Coping Mechanisms: NCLEX-RN
In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of coping mechanisms in order to:
- Assess the client's support systems and available resources
- Assess the client's ability to adapt to temporary/permanent role changes
- Assess the client's reaction to a diagnosis of acute or chronic mental illness (e.g., rationalization, hopefulness, anger)
- Assess client in coping with life changes and provide support
- Identify situations which may necessitate role changes for a client (e.g., spouse with chronic illness, death of parent)
- Provide support to the client with unexpected altered body image (e.g., alopecia)
- Evaluate the constructive use of defense mechanisms by a client
- Evaluate whether the client has successfully adapted to situational role changes (e.g., accept dependency on others)
Simply defined, coping, is the patient's ability to institute, maintain and regain psychological homeostasis when this homeostasis is disrupted for one reason or another. Coping can be adaptive and it can also be useless and maladaptive. Coping is adaptive when it resolves the stress, and it is maladaptive when it does not resolve the stress and/or it creates further problems for the client. For example, alcoholism that results from a client's self medication to cope with the loss of a loved one not only does not resolve the stress associated with this situation crisis, it also leads to depression and other psychological and physical health problems.
Coping strategies are thoughts, behaviors, perceptions, and emotions that a client can and does use to cope with stress and any of their disruptions of psychosocial homeostasis. Stress significantly and adversely impacts on the wholistic client and their physical, mental and social health and wellbeing.
Stress occurs as the result of significant life events such as illness, divorce, moving, parenthood, financial problems, and the death of a loved one and it also can occur secondary to the daily stressors that occur in normal life.
The adverse effects of stress are intensified as based on the intensity of the stress, the duration of the stress, the effectiveness of the client's protective mechanisms against stress, and the effectiveness of the coping mechanisms that the client is using to cope with the stress. Excessive and intense stress can lead to distress and the damaging physiological effects of the General Adaptation Syndrome
Hans Selye developed the General Adaptation Syndrome theory, in addition to the Local Adaptation theory which details the inflammatory process, as previously discussed with the "Infection Control" section at the beginning of this NCLEX-RN review. The General Adaptation Syndrome theory describes the stages of stress and the effects of this stress on the human being.
The stages of stress, according to the General Adaptation Syndrome theory, in correct sequential order, include:
- The stage of alarm also referred to as "Fight or Flight": The signs and symptoms of this first stage of the stress response include increases in terms of the person's cardiac, respiratory, and blood pressure measurements, increased blood cortisol and adrenalin levels, increased cardiac output, the increased and enhanced use of glucose by the body, an increased metabolic rate, apprehension, fear, dilated pupils, decreased gastrointestinal functioning, sympathetic nervous system activation, and impaired immune system functioning, all of which prepare the client to fight or flee.
- The stage of resistance is characterized with the return of many physiological changes to their normal level in addition to maintained increased blood glucose, cortisol and adrenalin levels, increased blood pressure, cardiac rate and respiratory rate.
- The stage of exhaustion, which can lead to death, is characterized with the complete loss of and exhaustion of all the body's resources and mechanisms.
Some patients use a wide variety of coping mechanisms and other patients may have only a few or no coping mechanisms. Coping mechanisms are learned; some are effective and others are not. Patients with no effective coping mechanisms must be taught about new and more effective ways to cope with stress and stressors. Those who have effective methods of coping should be encouraged to use and refine them during times of crisis.
Commonly used coping mechanisms include changing one's perception of the issue at hand, using humor, using problem solving skills, employing stress management and relaxation techniques, seeking out and using the support of others, ventilating feelings, embarking on a physical exercise and activity routine, decreasing personal expectations, and avoiding self-blame.
