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Coping Mechanisms

by Diana Shenefield, PhD
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    00:00 Welcome. My name is Diana Shenefield.

    00:03 The topic we are gonna talk about today is Psychosocial Integrity.

    00:07 That's part of our NCLEX review and the topic underneath that is Coping Mechanisms.

    00:14 Coping Mechanisms is something that we are going to be assessing in our patients and a lot of times we known a patient aren't coping.

    00:21 And we know that it can lead to problems with their physical diagnosis but also with their mental diagnosis.

    00:28 So what can i do as a nurse? Why should i be watching for in my patients that are having coping difficulties? So we are gonna look at assessing their ability to cope.

    00:39 Assessing whether they can are just having problems at the time of coping or whether this is a long term problem.

    00:45 We gonna provide support to our patients coping with life changes.

    00:50 A lot of times we see patients at the lowest part of their life as they are making changes in the way that they are going to live the rest of their lives. May be they are just being diagnosed with a chronic illness.

    01:02 May be they have had a surgery that's going to be a body image changing.

    01:06 So a lot times we are there as nurses to help people to learn how to cope with the changes in their life styles.

    01:14 And then we are going to evaluate. Can we evaluate that the patient is successfully coping and adapting to the situation that they have been presented? Again a lot of times our patients are with us for such a short period of time that we don't always see what happens when they leave.

    01:30 But may be we can get a sense on whether they are able to cope and whether they have the capabilities of coping before they leave.

    01:38 So let's look at question. If a patient that was that admitted yesterday with a diagnosis of acute traumatic stress disorder.

    01:45 What should a nurse expect this patient's assessment to reveal? Again as you looking at patients, we know all patients are individuals.

    01:53 And what kind of glamping them all together when they have acute traumatic stress disorder.

    01:58 But there are somethings that as a nurse i know that are pretty common to a lot of patients.

    02:03 This question happens to be "select all" that apply and i know most students do not like "select all" that apply.

    02:10 That as you are answering these questions, take each answer and make it a true/false and make sure that your answer in true/false, to the question.

    02:19 And hopefully that will help you decide which ones to pick.

    02:23 So let's look at A. Increased intimacy.

    02:26 So wanna ask your self, "true/false will that happen with somebody with a acute traumatic stress disorder?" B. Amnesia C. Flashbacks D. Expressions of guilt and E. Sleeping disturbances.

    02:40 So you think about people that are going through crisis and they are coping and they have just came to some kind of traumatic event.

    02:48 What would you expect to see as a nurse? You would expect to see B. say Amnesia.

    02:53 We know its the way that the mind protects the body from certain feelings, from certain stresses.

    02:59 You would also see C. Flashbacks.

    03:02 As people are trying to remember what has happened.

    03:05 D. Expressions of guilt. Again as to what's caused the crisis or what's going on and E. Sleep Disturbances. We known that where there is guilt and flashbacks the amnesia, sleep disturbances can be goes along with that.

    03:21 So the only one you would not want to pick is increase intimacy.

    03:24 and actually it would be opposite. It would be decreased intimacy.

    03:29 When you go back and you look at your psych text books and i hope that you do.

    03:34 There is lot of terms that are used specifically for coping.

    03:38 And on the screen is a big list that you need to be familiar with the definitions of these terms.

    03:45 Not the NCLEX is gonna ask you for definitions. But at least if you have an understanding you will be able to identify your patients that are at risk for coping disabilities.

    03:56 May be they didn't cope well before but now they have been presented with chronic illness or life changing event and now what they had before isn't going to work.

    04:08 So again know these terms. Some of them we use a lot. Some of we don't use as much.

    04:13 But make sure you at least familiar with these terms so that you can understand your patient.

    04:18 So in general, what kind of defense mechanisms? Usually that's what we think when we talk about with coping. What kind of defense mechanisms? Is my patient going to use to substitute for coping? And we all do it. We all look for defense mechanisms when we want to remove ourselves from may be the situation that we are in.

    04:39 May be i don't want to deal with the fact that i have just been diagnosed with breast cancer.

    04:45 So what kind of defensive mechanisms am i going to use to protect my self from that? Again be looking at those patients when you known your patients have got devastating news.

    04:55 Be aware of defense mechanisms and help people work through that.

    05:00 Some patients may not have the right resources.

    05:04 Some people don't have the help that they need.

    05:08 They don't have people to rely on.

    05:10 May be they never have. May be they have never developed coping skills.

    05:14 That leads to a problem from when you are faced to something like a crisis of health.

    05:19 That you have nothing to base your reactions on.

    05:23 So again do i always know that when patients come in? Absolutely Not.

    05:28 But i can work for signs and symptoms and be asking about support systems. Be asking about "is there anybody that you rely on?" "Anybody that can work you through these things?" And a nurse is should be able to, again, assess patient support systems.

    05:44 Is there anybody there? Is there anybody i can call? Is there somebody at the church? Somebody at your work? Again from not asking those questions then we are not going to known whether a patient has the proper resources and that is part of our assessment.

    06:00 When we are assessing our patient, not only we are assessing physically but we are also assessing psychosocially, socially, psychiatrically.

    06:09 Again being able to best help our patient, holistically help our patients.

    06:15 So when you do your assessment what are the signs that they are not coping very well? Well, hopefully the easy thing would be was their verbalizing and just not coping well.

