NANDA-I 2024-2026 edition · Reviewed November 2, 2026 by the editorial team
Diagnosis at a glance
| Code | 00331 |
|---|---|
| Label | Decreased self-care ability syndrome |
| Spanish label | Síndrome de disminución de la capacidad de autocuidado |
| Domain | 4. Activity / rest |
| Class | 5. Self-care |
| Type | Syndrome |
| Status | New in 2024-2026 |
What it means
It describes a patient who needs help with several personal care activities at once, from a common cause. Instead of writing one diagnosis per activity, they are grouped into one, and the care plan is organized around what they have in common.
Explanation written by our team. The official definition is in the NANDA-I 2024-2026 book.
When to use it
Clinical situations where it commonly shows up. The diagnosis is confirmed by your assessment, not by the medical diagnosis.
- After a stroke with hemiparesis that limits bathing, dressing, feeding and toileting.
- After sepsis with a prolonged ICU stay and generalized muscle weakness.
- During recovery from major surgery or trauma that requires rest and limits several movements.
- In people with moderate or advanced dementia who forget how to carry out personal care sequences.
- In advanced chronic illnesses with severe fatigue (heart failure, COPD, cancer).
What to assess
- Level of assistance for each activity: bathing, dressing, feeding, grooming, toileting, transfers. The Barthel Index organizes this assessment.
- Which part of each task the patient can do: for example, washes their face but not their back, buttons a shirt but cannot put on socks.
- Strength, range of motion, sitting and standing balance.
- Cognitive status: whether they understand and remember the sequence and start the task on their own.
- Pain, fatigue and dyspnea during activities.
- Vision and sensation in the hands.
- Motivation, mood and how they are coping with being dependent.
- Who will help at home and what adaptations are in place (grab bars, shower chair, raised toilet seat).
Defining characteristics
Assessment findings that support the diagnosis. They go in the "as evidenced by" part of the statement.
- Needs help washing their body, getting in and out of the shower or drying off.
- Cannot put on or take off clothing, shoes or socks without help.
- Cannot cut food, open containers or bring utensils to the mouth effectively.
- Needs help getting to the toilet, sitting down, standing up or cleaning themselves.
- Cannot comb their hair, shave or brush their teeth without assistance.
- Takes much longer than usual for each task and becomes exhausted before finishing.
- Barthel Index below what it was before the illness.
- Leaves tasks half done or does not start them even with the items within reach.
Related factors
The causes nursing can act on. They go in the "related to" part of the statement.
- Muscle weakness or loss of strength in one or more limbs.
- Fatigue or dyspnea on exertion.
- Uncontrolled pain with movement.
- Lack of assistive devices or environmental adaptations.
- Unfamiliarity with adaptive techniques (dressing the affected side first, using a long-handled shoehorn).
- Low mood or little motivation to participate.
- Caregivers who do everything for the patient instead of helping them do it.
At-risk populations
- Older adults hospitalized for more than a week.
- Stroke survivors in the acute and subacute phases.
- Patients recently discharged from the ICU.
- People with dementia living at home.
- People with advanced chronic illness.
Associated conditions
- Stroke.
- Sepsis and prolonged ICU stay.
- Hip or upper-extremity fractures.
- Dementias and other neurocognitive disorders.
- Neuromuscular diseases and Parkinson's disease.
- Advanced heart or respiratory failure.
How to write it (PES)
Decreased self-care ability syndrome related to right-sided weakness, fatigue on exertion and lack of assistive devices as evidenced by need for assistance with bathing, lower-body dressing, cutting food and transferring to the toilet, with a Barthel Index of 30/100.
Decreased self-care ability syndrome (00331).
What the limitations have in common and what nursing can act on: weakness, fatigue, pain, lack of adaptations or practice. The underlying disease is the associated condition.
The specific activities the patient needs help with and how much. In a syndrome, the evidence is exactly those grouped limitations; list them separately and use a scale.
Example written by our team for a fictional patient. Adapt it to your own patient's data. Build your statement with the PES generator.
Goals / expected outcomes
Written in measurable terms: what, how much and by when.
- Patient's Barthel Index increases by at least 15 points from admission to discharge.
- Feeds self with adaptive utensils once the meal tray is set up, within 5 days.
- Dresses upper body with minimal assistance (supervision only) within one week.
- Transfers from bed to toilet with one-person assist and a grab bar, without falls, before discharge.
- Caregiver demonstrates how to assist without doing the parts the patient can do for themselves.
Nursing interventions and rationales
| Intervention | Rationale |
|---|---|
| Assess with the Barthel Index on admission, weekly and at discharge. | It measures progress with a scale the whole team knows and helps with discharge planning. |
| Agree with the patient on which parts of each activity they do alone and which with help, and document it in the care plan. | It keeps each shift from doing everything for them and undoing what they had regained. |
| Schedule bathing and dressing after rest periods and with pain controlled. | With less fatigue and pain, the patient participates more and tires less. |
| Teach adaptive techniques: dress the affected side first and undress the unaffected side first; loose clothing with Velcro or elastic. | It reduces effort and lets them dress with less help. |
| Provide devices: built-up handle utensils, a plate guard, shower chair, grab bars, bedside commode or raised toilet seat. | They make up for lost strength or mobility and increase independence. |
| Set a regular toileting schedule and keep the call light within reach on the unaffected side. | It prevents incontinence from not getting there in time and falls from getting up alone. |
| For patients with cognitive impairment, give one-step instructions and lay out clothes in the order they are put on. | It simplifies the sequence and helps them finish the task. |
| Coordinate exercises with physical and occupational therapy and reinforce them during daily activities. | Practicing real tasks speeds functional recovery. |
| Acknowledge every achievement and teach the family to assist without taking over. | Motivation and daily practice are what keep the patient independent at home. |
NOC outcomes and NIC interventions
Outcomes (NOC) and interventions (NIC) that published sources link to this diagnosis. Pick the ones that fit your patient.