Assessment data and information that should be collected in respect to the client's level of psychosocial functioning and coping mechanisms should entail the client's age at the onset of the coping disorder, the client's specific psychosocial signs and symptoms, the duration of these episodes, the number of episodes that required intense treatment, the client's family history of any psychiatric mental health disorders, the client's use of support systems, the effectiveness of these support systems, the client's utilization of available resources in their community, the effectiveness of these available resources in terms of the client's needs, the client's past coping mechanisms, and the client's current use of adaptive and effective and/or maladaptive and non effective coping strategies.
Two standardized assessment measurement tools that can be used to collect psychosocial data and information are the "Interval Follow Up Evaluation" and the "Range of Impaired Functioning" tool which assess and measure the client's level of functioning in terms of their interpersonal relationships, their work, their leisure and recreational activities, and their overall level of satisfaction with life over time as well as the measurement and assessment of these same variables at the current time, respectively. Coping and stressors can also be assessed and measured with standardized tests like the "Hommes and Rahe Life Change Scale" and the "Lazarus Cognitive Appraisal Scale".
Some of the signs and symptoms of maladaptive coping, in addition to the signs and symptoms associated with the General Adaptation Syndrome, include subjective complaints of not feeling or believing that one is able to cope.
Prolonged stress can affect the body in physical, emotional or psychological ways. For example, stress can lead anxiety, chronic pain, a weight gain or loss, distress, tension, distress, dangerous and harmful behaviors towards self and/or others, irritability, depression, a lack of focus, forgetfulness, hypertension, fatigue, poor concentration levels, headaches, sleeping impairments, trembling, stomach aches, muscular tension and other somatic complaints, increased vulnerability to disorders and diseases such as a cerebrovascular accident, infections, a myocardial infarction, and poor control of preexisting diabetes.
In addition to the assessment of individual client's signs and symptoms, nurses also assess their support systems, available resources, coping strategies of families, other groups, communities and populations.
Nurses must be able to assess and plan care for clients to enhance and facilitate their ability to adapt to temporary and permanent life changes.
Temporary role changes are typically less stressful to the client when compared to permanent role changes that can lead to stressful major life changes and an increasing dependency on others which are also often coupled with a decrease in the client's levels of self-worth and self-esteem. Examples of temporary role changes include things like an extensive loss of work as the result of an injury such as a back injury that prohibits one's working and the temporary inability of the client to adequately care for their children because of a physical or psychological problem such as a broken leg or a substance related addiction; and examples of permanent role changes include the loss of children as the result of child abuse or neglect and a client's permanent lack of ability to perform their basic activities as the result of paralysis. Permanent as well as temporary role changes can often lead to anxiety and stress.
After a complete focused assessment relating to the client and their responses to role changes, registered nurses plan interventions that are appropriate for the individual client and their assessed needs. Some of these interventions can include facilitating and encouraging the client to ventilate their true feelings about this loss in an accepting, open and trusting nurse-client relationship, engaging the client with the identification of realistic expectations of self and then nurses can assist patients with their responses and reactions to permanent and temporary role changes by allowing and encouraging the patient to ventilate their feelings and also by helping the patient explore and identify realistic goals and to establish realistic expectations of what they are able to do despite some role changes and losses.
Assessing the Client's Reactions and Responses to Acute and Chronic Illnesses Including Mental Illness
Some of the most commonly occurring psychological and emotional alterations associated acute and chronic illness, including a mental illness can include:
- Loss of hope and meaning
Distress: Distress can range from mild to severe and even disabling with signs and symptoms which can be behavioral as well as physical in nature. Distress can be characterized with signs and symptoms such as irritability, insomnia and social withdrawal. Distress can manifest with client forgetfulness, irritability, restlessness, hyperactivity, and somatic complaints such as headaches and insomnia in addition to some of the signs and symptoms of stress as detailed above under the General Adaptation Syndrome.
Anger: Anger can be turned inward and lead to depression and anger can also be turned outward and lead to hostility, anger, harm to others, harm to self, and destructiveness, all of which are not socially acceptable. Anger is often displaced onto another as will be discussed below under the section entitled "Evaluating the Constructive Use of Defense Mechanisms by a Client".
