Ineffective coping is the inability to manage, respond to, or make decisions surrounding a stressful situation. Stressors and everyday demands such as work schedules, school deadlines, and family needs can compound on top of more serious stressors, such as divorce or the loss of a loved one.
Patients dealing with chronic, life-altering, or even terminal illnesses are under additional stress and are at risk for ineffective coping. This can arise from a poor understanding of their condition, a lack of financial or social support, or insufficient skills in handling stress. Nurses can provide an unbiased and nonjudgmental perspective to help patients identify the causes of their ineffective coping and can give suggestions about how to successfully manage their stress.
Attention: This nursing diagnosis has been renamed.
Nursing diagnoses are revised, added, or retired by the NANDA International Diagnosis Development Committee (DDC) to coincide with shifts in language standardization. “Ineffective Coping” has been renamed to “Maladaptive Coping”. Students and seasoned nurses alike may be unfamiliar with this change, and thus NurseTogether has chosen to continue to use the diagnostic label “Ineffective Coping” in this article until the recent relabeling receives wider adoption.
In this article:
- Causes (Related to)
- Signs and Symptoms (As evidenced by)
- Expected Outcomes
- Nursing Assessment
- Nursing Interventions
- Nursing Care Plans
- References
Causes (Related to)
The following are common causes of ineffective coping:
- Uncertainty or fear of the future
- Inadequate resources
- Sudden change or threat to health
- Inadequate opportunity to prepare for stressor
- Change in socioeconomic status (job loss, financial situation)
- Lack of confidence in the ability to cope
- Lack of support systems (family, spouse, friends)
- Outside compounding stressors (relationships, deadlines, schedules)
- Lack of sufficient coping behaviors
Signs and Symptoms (As evidenced by)
The following are common signs and symptoms of ineffective coping. They are categorized into subjective and objective data based on patient reports and assessment by the nurse.
Subjective: (Patient reports)
- Verbalizes an inability to cope and handle stressors
- Complaints of secondary concerns from lack of coping (sleep disturbances, fatigue, lack of appetite)
Objective: (Nurse assesses)
- Not caring for basic needs (poor grooming and hygiene, not eating nutritionally adequate meals)
- Insufficient skills to meet goals, problem-solve or reach resolutions
- Behaviors that impede progress (defensive speech, making excuses, manipulation)
- Inability to handle life responsibilities and activities of daily living
- Use of drugs, alcohol, or medication as coping mechanisms
- Multiple acute illnesses or chronic pain
- Depression
Expected Outcomes
The following are common nursing care planning goals and expected outcomes for ineffective coping:
- Patient will identify their disruptive behaviors and how they prevent them from coping effectively.
- Patient will verbalize appropriate coping strategies and resources to prevent ineffective coping.
- Patient will express confidence in handling their stressors and when to ask for help.
Nursing Assessment
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In the following section, we will cover subjective and objective data related to ineffective coping.
1. Assess for individual stressors.
Evaluate the feelings the patient may be having in regard to their new diagnosis, fear about a medication or procedure, feeling overwhelmed with childcare or returning to work, recent losses, or changes to their relationships.
2. Observe for nonverbal signs of stress.
Patients may not be forthcoming with their stressors. Patients may become distant, irritable, fidgety, or easily distracted.
3. Assess for destructive coping mechanisms.
Patients may turn to drugs, alcohol, sedating medications, or smoking to cope.
4. Assess how the patient copes with everyday stressors.
Ask the patient if they have any hobbies, support systems, or beliefs that assist the patient in coping with everyday stress. Common activities that can assist with stress reduction include exercise, crafting, religion, music or time with loved ones.
5. Assess the patient’s support system and available resources.
Facing difficult situations alone can make them appear daunting. Assess the patient’s living situation, family members, caregivers, and community resources.
6. Evaluate the patient’s perception of the situation.
The patient may not have a realistic understanding of the stress-inducing situation. They may be experiencing an overly dramatic response or may not fully grasp the magnitude of their condition. It is important for the nurse to provide factual information and guide the patient in coping.
Nursing Interventions
Nursing interventions and care are essential for the patients recovery. In the following section, you will learn more about possible nursing interventions for a patient with ineffective coping.
