A person’s functional ability relates to their capability to engage with their surroundings and carry out their desired activities and duties.
A marked decrease in one’s ability to perform daily activities is often a sign of disease and an increased demand for assistance.
These changes have an impact on nursing care in all settings. The use of functional assessment tools improves patient-healthcare provider communication, helps define realistic goals, and determines the need for continuity of care.
Common Causes of Declining Functional Ability
- Acute illness (e.g., pneumonia, musculoskeletal disorders)
- End-stage chronic diseases
- Variable deterioration of particular organs and systems (Body system impairments
- Transient responses associated with hospitalization (e.g., prolonged bed rest)
- Medications
Risk Factors to Declining Functional Ability
- Age
- Underlying health conditions
- Comorbidities
- Contextual factors (e.g., lack of social support, financial instability
- Sedentary behavior
- Sensory impairments
- Smoking
- Alcohol consumption
Assessment of Functional Ability
- Activities of Daily Living (ADLs). There are a variety of ADL and IADL assessment instruments available for assessing the typical changes that occur with advancing age and the onset of health issues. One of the most useful instruments include:
- Katz ADL Index. Measures activities like bathing, dressing, moving, going to the bathroom, and eating. Baseline measurements should be collected when the patient is feeling well. By using this baseline as a reference point, subsequent tests can be used to monitor the onset or progression of impairment.
- Barthel ADL index. The eight activities covered by this metric include eating, bladder, dressing, bowel, toilet, transfers, mobility, bathing, and stairs. Observations from clinicians and patient self-report are used to score patients’ capacity to perform these ADLs in a real setting over the last 24-48 hours.
- Physical self-maintenance scale (PSMS). Utilizes informant reports to assess physical functioning. It evaluates the six ADLs and includes a wider range of descriptors than Katz.
- Erlangen Test of ADL (E-ADL-Test). Since administration normally takes eight minutes, it is considered a quick and simple test to perform. This is a more objective measure of a person’s actual ability. It assesses five behavioral domains concerning hygiene and food preparation, each of which is evaluated on a six-point scale.
2. Instrumental activities of daily living (IADL). IADL, which is used to assess the degree of physical function, has been recommended for comprehensive assessment inclusion to estimate function in older adults. IADLs, which are more sophisticated than ADLs, can significantly improve an aged person’s overall quality of life. These tools are mostly employed to ascertain whether or not a person can carry out the required functions or tasks. The most often used instruments for determining IADL are the following:
- Lawton IADL Scale. Administration typically takes between 10 and 15 minutes to complete. It consists of self-reported information using an 8-item summary score that ranges from 0 (being the lowest) to 8 (being the highest).
- Direct Assessment of Functional Abilities (DAFA) scale. Consists of a performance-based, ten-item dimension that quantifies IADL directly. Additionally, it has been demonstrated to be effective in assessing function in the context of dementia.
- Older Americans Resources and Services Instrumental Activities of Daily Living (OARS-IADL) scale. Used to assess the level of ADL and IADL independence through the use of a 14-questions questionnaire, ranging from a rating of 0 to 2. ADLs measured include feeding, grooming, walking, and voiding.
3. Mobility. Consists of four measures (e.g., transfers, gait steadiness, balance in sitting and standing) that assess the patient’s mobility and ability to ambulate by observation or patient self-report.
- Get up and go test (GUG). It is a screening instrument that should be undertaken as part of a normal evaluation when dealing with elderly individuals who demonstrate signs of increased risk of falling. During the procedure, the patient may be asked to perform several maneuvers, such as taking a seat and a brief walk.
4. Frailty
- Fried Frailty scale. The most frequently used scale for assessing and quantifying an individual’s performance on the basis of five variables: weight loss, muscle strength, exhaustion, walking speed, and physical activity.
- Clinical Frailty scale. This scale is used to measure the level of disability and frailty in the emergency department. CFS consists of a nine-point scale that distinguishes seriously weak and terminally ill as distinct entities (which were formerly grouped). The nine-point scale serves as a characterization for each stage of frailty. A visual chart is included to assist with frailty classification. It is used to facilitate in-depth assessments, care, and support and is divided into five categories ranging from non-frail to severely frail.
- Edmonton Frail Scale. This measure is considered to be multidimensional since it can be used alone or in conjunction with other measures of frailty.
