Chapter 2 – Inclusive Approaches to Health Assessment
Pause for a moment and put yourself in a client’s shoes. Imagine seeking care and having the nurse diminish your feelings, make you feel unimportant, and exclude you from the care process. How would this make you feel? Probably disrespected, disengaged, and that you don’t matter – maybe even silenced.
Now, imagine the alternative: the nurse values your feelings, perspectives, experiences, and considers what is important to you. How would you feel? Probably included, respected, and engaged.
The difference here is between health assessments that are exclusive/ versus inclusive/liberating.
Learning to conduct a health assessment is an important part of nursing education and practice. Health assessments help nurses understand the health needs of each client and set priorities for their care. Acquiring this understanding requires:
- objective knowledge, which is obtained through assessment techniques and skills.
- subjective knowledge, which is obtained through empathetic, relational, and interactional skills.
During a health assessment, you will need to communicate and engage critically and empathetically with each unique client to understand how to care for them in relevant and holistic ways.
We are all different, and our illness experiences are informed by, and are as unique as, our social experiences, so you cannot apply a one-size-fits-all care plan. Individual health assessments are important to help you understand each client and tailor a unique plan for them. You will need to embrace all aspects of the client’s humanity and be mindful and attentive to any personal and unconscious biases that may negatively influence your views and interactions with them – this is what is meant by an inclusive health assessment.
Safe nursing practice requires an inclusive approach to health assessment. Nurses are expected to protect the physical and psychological safety of clients. If clients have experienced trauma in the past, they may have psychological and physiological reactions (Cohen et al., 2006) that affect how they engage with health professionals and health interventions. It is especially important to protect the psychological safety of clients who have experienced racial or social trauma, or any type of trauma for that matter. The ongoing global social justice movement has brought to light how experiences with – especially discrimination and racism – lead to socioeconomic disparities that eventually have devastating impacts on health. You must consider this reality during any health assessment.
Unfortunately, the healthcare system is not free of discriminatory and exclusionary practices, and as a result, this can make clients feel unsafe. Black, Indigenous, and LGBTQI2SA+ (Lesbian, gay, bisexual, transgender, queer, intersex, Two-spirit and asexual) populations continue to experience inequitable care and access disparities, which can lead to distrust of healthcare providers, including nurses.
A health assessment is one of the first points of contact between nurse and client. It can be a critical step where a nurse starts to address the experiences of, and repair the harm done to, these groups and others through assessment approaches that uplift, not oppress. For some time, nurses and other healthcare professionals have been encouraged to consider the cultural experiences of clients. However, it is important to transcend the usual emphasis on culture awareness: you should also include anti-oppressive, humanistic practices in health assessments.
This chapter explores what it means to be inclusive during a health assessment, in terms of intent and process.
Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. The Guilford Press.
refers to burdensome and unjust impositions of power upon a person or group.
also referred to as institutional oppression, is when established customs and practices reflect and produce mistreatment and inequities based on a person's membership in a social group.