Coping Strategies for your Patients

Being diagnosed with a chronic illness is hard; not just for the client but his family as well!  Mental illnesses are not different.

I remember one of my clients once said to me;

“There were times when I thought I was super human.   There was no stopping me.  I ate the junk foods, began drinking excessively, and led a reckless lifestyle…until I crashed my car into a lamp post trying to overtake a truck….which cost me the life of my unborn child.  My wife had a miscarriage.  She never forgave me for my recklessness…that was the day when I lost my all….”  He goes on about a series of events that happened after, only to continue saying, “I wish I knew how to cope then; I wish someone gently took my arm and taught me how to deal with my mood swings…..If only I could rewind my life and the foolishness….”

Nurses, you are in position to touch and to heal; and to make a difference in a person’s life; do not let go of this opportunity!  It is not sufficient to stay by the patient’s side holding their hands, providing them comfort, empathy and hope; it is now time to up your game!

Teach them how to cope!

More importantly; let them know that healthy coping skills don’t necessarily remove stress or eradicate challenges like mental illness, but they go a long way toward helping people function well despite challenges.

Tell them the difference between positive and negative coping!

Assessment is the key!

Assess what emotional or mental state your client is in:

Is he/she in distress, anger or denial?

Is he/she mourning or grieving the loss of a loved one?

Is he/she experiencing fear, anxiety or detachment?

Has she/he lost all meaning in life?

“Give them a fish and you have satisfied their hunger; teach them to fish and you have given them a career”

Teaching healthy coping strategies:

1. Help them identify their negative coping strategies if any:

What are the negative coping strategies most people use?

1. Substance misuse and dependence

The most often noted negative coping mechanism is alcoholism, excessive use of caffeine or nicotine and other illicit drugs.

• Avoidant behaviors

Certain people experience extreme stress and anxiety while dealing with crowds and people in general.   These interactions may trigger stress, anger or panic attacks, or remind someone of traumatic memories, such as flashbacks.

• Denial/Stubbornness

People at times are of the opinion that if they refuse to think about their trauma; it just goes away.   At times like these, they refuse treatment and ignore appointments.

• High risk behaviors

Indulgence in risky behaviors, high risk sports, poor nutrition, sexual promiscuity and others poses a risk not just to themselves but to others as well. 

I once attended to a young client who was brought seriously ill after consuming rat poison.  Once he started feeling better, he simply stated that he had challenged his friends that no poison could hurt his body; and he had taken poison to prove his point.  The client suffered from Axis-11 Personality disorders.

• Violence, hostility and Manipulation

Being violent, throwing things, destruction of property, temper tantrums, yelling, staff splitting, using manipulation for secondary gains, blaming, playing the victim, cussing at others, and provoking violence in others are commonly seen behaviors from clients suffering from mental illnesses who use poor coping mechanisms

• Self-harm, somatic complaints, De- generalization, crying, prolonged grieving, self-blame, guilt are some other manifestations of poor coping.

•  Help them identify their strengths:

Give them a notebook and help them identify their strengths.  Their strengths can be anything that helps them cope with their illnesses and stressors; including, their family and social support, talents and abilities, positive outlook and optimism, educational or vocational training, spiritual belief system and resourcefulness.

Leading your patients to identify their strengths and apply them in their day to day activities as part of their coping strategies takes time; but gradually, you will learn that it is an integral part of the nursing process.

•  Developing a coping strategy for the day:

Help your clients keep a journal of their thoughts, feelings and emotions

1.  How am I feeling today?

Help them express their emotions or feelings using emoji’s.

•  What healthy coping strategy will I use for my emotions?

(Help them circle out the most appropriate one or encourage them to come up with their own strategy.)

*I will reach out to my family or friends or staff members

*I will read some material regarding my mental illness and try to learn more about why I feel the way I feel or reach out to my clinician to gain more information and knowledge

*Self-monitoring of behaviors:

•   I will track and monitor my emotions/feelings throughout the day and watch how I react to them. 
• This way I can tell myself to slow down and think twice before I react.  I will use positive affirmations to tell myself that I am worthy. 
• I will choose to be happy and do things that make me happy.

