Declare Independence and Build Solar Panels
بِسۡمِ ٱللهِ ٱلرَّحۡمَـٰنِ ٱلرَّحِيمِ (١)
In the name of Allah, the Beneficent, the Merciful (1)
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ineffective community Coping
[Diagnostic Division: Social Interaction]
Submitted 1994; Nursing Diagnosis Extension and
Classification (NDEC) Revision 1998
Definition: Pattern of community activities (for adaptation and problem-solving) that is unsatisfactory for meeting the demands or needs of the community.
Deficits in social support services and resources
Inadequate resources for problem-solving
Ineffective or nonexistent community systems (e.g., lack of emergency medical system, transportation system, or disaster planning systems)
Natural or human-made disasters
SUBJECTIVE
Community does not meet its own expectations
Expressed vulnerability; community powerlessness
Stressors perceived as excessive
OBJECTIVE
Deficits of community participation
Excessive community conflicts
High illness rates
Increased social problems (e.g., homicide, vandalism, arson, terrorism, robbery, infanticide, abuse, divorce, unemployment, poverty, militance, mental illness)
Criteria—Community Will:
• Recognize negative and positive factors affecting community’s ability to meet its own demands or needs.
• Identify alternatives to inappropriate activities for adaptation/ problem-solving.
• Report a measurable increase in necessary/desired activities to improve community functioning.
NURSING PRIORITY NO. 1. To identify causative or precipitating factors:
• Evaluate community activities as related to meeting collective needs within the community itself and between the community and the larger society.
• Note community reports of community functioning, including areas of weakness or conflict.
• Identify effects of Related Factors on community activities.
• Determine availability and use of resources.
• Identify unmet demands or needs of the community.
NURSING PRIORITY NO. 2. To assist the community to reactivate/ develop skills to deal with needs:
• Determine community strengths.
• Identify and prioritize community goals.
• Encourage community members/groups to engage in problemsolving activities.
• Develop a plan jointly with community to deal with deficits in support to meet identified goals.
• Create plans managing interactions within the community itself and between the community and the larger society to meet collective needs.
• Assist the community to form partnerships within the community and between the community and the larger society. Promotes long-term development of the community to deal with current and future problems.
• Provide channels for dissemination of information to the community as a whole, for example, print media; radio/television reports and community bulletin boards; speakers’ bureau; reports to committees, councils, advisory boards on file and accessible to the public.
• Seek out and evaluate underserved populations.
ASSESSMENT/REASSESSMENT
• Assessment findings, including perception of community members regarding problems.
PLANNING
• Plan of care and who is involved in planning.
• Teaching plan.
IMPLEMENTATION/EVALUATION
• Response of community entities to plan/interventions and actions performed.
• Attainment/progress toward desired outcome(s).
• Modifications to plan of care.
DISCHARGE PLANNING
• Long-range plans and who is responsible for actions to be taken.
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ineffective Coping
[Diagnostic Division: Ego Integrity]
Submitted 1978; Nursing Diagnosis Extension and Classification (NDEC) Revision 1998
Definition: Inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or inability to use available resources.
Situational/maturational crises
High degree of threat
Inadequate opportunity to prepare for stressor; disturbance in pattern of appraisal of threat
Inadequate level of confidence in ability to cope/perception of control; uncertainty
Inadequate resources available; inadequate social support created by characteristics of relationships
Disturbance in pattern of tension release; inability to conserve adaptive energies
Gender differences in coping strategies
[Work overload, no vacations, too many deadlines; little or no exercise]
[Impairment of nervous system; cognitive/sensory/perceptual impairment, memory loss]
[Severe/chronic pain]
SUBJECTIVE
Verbalization of inability to cope or inability to ask for help
Sleep disturbance; fatigue
Abuse of chemical agents
[Reports of muscular/emotional tension, lack of appetite]
OBJECTIVE
Lack of goal-directed behavior/resolution of problem, including inability to attend to and difficulty with organizing information;
[lack of assertive behavior]
Use of forms of coping that impede adaptive behavior [including inappropriate use of defense mechanisms, verbal manipulation]
Inadequate problem-solving
Inability to meet role expectations/basic needs
Decreased use of social supports
Change in usual communication patterns
High illness rate [including high blood pressure, ulcers, irritable bowel, frequent headaches/neckaches]
Risk taking
Destructive behavior toward self or others [including overeating, excessive smoking/drinking, overuse of prescribed/OTC medications, illicit drug use]
[Behavioral changes (e.g., impatience, frustration, irritability, discouragement)]
Criteria—Client Will:
• Assess the current situation accurately.