- Frailty index. Estimates the degree of deficits and the probability of impairment accumulation as a result of aging. It is regarded as the best indicator of poor outcomes in geriatric patients.
Special Functional Assessments
- Ambulation. Ambulation is a significant metric for functional evaluation. Hospitalized patients who are unable to walk should be assessed by nurses to prevent patients from falling or suffering an injury. Patients must achieve or maintain functional ambulation in the absence of assistive aids in order to safely and adequately perform mobility-related activities. Additionally, it is a highly sensitive indicator of acute medical dysfunctions. It is recommended that the capacity to ambulate should be evaluated using a combination of self-report, third-party reporting, and direct observation.
Methods for evaluating mobility might be time-consuming, but they are sensitive to functional assessment. It is significantly simpler and more accurate to measure physical domains such as an individual’s capacity to stand, sit in a chair, and walk for short distances.
- Cognition. Determining a person’s functional ability necessitates obtaining accurate baseline data on that person’s cognitive performance. Medical attention should be immediately sought if there is a sudden change in cognition that could be life-threatening.
- Sensory capacity. The potential effect of sensory changes on ADL performance is frequently overlooked. For instance, functional vision loss in older adults affects their ability to read medication packs and repeat instructions for use, possible side effects, and the need to seek medical attention. Patients with vision issues or impaired vision may also be at risk of falling or being injured. The capacity to hear is equally critical to one’s ability to perform and comprehend. People with hearing loss may be misclassified as intellectually handicapped, which can lead to further challenges.
Nursing Considerations Related to Functional Ability
- Obtain baseline data through physical and cognitive evaluations
- Increase fluid and dietary intake and abstain from meals prior to bedtime
- Closely monitor patient adherence to toileting regimen
- Avoid bed rest and inactivity, and encourage a range of motion exercises, ambulation, or frequent repositioning
- Consult with a therapist for counseling, dietary adjustments, or relaxation techniques.
- Assess the patient’s orientation, mood, and care requirements
- Ensure that assistive devices are easily accessible.
- Promote continuous communication between all team members
- Inform the patient that he or she should report any disease complications or medication side effects.
Functional Ability Nursing Diagnosis
Functional Ability Nursing Care Plan 1
Nursing Diagnosis: Impaired Physical Mobility related to declining functional ability (cognitive capacity) secondary to Alzheimer’s disease (AD) as evidenced by weakness, fatigue, difficulty turning, decreased mobility, jerky movement, and balance deficits.
Desired Outcome: The patient will be able to maintain a functional level of mobility.
| Functional Ability Nursing Interventions | Rationale |
| Assess and document the patient’s functional capacity for mobility. | This assessment and baseline report serves as a benchmark for future comparisons. It identifies issues and aids in the development of a treatment plan. And although mobility declines as AD develops, most patients remain ambulatory until the late stages. |
| Advise active range of motion exercises. | Exercising improves flexibility, strength, gait, and balance, minimizing the patient’s risk of falling. Additionally, it aids in the prevention of muscular atrophy and joint contractures. Exercises performed regularly in conjunction with prescription drugs may help prevent or delay functional impairment. |
| Determine the extent of the patient’s cognitive impairment and capacity to follow instructions and tailor interventions accordingly. | Aids in determining whether or not deficiencies exist. This demonstrates the severity of the condition and the effectiveness of treatment. |
| Allow sufficient time for patients to execute mobility-related tasks. Employ simple and straightforward instructions. | The patient may require a lot of support and guidance to complete the task. Patients with Alzheimer’s disease (AD) often have trouble initiating movement since their condition impairs the cognitive processes that control movement and balance. These interventions considerably decrease functional decline and increase mobility endurance in mentally and physically disabled individuals. |
| Assist with patient repositioning every 2 hours. | Long-term pressure on the skin and muscles can lead to localized ischemia, tissue inflammation, and pressure ulcers. Frequent repositioning or shifting can help reduce skin pressure. Patients with pressure ulcers are more likely to stay longer in the hospital, making it more challenging to return to their typical activities. |
| Maintain proper joint alignment by using cushions or trochanter rollers. | Patients with AD are likely to suffer from pain and diminished physical function, leading to mental health problems and an increased risk of other health complications. In addition, joint contractions are a marker of functional impairment in patients with AD. |
| Assist with walking whenever possible, utilizing a transfer belt if necessary. If the patient is incapable of bearing weight, provide a one- or two-person pivot assistance. | Patients rehabilitating from the condition may require assistance moving or transferring around in bed. A single- or two-person standing pivot can assist with weight-bearing. Aside from preserving muscle tone, ambulation also helps avoid immobility-related problems and maintain physical functioning. |
