Effective management of adaptive tasks by family member involved

with the client’s health challenge, who now exhibits desire and

readiness for enhanced health and growth in regard to self and in

relation to the client


• Individual expresses interest in making contact with others who

have experienced a similar situation.

• Family member attempts to describe growth impact of crisis.

• Family member moves in direction of enriching lifestyle.

• Family member moves in direction of health promotion.

• Individual chooses experiences that optimize wellness.


• Adaptive tasks effectively addressed to enable goals of self-

actualization to surface

• Needs sufficiently gratified to enable goals of self-actualization

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Behavior

• Emotional status

• Coping

• Roles/responsibilities


Family members will

• Discuss the impact of patient’s illness and feelings about it with

healthcare professional.

• Participate in treatment plan.

• Establish a visiting routine beneficial to the patient.

• Demonstrate the care needed to maintain patient’s health status.

• Identify and use available support systems.


Caregiver–Patient Relationship; Caregiver Well-Being; Family

Coping; Family Normalization; Health-Promoting Behavior


Determine: Assess normal pattern of communication among family

members; understanding and knowledge of family members about

patient’s condition; family’s past response to crises; patient’s percep-

tion of health problem. Assess patient and family’s spiritual needs,

including religious beliefs and affiliation. Assessment of these factors

will assist in selecting appropriate interventions.

Perform: Schedule time to meet with family and patient in order to

listen to ways in which they plan to enhance their coping skills in

the present situation.

Provide comfort measures such as bathing, massage, regulation of

environmental temperature, and mouth care, according to the


patient’s needs and preferences. Comfort can promote ability to

cooperate with the plan.

Establish a visiting schedule that will not tax patient’s or family’s

resources. Use patient’s daily routine to aid in planning (e.g., no vis-

iting during treatments or during periods of uninterrupted rest).

Establishing a routine will allow the patient have consistency and a

measure of control.

Inform: Teach self-healing techniques to patient and family such as

meditation, guided imagery, yoga, and prayer. These strategies pro-

mote anxiety reduction.

Teach patient how to incorporate the use of self-healing

techniques in carrying out usual daily activities in order to encour-

age ongoing use of the strategies.

Demonstrate procedures and encourage participation in patient’s

care in a way that maximizes patient’s comfort. Both patient and

family need to work together to implement the plan with patient’s

comfort in mind.

Provide patient with concise information about condition. Be

aware of what family members already know. Honesty is important

when conveying information.

Attend: Reinforce family’s efforts to care for patient. Let family

know they are doing well to ease adaptation to new caregiver roles.

Ensure privacy for patient and family visits to foster open


Encourage family to support patient’s independence. Encourage

patient’s cooperation as you continue with healing techniques, such

as therapeutic touch. There is a need to allow for as much independ-

ence on the part of the patient as possible. At times the family will

try to promote dependency to the detriment of the patient.

Provide emotional support to family by being available to answer

questions. Availability will communicate to the family that you are

concerned for them and the patient.

Manage: Refer family to community resources and support groups

available to assist in managing patient’s illness and providing emo-

tional and financial assistance to caregivers.

Refer to a member of the clergy or a spiritual counselor, accord-

ing to the patient’s preference, to show respect for the patient’s

beliefs and provide spiritual care.


Coping Enhancement; Family Process Management


Nelson, J. E., et al. (2005, March). When critical illness becomes chronic: Infor-

mational needs of patient and family. Journal of Critical Care, 20(1), 79–89.





Pattern of community activities for adaptation and problem solving

that is satisfactory for meeting the demands or needs of the commu-

nity but can be improved for management of current and future



• Active planning to handle predicted stressors

• Active problem solving when faced with stressors

• Agreement that community carries responsibility for stress manage-


• Positive communication among community members and between

community members and larger organizations


One or more characteristics that indicate effective coping:

• Acknowledges power

• Defines stressors as manageable

• Aware of possible environmen-

• Seeks knowledge of new

tal changes


ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Communication

• Populations

• Coping

• Risk management


Community members will

• Express understanding of problems associated with failure to

immunize population and will recognize the needs to reduce the
number of adults and children who are not immunized.

