Nursing Diagnosis: Ineffective Coping

Nursing Diagnosis for Hypertension: Ineffective Coping related to situational or maturational crisis, multiple life changes, inadequate relaxation, little or no exercise; work overload, inadequate support systems, poor nutrition, unmet expectations, unrealistic perceptions, inadequate coping methods

Possibly evidenced by

Verbalization of inability to cope or ask for help

Inability to meet role expectations, basic needs, or problem-solve

Destructive behavior toward self, overeating or lack of appetite, excessive smoking and drinking, and proneness to alcohol abuse

Chronic fatigue, insomnia, muscular tension, frequent headaches and neck aches, chronic worry, irritability, anxiety, emotional tension, and depression

Desired Outcomes/Evaluation Criteria—Client Will

Coping

Identify ineffective coping behaviors and consequences.

Verbalize awareness of own coping abilities and strengths.

Identify potential stressful situations and steps to avoid or modify them.

Demonstrate the use of effective coping skills.

Nursing care plan intervention with rationale:

1. Assess effectiveness of coping strategies by observing behaviors, such as ability to verbalize feelings and concerns, and willingness to participate in the treatment plan.

Rationale: Adaptive mechanisms are necessary to appropriately alter one’s lifestyle, deal with the chronicity of hypertension, and integrate prescribed therapies into daily living.

2. Note reports of sleep disturbances, increasing fatigue, impaired concentration, irritability, decreased tolerance of headache, and inability to cope or problem-solve.

Rationale: Manifestations of maladaptive coping mechanisms may be indicators of repressed anger and have been found to be major determinants of diastolic BP (Shapiro et al, 1995).

3. Assist client to identify specific stressors and possible strategies for coping with them.

Rationale: Recognition of stressors is often the first step in altering one’s response to the stressor.

4. Include client in planning of care and encourage maximum participation in treatment plan and with the interdisciplinary team.

Rationale: Involvement provides client with an ongoing sense of control, improves coping skills, and enhances commitment to achieving health goals. Ongoing intensive assessment and management by an interdisciplinary team promotes timely adjustments to therapeutic regimen.

5. Encourage client to evaluate life priorities and personal goals. Ask questions such as, “Is what you are doing getting you what you want?”

Rationale: Focuses client’s attention on reality of present situation relative to client’s goals. Strong work ethic, need for “control,” and outward focus may have led to lack of attention to

personal needs.

6. Assist client to identify and begin planning for necessary lifestyle changes. Assist to adjust, rather than abandon, personal and family goals.

Rationale: Necessary changes should be realistically prioritized so client can avoid being overwhelmed and feeling powerless.