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Meet the family


The Greenleaf family is an African-American family that owns a mega-church in Memphis. They are of Christian faith and practice their religion in their church called the Calvary Fellowship. The members of the family include both parents (mother and father), and their adult children. The family members work in the church and live in the same household. The Greenleaf household is occupied by the parents, adult children, and the grandchildren. They own a vast estate where their mansion is located and shared among the family members. Bishop James Greenleaf is the head of the family and manages the church. He has been diagnosed with Parkinson’s disease, and has been experiencing hand tremors spontaneously. According to Duvall’s developmental stages of families, the family is in the stage of aging families. During this stage, the family will experience retirement of both the parents. This means letting go of the responsibility of being the main provider. Secondly, the parents will be fulfilling their roles as grandparents to their grandchildren whom they live with. Moreover, the death of a spouse may occur if Bishop Greenleaf’s condition progresses rapidly. Lastly, the parents must adapt to living alone when their children decide to move out of their estate. This stage focuses on role adjustments, and adaptation to new family functions. (Rowe-Kaakinen, 2015).

Parkinson’s Disease


Age: 6065 years old 3 James Greenleaf is the ill family member who has been diagnosed with Parkinson’s disease. He is a Bishop and sermons at the Calvary Fellowship. He has a wife, three adult daughters, and one adult son. His role in the family includes being a provider, a protector, and the family gatherer. His wife and children tend to seek for his support and approval in every aspect of their lives. He treats his family kindly and provides for them as best as he can. In addition to his role as the bishop of the church, he also manages the finances of the church by bringing in sponsorships and deciding where to spend the money. His stress stems from making sure the church is running smoothly while dealing with family issues like the death of his youngest daughter, and the constant disagreements within family members. Due to his recent diagnosis, he has been thinking about stepping down from his responsibilities and passing it down to his children.

Parkinson’s disease (PD) is a progressive neurodegenerative disorder that affects the individuals motor ability (Ignatavicius & Workman, 2016, p. 867). Fundamentally, there are four symptoms of PD that includes tremors, bradykinesia, muscle rigidity, and postural instability. This condition is a result of a neurotransmitter imbalance, thus causing the ill individual to lose his/her ability to make voluntary and controlled movements. The pathophysiology of this condition pertains to the degeneration of a part of the brain called the substantia nigra. This action causes a decrease in dopamine, and large amounts of excitatory ACh secreting neurons in the brain (Ignatavicius & Workman, 2016, p. 867). This disorder develops gradually; however, it essentially worsens dramatically in time. The symptom that Mr. Greenleaf was experiencing were hand tremors. Tremors are uncontrollable shaking motions that can present in the limbs, hands, and fingers (Mayo Clinic, 2015). Another symptom that Mr. Greenleaf will experience as the disease progresses is bradykinesia or akinesia; this causes the ill individual to move abnormally slow or produce no movements at all. Most individuals who experience bradykinesia will drag their feet, and experience difficulties with everyday tasks because it becomes time-consuming (Mayo, 2015). In addition, rigid muscles and postural inability will affect the individuals balance and cause a stopped posture (Mayo, 2015). As the disease progresses to later stages, symptoms become significantly severe and debilitating. Mr. Greenleaf will experience loss of automatic movements like blinking and will have difficulties with speech. Mr. Greenleaf will not be able to perform daily self-care needs and will require full assistance. The onset of Parkinson’s disease typically begins around the age of 60 and it is more common in men than women (MedlinePlus, 2016). There is no cure for this disease however, there are medications available that can relieve the symptoms. The symptoms of PD vary in people; some people become disabled while others have minor motor disruptions (NIH, 2017). Individuals with PD have poor quality of life and require all the help they can get. This disease can be physically, and emotionally draining for the ill patient and his family members. However, family support is crucial in producing positive outcomes.

Daisy Mae

Age: 6065 years old


Daisy Mae Greenleaf has been married to Mr. Greenleaf for about 40 years. She works under her husband in the Calvary Fellowship and plays a role in overseeing certain projects within the community. Her role in the family includes raising her children and providing guidance. She continues to take on her motherly role as her children remain in the same household as her. She fulfills her duties of cooking at home, taking care of husband, as well as taking care of her grandchildren. She has a good relationship with her husband and has his best interest at heart. She can sometimes shut her children out when they do things that are against her personal beliefs. Her relationship with her children can be described as lacking, and weak. She disagrees with most of her children’s decisions and opposes their actions. She is very religious and uses prayer as a form of therapy when she is under stress. She relies on her religion when she becomes overwhelmed by her husband’s condition.

Grace Greenleaf is the eldest daughter of James and Daisy Mae. She is not married and has a daughter who is 18 years old. She is currently a single parent raising her child with the help of her family. She moved out of the Greenleaf residence 20 years ago, which created conflict between her and her mother. Her occupation was a news anchor; however, she is continuing her role as a pastor in the Calvary fellowship. She decided to move back to their home when her youngest sister passed away from suspected suicide. Her role in the church includes leading sermons, baptizing, and partaking in wedding ceremonies. Her role in the family includes taking care of her daughter and lending an extra hand to her parents, whether it is in the workplace or at home. She seems to have a strong bond with her father and a distant relationship with her mother. She avoids conflict by running away and avoiding her family. She can be very persistent when she chooses to do something.


