Counterproductive cognitive and/or behavioral efforts to manage a stressful or unpleasant situation

• High degree of threat
• Impaired resilience
• Inaccurate threat appraisal
• Inadequate access to resources
• Inadequate confidence in ability to deal with a situation
• Inadequate knowledge of resources
• Inadequate knowledge of stress management strategies
• Inadequate preparation for stressors
• Inadequate sense of control
• Inadequate social support
• Inadequate use of emotion-focused strategies
• Inadequate use of problem-focused strategies

• Psychosocial status, including age, developmental stage, health beliefs, and attitudes
• Current health status
• Diversional activities
• Motivation to learn and obstacles to learning
• Financial resources
• Occupation
• Patient's perception of present health problem or crisis
• Coping techniques that have worked for the patient in the past
• Usual problem-solving techniques/behaviors used to cope with life problems
• Physical or emotional impairment
• Family members' understanding of the client's health status
• Problem-solving techniques usually employed by the family to cope with life problems
• Support systems, including family, companion, friends, and clergy

• Patient will express need to develop better coping behaviors.
• Patient will express understanding of the relationship between emotional state and behavior.
• Patient will communicate feelings about the present situation.
• Patient will be actively involved in planning own care.
• Patient will demonstrate ability to use newly learned coping skills.
• Patient will express feeling of having greater control over present situation.
• Patient will use available support systems, such as family and friends, to aid in coping.
• Patient will reduce use of manipulative behavior to gratify needs.
• Patient will accept responsibility for behavior.
• Patient will demonstrate ability to cope with unexpected changes.
• Patient will identify effective and ineffective coping techniques.
• Patient will identify and demonstrate ability to use at least two healthy coping behaviors.

Suggested NOC Outcomes

• If possible, assign a consistent care provider to patient to provide continuity of care and promote development of therapeutic relationship.
• Arrange to spend uninterrupted periods of time with patient. Encourage open expression of feelings. Try to identify factors that cause or exacerbate patient's inability to cope, such as fear of loss of health or job. Devoting time to listening helps patient express emotions, grasp situation, and cope effectively.
• Identify and reduce unnecessary stimuli in environment to avoid subjecting patient to sensory or perceptual overload.
• Explain all treatments and procedures, and answer patient's questions to allay fear and allow patient to regain sense of control.
• Have patient increase self-care performance levels gradually to allow self-paced progress.
• Praise patient for making decisions and performing activities to reinforce coping behaviors.
• Establish an environment of mutual trust and respect to enhance the patient's learning.
• Negotiate with patient to develop learning goals to promote cooperation and foster a sense of control.
• As patient becomes able to express feelings more openly, discuss the relationship between feelings and behavior. To change, patient must understand this relationship.
• Discourage dependent behavior by assisting patient only when necessary. Provide positive reinforcement for independent behavior to enhance self-esteem, encourage repetition of desired behavior, and promote effective coping.
• Encourage the patient to make decisions about care to reduce feelings of helplessness and enhance the patient's sense of mastery over the current situation.
• Set limits on manipulative behavior. Provide patient with clear expectations for behavior and describe the consequences if limits are violated. If patient can't curb inappropriate behavior, consistent limit-setting imposes external controls.
• Help patient recognize and accept responsibility for own actions. Discourage patient from unfairly placing blame on others. Developing a sense of responsibility is necessary before change can occur.
• Help patient recognize and feel good about positive personal qualities and accomplishments. Provide rewards to reinforce acceptable coping behaviors. As self-esteem increases, patient will feel less need to manipulate others.
• Praise patient for identifying and using effective coping techniques to reinforce appropriate behavior.
• Suggest alternatives to ineffective behaviors identified by patient. Encourage patient to determine what new behaviors can be effectively incorporated into the lifestyle. Fostering patient participation in care promotes feelings of independence.
• Select teaching strategies (discussion, demonstration, role-playing, and visual materials) appropriate for patient's learning style to encourage compliance.
• Teach strategies that patient can use to develop coping skills. Knowing different strategies gives patient options in stressful situations.
• Teach patient relaxation techniques of deep breathing and guided imagery. Relaxation can assist to reduce anxiety and feelings of anger.
• Encourage patient to use support systems to assist with coping, thereby helping restore psychological equilibrium and prevent crisis.
• Help patient look at current situation and evaluate various coping behaviors to encourage a realistic view of crisis.
• Encourage patient to try coping behaviors. A patient in crisis tends to accept interventions and develops new coping behaviors more easily than at other times.
• Request feedback from patient about behaviors that seem to work to encourage patient to evaluate effect of these behaviors.
• Refer patient for professional psychological counseling. If patient's maladaptive behavior has high crisis potential, formal counseling helps ease nurse's frustration, increases objectivity, and fosters collaborative approach to patient's care.

Suggested NIC Interventions

• Patient states need for better coping behaviors.
• Patient discusses recent stressful event and describes related emotions.
• Patient describes emotions triggered by illness or personal crisis and usual coping behaviors.
• Patient cooperates with nurse to plan care.
• Patient describes one difficult interpersonal situation that was solved by identifying the problem, choosing alternative ways to communicate, and taking action.
• Patient identifies problems, makes plans, and takes action.
• Patient requests assistance from family and friends.
• Patient demonstrates ability to cope with unexpected change.
• Patient identifies and uses at least two healthy coping behaviors such as relaxation techniques.

• Patient's perception of present situation and what it means
• Patient's verbal expression of feelings indicating comfort or discomfort
• Patient's expressions indicating his or her motivation to learn
• Patient's learning objectives
• Methods used to teach patient
• Information taught and skills demonstrated to patient
• Observations of patient's behaviors
• Interventions to help patient cope
• Patient's responses to interventions
• Evaluations for expected outcomes

• Evans, C., Cotter, K., & Smokowski, P. (2017). Giving victims of bullying a voice: A qualitative study of post bullying reactions and coping strategies. Child & Adolescent Social Work Journal, 34(6), 543-555.
• Ito, M., & Matsushima, E. (2017). Presentation of coping strategies associated with physical and mental health during health check-ups. Community Mental Health Journal, 53(3), 297-305.
• Lim, R. H., & Sharmeen, T. (2018). Medicines management issues in dementia and coping strategies used by people living with dementia and family carers: A systematic review. International Journal of Geriatric Psychiatry, 33(12), 1562-1581.
• Suzuki, M., Furihata, R., Konno, C., Kaneita, Y., Ohida, T., & Uchiyama, M. (2018). Stressful events and coping strategies associated with symptoms of depression: A Japanese general population survey. Journal of Affective Disorders, 238, 482-488.