Ineffective Coping

Ineffective Coping 5 Nursing Care Plans Diagnosis and Interventions

Ineffective Coping NCLEX Review Care Plans

5 Nursing Care Plans on Ineffective Coping

Ineffective coping can be defined as the inability to make sound decisions due to the failure of assessing a stressful life event. The person may verbalize being unable to ask for help, find proper resources, and/or utilize problem-solving skills to manage the situation at hand.

The person may also find it hard to meet basic needs such as proper food and shelter, or role expectations such as being a parent. Ineffective coping may also manifest as showing violence to self or others, as well as having recurrent medical conditions, accidents, and hospitalizations.

Factors Related to Ineffective Coping

  • Sudden life changes such as physical or mental illness, job loss, or loss of a significant other
  • Insufficient resources
  • Lack of confidence or low self-esteem
  • Deficient knowledge
  • Inability to correctly gauge situations

Signs and Symptoms of Ineffective Coping

  • Verbalization of inability to cope with a new or changing situation or event
  • Self-neglect as evidenced by poor personal care and hygiene
  • Expression of fear about the future
  • Fatigue
  • Restlessness
  • Self-sabotage or destructive coping such as the use of alcohol or illicit drugs
  • Inability to perform daily life roles and responsibilities
  • Emotional outbursts, irritability, or mood swings

Coping Mechanisms

Coping mechanisms are strategies and techniques used to help an individual adjust to a stressful event or situation. There are two types of coping mechanisms:

  1. Adaptive Coping Mechanisms – constructive; generally considered to be “healthy” and effective coping mechanisms. Examples include:
  • Problem-solving
  • Support
  • Relaxation
  • Physical activity
  • Humor

2. Maladaptive Coping Mechanisms – counterproductive; usually regarded as negative coping mechanisms used in a person’s attempt to reduce the consequences of the situation but often ineffective; instead, these can maintain or even strengthen the stressor. Examples include:

  • Escape or avoidance
  • Unhealthy-soothing
  • Risk-taking and compulsion
  • Self-harm
  • Numbing

Coping mechanisms are commonly mistaken as defense mechanisms, and vice versa.  Coping strategies are usually used consciously and purposefully, while defense mechanisms generally happen on an unconscious level.

For example, problem-solving is a coping mechanism that involves identifying the stress-causing problem and actively planning to resolve it, while denial is a defense mechanism that includes unconsciously blocking external events from entering one’s awareness.

Nursing Care Plans for Ineffective Coping

Nursing Care Plan 1

Eating Disorders (e.g., Anorexia, Bulimia)

Nursing Diagnosis: Ineffective Coping related to expression of morbid fear of weight gain or obesity, verbalization of being “too fat”, lack of self-confidence, low self-esteem, perceived loss of control in eating habits, self-neglect, and underweight status secondary to anorexia

Desired Outcome: The patient will show adaptive coping as evidenced by verbalization of increased sense of control and improving eating habits and weight status

InterventionRationale
Using open-ended questions, ask the patient to express his/her fear of weight or obesity and feelings about controlling his/her eating habits.To provide an atmosphere of acceptance and to establish rapport with the patient. It is important to use open-ended questions to allow the patient enough time to speak, rather than asking questions that are only answerable by “Yes” or “No.”
Re-assure the patient that his/her statements will be held in utmost confidentiality and privacy and will only be shared to named members of his/her healthcare team.To re-assure that patient regarding his/her privacy and confidentiality, encouraging him/her to be open and honest about the situation.
Encourage the patient to participate in a personal development program, which includes joining a group of individuals with similar issues. Allow the patient to make choices and promote active participation on creating the personal development plan.A personal development program can help the patient learn different methods to improve his/her perception of self and body image, as well as to have feedback from others in a group setting which can promote feelings of self-worth and confidence. Encouraging decision making and active participation promotes feeling of control and improves self-esteem.
As weight gain happens, suggest to dispose “thin” clothes.To remove visual reminders of self-neglect, underweight status, and loss of control.
Teach the patient on how to keep a daily food diary.To monitor the patient’s eating habits, and to encourage the patient to adhere strictly to the nutritional regimen set by the dietitian.  

