Self Neglect Nursing Diagnosis and Nursing Care Plan

Self Neglect Nursing Care Plans Diagnosis and Interventions

Self Neglect Nursing Care Plans Diagnosis and Interventions

Self-neglect is an extreme behavioral condition or abuse of self in a way that puts at risk one’s well-being or safety. It was defined as the inability to maintain culturally and socially accepted standards of self-care possessing potentially serious consequences to the vulnerable adult and their community.

It is a general term to describe a vulnerable individual with a serious problem of ignoring care for their hygiene, health, or surroundings. Extreme self-neglect related to deteriorating health and ability is also called Diogenes syndrome.

Everyone needs to know when they can help and when they can get social services and law enforcement agencies involved. There is little research about self-neglect which is why it still lacks clarity regarding its etiology, early detection, and prevention.

Research has shown that 30% to 50% of people suffering from self-neglect have no psychiatric disorders.

Signs and Symptoms of Self-Neglect

The following are the most common characteristics of individuals who neglect themselves. These may include:

  • Poor personal hygiene from the skin, hair, or nails
  • Filth or bad odors
  • Uncoordinated or improperly dressed for the weather
  • Hypothermia or heat exhaustion
  • Presence of skin rashes or pressure ulcers
  • Being underweight or obese
  • Poor skin turgor or dehydration
  • Confused or disoriented
  • Lack of interest in everything
  • Unkept or unsafe living conditions
  • Inadequate necessities
  • Hoarding items or pets
  • Self-destructive behaviors
  • Untreated medical conditions
  • Presence of delusions or hallucinations
  • Alcohol or drug misuse

Causes of Self-Neglect

Self-neglect can affect the individual’s physical abilities, attention, skills, motivations, or energy levels resulting in physical or mental illness.

Vulnerable adults are trying to maintain their identity and control even when they are unable to perform the essential task to maintain independence resulting in failing physical and mental health.

They do not see themselves with self-neglect, instead, they see themselves with self-care challenges or self-care disabled. There are two types of self-neglect cause:

  • Intentional or Active Self-Neglect. Vulnerable adults may make a conscious choice to neglect themselves such as refusing help, isolating themselves from others, or refusing to visit a doctor. The most common experiences cited by vulnerable individuals with self-neglect are the traumatic loss of a loved one and being a victim of violence or abuse.
  • Non-Intentional or Passive Self-Neglect. This happens when a vulnerable individual has health-related conditions that contribute to developing self-neglect. This includes psychiatric medications, mental illness, and physical disabilities causing difficulties in performing self-care tasks.

Risk Factors to Self-Neglect

Some common characteristics increase the individual’s risk to neglect themselves such as:

  • Individuals living alone
  • Advancing age
  • Women are most likely to live alone than men
  • Cognitive impairment or mental health problems
  • Individuals with depression
  • Adults with disorders that impair the memory or judgment
  • Alcohol and substance abuse
  • Socially and financially challenge individuals

Complications of Self-Neglect

Existing problems may exacerbate due to an individual’s self-care deficit. This includes:

  • Social Isolation. Vulnerable adults may refuse offers of help from others because they do not feel the need for it.
  • Pressure ulcers. Minor wounds or sores may become infected and develop into pressure ulcers if not treated appropriately.
  • Halitosis. This usually results from poor oral hygiene leading to dental decay.
  • Malnutrition. Self-neglect generally reduces the individual’s attempt to maintain a healthy lifestyle.
  • Addiction. Vulnerable adults have increased emotional or psychological harm due to increased social isolation, engagement in recreational drugs, and criminal activity.
  • Delirium. Self-neglect often manifests as confusion and dehydration. It often leads to changes in consciousness and delirium.

Diagnosis of Self-Neglect

There are assessment tools to measure individuals’ level of self-neglect, these includes:

