NCLEX: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span

Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span: Human Sexuality Throughout the Life Cycle

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span

Human sexuality refers to all the characteristics of an individual (social, personal, and emotional) that are manifest in his or her relationships with others and that reflect gender-genital orientation.

I. COMPONENTS OF SEXUAL SYSTEM

  • Biological sexuality—refers to chromosomes, hormones, primary and secondary sex characteristics, and anatomical structure.
  • Sexual identity—based on own feelings and perceptions of how well traits correspond with own feelings and concepts of maleness and femaleness; also includes gender identity.
  • Gender identity—a sense of masculinity and femininity shaped by biological, environmental, and intrapsychic forces, as well as cultural traditions and education.
  • Sex role behavior—includes components of both sexual identity and gender identity. Aim: sexual fulfillment through masturbation, heterosexual, or homosexual experiences. Selection of behavior is influenced by personal value system and sexual, gender, and biological identity. Gender identity and roles are learned and constantly reinforced by input and feedback regarding social expectations and demands (Sexual Behavior Throughout the Life Cycle).
Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span
Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span

II. CONCEPTS AND PRINCIPLES OF HUMAN SEXUAL RESPONSE

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span

  • Human sexual response involves not only the genitals but the total body.
  • Factors in early postnatal and childhood periods influence gender identity, gender role, sex typing, and sexual responses in later life.
  • Cultural and personally subjective variables influence ways of sexual expression and perception of what is satisfying.
  • Healthy sexual expressions vary widely.
  • Requirements for human sexual response:
    1. Intact central and peripheral nervous system to provide sensory perception, motor reaction.
    2. Intact circulatory system to produce vasocongestive response.
    3. Desirable and interested partner, if sex outlet involves mutuality.
    4. Freedom from guilt, anxiety, misconceptions, and interfering conditioned responses.
    5. Acceptable physical setting, usually private.

Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span: Sexual-Health Counseling

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span

Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span: General Issues

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span

I. ISSUES in sexual practices with implications for counseling:

  • Sex education—need to provide accurate and complete information on all aspects of sexuality to all people.
  • Sexual-health care—should be part of total healthcare planning for all.
  • Sexual orientation—need to avoid discrimination based on sexual orientation (such as homosexuality); the right to satisfying, nonexploitive relationships with others, regardless of gender.
  • Sex and the law—sex between consenting adults not a legal concern.
  • Explicit sexual material (pornography)—can be useful in fulfilling various needs in life, as in quadriplegia.
  • Masturbation—a natural behavior at all ages; can fulfill a variety of needs (see Masturbation, p. 726).
  • Availability of contraception for minors—the right of access to medical contraceptive care should be available to all ages.
  • Abortion—confidentiality for minors.
  • Treatment for sexually transmitted infections (STIs)— naming of partners as part of STI control.
  • Sex and the elderly—need opportunity for sexual expression; need privacy when in communal living setting.
  • Sex and the disabled—need to have possible means available for rewarding sexual expressions.