• Initiate a plan to increase the number of immunizations in popula-

tion and provide adequate protection from communicable diseases.

• Work to reduce spread of communicable diseases and increase the

number of immunizations.

• Evaluate established plans for ensuring that all children become

immunized, and will make changes to plans as needed.


Community Competence; Community Health Status: Immunity;

Community Risk Control: Communicable Disease


Determine: Assess community member’s level of understanding of the

importance of immunization. If level of compliance is low, survey

community needs to determine why. Determine ease of access in the

community for members to comply with immunization

requirements/needs. Identify new members of the community, such

as immigrants or refugees. This assessment will assist in identifying

appropriate intervention.


Perform: Collect statistical data from community health sources,

such as the health department and schools to continue to identify

children who have not been immunized. Recruit local agencies with

an adequate number of professionals able to deliver the immuniza-

tion services.

Contact parents personally or by handwritten note about children

who have not been immunized. Make it clear to the parents that

your purpose is to protect the children.

Inform: Provide extensive educational opportunities in the

community about communicable diseases and the importance of

immunization. Educate persons in the community in their first lan-

guage to ensure adequate understanding.

Attend: Encourage community members to implement a program to

disseminate information about problems associated with inadequate

immunization to educate residents and promote the community’s

established immunization program.

Encourage health departments, clinics, and practitioners’ offices to

provide information on the recommended childhood immunization

schedule to the public to foster understanding about the importance

of educating the public.

Conduct a follow-up survey on immunization rates to measure the

effectiveness of educational initiatives.

Manage: Supply a list of referrals for the parents of children who

are not immunized. Include information on low-cost health

insurance, city health centers, and well-baby clinics to encourage

compliance. Helping the parents by giving referrals will empower

them to meet their child’s health care needs.


Communicable Disease Management; Community Health Develop-

ment; Health Education; Health Policy Monitoring; Immunization/

Vaccination Management


Pender, N. J., Murdaugh, C., et al. (2006). Health promotion in nursing prac-

tice (5th ed.). Upper Saddle River, NJ: Prentice Hall.




A pattern of cognitive and behavioral efforts to manage demands

that is sufficient for well-being and can be strengthened


• Defines stressors as manageable

• Seeks knowledge of new strategies

• Seeks social support

• Uses a broad range of problem-oriented and emotion-oriented


• Uses spiritual resources

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Behavior

• Roles/relationships

• Communication

• Self-perception

• Coping


The patient will

• Identify major issues that require ongoing enhancement of coping


• Express feelings associated with coping strategies.

• Demonstrate readiness to develop enhanced strategies.

• Identify support persons and activities that will assist in goal



Coping; Quality of Life


Determine: Assess patient’s usual coping mechanisms, roles and

responsibilities, social support, spiritual resources, and use of alcohol

and tobacco in order to decide on a focus for interventions.

Perform: Establish a trusting relationship with patient by spending

time with the patient each shift, which will encourage the patient to

be more honest and open.

Begin discussions at patient’s level of comfort. If patient wants to

express anger or other emotion, listen carefully. Until the patient has

had an opportunity to talk, you will not be able to move him to a

place where the issue can be discussed logically.

Inform: Provide information on informed consent because parents

will be making decisions for the child’s care.

Teach additional skills that enhance coping strategies. Help the

patient develop a program by using relaxation strategies (i.e., medi-

tation, guided imagery, yoga, exercise); these strategies will help to

reduce anxiety and allow the patient to concentrate.

Teach problem-solving skills. Have patient role-play to

demonstrate how to set up options and choose from among them.


Attend: Encourage patient to continue adhering to his plan for

enhanced coping strategies. Compliance with the plan will produce

results for the patient. It will also help patient measure success.

Encourage patient to continue involvement in a wide range of

activities. More activities will involve more choices.

Encourage patient to look for volunteer opportunities in the com-

munity as a way of keeping the patient involved with others.

Offer to meet with patient regularly, if desired, to help patient

continue developing enhanced coping skills.

Manage: Refer patients to support groups and offer ideas about edu-

cational opportunities in the community.


