When evaluating the diagnosis of self care deficit, it is important to assess the patient's personal care requirements from several aspects. This article focuses on the biopsychosocial factors that affect activities of daily living (ADL) care and provides clinical recommendations for improving the ability to dedicate oneself to personal care. The FIM nursing evaluation measures 18 personal care items related to eating, bathing, grooming, clothing, using the bathroom, managing the bladder and bowels, moving, walking and climbing stairs. This is helpful in providing comprehensive care and can reveal how well the support and educational system can be used to solve problems in a patient with rheumatoid arthritis.
There are mainly 3 types of personal care requirements: universal personal care requirements, for development and for deviations from health. Personal care deficit refers to the patient who has limitations in performing ADLs. An important aspect of the evaluation is to determine if the person simply refuses to complete an ADL and, if so, their motivation to do so. People with dementia may not understand why they are being confronted and may not be able to verbally express the reasons why they are refusing to receive care.
Neuropsychological evaluations alone are generally not sufficient to fully assess basic functional capacity. ADL capacity evaluation is often requested during the middle or later stages of dementia, but it can also be performed during recovery from an acute event, such as a stroke. This section describes the steps in the nursing process when providing care to adults with cognitive disabilities. Informant-based ratings are often completed by caregivers who know the patient well, but they can also be biased by their own burden of caring for the person or by overestimating or underestimating the patient's true functioning.
Apraxia, with regard to the functioning of the ADL, can be evaluated through a combination of practice tests and measures based on the performance of the ADL, since self-reporting is not sufficient and only the use of ADL instruments such as Barthel may not capture the extent of apraxia (Donkervoort, Dekker, & Deelman, 200). In institutional settings, partnering with direct care staff to develop individualized care plans can produce positive outcomes for both patients and staff. It is necessary to know personal biases related to age discrimination and cognitive impairments when providing care to older adults who suffer from confusion, memory deficits, and judgment problems. For example, the PAT includes measures of fine and gross motor control, and evaluates the basic and instrumental tasks of the ADL, so it may be able to detect changes over time in a way that self-information cannot.
An example of a general objective for an older adult suffering from cognitive impairment due to dementia is: “The patient will perform daily self-care activities within the level of their abilities. In addition, bathing difficulties may be due to the caregiver's approach, the bathing environment and the individual needs of the person receiving the care (e.g., physical limitations). It is important for caregivers to understand these factors in order to provide effective care.