Denial: Denial, like rationalization and displacement, is another psychological defense mechanism. Denial occurs when the client pushes the threatening situation into the subconscious so that the client is not forced to deal and cope with it until the client's psyche is better able to deal with it.
Rationalization: Rationalization occurs when the client explains away the threatening event or situation with faulty thinking rather than dealing and coping with it. Rationalization will also be more fully discussed later in this review with the section entitled "Evaluating the Constructive Use of Defense Mechanisms by a Client"
Guilt: The ultimate purpose of guilt is to let a human know and gain insight into something that they have done that is wrong. The identification and the recognition of guilt give the person the opportunity to change their unacceptable behaviors and to make amends for their transgressions and wrong doings. Unresolved guilt, however, can lead to despair, distress, spiritual distress, physical signs and symptoms and psychological signs and symptoms.
Nurses can help the patient to overcome and resolve their guilt by emotionally and spiritually supporting the client, by facilitating the client's ventilation of feelings, by encouraging the patient to change behaviors, and by encouraging the client to make necessary amends to others for their wrong doings.
Grief: Grief, as defined by the North American Nursing Diagnosis Association (NANDA), is the "normal complex process that includes emotional, physical, spiritual and intellectual responses and behaviors by which the individuals, families, and communities incorporate a loss into their daily lives". All losses can be accompanied with grief. For example, the loss of the use of a limb as the result of paralysis is a physical loss, the loss of a loved one and the loss of self-esteem are losses which can be accompanied with grief. Although grief is a normal, adaptive response to loss, complicated and unresolved grief is maladaptive. More details about grief and loss will be provided in a later section of this NCLEX-RN review under the section entitled "Grief and Loss".
Depression: Depression commonly occurs as the result of an acute or chronic illness, including mental health disorders; depression can affect both the client and the family unit. This symptom can lead to physical, psychological and cognitive changes. Some of the signs and symptoms associated with depression include feelings of helplessness, hopelessness, low self-esteem, decreased sense of self-worth, sadness, insomnia, poor problem solving and decision making processes, and decreased libido among other signs and symptoms. Severe and unresolved depression can, in some cases, lead to suicidal and/or homicidal ideation.
Fear: Fear is a response to a perceived impending or actual danger, including illness. Although there are similarities with both anxiety and fear, there are also some distinct differences. Fear is less vague and less diffuse than anxiety; fear is most often associated with a current threat and anxiety is most often associated with a future threat, and fear, unlike anxiety, is most often associated with a specific physical threat and anxiety is most often associated with psychological and emotional conflicts. Some of the signs and symptoms of fear include tachycardia, hypertension, pallor, dilated pupils, aggression, hostility and fatigue.
Loss of hope and meaning: A loss of hope or hopelessness, as defined by the North American Nursing Diagnosis Association (NANDA), is "the subjective state in which an individual sees limited or no alternatives for personal choices available and is unable to mobilize energy on one's own behalf". A loss of hope and meaning has physical, psychological, spiritual and social consequences such as distress, apathy, impaired appetite, passivity, withdrawal, a lack of motivation, spiritual distress, despondency, psychological distress, and a lack of involvement by the client in terms of their activities of daily living and their plan of care.
All changes threaten the homeostasis of the human being. As such, clients have to be able to effectively cope with physical, psychological, social, and economic changes in a healthy and adaptive way with coping. Life changes can be broadly classified and categorized as permanent or temporary, physical, psychological and social, mild to highly significant, and situational or maturational. Despite the nature of the particular change, all changes have to be coped with. Change affects not only individual clients, but it also affects and impacts on family units, groups, populations and communities, including the global community.
