Ineffective Coping


Ineffective Coping

Contents:

Ineffective coping is the inability to assess a stressful situation or event comprehensively and therefore fail to make sound decisions using inappropriate resources or none at all. Coping mechanisms break down due to stress and build pressure that eventually exceeds problem-solving skills. 

  • Sudden change in health status 
  • Change in socioeconomic status such as loss of job 
  • Insufficient preparation 
  • False confidence/lack of confidence
  • Loss of a spouse, family member, or friend 
  • Fear about the future 
  • Insufficient resources 
  • Deficient knowledge 
  • Inability to correctly gauge situations 

Common Signs and Symptoms…

  • Expresses that unable to cope with a new reality 
  • Unable to take care of daily life responsibilities 
  • Neglect in personal care 
  • Expresses fear about the future 
  • Insufficient skills to solve problems 
  • Tiredness
  • Decision fatigue 
  • Self-sabotage by using destructive coping mechanisms such as drugs and alcohol 

Expected Outcome

  • The patient will use effective coping mechanisms to deal with unexpected situations 
  • The patient will verbalize that he or she feels more confident about dealing with difficult future situations 
  • The patient will verbalize that newly learned strategies are helpful to manage current problems 

Assessment

Subjective data: patients might say…

“I feel overwhelmed by this new situation/ diagnosis.”
“I don’t know how to handle this new reality.” 
“Please, I need help” (verbalizes that unable to cope)
“I’m not able to keep up with daily chores or the kids”(unable to take care of responsibilities)
“I recently started smoking to calm my nerves”(self-destructive behavior and/or substance abuse)

Objective data: you might observe the following during your assessment…

The patient appears nervous and seems to be easily distracted during questioning about health history. (difficulty focusing)
The client’s heart rate is elevated by 20 points above the normal range. Blood pressure, oxygen saturation, and temperature are within normal limits.
The patient appears unkempt. (neglect in personal care)

Nursing Interventions for Ineffective Coping

Ask about previous difficult situations and how the patient handled it. 

These answers will give you information about how the patient has dealt with crises before. This will provide you with a baseline that you can use to start your plan. You can determine if the coping mechanisms that the patient used are still helpful in their current situation or if they need additional strategies. 

Get a detailed picture of how the patient perceives his or her situation. 

Hearing it from the patient shows how overwhelmed they feel and how their environment, upbringing, relationships, and stimuli affect their behavior and reaction to their situation. This information provides an excellent baseline for choosing the right treatment and strategies.

Use therapeutic communication such as active listening, maintaining eye contact, and encouraging the patient to verbalize feelings without showing judgment.

Showing understanding and empathy establishes trust between the patient and the healthcare team. The patient is more likely, to be honest about thoughts and feelings when in a trusted and comfortable environment. Cultural or religious influences might make a difference in the approach of communication. Always consider different cultural norms and courtesies. 

Assess if the patient is ready and willing to learn new coping skills.

The patient must acknowledge that current coping skills are inadequate. Once the patient understands that there is a need to change the approach to solve a problem, the patient will be open to receive advice about necessary changes and adjustments. 

Introduce one coping method at a time.

A slow but steady approach ensures that the patient can genuinely practice these new coping skills without feeling overwhelmed. 

Identify strengths and accomplishments with the patient.

This exercise provides an excellent foundation the patient can build on and also increases confidence and the feeling of self-worth. 

Provide an environment for the patient to express doubt and other negative emotions. 

This will allow the patient to relieve stress and anxiety as well as build trust. 

Establish short-term goals with the patient.

A step by step approach might be easier for the patient to retain. Focusing on small goals that are attainable in a short period keeps the patient motivated to improve daily. 

Assist the patient in judging the situation realistically. 

A neutral appraisal of a situation often offers a more realistic perspective. The situation might not be as difficult as the patient perceives it. A set of fresh eyes sometimes helps the patient recognize the reality of the situation and discover solutions to it. 
Praise and encourage the patient about progress.

Positive encouragement shows that the patient moves in the right direction and helps motivate the patient to continue with new coping strategies. 

Teach breathing exercises and relaxation exercises. 


Breathing exercises help with stress relief and grounding. Once the patient can clear his or her mind, problem-solving will be easier. 

If necessary, collaborate with social services or suggest a psychiatric consultation.

The patient might benefit from specialized treatment to further improve coping skills. Some conditions need to be treated medically in addition to 

Education and discharge planning

While the patient is hospitalized, provide the patient with resources that will be available after discharge. Make follow up appointments before discharge and provide the patient with the necessary paperwork. 

Pediatric considerations 

Keep in mind that children and adolescents might have different stressors, such as school or peer pressure. Some children might not be as forthcoming. Therefore, coping strategies might differ. 

Geriatric 

Seasoned clients might be limited in their physiological and mental abilities to use coping strategies. Adapt coping methods accordingly. 

Multicultural 

Be mindful of religious or cultural norms. Inquire about this information when taking the health history of the patient. This might give information about specific behaviors or preferences that you want to consider when establishing a care plan. 

Home care 

Assess the family’s readiness to help take care of the patient at home. The family or caregiver might be able to assist in the hospital setting but not ready to care for the patient at home. 

Evaluation: 

Determine if the goals were met or not met. 

More Care Plans:

Ineffective Health Maintenance [Care Plan]

Impaired Physical Mobility Nursing Diagnosis & Care Plan

Activity Intolerance Nursing Diagnosis & Care Plan

Impaired Gas Exchange Nursing Diagnosis & Care Plan

Fatigue Nursing Diagnosis & Care Plan

References:

Ackley, B., & Ladwig, G. (2014). Nursing diagnosis handbook (10th ed.). Maryland Heights: Mosby Elsevier.

Gulanick, M., & Myers, J. (2014). Nursing care plans (8th ed.). Elsevier.

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