Week 5: Psychosocial and Spiritual Health

Mental health

A large umbrella encompassing both the cognitive and affective aspects of a person

Psychosocial refers to...

Mental health

Cognition

Affective function

Cognition

Involves thinking and reasoning

Includes impairments like delirium and dementia

Affective function

- Intrapersonal (within us)

- Interpersonal (relationship with others and the world)

- Includes impairments like depression, psychiatric illness & loss of touch with reality

What are life events and examples

Major changes affecting daily life:

- retirement

- relocation

- chronic illness

- functional impairment

- widowhood

- death of friends & family

- ageist attitudes

- loss of autonomy (ex. driving)

Risk factors that affect psychosocial function

Factors contributing to high levels of stress such as:

-Poor physical health

-Impaired functional abilities

-Weak social supports

-Lack of economic resources

-Immature developmental level

-Narrow range of coping skills

-Occurrence of unanticipated events

-Occurrence of several major life events over short time

Stress

The sum of all the effects of factors that act on the body

- Distress = Panic

- Eustress = Positive things that cause stress (Ex. Getting married)

Stressors

Normal activities and disease states

- Both pleasant and unpleasant

What are the 3 stages of stressors?

1. Alarm

2. Resistance

3. Exhaustion

How are coping strategies categorized?

Problem focused

Emotion focused

How can older adults cope with stress?

- seek information

- reframing situation

- maintaining hopeful outlook

- using stress reduction techniques

- channeling energy into physical activity

- creating fantasies regarding outcomes

- finding reassurance and emotional support

- identifying limits/realistic goals

- involvement in activities such as art, music & writing

What are 4 factors that affect psychosocial function?

Culture

Resilience

Spirituality

Support system

How is spirituality linked with aging?

It is linked with positive health outcomes

How is culture linked with psychosocial function?

Culture influences the way a person perceives psychosocial function

Support System Examples

Social, spiritual & emotional support

Informational Support

Health literacy - listening skills, ability to speak & communicate health needs, ability to act on written health information/instruction from healthcare providers

Resilience

The ability to bounce back and recover physical & psychological health in the face of adversity

- ability to use coping mechanisms

- outcome of increasing wisdom

- closely linked to spirituality, a sense of hopefulness & finding meaning in life and losses

What are the elements of a psychosocial assessment?

Contact with reality

Affective function

Mental Status Assessment

Physical appearance

Executive function/Decision making

Religion & spirituality

Social support

What do nurses assess in the Mental Status Assessment?

Calculation and higher language skills

Alertness and attention

Mental status screening tools (MMSE)

Physical appearance

Psychomotor behaviours

Response to the interview

Orientation

Body language

Motor function

Memory

Social skills

Speech and language characteristics

Which 5 areas of cognitive function does the Mini-Mental Status Exam (MMSE) assess?

1. Orientation

2. Attention

3. Memory

4. Language

5. Spatial-visual skills

Contact with reality: what is delusion

Fixed false beliefs

Contact with reality: what are hallucinations

Sensory experiences that have no basis in an external stimulus

Contact with reality: what is an illusion

Misperceptions of an external stimuli

Have some basis in reality

What are some interview questions to ask during a psychosocial assessment?

Do you have any thoughts that you can't seem to get rid of?

Do you sometimes hear voices when you are alone?

Do you sometimes think you see things that other people don't see?

What are some nonverbal clues to hallucination?

Extreme withdrawal and isolation

Contentment with social isolation

Gestures/other actions that normally occur in response to perceive stimuli

What are some examples of psychosocial nursing diagnoses?

Situational low self esteem

Powerlessness

Social isolation

Ineffective coping

Readiness for enhanced spiritual wellbeing

Readiness for enhanced coping

Readiness for enhanced resilience

What are some nursing interventions?

Incorporate communication techniques

Promote sense of control

Address spiritual needs - refer to spiritual care, encourage participation in religious activities

Life review and reminiscence

Healthy aging classes

Improve functional abilities

Enhance self esteem

Involve them in decision making

Addressing role loss

Foster social supports

What are some examples of expected outcomes?

Self esteem

Psychosocial adjustment to life changes

Adaptation to physical disability

Grief resolution —> better looked at as "coming to terms" with grief

Body image