A Case Study

Presented to the Faculty of

The Ateneo de Davao University
College of Nursing

In Partial Fulfilment for the Requirements in

Nursing Care Management 101 [Related Learning Experience]

A Community Case Study of the C Family

Submitted to:

Clinical Instructor – Community Health Nursing in Purok 2, Tugbok District Mintal

Submitted by:
Lim, Stephanie Marie
Madrazo, Benedict Edmund
Mangitngit, Jeferson
Margaja, Dominique Dawn
Maulion, John Charls
Mendoza, Kathreen Glaiza
Nalzaro, Sheena Anne
Omandac, Alyssa
Olalo, Angeli M.

BSN 3E; Group 3; College of Nursing

December 2, 2008
TABLE OF CONTENTS
Introduction...............................................................................

Acknowledgement....................................................................

Objectives.................................................................................

Initial Data Base........................................................................

First and Second Level Assessment..........................................

Family Coping Index................................................................

Prioritization of the Problems...................................................

Family Nursing Care Plans.......................................................

Conclusion and Recommendation............................................

References.................................................................................

Appendices................................................................................
INTRODUCTION
 Community Health Nursing according to the World Health Organization (WHO)
is concerned with the promotion of health, improvement of conditions in terms of
physical and social environment, rehabilitation and prevention of illness or disability. It
is to render service which the nurses and clients work together to identify specific goals
related to wellness promotion, disease and illness prevention, health restoration, and
coping and altered functioning, which are most important to the client, and to match
them with the appropriate nursing actions.

As of November 2008, the world's population is estimated to be about 6.72

billion (6,720,000,000). In line with population projections, this figure continues to grow
at rates that were unprecedented before the 20th century, although the rate of growth has
almost halved since its peak of 2.2% per year, which was reached in 1963. The world's
population, on its current growth trajectory, is expected to reach nearly 9 billion by the
year 2042; While in the Philippines, the world's 12th most populous country with a
population of 90 million people. Its national economy is the 46th largest in the world
with an estimated 2008 gross domestic product (GDP) of over US $154.073 billion.
There are more than 11 million overseas Filipinos worldwide, about 11% of the total
population of the Philippines. It is a multi-ethnic country. Ecologically, The Philippines
is considered to be among 17 of the most megadiverse countries in the world.

As of 2005, just ten countries account for over 75% of the 27 million children
who remain unimmunized every year. WHO is working closely with these countries to
identify the weaknesses in their immunization systems, and to search for solutions. In
large countries it are often only a few areas that are responsible for most unimmunized
children, making it necessary to take a sub-national, area-tailored approach. It is possible
that through GAVI in the future funding will become available to specifically address the
issues faced by these large countries.
 For three weeks, BSN 3E were assigned to provide free health services that
address the health needs, problems and concerns of all people in Tugbok District, Davao
City. We implemented buddy system wherein we choose a partner in interviewing our
chosen family with different cultures and backgrounds. For our Case Study, we chose the
C Family because we see them as a cooperative and interesting family. In addition, we
can see what their different perceptions in terms of health are.
ACKNOWLEDGEMENT
 First, we would like to thank the Almighty God for giving us guidance, strength
and enlightenment upon doing this case study.

Second, we would like to thank each and everyone’s parents for their undying
support financially, physically and emotionally.

Third, we would like to thank our dearest clinical instructors, Ms. Margie Miano,
Mrs. Loreen Marcelo, Mrs. Neriza Gudoy and Ms. Mary Anne Silvino for guiding us in
choosing the appropriate family for our case study and for giving us some guidelines that
could help us in acquiring necessary information.

Fourth, we would like to thank our groupmates for their cooperation and
determination to finish and learn something from this case presentation.

Fifth, we would like to thank the people of Purok 2, Tugbok Distict for their
warm welcome and appreciation to all our activities and projects.

Lastly, we would like to extend our heartfelt gratitude to the C family for their
willingness to involve themselves openly in this case study.
OBJECTIVES
General Objectives:

To conduct a thorough case study about the C Family residing in Manga St.,
Purok 2, Barangay Tagakpan, Tugbok District, Mintal, Davao City according to data that
was gathered by conducting a series of interviews within a total of 9 days community
exposure [3 days a week for 3 weeks].

Specific Objectives:

* To present the C Family’s Initial Data Base (IDB) containing information which will
reveal the family’s structure and characteristics, socio-economic and cultural practices,
environmental factors, health assessment of each member, and values, habits and
practices on health promotion maintenance and disease prevention.
* To present the family’s Genogram containing information that will help out in tracing
any hereditary risk factors.
* To come up with the Typology of Nursing Problems that will explain which data
from the IDB has the nature of being a hazard to the health of the family.
* To score the initial and final Family Coping Index (FCI) identifying the effectiveness
of the nursing interventions implemented within the time spent with the family.
* To Prioritize the Problems identified within the family data according to how they are
scored by ways of identifying the nature, modifiability, preventive potential and salience
of each problem.
* To present the Family Nursing Care Plans (FNCP) developed for the most prevalent
problems identified in the Typology of Nursing Problems.
* To have our Conclusions and Recommendations about the Case Study.
* To present our Appendices for references.
INITIAL DATA BASE
 A. FAMILY STRUCTURE AND CHARACTERISTICS

