Psychosocial Integrity

The nurse provides and directs nursing care that focuses on psychosocial integrity.  The Registered Nurse must promote and support the emotional, mental, and social well being of the client undergoing stressful situations and experiencing acute or chronic mental illness.  This category accounts for about 9% of the questions on the NCLEX-RN exam.  The categories covered under this topic include:

Abuse and Neglect

This section will cover the responsibility the Registered Nurse has for assessing for abuse and neglect and mandatory reporting rules.  The RN assesses the client and identifies risk factors for domestic, child, elder abuse and neglect, and sexual abuse.

The RN plans interventions for victims of abuse, counsels clients affected and develops coping strategies, provides a safe environment for the client, evaluates the client response to interventions, and provides community and mental health resources. 

Behavioral Interventions

This section covers behavioral interventions that the Registered Nurse can implement.  The RN assesses the client’s appearance, mood, and psychomotor behavior, identifies inappropriate or abnormal behavior, and orients the client to reality.   The RN may assist the client with interventions like behavior modification and contracts to achieve and maintain self-control of behavior, and support the client to develop and use strategies to decrease anxiety.  The RN may lead and participate in support groups and counseling sessions, incorporate behavioral management techniques when caring for a client, and evaluate the client’s response to behavior intervention plan.

Chemical and Other Dependencies and Substance Abuse Disorders

This section covers relevant information about substance abuse disorders, chemical addictions, and other dependencies.  The RN will assess the client for chemical and other dependencies, withdrawal syndrome, or toxicities and facilitate care as appropriate.  The RN should assess the client’s feedback to the diagnosis and treatment of the dependency disorder, plan and care for clients experiencing withdrawal or toxicity, provide education on substance abuse diagnosis and treatment care plans, provide care and support to a client with non-substance-related dependencies.  The RN will provide symptom management for clients facing withdrawal, encourage each client to participate in community resources like support groups and outpatient addiction rehabilitation services, and evaluate the client’s response to a treatment plan and revise as needed.

Coping Mechanisms

This section will cover coping mechanisms the RN will utilize to promote client wellness. The RN should assess the client’s support systems, resources, ability to adapt to temporary or permanent role changes, coping mechanisms with life changes.  The RN also will evaluate reaction to the diagnosis of acute or chronic mental illness, provide the client with support, identify events that precipitate role changes for the client and evaluate the constructive use of defense mechanisms and adaptations to role changes.

Crisis Intervention

This section covers the nurse’s role in crisis intervention that may be covered by the NCLEX-RN.  The RN will assess the client’s probability for violence (suicide, homicide, self-destructive behavior) practice safety precautions, identify the client in crisis and use crisis intervention techniques to promote coping and provide appropriate community resources for crisis recovery and social support.

Cultural Awareness and Influences on Health

This section discusses cultural awareness and influences on health and how it affects Registered Nurses.  The RN should identify cultural matters that may impact the client’s acceptance of their medical diagnosis, evaluate the significance of client culture and ethnicity when planning, delivering and evaluating care.  The RN should combine client cultural practice and beliefs with nursing care planning and delivery and respect the client’s cultural background and related practices.  The nurse must use suitable interpreters and other language appropriate learning tools to support client comprehension and to assess and record how the client language needs are being fulfilled.

End of Life Care

This section discusses the important nursing care component surrounding the end of life care that Registered Nurses provide.  The RN must identify the end of life needs of the client, assess the client's ability to cope with end-of-life interventions, distinguish the need for support to the family, provide psychosocial aid to caregivers, assist the client and family in significant end of life issues, and provide end of life care and education to clients.

Family Dynamics

This section discusses how a Registered Nurse negotiatesfamily dynamics.  The RN must assess barriers and stressors that could influence family dynamics, develop the nursing care plan, and assess parent’s chosen form of discipline.  The RN will encourage the client's participation infamily therapy sessions or group therapy, support the client to incorporate new members into the family structure, and evaluate assets to advance family functioning.

Grief and Loss

This section discusses how a Registered Nurse helps a client deal with grief and loss.

The RN will assist the client in handling grief, loss, dying, and mourning the loss of a loved one, support the client through suffering and anticipatory grieving, educate the client regarding the expected reactions to grief, provide community resources to adjust to loss, and evaluate the client’s copings related to grief.

Mental Health Concepts

This section will cover the mental health concepts that a Registered Nurse must be familiar with when taking the NCLEX-RN exam. They must be aware of a number of psychiatric disorders including anxiety, depression, bipolar disorder, dementia, eating disorders, and schizophrenia.  The Registered Nurse must be competently able to identify signs and symptoms of impaired cognition, acute mental health disorders, and chronic mental illness, as well as provide nursing care plans and extensive education.  The RN should identify possible client defense mechanisms, understand why the client is refusing to follow the treatment plan, and assess the client for alterations in mood, judgment, cognition, and reasoning. The RN applies psychopathology knowledge to mental health concepts for all types of therapy including individual, group, and family.  The RN will also evaluate the patient’s ability to adhere to treatment plan and their abnormal response to the aging process.

Religious and Spiritual Influences on Health

This section will discuss the religious and spiritual influences on health that a nurse must be cognizant of when caring for their client.  The RN will recognize the emotional issues of a client and their needs related to spiritual beliefs, particularly those that involve in reconciling the conflict between the suggested treatment and their religious beliefs.  The RN should also assess the spiritual, psychosocial, and occupational factors that affect their care, provide appropriate nursing interventions that meet their emotional and spiritual needs and evaluate whether the client’s spiritual needs are being met. 

Sensory and Perceptual Alterations

This section will discuss the sensory and perceptual alterations that a Registered Nurse should know for the NCLEX-RN.  The RN must identify the setting, time, and the preceding events framing the emergence of symptoms, promote strategy development for the client experiencing sensory and thought disorders, and participate in care delivery for a client experiencing visual, auditory or cognitive delusions.  The RN must be competent to provide nursing care in a soothing and nonjudgmental style, as well as provide reality-based diversions.

Stress Management

This section will examine the stress management techniques that a Registered Nurse should be familiar with for the NCLEX-RN.  The RN must identify nonverbal signals that a client is stressed by their physical or psychological setting, assess which environmental stressors affect client care, execute interventions to reduce environmental stressors, provide knowledge to their client regarding stress management techniques (i.e. meditation, guided imagery, exercise, stress reduction or relaxation techniques), and then evaluate the client's use of those stress management techniques.

Support Systems

This section will enable the future RN to study the support systems that are present in the healthcare experience.  The RN will promote family care planning for the client with impaired cognition (i.e. dementia or Alzheimer's disease), further the client's participation in the healthcare management process, and assess the client's feelings and comfort level surrounding the diagnosis treatment plan

Therapeutic Communication

This section will review the important issues regarding nursing therapeutic communication.  The RN will assess every part of a client’s communication needs including both verbal and nonverbal, respect the client's personal values and beliefs, and allow time to communicate with the client.  The nurse will use therapeutic communication methods to give patient support, encourage verbalization of personal feelings, and evaluate if communication with the client is effective.

The Therapeutic Environment

This section will discuss how a Registered Nurse can promote the therapeutic environment. The RN will identify external influences that impede the client recovery like family dynamics and stressors, create room assignments that reinforce the therapeutic environment, and provide a therapeutic environment for clients with emotional and behavioral issues.

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