NRNP 6645 Week 2 Assignment – Family Assessment

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NRNP 6645 Week 2 Assignment – Family Assessment – Step-by-Step Guide

The first step before starting to write the NRNP 6645 Week 2 Assignment – Family Assessment, it is essential to understand the requirements of the assignment. The first step is to read the assignment prompt carefully to identify the topic, the length and format requirements. You should go through the rubric provided so that you can understand what is needed to score the maximum points for each part of the assignment. 

It is also important to identify the audience of the paper and its purpose so that it can help you determine the tone and style to use throughout. You can then create a timeline to help you complete each stage of the paper, such as conducting research, writing the paper, and revising it to avoid last-minute stress before the deadline. After identifying the formatting style to be applied to the paper, such as APA, you should review its use, such as writing citations and referencing the resources used. You should also review how to format the title page and the headings in the paper.

How to Research and Prepare for NRNP 6645 Week 2 Assignment – Family Assessment

The next step in preparing for your paper is to conduct research and identify the best sources to use to support your arguments. Identify the list of keywords from your topic using different combinations. The first step is to visit the university library and search through its database using the important keywords related to your topic. You can also find books, peer-reviewed articles, and credible sources for your topic from PubMed, JSTOR, ScienceDirect, SpringerLink, and Google Scholar. Ensure that you select the references that have been published in the last words and go through each to check for credibility. Ensure that you obtain the references in the required format, for example, in APA, so that you can save time when creating the final reference list. 

You can also group the references according to their themes that align with the outline of the paper. Go through each reference for its content and summarize the key concepts, arguments and findings for each source. You can write down your reflections on how each reference connects to the topic you are researching about. After the above steps, you can develop a strong thesis that is clear, concise and arguable. Next you should create a detailed outline of the paper so that it can help you to create headings and subheadings to be used in the paper. Ensure that you plan what point will go into each paragraph.

How to Write the Introduction for NRNP 6645 Week 2 Assignment – Family Assessment

The introduction of the paper is the most crucial part as it helps to provide the context of your work, and will determine if the reader will be interested to read through to the end. You should start with a hook, which will help capture the reader’s attention. You should contextualize the topic by offering the reader a concise overview of the topic you are writing about so that they may understand its importance. You should state what you aim to achieve with the paper. The last part of the introduction should be your thesis statement, which provides the main argument of the paper.

How to Write the Body for NRNP 6645 Week 2 Assignment – Family Assessment

The body of the paper helps you to present your arguments and evidence to support your claims. You can use headings and subheadings developed in the paper’s outline to guide you on how to organize the body. Start each paragraph with a topic sentence to help the reader know what point you will be discussing in that paragraph. Support your claims using the evidence conducted from the research, ensure that you cite each source properly using in-text citations. You should analyze the evidence presented and explain its significance and how it connects to the thesis statement. You should maintain a logical flow between each paragraph by using transition words and a flow of ideas.

How to Write the In-text Citations for NRNP 6645 Week 2 Assignment – Family Assessment

In-text citations help the reader to give credit to the authors of the references they have used in their works. All ideas that have been borrowed from references, any statistics and direct quotes must be referenced properly. The name and date of publication of the paper should be included when writing an in-text citation. For example, in APA, after stating the information, you can put an in-text citation after the end of the sentence, such as (Smith, 2021). If you are quoting directly from a source, include the page number in the citation, for example (Smith, 2021, p. 15). Remember to also include a corresponding reference list at the end of your paper that provides full details of each source cited in your text. An example paragraph highlighting the use of in-text citations is as below:

The integration of technology in nursing practice has significantly transformed patient care and improved health outcomes. According to Smith (2021), the use of electronic health records (EHRs) has streamlined communication among healthcare providers, allowing for more coordinated and efficient care delivery. Furthermore, Johnson and Brown (2020) highlight that telehealth services have expanded access to care, particularly for patients in rural areas, thereby reducing barriers to treatment.