Family Name: C family

Address: Manga St., Purok 2, Barangay Tagakpan, Tugbok District, Mintal,

Davao City

Position Relationship Ethnic

Civil Place of
Name Age Sex in the to the head back-
status residence
family of the family ground

Mr. A 24 M Married Father Head of the Purok 2, Manga Davaoeno

family St., Tugbok,
Davao City

Mrs. B 22 F Married Mother Wife Purok 2, Manga Davaoena

St., Tugbok,
Davao City

Baby girl 2 F Single Eldest Daughter Purok 2, Manga Davaoena

child St., Tugbok,
Davao City

Baby boy 11 M Single Youngest Son Purok 2, Manga Davaoeno

m child St., Tugbok,
Davao City

Type of family structure:

The C family is nuclear according to membership since they all live together and

with no other relatives living with them. In terms of descent, the family is matrilineal

since the members of the family affiliates with a group of relatives who are related to

them through their mother. The family resided near Mrs. B’s mother that is about five

meters away from their house and this makes the family a matrilocal type according to

residence.
Dominant family members in terms of decision-making, especially in matters of

health care:

When it comes to decision-making, especially in matters of health care, they both

have an equal say. Whenever there are misunderstandings and problems in the family,

they get to have mature conversations to solve whatever conflicts they have, thus the C

family shows an egalitarian type when it comes to authority.

General Family Relationship:

It is unavoidable that in every family certain issues arise which causes conflicts

between both parents as well as their children. According Mrs. B, they seldom quarrel

about their financial needs but when they do, they see to it that they get to talk and find

ways to solve their problem. What they usually quarrel about is Mr. A’s drive for sex. As

for their kids, when they are placed in the same crib with toys, this will end up with one

kid taking the toy of the other leading to a tug of war between both kids.

Activities of Daily Living:

Sleeping pattern:
 The members of the C family especially the young ones observe 7:00 pm as their

sleeping time while Mr. A and Mrs. B observe 10:00 pm as their sleeping time. The

mother and the father usually wakes up at around 5:00 am to 6:00 am to get their

breakfast ready and wash their dirty clothes. The kids, Baby Girl and Baby Boy, usually

wake up at 7:00 am just in time for breakfast.

Eating pattern:

The family is able to eat three times a day and this includes breakfast served at

7:00 am, lunch at 11:30 am, and dinner at 6:30 pm. What they usually have for their meal

are vegetables, fish, and rice. Sometimes boiled eggs, noodles, sardines, and dried fish

are served.

Leisure time activities:

The family owns a 12 inch television and this is their source of entertainment and

relaxation. Sometimes they would go to Mrs. B’s mother whose house is adjacent to

theirs and they would talk about their problems of there are any.
B. SOCIO-ECONOMIC AND CULTURAL PRACTICES

Family Occupation Place of Income Educational Religion Ethnic

Members work attainment background

Mr. A Multiple jobs Tagakpan Php High school Roman Davaoeno

(e.g. 3600 per graduate Catholic
construction month
worker)

Mrs. B Housewife N/A N/A High school Roman Davaoena

graduate Catholic

Baby N/A N/A N/A N/A Roman Davaoena

girl Catholic

Baby N/A N/A N/A N/A Roman Davaoeno

boy Catholic

Family Expenses

Food 50.00% 31.09%

Electrical Bill 4.45%

Water Bill 6.12% 50.00%

Food
Rent 8.34% Electric Bill
8.34% Water Bill
Miscellaneous 31.09% Rent
6.12%
4.45% Miscellaneous
-clothes
-toiletries
-transportation
-etc.

Decision Maker about Financial matters:

 In the C family, both the mother and father make the decision when it comes to

allotment of monthly income.

Significant others:

Just about five meters from the house of C family is the house of Mrs. B’s

mother. The family shows a close relationship towards Mrs. B’s mother except for Mr.

A. According to her mother, Mr. A does not work hard enough for his family that’s why

she does not like him that much. But even though she does not like him she still

considers Mr. A part of the family.

Relationship of the family to the larger community:

According to Mrs. B they are not that participative with the barangay activities

and organizations. However, they participate in celebrating their fiesta is they have

money and when they were asked to attend our lecture and culmination day they were

present and they actively participated.

In terms of health care, the family avails some of the government programs for

immunizations and vitamins. Every month a BHW visits every household in their area

and provides medicines for the children.

C. ENVIRONMENTAL FACTORS:

Housing:

The C family rents their house and they pay Php 300/month. It is made up of coco

lumber and bamboo, and woven coconut leaves for their roof. The windows are

unscreened and the roof has some holes on it, that during rainy days, the water drips

inside the house. They use electricity for lighting and for the use of their television with

which they pay Php 160/month.

