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Ineffective Coping Nursing Care Plan

BY GIL WAYNE, BSN, R.N. UPDATED ON SEPTEMBER 24, 2017
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Most people often feel uncomfortable when they feel like the demands or pressures on
them are more than what they can cope with. This includes its share of stressors and
demands, ranging from family, work, and professional role responsibilities to major life
events such as divorce, illness, and the death of loved ones. Everybody feels stressed at
times. However, the way one responds to such stressors depends in part on the person’s
coping resources.

Considering healthy ways to cope and getting the appropriate care and support can put
problems in perspective and help stressful feelings and symptoms subside. Nurses,
together with the patients, need to recognize stress accordingly to come up with the most
effective yet proper strategies that work best for every patient.

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Nursing Assessment
Assessment is required in order to distinguish possible problems that may have lead to
the patient’s ineffective coping as well as name any episode that may happen during
nursing care.

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Open
discoverflow.co Assessment Rationales

Behavioral and physiological responses to

Assess for the presence of defining
stress can be varied and provide clues to
characteristics.
the level of coping difficulty.

Assess for the influence of cultural beliefs, The patient’s coping behavior may be
norms, and values on the patient’s based on cultural perceptions of normal
perceptions of effective coping. and abnormal coping behavior.

Observe for causes of ineffective coping Situational factors must be identified to

such as poor self-concept, grief, lack of gain an understanding of the patient’s
problem-solving skills, lack of support, or current situation and to aid patient with
recent change in life situation. coping effectively.

Assess for intergenerational family

Intergenerational family problems put
problems that can overwhelm coping
families at risk of dysfunction.
abilities.
 Assessment
Identify specific stressors.
Observe for strengths such as the ability
to relate the facts and to acknowledge the
source of stressors.
Determine the patient’s understanding of
the stressful situation.
Analyze past use of coping mechanisms
including decision-making and problem-
solving.
Monitor risk of harming self or others and
intervene appropriately.
Rationales Menu
Accurate appraisal can facilitate
development of appropriate coping
strategies. Because a patient has an
altered health status does not mean the
coping difficulties he or she exhibits are
only (if at all) related to that. Persistent
stressors may exhaust the patient’s ability
to maintain effective coping.
Family members who are coping with
critical injuries often feel defeated,
hopeless, and like a failure; therefore it is
necessary to verbally praise them for their
strengths and use those strengths to aid
functioning.
Patients may believe that the threat is
greater than their resources to handle it
and feel a loss of control over solving the
threat or problem. The patient’s cultural
heritage and previous experiences may
affect the patient’s understanding of and
response to the present situation. This
information provides a foundation for
planning care and choosing relevant
interventions.
Successful adjustment is influenced by
previous coping success. patients with a
history of maladaptive coping may need
additional resources. Likewise, previously
successful coping skills may be
inadequate in the present situation.
A patient with hopelessness and an
inability to problem solve often runs the
risk of suicide.
 Assessment Rationales Menu

Patients may have support in a single

Evaluate resources and support systems
setting, such as during hospitalization, yet
available to the patient.
lack sufficient support in the home setting.

Identify an emergency plan should the

Assess for suicidal tendencies. Refer for
patient become suicidal. A suicidal patient
mental health care immediately if
is not safe in the home environment
indicated.
unless supported by professional help.

Nursing Interventions
The following are the therapeutic nursing interventions for patients with ineffective
coping:

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Interventions Rationales

 An ongoing relationship establishes trust,

Set a working relationship with the patient
reduces the feeling of isolation, and may
through continuity of care.
facilitate coping.
 Interventions Rationales Menu

Assist patient set realistic goals and Involving patients in decision making
identify personal skills and knowledge. helps them move toward independence.

Verbalization of actual or perceived

Provide chances to express concerns,
threats can help reduce anxiety and open
fears, feeling, and expectations.
doors for ongoing communication.

Acknowledging and empathizing creates a

Use empathetic communication. supportive environment that enhances
coping.

An honest relationship facilitates problem-

solving and successful coping. False
Convey feelings of acceptance and
reassurances are never helpful to the
understanding. Avoid false reassurances.
patient and only may serve to relieve the
discomfort of the care provider.

Encourage patient to make choices and

Participation gives a feeling of control and
participate in planning of care and
increases self-esteem.
scheduled activities.