How to Write the Conclusion for NRNP 6645 Week 2 Assignment – Family Assessment

When writing the conclusion of the paper, start by restarting your thesis, which helps remind the reader what your paper is about. Summarize the key points of the paper, by restating them. Discuss the implications of your findings and your arguments. End with a call to action that leaves a lasting impact on the reader or recommendations.

How to Format the Reference List for NRNP 6645 Week 2 Assignment – Family Assessment

The reference helps provide the reader with the complete details of the sources you cited in the paper. The reference list should start with the title “References” on a new page. It should be aligned center and bolded. The references should be organized in an ascending order alphabetically and each should have a hanging indent. If a source has no author, it should be alphabetized by the title of the work, ignoring any initial articles such as “A,” “An,” or “The.” If you have multiple works by the same author, list them in chronological order, starting with the earliest publication. 

Each reference entry should include specific elements depending on the type of source. For books, include the author’s last name, first initial, publication year in parentheses, the title of the book in italics, the edition (if applicable), and the publisher’s name. For journal articles, include the author’s last name, first initial, publication year in parentheses, the title of the article (not italicized), the title of the journal in italics, the volume number in italics, the issue number in parentheses (if applicable), and the page range of the article. For online sources, include the DOI (Digital Object Identifier) or the URL at the end of the reference. An example reference list is as follows:

References

Johnson, L. M., & Brown, R. T. (2020). The role of telehealth in improving patient outcomes. Journal of Nursing Care Quality, 35(2), 123-130. https://doi.org/10.1097/NCQ.0000000000000456

Smith, J. A. (2021). The impact of technology on nursing practice. Health Press.

NRNP 6645 Week 2 Assignment – Family Assessment Instructions

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.

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. Have a look at NRNP 6645 Week 3 Assignment: Analyzing Group Techniques.
  • 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. 

Mother and Daughter: A Cultural Tale Transcript

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00:00:00TRANSCRIPT OF VIDEO FILE: 

00:00:00_____________________________________________________________________ 

00:00:00BEGIN TRANSCRIPT: 

00:00:00[music] 

00:00:35A MOTHER and A DAUGHTER: 

00:00:35A CULTURAL TALE 

00:00:35AN INTERVIEW WITH 

00:00:35GONZALO BACIGALUPE, PhD 

00:00:35Produced by 

00:00:35Andrews & Clark 

00:00:35Explorations, Inc. 

00:00:35copyright 2003 

00:00:35GONZALO BACIGALUPE When I’m asked to do a consultation, one of the first things I ask is, what will be the most benefit for the client and the therapist and in the case that you’re going to see I’m basically asked to have a reflecting team and what we did was first have an interview with the therapist and the family and ask them what they will find useful for the interview and basically to ask them about the history of the therapy and the history of what are the kinds of things that they have been working on.

I ask the reflecting team to come in and I instructed them to think of themselves as so let the god mothers of the therapist, who in a way, put them, himself, or in this case herself at risk in front of her peers and another people. So, I wanted them, the reflecting team to address the therapeutic system as a whole not just to address the family, I wanted them to talk also about the therapist and to be protective of them.

I also ask the reflecting team not to be too much of clinician, but to really react on a more personal level around the family. I sometimes reflected on what they were saying to clarify or to expand the idea or how I understood it to give voice to other possibilities, but respecting the personal peace, and then, I ask I ask the family to come back to, in a classical way, to respond to those comments what strike them. 

In the case that we watch, it seems that the family was dealing with sort of like two forms of trauma and/or three forms of trauma; one is, history of battering the domestic violence, child sexual abuse, a history of immigration that in some ways we lay it to that trauma getting away from it and basically the mother of five children deciding that they need to move out of the home, but in the process leaving one behind who is later on sexually, I mean, raped by the father.

And then at the present moment mother dealing with a fairly traumatic illness that have her, very disable, unable to walk and to work. So, it’s sort of like the interview trying to address this different forms of trauma and the way in which the young adults are trying to make sense of their bicultural life and how the whole family is trying to make sense of being bicultural and being immigrants.

