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Nursing Care Plans: Nursing Diagnosis and Intervention, 5/e
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Nursing Diagnosis: Ineffective Health Maintenance

NOC Outcomes (Nursing Outcomes Classification)

  • Health-Promoting Behavior
  • Self-Direction of Care
  • Health-Seeking Behavior
  • Social Support

NIC Interventions (Nursing Interventions Classification)

  • Health System Guidance
  • Support System Enhancement
  • Discharge Planning
  • Health Screening
  • Risk Identification

NANDA Definition: Inability to identify, manage, and/or seek help to maintain health

Altered health maintenance reflects a change in an individual’s ability to perform the functions necessary to maintain health or wellness. That individual may already manifest symptoms of existing or impending physical ailment or display behaviors that are strongly or certainly linked to disease. The nurse’s role is to identify factors that contribute to an individual’s inability to maintain healthy behavior and implement measures that will result in improved health maintenance activities. The nurse may encounter patients who are experiencing an alteration in their ability to maintain health either in the hospital or in the community, but the increased presence of the nurse in the community and home health settings improves the ability to assess patients in their own environment. Patients most likely to experience more than transient alterations in their ability to maintain their health are those whose age or infirmity (either physical or emotional) absorb much of their resources. The task before the nurse is to identify measures that will be successful in empowering patients to maintain their own health within the limits of their ability.

    Defining Characteristics:
  • Behavioral characteristics:
    • Demonstrated lack of knowledge
    • Failure to keep appointments
    • Expressed interest in improving behaviors
    • Failure to recognize or respond to important symptoms reflective of changing health state
    • Inability to follow instructions or programs for health maintenance
  • Physical characteristics:
    • Body or mouth odor
    • Unusual skin color, pallor
    • Poor hygiene
    • Soiled clothing
    • Frequent infections (e.g., upper respiratory infection [URI], urinary tract infection [UTI])
    • Frequent toothaches
    • Obesity or anorexia
    • Anemia
    • Chronic fatigue
    • Apathetic attitude
    • Substance abuse
    Related Factors:
  • Presence of mental retardation, illness, organic brain syndrome
  • Presence of physical disabilities or challenges
  • Presence of adverse personal habits:
    • Smoking
    • Poor diet selection
    • Morbid obesity
    • Alcohol abuse
    • Drug abuse
    • Poor hygiene
    • Lack of exercise
  • Evidence of impaired perception
  • Low income
  • Lack of knowledge
  • Poor housing conditions
  • Risk-taking behaviors
  • Inability to communicate needs adequately (e.g., deafness, speech impediment)
  • Dramatic change in health status
  • Lack of support systems
  • Denial of need to change current habits
    Expected Outcomes
  • Patient describes positive health maintenance behaviors such as keeping scheduled appointments, participating in smoking and substance abuse programs, making diet and exercise changes, improving home environment, and following treatment regimen.
  • Patient identifies available resources.
  • Patient uses available resources.

Ongoing Assessment

  • Assess for physical defining characteristics. Changing ability or interest in performing the normal activities of daily living (ADLs) may be an indicator that commitment to health and well-being is waning.
  • Assess patient’s knowledge of health maintenance behaviors. Patients may know that certain unhealthy behaviors can result in poor health outcomes but continue the behavior despite this knowledge. The health care provider needs to ensure that the patient has all of the information needed to make good lifestyle choices.
  • Assess health history over past 5 years. This may give some perspective on whether poor health habits are recent or chronic in nature.
  • Assess to what degree environmental, social, intrafamilial disruptions, or changes have correlated with poor health behaviors. These changes may be precipitating factors or may be early fallout from a generalized condition reflecting decline.
  • Determine patient’s specific questions related to health maintenance. Patients may have health education needs; meeting these needs may be helpful in mobilizing the patient.
  • Determine patient’s motives for failing to report symptoms reflecting changes in health status. Patient may not want to "bother" the provider, or may minimize the importance of the symptoms.
  • Discuss noncompliance with instructions or programs with patient to determine rationale for failure. Patient may be experiencing obstacles in compliance that can be resolved.
  • Assess the patient’s educational preparation and ability to integrate and relate to information. Patients may not have understood information because of a sensory impairment or the inability to read or understand information. Culture or age may impair a patient’s ability to comply with the established treatment plan.
  • Assess history of other adverse personal habits, including the following: smoking, obesity, lack of exercise, and alcohol or substance abuse. Long-standing habits may be difficult to break; once established, patients may feel that nothing positive can come from a change in behavior.
  • Determine whether the patient’s manual dexterity or lack of mobility is a factor in patient’s altered capacity for health maintenance. Patients may need assistive devices for ambulation or to complete tasks of daily living.
  • Determine to what degree patient’s cultural beliefs and personality contribute to altered health habits. Health teaching may need to be modified to be consistent with cultural or religious beliefs.
  • Determine whether the required health maintenance facilities/equipment (e.g., access ramps, motor vehicle modifications, shower bar or chair) are available to patient. With adequate assistive devices, the patient may be able to effect enormous changes in maintaining his or her personal health.
  • Assess whether economic problems present a barrier to maintaining health behaviors. Patients may be too proud to ask for assistance or be unaware that Social Security, Medicare, or insurance benefits could be helpful to them.
  • Assess hearing, and orientation to time, place, and person to determine the patient’s perceptual abilities. Perceptual handicaps may impair an individual’s ability to maintain healthy behaviors.
  • Make a home visit to determine safety, accessibility, and quality of living conditions. This will help identify and solve problems that complicate health maintenance.
  • Assess patient’s experience of stress and disruptors as they relate to health habits. If stressors can be relieved, patients may again be able to resume their self-care activities.

Therapeutic Interventions

  • Follow up on clinic visits with telephone or home visits. This will develop an ongoing relationship with patient and provide ongoing support.
  • Provide patient with a means of contacting health care providers. This will add available resources for questions or problem resolution.
  • Compliment patient on positive accomplishments. Positive reinforcement enhances behavior change.
  • Involve family and friends in health planning conferences. Family members need to understand that care is planned to focus on what is most important to the patient. This enables the patient to maintain a sense of autonomy.
  • Provide assistive devices (e.g., walker, cane, wheelchair) as necessary. These promote independence and a sense of autonomy.

Education/Continuity of Care

  • Provide patient with rationale for importance of behaviors such as the following:
    • Balanced diet low in cholesterol This prevents vascular disease.
    • Smoking cessation Smoking has been directly linked to cancer and heart disease.
    • Cessation of alcohol and drug abuse In addition to physical addictions and the social consequences, the physical consequences of substance abuse mitigate against it.
    • Regular exercise This promotes weight loss and increases agility and stamina.
    • Proper hygiene This decreases risk of infection and promotes maintenance and integrity of skin and teeth.
    • Regular physical and dental checkups Checkups identify and treat problems early.
    • Reporting of unusual symptoms to a health professional This initiates early treatment.
    • Proper nutrition
    • Regular inoculations
    • Early and regular prenatal care
  • Ensure that other agencies (e.g., Department of Children and Family Services [DCFS], Social Services, Visiting Nurse Association [VNA], Meals-on-Wheels) are following through with plans. Coordinated efforts are more meaningful and effective.

Include Rationales?

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