  • Patient history. Complete medical history, cognition, function, social networks, environment, and psychiatric screening for clinical evaluation of vulnerable individuals.
  • Physical examination. A complete physical exam will determine the extent of the self-care deficit.
  • Personality assessment. This may determine the underlying cause of the patient’s self-neglect.
  • Kohlman Evaluation of Living (KELS). This tool assesses an individual’s performance, subjective reports, and observation of the administrator. It measures both the basic and instrumental activities of daily living to determine if the individual can safely live by themselves.
  • Self-Neglect Severity Scale (SSS). It consists of clustered questions about personal hygiene, cognitive abilities, and health and safety issues.
  • The SN-37 Tool. It is a brief and comprehensive tool comprising 37 items that contribute to self-neglect. It defines the severity and classification of self-neglect to focus more on an intervention based on responses.
  • The Elder Self-Neglect Assessment (ESNA). Determine the behavioral characteristic or environmental factors associated with self-neglect.
  •  The Abrams Geriatric Self-Neglect Scale (AGSS). Questions about personal care, nutrition, prescription medications, socialization, environment/housing, and financial stewardship classify which range of self-neglect the scores will relate to.
  • The Istanbul Medical School Elder Self-Neglect (IMSelf-neglect). It is a screening tool in outpatient clinics for a complete geriatric assessment.
  • The Chicago Health and Aging Self-Neglect Instrument. It encompasses personal hygiene, behavioral characteristics, financial independence, health habits, and environmental characteristics classifying self-neglect as mild, moderate, or severe.

Treatment for Self-Neglect

Management of self-neglect varies on a case-to-case basis due to different cultures and acceptable living standards in society. Whether a response is needed or not, will depend on the adult’s ability to protect themselves by controlling their behavior. These includes:

  • Treatment of underlying conditions such as depression, dementia, cognitive impairment, or physical disabilities that may hamper their ability for self-care.
  • Home care. Care workers attend to vulnerable individuals’ needs without reducing their independence and autonomy. They will be monitored for any excessive deterioration of their health and levels of self-care observed or acted upon.
  • Approach. There are effective approaches to understanding vulnerable adults and their behaviors:
  • Multi-agency. Working with partners and other professionals to ensure the right approach for each individual.
  • Person-centered. Respecting individuals’ perspectives and listening to them to establish a plan of care.
  • Acceptance. Respecting their views to change their behavior and lifestyle.
  • Analytical. Identifying underlying causes to address the issue.
  • Non-judgemental. Making judgments isn’t helpful for the patient and may result in withdrawal and loss of interest.
  • Empathy. It is always helpful to try and understand behaviors unusual for everyone.
  • Patience and time. It will take time for interventions to work for everyone.
  • Trust. Establish rapport and a trusting environment.
  • Reassurance. Allay fears and anxiety to establish control.
  • Bargaining. Remain respectful by making agreements to achieve progress.
  • Exploring alternatives. Encourage vulnerable individuals to engage in alternative ways and give choices moving forward.
  • Always go back. Encourage engagement and persistence to achieve progress.
  • Practical task. There is a range of options and practical measures to help vulnerable individuals to be engaged, these include:
  • Risk assessment. A multi-agency approach to assess and monitor risk effectively.
  • Assess capacity. Ensuring competent results of self-care assessment.
  • Mental health assessment. It is the most important determinant of care for patients with self-neglect.
  • Signpost. Provide additional support outside the family.
  • Contact family. Engage family or friends as the strongest support.
  • Decluttering and cleaning services. Provide practical help without exhausting themselves.
  • Utilize local partners. Neighbors, community organizations, or support groups within reach.
  • Occupational therapy assessment. Addressing physical limitations from self-neglect.
  • Help with property management and repairs. Maintenance of property and valuable belongings.
  • Peer support. Assist with advice, insight, and understanding among individuals with the same experiences.
  • Counseling and therapies. Cognitive behavior therapy can help individuals with obsessive-compulsive disorders, hoarding disorders, or addictions.
  • Levers. This includes housing enforcement based on public health risks relating to anti-social behaviors. This is used as a last resort in extreme circumstances to help the patient have the right support.

Prevention for Self-Neglect

Support from family, friends, community, or groups is very important in helping individuals prevent neglecting themselves.

  • Avoid isolation because it is the most common cause of self-neglect.
  • Family and friends should offer support and help especially during their most vulnerable time.
  • Know and interact with neighbors. It may be helpful to let other people know about the situation and let them offer help and support.
  • Schedule regular physical, medical, and dental check-ups.
  • Automated monitoring systems with the presence of clinical personnel or a designated advocate for in-home care and visitations.
  • Adult Protective Services (APS). It is a part of a community involvement that will ensure the safety and well-being of the self-neglecting vulnerable adult.

Self-Neglect Nursing Diagnosis

Nursing Care Plans for Self Neglect 1

Self-care Deficit (Grooming)

Nursing Diagnosis: Self-care Deficit (Grooming) related to decreased motivation secondary to self-neglect as evidenced by unevenly long facial hair.

Desired Outcomes:

The patient will be able to independently perform grooming with the aid and appropriate use of adaptive equipment.

