FAMILY ASSESSMENT NRNP 6645
Sample Answer for FAMILY ASSESSMENT NRNP 6645 Included After Question
Assessment is as essential to family therapy as it is to individual therapy. Although families often present with one person identified as the “problem,” the assessment process will help you better understand family roles and determine whether the identified problem client is in fact the root of the family’s issues.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To prepare:
- Review this week’s Learning Resources and reflect on the insights they provide on family assessment. Be sure to review the resource on psychotherapy genograms.
- Download the Comprehensive Psychiatric Evaluation Note Template and review the requirements of the documentation. There is also an exemplar provided with detailed guidance and examples.
- View the Mother and Daughter: A Cultural Talevideo in the Learning Resources and consider how you might assess the family in the case study.
THE ASSIGNMENT
Document the following for the family in the video, using the Comprehensive Evaluation Note Template:
- Chief complaint
- History of present illness
- Past psychiatric history
- Substance use history
- Family psychiatric/substance use history
- Psychosocial history/Developmental history
- Medical history
- Review of systems (ROS)
- Physical assessment (if applicable)
- Mental status exam
- Differential diagnosis—Include a minimum of three differential diagnoses and include how you derived each diagnosis in accordance with DSM-5-TRdiagnostic criteria
- Case formulation and treatment plan
- Include a psychotherapy genogram for the family
Note: For any item you are unable to address from the video, explain how you would gather this information and why it is important for diagnosis and treatment planning.
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A Sample Answer For the Assignment: FAMILY ASSESSMENT NRNP 6645
Title: FAMILY ASSESSMENT NRNP 6645
CC (chief complaint): ” I have a problem as my house is in chaos
HPI: Mrs. P is a forty-year-old female patient who presented to the facility accompanied by one of her daughters. The patient is an immigrant from Iran and has been in the US for the last two decades. She has four children in the US, while one of her children remained in Iran due to immigration issues. She has been working as a caregiver for income, and her eldest daughter has been helping her. Shireen, the daughter who remained in Iran, finally got an opportunity to join her mother in the US; however, the family has been in chaos since she joined them. She reported how her father abused her physically, sexually, and emotionally while she was in Iran and put the blame on her mother, whom she accuses of leaving her behind to suffer in Iran. Mrs P reports that the husband, from whom they are now separated, was an abusive man who brought trauma to their family. The patient is currently obese and disabled after experiencing a failed foot surgery. She is also in pain. While the daughters prefer a contemporary lifestyle, the patient still holds onto the traditional way of living, which brings chaos to their family. As such, she feels hopeless, helpless, and sad as she can’t control her children. The children also accuse her of being controlling, disrespectful, and lacking patience.
Past Psychiatric History:
- General Statement: The patient immigrated from Iran and strived to cling to the traditional lifestyle while the children, having been raised in the US, lean towards a contemporary lifestyle, hence a source of conflict in the family, leading to chaos
- Caregivers (if applicable): The patient is currently disabled, and she depends on her five children to act as caregivers.
- Hospitalizations: The patient reports a failed foot operation, which has left her disabled and in pain. There are no further reports of hospitalizations.
- Medication trials: There are no reports of medication trials
- Psychotherapy or Previous Psychiatric Diagnosis: The patient and the family have no past history of psychiatric diagnosis or psychotherapy. However, the patient admits to feeling depressed for various reasons, such as loneliness.
Substance Current Use and History: There are no reports of substance use or substance abuse
Family Psychiatric/Substance Use History: Mrs. P and her daughter Shireen indicated that they had been victims of emotional, physical, and sexual abuse, which the husband propagated. There is no history of substance use or abuse.
Psychosocial History: Mrs P and her daughter report no educational background or history. The mother was married, but she is currently separated from her husband. She has a total of five children, three adult daughters and two teenage sons who live with her.The mother is currently not employed as she is disabled due to a failed foot surgery. However, she previously worked as a caregiver. The eldest daughter has a partner, while the other two adult daughters also live independently.
Medical History:
- Current Medications: The patient is not using any medications currently.
- Allergies: No known allergies
- Reproductive Hx: The patient is currently separated from her husband. She has five children: three daughters and two younger sons.
ROS:
- GENERAL: She is alert, oriented, and well-groomed
- HEENT: An assessment should be completed using standard strategies.
- SKIN: An assessment should be completed using standard strategies.
- CARDIOVASCULAR: An assessment should be completed using standard strategies.
- RESPIRATORY: An assessment should be completed using standard strategies.
- GASTROINTESTINAL: An assessment should be completed using standard strategies.
- GENITOURINARY: An assessment should be completed using standard strategies.
- NEUROLOGICAL: An assessment should be completed using standard strategies.
- MUSCULOSKELETAL: An assessment should be completed using standard strategies.
- HEMATOLOGIC: An assessment should be completed using standard strategies. LYMPHATICS: An assessment should be completed using standard strategies.
- ENDOCRINOLOGIC: An assessment should be completed using standard strategies.
Physical exam: if applicable
Diagnostic results:
Assessment
Mental Status Examination: The mother and daughter are both appropriately dressed. The patient is alert and oriented. The mother appears older than her age, possibly due to the stresses of abusive marriage. She appears anxious with a stressed mood. The patient establishes and maintains eye contact. The patient’s speech appears pressured, and she talks at a louder-than-usual volume. She also has goal-oriented thoughts and is irritable. The patient denies suicidal ideation or thoughts, delusions, or hallucinations. The patient’s short-term and long-term memory is intact.
