Self care deficits of admitted patients

http://doi.org/10.33698/NRF0044-  Manjeet Kaur, Jogindra Vati,Sukhpal Kaur

Abstract: A descriptive study was undertaken to identify the self-care deficits related to personal care of the admitted patients in selected wards of Nehru Hospital, PIGMER, Chandigarh. The self-care deficits were described with respect to various self-care activities including feeding, bathing, dressing and toileting. Subjects were interviewed and observed by using patient’s profile sheet, general assessment Performa and self-care deficit assessment scale. A total of 650 subjects were included in the study. It was found that mild, moderate and severe deficits for feeding was in 20.77%, 6.46%, 7.85% ; for bathing in 24.6%, 14.%, 5.5% ; in case of dressing it was present in 18.21% 12.65%, 5.86% of the subjects and for toileting it was in 9.22%, 15.53% and 7.12% of the subjects respectively, whereas 19.61%, 14.75% and 9.56% had mild, moderate and severe deficits respectively in carrying out their self-care activities

Key words: self-care activities, self-care deficits, admitted patients

Introduction: Health care is of increasing interest in the advanced and developing societies. The human practice of care of self is considered with respect to self-care. Self-care is the voluntary regulation of one’s own human functioning and development that is necessary for individual to maintain life health and well being. The essence of self-care is control, responsibility, freedom expanded options and an improved quality of life. Self-care refers to the individual assuming preventive or therapeutic health care activities often in collaboration with health care professionals. Levin has defined self-care as a “process whereby a layperson can function effectively on his or her own behalf in health promotion and prevention and in disease detection and treatment at the level of the primary health resources in the health care system.” From this definition it is clear that specialists view self-care in terms of initiating or changing programs that address the well population as well as the patient population with defined health problems. Thus self-care should address the goals of enhancing the ability of laypersons to make decisions regarding their health care and to recognize and exercise options of care.

Disease, injury and mental or physical malfunctioning may limit what a person can do for himself, and may involve structural and functioning changes, which may necessitate the use of specialized self-care measures. In adult clients, activities of daily living are those skills or abilities that the client needs for independent performance of self-care, communication and mobility. The client’s ability to perform these activities contributes either positivity or negativity to total health. The most important of these activities are feeding, bathing, dressing & grooming and toileting. In assessing activities of daily living, it is to be determined whether the individual is able to perform self-care activities independently or requires the assistance of others and whether performance of these activities supports or hinders the client’s overall health.

When a person is not able to know and meet his own health-associated demands, the person develops some deficits. According to Orem, a self-care deficits exists when the self-care agency is unable to meet some or all the components of self-care demands. Self-care agency refers to an individual’s capabilities to perform self-care. Therapeutic self-care demand refers to the actions required in order to meet the requirements for self-care. A self-care deficit may be relatively temporary or permanent. It may be wholly or partially eliminated or overcome when persons with deficits have necessary human capabilities, dispositions and willingness. Identification of self-care deficits plays an important role in planning patient care. Although a number of studies have been done on self-care abilities. Thus the present study was conducted with an objective to identify and to describe the deficits of the admitted patients with respect to their personal care.

Materials and Methods

A descriptive design was employed to study the self-care inabilities among the patients of Nehru Hospital of PGIMER, Chandigarh. Nehru hospital is a referral hospital with the bed capacity of more than 1200. For the purpose of study all the wards except psychiatric ward, pediatric ward and de addiction center were selected. The target population included all the admitted patients in the selected wards. A total of 650 patients were included in the study. Data was collected by using ‘patient profile sheet’ (for identification data); ‘General assessment proforma’ ( to get information regarding vital signs and therapeutic profile of the subjects); and ‘self care deficit assessment scale (to know the activity of daily living i.e. feeding, bathing, dressing and toileting was put on four-point continuum i.e. from 1-4 with score for no deficit and score 4for severe deficit. The data was analyzed by applying descriptive statistics.

Results

Patient profile

Age of the subjects ranged between 20 to 97 years with the mean age of 42.79 ± 15.7. Among the 650 subjects, 387 (59.54%) were males and 263 (40.46%) were females. Out of the total, 537 (82.62%) were married. The income of the subjects ranged between Rs. 500 to 30,000 per month with a mean income of Rs. 8530 ± 9.07. About half i.e. 326(50.23%) of the subjects were from the urban area.

