Psychosocial Integrity Study Guide for the NCLEX-PN Exam

Extreme Situations

There are a number of extreme situations that the PN should be prepared to handle. While they will hopefully be less common, is it important to know how to deal with these situations, as the involved clients may be in danger or at high risk for injury.

Abuse or Neglect

There are multiple forms of abuse or neglect; some present themselves more obviously than others. When interviewing clients, the PN should always be alert for signs of abuse or neglect.

Recognize

One of the best ways to prevent injury to clients is to recognize the risk factors of potential abuse or neglect along with the actual signs of abuse or neglect. If the care team is able to intervene early, there is a better chance that the client may be able to be removed from the situation.

Risk Factors

Clients can be at risk to be the perpetrator or a victim of abuse. Several types of abuse exist, including physical abuse, sexual abuse, verbal abuse, domestic violence, and neglect. There are a number of standard questions to be asked during healthcare assessments to screen for this. Vulnerable populations, such as children, people with special needs, and elderly populations, are at increased risk for abuse.

Signs

When assessing a client, the PN should attempt to identify signs and symptoms of any physical, psychological, or financial abuse. For example, a lack of family involvement or inadequate weight gain may indicate a neglected child, while poor hygiene may indicate elder neglect.

Support

In these delicate situations, the client will likely be in need of additional support from the health care team. This can include physical and/or emotional support. The PN should pay close attention to needs that are expressed outwardly or implied to assist these vulnerable clients. Keep in mind that these clients may have a difficult time placing trust in anyone unknown. Ensure client safety and confidentiality while the client is in the PN’s care.

Provide

Physically, the PN should try to provide a safe environment for any abused or neglected clients. This may include isolating the clients from their family members and/or caretakers. The PN may also be able to provide emotional support, such as active listening, to these clients. And with all clients, the PN should reinforce teaching on coping strategies to prevent abuse or neglect.

Evaluate

The PN should constantly evaluate the client’s response to these interventions and evaluate the client’s progress and safety. Often, additional referrals to other support groups, community resources, or government agencies may be appropriate.

Chemical and Other Dependencies

There are a number of chemical/substance dependencies that the PN should be aware of and identify throughout client assessments. Additionally, there are other addictions or dependencies that may present themselves.

Substance Abuse

The PN may deal with clients admitted for conditions related to substance abuse or may encounter clients with side effects related to substance abuse prior to admission for other reasons. This may include a chemical dependency, withdrawal, or toxicity/overdose to substances such as nicotine, opioids, or sedatives.

Signs and Symptoms

Depending on the substance, the signs and symptoms of abuse or withdrawal may vary. If the client is admitted and no longer has access to nicotine or other substances, he or she may experience tremors or headaches. Additionally, a client may present with a lack of consciousness and decreased or absent respirations related to a substance overdose or toxicity.

Treatment Plan

Again, depending on the substance, the treatment plan may vary. However, the PN should assist as needed to help develop an appropriate treatment plan, monitor the client’s response, and contribute to treatment plan revisions as needed. The PN should reinforce provided information on substance abuse diagnoses and treatment plans.

Support Groups

A number of support groups for common substance abuse clients exist, such as Alcoholics Anonymous and Narcotics Anonymous. The PN should encourage client participation in these support groups to aid in recovery.

Impulse Control Disorders

There are impulse control disorders that may be less apparent on admission or clinical review. These may include gambling addiction, sexual addiction, or pornography addiction. The nurse should assist with the treatment plans for these clients as needed.

Crisis Intervention

Additionally, there are acute crises that the PN should be prepared for, as they are extremely unpredictable and critical.

Assess Client

During a crisis, the client should be assessed and kept as safe as possible at all times. The PN should identify the client’s risk for self-injury and/or violence, including suicide. The PN can also collect data from family members or caregivers on the client’s potential for violence to self or others in the past and report changes in client behavior that may indicate a developing crisis to a supervisor and the care team.

Crisis Intervention Techniques

The PN should use crisis intervention techniques to assist the client in coping with any critical situation. The safety of the client should always be a top priority.

De-escalation Techniques

There are a number of de-escalation techniques that may assist in managing an angry or agitated client. For example, the PN, other clients, and other staff members should maintain a safe distance from the angry client, avoid turning their backs on the client, and identify an escape route. The PN should keep his or her posture relaxed, keep hands visible to the client, and avoid using excessive hand gestures.

Communication Techniques

When communicating with an angry or agitated client, the care team should identify a single person to communicate with the client. This person should use a clear and calm voice to restate the client’s statements, be respectful, utilize silence, and set boundaries. Use therapeutic communication strategies and avoid prompting further client agitation.

Offer Realistic Explanations and Choices

While attempting to resolve the crisis, the PN or member of the care team communicating with the client should offer explanations and realistic choices. A clear explanation may help the client understand the situation that led to the crisis, and realistic choices will allow the client to take control of what he or she can do to resolve the crisis.

Moving Forward

Following the acute phase of a crisis, the PN should provide opportunities for the client to understand why the crisis occurred and how it could be avoided in the future. The PN can assist by guiding the client to resources for recovery such as social support. As always, the PN should reinforce teaching on suicide prevention and violence prevention even if the client does not seem to be high risk.