They have a kitchen and at the same time a dining area, a living room and at the

same time a bedroom, and a room where their television as well as their clothes and
beddings are placed. They have a 12 inch television, 1 long bench, a table with one bench

in their kitchen, and one shelf.

There is inadequacy of living space since they do not really have a specific or

separate area where they can cook, sleep, and watch TV.

The family spreads a mat in the floor where they all sleep together except for

Baby Boy since he sleeps in his hammock or “duyan”. They also use mosquito nets to

protect themselves from mosquito bites.

There are presence of pests inside the house which includes mosquitoes,

cockroaches, lizards, and flies. An open canal is also present outside their house with a

wooden unsteady bridge, and tires were also seen with stagnant water on them which

serves as a good breeding ground for mosquitoes. Protruding nails are also present which

serves as a possible accident hazard.

They prepare their food using firewood and charcoal, and uses utensils such as

plastic plates, spoons, forks, and cups when they eat. However, these utensils are not

properly stored and kept in their cupboards and are exposed to vectors which poses a

threat to their health. Their water supply comes from ‘nawasa’ which they use for

bathing, washing their clothes, cleaning their utensils and for drinking. They store their

drinking water in 1 liter plastic bottles which, when observed closely, are not really

clean.

The family has a bathing area but they don’t have their own toilet facility. Their

bathing area is not clean, cannot fully provide privacy when one takes a bath, toiletries

are not properly kept and are exposed to contact with flies, chickens and cats. When they
 have to use the toilet, they still have to go to Mrs. B’s grandparents which is

approximately 80 meters from their house and is located across a wide, running river.

According to Mrs. B, the toilet is a water-sealed type.

Kind of Neighborhood

The family’s house is located at Manga St., Purok 2 of Tugbok, Davao City. The

houses in the community are quite congested and not adequately spaced from each other.

Social and health facilities available

The C family was not able to fully avail of the facilities and medicines that should

be available in the health center. This is because every time they go there to ask for

medicines, they were always told that no medicines are available.

Communication and transport facilities

Tugbok can be reached by riding in a jeepney for 30 to 45 minutes from the city

proper. They either ride on PUJs or motorcycles if there is a need to go to a certain place.

They use their cellular phones as their means of communication.

D. HEALTH ASSESSMENT OF EACH MEMBER

Family Member Past illness and health actions taken

Mr. A About 1 year ago Mr. A had seen a pimple-like lump on

his chest with pus present around it. They used an

antibiotic given to them by a friend who used to be a

pharmacist. They also applied the concoction from the

leaves of cacao, mayana, and mansanilyas to treat it.

Mrs. B While Mrs. B was still pregnant, she did not go to the

doctor for her prenatal check-up. According to her, she

was too tired and lazy to have her check-up done. She was

on NSVD when she gave birth to her first and second

child. About two months after she gave birth to her second

child she took trust birth control pills given by her mother

since she does not want to be pregnant for the third time.

She took those pills for 6 months and consumed 6 pads.

By August of 2008 she stopped taking it since she

experienced pain around her breasts. The pain eventually

went after and she did not bother anymore to consult the

doctor.

Baby Girl According to her mother, when Baby Girl was just about

1 year and 2 months old, she experienced itchiness around

her arm. When they went to the doctor and they were

given prescriptions of ointment.

Baby Boy The youngest child of the family did not experience any
 serious illness. He only experienced fever, cough, colds,

and flu. The mother consults the “manghihilot” if ever he

has fever.

There are times wherein the family prefers to go to a “manghihilot” rather

than to a doctor. This is because it would take too much time for them to go to a

doctor and it would cost them a lot when compared to a “manghihilot”. There are

also times wherein they self-medicate. However, they also consider seeking help

from a medical practitioner if the situation demands it.

E. VALUES, HABITS, PRACTICES ON HEALTH PROMOTION,

MAINTENANCE AND DISEASE PREVENTION

According to Mr. A, he was completely immunized. He received the needed

immunizations before he reached 1 year old. However, Mrs. B, Baby Girl, and Baby Boy

were not able to receive the needed immunizations. When Mrs. B’s mother was asked

whether Mrs. B was fully immunized or not, she said that she was only given BCG when

she was born. After that, she was not able to receive any other immunizations. The only

immunization that Baby G did not receive is measles and the only immunization that

Baby Boy received was BCG.

When Mrs. B was asked why her children did not receive the needed

immunizations, she said that with Baby Girl she was too lazy to go to the health center

and have her baby immunized. As for Baby Boy, she had misconceptions when one of

her friend’s baby died after being immunized while the baby had fever.

The C family agreed to consult a health care professional after they were

advised to ask whether they be allowed to receive immunizations past the required age.

