This document discusses the importance of understanding clients within their cultural, family, and community contexts when performing health assessments. It emphasizes that a client's health status is affected by and affects these surrounding contexts. The nurse must see the client as an individual embedded within these wider systems of interaction to accurately interpret health issues. All cultural beliefs and practices discussed are considered normal variations that exist within cultural groups. Family is also defined by a client's perspective rather than the nurse's preconceptions. A client's culture and family context interact to form the surrounding environment for their health.

1. The Client in Context

2. • 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
in return)
Maria Carmela L. Domocmat, RN, MSN

3. • 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
the person’s spirituality, are affected by
the individual’s health status
Maria Carmela L. Domocmat, RN, MSN

4. • Understanding or being aware of the client
in context is essential to performing an
effective health assessment
Maria Carmela L. Domocmat, RN, MSN

5. • 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
community operate as systems interacting
to form the context
Maria Carmela L. Domocmat, RN, MSN

6. Culture and biologic variations
• Within a culture there are many variations
of belief and practices, and these
variations are defined as normal
Maria Carmela L. Domocmat, RN, MSN

7. Activity:
• Cultural beliefs and practices: normal or
abnormal?
• Of the following beliefs and practices,
which are normal variations and which are
abnormal findings?
Maria Carmela L. Domocmat, RN, MSN

8. • The request for anointing by a priest
before surgery
• The request for a shaman (witch doctor) to
treat the client along with the medical
doctor
• Placement in a room with a bed pointing
toward Mecca in Saudi Arabia
Maria Carmela L. Domocmat, RN, MSN

9. • 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
eye
Maria Carmela L. Domocmat, RN, MSN

10. • Conclusions: all of the above beliefs and
practices are based on cultural practices
of different cultural groups. Therefore, all
may be considered normal variations
Maria Carmela L. Domocmat, RN, MSN

11. Selected physical variations r/t
human variation
Maria Carmela L. Domocmat, RN, MSN

12. Maria Carmela L. Domocmat, RN, MSN

13. Maria Carmela L. Domocmat, RN, MSN

14. Maria Carmela L. Domocmat, RN, MSN

15. Maria Carmela L. Domocmat, RN, MSN

16. Maria Carmela L. Domocmat, RN, MSN

17. Maria Carmela L. Domocmat, RN, MSN

18. FAMILY
Maria Carmela L. Domocmat, RN, MSN

19. 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
criteria you use for determining family
Maria Carmela L. Domocmat, RN, MSN

20. Maria Carmela L. Domocmat, RN, MSN

21. • 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
• The family works as a system of
interactions
Maria Carmela L. Domocmat, RN, MSN

22. • The client’s beliefs about human
interactions, about roles, and about illness
and its effect on lives are all inter-related
with family beliefs
Maria Carmela L. Domocmat, RN, MSN

23. • The culture in which the family operates and the specific
culture developed within the family unit interact to form a
context for the client
Maria Carmela L. Domocmat, RN, MSN

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