Editing Mental Health and Psychosocial Nursing (section)

== Psychosocial Aspects of Physical Illness and Coping ==

=== Stress, Coping, and Adaptation ===
Lazarus and Folkman described '''primary appraisal''' (is this a threat?) and '''secondary appraisal''' (can I handle it?), followed by '''problem-focused coping''' (change the stressor, useful when the situation is controllable) or '''emotion-focused coping''' (change the response, useful when it is not). Selye's general adaptation syndrome describes alarm, resistance, and exhaustion.

Nursing interventions: teach diaphragmatic breathing, progressive muscle relaxation, guided imagery, mindfulness, sleep hygiene, exercise, journaling, and structured problem-solving. Mobilize support systems and address financial, transport, and childcare barriers, which are frequently the real obstacle to coping.

=== Body Image, Role Change, and Chronic Illness ===
Amputation, mastectomy, ostomy, burns, stroke, and disfiguring surgery all provoke grief for the lost body and lost role. Assess whether the client looks at, touches, or names the affected part. Do not force viewing; offer opportunities and allow refusal. Involve the client in self-care gradually, use peer visitors from ostomy or amputee programs, and include partners in teaching about sexuality, which nurses commonly omit.

Chronic illness care includes managing uncertainty, regimen fatigue, stigma, and the emotional consequences of dependency. Screen routinely for depression in chronic illness; comorbid depression worsens adherence, function, and mortality.

=== Grief and Loss ===
Kübler-Ross's stages (denial, anger, bargaining, depression, acceptance) are not linear and not obligatory. Other useful frames include Worden's four tasks of mourning (accept the reality of the loss, process the pain, adjust to a world without the deceased, and find an enduring connection while moving forward) and Bowlby's phases.

Types: '''anticipatory''' grief before the loss, '''disenfranchised''' grief that society does not acknowledge (perinatal loss, loss of a same-sex partner in unsupportive settings, loss of a pet, death of an estranged relative), and '''complicated or prolonged grief''' with persistent intense yearning, preoccupation, and functional impairment beyond 12 months in adults.

Nursing interventions: be present, use silence, avoid clichés such as "at least" and "everything happens for a reason," use the deceased person's name, permit the full range of feeling including anger and relief, honor cultural and religious rituals, offer memory-making for perinatal and pediatric loss, and refer for bereavement support. Assess your own grief; staff bereavement is real and unaddressed staff grief drives burnout.

=== Across the Lifespan ===
* '''Children''': express distress somatically and behaviorally (abdominal pain, headaches, regression, school refusal, irritability rather than sadness). Use play and drawing to assess. Explain procedures in developmentally appropriate terms and permit parental presence. Screen for abuse when the injury does not match the history or the developmental stage.
* '''Adolescents''': identity, autonomy, and peer belonging dominate. Screen for depression, self-harm, disordered eating, substance use, bullying and cyberbullying, and suicidal ideation. Interview privately without the parent for part of the visit. Explain confidentiality and its limits explicitly.
* '''Adults''': role strain, caregiving burden, occupational stress, intimate partner violence. Screen for intimate partner violence privately, never with the partner in the room, and never using a family member as interpreter.
* '''Older adults''': loss accumulation, retirement, sensory decline, functional dependence, relocation stress, elder mistreatment, and polypharmacy. Depression in older adults frequently presents as somatic complaint or cognitive slowing ("pseudodementia") rather than reported sadness. Older adults have high suicide completion rates and often have contact with a primary care provider shortly before death, making routine screening essential. Assess for '''relocation stress syndrome''' after a move to long-term care and mitigate it with familiar objects, choice, and orientation.