Promoting-Psychosocial-Responses -

1. Fundamentals of Nursing
NCM103
Promoting Healthy
Psychosocial Responses

2. Self-Concept
Self-Concept – is the cognitive component of self system.
Self-Esteem – is the affective component
Self-concept influences the following:
• How one thinks, talks, and acts
• How one sees and treats another person
• Choices one makes
• Ability to give and receive love
• Ability to take action and to change things.

3. Four Components of Self-Concept
1. Body image – physical self, how a person perceives the size,
appearance , and functioning of the body and its parts.
2. Role performance -
3. Personal Identity
4. Self-esteem
Dimensions of Self-Concept
Self-knowledge – insight into one’s own abilities, nature and
limitations
Self-expectation – what one expects of oneself, maybe realistic or
unrealistic
Social self – how a person is perceived by others and society
Social evaluation – the appraisal of oneself in relationship[ to
others, events, or situation

4. Stress & Adaptation
Stress is an essential aspect of existence and has always
been part of human experience, it is something that each
person has to cope.
Coping is a process that a person uses to manage events that
she/he encounters, perceives, and interprets as stressful.
Crisis suggests a situation in which usual coping strategies are
ineffective, and the person is disorganized or unable to solve
problems appropriately.

5. Behavioral Responses
Anxiety – a feeling of dread or uneasiness from unknown cause.
Four Levels of Anxiety
1. Mild
- Increased alertness and awareness of environment details
2. Moderate
- Decreased awareness and focus is on selected aspects of
self/illness
3. Severe
- Incongruence of thoughts, feelings and actions
4. Panic
- distorted perceptions of the environment
- unpredictable response

6. Nursing Interventions
• Reduce stimuli e.g. calm, quiet environment
• Provide explanations for treatment
• Promote, explore feelings. Focusing on the client’s feelings
• Avoid asking client to make choices
• Therapeutic Communication
• Validate perception. “How are you feeling?”
• Pause. Allow client to think & response.
- In what ways can I help you?
- I’ll stay with until you settle down.

7. • Aggressiveness - Acting in a hostile manner. Irritable,
uncooperative, project anger to others.
- Allow expression of feelings, Maintain eye contact, Set limits,
Approach in calm, direct manner
• Depression – extreme sadness/unhappiness, lack of interest in
activities and environment
- Approach in serious mood, communicate an understanding of
feeling, help to express of feelings and concerns, listen to the
person
• Fear - is an emotion or feeling of apprehension aroused by
impending or seeming danger, pain, or another perceived threat
• Suspiciousness – Powerlessness, lack of control, difficulty with trust
- Avoid whispering or talking softly within person’s hearing, Provide trust
• Somatic behavior - Preoccupied with body functions and feelings of
pain, seek attention.
- Spend time with the person and listen to physical complaints with some
limit setting

8. Defense Mechanism
• Repression – a person cannot be recalled or recognized
experiences that involved guilt, shame or low self-esteem and
thus we are protected from anxiety.
• Suppression – opposite of repression. One willfully and
consciously forgot or puts a feelings out of one’s mind.
• Identification – a person admires the qualities of significant
people and aspires to be like them.
• Reaction formation – a behavior of a person that is the exact
opposite of what the person feels would tend to show.
• Compensation – is a substitute phenomenon. A boy cannot
participate in athletics compensates by studying hard and
attain a high grades.
• Rationalization – designed to maintain the self respect of a person
and prevent feelings of guilt.

9. • Substitution – one chooses alternate goals, which are
attainable and which have comparable gratification.
• Displacement – an emotional feeling is transferred from the
actual object to a substitute. E.g hostility
• Restitution – one relieves one’s mind of guilt by restitutive
acts. A boy breaks his sister’s toy then feels guilty and offers
to give the sister prize to make up for the broken toy.
• Projection – one attributes to others characteristics that one
does not want to admit are one’s own. A person criticizes his
friend for being gossip when in fact a person himself who
gossips but is not aware of it.
• Conversion – transforming a mental conflict into a physical
symptom.
•Symbolization – is the use of objects to represent ideas or
emotions that are too painful to express.

