Chapter 7: Client’s Response to Illness

Nursing believes that the individual is a unique biopsychosocial

being, so the nurse must assess clients in terms of their unique
characteristics and responses to health and illness. Differences in the
person’s response to illness can be examined in terms of individual or
personal, interpersonal, and cultural factors.

Individual Factors
•  Age, stage of growth and development
•  Genetics and biologic factors
•  Physical health and health practices
•  Response to drugs
•  Self-efficacy (belief that personal abilities and efforts affect
life events.
•  Hardiness (ability to resist illness when under stress)
•  Resilience (healthy response despite stressful or risky
situations) and resourcefulness (problem solving and faith in ability to
deal with new and adverse situations)
•  Spirituality (essence of being and beliefs about
purpose/meaning of life).

Interpersonal Factors
•  Sense of belonging
•  Connectedness in a social system
•  Social networks (connected with one another)
•  Social support (emotional sustenance from family, friends,
others)
•  Family support

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Cultural Factors
•  Customs and meanings of communication
•  Beliefs about causes of illness
•  Physical space or distance
•  Social organization
•  Time orientation
•  Environmental control
•  Biologic variations
•  Socioeconomic status and social class

Cultural Patterns and Differences

Knowledge of expected cultural patterns provides a starting
place for the nurse to begin to relate to persons from different ethnic
backgrounds. However, there are wide variations among members of
any cultural group, so not everyone fits the general pattern. Individual
assessment is needed to provide culturally competent care that meets
the client’s needs.
African Americans
•  Usually family-oriented, but client makes own decisions
•  Conversation animated
•  Handshakes and direct eye contact convey interest and
respect.
•  Silence may indicate a lack of trust.
•  Church and prayer important
•  View mental illness as a spiritual imbalance or punishment
for sin

American Indians

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•  Slow speech with many pauses. Communication is telling a
story and shouldn’t be rushed.
•  Prefer a light-touch handshake and minimal direct eye
contact
•  Family members are reluctant to provide information
unless necessary preferring to let the client speak for him or herself.
•  View mental illness as resulting from ghosts, breaking
taboos, or loss of harmony with the environment.
•  May be reluctant to discuss spiritual beliefs and practices
with strangers.
•  Allow client to keep medicine bag or other healing objects,
and do not touch or question them.

Arab Americans
•  Greet others with a smile and handshake
•  Loud voice denotes importance of subject.
•  Expressions of agreement may indicate respect, not
intended compliance.
•  Eldest male may be family spokesperson.
•  View mental illness as caused by fear, manipulation, God,
or loss of country, family or friends
•  Mental illness has a stigma; treatment is sought only when
all other remedies fail.

Cambodians
•  May not include physical contact in greetings
•  Soft voices
•  Politeness highly valued
•  Silence common
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•  Avoid social chatter or touching the person’s head.
•  Mental illness viewed as caused by war or brutalities
•  Passive in sick role
•  May use healers as well as Western medicine
•  May resist having blood drawn

Chinese
•  Shy in unfamiliar surroundings
•  Keep a respectful distance.
•  Asking questions may be seen as disrespectful; silence is
respectful.
•  Eldest male may be family spokesperson.
•  Mental illness viewed as caused by disharmony of
emotions or evil spirits.
•  Herbalists and acupuncture may be used.
•  Health practices greatly influenced by length of time in the
U.S.

Cubans
•  Outgoing, animated in conversation
•  Expect direct eye contact as sign of respect or honesty
•  Extended family important
•  Mental illness viewed as inherited or caused by stress; is a
stigma for family.
•  Seek Western medicine for serious illness

Filipinos
•  Greet others with smiles, rather than handshake

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•  Facial expressions animated
•  Direct eye contact impolite, especially with authority
figures
•  Mental illness viewed as having religious and mystical
causes
•  Client is passive.
•  Decisions made by eldest male
•  Prayer important

Haitians
•  Polite but shy, especially with authority figures
•  Greet with handshake
•  May smile and nod, even when not understanding
•  Gestures and tone of voice used for emphasis
•  Mental illness not well accepted, viewed as having
supernatural causes.
•  Client is passive.
•  Home and folk remedies are first choice of treatment.

Japanese Americans
•  Identified by the generation in which they were born (Isei,
Nisei, Sansei, Yonsei) with each generation more accustomed to
Western belief and practices.
•  Greetings are formal.
•  Facial expressions are controlled.
•  Nodding indicates politeness, not necessarily agreement.
•  Self-disclosure is minimal; ask open-ended questions.
•  Mental illness is shameful, reluctant to seek treatment

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•  Evil spirits cause mental illness; client is expected to use
will power to overcome it.

Mexican Americans
•  Wide variation
•  Touching prevalent among family but not necessarily
welcome from strangers.
•  Direct eye contact with authority figures avoided
•  Silence denotes disagreement.
•  Only a few questions will elicit much information.
•  Social conversation should precede questions.
•  Illness comes from imbalance between person and
environment.
•  Spiritual and psychic aspects of care may be very
important.

Russians
•  Greet strangers formally, but kiss and embrac close friends
and family.
•  Mental illness viewed as caused by stress and moving into
a new environment.
•  Sick people go to bed, may be reluctant to take
medications

South Asians
•  Greet others with words and gestures
•  Touching not common
•  Express emotions through eyes and facial expressions
•  Direct eye contact and loudness disrespectful
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•  Mental illness viewed as caused by spells cast by enemies
or evil spirits.
•  Sick people assume passive role.
•  Spiritual healing practices common

Vietnamese
•  Greet others with smile and bow
•  Touch is limited.
•  Head is sacred, feet profane.
•  Direct eye contact with elders and authority figures
disrespectful
•  Soft-spoken
•  Open expression of emotions may be seen as being in bad
taste.
•  Mental illness viewed as caused by disharmony or
punishment by ancestral spirits
•  Folk medicine and practices common

Nurse’s Role in Working With Clients From Various Cultures

•  Nurse must learn about the client’s cultural values, beliefs,
and health practices. The best source of information is the client: “How
would you like to be cared for?”, “What do you expect (or want) me to
do for you?”
•  General knowledge about culture can guide nurse in initial
meetings with client and deciding what questions to ask, but this
general knowledge cannot replace client assessment. Individuals in a
culture can vary a great deal from one another.

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Self-Awareness Issues
•  Maintain a genuine, caring attitude.
•  Ask how the nurse can promote or assist with spiritual,
religious, and health practices.
•  Recognize own feelings and possible prejudices.
•  Remember that the client’s response to illness is complex
and unique.

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