To understand the health issues of patients, a family assessment is paramount. The assessment gives the care provider an understanding of the familys cultural, social, and economic issues, which determine the treatment that needs to be administered and the patients response to the treatment. In addition to family assessment, a nursing plan outlines the plan of action or care that the provider finds appropriate for treating the medical concerns identified during the assessment of the family. This family assessment is of a family from the African American minority community from Flint. The Richards family is comprised of six members: three males and three females between age 15 and age 69. This assessment will look into the relations within the family, its environment, and the health concerns affecting it. A nursing plan will then be created; it will recommend health care actions to rectify the medical issues. Family relations contribute to and at times increase the possibility of a certain illness. Hence, understanding a patients family history and the cultural, social, and economic environment is imperative for an effective treatment.

Keywords: assessment, anxiety, treatment, health, support group

1. Family composition.

The assessment family is a nuclear family consisting of a married couple and three children, but also hosting the childrens maternal grandmother. There are three males, the father and the two sons, the firstborn and second-born of the family. There are three females, the grandmother, the mother, and the lastborn. The grandmother, being the eldest, is sixty-nine years old. The father is in his early forties (42 years old), while the mother is 40 years old. The eldest son is 20, the second one is 17, and the girl is 15 years old. It is a low-income African-American family.

2. Roles of each family member. Who is the leader of the family? Who is the primary provider? Is there any other provider?

The man, the husband and father of the three, is the head of the family. He is the primary provider; he makes most major decisions about the family. His job is considerably reliable, with healthcare insurance and pension benefits, and he can access mortgage loans and other such financial programs through it. The wife, Mrs. Esther Richards, is also working, although her income is considerably low. She supplements her husbands income through taking care of household consumption and purchases. Also, the firstborn son, Brian, takes part-time jobs whenever possible, in the evenings and on the weekends, as he is working out his college education. Therefore, the three, the husband, the wife, and the firstborn, are the providers in the family. The grandmother, Miranda, is the home caretaker; she oversees the childrens development and the home welfare in general. The second-born son, John, is struggling through high school and has a high risk of dropping out, since he is completely addicted to substance abuse. The lastborn, Claire, is doing well in her first year of high school. She spends most her time in books and is quite reserved.

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3. Do family members have any existing physical or psychological conditions that are affecting family function?

Miranda suffers from dementia, so she cannot go out on her own and requires considerable observation and care when at home. Her forgetfulness requires her to have verbal reminders of what she ought to do and at what time with clear and specific instructions for every activity. She is also seeking healthcare regarding the same and is on medication. John, on the other hand, suffers from maladaptive aggressiveness and impulsiveness. He is probably suffering from Attention Deficit Hyperactivity Disorder (ADHD) comorbid with autism spectrum disorders. The family has a hard time trying to understand and cope as well as control Johns impulsiveness and aggressiveness. Esther suffers from hypertension, which fluctuates. The family requires finances to take care of these health issues, at the same time keeping up with other family expenses.

4. Home (physical condition) and external environment; living situation (this must include financial information). How the family supports itself; for example, working parents, children or any other member.

The family owns a home in a poor black neighborhood. The environment is dirty and involves high health risks. There are rarely any exercise facilities around, and the family does not have a built-in gymnasium facility. Therefore, the family members do not work out at all. Additionally, the working members of the family have no time at all for social life or exercise, as they maximize on overtime and extra jobs to increase their income. The Richards meet their basic needs for food and education for children in public schools. They cannot afford hygienic living owing to the little income available from the three providers and their neighborhood. Notably, Brain, is frequently off work because of the high rate of unemployment among the blacks.

5. How adequately have individual family members accomplished age-appropriate developmental tasks?

Miranda has accomplished her age-appropriate developmental tasks. She managed to give at least a college education to her two children, Esther and her brother Antonio. She could not do more for them because her socioeconomic status could only allow for that much. Mr. Richards, however, feels inadequate in his age-appropriate tasks, thus depressed and anxious. He aimed to have completed a post-graduate degree by the time he was forty. However, as a result of earlier unemployment and the family responsibilities of marrying early, he is still amid his graduate degree. Esther is comfortable with her age-appropriate tasks so far. She has a college diploma and gives priority to her childrens education but has forgone her desire to upgrade. Brian is happy about his achievements so far, and he transmits the same happiness to the rest of the members. He has successfully graduated from high school and is pursuing his dream career in college. John did not transition from childhood to young adulthood properly and is causing a lot of worries and anxiety to the family. He is headed for adulthood, and he has not conquered his teenage life. Claire has so far achieved her age transition properly.

