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, family needs, and more 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 how to successfully manage their stress.
Causes of Ineffective Coping (Related to)
- 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)
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 while also maintaining boundaries
- Use of drugs, alcohol, or medication as coping mechanisms
- Multiple, acute illnesses or chronic pain
- Depression
Expected Outcomes
- 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 for Ineffective Coping
1. Assess for individual stressors.
Evaluate the feelings the patient may be having in regards 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.
Through conversation, assess hobbies, support systems, or beliefs that assist the patient in coping with everyday stress such as exercise, crafting, religion, music, etc.
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 for 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, diseases 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 themselves 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 or if they are displaying any signs of suicidal ideation or self-harm need an immediate psych referral.
6. Arrange for the support of other professionals.
If a patient is highly 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.
References and Sources
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
- Exercising to relax. (2020, July 7). Harvard Health Publishing. https://www.health.harvard.edu/staying-healthy/exercising-to-relax
- Good Therapy. (2018, September 26). Coping Mechanisms. Good Therapy. https://www.goodtherapy.org/blog/psychpedia/coping-mechanisms
- Rivier University. (2017, March 29). 17 Therapeutic Communication Techniques. Rivier University. https://www.rivier.edu/academics/blog-posts/17-therapeutic-communication-techniques/
- Shaw, W., Labott-Smith, S., & Burg, M. M. (2018, November 1). Stress effects on the body. American Psychological Association. https://www.apa.org/topics/stress/body