| Use a mechanical lift to assist patients who are unable to bear their own weight and assist them out of bed. | Patients with functional disabilities are unable to stand or walk normally due to their weight or condition. If the patient is unable to move or lift himself, the use of a mechanical lift may be necessary. It also encourages the patient to willingly participate in activities provided. |
| Avoid the use of restraints. | Restraints can lead to muscle weakness and poor balance due to prolonged inactivity. |
| Avoid the use of assistive devices without proper instructions to the patient. | Patients with functional disabilities, such as AD, are more likely to sustain injuries since they are unable to utilize these devices appropriately due to cognitive impairment. |
| Instruct family members on the range of motion (ROM) exercises, bed-to-wheelchair transfers, and repositioning at regular intervals. | Prevents immobility-related complications and helps family members better prepare for home care. |
Functional Ability Nursing Care Plan 2
Nursing Diagnosis: Self-care deficit related to a decline in functional ability (cognitive impairment) secondary to dementia, as evidenced by an incapacity to shower on their own, inability to procure bathing supplies, choose suitable clothing, flush toilet, get to the bathroom, shave, brush hair, maintain a good level of oral hygiene, and physical appearance.
Desired Outcomes:
- The patient’s self-care requirements will be addressed.
- The patient will present themselves in an appropriate manner.
| Functional Ability Nursing Interventions | Rationale |
| Evaluate for the presence of self-care deficit (e.g., bathing, grooming). | This measure determines the patient’s individual needs, functional level, and the type of assistance required to develop a care plan. |
| Evaluate the need for ambulation aids/devices. | Assistive devices help improve independent mobility, reduce disability, and prevent functional decline |
| Evaluate the adequacy of daily scheduled activities. | Rapid patient mobilization relies on accurate and timely medical assessments performed regularly. |
| Promote autonomy and self-sufficiency, providing simple, step-by-step instructions on performing care. | Dementia patients should be allowed to make their own decisions and participate in self-care activities. |
| Educate family members on proper clothing changes for the patient. Arrange clothing according to the intended use and promote the use of larger-sized garments with easier-to-work-with buttons, Velcro, and zippers. Instruct significant others about cutting the patient’s hair when it becomes excessively long or untidy. | Involved in assisting dementia patients with self-care and supporting caregivers when they assume this responsibility. Additionally, this measure aids in keeping the patient’s appearance clean and their level of functioning within reasonable parameters. |
| Ascertain that the patient has sufficient time to complete his or her toileting routine. | Helps the patient to be as self-sufficient as possible within the limitations of their condition. |
| Provide the patient with either a towel or washcloth to keep and use. | Allowing patients to take charge of their own care promotes their sense of self-worth and empowers them. |
Functional Ability Nursing Care Plan 3
Nursing Diagnosis: Risk for Falls related to a decline in functional ability secondary to advanced age.
Desired Outcome: The patient and his/her caregiver will take steps to improve home safety and prevent falls.
| Functional Ability Nursing Interventions | Rationale |
| Be alert for any physical and mental changes. | Falls are more common in the elderly due to muscle weakness and poor balance. Impaired color perception, weakening muscle, and vision are the most common signs of declining functional ability as seen in geriatric patients. |
| Alert medical personnel to the need for fall precautions by having the patient wear an identifier (e.g., a wristband). | Patients who are at high risk of falling need to be identified by healthcare practitioners so that preventative steps can be taken to keep them safe |
| Provide assistive devices | There is a greater risk of injury for the elderly who do not have ambulatory assistive equipment available. Physical assistive equipment such as a cane, walker, or wheelchair can be used to aid the patient in moving independently, minimizing impairment, and postponing functional disability. |
| Provide easy access to assistive devices and other personal care items. | It allows simple access to personal care and assistive devices so that they aren’t constantly being reached for. |
| Instruct the patient and family to apply protective guards, signs, call lights, and side rails. Ensure that at least one of the side rails is lowered if the bed has split rails. | Patients with age-related functional impairments have a higher risk of falling during regular activities. Likewise, geriatric patients may climb over sidebars. This measure reduces the risk of falling and prevents the patient from unassisted ambulation. |
| Examine hospital protocols for patient transfer. | There should be clear regulations and procedures in place for patient transfers to safeguard their safety. |
| Advise the patient to wear slip resistance and lace-free footwear whenever possible. | To avoid slipping and falling. |
| Place the patient in a room that is close to the nurse’s station. | Allows close monitoring and faster response times in case of emergency. |
| Advice the patient to engage in regular exercise and gait training. | In order to prevent falls and avoid injuries, it is important to maintain a healthy level of physical fitness. Regular physical activity has been shown to promote bone density, improve balance, and build muscle strength. |
Functional Ability Nursing Care Plan 4
Nursing Diagnosis: Activity Intolerance related to a decline in functional ability secondary to osteoarthritis, as evidenced by limited mobility, muscle atrophy, joint pain, fatigue, and malaise.
