NANDA defines Ineffective Coping nursing diagnosis as the inability to form a valid appraisal of the stressors; inadequate choices of practical responses; and/or inability to use available resources.
Ineffective Coping Related To (Etiology)
- Severe to panic levels of anxiety –panic attack, GAD
- Excessive negative beliefs about self– GAD, OCD, other
- Hyper vigilance after a traumatic event–PTSD, ASD
- Presence of obsessions and compulsions associated with fear of contamination–OCD, phobia
- Avoidance behavior associated with phobia (list phobia)–phobia
As Evidenced By (Assessment Findings/Diagnostic Cues)
- Verbalization of inability to cope or inability to ask for help
- Inability to problem solve
- Expression of anxiety
- Disturbance in vocational and social functioning related to (phobias, obsessions, compulsions, panic attacks, post trauma symptoms)
- Panic attacks, severe obsessive acts, disturbing thoughts, disabling phobias, post trauma symptoms
Ineffective Coping Nursing Diagnosis Outcome Criteria
- Uses multiple coping strategies
- Verbalizes a sense of control
- Functions at previous level of independence without interference from phobias, compulsions, obsessions, post trauma event, panic attacks, disabling anxiety
- Verbalize ability to cope effectively with anxiety using two new stress-reducing skills by (date)
- Demonstrate new coping skills (cognitive, behavioral, relaxation techniques, insight) that allay anxiety symptoms, such as visualization,deep breathing, and thought-stopping techniques by (date)
- Report increase in psychologic comfort by (date)
- Demonstrate knowledge of breathing techniques and relaxation skills by end of first/second session with nurse
- Describe the different therapies that are effective in treating their particular anxiety disorder (cognitive, behavioral, group) (see Table 5 -1)
- Demonstrate one new anxiety reduction technique that works best for him or her within 2 weeks
- Accurately describe the desired effects, side effects, and toxic effects of any medication he or she might be given as an adjunct to therapy within 2 days
Ineffective Coping Interventions and Rationales
- Monitor and reinforce client’s use of positive coping skills and healthy defense mechanisms. R: Identifies what does and does not work for client. Nurse uses client’s strengths to build upon.
- Teach new coping skills to substitute for ineffective ones. R: Gives client options.
- At client level of understanding, explain the fight-or-flight response and the relaxation response of the autonomic nervous system. Address how breathing can be used to elicit the relaxation response. R: Understanding the physiologic aspects of anxiety, and that people have some degree of control over their physiologic responses, gives clients hope and a sense of control in their lives, and aids them in mastering relaxation techniques.
- When the client’s level of anxiety is mild to moderate, teach client proper breathing techniques and breathe with the client. R: Breathing techniques can prevent anxiety from escalating. Doing exercises with client helps foster compliance.
- When the client’s level of anxiety is mild to moderate, teach client relaxation techniques (such as imaging, visualization) R: Help the client gain some control over switching the autonomic nervous system from the fight-or-flight response to the relaxation response.
- Identify for client which therapies have been highly effective with individuals who have the same disorder (cognitive, behavioral) R: Not only do cognitive and behavioral approaches work to decrease client’s anxiety and improve quality of life, they also foster chemical changes in the brain that lessen the brain’s response to anxiety.
- Use a cognitive approach. R: Helps the client recognize that thoughts and beliefs can cause anxiety.
- Teach client proven behavioral techniques. Client can become desensitized to a feared object or situation over time. R: Cognitive and behavioral techniques are extremely effective interventions for treating anxiety disorders. Once they are learned, clients can draw upon these skills for the rest of their lives.
- Keep focus on manageable problems; define them simply and concretely. R: Concrete, well-defined problems lend themselves to intervention.
- Provide behavioral rehearsals (role play) for anticipated stressful situations. R: Predetermination of previous effective or new coping strategies, along with practice, increases potential for success.
- Some clients respond well to biofeedback and feel more comfortable with physiologic manipulations than one-on-one therapy. R: Biofeedback is extremely useful for decreasing anxiety levels. Some clients might feel less “shame” in getting help.
- Many anxiety disorders respond to medications along with therapy (e.g., selective serotonin reuptake inhibitors [SSRIs] for OCD, buspirone [Buspar] for GAD). Therefore, medication teaching is extremely important, especially with the anxiolytics. R: Clients need to know what the medications can and cannot do. They need to know that “more is not better”, the side effects and toxic effects, and what to do if an untoward reaction occurs. This information should always be given to clients in writing after it is verbally explained by the nurse clinician.
Ineffective Coping Nursing Diagnosis and Nursing Care Plan::