Psychosocial Integrity
Psychosocial Integrity
This domain tests therapeutic communication, mental status assessment, crisis intervention, suicide risk, delirium versus dementia, abuse and neglect, grief, and culturally safe care. The exam rewards empathy, direct assessment, and safety over reassurance.
Therapeutic communication
- Use open-ended questions, reflection, silence, clarification, and empathy.
- Avoid false reassurance ("Don't worry"), "why" questions, advice-giving, changing the subject, and excessive self-disclosure.
- Maintain boundaries: no personal social media contact, no gifts that create obligation, no meeting outside the professional relationship.
- Use an interpreter, not a family member, for sensitive disclosure when possible.
Assessment and crisis
- Mental status exam: appearance, behaviour, speech, mood and affect, thought process and content, cognition, insight, judgment.
- Ask directly about suicide: "Are you thinking of killing yourself?" Ask about plan, means, and intent. If risk is present, do not leave the client alone, remove means, notify the team, and arrange one-to-one observation.
- Delirium is acute, fluctuating, and often reversible; dementia is gradual and progressive. Use a tool such as the CAM to screen.
- De-escalate with calm tone, space, and choices; avoid confrontation.
- Know provincial mandatory reporting laws for child abuse, elder abuse, and intimate partner violence.
Worked example
A client says, "I can't go on like this." The PN does not say "You'll feel better tomorrow." Instead, the PN sits down and asks directly, "Are you having thoughts of suicide?" The client discloses a plan. The PN stays with the client, removes accessible means, calls the team, and initiates one-to-one observation. The PN documents the exact words and actions taken.
Traps that cost marks
- Promising confidentiality when there is a risk of harm.
- Accepting "I'm fine" without exploring a change in mood.
- Treating new confusion as dementia rather than delirium.
- Confronting an agitated client or crowding their space.
- Ignoring culture, trauma history, or language needs.