Self Neglect Nursing InterventionsRationale
Assess the patient’s degree of grooming difficulties, impairments, barriers, or disabilities.This will help the nurse identify the extent of the patient’s condition and create an attainable goal for self-care.
Assess the patient’s ability to safely perform and complete self-care. Check the patient’s knowledge about the use of a grooming kit and device such as a razor.This will help the nurse identify which task can be done by the patient independently and when they need assistance during grooming to prevent an accident.
Establish an attainable short-term goal with the patient.Setting a realistic goal will reduce the patient’s frustration and increase self-esteem.
Provide specific step-by-step instruction through activities with the use of tools or assistive devices for grooming.Some tools or assistive devices may not be familiar to the patient which may cause delay and dependence on the caregiver.
Provide limited choices.These promote autonomy and completion of tasks on hand without allowing pushback.
Assist and adapt to the pace of the patient.Giving the patient enough time to perform grooming tasks at their own pace can be beneficial.
Provide privacy during grooming.The need for privacy is essential for most patients to decrease their anxiety and the need to accomplish the task immediately.
Encourage participation of family members and significant othersInvolving them in the plan of care will increase compliance and monitor progress.
Promote energy-saving techniques and positive reinforcement.Patients with decreased motivation can be easily exhausted. Positive reinforcement increases self-esteem and compliance.

Nursing Care Plans for Self Neglect 2

Self-care Deficit (Toileting)

Nursing Diagnosis: Self-care Deficit (Toileting) related to poor mobility secondary to self-neglect as evidenced by unusual body odor and skin breakdown.

Desired Outcomes:

The patient will be able to safely perform toileting with the aid of assistive equipment.

The patient will be able to identify techniques to continue building independence with toileting.

Self Neglect Nursing InterventionsRationale
Assess the patient’s degree of toileting or bathing difficulties, impairments, barriers, or disabilities.This will help the nurse identify the extent of the patient’s self-neglect and create an attainable goal for self-care.
Assess the patient’s prior and present elimination pattern or toilet routine in bathing.Re-establishing bowel/bladder training can be efficient if the patient’s elimination pattern and bathing routine are taken into consideration.
Assess the patient’s ability to safely perform and complete toileting and bathing. Check the patient’s knowledge about the use of a urinal, bedpan, or bedside commode.This will help the nurse identify which tasks can be done independently and which toileting tasks might need assistance to prevent an accident.
Establish an attainable short-term goal with the patient.Setting a realistic goal will increase self-esteem and reduce the patient’s frustration.
Assist the patient to the bathroom at regular intervals to void or defecate. Provide detailed instructions about the use of urinal, bedpan, and bedside commode for toiletingThis will help the patient establish a regular elimination pattern. Patients may not be familiar with these tools which may cause delay and dependence on the caregiver
Assist the patient in the bathroom or keep the call light and bathing equipment within reach.It promotes safety and prompt response in case of body weakness or need for assistance.
Encourage increased fluid intake and eating a balanced diet.This aids in digestion and prevents skin breakdown with adequate nutrition and hydration.
Educate the patient about exercise and rehabilitation programs.This will strengthen the patient’s body, reducing weakness and improving flexibility in performing activities of daily living.

Nursing Care Plans for Self Neglect 3

Self-care Deficit (Dressing)

Nursing Diagnosis: Self-care Deficit (Dressing) related to body weakness secondary to self-neglect as evidenced by unfastened buttons and inappropriate clothes for the weather.

Desired Outcomes:

The patient will be able to dress independently wearing comfortable clothes appropriate for the weather.

Self Neglect Nursing InterventionsRationale
Assess the patient’s degree of dressing difficulties, impairments, barriers, or disabilities.This will help the nurse identify the extent of the patient’s self-neglect and create an attainable goal for self-care.
Assess the patient’s ability to perform and complete dressing.This will help the nurse identify a task that can be done independently and a task that needs assistance.
Establish a routine with an attainable short-term goal with the patient.Setting a realistic goal will reduce the patient’s frustration and increase self-esteem.
Provide easier and more comfortable clothing options beforehand.This saves the time and energy of the patient while promoting autonomy and appropriate choice of clothes.
Encourage participation by offering choices of comfortable clothes and accessories.This will promote autonomy and independence while motivating the patient to participate.
Assist and allow sufficient time for the patient to perform the task at hand without interrupting or rushing.Giving the patient enough time to perform dressing at their own pace promotes independence and completion of tasks while ensuring safety and support by assisting.
Provide privacy during dressing.Respecting the patient’s privacy builds trust and open communication with the patient.
Encourage participation of family members and significant othersInvolving them in the plan of care will increase compliance and monitor progress.
Promote energy-saving techniques and positive reinforcement.This reduces energy expenditure and frustrations from being exhausted easily. Positive reinforcement increases self-esteem and compliance.
Educate the patient about the proper use of assistive devices for dressing.This provides support for the body and saves the patient’s energy while dressing.

