Nursing Dx

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.