What's Tested on the NCLEX: Psychosocial Integrity

Psychosocial integrity, along with physiological integrity, is a basic health need for all clients. It is the state of dynamic psychological and sociological homeostasis, which may be affected during periods of stress, illness, or crisis. Any threats to a person’s emotional, mental, and social well-being can disrupt this homeostasis. Any change in adaptive and coping responses may result in counterproductive ways of thinking, communicating, feeling, and acting. When assisting clients with psychosocial needs, you must be able to anticipate, recognize, and analyze these types of responses.
On the NCLEX-RN® exam, you can expect approximately 9 percent of the questions to relate to Psychosocial Integrity. This category focuses on promoting and supporting the emotional, mental, and social well-being of clients experiencing stressful events, as well as clients with acute or chronic mental illness.
Nursing actions that are covered in this category include:
•Behavioral interventions
•Chemical and other dependencies
•Coping mechanisms
•Crisis intervention
•Cultural diversity/cultural inf luences on health
•End of life care
•Family dynamics
•Grief and loss
•Mental health concepts
•Religious and spiritual influences on health
•Sensory/perceptual alterations
•Stress management
•Support systems
•Therapeutic communication
•Therapeutic environment

4 Key Principles Tested on the Psychosocial Integrity Section

  • Psychosocial Support Systems

    A patient who is emotionally balanced, mentally prepared to cope with illness, and has a support system—whether spiritual or family/friends—is often better equipped to take on the challenge of illness.
    First, many patients find peace in having a spiritual affiliation. Believing in and placing hope in a higher power is comforting. In fact, this is so important most hospitals have chaplaincy services that are offered to patients in need of support.
    Second, social workers help a patient communicate with their family about life at home and being sick. This becomes especially important when talking about family dynamics, because not all patients want their families involved in their care or even knowing about their illness. They fear they will be a burden to their family, yet they still need someone to talk too. A social consult can help you find a balance you’re comfortable with.

  • Coping Mechanisms

    Patients can demonstrate feelings of frustration through various coping mechanisms. A patient in denial may refuse to accept a terminal diagnosis and continue to request treatment. Many patients displace their anger, either acting out and behaving rudely to family members or the nurse. Others may compensate or make up for their illness by improving their health in other ways, such as taking additional vitamins or supplements. While others may suppress feelings and choose not to talk about them at all. As a patient ultimately has agency over his/her own bodies, these methods must be addressed, but respected.

  • Grief and Loss

    Denial, anger, bargaining, depression, and acceptance are the five emotions recognized throughout the process of grief and loss. Initially, the person may deny the situation and refuse to believe the unfavorable news. After accepting the news, they will likely experience anger about contracting their illness. They can then move into bargaining or trying to make a deal. For example, if I am a better person or take better care of myself this will go away. This can be followed by depression or sadness as the reality of their situation sets in. Lastly, the person will accept the diagnosis/situation as it has been presented to them, deciding to make the most of their circumstances moving forward.

  • End of Life Care

    Nurses help make terminally ill die as comfortably as possible with respect to the wishes predetermined by the dying patient. Completion of advanced directives and health care proxy documentation in advance will ease the end of life process. It is important to ask patients if they have considered filling out such documentation with hospital admission. In addition to this documentation, management of disease throughout palliative care services can be arranged. Palliative care refers to the management of pain during the dying process ensuring as comfortable of an end of life process as possible. Comfort during this process can include pain management, making breathing easier, and relieving feelings of nausea, to name a few.

Psychosocial Integrity Practice Question

A 50-year-old male client comes to the nurses’ station and asks the nurse if he can go to the cafeteria to get something to eat. When told that his privileges do not include visiting the cafeteria, the client becomes verbally abusive. Which of the following approaches by the nurse would be MOST effective?
1.Tell the client to lower his voice, because he is disturbing the other clients.
2.Ask the client what he wants from the cafeteria and have it delivered to his room.
3.Calmly but firmly escort the client back to his room.
4.Assign the nursingassistive personnel (NAP) to accompany the client to the cafeteria.

The correct answer is (3). The nurse should not reinforce abusive behavior. Clients need consistent and clearly defined expectations and limits.

You utilize the nursing process (assess, diagnose, plan, implement, and evaluate) to promote a client’s psychosocial integrity by conveying understanding, sensitivity, and compassion to a client who is experiencing stress, illness, or crisis. Promoting a client’s psychosocial integrity is not just for the mental health client, but for all clients. The nursing process respects the client’s autonomy, freedom to make decisions, and involvement in nursing care.
Although you need to identify emotional disorders and behaviors that indicate mental illness, a client does not need to be mentally ill for you to include psychosocial integrity in the care plan. You must possess sound knowledge and focused clinical experiences to be prepared to recognize and effectively intervene with any client whose state of dynamic psychological and sociological homeostasis is being threatened—whether or not the client has a mental illness.