Active Listening; Coping Enhancement


Fiks, A. G., et al. (2006, December). Identifying factors predicting immuniza-

tions delay for children followed in an urban primary care network using
an electronic health record. Pediatrics, 118(6), 1680–1686.




Pattern of community activities for adaptation and problem-solving

that is unsatisfactory for meeting the demands or needs of the com-



• Deficits in participation

• Excessive conflicts

• Expressed powerlessness and vulnerability

• Failure of community to meet its own expectations

• High illness rate

• Increased social problems (abuse, divorce, and unemployment)

• Perception of stressors as excessive


• Deficits in community social

• Natural disasters

support services

• Man-made disasters

• Deficits in community social

• Inadequate resources for prob-


lem solving

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Communication

• Risk management

• Coping

• Values and beliefs

• Healthcare system


Community members will

• Express awareness of seriousness of high school adolescent preg-

nancy rate in their community.

• Express need for plan to reduce prevalence of teen pregnancy.

• Develop and implement plan to reduce teen pregnancy.

• Evaluate success of plan in meeting goals and objectives and will

continue to revise it, as necessary.

• Report reduction in rate of teen pregnancy.


Community Competence; Community Health Status


Determine: Assess the following: community demographics; number of

teen pregnancies in the community in the past 2 years; attitudes toward

teen mothers and their infants; availability of programs in the schools

that help teen mothers continue their education; teens’ knowledge about

sex and sexuality; religious attitudes in the community toward sex

and sexuality; influence of religious groups on educators. Assessment

information will be useful in establishing appropriate interventions.

Perform: Collect statistical data from schools to analyze teen

pregnancy rates as a basis for evaluating a pregnancy prevention


program. Plan a teen pregnancy program that can be used in

schools. Include information on risks, problems, and complications

of teen pregnancy. Contact local corporations for financial assistance

in supporting educational programs.

Establish clubs for adolescent girls in the community. These can

be used as a method for educating as well as helping girls establish

healthy relationships.

Establish therapeutic relationships with pregnant adolescents to

build support during this difficult period.

Inform: Provide education on birth-control measures (including absti-

nence from sex) and have this information available at school.

Encourage an information campaign to educate adolescents, parents,

and community members about problems related to teen pregnancy.

Teach parent to observe behavioral cues from child. For example,

the child may become fussy when he is ready for a nap or may pull

his ear if he has an earache to indicate that he has pain. Explain the

range of options for responding to these cues in positive ways. Par-

ents may be unfamiliar with cues from child behavior.

Teach parents to give physical care when the need exists. The

parents may need instruction on the importance and proper way of

providing care. Teach relaxation techniques that can be done by the

parents such as guided imagery, progressive muscle relaxation, and

meditation. These measures restore psychological and physical equi-

librium by decreasing autonomic response to anxiety.

Encourage local youth groups and religious and social

organizations to feature guest speakers on pregnancy prevention at

their meetings. Speakers with expertise in the area of teen pregnancy

are better able to provide information that may help teens make

better choices in sexual behavior.

Attend: Encourage community members to establish school-based

clinics that allow teens access to reproductive-system models, preg-

nancy tests, and nonprescription birth-control measures to support

teens who choose to protect themselves from unwanted pregnancy.

Manage: Develop a referral list for teens that includes resources such as

hospitals with human sexuality courses, charities that provide prenatal

care and childbirth services, women’s clinics, and Planned Parenthood

to compensate for restricted access to information in the schools.


Community Health Development; Health Education; Health Screen-

ing; Program Development


Brindis, C. D. (2006). A public health success: Understanding policy changes

related to teen sexual activity and pregnancy. Annual Review of Public
Health, 27, 277–295.

Nursing diagnosis – INEFFECTIVE COPING



Inability to form a valid appraisal of the stressors, inadequate

choices of practiced responses, and/or inability to use available



• Change in communication patterns

• Decreased use of social support

• Destructive behavior toward self or others

• Difficulty asking for help

• Fatigue

• High illness rate

• Inability to meet basic needs and role expectations

• Statements indicating inability to cope


• High degree of threat

• Inability to conserve adaptive energies

• Inadequate resources available

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Behavior

• Communication

• Coping


The patient will

• Verbalize increased ability to cope.