*Distraction:

I will use distraction to help me deal with the voices in my head and the range of emotions I feel.

• -I will watch some television or a movie, listen to music or do some cleaning and laundry.
• -Word search, finger painting or playing with slime or clay.
• – Send texts/messages to friends to check in with them
• -I will start bullet journaling or diary writing
• -Practice gratitude and make a list of my recent accomplishments; however minor

 However, I will keep in mind that distraction is not permanent and will not rely on it too heavily!  (Unhealthy reliance on distraction can actually lead to “stuffing”, avoidance, and increasing the dissociation of the stressful factor).

*Mindfulness:

I will practice reflecting on who I am, what makes me tick and things that make me happy. 

I will tune in to my inner self and be mindful of my actions, my reactions to other people, my thoughts, feelings, bodily sensations and environment and discover ways to improve my insight into my own mental health.

  I will learn to accept myself without judgment, shame or guilt

*Emotional release:

 I will seek emotional release by screaming into my pillow or punching it if necessary, taking a cold shower or popping balloons, going for a run or doing cardio/strengths training

*Self-love and compassion

I will keep a pack of hand made positive affirmation cards ready; for the times when I feel depressed or give in to self-loathing.    Words such as “I am worthy”, “I am not responsible for all that suffering” or “I will overcome” to help me feel better.

I will adapt healthy activities, like sound nutrition, exercise, proper sleep, intimacy and healthy social interactions and take care of myself

*Helping others/Volunteering

I will choose to volunteer at my church and other charity organizations, to help me cope with my loss.

*Spirituality

I will get in touch with the superior power, through my church, through the members of my church, participate in fellowship and bonding, and grow stronger with my inner self

* Practicing my favorite hobby

I will draw and paint to express my inner most self, when my words start failing me

I will water my roses daily; as looking at them gives me comfort

4)  Re-Inforce

Teach them to go back and look at their chosen coping strategy for their day; monitor progress every hour or two to see how things are going.  There are times when what works for one may not necessarily work for other; there are also times when  coping strategies that works when stressed may have the adverse effect when angry. 

I recently had a client who enjoyed listening to very loud ‘rock music’ when overwhelmed with hearing voices.  He often drowned his auditory hallucinations with blaring music.  But since he had anger issues, when provoked by any small stimuli; the sound of music would make him increasingly violent, literally so much as to punch anyone who came his way.

5.  Be open minded and non-judgmental

While teaching coping strategies to your clients and you see them failing; that’s when you need to understand; developing a new habit or a strategy, takes time, perseverance and patience.  Let your patients know that they won’t be cured overnight.

It may also take several different methods before you find the strategy that works best for your client. 

Also know that, by agreeing to learn these strategies you client has taken one step ahead, out of his comfort zone.  Be patient, be non-judgmental.

When do you know that your patient has begun making progress?

You know your patient has finally learnt to explore and experiment with his coping strategies and is achieving success; when he

1. Seeks support and help – When he is able to ask for a staff member and is willing to seek help; you know the battle is half won

• Relaxation – When you find your patient trying to take a comforting walk, or listening to soothing music, or trying relaxing activities like yoga or meditation, or participates in chaplain’s services; you know he has been making an effort

• Problem-solving:  When you notice that your patient has not retaliated when a peer made a sarcastic comment; but instead tries to rationally speak to his peer, identifies the cause of the problem and is able to come to an reasonable conclusion, that is progress

• Humor –When upon hearing distressing news over the telephone; your client is still able to find a way to make light of the situation, without losing the actual perspective, and finds humor; you know that he has found his coping style.

• Exercise – When your clients expresses an interest in his local gym and talks about maintaining an exercise regimen, or talks about running, dancing, swimming, or joining the local basketball team;  you know they are ready to take on the world with all its stressors!