Nursing Diagnosis: Ineffective Coping
Definition of Ineffective Coping
- Inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or inability to use available resources
Related Factors of Ineffective Coping | Nursing Care Plan for Ineffective Coping
- 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 of Ineffective Coping | Nursing Care Plan for Ineffective Coping
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 psychologic needs as evidenced by appropriate expression of feelings, identification of options, and use of resources.
Nursing Interventions for Ineffective Coping | Nursing Care Plan for Ineffective Coping
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 Interventions for Ineffective Coping | Nursing Care Plan for Ineffective Coping
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 Interventions for Ineffective Coping | Nursing Care Plan for Ineffective Coping
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 Body Image, disturbed.)
Nursing Interventions for Ineffective Coping | Nursing Care Plan for Ineffective Coping
NURSING PRIORITY NO. 4. To provide for meeting psychologic 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 Interventions for Ineffective Coping | Nursing Care Plan for Ineffective Coping
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.
- Refer to other NDs as indicated (e.g., Pain; Anxiety; Communication, impaired verbal; Violence, [actual/] risk for other-directed and Violence, [actual/] risk for selfdirected).
Documentation Focus | Nursing Care Plan for Ineffective Coping
ASSESSMENT/REASSESSMENT | Nursing Care Plan for Ineffective Coping
- Baseline findings, degree of impairment, and client’s perceptions of situation.
- Coping abilities and previous ways of dealing with life problems.
PLANNING | Nursing Care Plan for Ineffective Coping
- Plan of care/interventions and who is involved in planning.
- Teaching plan.
IMPLEMENTATION/EVALUATION | Nursing Care Plan for Ineffective Coping
- 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 | Nursing Care Plan for Ineffective Coping
- Long-term needs and actions to be taken.
- Support systems available, specific referrals made, and who is responsible for actions to be taken.
This sample of Medical Surgical Nursing: Nursing Care Plan for Ineffective Coping.
