Nursing diagnosis: risk for ineffective Coping
Risk factors may include
Physiological changes—cerebral and spinal lesions
Psychological conflicts, anxiety; fear
Impaired judgment, short-term memory loss, confusion, unrealistic perceptions and expectations, emotional lability
Personal vulnerability; inadequate support systems
Multiple life changes
Inadequate coping methods
Desired Outcomes/Evaluation Criteria—Client Will
Recognize relationship between disease process (cerebral lesions) and emotional responses and changes in thinking and behavior.
Verbalize awareness of own capabilities and strengths.
Display effective problem-solving skills.
Demonstrate behaviors and lifestyle changes to prevent or minimize changes in mentation and maintain reality orientation.
Nursing intervention with rationale
1. Assess current functional capacity and limitations; note presence of distorted thinking processes, labile emotions, and cognitive dissonance. Determine how these affect coping abilities.
Rationale: Organic or psychological effects may cause client to be easily distracted and to display difficulties with concentration, problem-solving, dealing with what is happening, and being responsible for own care.
2. Determine client understanding of current situation and previous methods of dealing with life problems.
Rationale: Client understanding of current health situation provides clues on coping abilities, support system, individual resources, and other needs.
3. Discuss ability to make decisions, care for children or dependent adults, and handle finances. Identify available options.
Rationale: Impaired judgment, confusion, and inadequate support systems may interfere with ability to meet own needs and needs of others. Conservatorship, guardianship, or adult protective services may be required until client is able to manage own affairs (if ever).
4. Maintain an honest, reality-oriented relationship.
Rationale: Honest, reality-based relationship reduces confusion and minimizes painful, frustrating struggles associated with adaptation to altered environment and lifestyle.
5. Encourage verbalization of feelings and fears. Accept client statements in a nonjudgmental manner. Note statements reflecting powerlessness and inability to cope.
Rationale: Nonjudgmental approach may diminish client’s fear, establish trust, provide opportunities to identify problems, and facilitate the problem-solving process.
6. Observe nonverbal communication—posture, eye contact, movements, gestures, and use of touch. Correlate with verbal content. Clarify meaning, as appropriate.
Rationale: Careful assessment of both verbal and nonverbal forms of communication provides insight into client response to the health condition and effective coping strategies.
7. Provide clues for orientation, such as calendars, clocks, note cards, organizers, and date book.
Rationale: Memory aids facilitate client orientation and coping.
8. Encourage client to tape-record important information and listen to the recording periodically.
Rationale: Repetition puts information in long-term memory, where it is more easily retrieved, and can support decision making and problem-solving process.
9. Refer to cognitive retraining program.
Rationale: Improving cognitive abilities can enhance basic thinking skills, including attention span, information processing, learning new skills, insight, judgment, and problem-solving.
10. Refer to counseling, psychiatric clinical nurse specialist, and psychiatrist, as indicated.
Rationale: Collaboration with psychiatric services may help resolve issues of self-esteem and regain effective coping skills.