Nursing Dx

Taxonomy II: Coping/Stress Tolerance—Class 2 Coping Responses (00077)
[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.

Related Factors
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

Defining Characteristics
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)

Desired Outcomes/Evaluation
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.

Actions/Interventions
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.

NURSING PRIORITY NO. 3. To promote wellness as related to community health:
• 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.

• Make information available in different modalities and geared to differing educational levels/cultures of the community.
• Seek out and evaluate underserved populations.

Documentation Focus
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.

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.

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]

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

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)]

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.

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. 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.

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.)

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.)

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).

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.

• 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.