They were also continuously reminded of the importance of strict sanitation and hygiene

since a strict compliance will greatly protect their family from illnesses and diseases.
TYPOLOGY OF NURSING PROBLEMS
 Cues First level Second level
assessment assessment

Subjective: Unmet sexual urges of Mr. Inability to provide a home

A as foreseeable crisis environment which is
“Wala man dyud mi situation conducive to health
nagaaway tungod sa maintenance and personal
kwarta, nagalalis lang mi development due to
pirminti about sa isa ka displacement of frustrations
butang. Dili naman gud ko toward the children.
gusto magkaanak, unya
kapoy pa ko pirminti sa
mga trabaho sa balay og sa
pagbantay sa mga bata.
Unya kada uli ni mister or
sayo pa sa buntag kay
manguhit na siya pero dili
naman dyud ko. Mao ng
pirmi na lng pud na siya
saputon. Pati mga bata kay
madamay sa iyahang
pagkasapot.” – as
verbalized by Mrs.B

Objective:

We observed that Mrs. B’s

facial expression is full of
emotion and her voice is
really sincere and true to
her words.

Mrs. B’s mother agreed

with what Mrs. B told the
interviewers during the
interview for she also
witnessed the
confrontations between the
couples.
 Cues
Subjective:
“Kung muulan kay usahay
lapok kaayo ang gawas sa
balay ug mutaas pud ang
tubig sa kanal.” -As
verbalized by Mrs. B.
Objective:
Outside their house, along
the road is an open canal.
Subjective:
“Wala man gud natarong
panday amoang balay kay
gina rentahan raman gud
namo ni.” -as verbalized by
Mrs. B.
Objective:
Protruding nails in their
living room and kitchen in
one.
First level Second level
assessment assessment
Open canal as accident Inability to recognize the
hazard. presence of the condition of
the problem due to
ignorance towards the issue.
Inability to provide a home
environment conducive to
health maintenance and
personal development due
to inadequate family
resources.
Exposed nails from the Inability to provide a home
wooden walls as accident environment conducive to
hazard. health maintenance and
personal development due
to inadequate knowledge
and initiative for preventive
measures.
 Cues First level Second level
assessment assessment

Subjective: Resettlement in a new Inability to provide a home

“Muadto baya ko og
Malaysia karong January
para magtrabaho. Mamiss
dyud nako ang mga bata
pati akoang asawa.” -as
verbalized by Mrs. B.
community and separation
from the family as
foreseeable crisis situation.
environment which is
conducive to health
maintenance and personal
development due to single
parenthood.

Objective:
Mrs. B will leave her whole
family to work as a
domestic helper in Malaysia
this coming January 2009.
The mother of Mrs. B also
agrees with what Mrs. B
told us.

Subjective:
“Wala nabakunahan og anti
measles si Baby Girl. Si
Baby Boy kay hantod BCG
lang pud. Nahadlok man
gud ko maparehas sila sa
namatay na anak sa akoang
amiga nagpabakuna mintras
nay kalintura human
namatay. Unya, wala pa
dyud mi natagaan ug
tambal para sa filariasis.”-
as verbalized by Mrs. B.
Lack of
immunization/inadequate
immunization status
especially of children as
presence of health deficit.
Inability to make decisions
with respect to taking
appropriate health action
due to failure to
comprehend the
nature/magnitude of the
problem/condition.
Failure to utilize
community resources for
health care due to
misconceptions and fears.

Objective: according to the

Purok leader, the
community has not yet been
given prophylaxis against
filariasis.
 Cues
Subjective: “Naa pud mi
problema sa kwarta kay
kulang man pud sweldo sa
akoang asawa pero dili
gyud ingon na mag away
mi tungod ana kay dali man
lang pud mi makapangita
ug pamaagi.” -as verbalized
by Mrs. B.
Objective:
They don’t have rice as of
the moment. The milk
supply for the baby is not
enough. They are
experiencing scarcity most
of the time for their daily
needs.
Subjective:
“Pasensya na ha, gamay og
gubot dyud mi og balay.
Hugaw pa dyud” -as
verbalized by Mrs. B.
Objective:
Poor home facilities and
resources. Unsanitary
environment,
Inadequate living space,
there are garbage’s around
and stagnant water with
wrigglers in an unused
water container.
First level
assessment
Family resources not
adequate for family needs
as a stress point.
Inadequate living space,
presence of breeding or
resting sites of vectors of
diseases such as
mosquitoes, cockroaches
and rodents; improper
garbage disposal and
unsanitary waste disposal as
health threat.
Second level
assessment
Inability to provide home
environment conducive to
health maintenance and
personal development due
to limited financial
resources.
Inability to make decisions
with respect to taking
appropriate health action
due to lack of community
resources.
Inability to provide home
environment conducive to
health maintenance and
personal development due
to inadequate knowledge of
importance of hygiene,
sanitation and preventive
measures.
 Cues First level Second level
assessment assessment

Subjective: Drinking alcohol as Inability to recognize the

“Nagainom man gud unhealthy lifestyle and presence of the condition or
akoang bana pero wala siya personal habits/practices. problem due to lack of or
naga panigarilyo.” -as inadequate knowledge.
verbalized by Mrs. B.

Subjective: Interpersonal conflicts Inability to provide a home

“Dili man close sila mama between family members as environment which is
ug akoang bana. Dili man stress provoking factors. conducive to health
dyud gusto ni mama akoang maintenance and personal
bana.” -as verbalized by development due to
Mrs. B. unhealthy family
relationship.

