Comprehensive Family Assessment Nursing Paper Example

Comprehensive Family Assessment Nursing Paper Example

Mother and Daughter: A Cultural Tale First

Healthcare professionals use health assessments as part of their care plans to determine each patient’s unique needs and plan how to meet them. Before providing care, nurses should perform a thorough evaluation of the patient. Family therapy, or family counseling, is created to address problems that impact the family’s well-being and functioning (McGoldrick & Hardy, 2019). As a result, it is crucial to address and consider all member issues. Healthcare professionals should investigate the patient’s current situation to see if family relationships have an impact. This paper covers comprehensive family mental examination and family therapy.(Comprehensive Family Assessment Nursing Paper Example)

Demographic Data: The family presenting at the clinic is of Iranian origin.

SUBJECTIVE:

Chief Complaint (CC): “Please help us. Our family is dysfunctional, and I am losing control of my family.”

History of Present Illness: Patti arrived with her daughter Sharleen at the clinic. The family relocated from Iran to the United States for medical care for one of the daughters. The third-born child was left behind with Patti’s husband in Iran, but she subsequently returned, joined the family in the US, and they separated from her husband and had him remarry. She underwent two unsuccessful foot surgeries, and as a result, she is now crippled. She has reported feeling powerless, hopeless, and unable to control her children because they are rebelling and no longer need her. The family therapist claimed that Patti was following her traditional ways and that her daughters were severing ties with her to pursue their interests. It caused the therapist concern because, according to her tradition, children should care for their parents when they are ill or elderly. Arguments ensued, claiming that her children told her she should learn to live independently because they are also attempting to forge their identities. Patti also laments that her kids do not spend enough time with her, but Sharleen, one of her daughters, says that despite her efforts to see Patti nearly every day of the week, she is constantly on her phone or watching television. According to Patti, she only spends a brief period with her, which she finds unappreciative.(Comprehensive Family Assessment Nursing Paper Example)

Past Psychiatric History: Patti and her girls have experienced traumatizing circumstances, including moving from Iran to the United States. Back in Iran, Pattie was subjected to spousal abuse and assault, and her husband sexually raped her third-born daughter, who was left behind when the family immigrated. The abused daughter joined them two years ago and shared her story with them, blaming Patti for the upheaval in the family, which led to the whole family attending therapy twice.(Comprehensive Family Assessment Nursing Paper Example)

Medical History: Patti has a history of two-foot surgeries that went wrong, leaving her crippled and raising the family’s pressure and anxiety levels.(Comprehensive Family Assessment Nursing Paper Example)

Substance use History: Denies history of substance use.

Family Psychiatric History: Patti and her family attended two therapy sessions before the others stopped. However, she and Sharleen have been going for the past one and a half years.

Psychosocial History: Patti was born in Iran and is a single parent of 5. She traveled to America to receive medical care for one of her children but stayed. She is a Muslim but does not go to the mosque due to her infirmity. She claims that her interests include playing phone games and watching religious lectures. She currently resides with her last-born son, who is 15 years old; the others, however, live elsewhere but frequently visit her.(Comprehensive Family Assessment Nursing Paper Example)

History of Abuse/Trauma: Patti’s third-born daughter, who was left behind when they immigrated, was sexually molested by her father, and the family has a history of experiencing physical abuse and battering.

Review of Systems

GENERAL: She denies loss of appetite, fever, weakness, weight changes, chills, fatigue, or intolerance to heat or cold.(Comprehensive Family Assessment Nursing Paper Example)

HEENT:

Head: Denies head trauma, dizziness, or headache.

Eye: Denies eye discharge, excessive tearing, blurred vision, double vision, or loss of vision.

Ear: Denies ear discharge, loss of hearing, or earache.(Comprehensive Family Assessment Nursing Paper Example)

Nose: Denies rhinorrhea, nasal congestion, or nose bleeding.

Throat: Denies painful swallowing or any difficulty in swallowing.

SKIN: Patient denies skin changes, rashes, or itchiness.