• Expand support network to meet social and emotional needs.

• Locate and use appropriate resources for help in problem solving.

• Report increased ability to meet demands of daily living.

• Make changes to environment to ensure enhanced coping or move

into long-term care facility, as needed.


Coping; Decision Making; Impulse Self-Control; Information

Processing; Social Interaction Skills


Determine: Monitor physiological responses to increased activity

level, including respirations, heart rate and rhythm, and blood pres-

sure. Vital signs are likely to change as the patient deals with the

frustration from poor coping strategies. Assess understanding of the

current health problem and desire to participate in treatment.

Perform: Listen to the patient. Respond in a matter-of-fact, nonjudg-

mental manner. Judgmental responses will impede the development

of a trusting relationship. Practice guided imagery and deep breath-

ing with the patient to help the patient relax.


Inform: Provide patient with information about relaxation

techniques. These techniques take practice. Information will help the

patient understand the benefit.

Teach patient about her disease process and explain treatments to

allay fear and allow the patient to regain sense of control.

Teach positive coping strategies and have patient role-play them

and give praise for successful modeling. This will help to reinforce

coping behaviors.

Attend: Assist patient to develop short- and long-term goals to

encourage better coping and a roadmap to measure progress.

Provide emotional support and encouragement to help improve

patient’s negative self-concept and motivate the patient to perform

ADLs. Involve patient in planning and decision making. Having the

ability to participate will encourage greater compliance with

treatment plan. Encourage patient to engage in social activities with

people of all age groups. Participation once a week will help relieve

the patient’s sense of isolation.

Manage: Refer patient for professional psychological counseling. For-

mal counseling helps ease the nurse’s frustration, increases objectiv-

ity, and fosters collaborative approach to patient’s care.

Before discharge, refer patient to case manager who can help

patient become involved in informal community programs, such as

volunteer, foster grandparents, or religious groups, to provide peer

and social contact and decrease the patient’s loneliness and isolation.

Refer patient to a support group. In the context of a group, the

patient may develop a more positive view in the present situation.


Coping Enhancement; Decision-Making Support; Emotional Support;

Environmental Management; Impulse Control Training; Support Sys-

tem Enhancement


Popejoy, L. (2005, September). Health-related decision-making by older adults

and their families: How clinicians can help. Journal of Gerontological Nurs-
ing, 31(9), 12–18.

Nursing diagnosis – DISABLED FAMILY COPING



Behavior of significant person (family members or other primary per-

son) that disables his or her capabilities and the patient’s capabilities

to effectively address tasks essential to either person’s adaptation to

the health challenge


• Intolerance

• Distortion of reality regarding

• Agitation, depression, aggres-


sion, hostility

• Impaired restructuring of a

• Taking on illness of patient

meaningful life

• Rejection


• Arbitrary handling of family’s

• Significant person with chroni-

resistance to treatment

cally unexpressed feelings (e.g.,

• Dissonant coping styles among

guilt, anxiety, hostility,

significant people


• Basic breast-feeding knowledge

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Communication

• Knowledge

• Coping

• Values and beliefs


To the extent possible, family members will participate in aspects of

patient’s care without evidence of increased conflict.

The patient will

• Express confidence in his or ability to make decisions despite pres-

sure from family members.

• Contact appropriate sources of support outside the family.

• Take steps to ensure that care needs are met despite family’s short-


• Express greater understanding of emotional limitations of family



Caregiver Emotional Health; Caregiver–Patient Relationship; Care-

giving Endurance Potential; Family Coping


Determine: Assess effects of patient’s disease on ability of family to

cope to identify strengths and weaknesses in patient’s patterns of


Describe role relationships in the family. Evaluate changes that

occur in family relationships during the course of the patient’s hos-

pitalization. This information will be helpful in making a plan.

Have patient identify support systems outside the family to encour-

age responsibility for knowing what support systems are helpful.

Perform: Engage family in assisting with physical aspects of patient

care. Family members should have an opportunity to overcome dys-

functional behavior.

