Psychosocial Integrity Study Guide for the NCLEX-RN Exam

Mental Health Concepts

Mental health is a person’s emotional and psychological well-being. Good mental health allows one the ability to function reasonably well in day-to-day life.

Mental Health

Good mental health includes the ability to act responsibly, be self-aware, remain in a positive mood, be relatively worry-free, and have the proper coping skills to deal with a variety of life situations.

In healthcare, the nurse will frequently assess a patient’s mental health status. Many patients may experience memory loss, loss of interest in themselves or their hygiene. This is especially common in the event of chronic illness or prolonged hospitalization. Nurses should tailor interventions to communicate with patients, remind them of details when they forget, reorient them frequently throughout the day, and assist in performing or encouraging good hygiene practices. Interventions may include writing the date and healthcare worker’s names in the patient’s room; promoting day/night schedules with set sleep and awake schedules; providing patients with appropriate bathing supplies, etc.

Influences on Mental Health

Genetic/inherited factors, childhood attachment/nurturing, and general life circumstances are major factors that influence mental health. In addition, to maintain good mental health, one must have good interpersonal communication skills, proper use of ego defense mechanisms, and access to and proper use of available support systems (family, friends, etc.).

Common Mental Health Disorders

Patients may be affected by acute and/or chronic mental illness. Common diagnoses to review include schizophrenia, depression, and bipolar disorder. Many of these diagnoses are chronic but may additionally present with acute symptoms. Depression may be complicated by a suicide attempt. Patients may be hospitalized in the event of mania related to their bipolar disorder. Nurses must provide safe environments for their patients, provide support for patients struggling with poor mental health, and maximize interventions to promote a return to a healthy state of mind.

Education is a key component in improving mental health. For patients struggling with addictions/dependencies, depression, dementia, and eating disorders, nurses may need to educate patients and caregivers on what to expect throughout the duration of the illness, the ups and downs, recovery, and possible relapse. Understand that many of these diseases have additional physical symptoms or complications that require nursing attention. Remember to care for the whole patient and not just a singular aspect of a patient’s illness.

The Nurse’s Role

The nurse must be able to analyze and assess the patient’s individual mental health needs and implement appropriate interventions. Patients may experience alterations in mood, judgment, cognition, and reasoning. Knowing a patient’s baseline helps the nurse to appreciate changes the patient may be experiencing.

Manage patient pain to reduce adverse mental strain; encourage maintaining as much normalcy throughout the day as possible; and provide choices in care when applicable to help patients regain some control. Often, a combination of interventions will be required to optimize care of a patient’s mental health. Apply knowledge of psychopathology to each individual patient to provide appropriate mental health care.

Religious and Spiritual Influences

Religion is defined as an organized, formalized set of beliefs that is based on one or more gods. Spirituality is defined as a “connectedness” to other individuals, the environment or universe, a higher power (not a god), and one’s self (intrapersonal connectedness).

Effects on Health

Both religion and spirituality can have major impacts on a patient’s physical and psychosocial well-being and health outcomes. Patients may experience internal conflict if their condition or treatment options are not supported by their beliefs. Spiritual distress may also occur as patients process emotions regarding their health status. Maintaining a balance of spiritual/religious well-being will improve nursing care and patient participation in healthcare treatments and interventions. Understand how a patient’s individual religious/spiritual beliefs will impact their perception of and reaction to clinical care.

The Nurse’s Role

Listen respectfully and empathetically to patients’ religious/spiritual needs and be aware of specific religious and spiritual traditions. Nurses must also have an understanding of their own religion, beliefs, and spirituality to provide the best and appropriate care for their patients. Even if the nurse’s beliefs differ from a patient’s beliefs, the nurse is responsible for providing the best care possible while supporting the patient toward his/her personal belief. In the event the nurse does not feel he/she can provide the best care to the patient due to religious or spiritual conflict, the nurse should seek a different assignment with the nursing supervisor. Likewise, nurses need to respect a patient’s right to refuse care that does not align with his or her religious or spiritual beliefs.

Sensory and Perceptual Alterations

Sensory and perceptual alterations are disruptions in a patient’s cognitive functioning that cause a distorted perception of his or her surrounding environment and interactions with others. They ultimately lead to a patient’s inability to function properly. This, in turn, may place a patient at risk for harm in the healthcare setting.

Precipitating Factors

A few factors can affect a patient’s sensory functioning, including:

Developmental stage— Age and general physical decline can affect a patient’s ability to hear, see, etc.

Culture— Different cultures have different norms for sensory functioning (i.e., eye contact, physical touch, personal space, etc.)

Stress— Stressors, both physical and emotional, can affect a patient’s cognition. Pain, testing, hospitalization, surgery, excess noise, uncertainty of the future, and lack of knowledge/education are examples of common stressors.

Medications— Medications such as benzodiazepines and opioids can affect a patient’s sensory functioning. Some medications such as gentamicin and lasix can be ototoxic.

Illness— There are some illnesses and conditions that severely impact a patient’s sensory and perceptual functioning. Critical illnesses such as cancer or stroke and chronic illnesses such as diabetes, hypertension, circulation, and neurological disorders can affect a patient’s ability to receive sensory stimuli.

Lifestyle— A patient who has recently had a change in lifestyle (loss of loved one, change of residency, etc.) may also experience impaired sensory function.

Personality— Some patients may have difficulties if they are more introverted, aloof and/or less likely to communicate.

Risk Factors

It is important to identify a patient at risk so that you may take preventive measures to keep him or her safe. Always orient the patient to person, place, and time with each encounter and explain your nursing care prior to giving it.

Environment— A patient with little sensory stimulation (confined in a room, etc.) may exhibit negative cognitive effects.

Vision and hearing problems— Apply appropriate nursing interventions for these patients including the use of assistive devices, sign language interpreters, etc.

Restricted mobility— Ensure these patients have access to activities, can get to personal belongings, and have assistance to ambulate when needed.

Emotional disorders— Specific nursing interventions will need to be individualized for these patients (decreased stimuli for mania and increased stimuli for depression, etc.).

Limited social contact— Patients with limited access to social stimuli will need intervention to prevent sensory deprivation symptoms.

Pain and discomfort— Apply proper nursing interventions including medications, positioning, and other techniques.

Acute illness— High fever, infections, seizures, and intoxication may require the use of interventions for sensory alterations.

Close monitoring— Intensely monitored patients such as those in the ICU setting may experience negative sensory alterations due to excessive stimuli.

Cognitive ability issues— Patients with conditions that result in cognitive disruptions (i.e., head trauma, etc.) will require special interventions.