II. SEXUAL MYTHS*

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span

  • Myth: Ignorance is bliss.
    Fact: What you don’t know can hurt you (note the high frequency of STI and abortions); myths can perpetuate fears and such misinformation as:
    1. Masturbation causes mental illness.
    2.  Womendon’t or shouldn’t have orgasms.
    3. Tampons cause STI.
    4. Plastic wrap works better than condoms.
    5. Coca-Cola is an effective douche.
    Fact: Lack of knowledge during initial experiences may result in fear and set precedent for future sexual reactions.
  • Myths: The planned sex act is not OK and is immoral for “nice” girls. If a woman gets pregnant, it is her own fault. Contraceptives are solely a woman’s responsibility.
    Fact: Sex and contraception are the prerogative and responsibility of both partners.
  • Myth: A good relationship is harmonious, free of conflict and disagreement (which are signs of rejection and incompatibility).
    Fact: Conflict can induce growth in self understanding and in understanding of others.
  • Myth: Sexual deviance (such as homosexuality) is a sign of personality disturbance.
    Fact: No single sexual behavior is the most desirable, effective, or satisfactory. Personal sexual choice is a fundamental right.
  • Myth: A woman’s sexual needs and gratification should be secondary to her partner’s; a woman’s role is to satisfy others.
    Fact: A woman has as much right to sexual freedom and experience as a man.
  • Myth: Menopause is an affliction signifying the end of sex.
    Fact: Many women do not suffer through menopause, and many report renewed sexual interest.
  • Myth: Sexual activity past 60 years of age is not essential.
    Fact: Sexual activity is therapeutic because it:
    1. Affirms identity.
    2. Provides communication.
    3. Provides companionship.
    4. Meets intimacy needs.
  • Myth: A woman’s sex drive decreases in postmenopausal period.
    Fact: The strength of the sex drive becomes greater as androgen overcomes the inhibitory action of estrogen.
  • Myth: Men over age 60 cannot achieve an erection.
    Fact: According to Masters and Johnson, a major difference between the aging man and the younger man is the duration of each phase of the sexual cycle. The older man is slower in achieving an erection.
  • Myth: Regular sexual activity cannot help the aging person’s loss of function.
    Fact: Research is revealing that “disuse atrophy” may lead to loss of sexual capacity. Regular sexual activity helps preserve sexual function.

III. BASIC PRINCIPLES OF SEXUAL-HEALTH COUNSELING

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span

  • There is no universal consensus about acceptable values in human sexuality. Each social group has very definite values regarding sex.
  • Counselors need to examine own feelings, attitudes, values, biases, knowledge base.
  • Help reduce fear, guilt, ignorance.
  • Offer guidance and education rather than indoctrination or pressure to conform.
  • Each person needs to be helped to make personal choices regarding sexual conduct.

IV. COUNSELING IN SEXUAL HEALTH

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span

  • General considerations:
    1. Create atmosphere of trust and acceptance for objective, nonjudgmental dialogue.

2. Use language related to sexual behavior that is mutually  comfortable and understood between client and nurse.
a. Use alternative terms for definitions (e.g., “being intimate” vs. “having sex”).
b. Determine exact meaning of words and phrases because sexual words and expressions have different meanings to people with different backgrounds and experiences.
3. Desensitize own stress reaction to the emotional component of taboo topics.
a. Increase awareness of own sexual values, biases, prejudices, stereotypes, and fears.
b. Avoid overreacting, under reacting.
4. Become sensitively aware of interrelationships between sexual needs, fears, and behaviors and other aspects of living.
5. Begin with commonly discussed areas (such as menstruation) and progress to discussion of individual sexual experiences (such as masturbation). Move from areas where there is less voluntary control (nocturnal emissions) to more responsibility and voluntary behavior (premature ejaculation).
6. Offer educational information to dispel fears, myths; give tacit permission to explore sensitive areas.
7. Bring into awareness possibly repressed feelings of guilt, anger, denial, and suppressed sexual feelings.
8. Explore possible alternatives of sexual expression.
9. Determine interrelationships among mental, social, physical, and sexual well-being.

  • Assessment parameters:
    1. Self-awareness of body image, values, and attitudes toward human sexuality; comfort with own sexuality.
    2. Ability to identify sex problems on basis of own satisfaction or dissatisfaction.
    3. Developmental history, sex education, family
    relationships, cultural and ethnic values, and
    available support resources.
    4. Type and frequency of sexual behavior.
    5. Nature and quality of sex relations with others.
    6. Attitude toward and satisfaction with sexual
    activity.
    7. Expectations and goals.
  • Nursing care plan/implementation:
    1. Long-term goals:
    a. Increase knowledge of reproductive system and types of sex behavior.
    b. Promote positive view of body and sex needs.
    c. Integrate sex needs into self-identity.
    d. Develop adaptive and satisfying patterns of sexual expression.
    e. Understand effects of physical illness on sexual performance.

2. Primary sexual-health interventions:
a. Goals: minimize stress factors, strengthen sexual integrity.
b. Provide education to uninformed or misinformed.
c. Identify stress factors (myths, stereotypes, negative parental attitudes).
3. Secondary sexual-health interventions: identify sexual problems early and refer for treatment.