Age: 40 years old 5

Charity Greenleaf is the second eldest daughter of James and Daisy Mae. She is married and has one son with her husband. She works in the Calvary Fellowship as the choir’s artistic director and composes gospel songs for the church. Her role in the family is to raise her child and care for her husband. In addition to that, she must contribute to household chores while she still lives with her parents. She has a very strong bond with both her parents however, she sometimes feels like she’s being left out of family business. She seems to always seek out for her family’s approval, especially her father’s. She sometimes feels like she is not appreciated by her family as much as her other siblings, which brings out resentment towards her sisters and brother. She became very devastated when she found out about her father’s diagnosis and has been willing to do as much as she can to take away from her parent’s work load.


Age: 30-35 years old 8


Age: 40-45 years old



Age: 20 years old (deceased)


Faith Greenleaf is the youngest daughter of James and Daisy Mae. She is deceased and passed away from suicide. She was not married and did not have any children. She used to have a close relationship with her brother and sisters, however this was lost when Grace left home. Faith contributed to the family’s work load by providing sermons to the younger children of the fellowship. She left her family’s home due to psychological issues of depression and PTSD. Faith was adventurous and had a free-spirited personality.

Jacob Greenleaf is the only son of James and Daisy Mae. He has been married for 10 years, has one son, and a daughter. He is a pastor and contributes to the family church by preaching sermons. He is unsure of his role as a pastor and if this is the right occupation for him. His role in the family is to provide for his wife and children while also helping out his parents. He has a strong relationship with both his parents however he seems to disagree with his father the most. He is expected to step up and take over his father’s responsibilities in the church and in the family as well. He is expected to be the main provider and protector of the family while his father’s condition progresses. He has strong relationships with his sisters and is always protective of them. He tends to gravitate towards bad habits when he experiences some sort of stress.


The Greenleaf family is an African-American family from Memphis. They’re family system can be described as traditional with parents who are married, and the children who are all biologically related. They are very well off; they own a massive estate, live in a mansion, and own the most successful church in Memphis. Their beliefs are Christian based, which is the religion they practice in their fellowship. The family has very strong faith and follows strict Christian values. They base their actions on God’s will and the word of the bible. They all work in the Calvary fellowship and live in the same household. They have meals together every day and help each other with personal responsibilities like taking care of the younger children. They have many disagreements that pertains to opposing ideas, however they always support each other in times of need.


Ø Strong faith in their religion that brings their family together. Ø Unconditional love within family members. Ø Loyalty Ø Financial stability Ø Access to multiple resources (i.e. health insurance)


Ø Death within the family Ø Illness in the family Ø Constant disagreements Ø Resentment between family members Ø Poor communication skills Ø Poor coping skills




The family presents with poor communication skills. They have many disagreements with each other affecting the relationships within the family unit. The family blames Grace for their family problems, so they only speak to her when they need to express their anger. They typically ignore each other in order to prevent anymore arguments. They avoid confrontation and will walk away in the middle of conversations. Communication between the parents and the children essentially involves God and their Christian values. The children speak to their parents with respect, and never raise their voice even if they are angry. There seems to be hidden issues within the family unit which is filled with resentments and holding grudges. Everyday communication involves conversations during meals, and quick conversations when they see each other at the church.

Chronic Illness Framework What is the Chronic Illness Framework? This framework was created in order to form an understanding on how chronic illness affects families. There are three elements in this framework that will help the nurse think about the multiple factors of the illness and how it affects family functioning. (RoweKaakinen, 2015). The three major elements: Ø Illness types (onset, course, and outcome) Ø Time phases of the illness (Initial, Mid-time, Terminal) Ø Family functioning

Family Function

Illness type

Time phase

The Greenleaf family is living with and adjusting to James’s chronic illness of Parkinson’s disease. James’s diagnosis is still new to him and his family. The gradual onset of the disease is giving the family time for acceptance and adaptation to new family functions and roles. The course of the condition gets worse over time however, the symptoms can be managed with medicine. This will require the family to make gradual changes in adapting their losses, and to preparing for what’s to come. The family experiences stress with knowing that the outcome will be fatal and can shorten James’s life. In addition, James’s condition will lead to incapacitation like poor mobility, and loss of autonomic functions. The Greenleaf family is in the initial phase of the illness trajectory. According to Post and Muslimovic et al, motor impairment, disability, and quality of life of new diagnosed patients show progression in the first three years. For the family, this means that the first three years of the condition will require constant changes and adjustments in both the ill individual and family’s life. The quality of life of the ill family member will deteriorate as symptoms progress and emotional function becomes altered (Post & Muslimovic, 2011). This phase in the patient’s chronic condition should be focused on establishing a positive working relationship with health care providers, gathering as much knowledge about the education (i.e. symptoms, prognosis, treatment options), and accepting the diagnosis. This phase will create a lot of stress in the family because of the shock, and thoughts of uncertainty. The nurse’s role during this time is family education and initiating family planning into the family member’s lives (Rowe-Kaakinen, 2015).