The session doesn’t end with a need or incredible intervention of my part because I feel that this is the part of the therapist to try to decide, this is the family that’s been working this therapist for year and half. Therefore, they have a relationship I feel that I need to respect and so those are the basic intercomments. So tell me how is it that you came out with the idea of having this interview with me? 

00:04:30Sharleen 

00:04:30Patti 

00:04:30SANDI Okay. I’m going to go back when Patti came in for the first time. She came in because they were chaos at her household. 

00:04:45Sandi – their therapist 

00:04:45SANDI She came to this country twelve years ago with her four children and one was left behind, her daughter who was 10 years old at that time, eight years old at that time, was left behind. Just two years back, finally they were able to get her visa and she brought her to United States. So ever since she came here chaos was created inside the household. 

00:05:20GONZALO BACIGALUPE So I’m clear, Sharleen you are? 

00:05:25SHARLEEN Her daughter. 

00:05:25GONZALO BACIGALUPE Her daughter. And how old are you? 

00:05:25SHARLEEN I’m 23. 

00:05:25GONZALO BACIGALUPE 23, and how old are your siblings? 

00:05:30SHARLEEN 24. 

00:05:30GONZALO BACIGALUPE And that’s sister or brother? 

00:05:35PATTI Sister. 

00:05:35SHARLEEN And then 21-year old sister and 18-year old brother and a 15-year old brother. 

00:05:50GONZALO BACIGALUPE Okay, and which one is the one that stayed there. 

00:05:50SHARLEEN 21. 

00:05:50SANDI 21. 

00:05:50GONZALO BACIGALUPE 21. Okay. All right. Okay. Go ahead, sorry. 

00:05:55SANDI And I met with the entire family for two couple of sessions and she really interested and wanted to be in therapy 21, so. 

00:06:10GONZALO BACIGALUPE What’s her name? 

NRNP 6645 Week 2 Assignment – Family Assessment Example

NRNP/PRAC 6645 Comprehensive Psychiatric Evaluation Note

The Psychiatric/ Mental health nurse performs complex functions in care delivery. They assess families and individuals comprehensively to determine areas of need, their physical and cognitive health, and their family cohesiveness. They work with the interprofessional team to fulfill these needs. Assessing families is somewhat complex and differs from individual analysis because the focus is to manage the family trauma and rewire the dysfunctional patterns in the family. This comprehensive psychiatric evaluation note focuses on Patti’s family and a dysfunctional pattern blamed on the arrival of her daughter, who had been left behind in Iran and recently rejoined the family.

CC: (chief complaint): “Chaos in Patti’s family since her daughter rejoined the family.”

HPI: A mother (Patti), her daughter, and the family therapists came to the healthcare facility complaining of chaos in the family since her daughter Shireen came to the US. The family immigrated from Iran 12 years ago, and a 10-year-old daughter was left behind before processing her visa and joining the family in the United States. Chaos (blaming, arguing, cursing) arose when she rejoined the family and told them of the trauma and abandonment she went through after she was left behind during the immigration.

Patti complains that her children are out of control, and she no longer feels in charge. The family therapist states that Shireen, the 21-year-old, claims she needs more money than a therapist and refuses to attend all appointments. Shireen has been through trauma after being sexually and physically abused by her father when the mother chose to stay with the four kids in the US and not return to Iran.

Patti is also attached to her culture; the daughters try to detach from their mother and live independently. Patti has had two foot surgeries, creating more family tension. Patti often feels hopeless, helpless, and detached from the children and has been advised to get psychiatric help. Patti admits to needing help to learn to detach from the kids and live independently because of her cultural affiliations.

Past Psychiatric History:
  • General Statement: The client has a history of fights and disagreements in the family due to cultural problems and started family therapy about two years ago
  • Caregivers (if applicable): Not applicable
  • Hospitalizations: 2 years ago, after two-foot surgeries
  • Medication trials: None
  • Psychotherapy or Previous Psychiatric Diagnosis: None

Substance Current Use and History: Denies current and past substance use history.

