Coping, Ineffective Individual
NANDA: Impairment of adaptive behaviors and problem-solving
abilities of a person in meeting life's demands and roles
For most persons, everyday life includes its share of stressors
and demands, ranging from family, work, and professional role responsibilities
to major life events such as divorce, illness, and the death of loved ones. How
one responds to such stressors depends on their coping resources. Such
resources can include optimistic beliefs, social support networks, personal
health and energy, problem-solving skills, and material resources.
Sociocultural and religious factors may influence how people view and handle
their problems. Some cultures may prefer privacy and avoid sharing their fears
in public, even to health care providers. As resources become limited and
problems become more acute, this strategy may prove ineffective. Vulnerable
populations such as the elderly, those in adverse socioeconomic situations,
those with complex medical problems such as substance abuse, or those who find
themselves suddenly physically challenged may not have the resources or skills
to cope with their acute or chronic stressors.
Such problems can occur in any setting--during hospitalization for
an acute event, in the home or rehabilitation environment as a result of
chronic illness, or in response to another threat or loss.
- Change in or loss of body part
- Diagnosis of serious illness
- Recent change in health status
- Unsatisfactory support system
- Inadequate psychological resources (poor self-esteem, lack of
- Personal vulnerability
- Inadequate coping method
- Situational crises
- Maturational crises
- Verbalization of inability to cope
- Inability to make decisions
- Inability to ask for help
- Destructive behavior toward self
- Inappropriate use of defense mechanisms
- Physical symptoms such as the following:
Overeating or lack
Overuse of tranquilizers
Excessive smoking and
- Irritable bowel
- Chronic depression
- Emotional tension
- High illness rate
- General irritability
- Patient identifies own maladaptive coping behaviors.
- Patient identifies available resources and support systems.
- Patient describes and initiates alternative coping strategies.
- Patient describes positive results from new behaviors.
- (i) independent
- (i) Assess for presence of defining
- Behavioral and physiological responses to stress can be
varied and provide clues to the level of coping difficulty.
- (i) Assess specific stressors.
- Accurate appraisal can facilitate development of
appropriate coping strategies. Because a patient has an altered health status
does not mean the coping difficulties he or she exhibits are only (if at all)
related to that.
- (i) Assess available or useful past and
present coping mechanisms.
- Successful adjustment is influenced by previous coping
success. Patients with history of maladaptive coping may need additional
resources. Likewise, previously successful coping skills may be inadequate in
the present situation.
- (i) Evaluate resources and support systems
available to patient.
- Patients may have support in one setting, such as during
hospitalization, yet be discharged home without sufficient support for
effective coping. Resources may include significant others, health care
providers such as home health nurses, community resources, spiritual
counseling, and the like.
- (i) Assess level of understanding and
readiness to learn needed lifestyle changes.
- Appropriate problem solving requires accurate information
and understanding of options. Often patients who are ineffectively coping are
unable to hear or assimilate needed information.
- (i) Assess decision-making and
- Patients may feel that the threat is greater than their
resources to handle it and feel a loss of control over solving the threat or
- (i) independent
- (i) Establish a working relationship with
patient through continuity of care.
- An ongoing relationship establishes trust, reduces the
feeling of isolation, and may facilitate coping.
- (i) Provide opportunities to express
concerns, fears, feelings, expectations.
- Verbalization of actual or perceived threats can help
- (i) Convey feelings of acceptance and
understanding. Avoid false reassurances.
- (i) Encourage patient to identify own
strengths and abilities.
- During crises, patients may not be able to recognize their
strengths. Fostering awareness can expedite use of these strengths.
- (i) Assist patient to evaluate situation
and own accomplishments accurately.
- (i) Explore attitudes and feelings about
required lifestyle changes.
- (i) Encourage patient to seek information
that increases coping skills.
- Patients who are not coping well may need more guidance
- (i) Provide information the patient wants
and needs. Do not provide more than patient can handle.
- Patients who are coping ineffectively have reduced ability
to assimilate information.
- (i) Encourage patient to set realistic
- To help gain control over the situation. Guiding the
patient to view the situation in smaller parts may make the problem more
- (i) Assist patient to problem solve in a
- (i) Discourage decision making when under
- (i) Reduce stimuli in environment that
could be misinterpreted as threatening.
- This is especially common in the acute hospital setting
where patients are exposed to new equipment and environments.
- (i) Provide outlets that foster feelings
of personal achievement and self-esteem.
- Opportunities to role play or rehearse appropriate actions
can increase confidence for behavior in actual situation.
- (i) Point out signs of positive progress
- Patients who are coping ineffectively may not be able to
- (i) Encourage patient to communicate
feelings with significant others.
- Unexpressed feelings can increase stress.
- (i) Point out maladaptive behaviors
- So patient can focus on more appropriate
- (c) Administer tranquilizer, sedative as
- To facilitate ability to cope.
- (i) Assist to grieve and work through the
losses of chronic illness and change in body function if appropriate.
Education/Continuity of Care
- (i) independent
- (i) Instruct in need for adequate rest and
- To facilitate coping strengths. Inadequate diet and fatigue
can themselves be stressors.
- (i) Teach use of relaxation, exercise, and
diversional activities as methods to cope with stress.
- (c) Involve social services, psychiatric
liaison, and pastoral care for additional and ongoing support resources.
- (i) Assist in development of alternative
support system. Encourage participation in self-help groups as available.
- Relationships with persons with common interests and goals
can be beneficial.
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