Self-care and Self-sufficiency
Self-care
- independent performing of daily activities
Self-sufficiency
- various degrees of autonomy in self-care (dependency/independence in performing daily activities)
- a fundamental human need
Evaluation of self-care
- during the patient's admission to the health-care institution
- during hospitalisation, at least once per week
- evaluation based on – an interview with the patient/ relatives/ health professionals; patient observation; documentation tests which evaluate a patient's functioning (ADL, IADL, M. Gordon)
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Barthel Index of Activities of Daily Living Scale (ADL)
Activity Scoring Total Score Feeding independent 10 needs help 5 unable to feed self 0 Dressing independent 10 needs help 5 unable to dress self 0 Grooming independent 5 dependent 0 Bathing independent 5 dependent 0 Use of toilet independent 10 needs some help 5 dependent 0 Bladder control continent 10 occasional accidents 5 incontinent 0 Bowel control continent 10 occasional accidents 5 incontinent 0 Transfer (bed to chair and back) independent 15 needs minor help 10 needs major help (can sit) 5 unable to sit, no sitting balance 0 Mobility (on level surface) independent > 50 yards 15 walks with help > 50 yards 10 wheelchair dependent > 50 yards 5 immobile < 50 yards 0 Stairs independent 10 needs help 5 unable to climb stairs 0 Outcome
- 0–40 points: high dependency
- 45–60 points: medium dependency
- 65–95 points: low dependency
- 100 points: independence
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Lawton-Brody Instrumental Activities of Daily Living Scale (IADL)
Activity Scoring Total Score Ability to use telephone operates telephone on own initiative – looks up and dials numbers, etc. 10 answers telephone, dials a few well-known numbers 5 does not use telephone at all 0 Transport travels independently on public transportation or drives own car 10 travels on public transportation when accompanied by another person 5 traveling limited to taxi or car with assistance of another person or needs special modified car 0 Shopping takes care of all shopping needs independently. 10 needs to be accompanied on any shopping trip 5 completely unable to shop 0 Housekeeping maintains house alone or with occasional assistance (e.g. "heavy work domestic help") 10 performs light daily tasks 5 does not participate in any housekeeping tasks 0 Household takes care of household independently 10 needs some help 5 unable to take care of household 0 Food preparation plans, prepares and serves adequate meals independently 10 heats and serves meals, but does not prepare meals 5 needs to have meals prepared and served 0 Responsibility for own medications is responsible for taking medication in correct dosages at correct time 10 takes responsibility if medication is prepared in advance in separate dosage 5 is not capable of dispensing own medication 0 Ability to handle finances manages financial matters independently (keeps budgets, pays rent and bills, goes to bank), collects and keeps track of income 10 manages day-to-day purchases, but needs help with banking, major purchases, etc. 5 incapable of handling money 0 Outcome
- 0–40 points: dependent
- 45–75 points: semi-independent
- 80 points: independent
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M. Gordon: Classification functional levels of the patient's self-care
- Independent, self-sufficient patient
- Patient needs minimal help (she/he is able to manage 75 % activities, she/he uses aids and equipment herself/himself)
- Needs minor help (she/he is able to manage 50 % activities)
- Needs major help (needs assistance, she/he is able to manage < 25 % of activities)
- Dependent (needs permanent help)
- Total self-care deficiency (no independent activity, needs complex care)
- evaluation and documentation is the doctor's obligation – evaluated during the patient's admission to the health-care institution, then according to current health status, has to be evaluated daily
- Lawton M., Brody E. Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living The Gerontologist Volume: 9 Issue 3 part 1 (Autum 1969, pp. 179-186) ISSN: 0016-9013 https://doi.org/10.1093/geront/9.3_Part_1.179 Accessed July 22, 2018
- Mahoney F. I, Barthel D. W. Functional evaluation: The Barthel Index. Maryland State Medical Journal 1965;14:56-61. http://www.strokecenter.org/wp-content/uploads/2011/08/barthel_reprint.pdf Accessed July 22, 2018
- Pokorná A. a kol. Ošetřovatelství v geriatrii: Hodnotící nástroje, Praha, Czechia: Grada Publishing, 2013. p 95. ISBN 978-80-247-4316-5.
- Pokorná, A. a Komínková, A. Ošetřovatelské postupy založené na důkazech. Brno, Czechia: Masaryk University, 2013. pp. 7-18. ISBN 978-80-210-6331-0
- Decree No. 467/2012 Coll., of 18 december 2012, drawing up the list of health acts with point score, as amended. In: Sbírka zákonů České republiky. 2012, amount 174, p. 6151. ISSN 1211-1244.
Patient category in institutional care
Decree No 467/2012 Coll., drawing up the list of health acts with point score, as amended.
| Category | Title | Legend |
| 0 | Patient on pass | records every day when the patient is on pass |
| 1 | Independent patient | patient is independent of fundamental nursing care activities; children over the age of 10 years |
| 2 | Semi – independent patient | patient is semi-independent, he/she is able to take care of himself/herself with assistance, he/she is able to move out of bed alone or with assistance, patient in a wheelchair; children aged between 6 and 10 years |
| 3 | Patient requiring enhanced surveillance | fully conscious patient, but non-ambulatory out of bed, neither alone nor with assistance, nor in a wheelchair. He/she requires enhanced surveillance. Psychically altered patient requiring enhanced surveillance with a temporary restriction of movement or pharmacological tranquillization if needed; children aged between 2 and 6 years |
| 4 | Immobile patient | fully conscious, but absolutely immobile patient, potentially incontinent, requiring nursing care in all activities; children up to the age of 2 years |
| 5 | Unconscious patient | patient is unconscious or in delirium |
Patient's movement regime
| Term | Movement regime |
| A – 1 | sufficient |
| B – 2 | walking patient, free movement within department |
| C – 3 | partly self-sufficient patient, self-sufficient within his/her bed, needs some help, doesn't leave bed |
| D – 4 | not self-sufficient, dependent patient, confined to bed, doesn't leave bed |