Develop short- and long-term goals with both patient and family.
Problems associated with coping may will require long-term plan-

ning to resolve.

Inform: Teach patient strategies to discuss, to confront in a positive

way that will help cope with the present situation. Role-play coping

strategies with the patient to reinforce new adaptive behaviors.

Educate family members about resources in the community that

can assist them with the patient after hospitalization.

Teach patient decision-making skills and assist him or her to prac-

tice with simple decisions. Beginning with simple decisions will

begin helping the patient lay out options before deciding.

Attend: Maintain objectivity when dealing with family conflicts. Do

not become embroiled in the dynamics of a dysfunctional family in

order to maintain objectivity and effectiveness.

Focus on being a patient advocate. Reaffirm patient’s right to

make decisions without interference from family members. Encour-

age patient to seek help family cannot provide by participating in

support group.

Help patient select a support group that best meets personal

needs. Participation in a support group may improve the patient’s

ability to cope as well as provide meaningful relationships.

Listen attentively to patient’s expression of pain over unresolved

conflicts with family members. The patient may have to grieve over

the fact that he or she does not have an “ideal” family, capable of

meeting his emotional needs. Therapeutic listening helps patient to

understand himself and his family better and to understand how

conflicts from the past affect his behavior.

Manage: Refer patient to a home health agency, homemaker service,

meals-on-wheels, or other appropriate community services for assis-

tance and follow-up. Use of various community services may help

make up the family’s shortcomings in coping.


Anger Control Assistance; Caregiver Support; Family Involvement

Promotion; Family Mobilization; Family Support


Andershed, B. (2006, September). Relatives in end-of-life care, Part 1: A sys-

tematic review of the literature the last five years, January, 1999–February,
2004. Journal of Clinical Nursing, 15(9), 1158–1169.

Nursing diagnosis – DEFENSIVE COPING



Repeated projection of falsely positive self-evaluation based on a

self-protective pattern that defends against underlying perceived

threats to positive self-regard


• Denial of obvious problems

• Projection of blame

• Denial of obvious weaknesses

• Projection of responsibility

• Difficulty establishing

• Rationalization of failures


• Ridicule of others

• Difficulty in perception of

• Superior attitude toward

reality testing



• Conflict between self-perception

• Low level of confidence in

and value system


• Fear of failure

• Low level of self-confidence

• Fear of humiliation

• Uncertainty

• Fear of repercussion

• Unrealistic expectation of

• Lack of resilience


ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Behavior

• Knowledge

• Emotional

• Roles/relationships

• Communication

• Self-perception

• Coping


The patient will

• State the reason for hospitalization.

• Verbally describe self-perception, body image, success, and failures.

• Engage in decision making about care.

• Express a responsible attitude toward own behavior.

• Demonstrate follow-through in decisions related to healthcare.

• Interact with others in a socially acceptable manner.


Acceptance: Health Status; Coping; Self-Esteem; Social Interaction



Determine: Assess patient’s understanding of current illness; relation-

ships with family and friends; self-esteem; self-perception; support

systems; spiritual support. Specific assessment information will assist

in developing an accurate plan of care for the individual.

Perform: Assist patient to compile a list of this that he likes and dis-

likes about his present situation. Performing this exercise can help


the patient identify aspects of self and identify changes he would

like to make with specific variables.

Have patient perform as many self-care activities as possible, and

make treatment-related decisions to encourage a sense of autonomy

and promote compliance.

Provide a structured daily routine. Structure may help provide an

alternative to self-absorption.

Inform: Teach patient relaxation techniques such as guided

imagery, deep breathing, meditation, aromatherapy, and progres-

sive muscle relaxation. Purposeful relaxation efforts helps reduce


Teach patient strategies for positive thinking. Work specifically

to identify negative thoughts and rephrase them in a positive way.

Making the patient conscious of negative thoughts will help

reinforce the need to think about things and people in a more

positive way.

Attend: Arrange for interaction between the patient and family

or friends and observe the interaction patterns. This allows

the nurse to provide feedback about the effectiveness of communi-


Allow time for patient to talk about his or her frustration. Speak-

ing to a sensitive listener may help to reduce some frustration and

may lead to new ideas about how to help the patient resolve his or

her issues.