  • Evaluation/outcome criteria:
    1. Reduced impairment or dysfunction from acute sex problem or chronic, unresolved sex problem.
    2. Evaluate how client’s goals were achieved in terms of positive thoughts, feelings, and satisfying sexual behaviors.

Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span: Specific Situations

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span

I. MASTURBATION

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span

  • Definition—act of achieving sexual arousal and orgasm through manual or mechanical stimulation of the sex organs.
  • Characteristics:
    1. Can be an interpersonal as well as a solitary activity.
    2. “It is a healthy and appropriate sexual activity, playing an important role in ultimate consolidation of one’s sexual identity.”*
    3. Accompanied by fantasies that are important for:
    a. Physically disabled.
    b. Fatigued.
    c. Compensation for unreachable goals and unfulfilled wishes.
    d. Rehearsal for future sexual relations.
    e. Absence or impersonal action of partner.
    4. Can help release tension harmlessly.
  • Concepts and principles related to masturbation:
    1. Staff’s feelings and reactions influence their responses to client and affect continuation of masturbation (i.e., negative staff actions increase client’s frustration, which increases masturbation).
    2. Masturbation is normal and universal, not physically or psychologically harmful in itself.
    3. Pleasurable genital sensations are important for increasing self-pride, finding gratification in own body, increasing sense of personal value of being lovable, helping to prepare for adult sexual role.
    4. Excessive masturbation—some needs not being met through interpersonal relations; may use behavior to avoid interpersonal relations.
    5. Activity may be related to:
    a. Curiosity, experimentation.
    b. Tension reduction, pleasure.

c. Enhanced interest in sexual development.
d. Fear and avoidance of social relationships.

  • Nursing care plan:
    1. Long-term goals:
    a. Gain insight into preference for masturbation.
    b. Relieve accompanying guilt, worry, self devaluation
    (Operationalization of the behavioral concept of masturbation).
    2. Short-term goals:
    a. Clarify myths regarding masturbation.
    b. Help client see masturbation as an acceptable sexual activity for individuals of all ages.
    c. Set limits on masturbation in inappropriate settings.
  • Nursing implementation:
    1. Examine, control nurse’s own negative feelings; show respect.
    2. Avoid: reinforcement of guilt and self devaluation; scorn; threats, punishment, anger, alarm reaction; use of masturbation for rebellion in power struggle between staff and client.
    3. Identify client’s unmet needs; consider purpose served by masturbation (may be useful behavior).
    4. Examine pattern in which behavior occurs.
    5. Intervene when degree of functioning in other daily life activities is impaired.
    a. Remain calm, accepting, but non-sanctioning.
    b. Promptly help clarify client’s feelings, thoughts, at stressful time.
    c. Review precipitating events.
    d. Be a neutral “sounding board”; avoid evasiveness.
    e. If unable to handle situation, find someone who can.
    6. For clients who masturbate at inappropriate times or in inappropriate places:
    a. Give special attention when they are not masturbating.
    b. Encourage new interests and activities, but not immediately after observing masturbation.
    c. Keep clients distracted, occupied with interesting activities.
    7. Health teaching: explain myths and teach facts regarding cause and effects.
  • Evaluation/outcome criteria:
    1. Acknowledges function of own sexual organs.
    2. States sexual experience is satisfying.
    3. Views sexuality as pleasurable and wholesome.
    4. Views sex organs as acceptable, enjoyable, and valued part of body image.
    5. Self-image as fully functioning person is restored and maintained.

II. HOMOSEXUALITY

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span

  • Definition—alternative sexual behavior; applied to sexual relations between persons of the same sex.
Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span
  • Theories regarding causes:
    1. Hereditary tendencies.
    2. Imbalance of sex hormones.
    3. Environmental influences and conditioning factors, related to learning and psychodynamic theories.
    a. Defense against unsatisfying relationship with father.
    b. Unsatisfactory and threatening early relationships with opposite sex.
    c. Oedipal attachment to parent.
    d. Parent who is seductive (incest).
    e. Castration fear.
    f. Labeling and guilt leading to sexual acting out.
    g. Faulty sex education.
    4. Preferred choice as a lifestyle.
  • Nursing care plan/implementation:
    1. Nurse needs to be aware of and work through own attitudes that may interfere with providing care.
    2. Accept and respect lifestyle of a client who is gay (man who is homosexual) or lesbian (woman who is homosexual).
    3. Assess and treat for possible sexually transmitted infections and hepatitis.
    4. Health teaching: assess and add to knowledge base about alternatives in sexual behavior.
  • Evaluation/outcome criteria: expresses self confidence and positive self-image; able to sustain satisfying sexual behavior with chosen partner and avoid at-risk behaviors for STIs.