1. Use therapeutic communication.
Using techniques such as active listening, reflecting, open-ended questions, and even silence. Nurses can foster trusting relationships with patients and further explore barriers to their ability to cope.
2. Explain procedures, disease processes, and next steps.
Offering the patient thorough information regarding signs and symptoms of their illness, what to expect with a test or surgery, and expected outcomes allows them to feel more in control of their care without the unnecessary stress of the unknown.
3. Provide stress-relieving and relaxation techniques.
After assessing which activities the patient uses to control stress, the nurse can offer available options such as books, music, distraction, and guided imagery.
4. Offer positive responses without false reassurances.
The nurse has a duty to educate honestly and discuss the seriousness of situations when called for. The nurse can also calm fears and prevent added stress by commenting on progress, such as improved vital signs, activity levels, or lab work.
5. Refer to counseling or support groups.
For patients with specific stressors such as a cancer diagnosis, community support groups can offer empathy. For assistance with learning to manage stress, counselors and therapists can discuss coping strategies. Patients with ineffective coping due to depression that are displaying any signs of suicidal ideation or self-harm need an immediate psychiatry referral.
6. Arrange for the support of other professionals.
If a patient is religious, it may be helpful to arrange for a visit from a religious leader of their faith. Other supportive therapies, such as pet therapy or music therapy may also be helpful.
7. Ask the patient how they dealt with difficulties in the past.
Patients may need to be reminded of stressful hurdles they handled in the past and how they can apply the same problem-solving and decision-making in current scenarios.
8. Encourage participation.
Offering the patient choices and including them in their treatment decisions empowers them to take control and play an active role in their care.
9. Help the patient identify possible behaviors delaying coping.
The patient may unconsciously display negative behaviors that prevent them from effectively coping such as deflecting or setting poor boundaries. The nurse can offer an outside perspective to assist the patient in recognizing barriers and changing behaviors.
10. Encourage rest as well as exercise.
Stress has a physiologic effect on the body causing increased blood pressure, heart rate, and blood sugar, and can worsen health conditions. Patients should be instructed to rest and try relaxing activities such as meditating. On the other hand, exercise is also stress-relieving by decreasing cortisol and increasing endorphins. Therefore, if appropriate, the nurse should encourage the patient to exercise.
Nursing Care Plans
Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for ineffective coping.
Care Plan #1
Diagnostic statement:
Ineffective coping related to work overload as evidenced by high illness rate and fatigue.
Expected outcomes:
- Patient will demonstrate effective strategies to overcome work overload.
- Patient will experiences lessened fatigue.
Assessment:
1. Assess for specific stressors at work.
Identifying the specific stressors at work will help develop the appropriate coping strategies.
2. Assess effective and ineffective coping mechanisms used.
Successful adaptations are influenced by previous coping mechanisms that work to help the patient cope with the stress. Examples of positive coping mechanisms promote rest and overall well-being. Previous maladaptive coping approaches may require modifications or new resources to support coping with the stress.
3. Determine the patient’s feelings and perceptions toward work.
Patients may feel that the stressor is too overwhelming to handle and feel powerless to overcome the problem.
Interventions:
1. Encourage verbalization of fears, anxieties, feelings of denial, depression, anger, and all other negative emotions.
Allowing the patient to open up provides a safe environment where their feelings are valid.
2. Assist the patient in performing diversion or relaxation techniques.
Learning new skills helps to divert anxiety and reduce stress brought by workload.
3. Teach the use of new coping behaviors and problem-solving techniques:
- Set some goals
- Learn about all aspects of a problem
- Take regular breaks
- Make some boundaries
- Split tasks into smaller subtasks
- Schedule tasks within realistic deadlines
Learning new coping techniques on top of what the patient was used to may be needed to address the problem. Old coping mechanisms may necessitate modifications to work.
4. Instruct the patient about the need for adequate rest and a balanced diet.
An unhealthy diet and lack of sleep and rest can weaken the immune system and increase disease vulnerability. Fatigue and poor nutrition can limit effective coping.