Differential Diagnoses:
- Post-traumatic stress disorder (PTSD): This is a mental health illness that is known to develop when a person witnesses or experiences a traumatic event. The events may include terrorist attacks, childhood abuse, accidents, natural disasters, sexual or physical assault, and military combat, among other things (Bryant, 2019). The mother reported abuse by her partner, which could have led to some of these symptoms. In addition, the patient also reports low energy levels and depressed mood. This information makes PTSD a differential diagnosis.
- Depression: The mother and the daughter confess to experiencing chaos in their family, which has led to a depressed mood. The mother also indicates that she becomes distressed due to loneliness as her daughters don’t want to visit her anymore. A patient with depression may present with various symptoms, such as irritability, lower energy levels, and challenges with concentration (Li et al.,2019). The patient exhibited some of these symptoms, making this a potential diagnosis.
- Persistent depressive disorder: This is a condition sometimes known as dysthymia. The condition is chronic depression, with the patients having it known to present with various symptoms such as persistent and long-term low mood. The patient seems to have had a prolonged duration of depressive symptoms such as hopelessness, sadness, and lack of interest in activities, making this a potential diagnosis.
Case Formulation and Treatment Plan: This family, especially the mother, has been experiencing unpleasant depressive symptoms, likely associated with events such as separation from abuse, stress, and abuse, and the family is in chaos. Therefore, the family should continue with the family psychotherapy sessions. It is important to combine both family therapy and individual therapy to help the mother adjust to the new life and accept that she can not control her children anymore (Esposito‐Smythers et al.,2019). Individual therapy can also help the mother and her children to be more accommodating to each other. As part of the treatment plan, the patient’s mother should combine psychotherapy with medications such as 20 mg Prozac. For excellent attendance of psychotherapy sessions, the patient should be offered transport means to improve her mobility as she is currently disabled. Besides, there is a need to commence an initiative or program that may help lower the patient’s weight as she is currently obese.
Reflections:
This case presents a situation showing that, even though the mother and daughter are of Iran origin and culture, they have completely different and contrasting cultures, which are always in conflict, hence impacting their relationships and mental health outcomes. Therefore, there are various learning opportunities. One of the learning opportunities is that family relationships have a significant impact on mental health outcomes. It is clear from the case that the relationships significantly affected the outcomes, especially for the mother. The patient is separated from her husband, and she is also not getting along well with her children due to conflict between contemporary and traditional beliefs. One aspect that needs to be explored is the family’s psychiatric history back in Iran before they came to the USA. One of the SDOHs that may impact the patient’s outcome is access to care (Jester & Pender, 2022). The patient is currently disabled and hence can be having a challenge honoring psychiatric visits. Therefore, there is a need to offer transport to this patient to enable access to appropriate care. As part of the patient education, the family needs to be educated on the choice of foods to help their mother deal with obesity, as well as strategies that they need to live harmoniously.
References
Bryant, R. A. (2019). Post‐traumatic stress disorder: a state‐of‐the‐art review of evidence and challenges. World Psychiatry, 18(3), 259-269. https://doi.org/10.1002/wps.20656
Esposito‐Smythers, C., Wolff, J. C., Liu, R. T., Hunt, J. I., Adams, L., Kim, K., … & Spirito, A. (2019). Family‐focused cognitive behavioral treatment for depressed adolescents in suicidal crisis with co‐occurring risk factors: A randomized trial. Journal of Child Psychology and Psychiatry, 60(10), 1133-1141. https://doi.org/10.1111/jcpp.13095
Jeste, D. V., & Pender, V. B. (2022). Social determinants of mental health: recommendations for research, training, practice, and policy. JAMA Psychiatry, 79(4), 283-284. Doi: 10.1001/jamapsychiatry.2021.4385
Li, Z., Ruan, M., Chen, J., & Fang, Y. (2021). Major depressive disorder: advances in neuroscience research and translational applications. Neuroscience Bulletin, 37, 863-880. Doi: 10.1007/s12264-021-00638-3
Schramm, E., Klein, D. N., Elsaesser, M., Furukawa, T. A., & Domschke, K. (2020). Review of dysthymia and persistent depressive disorder: history, correlates, and clinical implications. The Lancet Psychiatry, 7(9), 801-812. https://doi.org/10.1016/S2215-0366(20)30099-7
Rubric
NRNP_6645_Week2_Assignment_Rubric
| NRNP_6645_Week2_Assignment_Rubric | ||||||
| Criteria | Ratings | Pts | ||||
| This criterion is linked to a Learning OutcomeDocument the following for the family in the video, using the Comprehensive Evaluation Note Template: • Chief complaint• History of present illness• Past psychiatric history• Substance use history• Family psychiatric/substance use history• Psychosocial history/Developmental history• Medical history• Review of systems (ROS) • Physical assessment (if applicable) |
|
20 pts | ||||
| This criterion is linked to a Learning Outcome• Mental status exam • Differential diagnoses—Include a minimum of three differential diagnoses and include how you derived at each diagnosis in accordance with DSM-5-TR diagnostic criteria |
|
20 pts | ||||
| This criterion is linked to a Learning Outcome• Case formulation• Treatment plan that includes psychotherapy interventions |
|
25 pts | ||||
| This criterion is linked to a Learning Outcome• A psychotherapy genogram for the family |
|
20 pts | ||||
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided which delineate all required criteria. |
|
5 pts | ||||
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation |
|
5 pts | ||||
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. |
|
5 pts | ||||
| Total Points: 100 | ||||||