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Coping PPT - Class - Student

This document discusses coping and ineffective coping. It defines coping as an emotional and/or physical response to stress that aims to reduce stress. Ineffective coping can lead to physical or mental health problems. The document outlines Selye's general adaptation syndrome model of stress response and describes risk factors, consequences, assessments, nursing diagnoses, goals, and nursing interventions related to coping. The priority nursing intervention for a patient in distress is to encourage communication.

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301 views

Coping PPT - Class - Student

This document discusses coping and ineffective coping. It defines coping as an emotional and/or physical response to stress that aims to reduce stress. Ineffective coping can lead to physical or mental health problems. The document outlines Selye's general adaptation syndrome model of stress response and describes risk factors, consequences, assessments, nursing diagnoses, goals, and nursing interventions related to coping. The priority nursing intervention for a patient in distress is to encourage communication.

Uploaded by

katrinasd
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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COPING

RNSG 1128
Objectives – The student will be able to …

• Explain the concept of coping (including definition,


antecedents, and attributes).
• Analyze conditions which place a patient at risk for
Ineffective/Maladaptive Coping.
• Identify when Ineffective/Maladaptive Coping is
developing or has developed.
• List key points of common Ineffective/Maladaptive Coping
disorders.
• Apply the nursing process (including collaborative
interventions) for individuals experiencing
Ineffective/Maladaptive Coping and to promote
Effective/Adaptive Coping.
Definition of Coping
• Multiple definitions
• All definitions include an emotional and/or
physical response to a change in one’s status or
environment in order to reduce stress
• Easier to define ineffective/maladaptive coping
Antecedents of Coping -
• Individual perceptions
• Insight and honesty
• Individual boundaries
• Life experiences
• Anticipation
• Positive defense mechanisms
• Ability to cognitively and emotionally appraise and manage
internal and/or external situations
• Available resources and support systems
• Relationships with people
• Relationships with environment
Attributes of Coping -
• Calm affect
• Positive coping mechanisms
• Effective and age appropriate
communication
• Ability to perform ADLs and IADLs
• Use of available support systems
Selye’s
General Adaptation Syndrome

Any event (stressor) that threatens an individual


leads to a 3 stage response
• Alarm
• Resistance
• Exhaustion
• “Fight or flight” response

http://www.youtube.com/watch?v=N5txl89dzv8
Alarm Stage
•Brain activity
•Hypothalamus stimulates the sympathetic nervous
system
•Pupils dilate
•Bronchioles dilate, respiratory rate increases
•Cardiac contractility, HR, BP, and cardiac output increase
•Sweat gland secretions increase
•Adrenal medulla
•releases norepinephrine
•releases epinephrine (adrenolin)
•Adrenal cortex produces corticosteroids
•Glycogenolysis and gluconeogenesis increase
•Glycogen synthesis decreases
•Endorphins are released
Resistance Stage
• Adaptation stage
• Remain “On alert”
• HR remains elevated
• Outward appearance seems normal
• Glucose and hormone levels remain high
• Muscle perfusion is increased
• GI perfusion, motility and secretions decrease
• Failure to resolve stressor leads to next stage
Exhaustion Stage
• Stressors continue beyond the individual’s
resources
• Resources are depleted
• Susceptible to physical and emotional
disease and death
During which stage of the GAS will
the heart rate increase, breathing
quicken and pupils dilate?

A. Alarm
B. Resistance
C. Exhaustion
D. Recovery
Reflective Exercise
Think of a stressor
that you’ve experienced?
How did you respond?
Rate your coping ability
on a scale of 1-10.
What would have helped
you cope better?
Ego Defense Mechanisms
• Denial • Sublimation
• Undoing • Compensation
• Acting out • Assertiveness
• Dissociation • Suppression
• Regression • Identification
• Projection • Introjection
• Displacement • Isolation
• Intellectualization • Humor
• Reaction formation
Which defense mechanism is being
used when a student yells, “I would
have done better if you didn’t make
the test so hard.”

A. Regression
B. Intellectualization
C. Displacement
D. Reactive formation
Key Points of Coping

• Coping can apply to an individual, a family, or an entire


community
• Coping occurs along a spectrum from effective/adaptive
responses to ineffective/maladaptive responses
• Coping may be problem focused or emotion focused
• All individuals use coping mechanisms regardless of race,
sex, or gender.
• Outcomes of coping range from resolution to acceptance
How do you know a patient is effectively coping?

