Nursing diagnosis – DEFENSIVE COPING

DEFENSIVE  COPING

DEFINITION

Repeated projection of falsely positive self-evaluation based on a

self-protective pattern that defends against underlying perceived

threats to positive self-regard

DEFINING CHARACTERISTICS

• Denial of obvious problems

• Projection of blame

• Denial of obvious weaknesses

• Projection of responsibility

• Difficulty establishing

• Rationalization of failures

relationships

• Ridicule of others

• Difficulty in perception of

• Superior attitude toward

reality testing

others

RELATED FACTORS

• Conflict between self-perception

• Low level of confidence in

and value system

others

• Fear of failure

• Low level of self-confidence

• Fear of humiliation

• Uncertainty

• Fear of repercussion

• Unrealistic expectation of

• Lack of resilience

self

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Behavior

• Knowledge

• Emotional

• Roles/relationships

• Communication

• Self-perception

• Coping

EXPECTED OUTCOMES

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.

SUGGESTED NOC OUTCOMES

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

Skills

INTERVENTIONS AND RATIONALES

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

85

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

anxiety.

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-

cation.

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

provided.

SUGGESTED NIC INTERVENTIONS

Calming Techniques; Coping Enhancement; Emotional Support; Self-

Awareness Enhancement; Self-Responsibility Enhancement

Reference

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.

Leave a Reply