Objective:
The mother of Mrs. B
agrees with what Mrs. B
told the interviewers.

Subjective: Self-medication as Failure to utilize

unhealthy lifestyle and community resources for
“Pagmagkasakit akoang personal habits/practices. health care due to lack
mga anak kay ginapalitan of/inadequate knowledge of
dayon nako sila ug tambal community resources for
ug ginapainom dayon. health care.
Usahay, ginapahilot nalang
pud namo.” -as verbalized
by Mrs. B.
FAMILY COPING INDEX
 The family coping index is the profile of the family’s capacity to deal with problems associated with health care. Its
purpose is to provide a basis for estimating the nursing needs of the family. The following tables represent the nine areas
comprising the family coping index of C family during our community exposure at Purok 2 Tugbok district, Mintal D.C.
during our exposure last November 13-29, 2008.

Date Coping Area Initial Justification Health Teachings Date Final Justification
Score Score

PHYSICAL 5 All the family Encourage the family 5 The family

INDEPENDENCE members can perform must ensure that members are
activities of daily adequate physical care capable of
living such as taking a is given to one another performing
bath and doing without the cost of the activities
household chores. neglecting the need of of daily living
The family is also one member. Also the and can attend
able to attend to the mother must train her to the need of
needs of other children especially the other family
members especially to eldest one to perform members
the needs of the simple task appropriate especially the
children. Each and for her age such as children.
every one of the eating and drinking by There is no
members is capable herself. presence of
of caring for any physical
themselves. disabilities
present
among the
family
members.
THERAPEUTIC 3 The Family can carry Teach the family that 3 The family
COMPETENCE out some but not all administering or taking had been
of the procedures on over the counter drugs informed
treatment for the care is not advisable regarding the
of illness and especially without the benefits of
maintenance of recommendation of a carrying out
health. They usually health care professional the treatments
take OTC drugs when because it may not be prescribed by
they rae suffering effective and may alter a health
from from cough, the effects of other professional if
fever, colds, diarrhea, drugs taken by them. ever an illness
headache and muscle occurs and
pains. They not treat mild
sometimes use herbal sickness using
meds such as OTC drugs
malunggay and pau d’ only advised
arco. by their
relatives and
friends.
KNOWLEDGE OF 3 The family has some Encourage the family to 5 The family
HEALTH general knowledge ask questions or visit became well
CONDITION regarding the health the health centyer for informed
condition but was information about thje regarding the
unable to understand different diseases that risks of not
fully the risks of the are required if the attending
illness if not attended community immediately
well. They would let surroundings is not kept to an illness.
days pass before well inorder for them to
attending to any have reliable info and
sickness experienced be able to take
by one of their family preventive measures
members. Thus before a disease may
resulting to further occur.
complications.
The family
APPLICATION OF 3 The family sometimes Encourage the family to 5 realized the
PRINCIPLES OF forgets to wash their wash their hands before importance of
GENERAL hands during meal and after eating and also proper
HYGIENE times and when they advice them to bath hygiene and
prepare their food. their kids often because now puts in
Also when a child since they are still mind the need
urinates in bed or young they do not care to wash hands
while they are being where they urinate or before and
carried, they simply defecate to keep them after doing
wipe the wet area clean and infection free. anything, and
with damp cloth and keeping their
do not wash it with children
water. always clean
to prevent
infections and
diseases.
 HEALTH 3 The family Explain to the mother 3 The mother
ATTITUDES understands and the importance of understands
recognizes the need immunizations and the the need and
for medical care in need to complete them importance of
illnesses and for the while they are young. completing
preventive services Also tell them to her children’s
but sometimes consult physician if the immunization
because of some children are still s but still she
misconceptions heard allowed to take haven’t
from friends and immunizations even consulted any
relatives by the though they are already health
mother, the two older than the age professionals
children did not required for each. regarding her
received complete children’s
immunizations. situation.

EMOTIONAL 3 The family solves the Tell Mr. A to become 3 The way the
COMPETENCE problem calmly, as more understanding and family solves
what Mrs. B said sensitive to the feelings their problem
because it is not good of his wife and their are still the
to fight and it would children. Also tell Mr. same, they do
only add misfortune A not to displace his it in a calm
to their lives. Even in being angry to their way.
financial matters they children.
do not fight, they just
talk with each other
and solve it. On the
other hand, Mrs. B
said that there is only
one problem which
causes fight with Mr.
 B. she said that every
time Mr. A wants to
have sex with her she
refuses and so Mr. A
got angry. When he is
angry about it he
sometimes displaces
it to their children but
not physically.

FAMILY LIVING 3 In terms of decision, Emphasize to the family 3 Even though

they both talk about it the importance of that they do
and decide on what to closeness in the family not let their
do or not. The family and talking with each children play
gets along well with other about their outside some
each other to the point decision to make. In children go
that they do not addition, tell Mrs. A there and the
usually go out and and Mr. B to let their family
just stay at home. children play outside welcomes
They do not let their because it may possibly them to play
children play outside cause negative effects with their
their compound. As like developing children. Mrs.
Mrs. B said, they are mistrust. B usually
afraid that if they let stays with
them play outside their children
they can get bad especially
habits like saying bad when other
words. kids are
around.

