Introduction: Psychosocial Integrity – NCLEX-RN®

00:01 This category is the psychosocial integrity category.

00:05 Now, let me start with the definition that NCSBN uses to define this category.

00:10 The nurse provides indirect nursing care that promotes and supports the emotional, mental and social well-being of the client, experiencing stressful events as well as clients with acute or chronic mental illness.

00:25 There's a mouthful there, but they're actually giving you a lot of really good cues here. So I want to make sure that we spend a little bit more time in this definition than we typically would.

00:34 So they're expecting me as a nurse to promote and support emotional, mental and social well-being for patients going through stressful events and people with acute and chronic mental illness.

00:49 So this doesn't just focus on patients with an acute or chronic mental illness diagnosis.

00:54 This can be any patient who's going through something that's stressful.

00:58 Now, let me give you an example of what would be considered a stressful event in this category. Anyone having surgery or concerned about something and if the patient tells you they're concerned, then that counts as stress.

01:11 But there's also some major categories you're going to want to be aware of.

01:15 You're going to be looking for signs of abuse or neglect.

01:18 You're going to be looking for how you can help people change difficult behaviors.

01:22 Maybe it's substance abuse or toxicities.

01:26 Maybe they're having significant life changes because what's happened in the hospital, while there, they may have lost their ability to care for themselves, ability to dress themselves, and they might be grieving that life change.

01:39 Also, this is where we have to be really protective of our patients.

01:43 We talked about how you have to be on the lookout for abuse and neglect.

01:48 You also need to assess a potential for violence and figure out what's the safest way to handle the situation.

01:54 You may see a question about a patient in a mental hospital when they suddenly become violent. How do you keep all of the other patients safe? Don't forget, you do all this through the lens of cultural practices and beliefs when you're planning and providing care.

02:11 So that kind of gives you an overview of psychosocial integrity.

02:14 Let's take a look at a few more examples.

02:17 So we've touched on grief in the psychosocial integrity category, but I want to drill down a little bit more according to their statements.

02:24 End of life care is really a difficult and challenging area to practice in, and you may encounter questions there.

02:32 Just take it slow, make sure you understand the topic and think, how can I keep this patient safe and feel respected? And you'll do just fine in those areas.

02:42 Think about the client support system.

02:45 Make sure that you are aware when a patient is experiencing grief or loss or what they perceive to be grief or loss.

02:53 It doesn't matter if that's something you think is a big deal or not.

02:57 Remember, this section is helping people deal with stressful events.

03:01 Grief and loss definitely fall into that category.

03:05 Some of the acute and chronic psychosocial health issues you may encounter in the questions include addiction and dependencies, depression, dementia, or eating disorders. So you want to be familiar with what the risks are in each of those categories. And what's the best response for you as a nurse? Because the whole goal is to develop a therapeutic environment.

03:28 Now the key to that is therapeutic communication.

03:31 You've probably studied this in your psychosocial courses, but let's talk about just some quick rules for when you're looking at what's the most therapeutic thing to say to a client.

03:41 You want to make sure that you use open-ended questions.

03:44 Please don't use yes or no.

03:46 If it's possible to avoid that.

03:48 Open-ended questions are always considered more therapeutic because it allows the patient to express themselves and to give you as much information as possible.

03:58 Remember, listening is really powerful and make sure you do active listening.

04:05 But in the psychosocial section there's actually kind of a bent or a lean towards just staying with the patient who has depression, just sitting there, being quiet with them alongside of them can be very powerful.

04:20 Now, when you're listening to a patient talk to you, you want to use active listening and repeat what they said back to them in a very respectful manner.

04:28 Keep in mind, we don't always have the time to do this in real life, but you do in any world. So if you have a depressed client and the option is to just stay with them, maybe they're having a hard time eating, or they're super quiet.

04:44 Always look at that answer that says you just remain with the client.

04:48 I always tell students, Don't leave your patient alone, because in NCLEX world having you the RN with the patient is the best thing possible.

05:00 So don't. Look, the power of being quiet and just listening and don't overlook the positive nature of you staying with your clients.

05:09 You're the best thing for safety of that client, and you have all the time to do that.

05:15 Make sure you don't ever use anything that's disrespectful, condescending, or could appear scolding the patient.

05:21 And those are the key points for maintaining therapeutic communication in the psychosocial integrity questions.

05:29 Wow, that was a lot of information, but that should guide you.

05:34 And as you're answering and practicing the questions in our Psychosocial integrity section.