Page 1 - Psychosocial Integrity Study Guide for the NCLEX-PN Exam
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 the mental health and social/emotional well-being of clients. There’s a lot you, as an LPN, can do to promote this kind of comfort in your clients. If there’s anything we listed about which you still have questions, please look for more information in additional sources.
Respecting Client Differences
When caring for clients, the PN will encounter all ages, genders, ethnicities, religions, etc. Therefore, it is important to plan your care in accordance with and respect for client differences.
Cultural awareness is an important aspect of respecting client differences. While the PN may not agree or share the same culture as the client, having an awareness of the culture is key.
Cultural competence is the ability to appreciate, accept, and work with people of all cultures. The nurse must be aware of personal views and beliefs and how they may interact and/or conflict with others before they can achieve this competence.
Culture and Ethnicity
When planning care, providing care, and monitoring clients, it is important to be knowledgeable of the client’s culture and ethnicity, as this may impact certain choices.
For clients that are going to undergo a procedure, the client’s culture and ethnicity can have an effect on certain interventions. For example, a client may prefer to not make direct eye contact or speak to the PN without the presence of certain family members to help make decisions.
The nurse should understand that cultural and religious beliefs may cause a client to act differently than expected. This is not meant as a sign of disrespect. Maintaining open communication regarding the client’s background, cultural, and religious practices will help the nurse to understand the client’s behaviors and actions.
A client’s culture and/or ethnicity may also impact how the client understands and comprehends a diagnosis or certain intervention options. For example, a client may have alternative views on the cause of a psychiatric disorder and/or the use of pharmaceuticals to treat such disorders based on their personal beliefs which may not align with scientific beliefs.
One of the common tasks for the PN will be assisting in preparing and administering meals to clients. It is important that the PN is aware of how the client’s culture and/or ethnicity can impact dietary preferences. For example, some cultures may require kosher meals or halal meals. Some clients may have religious regulations that require fasting at times. Other cultures may have strict regulations on what meats can or cannot be consumed.
The PN will encounter clients that speak many different languages. If the PN only speaks English, it is important for the PN to determine the client’s ability to comprehend and speak the English language. If the client is not able to communicate, the PN should request a translator service for the client. Most healthcare facilities will have medically-trained interpreters on staff or accessible via phone or video. Of note, a family member that speaks the same language may not be an appropriate translator, as they may have their own biases.
Religious and Spiritual Awareness
In addition to cultural and ethical differences, clients 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 clients 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, emotional problems 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 clients of certain religious or spiritual groups. For example, many facilities offer pastoral care for many denominations that may be helpful for clients and/or their families. In addition, when making end-of-life decisions, the client 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.
Client 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 clients 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 client behavior.
When caring for clients, the PN should note the client’s current, exhibited behavior and how it compares not only to their baseline behavior but also to certain known disorders.
There are a number of different personality types that the PN will encounter. The client may also exhibit different behaviors when in a situation such as hospitalization. For example, a usually 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 clients 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 client 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 clients will exhibit behavior more appropriate for younger children as a sign of regression.
Sensory and Perceptual Alterations
Some clients may have chronic or acute sensory and/or perceptual alterations. These may be related to a condition or medication side effect. In particular, clients 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 clients.
Identify Needs— The PN will need to identify the needs of clients with these alterations. For example, when the client is having a hallucination, the most important task is to keep the client safe from harm to others and harm to themselves. These clients 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 clients effectively in order to properly care for them. The PN should assess and verify the clients’ ability to communicate their needs to ensure they are able to care for themselves.
The PN may encounter clients with varying degrees of cognitive impairment and will need to assist in the care of these clients. These impairments may be related to a genetic disorder or disease processes. The PN should monitor the ability of these clients to participate in their own care.
Changes in Behavior
One of the most important signs to look out for is a change in the client’s behavior. The PN should recognize this as either a change in mental status or symptom of relapse. The client may also suddenly refuse to follow their treatment plan. The client 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 clients and family members near the end of life and after death as they experience grief and loss.
As clients 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 client and/or family, as different levels of preparation will change the client’s and family’s 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 client 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 in or the role changes that will need to occur when they pass.
The PN should provide support and care to the client 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. Anticipatory guidance may be provided to help the client and family know what to expect near the end of life. Referrals to different resources may be applicable.
Grief and Loss
When clients have been diagnosed with a terminal illness, or when the clients 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 clients and their family, the PN should identify the client’s reaction to their diagnosis or the family’s reaction to a death. Clients 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 clients 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.