NRNP 6645 Week 2:  Family Assessment Paper

NRNP 6645 Week 2:  Family Assessment Paper

NRNP 6645 Week 2:  Family Assessment Paper

NRNP/PRAC 6645 Comprehensive Psychiatric

Evaluation Note Template

CC (chief complaint): “Household chaos ”

HPI: Patti, a 40-year-old woman of Iranian origin, arrived at the clinic with her second child, Sharleen, after being recommended for a mental health assessment. Her family has experienced harsh circumstances such as domestic violence and spouse abuse. She said that they left her first-born child, who she claims were sexually molested by her father, after moving to the United States. The daughter then allegedly left and joined her mother, siblings, and mother, but she then accused her mother of being responsible for the instability in the family due to the abuse she had experienced from her father. She began by saying that she felt helpless and defeated and that her daughters were out of control and that she couldn’t control them. Since the firstborn joined them, the entire family has attended a therapy sessions together. Their family therapist claimed that while Patti had been leading a traditional lifestyle, her daughter was drifting away from her in favor of their way of life. Patti was concerned since it was her norm for children to look after their parents in their advanced age and at times of illness. As the kids are trying to create a living for themselves, they believe she should learn how to live independently, which has led to a disagreement. Shirleen said that she tries to see her around six days each week, but she is usually on the phone or watching tv, which is why she worries that they do not spend sufficient time with her and that she does not appreciate it. She also expressed concern that the kids did not spend sufficient time with her. She underwent foot surgeries twice, none of which rendered her paralyzed. Shirleen had recently moved out and was married to a man the family knew little about, according to the woman, who claimed to routinely visit Sheela and Shirleen.

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Past Psychiatric History:

• General Statement: Patti and her kids have begun family counseling. 18 months before
• Caregivers (if applicable): N/A
• Hospitalizations: There is no history of hospitalization, self-harm, suicidal/homicidal conduct, or residential therapy.
• Medication trials: She has no history of utilizing any psychotropic medicines.
• Psychotherapy or Previous Psychiatric Diagnosis: Patti has been undergoing individual treatment as well as taking part in family therapy.

Substance Current Use and History: Not provided.

Family Psychiatric/Substance Use History: Patti stated that she along with her family had participated in two family therapy sessions.

Psychosocial History: The patient had one child back in Iran. But after being assaulted physically and sexually, she decided to leave for the United States. Her husband got remarried. But she currently has five kids, four of whom she gave birth to when she was in the US. She is a devout Muslim who prefers a traditional lifestyle over the western one embraced by her daughters. She enjoys playing video games and following religious teachings in her spare time.

Medical History: She had two botched foot surgeries, which rendered her crippled, but her medical records were not documented.

• Current Medications: It is unknown if she is presently taking any drugs.
• Allergies: There have been no reports of medication, food, or environmental allergies.

• Reproductive Hx: She is a five-time mother, but her sexual issues, contraception usage, and menstruation history have not been published.

History of Abuse/Trauma:

When she was left with him in Iran, Patti said her eldest daughter was sexually raped by her husband, and the couple had a history of domestic violence before they moved in together.

ROS: This patient does not require a systemic physical examination.

Diagnostic results: There will also be no diagnostic investigations required for this patient.

Assessment

Mental Status Examination: The mental health of Patti and Shirleen was not assessed. Yet, according to the information acquired during the examination, both of them were correctly clothed, well-groomed, and comfortable. They were also both awake, as well as oriented to time, person, location, and circumstance. They also exhibited average tone and fluent, understandable, and clear speaking with an Iranian accent. Occasionally, Patti would argue with Shirleen during the examination, raising her voice. Despite Patti using a wheelchair owing to a lower limb handicap, they are both cooperative and walk normally. She has a goal-oriented, logical thought process without any overt fantasies, delusions, or hallucinations. Patti was determined to be unhappy and apprehensive, with muted emotion at times, and she now rejects suicide and homicidal ideas. She has an undamaged short-range and long memory, excellent judgment and insight, and excellent focus. Both of them have a clear understanding of their current problems, and they are both willing to be helped to heal their relationship to avoid it from deteriorating.