Family Psychiatric/Substance Use History: History of domestic trauma (battery), child sexual, immigration trauma of leaving a child behind, fairly traumatic current illness for the mother

Psychosocial History: The client and her children were born in Iran and migrated to the US 12 years ago, leaving a daughter behind who rejoined them later. She has five children; the oldest daughter is a 24-year-old daughter, a 21-year-old daughter, an 18-year-old son who is a student, and a 15-year-old son.The 21-year-old got married recently. The oldest daughter works in promotional jobs and working on getting her real-estate job license. The father, back in Iran, remarried and did not admit her mistakes of abusing Shireen.

Patti worked at caregiving and has not been involved in any current or past legal issues. After bringing her child for medical attention in the US, Patti decided to stay and ran away from her husband, who used to beat and abuse her as she protected the children. At home, she quarrels with the children, argues, and curses over issues such as the need for assistance, controlling the children’s lives and dogs, and spending personal time, and she admits that there is a need for change.

Medical History:

  • Current Medications: None
  • Allergies:No known drug or food allergies
  • Reproductive Hx:She has four children. LMP three weeks ago, no pregnant or lactating, heterosexual.

ROS:

  • GENERAL:  The patient denies any recent weight gain, fatigue, weakness, fever, chills, or night sweats
  • HEENT: Denies headaches or recent traumas. Eyes: Denies pain, itchiness, dryness, or drainage. Ears: Denies ear pain, drainage, ringing, loss of balance, or hearing changes. Nose: Denies any pain, drainage, or congestion. Throat: Denies pain swallowing, dryness, itchiness, or sputum production
  • SKIN: Denies rashes, itchiness, swelling
  • CARDIOVASCULAR: Denies palpitations, high blood pressure, or chest pain
  • RESPIRATORY: Denies cough, wheezing, crackles, congestion, or shortness of breath
  • GASTROINTESTINAL: Denies changes in appetite, constipation, diarrhea, or abdominal pain
  • GENITOURINARY: Denies pain micturition, color or odor in urine, increased urgency or frequency
  • NEUROLOGICAL: Denies headaches, syncope, or loss of coordination
  • MUSCULOSKELETAL: Reports having had two previous leg surgeries, has excruciating pain hence movement problems
  • HEMATOLOGIC: Denies easy bruising, uncontrollable bleeding,
  • LYMPHATICS: Denies lymphadenopathy
  • ENDOCRINOLOGIC: Denies cold or heat intolerance or excessive sweating

Physical exam: Not Applicable. Performing a physical exam may help determine any physical needs that would inform care delivery.

Diagnostic results: No diagnostic tests were ordered

Assessment:

Mental Status Examination: Patti is a 40-year-old lady who appears the stated age. She is cooperative throughout the encounter. She has dressed appropriately and portrays no tics or other abnormal facial movements. In addition, her speech is coherent, clear, and in appreciable volume and tone. The thought process has no tangentiality, circumstantiality, thought block, or flight of ideas.

She reported her mood as happy and displayed a broad congruent affect throughout the encounter. She denies any tactile, auditory, or visual hallucinations or illusions. She does not display delusional thinking or suicidal or homicidal ideations. She is alert and well-oriented to time, place, person, and occasion. Her immediate recall and ratio, recent, and remote memories are intact. In addition, she has good insight and judgment. She denies sleep or appetite changes.

Differential Diagnoses:

Adjustment Disorder with Depressed Mood

According to DSM-5, adjustment disorder is diagnosed when emotional and behavioral symptoms are in response to an identifiable stressor, occurring within three months of the stress onset (APA, 2022). The patient is often tearful, hopeless, and helpless and even exhibits bizarre behavior, such as demanding kids to spend time with her. This family has been experiencing disturbances since the daughter came from Iran. O’Donnell et al. (2019) note that behaviors such as aggression, demanding character, hopelessness, helplessness, cursing, and shouting are clinical manifestations of the adjustment disorder.