Examples of permanent and temporary changes are a physical disfigurement that occurs as the result of a bomb blast and a transient episode of depression or grief, respectively; examples of physical, psychological and social changes can include the loss of a breast secondary to breast cancer or alopecia secondary to therapeutic cancer chemotherapy, grief that occurs as the result of a loved one, and the loss of financial income, respectively; examples of moderate or mild and significantly powerful changes include the birth of a newborn into a previously childless family unit and the loss of a home as the result of a disaster like a cyclone or tornado; and examples of change that can be classified and categorized as situational and developmental or maturational are the loss of work and a salary as the result of an acute illness or accident and the empty nest syndrome that is often seen among middle aged clients as the children leave the home and the normal changes associated with the aging process and disabilities, respectively.
Disabilities as the result of a situational life change can be classified and characterized in a number of different ways. Some of the models and frameworks that can be used to gain a fuller understanding of these situational changes and their nursing considerations are discussed below.
- Social and Cognitive Models: These models emphasize the importance of affected client's ability to remain as independent as possible and ways that the empowered client can exercise their own self-determination, confidence, self efficacy, and control over the environment. Some of the features associated with these social models include environmental and ecological controls and modifications such as legally mandated curb cuts and handicapped parking spaces, ramps, assistive devices and advocacy for the individual, family, group, population or community client.
- The Nagi Model: This model identifies and addresses disability as an emotional or physical impairment or limitation within the social environment. In essence, disability and limitations are a function of the discrepancy between the client's abilities and the limitations of the physical and social environment.
According to Nagi, "Disability is a limitation in performing socially defined roles and tasks expected of an individual within a sociocultural and physical environment. These roles and tasks are organized in spheres of life activities such as those of the family or other interpersonal relations; work, employment, and other economic pursuits; and education, recreation, and self-care. Not all impairments or functional limitations precipitate disability, and similar patterns of disability may result from different types of impairments and limitations in function. Furthermore, identical types of impairments and similar functional limitations may result in different patterns of disability.
Several other factors contribute to shaping the dimensions and severity of disability. These include the:
- Individual's definition of the situation and reactions, which at times compound the limitations;
- Definition of the situation by others, and their reactions and expectations—especially those who are significant in the lives of the person with the disabling condition (e.g., family members, friends and associates, employers and co-workers, and organizations and professions that provide services and benefits); and
- Characteristics of the environment and the degree to which it is free from, or encumbered with, physical and sociocultural barriers" (http://ptjournal.apta.org/content/86/5/726.full)
- The World Health Organization (WHO) Model: This integrated model defines disability as the inability to meet the criteria of this model's two parts which are bodily structures and functions (physiological criteria) and the environment and personal contextual problems.
- Models of Chronic Illness: Two examples of chronic illness models and theories are the Self in Chronic Illness and Time and the Chronic Illness Trajectory theories or models. These theories focus on how well the client with a chronic illness can cope with and manage their chronic illness, and how well the client is able to learn about and successfully cope with and manage their disabilities and limitation, respectively.
Nurses plan and implement care as based on the assessed needs of clients who are affected with change. In addition to establishing a supportive and open client-nurse relationship, the nurse also establishes trust with the client and allows and encourages the client to openly ventilate their feelings in an environment that is nonjudgmental and supportive, and they also facilitate the client's learning and utilization of coping mechanisms such as:
- Cognitive reframing therapy
- Positive reframing with techniques such as the appropriate use of humor
- Positive self talk
- Eliciting the help of social supports
- Eliciting and utilizing community resources that are appropriate to the client's needs
- Learning and using new and more effective coping skills, problem solving skills and decision making skills
- The use of relaxation and stress management techniques
- Readjusting and setting expectations of self that are achievable and realistic as based on the client's current state or status
Role changes occur along the life span. Some of these role changes are maturational or developmental and others are situational. All role changes, like other changes, have to be adaptively coped with by the individual, family, group, population and community.
Some of the maturational and developmental role changes and challenges along the life span include:
- Young adults: Establishing the family unit and family based roles, developing and maintaining interpersonal relationships with the in-laws, and having children which necessitates the parents' assumption of the care taker role.
