Ineffective Coping

Ineffective Coping: Inability to form a valid appraisal of the stressors, inadequate choices of practiced responses,
and/or inability to use available resources.

Nursing Diagnosis

Ineffective Coping

May be related to

Situational crises, vulnerability, cognitive perceptual changes

Possibly evidenced by

Inappropriate use of defense mechanisms

Inability to cope/difficulty asking for help

Change in usual communication patterns

Inability to meet basic needs/role expectations

Difficulty problem solving

Desired Outcomes

Verbalize acceptance of self in situation.

Talk/communicate with SO about situation and changes that have occurred.

Verbalize awareness of own coping abilities.

Meet psychological needs as evidenced by appropriate expression of feelings,

identification of options, and use of resources.
Nursing Interventions

Assess extent of altered perception and related

degree of disability. Determine Functional
Independence Measure score.
Identify meaning of the dysfunction and
change to patient. Note ability to understand
events, provide realistic appraisal of the
situation.

Rationale
Determination of individual factors aids in
developing plan of care/choice of interventions
and discharge expectations.
Independence is highly valued in American
culture but is not as significant in some
cultures. Some patients accept and manage
altered function effectively with little
adjustment, whereas others may have
considerable difficulty recognizing and adjust
to deficits. In order to provide meaningful

Nursing Interventions

Determine outside stressors: family, work,

future healthcare needs.

Provide psychological support and set realistic

short-term goals. Involve the patients SO in
plan of care when possible and explain his
deficits and strengths.
Encourage patient to express feelings,
including hostility or anger, denial, depression,
sense of disconnectedness.
Note whether patient refers to affected side as
it or denies affected side and says it is
dead.
Acknowledge statement of feelings about
betrayal of body; remain matter-of-fact about
reality that patient can still use unaffected side
and learn to control affected side. Use words
(weak, affected, right-left) that incorporate that
side as part of the whole body.
Identify previous methods of dealing with life
problems. Determine presence of support
systems.
Emphasize small gains either in recovery of
function or independence.
Support behaviors and efforts such as
increased interest/participation in rehabilitation
activities.
Monitor for sleep disturbance, increased
difficulty concentrating, statements of inability
to cope, lethargy, withdrawal.
Refer for neuropsychological evaluation and/or
counseling if indicated.

Rationale
support and appropriate problem-solving,
healthcare providers need to understand the
meaning of the stroke/limitations to patient.
Helps identify specific needs, provides
opportunity to offer information and begin
problem-solving. Consideration of social
factors, in addition to functional status, is
important in determining appropriate discharge
destination.
To increase the patients sense of confidence
and can help in compliance to therapeutic
regimen.
Demonstrates acceptance of patient in
recognizing and beginning to deal with these
feelings.
Suggests rejection of body part and negative
feelings about body image and abilities,
indicating need for intervention and emotional
support.
Helps patient see that the nurse accepts both
sides as part of the whole individual. Allows
patient to feel hopeful and begin to accept
current situation.
Provides opportunity to use behaviors
previously effective, build on past successes,
and mobilize resources.
Consolidates gains, helps reduce feelings of
anger and helplessness, and conveys sense of
progress.
Suggest possible adaptation to changes and
understanding about own role in future
lifestyle.
May indicate onset of depression (common
after effect of stroke), which may require
further evaluation and intervention.
May facilitate adaptation to role changes that
are necessary for a sense of feeling/being a
productive person. Note: Depression is
common in stroke survivors and may be a

Nursing Interventions

Rationale
direct result of the brain damage and/or an
emotional reaction to sudden-onset disability.