Differential Diagnoses:

1. Parent-Child relation problem: Parent-child connection issues, according to Chung et al. (2020), are communication issues and interpersonal barriers that happen between kids and parents at any stage of a kid’s development. The condition is primarily brought on by overly protective parents who place too much pressure on their kids, which can result in arguments or physical aggression if things go out of hand. The syndrome can also cause parents or children to become furious, unhappy, or indifferent, which exacerbates the incapacity to resolve the dispute. Patti and her daughters in the case study had difficulty resolving their issue, prompting them to seek the assistance of a professional, and Patti had shown despair and anger.
2. Acculturation Difficulty: Acculturation difficulties are a problem caused by an individual’s incapacity or trouble adapting to new surroundings or culture (Aqua et al., 2023). Psychosomatic symptoms like difficulty breathing, palpitations, nausea, swollen belly, anxiety, bewilderment, or sadness describe the illness. Patti had a history of moving to the U.S. from Iran with her kids, and she made it clear that she continued to follow her old habits and was dissatisfied with the new culture which her kids had adopted.
3. Family disruption through divorce and separation: Separation and divorce, according to Sbarra et al. (2019) are related to the formation of new roles for each family member, and children might become reclusive and defiant. Members of the family may also experience disruptions in their mental health and emotional dysregulation as a result of the disease. Patti has a history of divorcing her spouse and her kids moving away, resulting in an emotionally dysregulated household.

Case Formulation and Treatment Plan:

• The stress Patti and her family were experiencing when her first-born daughter rejoined them led them to seek professional assistance in the past. She was abandoned in Iran by her father, who used to sexually assault her, and she began blaming her mother, which caused pandemonium. Due to unsuccessful surgery on both of her feet, Patti is also crippled. She wished for her children to assist her since according to her culture, children are expected to take care of their elderly and ailing parents. The girls, who have embraced American culture and wished to live their own lives, disagree with her because they have done so.
• Sessions of family therapy will continue to be used to manage Patti and her family as a whole.
• Family therapy is a sort of psychotherapy that Ren et al. (2019) emphasized is used to settle disputes and enhance communication among family members.
• The entire family is expected to participate in the weekly treatment session that will be scheduled. This will be carried out to make sure that the concerns and opinions of every member of the family are taken into account.

Reflections: The case study asserts that the Iranian lady, who is middle-aged, has five children, which exacerbates the chaos in the home. As she fled Iran, she left her maltreated firstborn child behind. The PMHNP did a great job gathering all the information necessary to diagnose the patient and provide the best course of treatment. During going through family therapy, I liked the notion of including the entire family in the decision-making process and incorporating everyone’s opinions and sentiments (Conway et al., 2020). For this case study, there are a few legal and ethical factors that should be taken into account, consisting of respect for others’ privacy, integrity, compassion, and treatment compliance. Patti and her family are required to attend weekly family therapy sessions provided by their psychologist.

References

Aqua, J. K., White, K., & Johnson, D. A. (2023). A systematic review of acculturation and sleep health among adult immigrants in the United States. Sleep Health. https://doi.org/10.1016/j.sleh.2023.01.007

Chung, S., Zhou, Q., Kho, C., & Main, A. (2020). Parent–Child Conflict Profiles in Chinese American Immigrant Families: Links to Sociocultural Factors and School‐Age Children’s Psychological Adjustment. Family Process. https://doi.org/10.1111/famp.12546

Conway, C. A., Roy, K., Hurtado Choque, G. A., & Lewin, A. (2020). Family separation and parent–child relationships among Latinx immigrant youth. Journal of Latinx Psychology. https://doi.org/10.1037/lat0000153

Ren, L., Garcia, A. S., Esteraich, J. M., Encinger, A., Raikes, H. H., & Acar, I. H. (2019).  Parent–Child Relationships and Preschoolersʼ Social-Emotional Functioning Among Low-Income Families. Infants & Young Children, 34(2), 123–138. https://doi.org/10.1097/iyc.0000000000000138

Sbarra, D. A., Bourassa, K. J., & Manvelian, A. (2019). Marital separation and divorce: Correlates and consequences. APA Handbook of Contemporary Family Psychology: Foundations, Methods, and Contemporary Issues across the Lifespan (Vol. 1)., 687–705. https://doi.org/10.1037/0000099-038

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FAMILY ASSESSMENT

 

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 Tale video 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-TR diagnostic 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.

BY DAY 7

Submit your Assignment.

SUBMISSION INFORMATION

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.

1. To submit your completed assignment, save your Assignment as WK2Assgn_LastName_Firstinitial
2. Then, click on Start Assignment near the top of the page.
3. Next, click on Upload File and select Submit Assignment for review.