- Middle year adults: Accepting role changes secondary to a decline in physical health and stamina and coping with the loss of the parental role as the empty nest occurs and coping with this loss with other activities such as travel and civic roles, and the role reversal of the sandwich generation that now, often concurrently, require that the middle years adult cares for elderly parents and their children who remain dependent on this adult client.
- Older adults: The loss of the worker and bread winner role, a new role associated with caregiving for a spouse or significant other, caring for the grandchildren, and the losses of other roles as the normal changes of aging and chronic disorders disrupt the client's ability to continue to fulfill the roles that they fulfilled in the past.
Some of the situational role changes and challenges include those physical, psychological and social changes that occur as the result of some acute or chronic disorder or disease. The signs, symptoms and interventions for these changes were discussed above under the sections entitled "Assessing the Client's Reactions and Responses to Acute and Chronic Illnesses Including Mental Illness" and "Assessing the Client in Coping with Life Changes and Providing Support".
Some of the nursing diagnoses associated with role performance and ineffective role performance include:
- Ineffective role performance related to an inadequate or lacking role model
- Ineffective role performance related to a new role and its expectations
- Ineffective role performance related to unrealistic role expectations
- Ineffective role performance related to depression, poor self-esteem, pain, physical limitations and/or the lack of adequate social support systems
- Ineffective role performance related to domestic violence and poor parenting skills
- Ineffective role performance related to substance related disorders
- Ineffective role performance related to diminished cognitive functioning, poor decision making and poor problem solving skills
Some of the interventions that are used to promote the client's ability to cope with role changes, both maturational and situational, include:
- Facilitating the client's ventilation of feelings
- Emphasizing the client's strengths and minimizing their weaknesses
- Physiological assistive devices to overcome any lacks of the ability of the client to perform independent self care and activities of daily living such as bathing, ambulation, dressing and grooming
Clients can be expectedly and predictably affected with an alteration of their bodily image along the life span and they can also be unpredictably affected with body image changes along the lifespan and they can be also be unpredictably and unexpectedly as the result of an illness, disease, disorder and some therapeutic treatments.
Some of the normally occurring and predictable body image changes that occur along the life span include changes and events such as adolescent puberty, middle years female menopause, middle years male climacteric, and in the elder years when the normal changes of the aging process occur.
Major traumatic accidents that lead to disfigurement and/or physical disability, alopecia secondary to cancer chemotherapy treatments, a loss of cognitive functioning, disfiguring surgeries such as a radical mastectomy and an orchiectomy, and therapeutic interventions such as a structural fecal diversion colostomy are examples of unexpected and unpredicted altered bodily image changes.
A disturbed or altered body image, simply defined, is some confusion in the client's mental picture of one's physical body and self. Impaired body image is characterized with avoidance and hiding of the affected bodily part, a focus and emphasis on the client's past body image, depersonalization of self, subjective client statements that indicate a loss, and feelings of helplessness and hopelessness.
Patents with actual and perceived body image changes and alterations need the support of nurses and other members of the health care team in order to successfully cope with these losses. After a complete assessment of the client's perception of their body image which can include the use of standardized assessment measurement scales such as the Body Image Quality of Life Inventory, the nurse will plan care for the client.
Some of the interventions that are often used among clients who are affected with an impaired body image include encouraging the client to express and ventilate their feelings about the alteration, facilitating the client's coping with this alteration and some of the resulting feelings such as depression, anger, hopelessness and helplessness, facilitating the client to learn and develop more realistic expectation of self in terms of their body image, and focusing on the client's strengths and abilities, rather than these alterations and their weaknesses.
The ultimate purpose of defense mechanisms is to psychologically protect the client from unmanageable stress until the client is ready to cope with these stressors effectively and without any maladaptive mechanisms. Based on this fact, nurses and other health care professionals should never debate or argue with the client about their use of these subconscious ego defense mechanisms; they should not be stripped away until the client has garnered the psychological health and fortitude to deal with the threatening stress that they are confronted and affected with.
