160 Unit 2 BUILDING THENURSE–CLIENTRELATIONSHIP
his or her parents. If the client is 17 years old, these
struggles are normal and anticipated because these
are two of the primary developmental tasks for the
adolescent. If the client is 35 years old and still strug-
gling with these issues of self-identity and indepen-
dence, the nurse will need to explore the situation.
The client’s age and developmental level also may be
incongruent with expected norms if the client has a
developmental delay or mental retardation.
The nurse must be sensitive to the client’s cul-
tural and spiritual beliefs to avoid making inaccurate
assumptions about his or her psychosocial function-
ing (Schultz & Videbeck, 2002). Many cultures have
beliefs and values about a person’s role in society or
acceptable social or personal behavior that may dif-
fer from those of the nurse. Western cultures gener-
ally expect that as a person reaches adulthood, he or
she becomes financially independent, leaves home,
and makes his or her own life decisions. In contrast,
in some Eastern cultures three generations may live
in one household and elders of the family make major
life decisions for all. Another example is the assess-
ment of eye contact. Western cultures consider good
eye contact to be a positive characteristic indicating
self-esteem and paying attention. People from other
cultures, such as Japan, consider such eye contact to
be a sign of disrespect.
The nurse must not stereotype clients. Just be-
cause a person’s physical characteristics are consis-
tent with a particular race, he or she may not have
the attitudes, beliefs, and behaviors traditionally
attributed to that group. For example, many people
of Asian ancestry have beliefs and values that are
more consistent with Western beliefs and values than
with those typically associated with Asian coun-
tries. To avoid making inaccurate assumptions, the
nurse must ask clients about the beliefs or health
practices that are important to them or how they
view themselves in the context of society or relation-
ships. (See the section on cultural considerations in
Chap. 7).
The nurse also must consider the client’s beliefs
about health and illness when assessing the client’s
psychosocial functioning. Some people view emotional
or mental problems as family concerns to be handled
only among family members. They may view seeking
outside or professional help as a sign of individual
weakness. Others may believe that their problems can
be solved only with the right medication and they will
not accept other forms of therapy. Another commonBox 8-1
➤ PSYCHOSOCIALASSESSMENTCOMPONENTS
History
Age
Developmental stage
Cultural considerations
Spiritual beliefs
Previous history
General assessment and motor behavior
Hygiene and grooming
Appropriate dress
Posture
Eye contact
Unusual movements or mannerisms
Speech
Mood and affect
Expressed emotions
Facial expression
Thought process and content
Content (what client is thinking)
Process (how client is thinking)
Clarity of ideas
Self-harm or suicide urges
Sensorium and intellectual processes
Orientation
Confusion
MemoryAbnormal sensory experiences or misperceptions
Concentration
Abstract thinking abilities
Judgment and insight
Judgment (interpretation of environment)
Decision-making ability
Insight (understanding one’s own part in current
situation)
Self-concept
Personal view of self
Description of physical self
Personal qualities or attributes
Roles and relationships
Current roles
Satisfaction with roles
Success at roles
Significant relationships
Support systems
Physiologic and self-care considerations
Eating habits
Sleep patterns
Health problems
Compliance with prescribed medications
Ability to perform activities of daily living