NURSING DIAGNOSIS: Ineffective individual coping or Impaired adjustment*

related to:
  1. depression, fear, anxiety, and ongoing grieving associated with the diagnosis of AIDS and poor prognosis;
  2. need for permanent change in lifestyle associated with impaired immune system functioning and potential for disease transmission to others;
  3. uncertainty of disease course and feelings of powerlessness over course of disease;
  4. need for disclosure of diagnosis with possibility of subsequent rejection and/or distancing by others and loss of employment and health benefits;
  5. guilt associated with past behavior (if it was a factor in contracting HIV) and/or possibility of having transmitted HIV to others;
  6. lack of personal resources to deal with disability and premature death associated with youth (a significant number of clients are in their twenties or thirties and are not developmentally prepared to acknowledge and cope with disability and their own mortality);
  7. multiple losses (e.g. death of close friends with AIDS; loss of normal body functioning, family support, financial security, and/or usual lifestyle and roles);
  8. chronic symptoms (e.g. pain, diarrhea, fatigue) if present.

*The nurse should select the diagnostic label that is most appropriate for the client.

Desired Outcome
The client will demonstrate adjustment to current health status and effective coping as evidenced by:
  1. verbalization of acceptance of having AIDS and ability to cope with the disease
  2. verbalization of a sense of control over health status
  3. utilization of appropriate problem-solving techniques
  4. willingness to participate in treatment plan and meet basic needs
  5. absence of destructive behavior toward self and others
  6. utilization of available support systems.
Nursing Actions and Selected Purposes/Rationales
  1. Assess for and report signs and symptoms of:
    1. ineffective individual coping (e.g. verbalization of inability to cope; inability to ask for help, problem solve, or meet basic needs; insomnia; withdrawal; reluctance to participate in treatment plan; destructive behavior toward self or others; inappropriate use of defense mechanisms)
    2. impaired adjustment (e.g. denial of health status change, verbalization of lack of control, reluctance to participate in treatment plan and take actions to prevent further health problems).
  2. Implement measures to promote effective coping and adjustment to change in health status:
    1. allow time for client to begin to adjust to the diagnosis and its implications, planned treatment, and anticipated changes in lifestyle and roles
    2. perform actions to facilitate the grieving process (e.g. assist client to acknowledge the changes/losses experienced, discuss the grieving process and reinforce that phases may overlap or recur, encourage expression of feelings)
    3. perform actions to reduce fear and anxiety (see Diagnosis 13, action b)
    4. perform actions to reduce pain, control diarrhea, and reduce fatigue (see Diagnoses 4, action e; 9, action d; and 8, action b)
    5. assist client to identify personal strengths and resources that can be utilized to facilitate adjustment to and coping with the current situation
    6. demonstrate acceptance of client but set limits on inappropriate behavior
    7. support realistic hope by providing information about advances in the prevention of disease progression (e.g. HAART) and prevention of opportunistic infections
    8. if acceptable to client, arrange for a visit from another individual who is successfully living with AIDS
    9. include client in planning care, encourage maximum participation in treatment plan, and allow choices when possible to enable him/her to maintain a sense of control
    10. assist client to maintain usual daily routines whenever possible
    11. assist client to identify priorities and attainable goals as he/she starts to plan for necessary lifestyle and role changes
    12. assist client and significant others to identify ways that personal and family goals can be adjusted rather than abandoned
    13. discuss ways to maintain optimal health; focus on methods of altering rather than changing lifestyle
    14. assist client through methods such as role playing to prepare for negative reactions from others because of diagnosis of AIDS
    15. administer antianxiety and/or antidepressant agents if ordered
    16. assist client to identify and utilize available support systems; provide information about resources and support groups that can assist client and significant others in adjusting to and coping with effects of AIDS (e.g. American Foundation for AIDS Research, National AIDS Clearinghouse, National Association of People with AIDS, CDC National AIDS Hotline, Project Inform, hospice programs, drug abuse programs)
    17. when appropriate, assist client to meet spiritual needs (e.g. arrange for a visit from clergy)
    18. encourage continued emotional support from significant others
    19. encourage 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 and adjustment (e.g. participation in treatment plan, verbalization of the ability to cope with diagnosis of AIDS, utilization of effective problem-solving strategies).
  3. Consult appropriate health care provider (e.g. psychiatric nurse clinician, physician) if client continues to have difficulty adjusting to and coping with the diagnosis and current situation.