Page 1 Psychosocial Integrity Study Guide for the NCLEX-PN® exam
How to Prepare for the Psychosocial Integrity Questions on the NCLEX-PN® Test
The NCLEX-PN® test allots about 9% to 15% of its questions to the area of psychosocial integrity, and we’ve outlined the major topics you’ll need to know about here. A great deal of this content concerns mental health and social/emotional well-being of patients. There’s a lot you, as an LPN, can do to promote this kind of comfort in your patients. If there’s anything we listed about which you still have questions, please look for more information in additional sources.
Respecting Patient Differences
When caring for patients, the PN will encounter all ages, genders, ethnicities, religions, etc. Therefore, it is important to plan your care in accordance with and respect for patient differences.
Cultural awareness is an important aspect of respecting patient differences. While the PN may not agree or share the same culture as the patient, having an awareness of the culture is key.
Culture and Ethnicity
When planning care, providing care, and monitoring patients, it is important to be knowledgeable of the patient’s culture and ethnicity as this may impact certain choices.
For patients that are going to undergo a procedure, the patient’s culture and ethnicity can have an effect on certain interventions. For example, a patient may prefer to not make direct eye contact or speak to the PN without the presence of certain family members to help make decisions.
A patient’s culture and/or ethnicity may also impact how the patient understands and comprehends a diagnosis or certain intervention options. For example, a patient may have alternative views on the cause for a psychiatric disorder and/or the use of pharmaceuticals to treat such disorder based on their personal beliefs that may not align with scientific beliefs.
One of the common tasks for the PN will be assisting in meals for patients. It is important that the PN is aware of how the patient’s culture and/or ethnicity can impact dietary preferences. For example, some cultures may require kosher meals or halal meals or may have restrictions on types of meats.
The PN will encounter patients that speak many different languages. If the PN only speaks English, it is important for the PN to determine the patient’s ability to comprehend and speak the English language. If the patient is not able to communicate, the PN should request a translator service for the patient. Of note, a family member that speaks the same language may not be an appropriate translator as they may have their own bias.
Religious and Spiritual Awareness
In addition to cultural and ethical differences, patients may have a variety of religious and/or spiritual views. It is important to be aware of how these differences can impact care.
Understanding the Needs
The PN should feel comfortable asking the patients if they have any specific religious and/or spiritual beliefs as it pertains to healthcare decisions. In the case of hospitalization or a terminal illness, there are emotional problems that may arise related to these religious and/or spiritual beliefs, such as spiritual distress or conflict between recommended treatment and beliefs. The PN should adjust the plan of care and nursing interventions as necessary.
In some cases, additional assistance may be appropriate for patients of certain religious or spiritual groups. For example, many facilities offer pastoral care for many denominations that may be helpful for patients and/or their families. In addition, when making end-of-life decisions, the patient and/or their family may appreciate involving pastoral care so that their last wishes and/or rituals with respect to their religion can be honored.
Patient behavior can be relatively unpredictable. However, it is important that the PN understand concepts around behavior and inappropriate behavior so that he or she can monitor patients accordingly.
Mental Health Concepts
There are a number of mental health concepts that the PN should be familiar with. An understanding of these concepts will help the PN analyze patient behavior.
When caring for patients, the PN should note the patient’s current, exhibited behavior and how it compares not only to their baseline behavior but also certain known disorders.
There are a number of different personality types that the PN will encounter. The patient may also exhibit different behaviors when in a situation such as hospitalization. For example, a usual independent personality type may exhibit dependent behaviors as a result of his or her inability to care for themselves.
Even outside of work in mental health facilities, the PN will encounter patients with varying mental illnesses. Many people with chronic mental illnesses, such as schizophrenia, depression, or bipolar disorder, are able to manage their symptoms with medication and therapy. However, the PN should always be on alert for a change in behavior that may signal an acute episode.
Many people have natural personality defense mechanisms, but when a patient is in a situation outside of his or her control, such as hospitalization, these defense mechanisms may be exacerbated and range from constructive to destructive. For example, many pediatric patients will exhibit behavior more appropriate for younger children as a sign of regression.
Sensory and Perceptual Alterations
Some patients may have chronic or acute sensory and/or perceptual alterations. These may be related to a condition or medication side effect. In particular, patients with certain mental health diagnoses may experience alterations such as hallucinations and delirium. The PN should be able to recognize these alterations and assist in the care of these patients.
Identify Needs— The PN will need to identify the needs of patients with these alterations. For example, when the patient is having a hallucination, the most important task is to keep the patient safe from harm to others and harm of themselves. These patients will also need assistance from the PN to ensure their basic needs are met.
Communication of Needs— The PN will need to communicate with these patients effectively in order to properly care for them. The PN should assess and verify the patients’ ability to communicate their needs to ensure they are able to care for themselves.
The PN may encounter patients with varying degrees of cognitive impairment and will need to assist in the care of these patients. These impairments may be related to a genetic disorder or disease processes. The PN should monitor the ability of these patients to participate in their own care.
Changes in Behavior
One of the most important signs to look out for is a change in the patient’s behavior. The PN should recognize this as either a change in mental status or symptom of relapse. The patient may also suddenly refuse to follow their treatment plan. The patient should be assessed for the underlying causes of these changes, as it may indicate a clinical change or reaction to a drug.
In addition to these behavioral changes, there are certain considerations when dealing with patients and family members near the end-of-life and after death as they experience grief and loss.
As patients near the end of life, they, along with their families, may have unique needs. The PN should also consider how sudden these changes are to the patient and/or family as different levels of preparation will change the patient and family needs. The PN should also keep in mind that everyone will process end-of-life changes differently and should be open-minded to attitudes and beliefs.
When preparing for the end of life, the patient will have unique needs related to their concerns and emotions. Some may be fearful; some may feel a loss of control. Others may be concerned with the financial state they will leave their family or the role changes that will need to occur when they pass.
The PN should provide support and care to the patient at the end of life along with his or her family. The PN should identify the client’s ability to cope with interventions and assist with resolution of end-of-life issues or concerns. Referrals to different resources may be applicable.
Grief and Loss
When patients have been diagnosed with a terminal illness, or when the patients have passed away, they along with their family members or caretakers may experience grief and loss. The five basic stages of grief are denial, bargaining, anger, depression, and acceptance—and people may shift between these stages multiple times.
In caring for patients and their family, the PN should identify the patients’ reaction to their diagnosis or the family’s reaction to a death. Patients and family members will likely react differently if the event or diagnosis is expected as opposed to unexpected.
One of the PN’s responsibilities will be to provide support to these patients and family members by providing resources regarding the adjustment to loss and bereavement, which may include counseling and/or support groups. Further, in anticipatory grieving, there may be an opportunity to educate on possible reactions when the grieving time comes.