CARDIOVASCULAR: She denies shortness of breath, palpitations, edema, or chest pains.

RESPIRATORY: She denies cough, tachypnea, wheezing, or sputum production.

GASTROINTESTINAL: She denies nausea, loss of appetite, abdominal pains, heartburn, vomiting, diarrhea, or constipation.(Comprehensive Family Assessment Nursing Paper Example)

GENITOURINARY: She denies frequency, incontinence, urgency, oliguria, polyuria, burning sensation during micturition, or vaginal discharge.(Comprehensive Family Assessment Nursing Paper Example)

NEUROLOGICAL: She is disabled in both lower limbs but denies syncope, tingling sensation, dizziness, numbness, headache, or ataxia.

MUSCULOSKELETAL: She has pain in both feet but denies joint swelling and back pain.

HEMATOLOGICAL: She denies anemia, easy bruising, or bleeding.

LYMPHATICS: She denies lymphadenopathy or splenectomy.

ENDOCRINOLOGIC: She denies recent weight changes, intolerance to cold or heat, polyphagia, polyuria, or excessive sweating.(Comprehensive Family Assessment Nursing Paper Example)

OBJECTIVE:

Physical Assessment (if applicable): No physical examination is needed for this patient.

ASSESSMENT:

Mental Status Exam:

Patti has proper nutrition, the right attire, and proper grooming. She is attentive and perceptive of time, place, and people. She uses a wheelchair since she is paralyzed in both lower limbs, and her speech is clear, fluent, and at the appropriate level and tonality. She is cooperative during the exam, maintains eye contact, has a normal affect and attitude, and thinks rationally. Her long-term and short-term memories are intact, and she has a broad intellectual impression.(Comprehensive Family Assessment Nursing Paper Example)

Differential Diagnosis

1. Z62. 82 Parent-Child Relationship Problem

Niec et al. (2019) defined parent-child connection problems as communication issues and challenges in interactions between parents and children, which can happen at any stage of a child’s development. Parents often overprotect their children and pressure them, leading to disputes and occasionally physical violence. The parent’s behavior causes the child to avoid them, and the child may develop negative feelings toward the parent, such as resentment, sadness, or apathy. DMS-5 criteria require a diagnosis if there has been relationship dissatisfaction in the past month, as indicated by a persistent sense of unhappiness, thoughts of running away, and persistent need for professional help for the relationship (McGill University, 2020). Additionally, individuals must indicate the severe impact of the conflict on behavioral, cognitive, or affective systems, as indicated by either behavioral symptoms like conflict resolution difficulties and persistent lack of positive behaviors like affection, sharing, or supportive behaviors, cognitive symptoms like persistent negative attribution patterns, or affective symptoms like intense and pervasive anger, contempt, apathy, and sadness levels (McGill University, 2020). Parenting issues should not better account for the symptoms. These symptoms are pervasive in this family; hence the diagnosis was confirmed.(Comprehensive Family Assessment Nursing Paper Example)

• Z63. 5 Disruption of the Family by Separation and Divorce

Children may become defiant and withdrawn due to the family disruption caused by separation and divorce, which establishes new roles for family members (Gager et al., 2019). The family thus experiences more emotional dysregulation and disruptions to their mental health. The patient in the case study has a history of her children withdrawing, and most of her family members have experienced emotional instability. Various characteristics of family disruptions include emotional distress, including the feeling of sadness, confusion, and anger, financial stress, especially when some members are dependent on others, changes in living arrangements, with some members choosing to live independently, loss of support networks, health concerns, and significant impact on children development. Although these characteristics are observed in the family, they are not perceived as the primary cause of a damaged mother-daughter relationship. (Comprehensive Family Assessment Nursing Paper Example)