Nursing Care Plans for Self Neglect 4

Imbalanced Nutrition

Nursing Diagnosis: Imbalanced Nutrition Less Than Body requirements related to loss of appetite secondary to self-neglect as evidenced by poor skin turgor and being underweight.

Desired Outcomes:

The patient will be able to gain 2 to 3 lbs. after 2 weeks of nursing intervention.

The patient will display adequate skin perfusion and hydration.

Self Neglect Nursing InterventionsRationale
Assess the patient’s degree of self-neglect and contributing factors associated.This will help the nurse identify the extent of self-neglect and the underlying condition to create an attainable goal for self-care.
Provide a complete nutritional assessment and education. Assess the patient’s eating pattern and food choices.Determine possible underlying conditions associated with inadequate nutrition besides self-neglect. Patient education allows continuous compliance even after discharge.
Assess and monitor the patient’s vital signs, weight, intake, and output.This will help the nurse in monitoring the patient’s progress and nutritional intake ensuring compliance.
Assess the patient’s need for oral care and an assistive device for feeding.Good oral care can enhance the patient’s appetite. Special eating utensils may be used to aid the patient in eating.
Provide a diary with various nutritional resources. Instruct supplement administration as ordered.This ensures continuous nutritional intake even after discharge.
Provide good oral hygiene and dentition.It increases appetite and aids in the digestion of food via increased saliva production.
Encourage an increase in fluid intake of up to 3 liters per day.It promotes adequate hydration and tissue perfusion.
Educate the patient about small frequent feedings.Eating small, frequent meals decreases the feeling of fullness and the need to vomit.
Encourage the patient to remain in an upright position for up to 30 minutes after eating.This prevents vomiting and regurgitation of food from the stomach.
Administer enteral feedings as ordered.Given for patients with a severe case of self-neglect who cannot tolerate oral intake.
Referral to a nutritionist or dietitian upon consent.Professionals such as nutritionists and dietitians can provide an individualized nutritional plan for patients with special needs.

Nursing Care Plans for Self Neglect 5

Risk for Deficient Fluid Volume

Nursing Diagnosis: Risk for Deficient Fluid Volume related to inadequate fluid intake secondary to as self-neglect.

Desired Outcome:

The patient will be able to maintain adequate fluid volume as evidenced by adequate skin turgor and mucous membrane.

The patient will be able to recognize signs and symptoms and measures to keep them hydrated.

Self Neglect Nursing InterventionsRationale
Assess and monitor vital signs frequently along with intake and output, level of consciousness, and signs of dehydration.This will allow the nurse to establish baseline data, and monitor progress and the patient’s response to treatment.
Assess the patient’s daily pattern of fluid intake. Weigh the patient same time daily.Determining daily intake may help plan for nutritional intake. Sudden weight loss may indicate water loss such as decreasing urine output.
Encourage the patient to increase oral fluid intake to at least 3 liters per day. Distribute the number of fluids throughout the day.The distribution of fluids will aid with adequate hydration during the day to prevent nocturia.
Assist the patient in oral care at least every four hours or as needed.This will help prevent dry mouth making it more comfortable to drink and eat.
Assist the patient in drinking and place drinking water within reach.Patients with body weakness may need assistance while drinking. Drinking fluids within reach provides easy access and a reminder to drink more frequently.
Avoid caffeinated beverages.Caffeine promotes diuresis resulting in fluid volume loss.
Educate the patient and significant others about the importance of adequate fluid intake, signs of dehydration, and proper measuring of intake and output.Having adequate knowledge about the patient’s condition increases compliance of patients and significant others by being proactive.

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

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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Author
Anna Curran. RN, BSN, PHN

Anna Curran. RN, BSN, PHN
Clinical Nurse Instructor

Emergency Room Registered Nurse
Critical Care Transport Nurse
Clinical Nurse Instructor for LVN and BSN students

Anna began writing extra materials to help her BSN and LVN students with their studies and writing nursing care plans. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process and help nursing students pass the NCLEX exams.

Her experience spans almost 30 years in nursing, starting as an LVN in 1993. She received her RN license in 1997. She has worked in Medical-Surgical, Telemetry, ICU and the ER. She found a passion in the ER and has stayed in this department for 30 years.

She is a clinical instructor for LVN and BSN students and a Emergency Room RN / Critical Care Transport Nurse.

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