NANDA-Nursing Plan 00182 Readiness for enhanced self-care

Note: This article was translated from Japanese using translation software. Please use at your own risk, as there may be unnatural points in the content or differences in content due to cultural differences.

Area 4 Activity/Rest
production, storage, consumption, or balance of energy resources
Category 5 Self-care
Ability to carry out activities to care for one’s body and bodily functions

Readiness for enhanced self-care 00182

Nursing Diagnosis: Readiness for enhanced self-care
Definition: A state in which the pattern of activity you do for yourself can be further enhanced to achieve health-related goals.

The self-care promotion readiness state is similar to the health care promotion readiness state.
This promotion preparation is a state in which “the person is motivated”.
It’s not a matter of ability (whether you can do it), it’s a matter of mood (whether you’re willing to do it).
All right, let’s do our best! If you are motivated, you will be able to support us.
Let’s increase the number of successful experiences and support them so that their motivation can be maintained for a long time.
To that end, I think the key is to search for safe and sustainable methods.
Even if you can do it now, it will be difficult in a year from now, and you will feel uneasy about living at home.
(Even so, in the case of progressive disease, the physical condition changes, so intervention is necessary each time.)
In addition, many elderly people think that their own methods are the most efficient and easy to do.
Before I got sick, I might actually have. Let’s support the way to shift to a safer way while accepting the way.

1. What is self care

What exactly is self-care? Take a look at the WHO and OREM definitions to get an overview of self-care.

1) WHO definition

“Self-care promotes good health and empowers individuals, families and communities to prevent disease, maintain good health, and respond to illness and disability, regardless of access to medical care.”

2) Definition of Orem

Orem Dorothea (USA 1914-2007) has worked in both nursing services and education.
Orem’s definition of self-care is “individualized care, taken as an individual’s learned goal-directed activities, and used to regulate his or her own functioning and development”.
Orem used the self-care deficit theory to discover the self-care ability that is lacking in maintaining the well-being of individuals, and preached a nursing system theory that is a framework for orienting nursing practice.
It is also known as the Orem Nursing Model and is particularly popular in rehabilitation, primary care, and other settings that support patients’ independent living activities.

By looking at the definitions of both, I think I was able to get an overview of self-care.
Simply put, self-care is about taking care of yourself.
However, when it comes to taking care of yourself, the desired health and developmental stages differ depending on the stage of growth.
It can be said that the state of self-care is fulfilling when the child acquires the knowledge and skills necessary to achieve growth and development that is appropriate for his or her age.
Orem’s self-care deficiency theory is to seek out the knowledge and skills that are lacking and intervene to satisfy the lack, aiming for a state of self-care (complicated (;▽;)).
Let’s think a little more about the Orem Nursing Theory.

2. Orem Nursing Theory

Orem Nursing Theory is a nursing theory with self-care as the central concept.
This theory consists of three theories: “self-care theory”, “self-care deficiency theory”, and “nursing system theory”.
Let’s look at each.

1) Self-care theory

In order to maintain the continuation of life and health and well-being, humans fulfill (1) unchanging self-care requirements, (2) developmental health care requirements, and (3) self-care requirements for health deviations, and carry out coordinating functions.

(1) Universal self-care requirements

Universal self-care requirements are needs (care requirements) common to all human beings. It consists of the following eight items.
・Maintenance of sufficient air intake
・Maintenance of sufficient water intake
・Maintenance of adequate food intake
Maintaining care for the excretion process and excreta
・Maintaining a balance between activity and rest
Maintaining loneliness and social interaction
・Prevention of risks to human life, functions and stability
facilitating human functioning and development within social groups according to human potential, known capacity limitations, and a desire to be normal

(2) Developmental self-care requirements

Developmental self-care requirements refer to the care requirements that are required at each stage in each life cycle from the human womb to adulthood.
Supporting life processes, facilitating developmental processes, and general education necessary for maturity suitable for growth stages.
Orem cites deprivation of education, problems of social adjustment, failure of healthy individualization, loss of relatives, friends, and colleagues, loss of property, loss of occupational security, and the unknown. status-related problems, ill health or disability, difficult living conditions, terminal illness and imminent death.

(3) Self-care requirements for health deviations

Self-care requirements for health deviations are care requirements for treating or controlling injuries and illnesses.

2) Insufficient self-care theory

lack of self care
“Self-care deficit” occurs when individuals are unable to meet their own self-care requirements (constant self-care, developmental self-care, self-care for health deviations).
Insufficient self-care results from a lack of knowledge, inability to judge, and inability to take actions that produce self-care outcomes.
Nurses are supposed to detect this and help if needed.

