COPING

COPING
Coping refers to individuals
response to stress.
Coping may be described as
dealing with change successfully
or unsuccessfully.

COPING
PROBLEM FOCUSED are
efforts to improve the situation by
making changes or taking some action.
EMOTION FOCUSED
thoughts and actions that relieve
emotional distress.

COPING
LONG TERM COPING
STRATEGY constructive and
realistic
SHORT TERM COPING
STRATEGY reduces stress to a
tolerable limit temporarily but are
ineffective ways to permanently deal
with reality.

COPING
ADAPTIVE COPING effective
coping; helps the person deal
effectively with stress.
MALADAPTIVE COPING
ineffective coping; can result in
unnecessary distress for the
person.

3 Approaches to coping with
stress
3 As
ALTER the stressor
ADAPT to the stressor
AVOID the stressor

Effectiveness of an individuals
coping is influenced by:
Number, Duration and
Intensity of the stressor.
Past experiences of the
individual.
Support systems available to
the individual.
Personal qualities of the
person.


ASSESSMENT

Assessment
o NURSING HISTORY
o Client perceived stressor
o Stressful incidents
o Past and present coping strategies
o PHYSICAL EXMINATION
o Indicators of stress (nail biting,
nervousness, wt. changes)
o Stress related health problems
(hypertension, dyspnea)

Assessment Interview
On a scale of 1 to 10, where 1 is very
minor and 10 is extreme, how would you
rate the stress you are experiencing in the
following areas?
Home
Work or school
Finance
Recent illness or loss of loved one
Your health

Assessment Interview
Family Responsibilities
Relationship with friends
Relationship with parents or
children
Relationship with partner
Recent hospitalization
Others

Assessment Interview
How long have you been dealing with
these stressors?
How do you usually handle stressful
situations?
Cry
Get Angry

Assessment Interview
Talk to someone (Who?)
Withdraw from the situation
Control others or situation
Go for a walk or perform physical
exercise
Try to arrive at a solution
Pray

Assessment Interview
Laugh, joke or use some other
expression of humor
Meditate or use some other
relaxation technique such as yoga
or guided imagery
How well does your usual coping
strategy work?

NURSING DIAGNOSIS

Anxiety: Vague,
uneasy feeling of
discomfort

Anxiety: Vague, uneasy feeling
of discomfort
ASSESSMENT
SUBJECTIVE:
I really feel nervous and I cant sleep ...
[scared, regretful, feeling of impending
doom]

Anxiety: Vague, uneasy feeling
of discomfort
OBJECTIVE:
PR = 113 beats per minute
RR = 25 cycles per minute
(+) Restlessness
(+) Hand tremors and facial tension

Anxiety: Vague, uneasy feeling
of discomfort
NURSING DIAGNOSIS:
Anxiety [specify level: mild, moderate, severe, panic]
related to ________ as manifested by ________.
Related Factors:
Threat to or change in health status
Threat of Death
Unmet needs Stress

Caregiver Role
Strain: Difficulty in
performing the
caregiver role.

Caregiver Role Strain: Difficulty
in performing the caregiver role.
ASSESSMENT
SUBJECTIVE:
Im tired and cant focus. Im having
headaches and mild stomach cramps every
morning

Caregiver Role Strain: Difficulty
in performing the caregiver role.
OBJECTIVE:
BP = 190 / 110 mmHg
(+) Low work productivity
(+) Difficulty performing required tasks

Caregiver Role Strain: Difficulty
in performing the caregiver role.
NURSING DIAGNOSIS:
Caregiver Role Strain related to ________ as
manifested by _________.
Related Factors:
Increasing care needs and dependency
Insufficient recreation

Fear: Response to
perceived threat [real
or imagined] that is
consciously recognized
as a danger.

Fear: Response to perceived threat [real or
imagined] that is consciously recognized
as a danger.
ASSESSMENT
SUBJECTIVE:
I feel alarmed whenever Im near an
elevator
[Identifies object of fear; being scared, and
alarmed, decreased self assurance]

Fear: Response to perceived threat [real or
imagined] that is consciously recognized
as a danger.
OBJECTIVE:
PR = 121 beats per minute
RR = 29 cycles per minute
(+) Pupil Dilation
(+) Pallor
(+) Increased Perspiration

Fear: Response to perceived threat [real or
imagined] that is consciously recognized
as a danger.
NURSING DIAGNOSIS:
Fear related to _______ as manifested by
_________.
Related Factors:
Natural or innate origin (sudden noise, height, pain)
Separation from support system in potentially
stressful situation (hospitalization, treatments)

Impaired Adjustment :
Inability to modify
lifestyle in a manner
consistent with a change
in health status.

