Welcome. My name is Diana Shenefield.
The topic we are gonna talk about
today is Psychosocial Integrity.
That's part of our NCLEX review
and the topic underneath
that is Coping Mechanisms.
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.
And we know that it
can lead to problems
with their physical diagnosis but
also with their mental diagnosis.
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.
Assessing whether they can
are just having problems at the time of
coping or whether this is a long term problem.
We gonna provide support to our patients
coping with life changes.
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.
May be they have had a surgery that's
going to be a body image changing.
So a lot times we are there
as nurses to help people
to learn how to cope with the
changes in their life styles.
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.
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.
So let's look at question. If a patient
that was that admitted yesterday
with a diagnosis of acute
traumatic stress disorder.
What should a nurse expect this
patient's assessment to reveal?
Again as you looking at patients, we
know all patients are individuals.
And what kind of glamping them all together
when they have acute traumatic stress disorder.
But there are somethings that as a nurse i
know that are pretty common to a lot of patients.
This question happens to
be "select all" that apply
and i know most students do not
like "select all" that apply.
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.
And hopefully that
will help you decide
which ones to pick.
So let's look at A. Increased intimacy.
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.
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.
What would you expect to see as a nurse?
You would expect to see B. say Amnesia.
We know its the way that the
mind protects the body from
certain feelings, from certain stresses.
You would also see C. Flashbacks.
As people are trying to
remember what has happened.
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.
So the only one you would not
want to pick is increase intimacy.
and actually it would be opposite.
It would be decreased intimacy.
When you go back and you look at your
psych text books and i hope that you do.
There is lot of terms that are
used specifically for coping.
And on the screen is a big list
that you need to be familiar with
the definitions of these terms.
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.
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.
So again know these terms. Some of them we
use a lot. Some of we don't use as much.
But make sure you at least familiar with these
terms so that you can understand your patient.
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.
May be i don't want to deal with the fact that
i have just been diagnosed with breast cancer.
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.
Be aware of defense mechanisms and
help people work through that.
Some patients may not
have the right resources.
Some people don't have
the help that they need.
They don't have people to rely on.
May be they never have. May be they
have never developed coping skills.
That leads to a problem from when you are
faced to something like a crisis of health.
That you have nothing to
base your reactions on.
So again do i always know that when
patients come in? Absolutely Not.
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.
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.
When we are assessing our patient, not only we
are assessing physically but we are also assessing
psychosocially, socially, psychiatrically.
Again being able to best help our patient,
holistically help our patients.
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.
That's an easy one when they
determined out and tell you
most of the time you can pick up on that.
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.
The inability to make a decision.
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.
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.
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.
Be talking to family members
about their feelings and what's going and
are they able to help the patient cope.
Physical symptoms. A lot of
times we internalized.
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.
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.
So being able to identify those
illnesses and work through those.
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.
If i am worried. If i am not coping and
going to be irritable. So watching
for reasons that patients are irritable.
So what factors can lead
to the inability to cope?
Well, change in healthcare status
which we have talked about.
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.
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.
And then we known Situational crisis.
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.
So i need to provide opportunities
to express their thoughts.
Again, as nurses we cannot be so
busy that we are in and out.
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.
That's part of our nursing process
and we need to work with our
patients to set mutual goals.
Goals that we can both agree on.
We need to assist our patient's
constructive problem solving.
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.
So that they can see what their options are.
So that they can make good inoventional decisions.
That they can decide
what is best for them.
And so that they don't feel like
healthcare is telling them what to do.
And need to provide teaching
on strategies for coping.
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.
Giving them a referral to somebody
who can work with them on a
daily basis and make sure
that they learn how to cope.
again, and resources.
Knowing what my resources are and
being able to educate my patients
so that they can know
what their resources are.
Makes a big difference in not only
their coping mechanisms. But their
safety and the safety of others.
And helping patients define
healthy support systems.
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.
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.
Being able to lead people through
those times and teach them and
provide them with resources.
So that they can take care of
themselves, is a big part of nursing.
So again as you looking at NCLEX questions make sure
that you are using therapeutic communication.
Make sure you are not accusing and
make sure that you are showing respect.
And give your patients
options so that they
can make the decisions for themselves
that they need to have. Good Luck.