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
• 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.)
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.
SUGGESTED NOC OUTCOMES
Coping; Decision Making; Impulse Self-Control; Information
Processing; Social Interaction Skills
INTERVENTIONS AND RATIONALES
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
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.
SUGGESTED NIC INTERVENTIONS
Coping Enhancement; Decision-Making Support; Emotional Support;
Environmental Management; Impulse Control Training; Support Sys-
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.