• Identify ineffective coping behaviors and consequences.
• Verbalize awareness of own coping abilities.
• Verbalize feelings congruent with behavior.
• Meet psychological needs as evidenced by appropriate expression of feelings, identification of options, and use of resources.
NURSING PRIORITY NO. 1. To determine degree of impairment:
• Evaluate ability to understand events, provide realistic appraisal of situation.
• Identify developmental level of functioning. (People tend to regress to a lower developmental stage during illness/crisis.)
• Assess current functional capacity and note how it is affecting the individual’s coping ability.
• Determine alcohol intake, drug use, smoking habits, sleeping and eating patterns.
• Ascertain impact of illness on sexual needs/relationship.
• Assess level of anxiety and coping on an ongoing basis.
• Note speech and communication patterns.
• Observe and describe behavior in objective terms. Validate observations.
• Ascertain client’s understanding of current situation and its impact.
• Active-listen and identify client’s perceptions of what is happening.
• Evaluate client’s decision-making ability.
• Determine previous methods of dealing with life problems to identify successful techniques that can be used in current situation.
• Call client by name. Ascertain how client prefers to be addressed. Using client’s name enhances sense of self and promotes individuality/self-esteem.
• Encourage communication with staff/SO(s).
• Use reality orientation (e.g., clocks, calendars, bulletin boards) and make frequent references to time, place as indicated. Place needed/familiar objects within sight for visual cues.
• Provide for continuity of care with same personnel taking care of the client as often as possible.
• Explain disease process/procedures/events in a simple, concise manner. Devote time for listening; may help client to express emotions, grasp situation, and feel more in control.
• Provide for a quiet environment/position equipment out of view as much as possible when anxiety is increased by noisy surroundings.
• Schedule activities so periods of rest alternate with nursing care. Increase activity slowly.
• Assist client in use of diversion, recreation, relaxation techniques.
• Stress positive body responses to medical conditions but do not negate the seriousness of the situation (e.g., stable blood pressure during gastric bleed or improved body posture in depressed client).
• Encourage client to try new coping behaviors and gradually master situation.
• Confront client when behavior is inappropriate, pointing out difference between words and actions. Provides external locus of control, enhancing safety.
• Assist in dealing with change in concept of body image as appropriate. (Refer to ND disturbed Body Image.)
• Treat the client with courtesy and respect. Converse at client’s level, providing meaningful conversation while performing care. (Enhances therapeutic relationship.) Take advantage of teachable moments.
• Allow client to react in own way without judgment by staff. Provide support and diversion as indicated.
• Encourage verbalization of fears and anxieties and expression of feelings of denial, depression, and anger. Let the client know that these are normal reactions.
• Provide opportunity for expression of sexual concerns.
• Help client to set limits on acting-out behaviors and learn ways to express emotions in an acceptable manner. (Promotes internal locus of control.)
• Give updated/additional information needed about events, cause (if known), and potential course of illness as soon as possible. Knowledge helps reduce anxiety/fear, allows client to deal with reality.
• Provide and encourage an atmosphere of realistic hope.
• Give information about purposes and side effects of medications/ treatments.
• Stress importance of follow-up care.
• Encourage and support client in evaluating lifestyle, occupation, and leisure activities.
• Assess effects of stressors (e.g., family, social, work environment, or nursing/healthcare management) and ways to deal with them.
• Provide for gradual implementation and continuation of necessary behavior/lifestyle changes. Enhances commitment to plan.
• Discuss/review anticipated procedures and client concerns, as well as postoperative expectations when surgery is recommended.
• Refer to outside resources and/or professional therapy as indicated/ ordered.
• Determine need/desire for religious representative/spiritual counselor and arrange for visit.
• Provide information, privacy, or consultation as indicated for sexual concerns. Provide privacy when client not in own home.
• Refer to other NDs as indicated (e.g., Pain; Anxiety; impaired verbal Communication; risk for other/self-directed Violence).
ASSESSMENT/REASSESSMENT
• Baseline findings, degree of impairment, and client’s perceptions of situation.
• Coping abilities and previous ways of dealing with life problems.
PLANNING
• Plan of care/interventions and who is involved in planning.
• Teaching plan.
IMPLEMENTATION/EVALUATION
• Client’s responses to interventions/teaching and actions performed.
