Psychosocial Integrity Study Guide for the NCLEX-RN Exam

General Information

While under nursing care, some patients will experience needs that are not physical. Some patients react to the stress of medical treatments by exhibiting unusual emotional and social behaviors and are in need of mental health as well as physical support. Other patients present with acute or chronic mental illness that requires careful expertise and nursing support. Assessing and caring for the patient’s psychosocial integrity will be discussed throughout this document.

Abuse and Neglect

Abuse and neglect can take many forms. Abuse can be physical, sexual, or emotional. Neglect is the absence of appropriate care, a form of abuse that often manifests in physical and emotional ways. Both may affect patients of any age.

Reporting

All suspected cases of child abuse must be reported to the appropriate authorities or government agency. Nurses are mandated reporters and may face legal action if they fail to report suspected abuse. Many states have laws that mandate when and how to report known or suspected cases of abuse and neglect. Nurses are responsible for following the appropriate protocol for reporting these actions as well as documenting the abuse and/or neglect in the patient’s chart. Patient findings should be documented clearly and objectively in the medical record, as they may be used during legal proceedings later.

Risk Factors

To be alert for and recognize potential cases of abuse and neglect, the nurse must be aware of the risk factors for each type. Remember that risk factors are not a sign of guilt on the part of the abuser. However, when more than one risk factor is present in any case, the patient’s overall risk for abuse increases substantially.

Risk Factors for Child Abuse

These are risk factors for child abuse:

Past or present spousal abuse
Parental perception of stress
Life changes in the family
Young age at the birth of the first child
Low education level
Little to no prenatal care
No phone or having an unlisted phone number
Low income or current unemployment
Evidence of harsh discipline

Elder Abuse

While elder abuse can affect both males and females, the most common victims are women over the age of 75. Elder abuse also commonly occurs to patients with physical and/or mental impairment and those who are dependent on their abuser for daily care.

Risk Factors for Domestic Abuse

It is important to remember that domestic/spousal abuse can happen to anyone at any socioeconomic level. These are risk factors for this type of abuse:

Planning to leave or recently left an abusive relationship
History of abusive relationship(s)
Poverty, unemployment, and/or a poor living situation
Separation or divorce
History of abuse as a child
Mental and/or physical disabilities
Poor support system of family/friends or social isolation
Witness to domestic violence as a child
Pregnancy (especially unplanned)
Age under 30
Being stalked by a partner

Nursing Role

As a nurse working with a suspected or known case of abuse, it is important to encourage open communication that allows victims to share their problems. Educate them on what abuse and neglect is, and help them find resources and information on their own. Nurses provide counseling and support, as well as , teach coping strategies that victims can use. The nurse will often help plan interventions for suspected or known abuse victims and be able to evaluate their response to intervention.

In cases of elder abuse, the nurse should help caregivers understand the special needs of older adults. This involves finding appropriate resources for support of the elder and the caregiver. It is also important to note that a legally competent adult cannot be forced to leave an abusive situation/relationship.

Behavioral Interventions

Nurses need to understand, recognize, and plan appropriate care when patients’ are experiencing negative psychological effects due to stress, illness, or crisis. Intervention is necessary when a patient is unable to or cannot properly evaluate reality. Nurses may provide specific interventions to maintain a patient’s cognition.

Signs of Altered Mental Processes

Common signs of altered mental status include:

Disorientation
Altered mood
Altered behavior pattern
Inability to perform self-care activities
Altered sleep pattern
Altered perception of one’s surroundings

The patient’s treatment plan should be tailored to his or her specific needs and focus on the structure, safety, and symptom relief/management that is needed in each individual case. In addition, the nurse must be able to evaluate the patient’s response and adjust nursing interventions as indicated.

Possible Interventions

Remember that each patient will have specific needs, depending on each individual situation. In general, be familiar with all of the following interventions and be able to incorporate them into the nursing treatment plan.

Interaction

Try to maintain and encourage the patient’s normal daily interactions and activities. This normalcy helps develop more routine-based and structured behavior, which helps maintain the patient’s functioning and provides a sense of purpose.

Observation

During the patient’s interactions and daily activities, maintain close observation of the patient’s behaviors, attitudes, and responses. Evaluating and documenting reactions to the plan can help in understanding what is working and where adjustments are needed.

Relationship

It is important to develop an open and honest relationship with patients. Clearly verbalize relationship expectations from the beginning to improve patients’ compliance in formulating and progressing toward their goals.

Verbalizing

Patients need verbalized acceptance despite behavior that is inappropriate. This helps build trust and understanding and will help as the nurse continues to remind them of their individual goals for treatment.

Role-Modeling

Nurses must always role-model appropriate behavior and interaction around other patients and staff members. This helps patients better understand what is expected from them while reinforcing and supporting any discussions of behavior expectations.

Patient Responsibility

Encourage patients to accept responsibility for their own actions and behaviors. While encouraging them, nurses must also show the patient support and guidance. Therapeutic patient-nurse relationships naturally encourage this process.

Positive Reinforcement

Acknowledge and praise achievements. Additionally, discuss and analyze failures. Nurses must show patients that they are involved and sincerely care about them. Provide a source of accountability and support during the treatment process.

Patient Orientation

Orient and reorient patients so that they can be in touch with reality as much as possible. Encourage family members, friends, and other visitors to do the same.

Group Therapy

For appropriate patients, group therapy can be a powerful treatment tool. Discuss this with the patients, and encourage them to attend sessions. If patients are not receptive at first, continue to provide gentle persuasion and encouragement to give it a try.

Patient Self-Control

Know and teach patients ways to achieve and maintain self-control over their behaviors. If anxiety plays a role in acting out, provide appropriate coping strategies to help control this as well.