A. The patient is anxious but


working on the assigned task.
B. The patient is watching TV
and ignoring the therapist
C. The patient clearly states his
needs
D. The patient gets up to the
bathroom without necessary
assistance.
Desired Coping Response
• Results in resolution of stressor(s) if possible
• Results in acceptance of stressor(s)
• Requires full cognitive capacity
• Culturally sensitive and diverse

Individual evaluation
• Primary appraisal - Is the stressor a threat?
• Secondary appraisal - Can the individual overcome
the stressor?
Risk Factors
• Age
• Impaired cognition
• Inability to accurately assess the stressor
• Denial or avoidance of the stressor (negative defense
mechanisms)
• An actual or perceived lack of control over the situation
• An actual or perceived lack of support/resources
• No experience or poor past experiences handling stressful
situations
• Deterioration in Health or Chronic Health Conditions
Factors Affecting Ability to Cope

• Type and number of stressors


• Perception of stressors
• Length of time that stressor occurs
• Type of coping mechanism implemented
• Resilience of individual
• Previous experiences
• State of health
• Available resources
Consequences of Poor Coping
• Maladaptive coping responses can
lead to physical and/or psychosocial
problems
• Consider individual risk factors
• Highly variable
Consequences of Poor Coping
• Decline in physical health
• Peptic ulcer disease
• Hypertension
• Decline in mental health
• Isolation
• Depression
Consequences of Poor Coping
• Alteration in functional ability
• Job loss
• Poor hygiene
• Alteration in family dynamics
• Separation/divorce
• Poor communication
Which one of the following is not a
consequence of maladaptive coping?
A. Sue scores 74 on her biology exam
after studying all night and
forgoing sleep.
B. John’s heartburn rarely occurs now
even though his workload stayed
the same.
C. Wes is living on the street after he
argued with his parents
D. Mary is still with her boyfriend
even though she no longer loves
him.
Assessment
• History
• Perception of Threat
• Past Coping Patterns
• Social
• Family dynamics/friends
• Work/recreation
• Living environment
• Financial
Assessment
• Screening tools
• Global mental health assessment tool
• Self-HARM assessment tool
• CAGE-Alcohol misuse screening tool
• Assessment scales
• Mini Mental State Examination
• Sleep Scale
• Beck Anxiety Inventory Scoring for Children
• Mainz coping inventory
• Coping strategy inventory
Nursing Diagnoses
• Ineffective/Maladaptive Coping
• Compromised Family Coping
• Ineffective Community Coping
• Readiness for Enhanced Coping
Outcomes/Patient Goals
• Patient will display Effective/Adaptive Coping
• Patient will display Readiness for Enhanced Coping
• Patient will use Effective/Adaptive Family Coping
• Patient will use Effective/Adaptive Community Coping

• Patient will attend counseling bi-weekly


• Patient will follow medication regime
• Patient will state improvement in mood
• Patient’s blood pressure will be normalized
Nursing Interventions
• Accept patients where they are
• Assist with ADLs and IADLs
• Provide an environment of acceptance
• Quiet and safe environment
• Utilize therapeutic communication
• Encourage verbalization of feelings, perceptions, and fears
• Assist patient to recognize his or her own anxiety
• Reinforce that shame and guilt are self imposed
• Identify stressors related to the present physical condition
Nursing Interventions
• Identify ways to modify or eliminate the stressors
• Improve psychological and physiologic comfort
• Anxiolytics
• Interactive therapies
• Behavioral modifications
• Assist in the development of effective coping
skills
• Acknowledge the patient’s spiritual/cultural
background
• Discourage decision making when the patient is
under severe stress
Nursing Interventions
• Primary prevention
• Teach stress reduction
• Teach coping skills
• Identify available resources and supports
• Secondary prevention
• Various assessment and screening tools
• Tertiary prevention
• Continued counseling
• Providing referrals to available resources
and supports
Nursing Interventions
• Critical skills
• Assessment of coping response
• Therapeutic communication
• De-escalation techniques
• Medications
• Meet physiological needs
Nursing Interventions
• Collaborative interventions
• Psychiatry
• Psychology/counseling
• Social work
• Play or art therapy
• Occupational/physical therapy
• AA or other 12 step program
What is the priority intervention for a patient
in distress?

A. Escort patient to the


therapist’s office.
B. Medicate as prescribed
C. Provide nutrition
D. Encourage communication

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