NURSING DIAGNOSIS: Ineffective individual coping

related to fear; anxiety; depression; decreased ability to communicate verbally; changes in motor and sensory function, thought processes, and future lifestyle and roles; and need for lengthy rehabilitation.

Desired Outcome
The client will demonstrate effective coping as evidenced by:
  1. communication of ability to cope with the effects of the CVA
  2. utilization of appropriate problem-solving techniques
  3. willingness to participate in treatment plan and meet basic needs
  4. appropriate use of defense mechanisms
  5. utilization of available support systems.
Nursing Actions and Selected Purposes/Rationales
  1. Assess for and report signs and symptoms of ineffective individual coping (e.g. communication of inability to cope or ask for help; inability to meet role expectations, problem solve, or meet basic needs; insomnia; withdrawal; reluctance to participate in treatment plan; inappropriate use of defense mechanisms). Validate perceptions carefully, remembering that some behaviors may be a result of neurological changes.
  2. Assess client's perception of current situation.
  3. Implement measures to promote effective coping:
    1. allow time for client to begin to adjust to the diagnosis and planned treatment, residual effects of the CVA, and anticipated lifestyle and role changes
    2. perform actions to facilitate communication (see Diagnosis 5, action b)
    3. perform actions to reduce fear and anxiety (e.g. if speech or comprehension is impaired, establish an effective communication system as soon as possible; avoid startling client who is experiencing homonymous hemianopsia by approaching on unaffected side within his/her visual field; simplify client's environment as much as possible)
    4. assist client to recognize and manage inappropriate denial if it is present
    5. assist client to identify personal strengths and resources that can be utilized to facilitate coping with the current situation
    6. perform actions to support realistic hope about the effects of treatment on the residual impairments:
      1. focus on what the client is able to accomplish independently and with the use of assistive devices
      2. reinforce knowledge that impairments may improve with time
      3. reinforce positive effects of speech, physical, and occupational therapies and control of underlying cause of the CVA (e.g. hypertension, diabetes)
    7. if acceptable to client, arrange for a visit with another individual who has successfully adjusted to the effects of a CVA
    8. instruct client in effective problem-solving techniques (e.g. accurate identification of stressors, determination of various options to solve problem)
    9. assist client to maintain usual daily routines whenever possible
    10. assist client to identify priorities and attainable goals as he/she starts to plan for necessary lifestyle and role changes
    11. assist client through methods such as role playing to prepare for negative reactions of others to his/her altered appearance and other neurological impairments
    12. if client is incontinent, instruct in ways to minimize the problem so that socialization with others is possible (e.g. placing disposable liners in underwear, wearing absorbent undergarments such as Depends)
    13. set up a home evaluation appointment with occupational and physical therapists so that changes in home environment (e.g. installation of ramps and handrails, widening doorways, altering kitchen facilities) can be completed by discharge
    14. assist client and significant others to identify ways that personal and family goals can be adjusted rather than abandoned
    15. inform client that he/she may have times when impairments worsen; assure client that this is usually temporary and the result of physical and/or emotional stress or fatigue rather than an indication of deteriorating neurological status
    16. administer antianxiety and/or antidepressant agents if ordered
    17. if appropriate, assist client to meet spiritual needs (e.g. arrange for a visit from clergy)
    18. assist client to identify and utilize available support systems; provide information regarding available community resources that can assist client and significant others in coping with effects of the CVA (e.g. stroke support groups, local chapter of the American Heart Association)
    19. encourage the client to share with significant others the kind of support that would be most beneficial (e.g. listening, inspiring hope, providing reassurance and accurate information)
    20. support behaviors indicative of effective coping (e.g. participation in treatment plan and self-care activities, communication of ability to cope, utilization of effective problem-solving strategies).
  4. Consult appropriate health care provider (e.g. psychiatric nurse clinician, physician) if client continues to have difficulty coping with the effects of the CVA.