10. •Regression – a person adopts behavior that was comforting
earlier in life, seeking attention. A child unconsciously returns to
an earlier behavior pattern in order to obtain his mother’s
attention.
•Denial – consciously intolerable thoughts, wishes, facts and
deeds are disowned by unconscious denial of existence.
•Sublimation – a mechanism by energy inherent in unacceptable
impulses is redirected into socially useful goals. A man devotes
his time in charitable work rather than recognizes his loneliness
in his home.
•Introjection – an unconscious mechanism. Feelings of hatred
about a person that are turned inward can create depression
and suicide.

11. Sensory Functioning

12. Components of Sensory Process
Sensory reception
• Is the process of receiving stimuli either external or internal.
External – refers to senses
Internal – movement and positioning of the body (kinesthetic)
Sensory perception
• Involves conscious organization and translation of the data or stimuli
into meaningful information.
Clinical signs:
- changes in attention span, changes in thought process, emotional
lability (mood swing or irritability), altered sleeping pattern
Factors Affecting Sensory Stimulation
• Culture
• Stress
• Medication , illness
• Lifestyle

13. Sensory Alterations
• Sensory deficit – more than one sense is impaired (blind, deaf)
• Sensory deprivation – alteration in perception, decrease attention
span, yawning, drowsiness, decreased problem solving
• Sensory overload – increased quantity or quality of internal stimuli
causing a person to feel fatigue, sleepiness, restlessness e.g.
anxiety, pain
Common Diseases Affecting Older Adults
• Degenerative diseases
• Cataract
• Glaucoma
• Diabetic retinopathy
• Dementia (Alzheimer’s disease)
• Delirium – can be seen in all ages but most common in old
age
• Arthritis

14. State of Awareness
Full consciousness
- Alert, oriented to time, place, person, understands verbal and
written words.
Disoriented
- Not oriented to time, place, or person
Confused
- Reduced awareness, poor memory, impaired judgment,
misinterpret stimuli
Somnolent
- Extreme drowsiness but will respond to stimuli
Semi-comatose
- Can be aroused by extreme or repeated stimuli
Coma
- Will not respond to verbal stimuli

15. Delirium VS Dementia
Delirium – is an acute change in mental status. It occurs in acute or sudden
onset.
Cause: Infections, Cerebral and cardiovascular disease, stress etc.
Duration: Temporary last in hours to days
Time of day: Worsens at night
Thinking: Disorganized, impaired attention and memory
Delusions/hallucinations: visual, auditory, tactile hallucinations
Dementia – memory impairment, slow in onset
Cause: Alzheimer’s disease
Duration: Chronic, gradual, irreversible
Time of day: No change
Thinking: impaired judgment, difficulty with abstraction and word
finding
Delusions no hallucination

16. Nursing Diagnosis
Impaired Verbal communication related to disturbance in sensory
perception.
• Altered LOC
• Hearing loss
Risk for injury related to disturbance in sensory-perception
• Visual impairment
• Hearing loss
• Decrease kinesthetic sense

17. Nursing Management
• Assess the client current sensory perception and other potential problems.
• Assess the LOC
• Perform physical examination
• Check client risk for sensory-perceptual deprivation
• Assess the client environment for quantity, quality and type of stimuli e.g.
lights, noise
• Assess the social support or significant others
• Plan for safety and prevent injury of client, maintaining ADL, learn to use
cane and assistive device.
• Develop verbal communication
• Minimize noise, light and distraction for client with sensory overload.
• Always announce your presence when entering the client room
• Talk at a moderate rate tone of voice & use simple words
• Identify time and place, ask the client” Where are you?”
• Provide bed rest

18. Loss , Grief & Dying

19. Loss , Grief & Dying
Grief - is the process of coping with a loss.
Loss – is an actual or potential situation in which a valued object,
person or the like is inaccessible or changed so that it is no longer
perceived as valuable.
a. Actual loss can be recognized by others
b. Perceived loss is experienced by one person but cannot be
verified by others
c. Anticipatory loss is experienced before the loss actually occurs.
Bereavement – is the subjective response to a loss through the
death of a person with whom there has been a significant
relationship.
Mourning – is the behavioral process through which grief is
eventually resolved or altered; it is often influenced by culture and
custom.