The psychological ego defense mechanisms, their purposes and some examples will be discussed now.
- Displacement: Displacement transforms the target of one's anger and hostility from one person to another person or object. Displacement allows the person to ventilate and act out on their anger in a less harmful and a more socially acceptable manner. Displaced anger has far less consequences than anger that is not displaced and, instead, is directed in a socially unacceptable manner. A father of four children who gets fired by their boss displaces their anger and hostility and punches the wall on their way out the door rather than punching his boss. Punching the wall rather than punching the boss is far less harmful and more socially acceptable; and the fired person is able to diffuse their anger until they are psychologically able to address the anger in a more adaptive and healthy manner.
- Regression: Regression is used when a client, under extreme stress, regresses and returns to a previous, safer and far less threatening developmental stage to avoid coping with the stressors that are currently threatening them in their current stage of development. For example, a nine year old child who sucks their thumb while in the hospital with a serious illness, which is an immature behavior for a nine year old, is using regression to go back to a less threatening period of time when they were an infant or a toddler.
- Projection: Projection occurs when a client believes that another person, other than themselves, is the person who is at blame for their failures, weaknesses and inappropriate thoughts. Projection protects the client's ego from damages and threats to one's self image and self-esteem until the client is ready to cope with these failures, weaknesses and inappropriate thoughts. An example of projection is when a person aspiring to become a nurse fails out of nursing school and blames the nursing school and the nursing professors for their failure rather than recognizing the fact that the aspiring nurse's lack of commitment and studying led to their failure and a client who has threatening and sexually deviant thoughts and projects them on others is also using projection to protect their ego until the client is psychologically more able to identify and cope with these unacceptable feelings.
- Acting Out: Acting out entails the client's performance of extreme, disruptive and/or unacceptable behaviors and actions because the client is not able to cope with and ventilate the feelings that are occurring as the result of a stressor. For example, a child may have a temper tantrum because they are not able to express and cope with some frustration in their home or school.
- Reaction formation: A client is using reaction formation when the client acts and behaves in a manner that is completely the polar opposite of their true feelings. For example, the client who overly adores his wife but actually intensely despises her is using reaction formation. Reaction formation, again, protects the client's psychological stability until the client is able to cope with their intense despise in a conscious and purposeful manner using coping strategies and therapies such as cognitive behavioral therapy.
- Suppression: Suppression occurs when the client is somewhat able in a limited conscious manner to cope with a feeling but they subconsciously hide it. Suppression is somewhat similar to repression.
- Repression: The ego mechanism of repression allows the client to push threatening and socially unacceptable thoughts out of the person's consciousness and into the deep subconscious. For example, a client will not remember a violent rape as the result of repressive amnesia and a client will represses their thoughts of suicide and homicide deep into the subconscious until they are able to cope with it in a more conscious manner.
- Isolation of Affect: A client isolates their affect and true feelings by thinking about their feelings but not actually feeling the feeling because they are not yet able to cope with it. For example, a client may think about their anger but they do not feel the anger because it is too stressful at this time.
- Rationalization: Rationalization occurs when the client using logic, albeit faulty, and/or acceptable motives to justify behavior that is not socially acceptable or based on sound logic. This psychological ego defense mechanism allows the client to cope with a conscious realization that they have a lack of ability to meet standards and goals. For example, an adolescent who shop lifts cosmetics in the local store may rationalize this theft by subconsciously believing that this theft does not financially harm this mega store chain.
- Sublimation: A client uses the ego defense mechanism of sublimation when they transform and replace unacceptable urges and feelings into a socially acceptable urge or feeling. For example, a father who has the urge to sexually abuse their child transforms and replaces this unacceptable urge by becoming a deacon of their church is using this psychological defense mechanism.