Nursing Care Plan 2

Breast Cancer – Mastectomy

Nursing Diagnosis: Ineffective Coping related to expression of fear of life after surgery, verbalization of inability to cope and meet role expectations as a wife and mother, lack of self-confidence, low self-esteem, substance abuse secondary to upcoming mastectomy for breast cancer

Desired Outcome: The patient will show adaptive coping as evidenced by verbalization of increased sense of control, cessation of substance abuse, and report of decrease in negative thoughts and feelings towards the procedure

InterventionRationale
Using open-ended questions, ask the patient to express her fear of life after surgery, and how she thinks the surgery will affect her roles and self-confidence.To provide an atmosphere of acceptance and to establish rapport with the patient. It is important to use open-ended questions to allow the patient enough time to speak, rather than asking questions that are only answerable by “Yes” or “No.”
Re-assure the patient that his/her statements will be held in utmost confidentiality and privacy and will only be shared to named members of her healthcare team.To re-assure that patient regarding his/her privacy and confidentiality, encouraging him/her to be open and honest about the situation.
Allow the patient to make choices and promote active participation on creating the personal development plan.Encouraging decision making and active participation promotes feeling of control and improves self-esteem.
Involve the family and friends in the patient’s care and planning.To help the patient in establishing a stronger support system.
Refer the patient to a breast cancer support group and the mental health team after explaining the benefits of these referrals and gaining her consent.A referral to the mental health team can help the patient learn different methods to improve her perception of self and body image. The patient will have more opportunity to speak up about herself and receive feedback from others in a group setting which can promote feelings of self-worth and confidence.

Nursing Care Plan 3

Substance Abuse

Nursing Diagnosis: Ineffective Coping related to personal vulnerability, lack of support system, and fear of the future due to loss of a significant other secondary to substance abuse

Desired Outcome: The patient will show adaptive coping as evidenced by verbalization of increased sense of control and gradually reducing the use of illicit drugs and/or alcohol.

InterventionRationale
Using open-ended questions, ask the patient to express his/her fear of the future due to los of a significant other, and feelings about controlling his/her self in terms of substance abuse.To provide an atmosphere of acceptance and to establish rapport with the patient. It is important to use open-ended questions to allow the patient enough time to speak, rather than asking questions that are only answerable by “Yes” or “No.”
Re-assure the patient that his/her statements will be held in utmost confidentiality and privacy and will only be shared to named members of his/her healthcare team.To re-assure that patient regarding his/her privacy and confidentiality, encouraging him/her to be open and honest about the situation.
Discuss with the patient the Five Stages of Grief, relating to the loss of his/her significant other.Talking about the Five Stages of Grief by Kubler-Ross provides not only information but re-assurance to the patient that he/she is not expected to accept the loss of his/her significant other immediately, and that there are many steps before acceptance occurs. This creates an opportunity to discuss adaptive coping mechanisms instead of continuing with a maladpative coping mechanism which is avoidance through the use of illicit drugs and/or alcohol.
Encourage the patient to participate in a personal development program, which includes joining a group of individuals with similar issues. Allow the patient to make choices and promote active participation on creating the personal development plan.A personal development program can help the patient learn different methods to improve his/her perception of self and body image, as well as to have feedback from others in a group setting which can promote feelings of self-worth. Encouraging decision making and active participation promotes feeling of control and improves self-image.
Refer the patient to a substance abuse support group (e.g., AA for alcohol abuse), and the mental health team after explaining the benefits of these referrals and gaining his/her consent.A referral to the mental health team can help the patient learn different methods to improve his/her perception of self and body image. The patient will have more opportunity to speak up about herself and receive feedback from others in a group setting which can promote feelings of self-worth and confidence.
Involve the family and friends in the patient’s care and planning.To help the patient in establishing a stronger support system.

Nursing Care Plan 4

Panic Disorder

Nursing Diagnosis: Ineffective coping related to maturational crisis as evidenced by obsessive thoughts, ritualistic behavior, inability to meet basic needs and role expectations

Desired Outcome: The patient will demonstrate effective coping through the situational crisis.

