Chapter 4 of 712% of exam

Psychosocial Integrity

Psychosocial Integrity addresses the emotional, mental, and social needs of clients experiencing stress, crisis, mental illness, or loss. The nurse uses therapeutic communication, ensures safety, and supports coping and grief.

Therapeutic Communication

Therapeutic communication builds trust and helps clients express feelings. The nurse uses empathy, open-ended questions, and silence while avoiding blocks such as false reassurance.

Acknowledge feelings
Reflect and validate the client's emotions to encourage expression.
Use open-ended questions
Invite the client to share more rather than asking yes-or-no questions.
Use silence
Allow pauses so the client has time to process and respond.
Avoid communication blocks
Do not give false reassurance, advice, or change the subject.

Mental Health Conditions

The nurse cares for clients with mood, anxiety, psychotic, and eating disorders, tailoring interventions to the condition. Physiological stability may take priority in some disorders.

Present reality kindly
For hallucinations, acknowledge the client's experience without confirming or arguing about the perception.
Reduce stimulation in mania
Provide a calm environment and portable high-calorie foods for manic clients.
Watch physiology in eating disorders
Bradycardia and electrolyte imbalance in anorexia can be life-threatening and take priority.
Support panic clients
Stay present, remain calm, and use short, simple statements during a panic attack.

Crisis and Safety

The nurse assesses for suicide, violence, and substance withdrawal, placing safety first. Direct assessment guides protective action.

Ask directly about suicide
Directly asking about suicidal ideation assesses risk and does not increase self-harm.
Assess safety in abuse
Evaluate immediate safety and provide resources for clients disclosing violence.
Monitor withdrawal
Seizures during alcohol withdrawal are an emergency requiring immediate intervention.
De-escalate anger
Acknowledge feelings and invite discussion rather than commanding or threatening.

Coping and Grief

The nurse supports clients and families through loss using knowledge of grief stages and coping mechanisms. Presence and honest communication aid coping.

Recognize grief stages
Denial, anger, bargaining, depression, and acceptance may occur in any order.
Support the grieving
Use presence and silence and encourage expression of feelings.
Identify postpartum depression
Persistent sadness and disinterest in the infant beyond two weeks warrant evaluation.
Support families at end of life
Provide privacy and encourage families to express feelings.

Cognitive and Behavioral Alterations

The nurse distinguishes and manages delirium, dementia, and behavioral changes with supportive, consistent care. Environmental strategies reduce agitation.

Reorient in delirium
Provide frequent reorientation, familiar objects, and consistent caregivers.
Avoid overstimulation
Reduce noise and clutter that can worsen confusion and agitation.
Minimize restraints
Use nonpharmacologic strategies before considering restraints for confused clients.
Ensure a safe environment
Prevent wandering and injury while preserving dignity.

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Last updated: November 2026

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