They have poor

 PHYSICAL 1 physical environment Stress to them the 1 When we
ENVIRONMENT because their house is importance of come back to
in poor condition. cleanliness and safety to have another
Upon interview and prevent from having interview
ocular survey, we foreseeable problems in their house
have observed and illnesses and harm. was still the
saw some protruding same. There
nails, the window is still some
not screened, there garbage near
are mud noted in the there house.
floor, and the place
were they cook can
cause danger not only
to the house but also
to their children
because it isn’t that
high that their
children can reach it.

The Family does not After the

USE OF 1 involve themselves in Inform them that the 3 week we
COMMUNITY the activity in the services offered in the interviewed
FACILITIES community and health community are free. on the next
center. Their reason is They just have to be week we went
that it is tiring and patient in going to their their Mrs. B
crowded to go their. community health said that they
But if there are some center to avail it. went to the
people in the center Mintal gym to
going to their house avail the
they welcome it and program of
avails the program of DOH about
the center. filariasis.
PRIORITIZATION OF THE PROBLEMS
1. Inadequate hygiene
Criteria Computation Actual Score Justification
Nature of the Problem 2/3 x 1 2/3 It is a health threat. These may cause
untoward consequences to the family.

Modifiability of the 2/2 x 2 2 The problem is highly modifiable since basic

Problem hygienic products are readily available in the
community.

Preventive Potential 3/3 x 1 1 The problem is highly preventable because

the family is capable of learning better ways
of observing hygiene; They are also physically
independent.

Salience of the Problem 1/2 x 1 1/2 The family considers it as a problem, but they
don’t pay much attention to it.

TOTAL SCORE 4.17

2. Unmet sexual urges of Mr. A
Criteria Computation Actual Score Justification
Nature of the Problem 1/3 x 1 1/3 The problem is a foreseeable crisis situation.

Modifiability of the 2/2 x 2 2 The problem is highly modifiable because

Problem contraceptives are available in the
community and one resource to solve the
problem is the couple's choice to abstain.

Preventive Potential 2/3 x 1 2/3 The problem is partially preventable because

Mr. A can understand why Mrs. B does not
want to have sex with him; however, Mr. A
will be able to displace his frustrations on
their children while Mrs. B is not around.
Salience of the Problem 2/2 x 1 1 Mrs. B is really concerned about this problem
and she wants to be sure that their children
are safe with Mr. A.

TOTAL SCORE 4
3. Incomplete immunization of children
Criteria Computation Actual Score Justification
Nature of the Problem 3/3 x 1 1 It is a health deficit because the children are
more susceptible to get sick and this will
bring about very grave consequences to the
family.

Modifiability of the 1/2 x 2 1 The problem is partially modifiable because

Problem the correction of the misconception of Mrs. B
requires intensive explanation and
convincing.

Preventive Potential 2/3 x 1 2/3 This problem is partially preventable because

Baby Boy is 1 month from his 1st birthday;
by then it will be too late to have Baby Boy
completely immunized; however,
immunizations after his first birthday can
help out significantly.

Salience of the Problem 2/2 x 1 1 Mrs. B is truly concerned for the health of
their children.

TOTAL SCORE 3.67

4. Mrs. B with future plans of going to Malaysia
Criteria Computation Actual Score Justification
Nature of the Problem 1/3 x 1 1/3 It is a foreseeable crisis situation because the
planned date is still on January of 2009.

Modifiability of the 2/2 x 2 2 The resources required to modify the

Problem problem can be found within Mrs. B's choice.

Preventive Potential 2/3 x 1 2/3 The problem is partially preventable because

the prevention of future problems that the
departure of Mrs. B will bring can only be
accomplished by the husband having the
capacity to take care of himself and their two
children.

Salience of the Problem 1/2 x 1 1/2 They know it's a problem, but they have to
go through this so that their financial
problems will be lessened.

TOTAL SCORE 3.5

5. Open canal, exposed nails and wires and slippery soil as accident hazard
Criteria Computation Actual Score Justification
Nature of the Problem 2/3 x 1 2/3 It is a health threat. These may cause
untoward consequences to the family.

Modifiability of the 1/2 x 2 1 This problem is partially modifiable since the

Problem means to solve it is available but the initiative
of the family is needed.

Preventive Potential 3/3 x 1 1 The problem is highly preventable because

family can improve their carefulness by
paying more attention to their environment.

Salience of the Problem 1/2 x 1 1/2 The family recognizes it as a small problem
and they are used to it.

TOTAL SCORE 3.17

6. Open canal and stagnant water as breeding ground for vectors of disease
Criteria Computation Actual Score Justification
Nature of the Problem 2/3 x 1 2/3 It is a health threat. These may cause
untoward consequences to the family.