• Attainment/progress toward desired outcome(s).
• Modifications to plan of care.
DISCHARGE PLANNING
• Long-term needs and actions to be taken.
• Support systems available, specific referrals made, and who is responsible for actions to be taken.
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disabled family Coping
[Diagnostic Division: Social Interaction]
Submitted 1980; Revised 1996
Definition: Behavior of SO (family member or other primary person) that disables his/her capacities and the client’s capacity to effectively address tasks essential to either person’s adaptation to the health challenge.
Significant person with chronically unexpressed feelings of guilt, anxiety, hostility, despair, and so forth
SUBJECTIVE
[Expresses despair regarding family reactions/lack of involvement]
OBJECTIVE
Intolerance, rejection, abandonment, desertion
Psychosomaticism
Agitation, depression, aggression, hostility
Taking on illness signs of client
Neglectful relationships with other family members
Carrying on usual routines disregarding client’s needs
Neglectful care of the client in regard to basic human needs and/ or illness treatment
Distortion of reality regarding the client’s health problem, including extreme denial about its existence or severity
Decisions and actions by family that are detrimental to economic or social well-being
Impaired restructuring of a meaningful life for self, impaired individualization, prolonged overconcern for client
Client’s development of helpless, inactive dependence
Criteria—Family Will:
• Verbalize more realistic understanding and expectations of the client.
• Visit/contact client regularly.
• Participate positively in care of client, within limits of family’s abilities and client’s needs.
• Express feelings and expectations openly and honestly as appropriate.
NURSING PRIORITY NO. 1. To assess causative/contributing factors:
• Ascertain preillness behaviors/interactions of the family. Provides comparative baseline.
• Identify current behaviors of the family members (e.g., withdrawal—not visiting, brief visits, and/or ignoring client when visiting; anger and hostility toward client and others; ways of touching between family members, expressions of guilt).
• Note cultural factors related to family relationships that may be involved in problems of caring for member who is ill.
• Note other factors that may be stressful for the family (e.g., financial difficulties or lack of community support, as when illness occurs when out of town). Provides opportunity for appropriate referrals.
• Determine readiness of family members to be involved with care of the client.
• Establish rapport with family members who are available. Promotes therapeutic relationship and support for problemsolving solutions.
• Acknowledge difficulty of the situation for the family. Reduces blaming/guilt feelings.
• Active-listen concerns; note both overconcern/lack of concern, which may interfere with ability to resolve situation.
• Allow free expression of feelings, including frustration, anger, hostility, and hopelessness. Place limits on actingout/ inappropriate behaviors to minimize risk of violent behavior.
• Give accurate information to SO(s) from the beginning.
• Act as liaison between family and healthcare providers to provide explanations and clarification of treatment plan.
• Provide brief, simple explanations about use and alarms when equipment (such as a ventilator) is involved. Identify appropriate professional(s) for continued support/problemsolving.
• Provide time for private interaction between client/family.
• Include SO(s) in the plan of care; provide instruction to assist them to learn necessary skills to help client.
• Accompany family when they visit to be available for questions, concerns, and support.
• Assist SO(s) to initiate therapeutic communication with client.
• Refer client to protective services as necessitated by risk of physical harm. Removing client from home enhances individual safety and may reduce stress on family to allow opportunity for therapeutic intervention.
• Assist family to identify coping skills being used and how these skills are/are not helping them deal with situation.
• Reframe negative expressions into positive whenever possible. (A positive frame contributes to supportive interactions and can lead to better outcomes.)
• Respect family needs for withdrawal and intervene judiciously. Situation may be overwhelming and time away can be beneficial to continued participation.
• Encourage family to deal with the situation in small increments rather than the whole picture at one time.
• Assist the family to identify familiar things that would be helpful to the client (e.g., a family picture on the wall), especially when hospitalized for long period of time, to reinforce/ maintain orientation.
• Refer family to appropriate resources as needed (e.g., family therapy, financial counseling, spiritual advisor).
• Refer to ND anticipatory Grieving, as appropriate.
ASSESSMENT/REASSESSMENT
• Assessment findings, current/past behaviors, including family members who are directly involved and support systems available.
• Emotional response(s) to situation/stressors.
PLANNING
• Plan of care/interventions and who is involved in planning.
• Teaching plan.
IMPLEMENTATION/EVALUATION
• Responses of individuals to interventions/teaching and
actions performed.