During crises, patients may not be able to

Encourage the patient to recognize his or recognize their strengths. Fostering
her own strengths and abilities. awareness can expedite use of these
strengths.

Consider mental and physical activities

Interventions that improve body
within the patient’s ability (e.g., reading,
awareness such as exercise, proper
television, outings, movies, radio, crafts,
nutrition, and muscular relaxation may be
exercise, sports, games, dinners out, and
helpful for treating anxiety and depression.
social gatherings).

It can be helpful for the patient to

recognize that he or she has the skills and
Assist patients with accurately evaluating
reserves of strength to effectively manage
the situation and their own
the situation. The patient may need help
accomplishments.
coming to a realistic perspective of the
situation.
 Interventions
If the patient is physically capable,
encourage moderate aerobic exercise.
Provide information the patient wants and
needs. Do not give more than the patient
can handle.
Provide touch therapy with permission.
Give patient a back massage using slow,
rhythmic stroking with hands. Use a rate
of 60 strokes a minute for 3 minutes on 2-
inch wide areas on both sides of the
spinous process from the crown to the
sacral area.
Assist the patient with problem-solving in
a constructive manner.
Provide information and explanation
regarding care before care is given.
Eliminate stimuli in an environment that
could be misinterpreted as threatening.
Discuss changes with patient before
making them.
Provide outlets that foster feelings of
personal achievement and self-esteem.
Rationales Menu
Aerobic exercise improves one’s ability to
cope with acute stress.
Patients who are coping ineffectively have
reduced ability to absorb information and
may need more guidance initially.
A soothing touch can reveal acceptance
and empathy. Slow stroke back massage
decreased heart rate, decreased systolic
and diastolic blood pressure, and
increased skin temperature at significant
levels. The conclusion is that relaxation is
induced by slow stroke back massage.
Constructive problem solving can promote
independence and sense of autonomy.
In traumatic situations, families have a
need for information and explanations.
Providing information prepares the patient
and family for understanding the situation
and possible outcomes.
The presence of noise associated with
medical equipment can increase anxiety
and make coping more challenging.
Communication with the medical staff
provides patients and families with
understanding of the medical condition.
Opportunities to role-play or rehearse
appropriate actions can increase
confidence for behavior in actual
situations.
 Interventions Rationales Menu

Patients who are coping ineffectively may

Point out signs of positive progress or
not be able to assess their progress
change.
toward effective coping.

Relaxation techniques, desensitization,

Encourage use of cognitive behavioral
and guided imagery can help patients
relaxation (e.g., music therapy, guided
cope, increase their sense of control, and
imagery).
allay anxiety.

A supportive presence creates a

Be supportive of coping behaviors; give
supportive environment to enhance
patient time to relax.
coping.

Discuss with patient about his or her Describing previous experiences

previous stressors and the coping strengthens effective coping and helps
mechanisms used. eliminate ineffective coping mechanisms.

Use distraction techniques during Distraction is used to direct attention

procedures that cause patient to be toward a pleasurable experience and block
fearful. the attention of the feared procedure.

Apply systematic desensitization when

introducing new people, places, or Fear of new things diminishes with
procedures that may cause fear and repeated exposure.
altered coping.

Arranging for referral assists the patient in

working with the system, and resource use
Refer for counseling as necessary.
helps to develop problem-solving and
coping skills.

Refer to medical social services for This will promote adequate coping as part
evaluation and counseling. of the medical plan of care.
 Interventions Rationales Menu

Based on knowledge of the home and

family, home care nurses can often
If the patient is associated with the mental
advocate for patients. These nurses are
health system, actively engage in mental
often requested to monitor medications
health team planning.
and therefore need to know the plan of
care.

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Suicide Rates of Female Health Professionals Among the Highest

Gil Wayne, BSN, R.N.

Gil Wayne graduated in 2008 with a bachelor of science in nursing. He earned his license to practice as a
registered nurse during the same year. His drive for educating people stemmed from working as a community
health nurse. He conducted first aid training and health seminars and workshops for teachers, community
members, and local groups. Wanting to reach a bigger audience in teaching, he is now a writer and contributor
for Nurseslabs since 2012 while working part-time as a nurse instructor. His goal is to expand his horizon in
nursing-related topics. He wants to guide the next generation of nurses to achieve their goals and empower the
nursing profession.
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