NANDA Nursing Plan 00193 Self-neglect

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

Self-neglect 00193

Nursing Diagnosis: Self-neglect
Definition: A set of culturally defined behaviors that include one or more self-care activities that do not maintain societal standards of health and well-being.

Hello, thank you for always watching (*゚▽゚*)
This self-neglect is a very confusing definition (T_T)
Self-neglect itself can be imagined somehow. Neglect = abandonment of childcare and nursing care, so I wonder if self-neglect is a state of abandoning the care that is necessary for oneself.
If you look at the definition of this nursing diagnosis, you can see that it seems to have a slightly deeper meaning. What is the “society-accepted standard of health and well-being” in the definition? Is there a standard of health and well-being? Is there a standard that society recognizes? There will be a lot of Hatena.
In my interpretation, I believe that the state of being able to maintain a balance of mind and body that allows social activities is the state of meeting the “standard of health and well-being recognized by society.”
So, what is the “culture-prescribed course of action” in the definition? I think this is with public health in mind. As climates differ from country to country, dietary habits also differ, so I think that the order of causes of death and disease rates for infectious diseases and lifestyle-related diseases differ from country to country. You can imagine that there are measures for each country that match the climate and food culture. It also includes protecting the public health of the people of the country through vaccination to prevent diseases, guidance on lifestyle habits, lifestyle guidance, and sex education (it would be a problem if infectious diseases spread due to specific inappropriate behavior). I’m assuming there is.
Does this mean that we are required to be aware that we are members of society and to take care of not only our own health, but also the health of those around us, and engage in health maintenance activities?

So, before identifying the targets of self-neglect, let’s check the definition of self-care (*゚▽゚*)

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 Insufficient 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

What is 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 nursing 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 have learned about self-care, let’s think about “self-neglect,” which is the subject of this lesson.

3. Target of self-neglect

There are several factors that lead to self-neglect. Consider environmental factors and personal factors.

1) Environmental factors
・Inadequate sanitary environment
・ Garbage house
・ The water is polluted
・ The air is polluted
・Can’t get enough rest due to noise and easily gets tired.

2) Personal factors
・Insufficient personal hygiene
・ Mental illness
・Learning disability
・ Decline in cognitive function (cannot take clean behavior)
・ Frontal lobe dysfunction (trauma, tumor, cerebrovascular disorder, etc.)
Substance abuse (cannot think of anything else due to addiction)
・Drugs
・alcohol
・Game
・ Gambling
・Non-adherence to health activities (no understanding of health activities)*1
・ Refusal of vaccines (except when there is a reason not to vaccinate)
・Mental developmental immaturity (insufficient sex education)
・Decline in cognitive function
・Difficulties in health behaviors and self-care due to illness
・ Paralysis
・Motor paralysis: there is a limit to self-care on one’s own
・Motor paralysis: self-help devices required
・fracture
・Spatial neglect (limited visibility)
・Neuromuscular disease (weakness, involuntary movements, etc.)
・Difficulty sitting or standing
・pain
・Cardiac dysfunction (difficult to bathe, palpitations, chest pain)
・Respiratory dysfunction (difficulty in breathing when bathing, inhalation of oxygen)
・Exhaustive fatigue★1
・In the stages of denial, anger, bargaining, and depression in the disability acceptance stage *2 About the disability acceptance model

★1 Adherence:

Adherence means that the patient actively participates in the decision of the treatment policy and receives treatment according to the decision. Going one step beyond compliance (medication adherence to patients), medical professionals and patients discuss and determine treatment methods, encouraging active participation in treatment and aiming for treatment success.
Quoted from the Pharmaceutical Society of Japan “Glossary of Pharmaceutical Terms”:

https://www.pharm.or.jp/dictionary/wiki.cgi?%E3%82%A2%E3%83%89%E3%83%92%E3%82%A2%E3%83%A9%E3 %83%B3%E3%82%B9#:~:text=adherence.%20%E3%82%A2%E3%83%89%E3%83%92%E3%82%A2%E3%83%A9 %E3%83%B3%E3%82%B9%20%E3%81%A8%E3%81%AF%E3%80%81%E6%82%A3%E8%80%85%E3%81%8C %E7%A9%8D%E6%A5%B5%E7%9A%84%E3%81%AB%E6%B2%BB%E7%99%82%E6%96%B9%E9%87%9D%E3 %81%AE%E6%B1%BA%E5%AE%9A%E3%81%AB%E5%8F