- Undoing: Undoing is the ego defense mechanism that allows the person to avoid feeling conscious guilt for some wrongdoing or transgression with a form of atonement. For example, a husband may take his wife out for a fancy dinner in her favorite restaurant after he has had an illicit sexual affair with one of his co-workers earlier in the day.
- Dissociation: The psychological ego defense mechanism occurs when the client detaches and dissociates with person or time to avoid the stress until they are ready to cope with it. For example, a person may, on a temporary basis, reform their sense of self and the current time in order to cope.
- Compensation: Compensation protects the person's ego and levels of self-worth and self-esteem by over achieving in a new area after they have not been successful and failed in another area. For example, a young adult, hoping to become an engineer, fails their math courses in college so they then subconsciously decide to leave college, and, instead, get and excel in a sales career.
- Identification: Identification, another ego defense mechanism, allows the person to maintain their levels of self-esteem and self-worth without any devaluing. The client imitates, copies, and mimics the behaviors of the person that they greatly fear. An example of identification occurs when a young child imitates the behaviors of their greatly feared parent.
- Minimization: Minimization entails the client's subconsciously lowers, decreases and minimizes the magnitude of the problem or stressor that they are confronted with. For example, a diabetic client with severe peripheral neuropathy, a leg ulcer and/or retinopathy may believe that these losses are not important and "no big deal" in order to protect the ego against significant losses that they are not yet ready and able to cope with.
- Intellectualization: Intellectualization is using conscious, intellectual and rational thinking to explain some stressful event or circumstance that was so traumatic and stressful that the person is not yet able to recognize and cope with this trauma or stressor. Intellectualization protects the person and their ego from psychological trauma and pain. Intellectualization occurs when a grieving spouse, for example, subconsciously believes that their spouse died as the result of failures on the part of the spouse's health care providers rather than accept the fact that the spouse died because they were not compliant with their treatment plan.
- Introjection: Introjection, another ego defense mechanism, prevents the person from being rejected, ostracized and/or shunned by others, including society at large. When the client subconsciously introjects, they take on and practice the beliefs, values, norms, and perceptions of others despite the fact that these values, beliefs, perceptions and norms are the complete antithesis of what they really hold and believe. An example of introjection occurs when a client subconsciously believes gays, lesbians, bisexual and transgender people are abnormal and unacceptable but they consciously take a community advocacy role protecting their rights despite the fact that they do not consciously believe in these equal rights.
As with all aspects of nursing care, nurses evaluate whether or not the client has successfully adapted to situational role changes in terms of whether or not the client has achieved the pre-established goals that were established after a complete assessment of the affected client, their family members, and other significant others.
Some of the areas that the registered nurse may explore, as based on the client's specific needs, can include:
- Has the client coped with the situational role change?
- Does the client have realistic expectations and goals for themselves?
- Is the client able to accept their need to be dependent on others when necessary?
- Are the family members and other significant others participating in the care and support of the affected client?
- Is the client able to identify and maximize their strengths rather than focusing on their weaknesses and limitations?
- Is the client now experiencing self-satisfaction with their new or modified roles?
- Is the client exhibiting any objective or subjective signs and symptoms such as those associated with anxiety, stress, grief and/or distress?
- Are the family members and/or other significant others exhibiting any objective or subjective signs and symptoms such as those associated with anxiety, stress, grief and/or distress?
- Abuse and Neglect
- Behavioral Interventions
- Chemical and Other Dependencies/Substance Abuse Disorders
- Coping Mechanisms (Currently here)
- Crisis Intervention
- Cultural Awareness and Influences on Health
- End of Life Care
- Family Dynamics
- Grief and Loss
- Mental Health Concepts
- Religious and Spiritual Influences on Health
- Sensory/Perceptual Alterations
- Stress Management
- Support Systems
- Therapeutic Communication
- The Therapeutic Environment