III. SEX AND THE PERSON WHO IS DISABLED

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span

  • Assessment parameters:
    1. Previous level of sex functioning and conflict.
    2. Client’s view of sex activity (self and mutual pleasure, tension release, procreation, control).
    3. Cultural environment (influence on body image).
    4. Degree of acceptance of illness.
    5. Support system (partner, family, support group).

6. Body image and self-esteem.
7. Outlook on future.

  • Analysis/nursing diagnosis: sexual dysfunction associated with physical illness related to:
    1. Disinterest in sexual activity.
    2. Fear of precipitating or aggravating physical illness through sexual activity.
    3. Use of illness as excuse to avoid feared or undesired sex.
    4. Physical inability or discomfort during sexual activity.
  • Nursing care plan/implementation:
    1. Approach with nonjudgmental attitude.
    2. Elicit concerns about current physical state and perceptions of changes in sexuality.
    3. Observe nonverbal clues of concern.
    4. Identify genital assets.
    5. Support client and partner during adjustment to current state.
    6. Explore culturally acceptable sublimation activities.
    7. Promote adjustment to body image change.
    8. Health teaching:
    a. Teach self-help skills.
    b. Teach partner to care for client’s physical needs.
    c. Teach alternate sex behaviors and acceptable sublimation (e.g., touching).
  • Evaluation/outcome criteria: attains satisfaction with adaptive alternatives of sexual expressions; has a positive attitude toward self, body, and sexual activity.

IV. INAPPROPRIATE SEXUAL BEHAVIOR

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span

  • Assessment: public exhibitions of sexual behaviors that are offensive to others; making sexual advances to other clients or staff.
  • Analysis/nursing diagnosis: conflict with social order related to:
    1. Acting out angry and hostile feelings.
    2. Lack of awareness of hospital and agency rules regarding acceptable public behavior.

3. Variation in cultural interpretations of what is acceptable public behavior.
4. Reaction to unintended seductiveness by person’s attire, posture, tone, or choice of terminology.

  • Nursing care plan/implementation:
    1. Maintain calm, nonjudgmental attitude.
    2. Set firm limits on unacceptable behavior.
    3. Encourage verbalization of feelings rather than unacceptable physical expression.
    4. Reinforce appropriate behavior.
    5. Provide constructive diversional activity for clients.
    6. Health teaching: explain rules regarding public behavior; teach acceptable ways to express anger.
  • Evaluation/outcome criteria: verbalizes anger rather than acting out; accepts rules regarding behavior in public.

Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span: Concept of Death Throughout the Life Cycle

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span

I. AGES 1 TO 3

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span

  • No concept perse, but experiences separation anxiety and abandonment any time significant other disappears from view over a period of time.
  • Coping means: fear, resentment, anger, aggression, regression, withdrawal.
  • Nursing care plan/implementation—help the family:
    1. Facilitate transfer of affectional ties to another nurturing adult.
    2. Decrease separation anxiety of child who is hospitalized by encouraging family visits and rooming in, reassuring child that she or he will not be alone.
    3. Provide stable environment through consistent staff assignment.

