ineffective Coping
Taxonomy II: Coping/Stress Tolerance—Class 2 Coping Responses (00069)
[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.
[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.
Related Factors
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]
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]
Defining Characteristics
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
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
Poor concentration
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)]
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)]
Desired Outcomes/Evaluation
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.
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.
Actions/Interventions
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.
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.
NURSING PRIORITY NO. 2. To assess coping abilities and skills:
• 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.
• 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.
NURSING PRIORITY NO. 3. To assist client to deal with 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.)
• 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.)
NURSING PRIORITY NO. 4. To provide for meeting psychological needs:
• 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.)
• 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.)
NURSING PRIORITY NO. 5. To promote wellness (Teaching/ Discharge Considerations):
• 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).
• 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).
Documentation Focus
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.
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.
• Medication dose, time, and client’s response.
• 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.
• 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.
Tags: Coping/Stress Tolerance
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5 Respones to "ineffective Coping"
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