What is the most important nursing diagnosis for a patient in end

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Ineffective health maintenance incorporates components of related nursing diagnoses. Specific diagnoses such as impaired communication, confusion, grieving, hopelessness, spiritual distress, and many others can correlate to ineffective health maintenance. Regardless of the reason, it prevents the patient from identifying, managing, or seeking help to maintain their health.

Ineffective health maintenance can be the result of a patient’s lack of ownership of their health or it can be out of their control, such as with cognitive impairment. A patient displaying poor health due to lifestyle choices or disinterest in making changes presents a different challenge than a patient who attempts to improve their health but lacks finances or family support. In many instances, the nurse can present information and resources, support and empower the patient in making a plan or setting goals, and continue to follow-up, but the patient must play an active role in maintaining or improving their health status.

Causes of Ineffective Health Maintenance (Related to)

• Inability to make appropriate judgments 
• Cognitive impairment 
• Developmental delay 
• Lack of motor skills to perform tasks (opening pill bottles) 
• Ineffective coping 
• Lack of psychosocial support 
• Complicated family dynamics 
• Insufficient finances 
• Lack of access to resources 
• Lack of motivation 
• Poor adherence 
• Depression 
• Deficient knowledge 
• Poor lifestyle choices (substance abuse, smoking, poor diet) 

Signs and Symptoms (As evidenced by) 

Subjective: (Patient reports) 

• Expressed disinterest in improving health 
• Expressed lack of knowledge or knowing where to start 

Objective: (Nurse assesses) 

• Worsening of health status 
• Demonstrated lack of knowledge 
• Demonstrated lack of adherence 
• History of lack of health-seeking behaviors 
• Lack of motivation due to depression, grieving, hopelessness, etc. 
• Inability to make decisions due to cognitive functioning 
• Inability to perform health maintenance behaviors due to physical impairment

Expected Outcomes

• Patient will verbalize factors contributing to current health status/preventing improved health status 
• Patient will adopt lifestyle changes to support health goals (example: Patient will stop smoking by the end of the year to prevent worsening of asthma.) 
• Patient will identify resources necessary to support health maintenance 

Nursing Assessment for Ineffective Health Maintenance

1. Assess conditions that prevent health maintenance.
Physical impairments (Parkinson’s disease, stroke, paralysis) and cognitive impairments (dementia, mental retardation) may prevent the patient from making appropriate decisions or completing tasks without the help of others.

2. Assess for religious and cultural beliefs.
Patients who have strong religious or cultural beliefs (not receiving blood products, distrust in Western medicine) may present as barriers to appropriate health maintenance.

3. Assess for family support.
A lack of family or social support systems can be detrimental to all patients, regardless of physical or mental capabilities. Family and friends can also influence poor decisions.

4. Evaluate for substance abuse.
Without judging, the nurse evaluates the use of harmful substances and the role played in the patient’s life and health. People often use addictive substances (even caffeine) to cope.

5. Note recent losses or life changes.
Grieving the loss of a loved one, loss of independence, and changes in finances, causes stress and prevent the patient from focusing on maintaining their health.

6. Assess living environment and access to resources.
A patient that is homeless or living in a rural area may not have access to community resources or healthcare providers.

7. Assess interest and desire to improve health.
Before presenting the patient with information or resources or assuming interest the nurse should assess for readiness. The patient may not be motivated or have a thorough understanding of the need to improve health behaviors.

8. Assess prior attempts to change and their understanding of the situation.
It may help the nurse to better understand steps the patient took in the past to improve their health and what didn’t work. The nurse may be able to present information in a better way or help them implement more appropriate interventions.

Nursing Interventions for Ineffective Health Maintenance

1. Incorporate the patient in their health goals.
A patient who does not understand the reason for changing or is not interested/ready to change will not do so. The nurse must meet the patient where they are in their health journey and focus on what is important to them and their current capabilities.

2. Simplify their treatment plan.
If medication adherence is an issue or completing appointments discuss with the provider ways to increase adherence by suggesting once-daily pills instead of divided doses and telehealth visits when appropriate.

3. Coordinate resources.
The nurse is vital in advocating and coordinating on behalf of the patient. Patients who lack knowledge of available resources or how to set them up will benefit from support. The nurse can begin communication with community resources such as food pantries, free dental clinics, or patient assistance programs.

4. Offer mental health support.
Patients struggling with coping with their illnesses, instances of abuse, depression, or complicated grief may require mental health intervention. Patients cannot focus on health maintenance activities if they do not feel safe or mentally well.

5. Educate about the detriment of health behaviors.
Patients may not understand the consequences of certain behaviors. Without instilling unnecessary fear, the nurse can present facts that the patient may have been unaware of. For example, a pregnant patient that has multiple sexual partners may not understand the risk of sexually transmitted diseases that can be transmitted to her child.

6. Help the patient see a trend when making positive changes.
For patients that may need visual reminders, the nurse can suggest keeping a log or journal. A patient that can visualize their blood pressure normalizing or staying on track with their diet is more likely to continue and create a positive habit.

7. Use motivational interviewing.
MI is an evidence-based approach to behavior change. The nurse can use the acronym OARS to help explore the patient’s thoughts and feelings.

• O – Open-ended questions (Encourages the patient to think deeper)
• A – Affirmations (Build the patient’s confidence and their ability to succeed)
• R – Reflective listening (Show the patient you are listening and give them a chance to correct or elaborate)
• S – Summarize – (Tie up the plan, goals, and next steps)

8. Involve family as applicable.
Patients may not want family members involved or they may lack support. Some family members may also lack an understanding or awareness of the severity of a situation. In this case, the nurse can invite family members to appointments or have conferences to support positive health maintenance.

9. Refer to social workers or home health.
The nurse can request referrals to other clinicians for continued follow-up. These professionals may be able to assess for further barriers at home and make recommendations.

10. Consider alternatives and get creative.
Nurses can think outside the box to overcome barriers. A bed-bound patient may require virtual care or home visits by a provider. A patient that lacks transportation may need their medications delivered. Patients with memory loss or who miss appointments frequently can be sent text reminders.

11. Discuss programs for substance abuse or smoking cessation.
A patient that appears interested in overcoming addiction may seek out help. Offer phone numbers to Narcotics/Alcoholics Anonymous or programs that support smoking cessation.

12. Assist in setting up appointments for preventive health.
The best health maintenance begins with prevention. Remind and if necessary, set up appointments for breast cancer screenings, pap smears, and vaccinations. Make sure the patient understands the reasoning and importance for better adherence.

References and Sources

1. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
2. Hartney, E. (2021, May 30). What Is Motivational Interviewing? Verywell Mind. https://www.verywellmind.com/what-is-motivational-interviewing-22378
3. Canadian Institute for Substance Use Research. (2017). Understanding Substance Use: A health promotion perspective. Here to Help. https://www.heretohelp.bc.ca/infosheet/understanding-substance-use-a-health-promotion-perspective#applies

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