This section will review the nursing process as it applies to stress and coping.

Assessments Related to Stress and Coping

Here are several nursing assessments used to determine an individual’s response to stress and their strategies for stress management and coping:

• Recognize nonverbal cues of physical or psychological stress
• Assess for environmental stressors affecting client care
• Assess for signs of abuse or neglect
• Assess client’s ability to cope with life changes
• Assess family dynamics
• Assess the potential for violence
• Assess client’s support systems and available resources
• Assess client’s ability to adapt to temporary/permanent role changes
• Assess client’s reaction to a diagnosis of acute or chronic mental illness (e.g., rationalization, hopefulness, anger)
• Assess constructive use of defense mechanisms by a client
• Assess if the client has successfully adapted to situational role changes (e.g., accept dependency on others)
• Assess client’s ability to cope with end-of-life interventions
• Recognize the need for psychosocial support to the family/caregiver
• Assess clients for maladaptive coping such as substance abuse
• Identify a client in crisis

Diagnoses Related to Stress and Coping

Nursing diagnoses related to stress and coping are Stress Overload and Ineffective Coping. See Table 3.6 to compare the definitions and defining characteristics for these nursing diagnoses.

Table 3.6 Stress and Coping Nursing Diagnoses

Outcome Identification

An outcome is a measurable behavior demonstrated by the patient responsive to nursing interventions. Outcomes should be identified before nursing interventions are planned. Outcome identification includes setting short- and long-term goals and then creating specific expected outcome statements for each nursing diagnosis. Goals are broad, general statements, and outcomes are specific and measurable. Expected outcomes are statements of measurable action for the patient within a specific time frame that are responsive to nursing interventions.

Expected outcome statements should contain five components easily remembered using the “SMART” mnemonic:

• Specific
• Measurable
• Attainable/Action oriented
• Relevant/Realistic
• Time frame

An example of a SMART outcome related to Stress Overload is, “The client will identify two stressors that can be modified or eliminated by the end of the week.”

An example of a SMART outcome related to Ineffective Coping is, “The client will identify three preferred coping strategies to implement by the end of the week.”

Planning Interventions Related to Stress and Coping

Common nursing interventions that are implemented to facilitate effective coping in their clients include the following^[1]:

• Implement measures to reduce environmental stressors
• Teach clients about stress management techniques and coping strategies
• Provide caring interventions for a client experiencing grief or loss, as well as resources to adjust to loss/bereavement
• Identify the client in crisis and tailor crisis intervention strategies to assist them to cope
• Guide the client to resources for recovery from crisis (i.e., social supports)

Implementation

When implementing nursing interventions to enhance client coping, it is important to recognize signs of a crisis and maintain safety for the client, oneself, and others. Review signs of a client in crisis and crisis intervention strategies in the “Crisis and Crisis Intervention” section of this chapter.

Evaluation

After implementing individualized interventions for a client, it is vital to evaluate their effectiveness. Review the specific SMART outcomes and deadlines that have been established for a client and determine if interventions were effective in meeting these outcomes or if the care plan requires modification.