Impaired Adjustment : Inability to modify
lifestyle in a manner consistent with a change
in health status.
ASSESSMENT
SUBJECTIVE:
Im diabetic but I still love eating
chocolates. Im having a hard time
exercising.
[Denial of health status change, Failure to
achieve optimal sense of control]

Impaired Adjustment : Inability to modify
lifestyle in a manner consistent with a change
in health status.
OBJECTIVE:
(FBS) Fasting Blood Sugar: 225 mg / dl
(+) Demonstration of non acceptance of
health status change.

Impaired Adjustment : Inability to modify
lifestyle in a manner consistent with a change
in health status.
NURSING DIAGNOSIS:
Impaired Adjustment related to ________ as
manifested by _________.
Related Factors:
Disability or health status requiring change in
lifestyle
Negative attitudes toward health behavior
Lack of motivation to change behavior

INEFFECTIVE
COPING

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

Ineffective Coping
ASSESSMENT
SUBJECTIVE:
After my husbands death, I always feel
tired I cant sleep and I dont like eating
[Verbalizations of inability to cope or inability
to ask for help; sleep disturbance; fatigue]

Ineffective Coping
OBJECTIVE:
BP = 220 / 120 mm Hg
(+) Poor concentration
(+) Irritable bowel

Ineffective Coping
NURSING DIAGNOSIS:
Ineffective Coping related to _________ as
manifested by _________.
Related Factors:
Situational / Maturational Crisis
High Degree of Threat
Inadequate resources available

PLANNING

PLANNING
Decrease or resolve anxiety.
Increase ability to manage or
cope with stressful events or
circumstances.
Improve role performance.

INTERVENTIONS

INTERVENTIONS
Encouraging Health Promotion
Strategies
Minimizing Anxiety
Mediating Anger
Using Relaxation Techniques

Encouraging Health
Promotion
Strategies

Encouraging Health Promotion
Strategies
EXERCISE
NUTRITION
SLEEP
TIME
MANAGEMENT

EXERCISE
Physiologic Benefits:
Improved muscle Tone
Increased cardiopulmonary function
Weight Control
Psychologic Benefits:
o Relief of Tension
o A feeling of well being and relaxation

EXERCISE
2005, Federal
Dietary Guidelines
Advisory Committee
recommend:
30 minutes of
daily exercise

NUTRITION
AVOID:
Excess
Caffeine
Salt
Sugar
Fat

SLEEP
SLEEP restores the
bodys energy level.
To ensure adequate
sleep, clients may need
help to attain comfort
and to learn techniques
that promote peace of
mind and relaxation.

TIME MANAGEMENT
People who manage
their time effectively
usually experience
less stress because
they feel more in
control of their
circumstances.

Minimizing Anxiety

Minimizing Anxiety
Listen attentively
Provide an atmosphere of warmth
and trust
Determine if it is appropriate to
encourage clients participation in
the plan of care. GIVE THEM
CHOICES

Minimizing Anxiety
Stay with the client
Control environment
Implement suicide
precautions if indicated
Communicate in SHORT,
CLEAR sentences

Minimizing Anxiety
Help client to:
Determine situation that causes
anxiety and identify signs of
anxiety.
Verbalize feelings
Identify personal strengths
Recognize usual coping patterns

Minimizing Anxiety
Identify new strategies for
managing stress (exercise,
massage, progressive relaxation)
Identify available support systems
Teach client about:
Importance of exercise, balanced
diet, rest and sleep.

Minimizing Anxiety
Support groups: Alcoholic
Anonymous, Weight Watchers
or Overeaters Anonymous.
Educational programs: Time
management, Assertiveness
training and meditation groups.

Mediating Anger

Mediating Anger
FONTAINE and FLETCHER (2003)
recommend the following
strategies for dealing with clients
anger:

Mediating Anger
Know and understand your own
response to the feelings and
expression of anger.
Accept the clients right to be
angry.
Try to understand the meaning of
the clients anger.

Mediating Anger
Ask the client what contributed to
the anger.
Help the client own the anger.
Dont assume responsibility.
Let clients talk about their anger.
Listen. Act calmly as possible.

Using Relaxation
Techniques

Using Relaxation Techniques
Breathing
Exercises
Massage
Progressive
Relaxation
Imagery
Biofeedback
Yoga
Meditation
Therapeutic
Touch
Music Therapy
Humor and
Laughter

BREATHING EXERCISES
ABDOMINAL
(DIAPHARGMATIC)
BREATHING
It permits deep full
breaths with little
effort.
PURSED LIP
BREATHING
The purse lip creates a
resistance to the air
flowing out of the lungs
thereby prolonging
exhalation.
Client inhales to a count
of 3 and exhales to a
count of 7.