Care Plan #2
Diagnostic statement:
Ineffective coping related to the altered affect caused by changes secondary to a brain tumor, as evidenced by decreased use of social support and destructive behavior.
Expected outcomes:
- Patient will identify ineffective coping behaviors and consequences.
- Patient will engage in social activity.
- Patient will demonstrate adaptive behaviors to cope with the disease condition.
Assessment:
1. Assess the level of anxiety and coping of the patient.
Anxiety contributes to ineffective coping of the patient. The more anxious the patient is, the less likely they will be able to successfully overcome the problem.
2. Determine the patient’s understanding of the current condition and its impact on life.
The lack of knowledge or understanding of the condition would trigger anxiety and lead to poor health-seeking behavior and health outcomes.
3. Assess available resources or support systems.
The patient’s altered behavior and psychological health are due to the progression of the brain tumor. Additional community resources (e.g., social services, psychiatric help) may be necessary for a holistic approach to address ineffective coping behaviors).
Interventions:
1. Provide updated or additional information about the brain tumor, its therapeutic regimen, and the potential course of illness.
Knowledge about the potential course of illness will provide a better understanding of the patient’s situation. The information will help reduce anxiety and fear and allow the patient and family to deal with potentially challenging behavior.
2. Assist the patient in setting boundaries on acting-out behavior and demonstrate ways to express emotions acceptably.
This strategy will provide an internal locus of control.
3. Use strategies such as redirection, stress reduction and routines.
While it may not be possible to completely alter the patient’s behavior, creating a calming and predictable environment may lessen emotional outbursts.
4. Refer to a psychiatrist or social services for additional and ongoing support resources.
Complex interventions in collaboration with other experts may be needed to address possible mental health alterations and challenging behavior.
5. Encourage caretakers to engage in respite care
Caring for a person with a brain tumor is often physically and emotionally exhausting. Encourage care takers to take care of themselves as well.
Care Plan #3
Diagnostic statement:
Ineffective coping is related to disturbed relationships with parents, as evidenced by risk-taking and poor concentration.
Expected outcomes:
- Patient will use effective coping strategies.
- Patient will report an increase in psychological comfort.
Assessment:
1. Assess for factors contributing to disturbed relationships with parents.
Poor self-concept, grief, lack of problem-solving skills, absence of social support, recent change in life, and maturational or situational crises may lead to disturbed child-parent relationships. During the adolescence stage, teenagers typically tend to seek independence from their parents. Poor communication, changes in the family, sibling rivalry, discipline issues, or differences in opinions may cause child-parent disputes.
2. Assess adolescents for exposure to community violence.
Community violence has adverse psychological effects on adolescents.
3. Identify which family member or friend the patient can count on for support.
Having a particular person the patient can trust would encourage verbalizing feelings.
4. Assess knowledge of risk taking behaviors.
Ensure that the patient knows the risks of their behaviors and ensure that they understand what safety measure they should be following.
Interventions:
1. Support adolescent and children’s coping styles.
Each patient has their coping style. Their positive coping strategies may include seeking pleasure, engaging in fun/entertaining activities, and seeking emotional support. It is essential to support children’s individual coping strategies with information, guidance, and participation in decisions.
2. Encourage social support, religion-based coping, and moderate aerobic exercise as appropriate.
Exercise decreases the likelihood of depressive feelings when used as a positive coping strategy for school-aged children with angry feelings.
3. Use verbal and nonverbal therapeutic communication approaches.
These may include empathy, active listening, and confrontation to encourage the patient and family to express emotions such as sadness, guilt, and anger (within appropriate limits), verbalize fears and concerns, and set goals. Active, empathic listening and values-clarifying communication techniques are strategies used to support coping strategies.
4. Offer instruction regarding alternative coping strategies.
Cognitive behavioral therapy and mindfulness meditation may facilitate coping for both children and parents.
5. Encourage the use of social support resources.
Patients with social support use more facilitated coping and have lesser anxiety.
References
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- Rivier University. (2017, March 29). 17 Therapeutic Communication Techniques. Rivier University. https://www.rivier.edu/academics/blog-posts/17-therapeutic-communication-techniques/
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