II. AGES 3 TO 5

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span

  • Least anxious about death.
  • Denial of death as inevitable and final process.
  • Death is separation, being alone.
  • Death is sleep and sleep is death.
  • “Death” is part of vocabulary; seen as real, gradual, temporary, not permanent.
  • Dead person is seen as alive, but in altered form, that is, lacks movement.
  • There are degrees of death.
  • Death means not being here anymore.
  • “Living” and “lifeless” are not yet distinguished.
  • Illness and death seen as punishment for “badness”; fear and guilt about sexual and aggressive impulses.
  • Death happens, but only to others.
  • Nursing care plan/implementation (in addition to previous):
    1. Encourage play for expression of feelings; use clay, dolls, etc.
    2. Encourage verbal expression of feelings using children’s books.
    3. Model appropriate grieving behavior.
    4. Protect child from the over stimulation of hysterical adult reactions by limiting contact.
    5. Clearly state what death is—death is final, no breathing, eating, awakening—and that death is not sleep.
    6. Check child at night and provide support through holding and staying with child.
    7. Allow a choice of attending the funeral and, if child decides to attend, describe what will take place.
    8. If parents are grieving, have other family or friends attend to child’s needs.

III. AGES 5 TO 10

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span

  • Death is cessation of life; question of what happens after death.
  • Death seen as definitive, universal, inevitable, irreversible.
  • Death occurs to all living things, including self; may express, “It isn’t fair.”
  • Death is distant from self (an eventuality).
  • Believe death occurs by accident, happens only to the very old or very sick.
  • Death is personified (as a separate person) in fantasies and magical thinking.
  • Death anxiety handled by nightmares, rituals, and superstitions (related to fear of darkness and sleeping alone because death is an external person, such as a skeleton, who comes and takes people away at night).
  • Dissolution of bodily life seen as a perceptible result.
  • Fear of body mutilation.
  • Nursing care plan/implementation (in addition to previous):
    1. Allow child to experience the loss of pets, friends, and family members.
    2. Help child talk it out and experience the appropriate emotional reactions.
    3. Understand need for increase in play, especially competitive play.
    4. Involve child in funeral preparation and rituals.
    5. Understand and accept regressive or protest behaviors.
    6. Rechannel protest behaviors into constructive outlets.

IV. ADOLESCENCE

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span

  • Death seen as inevitable, personal, universal, and permanent; corporal life stops; body decomposes.
  • Does not fear death, but concerned with how to live now, what death feels like, body changes.
  • Experiences anger, frustration, and despair over lack of future, lack of fulfillment of adult roles.
  • Openly asks difficult, honest, direct questions.
  • Anger at healthy peers.
  • Conflict between developing body versus deteriorating body, independent identity versus dependency.
  • Nursing care plan/implementation (in addition to previous):
    1. Facilitate full expression of grief by answering direct questions.
    2. Help let out feelings, especially through creative and aesthetic pursuits.
    3. Encourage participation in funeral ritual.
    4. Encourage full use of peer group support system, by providing opportunities for group talks.

V. YOUNG ADULTHOOD

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span

  • Death seen as unwelcome intrusion, interruption of what might have been.
  • Reaction: rage, frustration, disappointment.
  • Nursing care plan/implementation: all of previous, especially peer group support.

VI. MIDDLE AGE

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span

  • Concerned with consequences of own death and that of significant others.
  • Death seen as disruption of involvement, responsibility, and obligations.
  • End of plans, projects, experiences.
  • Death is pain.
  • Nursing care plan/implementation (in addition to previous): assess need for counseling when also in midlife crisis.

VII. OLD AGE

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span

  • Philosophical rationalizations: death as inevitable, final process of life, when “time runs out.”
  • Religious view: death represents only the dissolution of life and is a doorway to a new life (a preparatory stage for another life).
  • Time of rest and peace, supreme refuge from turmoil of life.
  • Nursing care plan/implementation (in addition to previous):
    1. Help person prepare for own death by helping with funeral pre-arrangements, wills, and sharing of mementos.
    2. Facilitate life review and reinforce positive aspects.
    3. Provide care and comfort.
    4. Be present at death.

Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span: End-of-Life: Death and Dying

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span

Too often the process of death has had such frightening aspects that people have suffered alone. Today there has been a vast change in attitudes; death and dying are no longer taboo topics. There is a growing realization that we need to accept death as a natural process. Elisabeth Kübler-Ross has written extensively on the process of dying, describing the stages of denial (“not me”), anger (“why me?”), bargaining (“yes me—but”), depression (“yes, me”), and acceptance (“my time is close now, it’s all right”), with implications for the helping person.