Self care deficit as per activities (Fig-1)

Self care deficits were described for feeding, bathing, dressing, toileting activities. More than 50% of the subjects had no feeding and bathing deficit, and more than 60% of the subjects were independent in dressing and toileting. For feeding, bathing, dressing and toileting mild, moderate and severe deficit was present in 20.77%, 6.46%, 17.85% ; 24.6%, 14.6%, 5.5% ; 18.21%, 12.65%, 5.86%  and  9.22%, 15.53% and 7.12% of the subjects respectively. In total it was found that 49.43% of the subjects were able to perform their self care activities whereas 25.77%, 15.23% and 9.57% subjects had mild, moderate and severe deficits respectively in carrying out their self care activities.

Self-care deficits as per the activities in totality (Table-1)

The total score was done only for subjects having complete information about deficits in feeding, bathing, dressing and toileting which included 617 subjects. The score was grouped into four class intervals i.e no deficit if the total score was 4 and severe if the total score was in between 13-16. About 50% of the subjects had no deficit. Mild, moderate and severe deficits were present in 26%, 15% and10% of the subjects.

Table -1: Self-care deficits as per the activities in totality          N=617

Self-care deficit No of subjects

N (%)
Observed score Deficit
4 No 305 (49.43)
5-8 Mild 159 (25.77)
9-12 Moderate 94 (15.23)
13-16 Severe 59 (9.57)

Minimum score = 4                                                                                 Maximum score = 16

Factors affecting the restriction of activities (Table – 2)

Most of the subjects i.e. 227(34.92%) had no apparent cause of activity restrictions. Weakness was reported by 12.92%. The other reasons for not carrying out the activities were as per medical advice, pain, altered sensorium, surgery, breathing problems, physical deformities like plaster caste, amputation, vision loss etc.

Table – 2: Factors affecting the restriction of activities of the subjects                    N=650

Activity restriction n(%)
None

Weakness

Doctor’s advice

Orthopedic causes

Pain

Altered sensorium

Surgery

Dyspnea

Iv fluids

Drains

Burns

Vision problems

Foot problems

Paralysis

Ventilato

Vertigo

Others*

 227 (34.92)

84 (12.92)

54 (8.31)

52 (8.00)

45 (6.92)

42 (6.46)

27 (4.15)

21 (3.23)

20 (3.08)

20 (3.08)

14(2.15)

7 (1.07)

7 (1.07)

7 (1.07)

5 (0.78)

3(0.46)

15 (2.31)

 

*It includes staggering gait, abdominal distention, fever, vaginal bleeding, and loss of sensations in the extremities, dialysis and stiffness.

Discussion

The self-care deficit were described for each category of self-care activities i.e. feeding, bathing, dressing and grooming as well as in totality. More than 50% of the subjects had no feeding, bathing in total deficit whereas more than 60% of the subjects were independent in dressing and toileting. Expect in feeding less than 10% of the subjects had severe deficit. Supporting the finding Nicholas et al reported even higher percentage of independence in self-care i.e. 96.35% in feeding, 97% in dressing, 98% in grooming and 98% in toileting. Catherine king also found that most of her subjects were independent in doing their activities although by using the technical aids. Significant difference between the deficits of males and females on applying chi-square was found in feeding and dressing self-care (p<0.05) whereas Mc Dermott and Marry JD found no correlation between gender and self-care.

In the present study it is found that 45.24% had feeding deficit, 44.84% had bathing deficit, 36.72% had dressing deficit and 31.87% had deficit in toileting. Menton found that11% had deficit in eating , 45% had bathing deficit, which is similar to the present study, 22% had deficit in dressing, and 25% were deficit in toileting. In another study it has been reported that 17.5% had eating deficit, 27% had bathing deficit, 17.5% had dressing deficit and 25% had toileting deficit.

In total it was found that 305 (49.43%) had no deficit, 159 (25.77%) had mild deficit, 94 (15.23%) had moderate deficit and only 59 (9.57%) had severe deficit whereas Jonie Kayser reported the opposite results i.e. 72% were severely impaired 20% were moderately impaired and only 8% were mildly impaired.

