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Ineffective Coping | Nursing Care Plan (NCP) Substance Dependence

Nursing diagnosis: ineffective Coping related to personal vulnerability; negative role modeling, inadequate support systems; previous ineffective or inadequate coping skills with substitution of drug(s)

Possibly evidenced by
Impaired adaptive behavior and problem-solving skills
Decreased ability to handle stress of illness or hospitalization
Financial affairs in disarray, employment or school difficulties (e.g., losing time on job or not maintaining steady employment; poor work or school performances; on-the-job injuries)
Verbalization of inability to cope or ask for help

Desired Outcomes/Evaluation Criteria—Client Will
Substance Addiction Consequences
Identify consequences of using substance as a method of coping.
Identify other ineffective coping behaviors.
Engage in effective coping skills and problem-solving.
Initiate necessary lifestyle changes.

Nursing intervention with rationale:
1. Review program rules and philosophy expectations.
Rationale: Having information provides opportunity for client to cooperate and function as a member of the group or milieu, enhancing sense of control and sense of success.

2. Determine understanding of current situation and previous or other methods of coping with life’s problems.
Rationale: Provides information about degree of denial, acceptance of personal responsibility and commitment to change; identifies coping skills that may be used in present situation.

3. Set limits and confront efforts to get caregiver to grant special privileges, making excuses for not following through on behaviors agreed on, and attempting to continue drug use. Avoid use of labels, such as lying.
Rationale: Client has learned manipulative behavior throughout life and needs to learn a new way of getting needs met. Following through on consequences of failure to maintain limits can help the client to change ineffective behaviors. Use of labels promotes negative attitudes that can impede therapeutic relationships.

4. Be aware of staff attitudes, feelings, and enabling behaviors.
Rationale: Lack of understanding and judgmental or enabling behaviors can result in inaccurate data collection and nontherapeutic approaches.

5. Encourage verbalization of feelings, fears, and anxiety.
Rationale: May help client begin to come to terms with long-unresolved issues.

6. Explore alternative coping strategies.
Rationale: Client may have little or no knowledge of adaptive responses to stress and needs to learn other options for managing time, feelings, and relationships without drugs.

7. Structure diversional activity that relates to recovery such as social activity within support group, wherein issues of being chemically free are examined.
Rationale: Discovery of alternative methods of coping with drug hunger can remind client that addiction is a lifelong process and opportunity for changing patterns is available.

8. Use peer support to examine ways of coping with drug hunger.
Rationale: Self-help groups, such as AA, NA, and Crystal Methamphetamine Anonymous, are valuable for learning and promoting abstinence in each member by using understanding and support as well as peer pressure.

9. Identify possible and actual triggers for relapse. Encourage client to use the acronym HALT—“Am I hungry, angry, lonely, or tired?”
Rationale: Employment and financial stressors, isolation, unhealthy relationships, being around substance-using friends, hearing certain songs, premenstrual syndrome—the list of possibilities depends on the individual. Being aware of the triggers provides an opportunity to plan for ways to avoid and deal with them.

10. Encourage involvement in therapeutic writing. Have client begin journaling or writing autobiography.
Rationale: Therapeutic writing or journaling can enhance participation in treatment; serves as a release for grief, anger, and stress; provides a useful tool for monitoring client’s safety; and can be used to evaluate client’s progress. Autobiographical activity provides an opportunity for client to remember and identify sequence of events in his or her life that relate to current situation.
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