Self-Care Deficit: bathing/hygiene, dressing/grooming, feeding, toileting Taxonomy II: Activity/RestClass 5 Self-Care (Bathing/Hygiene 00108, Dressing/Grooming 00109, Feeding

00102, Toileting 00110) [Diagnostic Division: Hygiene] Submitted 1980; Nursing Diagnosis Extension and Classification (NDEC) Revision 1998 Definition: Impaired ability to perform or complete feeding, bathing/hygiene, dressing and grooming, or toileting activities for oneself [NOTE: Self-care also may be expanded to include the practices used by the client to promote health, the individual responsibility for self, a way of thinking. Refer to NDs impaired Home Maintenance; ineffective Health Maintenance.] Related Factors Weakness; fatigue; decreased motivation Neuromuscular/musculoskeletal impairment Environmental barriers Severe anxiety Pain, discomfort Perceptual/cognitive impairment Inability to perceive body part/spatial relationship [bathing/ hygiene] Impaired transfer ability [self-toileting] Impaired mobility status [self-toileting] [Mechanical restrictions such as cast, splint, traction, ventilator] Defining Characteristics SELF-FEEDING DEFICIT Inability to: Prepare food for ingestion; open containers Handle utensils; get food onto utensil; bring food from a receptacle to the mouth Ingest food safely; manipulate food in mouth; chew/swallow food Pick up cup or glass Use assistive device Diagnostic Studies Pediatric/Geriatric/Lifespan Medications 575 Information in brackets added by the authors to clarify and enhance the use of nursing diagnoses. SELF-CARE DEFICIT: bathing/hygiene, dressing/grooming, feeding, toileting Ingest sufficient food; complete a meal Ingest food in a socially acceptable manner SELF-BATHING/HYGIENE DEFICIT Inability to: Get bath supplies Wash body Obtain water source; regulate bath water Access bathroom [tub] Dry body SELF-DRESSING/GROOMING DEFICIT Inability to: Choose clothing; pick up clothing Put clothing on upper/lower body; put on socks/shoes; remove clothing Use zippers/assistive devices Maintain appearance at a satisfactory level Impaired ability to obtain clothing; put on/take off necessary items of clothing; fasten clothing SELF-TOILETING DEFICIT

Inability to: Get to toilet or commode Manipulate clothing for toileting Sit on/rise from toilet or commode Carry out proper toilet hygiene Flush toilet or [empty] commode Desired Outcomes/Evaluation CriteriaClient Will: Identify individual areas of weakness/needs. Verbalize knowledge of healthcare practices. Demonstrate techniques/lifestyle changes to meet self-care needs. Perform self-care activities within level of own ability. Identify personal/community resources that can provide assistance. Actions/Interventions NURSING PRIORITY NO.1. To identify causative/contributing factors: Determine age/developmental issues affecting ability of individual to participate in own care. Note concomitant medical problems/existing conditions that may be factors for care (e.g., high BP, heart disease, renal failure, spinal cord injury, CVA, MS, malnutrition, pain, Alzheimers disease). Review medication regimen for possible effects on alertness/ mentation, energy level, balance, perception. Note other etiological factors present, including language barriers, speech impairment, visual acuity/hearing problem, emotional stability/ability. (Refer to NDs impaired verbal Communication; impaired Environmental Interpretation; risk for unilateral Neglect; dusturbed Sensory Percption (specify) for related interventions.) Assess barriers to participation in regimen (e.g., lack of information, insufficient time for discussion; psychological and/or intimate family problems that may be difficult to share; fear of appearing stupid or ignorant; social/economic, work/home environment problems). NURSING PRIORITY NO. 2. To assess degree of disability: Identify degree of individual impairment/functional level according to scale (as listed in ND impaired physical Mobility).

