INEFFECTIVE COPING Nursing Care Plan

Ineffective Coping

NANDA-I Definition
Inability to form a valid appraisal of the stressors, inadequate choices
of practiced responses, and/or inability to use available resources
Defining Characteristics
Verbalization of inability to
cope or ask for help*
Inappropriate use of defense
mechanisms
Inability to meet role
expectations*
Chronic worry, anxiety
Sleep disturbance*
Fatigue*
High illness rate*
Reported difficulty with life
stressors
Poor concentration*
Difficulty organizing
information*
Decreased use of social
support*
Inadequate problem-solving*
Impaired social participation
Use of forms of coping that
impede adaptive behavior*
Risk taking*
Lack of goal-directed behavior*
Destructive behavior toward
self or others*
Change in usual communication
patterns*
High incidence of accidents
Substance abuse*
Related Factors
Pathophysiologic
Related to chronicity of condition
Related to biochemical changes in brain secondary to:
Bipolar disorder Personality disorder
Chemical dependency Attention-deficient disorders
Schizophrenia
Related to complex self-care regimens
Related to neurologic changes in brain secondary to:
Stroke Multiple sclerosis
Alzheimer’s disease End-stage diseases
Related to changes in body integrity secondary to:
Loss of body part Disfigurement secondary
to trauma
Related to altered affect caused by changes secondary to:
Body chemistry Intake of mood-altering
Tumor (brain) substance
Mental retardation

Treatment Related
Related to separation from family and home (e.g., hospitalization,
nursing home)
Related to disfigurement caused by surgery
Related to altered appearance from drugs, radiation, or other treatment
Situational (Personal, Environmental)
Related to poor impulse control and frustration tolerance
Related to disturbed relationship with parent/caregiver
Related to disorganized family system
Related to ineffective problem-solving skills
Related to increased food consumption in response to stressors
Related to changes in physical environment secondary to:
War Poverty Natural disaster
Homelessness Relocation Inadequate finances
Seasonal work
Related to disruption of emotional bonds secondary to:
Death Institutionalization Relocation
Desertion Separation or divorce Orphanage/foster care
Jail Educational institution
Related to unsatisfactory support system
Related to sensory overload secondary to:
Factory environment Urbanization: crowding, noise
pollution, excessive activity
Related to inadequate psychological resources secondary to:
Poor self-esteem Helplessness
Excessive negative beliefs Lack of motivation
about self to respond
Negative role modeling
Related to culturally related conflicts with (specify):
Premarital sex Abortion
Maturational
Child/Adolescent
Related to:
Poor impulse control Repressed anxiety Peer rejection
Parental substance abuse Panic Parental rejection
Inconsistent methods Childhood trauma Fear of failure
of discipline Poor social skills

Adolescent
Related to inadequate psychological resources to adapt to:
Physical and emotional changes
Educational demands
Sexual awareness
Sexual relationships
Independence from family
Career choices
Young Adult
Related to inadequate psychological resources to adapt to:
Career choices Marriage Educational demands
Parenthood Leaving home
Middle Adult
Related to inadequate psychological resources to adapt to:
Physical signs of aging
Social status needs
Problems with relatives
Child-rearing problems
Career pressures
Aging parents
Older Adult
Related to inadequate psychological resources to adapt to:
Physical changes
Response of others
Retirement
Changes in residence
Changes in financial status

Author's Notes
Ineffective Coping describes a person who is experiencing difficulty
adapting to stressful event(s). Ineffective Coping can be a recent, episodic
problem or a chronic problem. Usual effective coping mechanisms may
be inappropriate or ineffective, or the person may have a poor history of
coping with stressors.
If the event is recent, Ineffective Coping may be a premature
judgment.
For example, a person may respond to overwhelming stress
with a grief response such as denial, anger, or sadness, making a Grieving
diagnosis appropriate.
Impaired Adjustment may be more useful than Ineffective Coping in
the initial period after a stressful event. Ineffective Coping and its related
diagnoses may be more applicable to prolonged or chronic coping problems,
such as Defensive Coping for a person with a long-standing pattern
of ineffective coping.

Goals
The person will make decisions and follow through with appropriate
actions to change provocative situations in the personal environment
as evidenced by the following indicators:
• Verbalize feelings related to emotional state.
• Focus on the present.
• Identify response patterns and the consequences of resulting
behavior.
• Identify personal strengths and accept support through the
nursing relationship.