• Attainment/progress toward desired outcome(s).
• Modifications to plan of care.
DISCHARGE PLANNING
• Ongoing needs/resources/other follow-up recommendations and who is responsible for actions.
• Specific referrals made.
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defensive Coping
Taxonomy II: Coping/Stress Tolerance—Class 2 Coping Responses (00071)
[Diagnostic Division: Ego Integrity]
Submitted 1988
Definition: Repeated projection of falsely positive selfevaluation based on a self-protective pattern that defends against underlying perceived threats to positive self-regard
Related Factors
To be developed
[Refer to ND ineffective Coping]
Defining Characteristics
SUBJECTIVE
Denial of obvious problems/weaknesses
Projection of blame/responsibility
Hypersensitive to slight/criticism
Grandiosity
Rationalizes failures
[Refuses or rejects assistance]
OBJECTIVE
Superior attitude toward others
Difficulty establishing/maintaining relationships, [avoidance of intimacy]
Hostile laughter or ridicule of others, [aggressive behavior]
Difficulty in reality testing perceptions
Lack of follow-through or participation in treatment or therapy
[Attention-seeking behavior]
Desired Outcomes/Evaluation
Criteria—Client Will:
• Verbalize understanding of own problems/stressors.
• Identify areas of concern/problems.
• Demonstrate acceptance of responsibility for own actions, successes, and failures.
• Participate in treatment program/therapy.
• Maintain involvement in relationships.
Actions/Interventions
• Refer to ND ineffective Coping for additional interventions.
NURSING PRIORITY NO. 1. To determine degree of impairment:
• Assess ability to comprehend current situation, developmental level of functioning.
• Determine level of anxiety and effectiveness of current coping mechanisms.
• Determine coping mechanisms used (e.g., projection, avoidance, rationalization) and purpose of coping strategy (e.g., may mask low self-esteem) to note how these behaviors affect current situation.
• Assist client to identify/consider need to address problem differently.
• Describe all aspects of the problem using therapeutic communication skills, such as Active-listening.
• Observe interactions with others to note difficulties/ability to establish satisfactory relationships.
• Note expressions of grandiosity in the face of contrary evidence (e.g., “I’m going to buy a new car” when the individual has no job or available finances).
NURSING PRIORITY NO. 2. To assist client to deal with current situation:
• Provide explanation of the rules of the treatment program and consequences of lack of cooperation.
• Set limits on manipulative behavior; be consistent in enforcing consequences when rules are broken and limits tested.
• Develop therapeutic relationship to enable client to test new behaviors in a safe environment. Use positive, nonjudgmental approach and “I” language to promote sense of self-esteem.
• Encourage control in all situations possible, include client in decisions and planning to preserve autonomy.
• Acknowledge individual strengths and incorporate awareness of personal assets/strengths in plan.
• Convey attitude of acceptance and respect (unconditional positive regard) to avoid threatening client’s self-concept, preserve existing self-esteem.
• Encourage identification and expression of feelings.
• Provide healthy outlets for release of hostile feelings (e.g., punching bags, pounding boards). Involve in outdoor recreation program/activities.
• Provide opportunities for client to interact with others in a positive manner, promoting self-esteem.
• Assist client with problem-solving process. Identify and discuss responses to situation, maladaptive coping skills. Suggest alternative responses to situation to help client select more adaptive strategies for coping.
• Use confrontation judiciously to help client begin to identify defense mechanisms (e.g., denial/projection) that are hindering development of satisfying relationships.
NURSING PRIORITY NO. 3. To promote wellness (Teaching/ Discharge Considerations):
• Encourage client to learn relaxation techniques, use of guided imagery, and positive affirmation of self in order to incorporate and practice new behaviors.
• Promote involvement in activities/classes where client can practice new skills and develop new relationships.
• Refer to additional resources (e.g., substance rehabilitation, family/marital therapy) as indicated.
Documentation Focus
ASSESSMENT/REASSESSMENT
• Assessment findings/presenting behaviors.
• Client perception of the present situation and usual coping methods/degree of impairment.
PLANNING
• Plan of care and interventions and who is involved in development of the plan.
• Teaching plan.
IMPLEMENTATION/EVALUATION
• Response to interventions/teaching and actions performed.
• Attainment/progress toward desired outcome(s).
• Modifications to plan of care.
DISCHARGE PLANNING
• Referrals and follow-up program.
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The Current State of Nursing Education
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