3. aim setting


1) Goal setting by linkage (published in the second half of NOC)

*Linkage has the role of connecting NANDA (diagnosis) and NOC (results).
・Individual well-being and health
・Self-care status
・Self-care: ADL, IADL, cleanliness, bathing, excretion, dressing, oral hygiene
・Active adherence behavior
・Level of cognition and dementia
・Comfort situation: environment
– Sense of health and belief in health
・Effects of substance dependence
– level of depression

2) Goal

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.
・Be able to describe the information necessary for self-care and make use of it in actual self-care.
・You can break free from addiction, face yourself, and take care of yourself.
・You can arrange your life while consulting with a reliable person.

*Nurse goals include:

・In order to enhance self-care, prepare a recuperation environment suitable for ADLs and disabilities.
・Provide support according to the child’s developmental stage.
・Provide support according to the stages of the disability acceptance process.
・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.
・Be involved in increasing the sense of self-efficacy through repeated successful experiences. Watch over and support until motivation for self-care emerges.

4. 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
・Fence
· Portable toilet
・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 too much?)
・ Willingness
・Dementia scale: Hasegawa scale, MMSE
・Psychiatric disorders
・ Depression
· Hallucinations (visual hallucinations, auditory hallucinations)
· Delusions (poisoning delusions, being killed, etc.)
・ Decreased motivation, mood disorder
・ Decreased medication compliance (poor medication control)
・Medical history, current disease history
・ Timing of injury
・ Disease stage: acute stage, chronic stage, terminal stage, etc.
・Symptoms
・ Treatment:
  ・Diet therapy: restricted diet
・Aftereffects
・ 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 (I can’t ask even if I want to)
・ Bladder and rectal dysfunction
・Involuntary tremor, epileptic 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
・Anemia
· Undernutrition
・ Blood data necessary for current disease management
・Steps in the process of accepting disability and death
Current status at each stage of denial → anger → bargaining → depression → acceptance.
・ Pessimistic remarks
・ Harmful behavior to self or others
・Presence or absence of substance abuse
・Drugs
·alcohol
・Game
・ Gambling
・Isolation from society due to substance abuse
・ Interpersonal trouble
・ Money troubles
・ Harm to self or others
· Crime (Are you committing a crime to get money or addictive substances?)

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 recuperative 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.
*Please refer to “Insufficient excretion self-care” for stoma management.
・ Encourage them to choose clothes and shoes that are easy to move in.
・Provide support according to the process of accepting the disability.
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. Engage in relationships that enhance self-efficacy.
・Set medicines in the medication calendar.
– Keep addictive substances away.
・Be careful not to hurt yourself or others when you experience withdrawal symptoms from a substance you depend on.
(Keep consent for restraint in case restraint is necessary)

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 the efficacy of the vaccine. (Except when there are circumstances that prevent intake due to illness or allergy)
・Introduce vaccination information from the Ministry of Health, Labor and Welfare.

https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/kenkou/kekkaku-kansenshou/yobou-sesshu/index.html
https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/kenkou/kekkaku-kansenshou/kihonteki_keikaku/index_00001.html#Q1
・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.
・If you cannot maintain your health due to your living environment, ask a social worker to consider changing your living environment (relocation).
・Encourage participation in self-help groups, etc., if there is substance dependence. Ask a social worker. For substance dependence, please refer to

*2 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.

I. 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?”
② Anger: “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

II. Fink (U.S. Psychiatrist): The Grief Process Based on a Crisis Model

Presented the intervention process from the immediate aftermath of the crisis to adaptation.
①Impact: 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.

References


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.
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).

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投稿者 FlorenceMYM

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