6. Do individual family members developmental states create stress in the family?

Mr. Richards failure to achieve his education expectations is resulting in considerable tension and even violence, as he tries to come to terms with his failure. Also, Johns failure to transit properly is wreaking havoc in the family. The parents feel as if they have failed to guide him adequately, which leads to self-blame. Stress is building because of the fear of what John is capable of doing.

7. What developmental stage is the family in? How well has the family achieve the task of this and previous developmental stages?

The family is at a maturity stage. Apart from Johns aggressiveness and substance abuse, the family has achieved all the previous stages tasks as well as progressing well with the current stage tasks. 8. Any family history of genetic predisposition to disease?

The maternal side of the family has a genetic predisposition to hypertension from the age of 26 years. The paternal family has a history of genetic predisposition to depression in teenage years and early adulthood. 9. Immunization status of the family?

All members of the family have completed the standard immunization program. 10. Any child or adolescent experiencing problems

John, who is seventeen years old, is abusing drugs, mostly marijuana, tobacco, and possibly cocaine. He also has impulsive aggression. 11. Hospital admission of any family member and how it is handled by the other members?

There is no current hospital admission of a family member. 12. What are the typical modes of family communication? Is it effective? Why?

The typical mode of family communication is chatting around the dinner table and after dinner in the evening. Also, phone calls and messages are the typical forms of communication during the day, in the case of emergencies. The chats and talks at the dinner table and after dinner are currently not effective. The air in the family is prohibitive, as Mr. Richard gets irritated easily, and John hardly talks when the parents are around. Mr. Richard gets violent frequently, thus, the family hardly talks to avoid provoking a fight. 13. How are decisions made in the family?

Previously, the parents would discuss an issue and anonymously come up with a decision, then deliberate the decision with the children if it concerned them. Recently, the father has started to make major decisions without considering anyones opinions. Consequently, other family members no longer air their concerns for decision making, and everyone is making their own decisions, intensifying the tension in the family. 14. Is there evidence of violence within the family? What forms of discipline are used?

There is evidence of violence in the family. Mr. Richard beats Esther at times for what he calls extravagant expenses and bad child upbringing. He has been beating John regularly for his misconduct at school and home. He is violent to all the children over petty issues. The present form of discipline was initially verbal reasoning and counseling, which has changed eighteen months or so ago. Currently, children function on intrinsic discipline or they might have to take a beating from the father. 15. How well the family deals with the crisis?

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Esther and Miranda understand that the violence Mr. Richard is depicting is resulting from dissatisfaction and feelings of failure. Therefore, they have been seeking professional counseling help for the last five months. Since then, the incidents of violence have reduced considerably. The ways to deal with Johns aggressiveness and substance abuse are still underway. The family is looking for appropriate options of help that are available for such a case. The issues in the family seem to be taking a toll on Claire, and nobody seems to notice it.

16. What cultural and religious factors influence the family health and social status?

The family members are Christians, but they are not committed followers of the Christian faith. Since the family has been living in the U.S. for long, it hardly has any strong connections with its cultural beliefs. Nonetheless, Mr. Richards considers John a bad omen for the family and attributes all the problems of the family to his bad luck. The family also acknowledges that the depression predisposition in the paternal family has something to do with Johns behavior. Since the family believes Johns depression is inherited, they are not aggressively looking for a solution. They consider it to be fate, and only the same can get it reversed. Just like all other African-Americans, the Richards suffer from high rates of unemployment and low income. Their social status remains low since they can only manage to earn wages at the poverty level or below. This social status, in turn, affects their health, since the services affordable for them are few, and at times they cannot afford most of the medical care necessary. 17. What are the family goals?

The family goals focus on the basic needs. First of all, the parents want to give a college education to their three children; this is their priority goal. Secondly, the family wants to afford average medical care for Miranda, Esthers blood pressure, and Johns supposed depression. Lastly, Mr. Richards aspires to establish a business by the time Claire is done with college, to accord employment at least to one or all the children.

18. Identify any external or internal sources of support that are available?

The Richards have a supportive paternal family, which assists with finances and emotional support in need. The family members are also active participants in casual groups in the neighborhood, which double-up as support groups in case of need. At school, Brain has supportive friends, and Claire has supportive friends and staff, who offer emotional support. Lastly, the family members share deep bonds with each other, thus being the first support group for anyone of them. 19. Is there evidence of role conflict? Role overload?

There is no evidence of role conflict or even role overload in the Richards family. 20. Does the family have an emergency plan to deal with the family crisis, disasters?

The family does not have any emergency plan to deal with crisis or disasters. Plan of Care Using the Nursing Process for Three Diagnoses


Esther Richards

John Richards Date: 90-day Update

REASON FOR CARE: Miranda, aged 69, has age-related forgetfulness, and she hardly remembers even the critical details.