20. Stages of Grieving (Kubler-Ross)
1. Denial & isolation – refuses to believe that loss is
happening
2. Anger – family may direct anger at a nurse
3. Bargaining – seeks to bargain to avoid loss, feeling of guilt
(e.g., “let me just live until and then I will be ready to
die”).
4. Depression - decreased interest to support person (e.g.,
reviewing past losses such as money or job), or may
withdraw.
5. Acceptance - May have decreased interest in
surroundings and support people. May wish to begin
making plans (e.g., will, prosthesis, altered living
arrangements).

21. Development Concept of Death

22. Nursing Approaches
- Utilize play for expressing thoughts and feelings.
- Explain what is death that is final and not sleep.
- Permit a choice of attending a funeral.
3. School Age (5-12 years old)
- Death is personified
- Understand death is final
- Accept regressive or protest behavior
- Encourage verbalization of feelings

23. Nursing Approaches
4. Adolescent (12-16 years old)
- Mature understanding of death
- May have strong emotions about death, silent, withdrawn, angry.
- Worry about changes
Nursing Approaches:
- Encourage verbalization of feeling.
- Respect need of privacy and personal expression
5. Adult
- Death is a disruption of lifestyle.
6. Older Adult
- Accepts own mortality. A time of reflection, rest and place.
Nursing Approaches:
- allow ventilation of feelings.

24. Nursing Approaches
• Provide opportunity for the person to tell their story
• Recognize and accept the varied emotions that people express in
relation to a significant loss
• Provide support for the expression of difficult feelings e.g. sadness
• Acknowledge the usefulness of mutual –help groups
• Encourage self-care by family members particularly, the primary
caregivers
• Acknowledge the usefulness of counseling for especially difficult
problems

25. Nursing Diagnosis
Anticipatory grieving related to:
• Potential loss of loved one
• Loss of body part or function
• Loss of social role
Impaired adjustment related to:
• Disability requiring change in lifestyle
• Inadequate or unavailable support systems
• Impaired cognition
• Ineffective denial

26. Signs of Impending Clinical Death
• Loss of muscle tone
• Slowing circulation
• Changes in vital signs
• Sensory impairment
Indications of Death:
• Total lack of response
• No muscular movement
• No reflexes
• Flat encephalogram(ECG) – Accurate indicator

27. Nursing Intervention
Assist the client achieve a dignified and peaceful death
• Provide relief from loneliness, fear and depression
• Provide physical comfort
Maintain physiologic comfort
• Personal hygiene measures
• Pain control –highest priority for dying
• Relief for respiratory difficulties
• Measures assistance related to sensory changes
Provide spiritual support
• Sense of forgiveness
• Need for love
• Need for hope

28. Body Changes After Death
Rigor Mortis
•Stiffening of the body that occurs about 2-4 hours
after death
•Position the body, place the dentures in the mouth
and close the eyes and mouth before rigor mortis
sets in.
Algor Mortis
•Gradual decrease of the body’s temperature after
death
Livor Mortis
•Discoloration of the skin after death after circulation
has ceased.

29. Nursing Intervention After Death
• Make the environment clean
• Make the body appear natural and comfortable
• Remove all equipment and supplies from the bedside
• Place the body in supine position, the arms at the sides, palms down
• Place one pillow under the head and shoulders to prevent blood from
discoloring the face
• Close the eyelids, insert dentures and close the mouth
• Wash soiled areas of the body and provide clean gown
• remove all jewelries , valuable things are listed and placed in safe
storage.
• Allow family to view the patient’s body
• Wrap the body in shroud. Place ID tag to the outside of the shroud
• Bring the body to the morgue for cooling (cryonics)

30. END
Prepared by: JRIOS, R.N., M.A.N.