Desired Outcomes:
- The patient will employ the techniques outlined to improve activity intolerance.
- The patient will report an increase in exercise intolerance that is quantifiable.
| Functional Ability Nursing Interventions | Rationale |
| Determine the patient’s level of physical activity. | Proper assessment of the current status of the patient’s physical activity provides baseline data for developing patient-centered nursing goals and interventions. Activity intolerance can be recognized by monitoring the patient’s response to various forms of exercise or physical activity. |
| Evaluate the need for ambulation aids to assist with ADLs and mobility. | Patients suffering from osteoarthritis develop activity intolerance, rendering them unable to do necessary or desirable activities. Assistive devices help the patient’s mobility by improving independent mobility, reducing disability, and preventing functional decline. |
| Evaluate the adequacy of daily scheduled activities. | Rapid patient mobilization relies on accurate and timely medical assessments performed regularly. |
| Assist clients with activities of daily living while preventing patient reliance/dependence by gradually decreasing the amount of assistance for each given activity. | Osteoporosis can cause physical decline, leading to activity intolerance. During therapy, the patient’s ability to do basic daily tasks (ADLs) may decline. Assisting the patient while progressively increasing their tolerance and self-esteem will also help them in conserving energy. |
| Ensure that the patient gets adequate rest after finishing a part of the activity. | Allowing for relaxation in between tasks reduces the patient’s stress, agitation, and anxiety. |
| Encourage active range of motion (ROM) exercises. | Involve the patient in preparing activities that will gradually increase their endurance. For physically inactive patients, exercises that improve functional capability should be repeated over an extended period of time. In addition, ROM exercises reduce sedentary behaviors while preserving muscle strength and exercise tolerance. |
| Assess the patient’s nutritional intake. | Dietary requirements are critical since they provide the energy required to participate in physical activities. |
| Encourage the patient to express his/her worries and feelings. | Having a serious disease means going through a lot of transitions and dealing with a lot of discomforts/pain. Venting and communicating about one’s feelings can be helpful for the patient. |
Functional Ability Nursing Care Plan 5
Functional Urinary Incontinence
Nursing Diagnosis: Functional Urinary Incontinence related to a decline in functional ability (bladder control impairment) secondary to multiple sclerosis, as evidenced by frequent urination, restlessness, urine leakage, and sudden urges to void.
Desired Outcome: The patient will express his or her understanding of the cause of the transient incontinence and the treatment required to restore bladder control.
| Functional Ability Nursing Interventions | Rationale |
| Observe the patient’s recognition of the need to urinate. | Urinary incontinence (UI) reduces the patient’s ability to care for themselves, which might lead to a nursing home admission. They are unable to urinate due to their functional incontinence. |
| Obtain information regarding the patient’s care environment (e.g., acute care, long-term care), with a particular emphasis on the following:Bed featuresPhysical barriers (side rails, staircases) Dim lightingAccess to working restrooms | Patients with UI should be encouraged and aided in their efforts to function independently. Functional incontinence can occur if a person is unable to go to the bathroom due to environmental barriers. Nurses can plan for assistance in transporting patients from their beds to their restrooms or bedside toilets based on this information. |
| Advise the patient to restrict fluid consumption two to three hours before bedtime and void immediately before bed. | Excessive hydration can exacerbate sleeping difficulties. Restriction of fluid intake and voiding before bedtime decreases the frequency of bathroom visits. |
| Explain the reason for implementing a toileting program to the patient and caregiver. | Preventing or reducing UI in older persons by addressing functional decline appears to be a promising method. In order to achieve functional continence, a toileting routine must be consistently followed. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
