Psychosocial Integrity Therapeutic Communication Verbal • • • • Methods of Communication Vocabulary Credibility Tone Clarity Nonverbal • • • • Appearance Facial expressions Sounds Personal space Electronic Nursing Process Assess needs Vision Plan communication Ample time Trusting relationship Hearing Minimize distractions Empathetic responses Cognitive Implement Effective Skills and Techniques Silence Presenting Reality Active listening Asking questions Open-Ended Clarifying Techniques Showing acceptance and recognition Focusing Giving Information Summarizing Offering self Touch Offering general leads Sharing feelings Barriers to Effective Communication BEING DEFENSIVE TESTING OFFERING SYMPATHY JUDGING ARGUING Stress and Coping Which of the following images describes you best? (Select all that apply) Stress A feeling of emotional or physical tension • Frustration • Anger • Nervousness Positive or Negative • Finish deadline • Avoid injury • Health problems Physiological Effects of Stress • Elevated • Heart rate • Blood pressure • Glucose level • O2 intake • Pupil dilation Sources of Stress Physiological • Injury • illness Psychological • Event/situation • Comment • Condition Acute Stress Types of Stress • Common • Immediate reaction Episodic Acute Stress • Frequent bouts of acute stress Chronic Stress • Prolonged Stress Related Disorder • Acute Stress Disorder (ASD) • Posttraumatic Stress Disorder (PTSD) • Irritable Bowel Syndrome (IBS) • • • • Abdominal discomfort Cramping Bloating Constipation/diarrhea Crisis • Pushed beyond ability to cope • Can be due to: • • • • • Situations Developmental Disasters Socioeconomic Cultural Types of Defense Mechanisms Compartmentalization Denial Rationalization Projection Repression Regression Coping Strategies • • • • • • • Eating nutritious foods Exercising daily Time management Building personal resilience Mindfulness activities Rest and Relaxation Complementary and Alternative Therapy • Journaling Self-Concept Self-Concept • • • • • Feelings Perception Thoughts Attitudes Beliefs Roger’s Theory of Self-Concept • Self-image • Self-esteem • Ideal self Elements of SelfConcept • Identity • Body image • Role Performance • Self-esteem • Self-efficacy • Culture 8 Stages of Erikson’s Theory of Psychosocial Development 1. Trust vs. Mistrust (Birth to 1 year) 2. Autonomy vs. Shame and Doubt (1 to 3 years) 3. Initiative vs. Guilt (3 to 6 years) 4. Industry vs. Inferiority (6 to 12 years) 5. Identity vs. Role Confusion (12 to 19 years) 6. Intimacy vs. Isolation (20 to mid-40s) 7. Generativity vs. Stagnation (mid-40s to mid-60s) 8. Integrity vs. Despair (mid-60s to death) Identity Stressors • Body image stressors • Self-esteem stressors • Role performance stressors Sexuality Developmental stage • Adolescence – puberty • Older women – menopause Factors Influencing Sexuality Sexual orientation Gender identity Culture Medications Sexuality – Patient Centered Care • Be straightforward • Health promotion • Contraception • STI prevention • Sexual abuse • Sexual dysfunction Nursing Process: Self-Concept and Sexuality Assessment • Build a trusting relationship • Be aware of verbal and nonverbal communication • Assess • Identity • Body image • Self-esteem • Role performance • PLISSIT tool Disturbed Body Image Disturbed Personal Identity Ineffective Role Performance Diagnosis Readiness for Enhanced Self-Concept Chronic Low Self-esteem Situational Low Self-esteem Sexual Dysfunction Ineffective Sexuality Pattern Planning Set Set goals • Include family and client Prioritize Prioritize interventions Encourage Encourage expression of feelings and emotions Carry out plan of care Implementation Document progress Include stress reduction techniques Healthy eating Adequate rest Physical exercise Have outcomes been met? Evaluatio n The client verbalize • Self-acceptance • Self-worth Validate • Body image • Appearance Client-Centered Care Client-Centered Care • Client preferences • Endorsing participation • Promote client understanding • Sharing information • Client considerations • Culturally competent care • Age related considerations Nursing Caring Theories • Watson’s Theory of Human Caring • Swanson’s Theory of Caring Caring Behaviors • • • • • Listening Touch Being present Providing comfort Showing compassion Key questions exemplifying caring • Tell me about your health. • What is it like to be in your situation? • Tell me how you perceive yourself? • What are your health priorities? • How do you envision your life? • What is the meaning of healing for you? • What is the most important thing I can do for you? • What is most important thing you need right now? Nurse, See Me Spirituality Concepts in Spiritual Health • • • • • Faith Hope Transcendence Self-transcendence Religion Nursing Process: Spirituality Assessment • Spiritual assessment tool • FICA • HOPE • Spiritual distress Nursing Diagnosis • • • • • • Anxiety Ineffective Coping Complicated Grieving Hopelessness Powerlessness Readiness for Enhanced Spiritual Well-Being • Spiritual Distress • Risk for Spiritual Distress • Risk for Impaired Religiosity Implementation • Health promotion • • • • Establish presence Support healing relationship Support systems Restorative care Christianity Spiritual Rituals and Observanc es Buddhism Hinduism Islam Jehovah Witness Judaism Mormonism Grief, Loss, Palliative Care Types of Grief • Normal • Anticipatory • Prolonged grief disorder • Disenfranchised Kubler-Ross Five Stages of Grief Model • Denial • Anger • Bargaining • Depression • Acceptance Individual Experiences of Loss and Death • Bereavement • Mourning • Symptoms • Crying • Difficulty sleeping • Appetite changes • Decreased productivity Types of Loss • Actual loss • Necessary loss • Maturational loss • Situational loss • Perceived loss • Anticipatory loss Nursing Process: Grief Assessment • Symptoms of grief • Anger • Resentment • Crying • Speaking loudly • Exaggerated body movements Speak Planning Speak with family • NURSE mnemonic Provide Provide additional resources Highligh Highlight strengths t Facilitate mourning Implementation: Health Promotion Use therapeutic communication Palliative care Interventions relieve symptoms Hospice care Not expected to live greater than six months Make Your End of Life Wishes Known Postmortem Care • Support the grieving family • Care of the body • Prepare for viewing • Organ/tissue donation • Autopsy considerations Nurse Self-Care • Self-care • Self-evaluation • Recognizing personal grief • Compassion fatigue

Psychosocial Integrity

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