• Z60.3 The Acculturation Difficulty

According to AI Wekhian (2019), acculturation difficulty is the inability to adjust to an unfamiliar culture or environment. This may also involve other problems brought on by migration and social transplantation, such as bias, conflicts between cultural beliefs, and discrimination. The patient in the case study had immigrated to the United States with her family from Iran, and she still practices her cultural values and way of life. The ICD-10 criteria for acculturation difficulty include an indication of migration, social transplantation/ adjustment to a new culture, social exclusion, rejection, perceived discrimination, and persecution (Paniagua, 2018). Although these symptoms are present, they are not perceived as the primary cause of the relationship problem.(Comprehensive Family Assessment Nursing Paper Example)

Case Formulation

Due to the upheaval in their home, Patti and her daughter Sharleen have been seeing a therapist for the past 1.5 years. Patti attended family therapy due to her feelings of helplessness, hopelessness, and powerlessness over them. She argues that since her disability limits her from working, she wants her children to help her as their culture dictates. Patti disagrees with her children’s desire to begin their own lives because they have distanced themselves from her.(Comprehensive Family Assessment Nursing Paper Example)

Treatment Plan

The rest of the family will be urged to attend the sessions, and the family is encouraged to continue with family therapy. Every week, a family therapy session will be planned. Also, the third-born daughter will be called and persuaded to go to therapy because she was the one who had been sexually attacked.(Comprehensive Family Assessment Nursing Paper Example)

Patient Education

1. Teach family members communication and conflict resolution strategies.
2. Educate the family on understanding and addressing special family circumstances.
3. Educate the mother on establishing a better-functioning home environment
4. Educate family on addressing financial issues(Comprehensive Family Assessment Nursing Paper Example)
5. Educate the family on cultural assimilation and diversity.

Reflection

It is crucial to take into account everyone’s feelings and views when caring for a group of people or a family. Becvar & Becvar (2017) emphasized that during family therapy, medical professionals should use the information to diagnose and formulate the patient’s treatment plan. Ideally, family members may become frustrated and interact poorly due to a family member’s mental illness. In this case, family therapy focuses on the emotions and sentiments of the family members to ensure everyone is happy. Healthcare professionals must thoroughly assess the family to identify the family’s dysfunctional and functional aspects to enhance the family therapy’s effectiveness. Given another chance with the family, I would focus more on rebuilding the mother-daughter relationship and inquire more from the mother regarding what she perceives her future to be. In this case, the mother is more knowledgeable and is key in reuniting the family and making it functional again. The mother has to learn that as children grow, they need independence, which does not mean rebellion. I would focus on strategies the family can apply to live a more independent but healthy life and have functional relationships.(Comprehensive Family Assessment Nursing Paper Example)

Family Genogram

        : male

         : Female

//: divorced

References

Al Wekhian, J. (2019). Acculturation Process of Arab-Muslim Immigrants in the United States. Asian Culture and History, 8(1), 89-99.(Comprehensive Family Assessment Nursing Paper Example)

Becvar, R. J., & Becvar, D. S. (2017). Systems theory and family therapy: A primer. Rowman & Littlefield.

Gager, C. T., Yabiku, S. T., & Linver, M. R. (2019). Conflict or Divorce? Does parental conflict and divorce increase the likelihood of adult children’s cohabiting and marital dissolution? Marriage & Family Review, 52(3), 243-261.(Comprehensive Family Assessment Nursing Paper Example)

McGill University. (2020). Diagnostic Criteria for Relational Problems. https://www.mcgill.ca/crcf/files/crcf/diagnostic_criteria_for_relational_problems_heyman_slep.pdf

McGoldrick, M., & Hardy, K. V. (Eds.). (2019). Re-visioning family therapy. Guilford Publications.

Niec, L. N., Barnett, M. L., Prewett, M. S., & Shanley Chatham, J. R. (2019). Group parent–child interaction therapy: A randomized control trial for treating conduct problems in young children. Journal of consulting and clinical psychology, 84(8), 682.(Comprehensive Family Assessment Nursing Paper Example)

Paniagua, F. A. (2018). ICD-10 versus DSM-5 on cultural issues. Sage open, 8(1), 2158244018756165.

https://www.ncbi.nlm.nih.gov/