A number of causes emerged as the factors leading to activity restriction with weakness being the most common i.e. 84 (12.92%). Similar finding has been reported by Nicholas et al who found weakness, loss of motion of an extremity and pain as the cause of activity restriction in 60% of his subjects. Lehman et al also reported 35% of the patients being limited by generalized weakness. 12 in the present study 45 (6.92%) reported pain as the factor limiting their activities. Many other studied have also reported pain as the cause interfering with the performance of daily activities.

Although commonly reported factors influencing self-care were disease condition, pain, medial advice, etc some individuals reported causes that were unique to them showing that factors affecting self-care varies from individual to individual. The findings are also supported by Connely et al.

Thus in conclusion it can be said that more than 50% of the subjects were independent in doing their personal care in relation to feeding, bathing, dressing and toileting. The rate of carrying out the dressing and toileting was even higher than 60%. The patient’s ability to perform self-care practices is an important concern for nurses. Inability to perform self-care produces a feeling of dependency and poor self-concept. With increased self-care abilities self-esteem increases. Thus identifying the patient’s abilities and deficits in performing self-care activities is an important nursing aspect in today’s era.

References

  1. Norris CM. self care. American journal of nursing; March 1979; 79(4): 486-489
  2. Orem DE. Nursing: Concepts of practice .5th ed. New York: Mosby, 1995
  3. Levin L. Patient education and self-are: how do they differ. Nursing outlook1978; 26(3):170-175
  4. Orem DE. Nursing: Concepts of practice .2nd ed. New York: McGraw – Hill 1980:87
  5. Potter JM, Evans AL, Ducan G. Gait speed and activities of daily living function in geriatric patients. Arch phys Med Rehabil 1995; 76:997-99
  6. Moser VF, Crevena R, korpan M et al. Cancer rehabilitation: particularly with aspects on physical impairments. J Rehabil Med 2003;35(4):153-162
  7. Denyes MJ. Orem’s model used for health promotion: Directions from research. Adv Nurs Sci 1988; 11(1): 13-21
  8. Menton, Kenneth G.A longitudinal study of functional change and mortality in the United States. Journal of Gerontology: Social Sciences. 1988; 43: S153-S161
  9. Brend WJH, Messier SP, Rajeski WJ et al. physical exercise and prevention of disability in older persons with osteoarthritis. Arch intern Med 2001; 161: 2309-2316.
  10. Joenie K. The effect of staffing on the quality of care at mealtime. Nursing Outlook 1997; 45(2); 67-72.
  11. woods N. conceptualization of self-care: Towars health oriented models. Advances in Nursing science 1989; 1293): 1-13
  12. lehmann JF, Delisa JA, Warren CG et al. Cancer rehabilitation: assessment of need, development and evaluation of a modelof care. Archives of physical medicines and rehabilitation 1978; 59: 410-419
  13. Heinemann AW, LinarceJM, Wright BG et al. Relationship between impairment and physical disability as measured by functional independence measurement. Archives of physical medicine and rehabilitation 1993; 74(6): 566-573
  14. Nicholas JJ, Oleske D,Robinson L etal. Quality of life after orthopedic liver transplant an analysis of 166 cases. Archives of physical medicine and rehabilitation 1994; 75 (4): 431-435
  15. Koenug HG chronic pain: biomedical and spiritual approach. New York The Howorth Postoral Press 2003, 113-114
  16. Turner JA, Cardinas DD, Warms CA. Chronic pain associated with spinal cord injuries: A community survey. Achieves of physical Medicine and rehabilitation 2001; 82:501-509
  17. Davidoff G, Roth E, Guarracini M et al. function limiting dysesthetic pain syndrome among traumatic spinal cord injury patients: a cross sectional study pain 1998; 2:39-48
  18. Nepomuceno C, Fine PR, Richards JS etal. Pain in patients with spinal cord injury. Arch phys Med Rehabil 1979; 60:605-9
  19. Rose M, Robinson JE Eills P EYAL pain following spinal cord injury: results from postal survey, pain 1988; 34:101-2
  20. Surlin RC, Mendoga TR, Nakamura Y etal when is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain 1995; 61:277-84
  21. Winderstrom EG, Nogar DDS, Cuervo EF et al. Chronic pain after spinal injury interference with sleep and daily activities. Arch Phys Med Rehibil 2001; 82(11): 1571-1577
  22. Connely CE, Self-care and the chronically ill patient. Nursing Clinics of North America 1987; 22(3): 621-629