3) Nursing system theory

The nursing system is a complementary practice that nurses intentionally perform in a complementary relationship to meet self-care requirements for patients with self-care deficits. It consists of three support systems: full compensation, partial compensation, and supportive education, and more than one system is used according to the patient’s behavior.
Nursing systems are classified into the following three types from the viewpoint of assisting patients’ lack of self-care.
Total Compensation Nursing System
Partial Compensation Nursing System
Supportive/Supportive Nursing System
For example, the full compensatory nursing system is applied to coma patients.

There are three types of self-care: “constant self-care for lack of needs,” “developmental self-care,” and “self-care for health deviations.” I also learned that what is lacking in each self-care is called “insufficient self-care” and that there is a nursng system theory as an intervention method.
It is also important to point out that there are three intervention methods in nursing system theory: “full compensation,” “partial compensation,” and “support education.”
Now that we’ve learned about self-care, let’s think about the topic of this lesson, “readiness to promote self-care.”

3. Readiness for enhanced self-care targets

Let’s extract the “subject” from the diagnostic index.
Demonstrate commitment to self-care
・I want to strengthen my knowledge.
・ I’m trying to learn how.
・Motivated remarks are heard.
· Actively hope for rehabilitation
・Preparing for lifestyle changes
· Willing to self-manage internal medicine
– Ability to accept disability.
・ After going through the process of accepting the disability, you have reached the stage where you have decided to accept the residual disability and live with the inconvenience
*Please refer to (★1 )for the acceptance model of disability.
・There are supporters who will prepare the environment
・ Family members, care managers, etc. create an environment where self-care can be done
(L-shaped fence, portable toilet, handrail, wheelchair, slope, medication calendar, clothes, shoes, etc.)

★ 1 Disability acceptance model

When something shocking happens, it takes time to come to terms with it, especially about yourself and those closest to you.
There are people who have announced the process of accepting that fact as a “model”.
It is important for the interventionists (those who work directly with the patient, such as nurses) to know that they have gone through such a process. This is because there are different points to be aware of depending on the stage.
We introduce two famous models. There are also other models of “Cone” and “Shorts”. If you are interested, please check it out.

1. Kubra Ross (U.S. Psychiatrist): Acceptance Process of Death

Through systematic research on terminally ill patients, I discovered the process of acceptance of death.
① Denial: “Isn’t it true? Me?”
②Anger: “Why did this happen?” “What will happen after this? Will you die? Will it hurt? When will you die?”
③ Transaction: “God, please heal me. There are still things left unfinished.”
④ Depression: “If I can’t do anything, I want to die. I don’t want to cause trouble for my family.”
*Please note that this period may indicate a suicide attempt.
⑤ Acceptance: “Everyone will come to the end. This may be fate.” stage to

2. Fink (USA, Psychiatrist): The Grief Process Based on the Crisis Model

Presented the intervention process from the immediate aftermath of the crisis to adaptation.
① Impact: Psychological impact such as advance notice of death or bereavement
“Intense anxiety/panic/fainting”
② Defensive regression: a defense mechanism against the event of bereavement
Denial, repression, escapism
③ Acknowledgment: Perception of reality and a period of self-readjustment
*Please note that this period may indicate a suicide attempt.
④Adaptation: Responding to the bereavement situation and reality
Accept it in a constructive way and discover your own existence and value anew.

Kubra Ross’ model is based on “death”, but if you look at the content, it seems that bad news other than “death” follows the same process.
The process of accepting disability and death is not always a one-way process, and may progress and retreat repeatedly. Even if you think you have entered the acceptance stage, you may return to the previous stage of depression, so be especially careful during times when you are prone to harming yourself or others.

4. aim setting

The goal is to make the patient the subject.
Instead of saying “Nurses can do XX”,
For example, “The patient will be able to do ○○.”

・The recuperation environment can be arranged according to the residual function.
・The motivation for self-care can be maintained.
・Caregivers/caregivers can provide support according to the developmental stage.
• Caregivers/caregivers can provide support according to the stages of the disability acceptance process.

*Nurse goals include:

・In order to enhance self-care, prepare a recuperation environment suitable for ADLs and disabilities.
・Give advice to the person and their family members and have them acquire knowledge and skills so that they can live with their remaining functions.
・Listen to the complaints of the patient, family members, and caregivers, and try to alleviate their anxiety.
・Provide support according to the child’s developmental stage.
・Provide support according to the stages of the disability acceptance process.
・Support to maintain motivation for self-care while accumulating successful experiences and encouraging them.

