Nursing Dx

Taxonomy II: Coping/Stress Tolerance—Class 2 Coping Responses
[Diagnostic Divisions: Ego Integrity]

Definition: A pattern of cognitive and behavioral efforts to manage demands that is sufficient for well-being and can be strengthened.

Defining Characteristics
SUBJECTIVE
Defines stressors as manageable
Seeks social support; knowledge of new strategies

Acknowledges power
Is aware of possible environmental changes
OBJECTIVE
Uses a broad range of problem-oriented strategies; spiritual resources

Desired Outcomes/Evaluation
Criteria—Client Will:
• Assess current situation accurately.
• Identify effective coping behaviors currently being used.
• 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 needs and desire for improvement:
• Evaluate ability to understand events, provide realistic appraisal of situation. Provides information about client’s perception, cognitive ability, and whether the client is aware of the facts of the situation. This is essential for planning care.
• Determine stressors that are currently affecting client. Accurate identification of situation that client is dealing with provides information for planning interventions to enhance coping abilities.
• Identify social supports available to client. Available support systems, such as family and friends, can provide client with ability to handle current stressful events and often “talking it out” with an empathic listener will help client move forward to enhance coping skills.
• Review coping strategies client is aware of and using. The desire to improve one’s coping ability is based on an awareness of the current status of the stressful situation.
• Determine alcohol intake, other drug use, smoking habits, sleeping and eating patterns. Use of these substances impairs ability to deal with anxiety and affects ability to cope with life’s stressors. Identification of impaired sleeping and eating patterns provides clues to need for change.
• Assess level of anxiety and coping on an ongoing basis. Provides information for baseline to develop plan of care to improve coping abilities.
• Note speech and communication patterns. Assesses ability to understand and provides information necessary to help client make progress in desire to enhance coping abilities.

• Evaluate client’s decision-making ability. Understanding
client’s ability provides a starting point for developing plan
and determining what information client needs to develop
more effective coping skills.
NURSING PRIORITY NO. 2. To assist client to develop enhanced
coping skills:
• Active-listen and identify client’s perceptions of current
status. Reflecting client’s statements and thoughts can
provide a forum for understanding perceptions in relation to
reality for planning care and determining accuracy of interventions
needed.
• Determine previous methods of dealing with life problems.
Enables client to identify successful techniques used in the
past, promoting feelings of confidence in own ability.
• Discuss desire to improve ability to manage stressors of life.
Understanding motivation behind decision to seek new
information to enhance life will help client know what is
needed to learn new skills of coping.
• Discuss understanding of concept of knowing what can and
cannot be changed. Acceptance of reality that some things
cannot be changed allows client to focus energies on dealing
with things that can be changed.
NURSING PRIORITY NO. 3. To promote optimum wellness:
• Discuss predisposing factors related to any individual’s response
to stress. Understanding that genetic influences, past
experiences, and existing conditions determine whether a
person’s response is adaptive or maladaptive will give client a
base on which to continue to learn what is needed to improve
life.
• Assist client to create a stress management program. An
individualized program of relaxation, meditation, involvement
with caring for others/pets will enhance coping skills
and strengthen client’s ability to manage challenging situations.
• Help client develop problem-solving skills. Learning the
process for problem-solving will promote successful resolution
of potentially stressful situations that arise.
• Encourage involvement in activities of interest, such as exercise/
sports,music, and art. Individuals must decide for themselves
what coping strategies are adaptive for them. Most
people find enjoyment and relaxation in these kinds of activities.
• Discuss possibility of doing volunteer work in an area of the
client’s choosing. Many people report satisfaction in helping
others, and client may find pleasure in such involvement.
• Refer to classes and/or reading material as appropriate. May be helpful to further learning and pursuing goal of enhanced
coping ability.

Documentation Focus
ASSESSMENT/REASSESSMENT
• Baseline information, client’s perception of need.
• 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.