I. CONCEPTS AND PRINCIPLES RELATED TO DEATH AND DYING:

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span

  • Persons may know or suspect they are dying and may want to talk about it; often they look for someone to share their fears and the process of dying.
  • Fear of death can be reduced by helping clients feel that they are not alone.
  • The dying need the opportunity to live their final experiences to the fullest, in their own way.
  • People who are dying remain more or less the same as they were during life; their approaches to death are consistent with their approaches to life.
  • Dying persons’ need to review their lives may be a purposeful attempt to reconcile themselves to what “was” and what “could have been.”
  • Three ways of facing death are (a) quiet acceptance with inner strength and peace of mind;
    (b) restlessness, impatience, anger, and hostility; and (c) depression, withdrawal, and fearfulness.
  • Four tasks facing a person who is dying are (a) reviewing life, (b) coping with physical symptoms in the end stage of life, (c) making a transition from known to unknown state, and (d) reaction to separation from loved ones.
  • Crying and tears are an important aspect of the grief process.
  • There are many blocks to providing a helping relationship with the dying and bereaved:
    1. Nurses’ unwillingness to share the process of dying—minimizing their contacts and blocking out their own feelings.
    2. Forgetting that a person who is dying may be feeling lonely, abandoned, and afraid of dying.
    3. Reacting with irritation and hostility to the person’s frequent calls.
    4. Nurses’ failure to seek help and support from team members when feeling afraid, uneasy, and frustrated in caring for a person who is dying.
    5. Not allowing client to talk about death and dying.
    6. Nurses’ use of technical language or social chitchat as a defense against their own anxieties.

II. ASSESSMENT OF DEATH AND DYING:

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span

  • Physical:
    1. Observable deterioration of physical and mental capacities—person is unable to fulfill physiological needs, such as eating and elimination.
    2. Circulatory collapse (blood pressure and pulse).

3. Renal or hepatic failure.
4. Respiratory decline.

  • Psychosocial:
    1. Fear of death is signaled by agitation, restlessness, and sleep disturbances at night.
    2. Anger, agitation, blaming.
    3. Morbid self-pity with feelings of defeat and failure.
    4. Depression and withdrawal.
    5. Introspectiveness and calm acceptance of the inevitable.

III. ANALYSIS/NURSING DIAGNOSIS:

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span

  • Terminal illness response.
  • Altered feeling states related to fear of being alone.
  • Altered comfort patterns related to pain.
  • Altered meaningfulness related to depression, hopelessness, helplessness, powerlessness.
  • Altered social interaction related to withdrawal.

IV. NURSING CARE PLAN/IMPLEMENTATION:

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span

  • Long-term goal: foster environment where person and family can experience dying with dignity.
  • Short-term goals:
    1. Express feelings (person and family).
    2. Support person and family.
    3. Minimize physical discomfort.
  • Explore own feelings about death and dying with team members; form support groups.
  • Be aware of the normal grief process.
    1. Allow person and family to do the work of grieving and mourning.
    2. Allow crying and mood swings, anger, demands.
    3. Permit yourself to cry.
  • Allow person to express feelings, fears, and concerns.
    1. Avoid pat answers to questions about “why.”
    2. Pick up symbolic communication.
  • Provide care and comfort with relief from pain; do not isolate person.
  • Stay physically close.
    1. Use touch.
    2. Be available to form a consistent relationship.
  • Reduce isolation and abandonment by assigning person to room in which isolation is less likely to occur and by allowing flexible visiting hours.
  • Keep activities in room as near normal and constant as possible.
  • Speak in audible tones, not whispers.
  • Be alert to cues when person needs to be alone (disengagement process).
  • Leave room for hope.
  • Help person die with peace of mind by lending support and providing opportunities to express anger, pain, and fears to someone who will accept her or him and not censor verbalization.
  • Health teaching: teach grief process to family and friends; teach methods to relieve pain.

V. EVALUATION/OUTCOME CRITERIA:

Focus topic: Psychosocial Integrity: Behavioral/Mental Health Care Throughout the Life Span

  • Remains comfortable and free of pain as long as possible.
  • Dies with dignity.

FURTHER READING/STUDY:

Resources:

Leave a Reply

Your email address will not be published. Required fields are marked *