NOC outcomes
- 0300Self-Care: Activities of Daily Living (ADL)
- 1614Personal Autonomy
NIC interventions
- 1801Self-Care Assistance: Bathing/Hygiene
- 5602Teaching: Disease Process
- 5510Health Education
Linkages drawn from care plans published by health services, universities and nursing journals. Labels may vary depending on the NIC and NOC edition your facility uses.
Case study: Dependence after a stroke with hemiparesis
Patient. 71-year-old right-handed woman who lived alone and was independent. She is on day 6 of a hospital stay for an ischemic stroke with right hemiparesis.
Assessment
- Barthel Index 30/100 (100/100 before the stroke, according to her daughter).
- Strength 2/5 in the right arm and 3/5 in the right leg.
- Sits unsupported for 5 minutes; cannot stand on her own.
- Cannot cut meat or open containers; brings the spoon to her mouth with her left hand.
- Puts her gown on from the left side and cannot get her right arm through.
- Reports fatigue 6/10 after a bed bath.
- Understands and follows two-step commands.
Nursing diagnosis
Decreased self-care ability syndrome related to right-sided weakness, fatigue on exertion and lack of assistive devices as evidenced by need for assistance with bathing, dressing, cutting food and transferring to the toilet, with a Barthel Index of 30/100, in a patient with ischemic stroke (associated condition).
Goal
Patient will increase her Barthel Index to 45/100 or higher within 10 days.
Interventions
- Agree with her on what she does on her own for each activity and document it in the care plan.
- Shower her on a shower chair after her morning rest.
- Teach her to dress the right arm first.
- Provide built-up handle utensils and a plate guard; set up the meal tray.
- Transfer to the toilet with a grab bar and one-person assist every 3 hours during the day.
- Reinforce the exercises prescribed by rehab.
Evaluation
At 10 days her Barthel Index is 50/100: she eats on her own once the tray is set up and dresses her upper body with supervision. She still needs help with bathing and transfers. The diagnosis stays active and discharge is planned with her daughter trained as caregiver.
How it differs from similar diagnoses
- Decreased bathing abilities (00326): Used when the limitation is in bathing only. It was formerly called bathing self-care deficit (00108). If several activities are affected by the same cause, consider the syndrome.
- Decreased feeding abilities (00328): Focuses on feeding only (formerly feeding self-care deficit, 00102).
- Risk for decreased self-care ability syndrome (00332): There is no loss of ability yet, but the patient has factors that make it likely, such as a long hospital stay in a frail older adult.
- Impaired physical mobility (00085): Describes the limitation in movement itself. It is often one of the factors that explains the loss of self-care.
Common mistakes
- Writing separate bathing, dressing, feeding and toileting diagnoses with the same cause when the limitation is global: the syndrome groups them.
- Using the syndrome when only one activity is affected.
- Documenting "total care" without specifying which parts of each task the patient can do.
- Doing everything for the patient to save time, which delays their recovery.
- Listing the underlying disease as the only related factor.
Used in these conditions
Other diagnoses in the Self-care class
Domain 4, Activity / rest. See every diagnosis in this domain.
Frequently asked questions
What is the NANDA code for decreased self-care ability syndrome?
00331. It belongs to Domain 4 (Activity/rest), Class 5 (Self-care). It is a new diagnosis in the 2024-2026 edition.
What happened to the self-care deficit diagnoses for bathing, dressing, feeding and toileting?
They still exist with new names and codes: Decreased bathing abilities (00326), Decreased dressing abilities (00327), Decreased feeding abilities (00328) and Decreased toileting abilities (00329). 00331 is a separate diagnosis, used when several of those abilities are decreased at the same time.
How do you write a syndrome nursing diagnosis?
With the label, the related factors and the evidence. In a syndrome, the evidence is usually other problems that occur together, in this case each limited self-care activity.
What scale should I use to assess self-care?
The Barthel Index is the one most used in hospitals for basic activities of daily living. What matters is using the same scale on admission, during the stay and at discharge.
When do I resolve this diagnosis?
When the patient performs their basic activities independently or with a stable, accepted level of help, and the caregiver is prepared to provide it.
Study material: the explanation, characteristics, factors, examples and case study on this page were written by our editorial team. The official text for Decreased self-care ability syndrome (00331) is in NANDA International Nursing Diagnoses: Definitions and Classification 2024-2026. This page does not replace clinical judgment or your facility's protocols.
Classification sources: NANDA-I 2024-2026, Thieme supplement · Elsevier summary of changes · Spanish edition table of contents · NOC/NIC: source 1. Reviewed November 2, 2026.