    06:25 That's an easy one when they determined out and tell you most of the time you can pick up on that.

    06:31 But again the person that verbalizes that they are not coping, there is somebody that's aware of what's going on and they are aware of themselves and their processes.

    06:40 The inability to make a decision.

    06:43 A lot of times we come in and physicians would tell you that you have a devastating illness. May be its a breast cancer and all the sudden we want them to make decisions on their treatment plans.

    06:54 Again its hard for anybody to do that. But do they have resources? Do they have people that can help them, to walk them through that? And if not, as a nurse, am i able to do that? Am i able to help them make their decisions? Or give them options. Give them the education that they need to so that they can make a good decision.

    07:14 Do have the destructive behavior towards self or others? A lot of time it is easy to lash out and we use lash out to our loved one. So be looking at family members.

    07:25 Be talking to family members about their feelings and what's going and are they able to help the patient cope.

    07:31 Physical symptoms. A lot of times we internalized.

    07:35 So all the sudden we are very sick to our stomach. We have headaches That's the way that we can protect our mind by focusing on a physical element.

    07:44 So does your patient all of the sudden have physical signs and symptoms of another illness? That may be is not directly related to the health crisis that's going on.

    07:53 So being able to identify those illnesses and work through those.

    07:58 Emotional tensions: Again, are they emotional? Ofcourse they are going to be emotional when you first give them a diagnosis. But are they able to work through that? And as a nurse what are the resources that i can provide to help the patient work through that? Irritability: Again if i am not getting sleep.

    08:16 If i am worried. If i am not coping and going to be irritable. So watching for reasons that patients are irritable.

    08:24 So what factors can lead to the inability to cope? Well, change in healthcare status which we have talked about.

    08:31 Anytime you come into a hospital setting or doctor's office and there is going to be a change in your healthcare. It can cause an inability to cope. Inadequate support systems: Again, if i have no body to rely on, it's very hard to learn how to cope.

    08:47 Inadequate psychosocial support system: Again if i don't have that, if i don't have somebody that i can bare my thoughts and my feelings to then i am gonna internalize that. And if i don't know what to do with that its gonna show up in physical problems Its also can show up in some hostility.

    09:05 And then we known Situational crisis.

    09:07 Sometimes its just the hearing "now may be i have been faced with i have to have emergency surgery" And can i help my patient be able to get pass that situational crisis and be able to move on.

    09:21 So i need to provide opportunities to express their thoughts.

    09:25 Again, as nurses we cannot be so busy that we are in and out.

    09:28 But we need to make sure that we are giving people the time to express their thoughts. We need to help our patients set realistic goals.

    09:36 That's part of our nursing process and we need to work with our patients to set mutual goals.

    09:42 Goals that we can both agree on.

    09:44 We need to assist our patient's constructive problem solving.

    09:48 Again, if they don't know what resources are out there. If they don't understand what options that they have. As a nurse i need to make sure that they are educated on that.

    09:58 So that they can see what their options are. So that they can make good inoventional decisions.

    10:04 That they can decide what is best for them.

    10:07 And so that they don't feel like healthcare is telling them what to do.

    10:10 And need to provide teaching on strategies for coping.

    10:14 Again if i myself as a nurse on the floor can't teach because they are there for such a short time being able to hook them up with somebody.

    10:22 Giving them a referral to somebody who can work with them on a daily basis and make sure that they learn how to cope.

    10:29 Provide education, again, and resources.

    10:33 Knowing what my resources are and being able to educate my patients so that they can know what their resources are.

    10:40 Makes a big difference in not only their coping mechanisms. But their safety and the safety of others.

    10:47 And helping patients define healthy support systems.

    10:50 Are the people that surrounding themselves with healthy and how their best interest in mind? So in closing, again coping we deal with people as nurses that are at the worst times of their lives many times.

    11:05 And learning how to cope, learning how to get pass that situational crisis is a big part of what we do as a nurses as well.

    11:12 Being able to lead people through those times and teach them and provide them with resources.

    11:18 So that they can take care of themselves, is a big part of nursing.

    11:21 So again as you looking at NCLEX questions make sure that you are using therapeutic communication.

    11:27 Make sure you are not accusing and make sure that you are showing respect.

    11:31 And give your patients options so that they can make the decisions for themselves that they need to have. Good Luck.


    About the Lecture

    The lecture Coping Mechanisms by Diana Shenefield, PhD is from the course Psychosocial Integrity. It contains the following chapters:

    • Coping Mechanisms
    • Assessment
    • Factors That May Lead to Inability to Cope

    Included Quiz Questions

    1. The patient will stop blaming himself or herself for the lack of insurance
    2. The patient will develop adaptive coping patterns
    3. The patient will identify a realistic perception of stressors
    4. The patient will express and share feelings regarding the present crisis
    1. Expressing his angry feelings to the nurse
    2. Accepting his death as imminent
    3. Decreasing interaction with peers to conserve energy
    4. Gaining an intellectual understanding of the illness
    1. „You sound angry. What is upsetting you?“
    2. „I’ll leave, but you need to eat.“
    3. “I’ll get you something for your pain.”
    4. „Your anger doesn’t bother me. I’ll be back later.“

    Author of lecture Coping Mechanisms

     Diana Shenefield, PhD

    Diana Shenefield, PhD


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