James is accepting his diagnosis and is adapting to letting go of his provider role. This includes stepping down from his responsibilities from work and leaving it to his children. The nurse must assist the family in redefining roles and adjusting to these changes. Jacob and Grace are taking over the management of the church, while keeping up with their own responsibilities. Charity is trying to help out as much as she can however, she is raising her child at the same time. Daisy Mae is working on accepting her husband’s diagnosis and realizing that significant changes will occur in their relationship. Some changes might include lack of emotional support from the ill spouse, and intimacy. The nurse must support Daisy Mae in preparing herself and her children for the course of the disease by looking for potential caregivers, if exhaustion occurs. In addition, the family’s religious and cultural beliefs must be considered. The time dedicated to attending church and praying will be affected by the condition. The family must learn to adjust to this change and implement new ways in which they can continue to practice their faith. Finally, the nurse should assist the family in exploring treatment options as the disease progresses to the terminal stage.


Problem #1: The family members have just been informed of James newly-discovered diagnosis and they are having difficulty coping. The children are taking their anger out on each other and disagreements are constant. In addition to that, they just buried Faith, the youngest daughter of James and Daisy Mae. ØIntervention: Assess how the family is adapting to Mr. Greenleaf’s chronic condition and consider each of the family members roles in the family. ØRationale: According to Whitehead & Jacob et al, change in roles and adaptation can be stressful for family members (Whitehead & Jacob et al, 2017). When family members become ill, it triggers a stress response in the family to adapt to the needs of the individual and family member (Rowe-Kaakinen, 2015). ØOutcome: The family members will be able to identify their roles in the family and adapt to any adjustments in order to reduce stress.

Problem #2: James and his family members feel that they aren’t educated enough about this diagnosis. They haven’t explored any treatment options and are unsure of what to expect during the course of the chronic illness. ØIntervention: Educate the family about James’s condition and how to manage certain symptoms. Provide three to five education sessions to the family members, and hands-on sessions that includes assisting with the ill member’s self-care activities. ØRationale: Caregivers need to be provided information about the health condition, lifestyle management, and medication adherence, be involved in the management plan, and accompany ill patients to their accompaniments (Deek & Hamilton et al, 2016). Family education is critical to health outcomes, specifically integrating the medical treatment plan into family life and family roles (Rowe-Kaakinen, 2015). ØOutcome: James and his family will be educated on every aspect of his condition. They will understand the symptoms of the disease, the treatment options, what they should expect in the next three years, and his prognosis. They will utilize what they learned by preparing for a care management plan specifically for James’s personal preferences.

Problem #3: James’s wife is the main caregiver and is beginning to feel overworked due to the emotional toll this condition has taken. Daisy Mae doesn’t openly communicate to her children about her feelings and she needs her children’s support in taking over her responsibilities at the church, at home, and with caring for James. ØIntervention: Assist the family in sharing the support for aspects of the chronic disease management. ØRationale: Sharing support between family members was described as helping promote autonomy for the family member living with illness and maintains harmony within family (Whitehead & Jacob et al, 2017). According to Chesla, The value of families organizing themselves to meet the challenges they faced in relation to chronic illness within the family, through flexibility and sustained adaption, are important in supporting positive health outcomes (as cited in Whitehead & Jacob et al, 2017). ØOutcome: The family members will support each other in order to provide as much autonomy to James, and also relieve Daisy Mae of her additional responsibilities.

References Deek, H., Hamilton, S., Brown, N., Inglis, S. C., Digiacomo, M., Newton, P. J., . . . Davidson, P. M. (2016). Family-centred approaches to healthcare interventions in chronic diseases in adults: a quantitative systematic review. Journal of Advanced Nursing, 72(5), 968-979. doi:10.1111/jan.12885 Ignatavicius, D. D., Workman, M. L., Blair, M., Rebar, C. R., & Winkelman, C. (2016). Medicalsurgical nursing: patient-centered collaborative care. St. Louis, MO: Elsevier. Mayo Clinic. (2015, July 07). Parkinson's disease. Retrieved March 11, 2018, from Medlineplus. (2016, September). Parkinson's Disease | PD | MedlinePlus. Retrieved March 11, 2018, from NIH. (2017, December). Parkinson's Disease Information Page. Retrieved March 11, 2018, from Post, B., Muslimovic, D., Geloven, N. V., Speelman, J. D., Schmand, B., & Haan, R. J. (2011). Progression and prognostic factors of motor impairment, disability and quality of life in newly diagnosed Parkinsons disease. Movement Disorders, 26(3), 449-456. doi:10.1002/mds.23467 Rowe-Kaakinen, J. (2015). Family health care nursing: theory, practice, and research. Philadelphia: F.A. Davis Co. Whitehead, L., Jacob, E., Towell, A., Abu-Qamar, M., & Cole-Heath, A. (2017). The role of the family in supporting the self-management of chronic conditions: A qualitative systematic review. Journal of Clinical Nursing, 27(1-2), 22-30. doi:10.1111/jocn.13775

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N480 Family Assessment Visual Report  
N480 Family Assessment Visual Report  

The Greenleaf Family