Psychosocial Integrity
Psychosocial Integrity
This domain tests therapeutic communication, mental status assessment, coping, grief, crisis, abuse, and boundaries. The correct answer usually reflects the client's feelings and assesses safety rather than offering advice or reassurance.
Core rules
- Use open-ended questions, reflection, restating, clarifying, silence, and empathy. Explore the meaning behind the client's statement.
- Avoid false reassurance ('Don't worry'), advice-giving, 'why' questions, changing the subject, and minimizing.
- Defense mechanisms protect against anxiety: denial, projection, rationalization, displacement, regression, sublimation.
- Grief is individual; stage models are not linear and should not be used to judge a client.
- Assess suicide risk directly when warning signs appear. Asking about suicide does not plant the idea. A no-harm contract alone is not sufficient protection.
- Report suspected abuse according to law and facility policy; do not promise secrecy.
Worked example
A client with depression says, 'I'm worthless. Everyone would be better off without me.' The nurse responds, 'You're telling me you feel worthless and that others would be better off. Are you thinking about hurting yourself?' This reflects the feeling, clarifies, and directly assesses suicide risk. Responding 'You shouldn't feel that way' or 'Things will get better' blocks assessment and gives false reassurance.
Traps that cost marks
Offering reassurance instead of exploring; asking 'Why do you feel that way?'; promising confidentiality for abuse; accepting gifts or over-sharing; using a no-harm contract as the only intervention; ignoring escalating agitation.