Esther, aged 40, is suffering from hypertension, which worsens with incidents of anxiety and tension. She acknowledges that she suffers from high blood pressure, with a family history of genetic predisposition to the same.

John, aged 17, harasses siblings at home and colleagues in the neighborhood. He is also abusing drugs and does not seem to acknowledge that he acts aggressively or impulsively.

DIAGNOSIS: After a thorough family assessment, which doubles-up as a diagnostic work-up, the following diagnoses are prevalent.

Miranda suffers from dementia.

Esther suffers from hypertension.

John suffers from maladaptive impulsion and aggressiveness. Johns diagnosis suggests mental disorders, Attention-Deficit Hyperactivity Disorder (ADHD), and autism spectrum disorders.

MEDICATIONS: The three patients will undertake various medications as outlined below.

John will take stimulants for ADHD primary disorder. Also, he should take Atypical Antipsychotic and Mood stabilizers, such as lithium, for aggression and impulsion control (Stein, 2012).

Miranda will go through the stem cell treatment, which improves cell formation, reducing the deformed proteins (Wu et al., n.d.). There is no official treatment for dementia.

For stabilizing blood pressure, Esther will need Thiazide Diuretics, Beta blockers, and Alpha-beta blockers (James et al., 2014).


Miranda is a sociable woman, and she is highly flexible and accommodative.

Esther is very deterministic and keeps focused on what she sets to do.

John is passion-driven, and once he gets his passion for something, he never stops until he completes it.


Miranda spends most of the hours of the day alone, and she can hardly remember to follow up with the treatment requirements.

Esther experiences a lot of tension both at work and back at home. Controlling blood pressure in perpetual tension and anxiety may be difficult for her.

The tension in the family is pushing John further into drugs making recovery impossible.


All three have the support of all the family members as well as their neighbors, with whom the family maintains good relations.


Miranda forgets how to perform simple actions.

Esther suffers from migraines, shortness of breath, dizziness, and a hot temper.

John bullies siblings, abuses drugs, and demonstrates general aggressiveness.

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Miranda should engage in mental exercise as well as physical exercise, which will prompt the growth of brain cells.

Esther should have a long-term workout with a physician as well as introduce lifestyle changes to reduce the vulnerability of her genes to hypertension. She needs to engage in physical exercise to keep her heart fit.

Currently, autism spectrum disorders have no known medication, thus, psychosocial therapies and interventions are necessary for John. The therapies should be both family-focused and cognitive therapy because a combination of family and cognitive therapies increases the efficacy of the psychosocial interventions.


Johns therapies should occur once every week for two months.

Miranda should engage in mental exercise for at least one hour daily for one month, then increase the exercise time to two hours daily for the second month, then three hours daily for the third month. She should also get thirty minutes of exercise daily for ninety days.

Esther should engage in at least forty-five minutes of physical exercise daily for three months. She should also engage in diet control for three months, according to the prescription of the physician.


John should acknowledge that he has a problem and accept treatment. He should also stop substance abuse and show reduced aggressiveness as well as improved social behavior.

Miranda should show reduced forgetfulness and improved memory on how to perform simple actions.

Esther should show considerable control over her anxiety and reduced blood pressure fluctuation (James et al., 2014).

BY: (date of 90-day treatment plan update or within four sessions)


Miranda should stop forgetting things that have happened a short while ago and improve the memory of things that happened a long time ago.

Esther should have normal blood pressure with normal fluctuation, a controlled temper, and controlled tension and anxiety levels.

John should show controlled impulsion and aggression and increased social behavior as well as stop substance abuse.


Miranda will be able to remember what she did during her previous exercise session and remember the next sessions without aid. She will also interact with old friends without feeling odd that she cannot recollect most events.

Esther will maintain normal blood pressure, get angry less, and be calm without feeling anxious.

John should identify activities of interest to him and his talents to which he will channel his energy.


Miranda will be jotting down the things she does, and then checking later to see if she still remembers them.

Esther will list all the issues that make her anxious, causing a shoot in her blood pressure. She will also identify the things that make her feel calm and acquaint with them.

Lastly, John will acknowledge his academic interests and dream career, which always keep the mind active.

ANTICIPATED DISCHARGE DATE: The treatment must go on for three months, after which the efficacy of the interventions are to be assessed.


All the three patients have their family for support during and after the treatment. The family is their fast support group. Also, they have their neighbors, with whom they relate. Esther has her colleagues at work, who may also offer support. The support groups will require elucidation about supporting people with diagnosis such as maladaptive aggression, dementia, and hypertension. The elucidation involves resourceful material availability to the support groups. The materials may be in the form of films, handouts, websites, motivational talks, workbook pages, or even training sessions. The support groups form an indispensable part of the patients recovery, thus their knowledge is paramount.

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