Modifiability of the 1/2 x 2 1 This problem is partially modifiable since the

Problem means to solve it is available but the family
has no initiative to solve it.

Preventive Potential 3/3 x 1 1 The problem is highly preventable family can

work together with other people to clear up
the blockages that promote stagnant water in
the canal.

Salience of the Problem 1/2 x 1 1/2 The family recognizes it as a small problem.

TOTAL SCORE 3.17

7. Interpersonal conflicts between family members

Criteria Computation Actual Score Justification

Nature of the Problem 1/3 x 1 1/3 The problem is a foreseeable crisis situation
because some family members might develop
the tendency to hold grudges.

Modifiability of the 2/2 x 2 2 The problem is highly modifiable because

Problem disagreements between family members are
most often resolved peacefully by talking
personally.

Preventive Potential 2/3 x 1 2/3 The problem is partially preventable because

disagreements between family members can
never be excluded in family dynamics.

Salience of the Problem 0/2 x 1 0 The family does not recognize this as a
problem because for them, it is normal.

TOTAL SCORE 3
8. Family resources not adequate for family needs

Criteria Computation Actual Score Justification

Nature of the Problem 1/3 x 1 1/3 The problem is a foreseeable crisis because
prolonged inadequacy of family resources will
have a cumulative effect on the family.

Modifiability of the 1/2 x 2 1 The problem is partially modifiable because

Problem the family can find ways and means of
getting needed money, but most of the jobs
that are available to them are temporary.

Preventive Potential 2/3 x 1 2/3 The problem is partially preventable because

the family needs all the money that they get
and they tend to spend it all too quickly.

Salience of the Problem 1/2 x 1 1/2 The family considers it as a problem; but as
of the moment, their attention is elsewhere.

TOTAL SCORE 2.5

9. Unhealthy lifestyle practice of Mr. A: Drinking

Criteria Computation Actual Score Justification

Nature of the Problem 1/3 x 1 1/3 It is a foreseeable crisis that does not need
immediate attention.

Modifiability of the 1/2 x 2 1 The problem is partially modifiable because

Problem the solution is from the willingness of Mr. A to
stop drinking and can only be accomplished if
Mr. A truly does abstain.

Preventive Potential 2/3 x 1 2/3 The problem is partially preventable because

Mr. A can choose to abstain from drinking,
but might not be able to.

Salience of the Problem 1/2 x 1 1/2 The family recognizes it as a small problem.

TOTAL SCORE 2.5

10. Inadequate living space

Criteria Computation Actual Score Justification

Nature of the Problem 2/3 x 1 2/3 It is a health threat that does not demand
immediate action.

Modifiability of the 1/2 x 2 1 The problem can be modified, but they do not
Problem have enough resources to do any
modifications.

Preventive Potential 2/3 x 1 2/3 They can maximize the spaces in the house
and refrain from having an additional family
member.
Salience of the Problem 0/2 x 1 0 They do not mind if they live in a house that
is small.

TOTAL SCORE 2.34

11. Self-medication as unhealthy lifestyle and personal habits/practices

Criteria Computation Actual Score Justification

Nature of the Problem 2/3 x 1 2/3 The problem is a health threat because it can
bring forth harmful effects.

Modifiability of the 1/2 x 2 1 The problem is partially modifiable because

Problem the resources for the proper promotion of
health are readily available to them but they
will have to spend money for it.

Preventive Potential 2/3 x 1 1/3 The problem is partially preventable because

the family will always consider using
alternative cures for illnesses due to their low
income.

Salience of the Problem 0/2 x 1 0 The family does not consider this as a
problem since alternative medicine has
always yielded good results for them.

TOTAL SCORE 2
 Summary:

Problem Score:

1. Inadequate hygiene.....................................................................................4.17
2. Unmet sexual urges of Mr. A.......................................................................4.00
3. Incomplete immunization of children..........................................................3.67
4. Mrs. B with future plans of going to Malaysia .............................................3.50
5. Open canal, exposed nails and wires and slippery soil as accident hazard. 3.17
6. Open canal and stagnant water as breeding ground for vectors of disease3.17
7. Interpersonal conflicts between family members........................................3.00
8. Family resources not adequate for family needs.........................................2.50
9. Unhealthy lifestyle practice of Mr. A: Drinking............................................2.50
10. Inadequate living space.............................................................................2.34
11. Self-medication as unhealthy lifestyle and personal habits/practices.......2.00
FAMILY NURSING CARE PLANS
D Cues Health Family Nursing Goal of care Objectives of Nursing Methods Resources Evaluation
a Problem Problem care Interventions of
t family-
e
nurse
contact