5. nursing plan

1) Observation Plan 《OP》

(1) Factors in the treatment environment
・Is the living environment suitable for the developmental stage?
・Is the living environment suitable for the state of disability?
・ Handrails, slopes
・Whether or not medication errors occur
・Who checks the medication calendar and medication
(2) Personal factors
・Exertion-induced changes in vital signs
・Changes in vital signs at rest and during exertion
・ Presence or absence of subjective symptoms during exertion (dizziness, palpitations, shortness of breath, chest pain, pain)
・Cognitive decline
・ Medication compliance (Are you taking your medication properly and are you able to control your symptoms?
(Are you drinking excessively?)
・I’m motivated, but can I really do it?
(I forgot to take a bath and haven’t been in for weeks, etc.)
・Dementia scale: Hasegawa scale, MMSE
・Medical history, current disease history
・ Timing of injury
・ Disease stage: acute stage, chronic stage, terminal stage, etc.
・ Treatment:
  ・Diet therapy: restricted diet
・Food form: mousse color, liquid diet
・ Paralysis, deformation
・Paralysis: site, range, complete paralysis, partial paralysis
・ Residual function in case of paralysis
・Presence or absence of caregiver, caregiver’s ability to care
・Peripheral sensations (fingertips and toes)
・Language disorder
・ Swallowing dysfunction
・ Bladder and rectal dysfunction
・Involuntary tremor, epilepsy, seizure
・Self-help tools
· Cane, walker
・Pain management:
– Degree of pain: face scale, pain scale, etc.
・Timing of pain appearance: pain at rest, pain on exertion
・Pain area
Types of pain; stabbing pain, sudden pain, pain that feels like pressure, etc.
・Load test
・ Walk for 6 minutes
・Strength: MMT
・Venous blood data
· Undernutrition
・ Blood data necessary for current disease management
・Steps in the process of accepting disability and death
A stage that goes back and forth between the receptive stage and the depressive stage
・ Pessimistic remarks
・ Harmful behavior to self or others

2) Action plan 《TP》

・Extract self-care deficiencies related to “constant self-care for lack of needs”.
・Extract the lack of self-care related to “developmental self-care”.
・Extract the lack of self-care related to “self-care for health deviation”.
・Perform “full compensation,” “partial compensation,” and “support education” according to the content of the lack of self-care.
・Provide care that considers safety, comfort, and independence. (utilize remaining functions)
・Improve the recuperation environment
· Collaborate with care managers (long-term care insurance) and daily life supporters (disability services),
Prepare a recuperation environment after discharge.
・Install L-shaped fences, handrails, wheelchairs, non-slip mats, portable toilets, etc.
· Devise tableware and self-help tools for meals.
・ Secure enough space for movement. Tidy up.
・Manage the stoma.
・ Encourage them to choose clothes and shoes that are easy to move in.
・Provide support according to the lifelong acceptance process.
The process of accepting disability and death does not always proceed in one direction, and may progress and retreat repeatedly. Even if you think you have entered the acceptance stage, you may return to the previous stage of depression, so be especially careful during times when you are prone to harming yourself or others.
・Even if rehabilitation doesn’t go well or things don’t go the way you want, you will be happy together when you can and have them build up successful experiences. Watch out for depressive symptoms during periods of instability.
・Set medicines in the medication calendar.

3) Education plan 《EP》

・Instruct the patient not to discontinue taking the medicine on his/her own, but to take the medicine prescribed.
・Please let us know if you have any subjective symptoms (pain, palpitations, shortness of breath, breathing difficulty, etc.).
・Explain that pain should not be tolerated and should be reported. Explain that analgesics can be used if needed.
・Give advice on adapting to lifestyle changes.
・Explain to the family not to help too much and to provide assistance to preserve the remaining functions. (what to where)
・Consult with a social worker or care manager so that you can receive the services you need to live at home.
・Explain the disability-acceptance process to the family who supports home care, and explain that they can consult with a care manager if they have any problems.


T. Heather Hardman Shigemi Kamitsuru. (2016). NANDA-I Nursing Diagnosis Definition and Classification 2015-2017. Igaku Shoin.
Okaniwa, Yutaka. (2012). Review book for nurses and nursing students. Medic Media Co., Ltd.
Yutaka Okaniwa. (2019.3). Year Note 2020. Medic Media Co., Ltd.
Yutaka Okaniwa. (2003). Disease can be seen VOL.2 Cardiology. Medic Media Co., Ltd.
Yutaka Okaniwa. (2007). Illness can be seen VOL.4 Respiratory organs. Medic Media Co., Ltd.
Yuko Kuroda (Translation). (2015). Nursing Outcome Classification (NOC) Original 5th Edition Indicators and Measurement Scales for Measuring Outcomes. Elsevier Japan K.K.
Yamaguchi Toru, Kitahara Mitsuo, Fukui Tsuguya. (2012). Today’s treatment guidelines.
Toyoaki Yamauchi. (Date unknown). Physical Assessment Guidebook. Igaku Shoin.
Yumiko Ohashi, Hajime Yoshino, Naoki Aikawa, Sumi Sugawara. (2008). Nursing Learning Dictionary (3rd Edition). Gakken Co., Ltd. (Gakken).

Thank you for coming this far.
If you have any opinions, impressions, or questions, we are waiting for you from the comment section (*゚▽゚*)

投稿者 FlorenceMYM


メールアドレスが公開されることはありません。 が付いている欄は必須項目です