InterventionRationale
Assess the anxiety level of the patient, anxiety triggers and symptoms by asking open-ended questions.To establish a baseline observation of the anxiety level of the patient. Open-ended questions can help explore the thoughts and feelings of the patient regarding the situational crisis.
In the beginning of treatment / therapy, allow the patient to continue ritualistic behavior without any judgment or verbalization of disapproval.The client may become more relaxed and open for discussion if he/she is allowed to precipitate the heightened anxiety by performing ritualistic behaviors.
Initially, support the patient by meeting dependency needs if deemed necessary.The patient can become more anxious if the avenues for dependency are suddenly and/or complete eliminated.
Encourage the patient to be independent and provide positive reinforcement for being able to do self-care and other independent behaviors.To enhance the patient’s self-esteem and encourage him/her to repeat desired behaviors.  
Discuss with the patient and significant other/s the available treatments for anxiety.Panic disorder is treatable. Psychotherapy involves speaking with a licensed therapist and going through how to gradually cope with the symptoms. Medications such as anxiolytics and antidepressants can help the patient cope with anxiety.  
Support the patient’s efforts to verbalize and explore the meaning behind each ritualistic behavior or obsessive thought.The patient should first recognize and accept the presence of obsessive thoughts and ritualistic behavior before change can happen.
Provide a supportive approach when gradually limiting the time given for ritualistic behavior.To encourage the patient to replace his/her ritualistic behaviors with adaptive behaviors.
Teach the patient to perform relaxation techniques such as deep breathing exercises, guided imagery, meditation, and progressive muscle relaxation.To promote relaxation and reduce stress levels.

Nursing Care Plan 5

Alzheimer’s Disease

Nursing Diagnosis: Ineffective Coping (Compromised Family Coping) related to progression of cognitive and physiological impairment and progressive dependence of the patient to the caregiver and/or family secondary to Alzheimer’s disease as evidenced by problems with coordination and motor functions, difficulty handling complex tasks, confusion and disorientation, inability to do activities of daily living (ADLs) as normal, feeling of being a “burden” to the family, withdrawal or self-isolation of the patient, carer’s expression of fatigue and emotional stress, and verbalization of inability to cope by the caregiver and/or family

Desired Outcomes:

  • The family members will obtain increased coping ability by effectively caring for the patient with Alzheimer’s disease and reporting decreased feelings of fatigue and emotional stress.
  • The patient will be able to ask for help with ADLs and avoid feelings of withdrawal or self-isolation.
InterventionRationale
Assess the patient’s level of confusion.To monitor effectiveness of treatment and therapy.
Allow ample time for both the patient and family members to speak about their concerns and emotional stress.To provide an atmosphere of acceptance and to establish rapport with the patient and caregivers/ family members.
Involve the family in the patient’s care and planning.To help the patient in establishing a stronger support system.
Encourage the family members to assist the patient in performing activities of daily living by following an agreed ADL schedule.To maintain a good quality of life and promote dignity by allowing the patient to perform their ADLs while maintaining safety. Creating an ADL schedule means allotting enough time for each task to be done, which can significantly reduce stress levels for the caregivers/ family members.
Encourage the patient to perform some ADLs on his/her own as much as he/she can (e.g., eating, combing hair, etc.). Simplify tasks for the patients by using simple words and instructions. Label the drawers with simple words and big letters, and use written notes when necessary.Alzheimer’s disease patients may have difficulty handling complex tasks; techniques to simplify tasks can promote autonomy and dignity, preserve self-confidence, and eradicate the feeling of being a burden to the caregivers/ family members.  
Provide opportunities for the patient to have meaningful social interaction, but never force any interaction.To prevent feelings of isolation. However, forced interaction can make the patient agitated or hostile due to confusion.
Allow the patient to wander and hoard within acceptable limits and while maintaining patient safety.To prevent agitation and increase the sense of security while allowing the patient to perform activities that are difficult to stop for him/her.    

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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