Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Assessment of Coping Skills and Support Systems

Coping Skills

Individuals use a variety of coping mechanisms. These may include such things as withdrawing, trying to think it out, crying, physically acting out their distress, use of defense mechanisms, direct action, that is, taking action intended to solve the problem directly, or indirect action, putting things on hold or dealing with the problem through tension reduction.

Signs of maladaptive coping are difficulty in managing one’s feelings, suicidal or homicidal tendencies, alcohol or other drug abuse/misuse, encounters with the law and inability to effectively use available help (Hoff, 1995).

Some questions for assessing coping mechanisms are:

  • How does the client usually cope with stress?
  • What helped/what didn’t help in the past?
  • What is the client’s degree of coping now?

Support Systems

Almost two thirds of mental health crises have been found to be the result of social factors; family conflicts, marital discord, impending divorce, desertion and conflicts with parent’s account for approximately 50 per cent of crises (Voineskos, 1974). Support systems must be assessed and accessed for every person in crisis.

These include family support and accessibility, financial resources, and community and professional support networks. The strength of the client’s support systems significantly influences the outcomes of successful crisis resolution. Do not assume that families are always supportive of clients.

Some questions for assessing the client’s support systems include:

  • Does the client live alone or with others?
  • Who is the client close to?
  • Who is important for the client?
  • What supports have been helpful in the past and are these supports available now?

Because multiple studies have shown that what appear to be psychiatric symptoms are often caused by medical problems, best practice recommends a medical/psychiatric history that includes a mental status exam to be implemented by nurses. (See Appendix B for example of a mental status assessment).