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The Client in Context

• Health assessment involves assessment of the individual as a whole

• You need to see the client in contexts that affect the client (and that the client affects affect the client (and that the client affects in return)

Maria Carmela L. Domocmat, RN, MSN

• Client is part of a cultural context, a family context, and community context—all of which affect the client’s health status

• In turn – family and community, and even • In turn – family and community, and even the person’s spirituality, are affected by the individual’s health status


• Understanding or being aware of the client in context is essential to performing an effective health assessment


• Note: the nurse sees an individual client, but accurate interpretation of what the nurse sees depends on perceiving the client in context. Culture, family, and client in context. Culture, family, and community operate as systems interacting to form the context


Culture and biologic variations

• Within a culture there are many variations of belief and practices, and these variations are defined as normal


Activity:

• Cultural beliefs and practices: normal or abnormal?

• Of the following beliefs and practices, which are normal variations and which are which are normal variations and which are abnormal findings?


• The request for anointing by a priest before surgery

• The request for a shaman (witch doctor) to treat the client along with the medical treat the client along with the medical doctor

• Placement in a room with a bed pointing toward Mecca in Saudi Arabia


• Having a family member present at family member’s death

• Refusing iced drinks while ill • Claiming that a child’s illness is due to evil • Claiming that a child’s illness is due to evil

eye


• Conclusions: all of the above beliefs and practices are based on cultural practices of different cultural groups. Therefore, all may be considered normal variations may be considered normal variations


Selected physical variations r/t Selected physical variations r/t human variation








FAMILY


Family

• Activity: look at different pictures of family– Which image represents a family? – Once you have selected an image that meets

your criteria for family, think about what your criteria for family, think about what criteria you use for determining family



• For family health assessment purposes-the most effective way to work with clients is to accept the client’s definition of family rather than the nurse’s concept rather than the nurse’s concept

• The family works as a system of interactions


• The client’s beliefs about human interactions, about roles, and about illness and its effect on lives are all inter-related with family beliefs with family beliefs


• The culture in which the family operates and the specific culture developed within the family unit interact to form a context for the client


Source: Weber, Janet R & Jane Kelley. (2009).Health Assessment in Nursing. USA: Lippincott Williams and Wilkins

Technology

1b the client in context cld