The family is trying to adjust to the new realities, especially when trying to understand their sister and all the trouble she went through in Iran. Patti is also trying to cope with stressful changes, from an inability to work after two surgeries affecting her walking ability. She also needs adjustment to the new reality that she cannot entirely rely on the children for all her needs or be controlling or too demanding because they are already grown-ups. Thus, this is the primary diagnosis for this patient.

Dependent Personality Disorder

The condition presents with an excessive need to be cared for by others. It involves submissiveness and a need for constant reassurance, and the inability to make decisions (Heintz et al., 2021). The DSM 5 states that a person with this disorder displays a fearful and anxious presentation, excessive need, and dependence on others (APA, 2022). Patti has dependent behavior, but hers is more controlling than fearful. She demands that her children spend all day with her. However, she admits that she is unhappy they are arguing and fighting with her children because she loves them. She does not display a submissive and fearful character, thus ruling out the diagnosis.

Acute Stress Reaction

Acute stress disorder is caused by exposure to traumatic events that involve death, serious injury, sexual violence, and other symptoms, which must begin within three days of the event but last more than three days but subside within a month (APA, 2022). It must cause distress or impairment. Shahrour and Dardas (2020) note that acute stress can cause significant distress and occurs when individuals feel out of control. The daughter’s arrival, the stories she gave the family, and the blaming and the illness could have caused acute stress to the mother. She also presents as being depressive, hopeless, and helpless at times. However, these symptoms have persisted for more than a month, ruling out the diagnoses.

Case Formulation and Treatment Plan: Initiating Patti’s individual psychotherapy and family therapy every two weeks to help the client live a more independent life away from her children and to ensure her children support her as she learns to live independently. Hoffman and Stein (2022) note that psychotherapy is an effective treatment for adjustment disorders as it helps patients deal with the patterns responsible for them.

The recommendations were discussed with the family therapists, who agreed with the treatment plan and promised to cooperate. The family also consents to the arrangement for better family outcomes for this troublesome family. Returning to the clinic in four weeks will help the healthcare providers assess change and make other management decisions for better health outcomes.

Reflections

Working with this family and therapist was a complex activity that I could have improved in many ways. I agree with the preceptor’s diagnosis because Patti presents with a need for psychiatric interventions, as seen in her portrayal of maladjustment behaviors. In the future, I will ensure I listen to the family keenly before trying to start conversations. I will also establish some background rules to prevent patients from fighting or disagreeing harshly in the room, which can impede care delivery.

The care provider must ensure a therapeutic environment for effective problem management (Wheeler, 2020). Culture is essential to any individual, and these children also need to understand their mother and be supportive as she adjusts to the new realities. Thus, their involvement in family therapy is crucial. Educating the patient on identifying other sources of social support, such as community and religious groups, would also help relieve the overreliance on her children.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787

Heintz, H. L., Freedberg, A. L., & Harper, D. G. (2021). Dependent personality in depressed older adults: a case report and systematic review. Journal of Geriatric Psychiatry and Neurology, 34(5), 445-453. https://doi.org/10.1177/0891988720933361

Hoffman, J., & Stein, D. J. (2022). What are the pharmacotherapeutic options for an adjustment disorder? Expert Opinion on Pharmacotherapy, 23(6), 643-646. https://doi.org/10.1080/14656566.2022.2033209

O’Donnell, M. L., Agathos, J. A., Metcalf, O., Gibson, K., & Lau, W. (2019). Adjustment disorder: Current developments and future directions. International journal of Environmental Research And Public Health, 16(14), 2537. https://doi.org/10.3390/ijerph16142537

Shahrour, G., & Dardas, L. A. (2020). Acute stress disorder, coping self‐efficacy and subsequent psychological distress among nurses amid COVID‐19. Journal of Nursing Management, 28(7), 1686–1695. https://doi.org/10.1111/jonm.13124

Wheeler, K. (Ed.). (2020). Psychotherapy for the advanced practice psychiatric nurse: A  how-to guide for evidence-based practice (3rd ed.). Springer Publishing.