Page 2 - Psychosocial Integrity Study Guide for the NCLEX-PN Exam
When supporting clients, there are many opportunities and ways for the PN to assist. The PN should consider what the client’s normal support system consists of both in and out of the hospital.
Support systems typically refer to a client’s family. However, there are many different types of support systems that the PN may have to interact with.
When caring for and supporting the client, the PN should also acknowledge the family’s response to the client’s condition. This may vary depending on if the client is having an acute episode, has a chronic disorder, or has a terminal illness. These conditions may impact the family’s need for education and support.
It is also important to recognize that the family and client may be at varying levels of acceptance regarding the client’s condition. They may need different approaches to teaching and support regarding the client’s condition and treatment plan.
In addition to family support systems, the PN should identify additional client support systems and resources. This could consist of neighbors, caretakers, church groups, and/or government assistance groups. The PN should determine the client’s ability to access any of these support systems as they deem necessary and/or helpful.
For most clients, a need for care, whether inpatient or outpatient, will cause some level of stress. The PN should identify these stressors and coping mechanisms to care for the client.
Stressors may range from the illness itself to the effects this illness has on the client’s normal role and responsibilities. The PN should attempt to identify these stressors and assist the client in coping with them.
When a client is diagnosed with an illness, the PN should monitor the client’s response to this illness. The response can range from rationalization to hopelessness to anger to acceptance. The PN should recognize the client’s response, as it may impact the attitude toward care.
Health Status Changes
As the client’s health status changes, the PN should assist the client in coping and adapting to these changes. In addition to an illness, the client may also be suffering from abuse or neglect, end of life, grief and loss, life changes, and/or physical changes or disfigurement.
Unexpected Altered Body Image
A client’s illness or condition may lead to an unexpected altered body image. This perception of self should not be overlooked, and the PN should provide support. For example, a medication may cause alopecia, or an accident may cause an amputation that may change how the client views himself or herself.
Particularly for independent clients who are used to having control, an illness or health status change may change the normal role of the client. The PN should recognize the client’s ability to adapt to this role change and consider if it is temporary or permanent.
In addition to these actual stressors, the PN should be on alert for any potential stressors to the client. These may be more subtle, such as fear or lack of information. When possible, the PN should attempt to eliminate these stressors.
Assist the Client
The PN will also have the responsibility of assisting the client with their psychosocial needs. These interventions will include observations regarding the client all the way to providing physical assistance. The opportunity for these interventions will likely present themselves with every interaction with the client.
There are many opportunities for the PN to gather information about the client. These observations may range from basic vital signs to client statements about their well-being. The PN should be sure to document any notable items in the client chart.
Collect Data— The PN will be collecting information about the client frequently. In addition to the routine assessment data elements, the PN should also collect and document data regarding the client’s psychosocial functioning.
Observe— The PN will observe the clients to ensure their needs are taken care of but also observe how they are handling the stressors of their illness. The PN should also observe the clients’ coping mechanisms and if they are using them effectively.
Monitor— While making interventions, the PN should also constantly monitor the clients’ responses and progress. For example, for clients who have undergone a procedure that has altered their physical appearance, the PN should monitor the client’s progress toward achieving an improved body image.
Use Therapeutic Techniques
In all communication with clients, the PN should try to employ therapeutic communication techniques. When dealing with psychosocial impacts, these therapeutic techniques can improve the client’s ability to cope with illness and/or stressors.
Self-Esteem— When communicating with clients who have had an incident or procedure that has altered their physical appearance, the PN should work with the client to promote and maintain positive self-esteem.
Independence— The PN should assess the client’s ability to care for themselves independently and assist the client in maintaining and/or improving this level of independence, especially after unexpected body image changes such as amputation or paralysis.
Environment— While it may be difficult in an inpatient setting, the PN should attempt to implement measures to reduce any environmental stressors. This may include eliminating excess noises, keeping the room at an ideal temperature, and keeping the room free of trash and debris.
Monitoring— In all client interactions, the PN should continue to monitor the client’s use of stress management techniques. If they do not seem to be effective, the PN may suggest additional techniques to decrease stress as much as possible.
Therapeutic communication should be at the forefront of all interactions with clients. This includes both verbal and non-verbal communication.
The PN should try to establish a trusting relationship with the client while respecting the client’s personal values and beliefs. Given that the PN will be providing emotional support to the client, it is important to ensure that the relationship remains appropriate at all times.
The PN should encourage the client to communicate both verbally and non-verbally as appropriate. In particular, the PN may need to assist the client in communicating basic needs to other healthcare staff. The PN should monitor the effectiveness of different techniques of therapeutic communication when interacting with the client.
It is important to maintain a therapeutic environment for the client both in and out of the care setting. The PN should identify external factors, such as stressors or noise, that may interfere with recovery and monitor the client’s response to these environmental factors. The PN should contribute to the maintenance of a safe and supportive environment. For example, the PN may encourage the client to participate in community meetings.
There are additional behavioral management interventions that the PN may find especially appropriate in certain situations. Some of them are good practice in any situation.
Obtain Information About Clients and Behavior
When observing the client, the PN should monitor the client’s appearance, mood, and psychomotor behavior for any changes, and in the event of behavioral changes, the PN should explore the cause of this behavior. The PN may encourage the client to participate in a behavior management program, such as a client group session, and assist in recognizing environmental stressors.
Assist the Client
As the client uses learned techniques to modify his or her behavior, the PN should assist the client by reinforcing these techniques. For example, if a client is working on his or her self-control, the PN may want to minimize taking control of situations to allow the client to work on this skill and self-regulate behavior.
Behavioral Management Techniques
When caring for clients that require behavioral management, there are a number of techniques that the PN can employ. For example, positive reinforcement may encourage a client’s progress, while setting limits, contracts, and/or behavior modification may discourage negative behaviors.
Stress management is also important, as decreased stress allows the client to focus and heal without distractions. The PN should assist the client in using behavioral strategies to decrease anxiety, such as mindfulness and/or diaphragmatic deep breathing exercises.
The PN should try to keep the client’s environment as therapeutic as possible. Similar to stress management, this removes one external factor that may distract the client. Removing such distractions, like excess noise or clutter, can assist with the focus on behavior management.
Additionally, there are other therapeutic techniques that the client may benefit from. The client should be encouraged to participate in therapeutic approaches that are of interest, which include but are not limited to reminiscence therapy, validation therapy, and reality orientation.
Behavioral management is somewhat unique, as the client must actively participate in order to be successful. With all interactions, the PN should reinforce the client’s participation in his or her own therapy and during group therapy sessions to receive the greatest benefit.
In addition to client education, the PN may need to provide education to the client’s caregiver. The PN should assist in or reinforce education to caregivers and/or family on ways to manage clients with behavioral disorders.
The PN should continually monitor and assess the client’s response to both pharmaceutical and behavioral management interventions. If the client does not seem to be responding, his or her regimen may need to be adjusted by the care team.