Nursing diagnosis – IMPAIRED HOME MAINTENANCE

IMPAIRED  HOME  MAINTENANCE

DEFINITION

Inability to independently maintain a safe growth-promoting imme-

diate environment

DEFINING CHARACTERISTICS

• Difficulty in maintaining home in a comfortable environment

• Outstanding debts or financial crises

• Request for assistance with home maintenance

• Disorderly surroundings

• Unwashed or unavailable cooking equipment, clothes, or linens

• Accumulation of dirt, food wastes, or hygienic wastes

• Offensive odors

• Inappropriate household temperatures

• Lack of necessary equipment or aids

• Presence of vermin or rodents

RELATED FACTORS

• Deficient knowledge

• Impaired functioning

• Disease

• Insufficient finances

• Inadequate support systems

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Communication

• Roles/relationships

• Coping

• Self-perception

• Knowledge

EXPECTED OUTCOMES

The patient and family members will

• Express concern about poor home maintenance.

• Verbalize plans to correct health and safety hazards in home.

• Identify community resources available to help maintain home.

SUGGESTED NOC OUTCOMES

Family Functioning: Role Performance; Self-Care: IADLs

INTERVENTIONS AND RATIONALES

Determine: Assess home environment, financial resources, patient’s

knowledge about self-care; and communication patterns in the fam-

ily. Assessment information will assist in identifying appropriate

interventions.

Perform: List obstacles to effective home maintenance management

with patient and family to develop understanding of potential and

actual health and safety hazards. Begin discussions at patient’s level

of comfort. Adult learners learn best where they have specific needs

to fulfill.

Assist family members to assign daily and weekly responsibility

for home maintenance activities. Having a schedule will promote

consistency in following the plan of care.

169

Inform: Teach patient and family the importance of home

maintenance to ensure safety. Provide written materials on environ-

mental aspects of home maintenance.

Teach skills such as setting down and choosing from a list of

options, and assertiveness skills to enhance coping strategies. Help

patient and family develop a program by using relaxation strategies

(i.e., meditation, guided imagery, yoga, exercise) to reduce anxiety.

Attend: Encourage weekly discussions about progress in maintaining

home maintenance schedule to develop family unity and allow mem-

bers to address problems before they become overwhelming.

Manage: Assist family members to contact community agencies that

can assist them in their efforts to improve home maintenance man-

agement, such as self-help groups, cleaning services, and extermina-

tors. Community resources can lessen family’s burden while

members learn to function independently.

SUGGESTED NIC INTERVENTIONS

Active Listening; Coping Enhancement; Counseling; Emotional

Support; Family Integrity Promotion; Family Support; Home

Maintenance Assistance

Reference

Horvath, K. J., et al. (2005, September–October). Caregiver competence to

prevent home injury to the care recipient with dementia. Rehabilitation
Nursing, 30(5), 189–196.

Nursing diagnosis – INEFFECTIVE HEALTH MAINTENANCE

INEFFECTIVE  HEALTH  MAINTENANCE

DEFINITION

Inability to identify, manage, and/or seek out help to maintain health

DEFINING CHARACTERISTICS

· Demonstrated lack of adaptive behaviors (internal or external

environmental changes)

· Demonstrated lack of knowledge regarding basic health practices

· History of lack of health-seeking behaviors

· Reported or observed impairment of personal support systems

· Reported or observed inability to take responsibility for meeting

basic health practices in any or all functional pattern areas.

· Reported or observed lack of equipment or financial and other

resources

RELATED FACTORS

· Cognitive impairment

· Diminished gross motor skills

· Complicated grieving

· Inability to make appropriate

· Deficient communication skills

judgments

· Diminished fine motor skills

· Ineffective family coping

ASSESSMENT FOCUS                           (Refer  to  comprehensive  assessment  parameters.)

· Communication

· Knowledge

· Coping

· Risk management

· Healthcare system

· Values and beliefs

EXPECTED OUTCOMES

The patient will

· Maintain current health status.

· Sustain no harm or injury.

· Verbalize feelings and concerns.

· Explain health maintenance program.

· Identify available health resources.

SUGGESTED NOC OUTCOMES

Coping; Decision Making; Health Beliefs: Perceived Resources;

Health-Promoting Behavior; Social Support; Spiritual Health

INTERVENTIONS AND RATIONALES

Determine: Assess current health status; personal habits such as use

of tobacco, drugs, and alcohol; level of knowledge about disease

process; level of family and community assistance; coping

mechanisms and communication skills (verbal and written); and

degree of motivation to maintain health. Assessment factors will

assist the nurse in establishing interventions for this diagnosis.

Perform: Provide assistance with self-care, as needed. Encourage

increasing levels of independence. The patient should be as

independent in ADLs as possible.

167

Administer medications as prescribed to ensure continuation of

therapy.

Adapt environment to that which is best suited to the particular

patient. Reorient the patient as needed. In the disoriented patient,

reorientation should take place frequently to keep the person as

close to knowing person, place, and time as possible.

Provide a consistent caretaker whenever possible to promote sta-

bility for the patient.

Plan a health maintenance program for patient and family members

addressing current disabilities. Provide patient and family with a writ-

ten copy. Giving instructions in writing will reinforce the various

aspects of the program and increase the possibility of compliance.

Inform: Fully describe all aspects of the patient’s care to the family

to elicit cooperation from them in continuing a plan.

Instruct family members how to carry out health maintenance

practices. Demonstrate skills such as bathing, feeding, and reality

orientation; then, have family members return demonstration under

supervision. Involving family members allows them the opportunity

to perform skills and solve problems with support and supervision.

Provide specific instructions on how to maintain a safe

environment for the patient to avoid falls and other types of

accidental injuries.

Teach relaxation techniques (e.g., guided imagery, progressive mus-

cle relaxation, and meditation) that can be done by the patient and

the family to enhance coping ability and restore psychological and

physical equilibrium by decreasing autonomic response to anxiety.

Attend: Encourage patient and family to verbalize feelings and con-

cerns related to health maintenance. This promotes better

understanding and greater ease in managing challenging situations.

Demonstrate willingness to repeat instruction and demonstrate

skills needed to care for the patients until they feel comfortable.

Manage: Refer to social and community resources, such a stroke sup-

port group, and Alzheimer’s family support group. This helps the family

gain support and receive factual information. It provides opportunity to

express feeling in a group where others are experiencing similar issues.

Making referrals is appropriate to mental health professional to

assist with prevention of burnout for the family.

SUGGESTED NIC INTERVENTIONS

Anticipatory Guidance; Coping Enhancement; Counseling; Discharge

Planning; Health Education; Health System Guidance; Physician

Support; Referral; Support System Enhancement

Reference

Cole, C. S., et al. (2006, April). Assessment and discharge planning for the

older hospitalized adults with delirium. Medsurg Nursing, 15(2), 71–76.