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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 to >17.0 ptsExcellent 90%–100% The assignment includes an accurate, clear, and complete description of the subjective and objective information for the client family. The response addresses each of the required elements and demonstrates thoughtful consideration of the client family’s situation and culture. 17 to >15.0 ptsGood 80%–89% The assignment includes an accurate, clear, and complete description of the subjective and objective information for the client family. 15 to >13.0 ptsFair 70%–79% The assignment includes a description of the subjective and objective information for the client family but is somewhat general or contains small inaccuracies. 13 to >0 ptsPoor 0%–69% The assignment includes a description of the subjective and objective information for the client family but is vague or contains many inaccuracies. Or, several of the required elements are missing.	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 to >17.0 ptsExcellent 90%–100% The response thoroughly and accurately documents the results of the mental status exam…. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the family in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected. 17 to >15.0 ptsGood 80%–89% The response accurately documents the results of the mental status exam…. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected. 15 to >13.0 ptsFair 70%–79% The response documents the results of the mental status exam with some vagueness or innacuracy…. Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vaguess or innacuracy. 13 to >0 ptsPoor 0%–69% The response provides an incomplete or inaccurate description of the results of the mental status exam and/or explanation of the differential diagnoses. Or, assessment documentation is missing.	20 pts
This criterion is linked to a Learning Outcome• Case formulation• Treatment plan that includes psychotherapy interventions	25 to >22.0 ptsExcellent 90%–100% Case formulation is thorough, thoughtful, and demonstrate critical thinking…. The assignment includes an accurate, clear, and complete treatment plan for the client family that includes psychotherapy interventions. The response demonstrates thoughtful consideration of the client family’s situation and culture. 22 to >19.0 ptsGood 80%–89% Case formulation demonstrates critical thinking…. The assignment includes an accurate, clear, and complete treatment plan for the client family that includes psychotherapy interventions. 19 to >17.0 ptsFair 70%–79% Case formulation is somewhat general or does not demonstrate critical thinking…. The assignment includes a treatment plan for the client family that includes psychotherapy interventions but is somewhat general or contains small inaccuracies. 17 to >0 ptsPoor 0%–69% The assignment provides a vague and/or inaccurate description of the case formulation and treatment plan for the client family. Or, many of the required elements are missing.	25 pts
This criterion is linked to a Learning Outcome• A psychotherapy genogram for the family	20 to >17.0 ptsExcellent 90%–100% The assignment includes an accurate, clear, and complete genogram of the client family. The documentation style is consistent and a key is provided. 17 to >15.0 ptsGood 80%–89% The assignment includes an accurate genogram of the client family. The documentation style is consistent and a key is provided. 15 to >13.0 ptsFair 70%–79% The assignment includes a genogram of the client family but is somewhat limited or contains factual inaccuracies or inconsistencies in documentation style. 13 to >0 ptsPoor 0%–69% The genogram provided is vague or contains many inaccuracies. Or, the genogram is missing.	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 to >4.0 ptsExcellent 90%–100% Paragraphs and sentences follow writing standards for flow, continuity, and clarity…. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. 4 to >3.0 ptsGood 80%–89% Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time…. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive. 3 to >2.0 ptsFair 70%–79% Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time…. Purpose, introduction, and conclusion of the assignment are vague or off topic. 2 to >0 ptsPoor 0%–69% Paragraphs and sentences follow writing standards for flow, continuity, and clarity <60% of the time…. No purpose statement, introduction, or conclusion were provided.	5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation	5 to >4.0 ptsExcellent 90%–100% Uses correct grammar, spelling, and punctuation with no errors. 4 to >3.0 ptsGood 80%–89% Contains 1 or 2 grammar, spelling, and punctuation errors. 3 to >2.0 ptsFair 70%–79% Contains 3 or 4 grammar, spelling, and punctuation errors. 2 to >0 ptsPoor 0%–69% Contains many (≥5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.	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 to >4.0 ptsExcellent 90%–100% Uses correct APA format with no errors. 4 to >3.0 ptsGood 80%–89% Contains 1 or 2 APA format errors. 3 to >2.0 ptsFair 70%–79% Contains 3 or 4 APA format errors. 2 to >0 ptsPoor 0%–69% Contains many (≥5) APA format errors.	5 pts
Total Points: 100

REQUIRED VIDEO

https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/mother-and-daughter-a-cultural-tale

Please use 3 references in APA format