 Assess memory/intellectual functioning. Note developmental level to which client has regressed/progressed. Determine individual strengths and skills of the client. Note whether deficit is temporary or permanent, should decrease or increase with time. NURSING PRIORITY NO. 3. To assist in correcting/dealing with situation: Perform/assist with meeting clients needs when he or she is unable to meet own needs (e.g., personal care assistance is part of nursing care and should not be neglected while promoting and integrating self-care independence). Promote clients/SOs participation in problem identification and desired goals and decision making. Enhances commitment to plan, optimizing outcomes, and supporting recovery and/or health promotion. Develop plan of care appropriate to individual situation, scheduling activities to conform to clients usual/desired schedule. Plan time for listening to the clients/SOs feelings/concerns to discover barriers to participation in regimen and to work on problem solutions. Practice and promote short-term goal setting and achievement to recognize that todays success is as important as any long-term goal, accepting ability to do one thing at a time, and conceputalization of self-care in a broader sence. Provide for communication among those who are involved in caring for/assisting the client. Enhances coordination and continuity of care. Establish remotivation/resocialization programs when indicated. Establish contractual partnership with client/SO(s) if appropriate/

indicated for motivation/behavioral modification. Assist with rehabilitation program to enhance capabilities/ promote independence. Provide privacy and equipment within easy reach during personal care activities. Allow sufficient time for client to accomplish tasks to fullest extent of ability.Avoid unnecessary conversation/interruptions. Assist with necessary adaptations to accomplish ADLs. Begin with familiar, easily accomplished tasks to encourage client and build on successes. Collaborate with rehabilitation professionals to identify/ obtain assistive devices, mobility aids, and home modification as necessary (e.g., adequate lighting/visual aids; bedside commonde; raised toilet seat/grab bars for bathroom; modified clothing; modified eating utensils). Identify energy-saving behaviors (e.g., sitting instead of standing when possible). (Refer to NDs Activity Intolerance; Fatigue for additional interventions.) Implement bowel or bladder training/retraining program, as indicated. (Refer to Constipation; Bowel Incontinence; impaired Urinary Elimination for appropriate interventions.) Encourage food and fluid choices reflecting individual likes and abilities that meet nutritional needs. Provide assistive devices/alternate feeding methods, as appropriate. (Refer to ND impaired Swallowing for related interventions.) Assist with medication regimen as necessary, encouraging timely use of medications (e.g., taking diuretics in morning when client is more awake/able to manage toileting, use of pain relievers prior to activity to facilitate movement, postponing intake of medications that cause sedation until selfcare

activites completed). Make home visit to assess environmental/discharge needs. NURSING PRIORITY NO. 4. To promote wellness (Teaching/ Discharge Considerations): Assist the client to become aware of rights and responsibilities in health/healthcare and to assess own health strengths physical, emotional, and intellectual. Support client in making health-related decisions and assist in developing self-care practices and goals that promote health. Provide for ongoing evaluation of self-care program, identifying progress and needed changes. Review/modify program periodically to accommodate changes in clients abilities. Assists client to adhere to plan of care to fullest extent. Encourage keeping a journal of progress and practicing of independent living skills to foster self-care and self-determination. Review safety concerns.Modify activities/environment to reduce risk of injury and promote successful community functioning. Refer to home care provider, social services, physical/occupational therapy, rehabilitation, and counseling resources, as indicated. Identify additional community resources (e.g., senior services, Meals on Wheels). Review instructions from other members of the healthcare team and provide written copy. Provides clarification, reinforcement, and periodic review by client/caregivers. Give family information about respite/other care options. Allows them free time away from the care situation to renew themselves. (Refer to ND Caregiver Role Strain for additional interventions.)

 Assist/support family with alternative placements as necessary. Enhances likelihood of finding individually appropriate situation to meet clients needs. Be available for discussion of feelings about situation (e.g., grieving, anger). Refer to NDs risk for Falls; Injury/Trauma; ineffective Coping; compromised family Coping; risk for Disuse Syndrome; situational low Self-Esteem; impaired physical Mobility; Powerlessness, as appropriate. Documentation Focus ASSESSMENT/REASSESSMENT Individual findings, functional level, and specifics of limitation( s). Needed resources/adaptive devices. Availability/use of community resources. Who is involved in care/provides assistance. PLANNING Plan of care and who is involved in planning. Teaching plan. Response to interventions/teaching and actions performed. Attainment/progress toward desired outcome(s). Modifications of plan of care. DISCHARGE PLANNING Long-term needs and who is responsible for actions to be taken. Type of and source for assistive devices. Specific referrals made.