Psychosocial Care Skills
What this domain covers
Psychosocial items test person-centered care: resident rights (privacy, dignity, choice, confidentiality, refusal, visitors, personal belongings), therapeutic communication, behavior as communication, dementia and delirium, grief and dying, sexuality and intimacy, cultural and religious preferences, and promoting independence and activity.
Concepts you must know
Use open-ended questions, active listening, restating, and clarifying. Speak to the resident, not over them. Offer choices whenever possible; choice is a right, not a reward. In dementia, validate the feeling behind the statement, redirect gently, and keep routines familiar. Sundowning, catastrophic reactions, and wandering are symptoms to report and accommodate, not to punish. Recognize that a resident may use defense mechanisms such as denial or regression; do not confront them. Know the difference between reality orientation (for confusion that may be reversible) and validation (for progressive dementia).
Traps the exam uses
- Do not argue with a delusion or hallucination or try to prove the resident wrong; acknowledge the feeling and redirect.
- Never say "Don't you remember?" or use childish language with an adult.
- Do not make promises you cannot keep, and do not share your own personal problems.
- Do not discuss a resident's condition in front of them or with people who are not involved in care.
- A resident who is crying, withdrawn, or suddenly confused needs reporting, not just distraction.
Worked example
A resident with dementia insists her deceased husband is coming to pick her up. Weak answer: "He died years ago, you know that." Better answer: "You miss him. Tell me about him," then redirect to a familiar activity. The feeling is real even when the fact is not.
Rule of thumb
Before choosing an answer, ask: Does this treat the resident as an adult with rights and choices, and does it keep them safe? Answers that scold, argue, deceive, or expose private information are wrong.