MASSAGE
Manipulating soft tissues with the
hands to promote relaxation.
Includes: EFFLEURAGE
(stroking)
PETRISSAGE (kneading)
TAPOTEMENT (tapping)

MASSAGE
Massage aids the body to
heal itself!
Improves blood flow and
movement of lymph fluid.
Speeds the removal of
metabolic products
Allows more oxygen and
nutrients reach the cell

MASSAGE
Release muscle tension
Improves joint flexibility,
ROM
Improves posture
Lowers BP
Slows heart rate
Promotes deeper and
easier breathing

MASSAGE
Improves health of the skin
Relaxed state of alertness
Reduces mental stress
Increases capacity for
clearer learning
Satisfies the need for caring
and nurturing

PROGRESSIVE RELAXATION
Systematically TENSING
RELAXING muscle groups from
head to toe.
Duration: 15 to 30 minutes

PROGRESSIVE RELAXATION
TENSE each muscle group for 5
to 7 seconds then RELAX
quickly
- Face, jaw, mouth (squint eyes,
wrinkle brow)
- Neck (pull chin to neck)
- Right hand (make a fist)

PROGRESSIVE RELAXATION
- Right arm (bend elbow tightly)
- Left hand (make a fist)
- Left arm (bend elbow tightly)
- Back shoulders, chest (shrug
shoulders up tightly)
- Abdomen (pull stomach in)

PROGRESSIVE RELAXATION
- Right upper leg (push leg down)
- Right lower leg and foot (point
toes toward body)
- Left upper leg (push leg down)
- Left lower leg and foot (point toes
toward body)

IMAGERY
IMAGERY is
Formation of a
mental
representation
of an object
that is usually
only perceived
through
senses.

IMAGERY
GUIDED IMAGERY is a state of
focused attention, much like
hypnosis.
GUIDED IMAGERY can help us
stop troublesome thoughts and
focus on images that help us
relax.

GUIDED IMAGERY
Images maybe created by the THERAPIST.
FEELING STATE
-move from a feeling state of
tension to one of peace.
Ex: Imagine self at a beach or
floating gently on water

GUIDED IMAGERY
END STATE
-Imagine self in the situation
wished for.
Ex: See self as strong and
healthy

GUIDED IMAGERY
CELLULAR
-Imagine events at a cellular level
Ex: Imagine natural killers
surrounding and attacking cancer
cells.

BIOFEEDBACK
Biofeedback is a method for
learned control of physiologic
responses of the body. It is a
relaxation technique that uses
electronic equipment to amplify
the electrochemical energy
produced by body responses.

BIOFEEDBACK
Conscious control of bodily
processes normally thought to be
beyond voluntary command:
muscle tension, heartbeat, blood
flow, peristalsis and skin
temperature can be voluntarily
controlled.

BIOFEEDBACK
Feedback provided through:
Temperature meters indicates
temp. changes
EMG (electromyography) record
electrical activity of muscles

YOGA
First practiced in INDIA.
Typical Yoga Session: 20
minutes to an hour.
Beginning researches
indicates people with
diabetes who practice
yoga may increase the
release of insulin from
the pancreas.

MEDITATION
Meditation is a general term for a wide
range of practices that involve relaxing the
body and easing the mind.
Can be practiced individually or by groups.
If practiced regularly such as 20 minutes
twice a day, it produces widespread
positive effects.

MEDITATION
GUIDELINES:
1. Create a special time and place.
2. SIT. Avoid a lying position.
3. Support palms on thighs and close eyes.
4. Deep breathing or progressive relaxation
exercise.
5. Focus attention completely.
6. Practice daily for 10 to 20 minute period.

THERAPEUTIC TOUCH
Therapeutic touch is a process by
which energy is transmitted or
transferred from one person to
another with the intent of
potentiating the healing process
of one who is ill or injured.

MUSIC THERAPY
QUIET, soothing music without words is often
used to induce relaxation.
Music recordings are often used to relax and
distract client in operative settings, ICUs,
birthing rooms, rehabilitation and physical
therapy units.

HUMOR AND LAUGHTER
Humor in nursing is defined as helping the
client to perceive, appreciate and express
what is funny, amusing or ludicrous in order
to establish relationships, relieve tension,
release anger, facilitate learning or cope with
painful feelings.