Interventions
Assess Causative and Contributing Factors (Lyon, 2002)
Refer to Related Factors.
Establish Rapport
• Spend time with the client. Provide supportive companionship.
• Avoid being overly cheerful and cliché such as, “Things will
get better.”
• Convey honesty and empathy.
• Offer support. Encourage expression of feelings. Let the client
know you understand his or her feelings. Do not argue with
expressions of worthlessness by saying things such as, “How
can you say that? Look at all you accomplished in life.”
• Offer matter-of-fact appraisals. Be realistic.
• Allow extra time for the client to respond.
Assess Present Coping Status
• Determine the onset of feelings and symptoms and their correlation
with events and life changes.
• Assess the ability to relate facts.
• Listen carefully as the client speaks to collect facts; observe
facial expressions, gestures, eye contact, body positioning, and
tone and intensity of voice.
• Determine the risk of the client’s inflicting self-harm; intervene
appropriately.
• Assess for signs of potential suicide:
• History of previous attempts or threats (overt and covert)
• Changes in personality, behavior, sex life, appetite, and sleep habits
• Preparations for death (putting things in order, making a
will, giving away personal possessions, acquiring a weapon)
• Sudden elevation in mood
• See Risk for Suicide for additional information on suicide
prevention.
Assess Level of Depression
• Refer depressed people to specialists.
Assist the Client in Developing Appropriate Problem-Solving
Strategies
• Ask the client to describe previous encounters with conflict and
how he or she resolved them.
• Evaluate whether his or her stress response is “fight or flight”
or “tend and befriend.”
• Encourage the client to evaluate his or her behavior.
• “Did that work for you?” “How did it help?” “What did you
learn from that experience?”
• Discuss possible alternatives (i.e., talk over the problem with
those involved, try to change the situation, or do nothing and
accept the consequences).
• Assist the client in identifying problems that he or she cannot
control directly; help the client to practice stress-reducing
activities for control (e.g., exercise, yoga).
• Be supportive of functional coping behaviors.
• “The way you handled this situation 2 years ago worked well
then. Can you do it now?”
• Give options; however, leave the decision-making to the client.
• Mobilize the client to gradually increase activity:
• Identify activities that were previously gratifying but have
been neglected: personal grooming or dress habits, shopping,
hobbies, athletic endeavors, and arts and crafts.
• Encourage the client to include these activities in the daily
routine for a set time span (e.g., “I will play the piano for
30 minutes every afternoon”).
• Explore outlets that foster feelings of personal achievement
and self-esteem:
• Make time for relaxing activities (e.g., dancing, exercising,
sewing, woodworking).
• Find a helper to take over responsibilities occasionally
(e.g., sitter).
• Learn to compartmentalize (do not carry problems around
with you always; enjoy free time).
• Encourage longer vacations (not just a few days here and
there).
• Provide opportunities to learn and use stress management
techniques (e.g., jogging, yoga).
• Facilitate emotional support from others:
• Seek out people who share a common challenge: establish
telephone contact, initiate friendships within the clinical setting,
develop and institute educational and support groups.
• Establish a network of people who understand your situation.
• Decide who can best act as a support system (do not expect
empathy from people who themselves are overwhelmed with
their own problems).
• Make time to share personal feelings and concern with
coworkers
(encourage expression; frequently people who
share the same circumstances help one another).
• Maintain a sense of humor.
• Allow tears.
• Teach self-monitoring tools (Finkelman, 2000):
• Develop a daily schedule to monitor for signs of improvement
or worsening.
• Discuss reasonable goals for present relationships.
• Write down what is done when in control, depressed,
confused,
angry, and happy.
• Identify activities tried, would like to try, or should do more.
• Create a warning sign checklist that indicates worsening and
how to access help.
Teach Problem-Solving Techniques
• Goal setting is consciously setting time limits on behaviors,
which is useful when goals are attainable and manageable. It
may become stress-inducing if unrealistic or short-sighted.
• Information seeking is learning about all aspects of a problem,
which provides perspective and, in some cases, reinforces selfcontrol.
• Mastery is learning new procedures or skills, which facilitates
self-esteem and self-control (e.g., self-care of colostomies,
insulin injection, or catheter care).
Initiate Health Teaching and Referrals, as Indicated
• Prepare for problems that may occur after discharge:
• Medications—schedule, cost, misuse, side effects
• Increased anxiety
• Sleep problems
• Eating problems—access, decreased appetite
• Inability to structure time
• Family/significant other conflicts
• Follow-up—forgetting, access, difficulty organizing time
• Instruct the client in relaxation techniques; emphasize the importance
of setting 15 to 20 minutes aside each day to practice
relaxation:
1. Find a comfortable position in a chair or on the floor.
2. Close the eyes.
3. Keep noise to a minimum (only very soft music, if desired).
4. Concentrate on breathing slowly and deeply.
5. Feel the heaviness of all extremities.
6. If muscles are tense, tighten, then relax each one from toes
to scalp.
• Teach assertiveness skills.
• Teach use of cognitive therapy techniques.
Pediatric Interventions
• Assess for signs of attention difficulties.
• Persistent pattern of inattention and/or hyperactivity.
• Clear evidence that behavior interferes with developmentally
appropriate social, academic, or occupational functioning.
• Cannot be accounted for by another mental disorder.
• Some hyperactive/inattentive symptoms must be present
before the age of 7.
• Establish eye contact before giving instructions.
• Set firm, responsible limits.
• State rules simply; do not lecture.
• Maintain regular routine.
• Advise parents to avoid disagreeing with each other in child’s
presence.
• Maintain a calm, simple environment.
• If hyperactive, provide for periods of activity using large
muscles.
• Provide immediate and constant feedback.
• Advise parents to consult with educational professionals for
educational programming.
Geriatric Interventions
• Assess for risk factors for ineffective coping in older adults
(Miller, 2009):
• Inadequate economic resources
• Immature developmental level
• Unanticipated stressful events
• Several major events in short period
• Unrealistic goals

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