Provide positive feedback to patient when he or she assumes

responsibility for his or her own behavior in order to reinforce posi-

tive coping behaviors.

Manage: Encourage the patient to meet with someone who is coping

successfully with a similar problem. This may assist the patient to

work toward a positive outcome.

Encourage the patient to consider participating in a support

group. Participation in such a group may help the patient cope

more effectively, as well as establish new relationships.

Refer to case manager/social worker to ensure that follow-up is



Calming Techniques; Coping Enhancement; Emotional Support; Self-

Awareness Enhancement; Self-Responsibility Enhancement


Schwinghammer, S. A., et al. (2006). Different selves have different effects:

Self-activation and defensive social comparison. Personality and Social
Psychology Bulletin, 32(1), 27–39.




Usually supportive primary person (family member or close friend)

provides insufficient, ineffective, or compromised support, comfort,

assistance, or encouragement that may be needed by the patient to

manage or master adaptive tasks related to health challenge


• Attempts to assist the patient with unsatisfactory results

• Displays of protective behavior disproportionate to the patient’s

abilities or need for autonomy (family member)

• Expresses concern about the family’s response to health problem

• Reports preoccupation with personal reaction to the patient’s



• Exhaustion of supportive

• Lack of reciprocal support

capacity of significant people

• Temporary preoccupation by a

• Incorrect information by a pri-

significant person

mary person

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Behavior

• Coping

• Communication

• Emotional status


The family members will

• Assume responsibility for roles and activities formerly held by the


• Express feelings about assuming responsibility of care for an older

family member.

The patient and family members will

• Identify and make use of appropriate community services.

• Express satisfaction with improved ability to cope with current crisis.


Caregiver Emotional Health; Caregiver–Patient Relationship; Care-

giver Stressors; Family Coping; Family Normalization


Determine: Identify the primary caregiver in family and assess roles

of other family members. Determine usual coping mechanisms

employed by this patient and family. Describe patterns of communi-

cation used in problem solving. Identify what support systems exist

for the family and patient outside the family. Identify strengths and

weakness in the family’s communication patterns. Assessment data

will assist with establishment of interventions.

Perform: Direct development of short- and long-term goals by the

patient and family members. Initially, the family members will need


help from the caregiver until they understand more about the

process of planning.

Identify appropriate community services for the family to assist

with coping.

Inform: Educate patient and family members about the process of

aging to assist patient and family to understand how changes in the

patient have affected the family.

Teach family members ways of maximizing the use of coping

strategies that seem to have worked for them in the past. Teach new

coping strategies and have family members role model them. Prac-

tice will help the family practice the behaviors in real situations.

Attend: Avoid becoming involved in a power struggle between

patient and family members. The patient may no longer be able to

fill ordinary roles and the sudden shift in roles may lead to a power


Encourage family members to express feelings about caring for an

older family member. Be nonjudgmental when listening to the

family; discuss the issues associated with caring for an older person.

If the nurse is judgmental, the family members may not be comfort-

able discussing their problem.

Provide emotional support for primary caregiver. Some families

may hesitate to accept outside help. Other families may be unwilling

to make even small sacrifices to care for an older family member. If

family members have not been supportive or caring for the elder

member before, they are unlikely to change.

Manage: Refer to community agencies (e.g., adult day care, respite

care, and geriatric outreach services) that can assist the family in

caring for the elder. Communicate to the hospice nurse where the

patient is at present in coping with the terminal illness.

Refer to case manager or social service to assist with ongoing

coordination of the patient’s needs after hospitalization.

Refer to a member of the clergy or a spiritual counselor when

deemed appropriate. Patients will often be more inclined to talk to a

spiritual counselor.


Caregiver Support; Coping Enhancement; Family Involvement

Promotion; Respite Care


Garity, J. (2006). Caring for a family member with Alzheimer’s disease: Cop-

ing with caregiver burden post-nursing home placement. Journal of Geron-
tological Nursing, 32(6), 39–48.