to be assessed regularly.

Doenges, et al, 2008; Kruse, et al, 2003; Gulanick, 2007