Nursing Interventions and Rationales Ineffective Coping
- Observe for causes of ineffective coping such as poor self-concept, grief, lack of problem-solving skills, lack of support, or recent change in life situation.
- Observe for strengths such as the ability to relate the facts and to recognize the source of stressors.
- Assess the risk of the client's harming self or others and intervene appropriately.
- Help the client set realistic goals and identify personal skills and knowledge.
- Use empathetic communication and encourage the client and family to verbalize fears, express emotions, and set goals.
- Encourage the client to make choices and participate in the planning of care and scheduled activities.
- Provide mental and physical activities within the client's ability (e.g., reading, television, radio, crafts, outings, movies, dinners out, social gatherings, exercise, sports, games).
- If the client is physically able, encourage moderate aerobic exercise.
- Provide information regarding care before care is given. Adequate information and training before and after treatment reduces anxiety and fear (Herranz and Gavilan, 1999).
- Discuss changes with the client before making them.
- Discuss the client's and family's power to change a situation or the need to accept a situation.
- Use active listening and acceptance to help the client express emotions such as sadness, guilt, and anger (within appropriate limits).
- Encourage the client to describe previous stressors and the coping mechanisms used.
- Be supportive of coping behaviors; allow the client time to relax.
- Help the client to define what meaning his or her symptoms might have for the client.
- Encourage the use of cognitive behavioral relaxation (e.g., music therapy, guided imagery).
- Use distraction techniques during procedures that cause the client to be fearful. Distraction is used to direct attention toward a pleasurable experience and block the attention to the feared procedure (DuHamel, Redd, and Johnson-Vickberg, 1999).
- Use systematic desensitization when introducing new people, places, or procedures that may cause fear and altered coping. Fear of new things diminishes with repeated exposure (DuHamel, Redd, and Johnson-Vickberg, 1999).
- Provide the client and/or family with a video of any feared procedure to view before the procedure. Ensure that the video shows a client of similar age and background. Videos provide the client and/or family with the information necessary to eliminate fear of the unknown (DuHamel, Redd, and Johnson-Vickberg, 1999).
- Refer for counseling as needed.
- Geriatric
- Engage the client in reminiscence. Reminiscence activates positive memories and evokes well-being (Puentes, 2002).
- Assess and report possible physiological alterations (e.g., sepsis, hypoglycemia, hypotension, infection, changes in temperature, fluid and electrolyte imbalances, and use of medications with known cognitive and psychotropic side effects).
- Determine if the individual is displaying a change in personality as a manifestation of difficulty with coping. An older individual's responses to age-related stress will depend on the balance of personality strengths and weaknesses.
- Increase and mobilize the support available to the elderly client. Encourage interaction with family and friends.
- Multicultural
- Assess for the influence of cultural beliefs, norms, and values on the client's perceptions of effective coping.
- Assess for intergenerational family problems that can overwhelm coping abilities.
- Encourage spirituality as a source of support for coping.
- Negotiate with the client with regard to the aspects of coping behavior that will need to be modified.
- Identify which family members the client can count on for support.
- Use an empowerment framework to redefine coping strategies.
- Assess the influence of fatalism on the client's coping behavior.
- Assess the influence of cultural conflicts that may affect coping abilities.
