Nursing Care Plan

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Medical Diagnoses: Ineffective coping , disturbance in pattern of tension release, uncertainty and inadequate resources available

Nursing DX/Clinical Problem

Client Goals/Desired Outcomes/Objectives

Nursing Interventions/Actions/Orders

Evaluation

Goals

Interventions

Ineffective coping r/t disturbance in pattern of tension release, uncertainty and inadequate resources available  as evidenced by client report of consuming a quart of alcohol a day, client report of smoking a pack of cigarettes a day, report of sleep disturbance and verbalization of avoiding others in the community out of fear and verbalization of lack of friends and lack of communication with family members.



Short term goals:

1.        Client will identify personal strengths as measured by the verbalization of two characteristics that aid in problem solving by 15:00, [Month] 14, [Year]. 

2.        Client will describe previous stressors and coping mechanisms used as measured by verbalization of at least two stressful circumstances and how she coped with them by 15:00, [Month] 14, [Year].

3.        Client will express feelings about using substances as a method of coping with stress as measured by verbalization of those emotions by 15:00, [Month] 14, [Year].

         

         

Long term goals:

1.        Client will demonstrate ability to cope effectively to stressors measured by utilization of two new stress-reducing skills by 15:00, August 1, [Year]

2.        Client will verbalize use of adaptive coping mechanisms utilized instead of substance use in response to stress as measured by verbalization of coping mechanisms by 15:00, August 1, [Year].

         

Monitor client for risk of harming self or others and intervene as warranted. Substance use is a risk factor for suicide and homicide (Hauenstein & Boyd, [Year]).

Use verbal and nonverbal therapeutic communication approaches including active listening, empathy, and acceptance to encourage the client to express negative emotions and verbalize fears and concerns. Psychological manifestations of ineffective coping can only be understood through the client’s framework of appraisal (Dudley-Brown, 2002).

Collaborate with the client to identify personal strengths. Recognition of personal strengths identifies a person’s values and beliefs as well as allowing for coordination of interventions to fit the client’s perception of threat (Raak, Hurtig, & Wahren, 2003).

Increase and mobilize support available by encouraging participation at Oak and Acorn facility and enrollment in the Senior Companion program through Elderserve. Relationships are pivotal in supporting coping in older adults (Ho, [Year]).

Offer instruction regarding alternative coping strategies including using physical activity as a distraction, deep breathing exercises, and reminiscence.  Alternate methods of coping should be introduced and offered to a client as a possible choice of a new coping strategy (Wassem, Beckham, & Dudley, 2001).

Engage the client in reminiscence. Life review as an intervention had a significant effect of lowering depression and evokes positive memories and well-being (Puentes, 2002).

         

         


Short term goals:

1.        Goal met.  Client identified personal strengths as being observant and knowledgeable about when to call her social worker for assistance on at 10:45 on June 30, [Year].

2.        Goal met.  Client reported situations where she called her social worker for guidance and her older brother C. for financial assistance. She also reported maintaining a positive attitude and attending church as sources of coping.

3.        Goal not met.  Client wasn’t forthcoming regarding emotions associated with substance use as a coping tool.  Development of a deeper trust is still necessary.

         

Long term goals:

         

1.        Goal not met. Evaluation of this goal is set for August 1, [Year], 15:00. The client has made no progress toward this goal.

2.        Goal not met. Evaluation of this goal is set for August 1, [Year], 15:00.  The client has made no progress towards this goal.

Client stated no desire to commit suicide or homicide.

Utilized verbal and nonverbal therapeutic communication approaches.  Client verbalized fear of others within the community, including hesitancy to develop relationships due to concerns of being taken advantage of, robbed, or assaulted. Client provided noncommittal responses to questions regarding substance use as a coping mechanisms. Continued development of a therapeutic relationship is required.

Collaborated with client to identify personal strengths and coping mechanisms that were successful in the past during periods of stress. She identified that she is observant and knows to call her social worker if she needs help.  Continued strength identification is warranted.

Oak and Acorn was suggested as a community resource and the client expressed interest in going there.  Referral will be in place [Month] 21, [Year]. Discussion regarding the Senior Companion program to be performed [Month] 21, [Year].

Provided instruction regarding the benefits of regular exercise on stress and suggested it as an alternative to drinking or smoking.  Demonstrated 4-square deep breathing and client return demonstrated it.  She has breathing problems related to asthma causing some difficulty; however, she indicated she would like to keep practicing.

Conducted a scrapbooking activity to facilitate reminiscence.  The client enjoyed the activity and expressed a desire to do it again.  Continuation of activity recommended as well as creation of a reminiscence program to foster socialization and support network development.

         

Subjective Data:

Client report of consuming approximately one quart of alcohol daily. Client report of smoking approximately 1 pack of cigarettes daily.  Client report of infrequent contact with immediate family members. Client’s verbalization of fear of developing relationships with others in her community because “they’re trouble.” Client’s report of sleep disturbances.

         

Objective Data

Client was observed drinking at 10:30 AM with her live-in boyfriend.

Client demonstrates lack of goal-directed behavior in problem solving (i.e. finding something to do when bored).

         

         



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