N Objective: Health Threat; Inability to After our four After our 6 1. Established H Human Goal Partially
O recognize the weeks of hours span of rapport. Resources: Met.
V Presence of presence of the rendering care, the family O
E accident problem due to care, the would be able ® To gain the Time and
Presence of an hazards. family’s trust and M effort of the
M ignorance of the family would to:
open canal near established a well- student The family was
B facts. be able to E
their house. 1. See the functioning nurses, able recognize the
E take
disadvantages relationship. family and problem of having
R appropriate
of what would the people an open canal as
action
be the danger 2. Educated the V in the area. an accident
towards
threats of family about the hazard; The family
avoiding any
20, having an open danger posed by an I expresses their
harmful
canal. open canal that can awareness of how
accidents S Knowledge/
possibly cause careful they must
from the information
2. become injuries to family be around the
2 canal. I that nurse
more aware of especially the open canal;
their children. will impart However, the
0 T
surrounding to the canal remains an
0 especially ® To make the family family. open canal and
things that can realize the dangers of still poses a threat
8 harm them not doing anything to ignorant
about the present individuals.
3. Find ways of problem.
fixing or
closing the 3. Encouraged the
canal. family to think ways
on how to solve the
problem.

® To promote the
family’s
independence and to
make them more
responsible to provide
solutions to their
problem.

4. Asked the family to

mention the possible
sanitary modifications
D Cues Health Family Goal of Objective of Nursing Methods Resources Evaluation
problem nursing care care intervention of family
a problem with rationale nurse
contact
t

Objective: Presence of Inability to After After the 1. Discussed Time and Goal met:
breeding provide a discussing nursing with the family effort of both
places of home with the intervention possible H the nurse and
insects and environment family the the family breeding the family.
Rainwater O The family
rodents as a conducive to risks of the will be able places present
stagnates was able to
N health health and presence of to: in their M
around the eliminate the
O threat. personal breeding surroundings
house. Knowledge/ breeding
V development places of ® To develop E
These serve information sites of
E due to lack of insects and awareness in
as breeding 1. realize that nurse will insects as
M knowledge rodents the the family.
grounds for that the impart to the evidenced by
B towards the family is
insects such presence of 2. Discussed V family.
E issue. expected to :
as breeding with the family
R identify I
mosquitoes grounds is a risks and
breeding 1. removal of
and flies. health threat threats of the
ground and S unnecessary
to the presence of
show ways containers;
family; breeding I and
of places such as
20, eliminating risks for T
such. 2. identify infection,
cross- 2. use of
existing
contamination mosquito
places as
and disease. nets and
breeding
2 insect
ground for
® To further repellants to
insects and
0 elaborate the protect
rodents; and
dangers of children
0 having from insect
breeding sites bites
8
3. show near the home.
ways to
eliminate 3. Explained
breeding the threatening
grounds of effects of
insects and insects or
rodents such rodents to
as regular family’s
cleaning and health.
arranging
® To stress the
D Cues Health Family Nursing Goal of care Objectives of Nursing Methods of Resources Evaluation
a Problem Problem care Interventions family-
t nurse
e contact

N Objective: Poor personal Inability to make After our four After our 6 1. Established H Human Goal Met.
O hygiene decisions with weeks of hours span of rapport. Resources:
V respect to taking rendering care, the family O
E appropriate health care, the would be able ® To gain the Time and
Uncombed hair family’s trust and M effort of the The family was
M action due to: family would to:
established a well- student able to
B be able to E
Ignorant attitude 1. verbalize the functioning nurses, and verbalize:
E have a
towards the health advantages of relationship. members of “Gibuhat nako
R Oily skin in face positive
problem. personal the family. katong gi-
and arms attitude
hygiene; 2. Provided the family V ingon ninyo sa
towards
with knowledge about akoa about sa
having good
20, 2. determine taking a bath with the I pag-alaga sa
personal Knowledge/
Dirty the importance use of clean water and lawas.”
hygiene. S information
fingernails, of personal a bathing soap.
toenails and feet hygiene; that nurse
2 ® To impart our I will impart
3. identify the knowledge about the to the Hair of the
0 T client was
need of a importance of family.
pleasing cleanliness. combed and
0
appearance for the nails are
8 good social 3. Discussed with cleaned. No
interaction; and them the strokes used foul odor was
in a good tooth smelled.
4. apply brushing technique.
measures in
doing good ® To promote good
personal oral hygiene.
hygiene
4. Discussed the
including skin
significance of good
care, taking a
appearance as part of
bath, combing
pleasing personality.
the hair and
brushing of ® To show how
teeth. hygiene can boost
self-confidence.

5. Explored with the

family the possible
ways of maintaining
good personal
Date Cues Health Family Nursing Goal of Care Objective of Nursing Method Resources Evaluation
Problem Problem Care Intervention of
Family
contact

N Subjective: Self- Inability to recognize After nursing After the nursing -Teach family about H Material
O medication the presence of intervention, intervention, the the advantage and o resources:
-Mother practices as problem due to: the family may family may be disadvantage of self m Goal Partially
V -visual aids Met
verbalized, “Kung health threat. be able to able to: medications. e
E a. ignorance of facts identify
magkasakit akong probable side - recognize the -Encourage the V
M
mga anak, effects and importance of family to consult a i
B Human The family
possible health consulting health health care provider s
ginapalitan dayon Inability to make resources: was able to
E complications care provider or a physician i
nako sila og decisions with recognize the
in relation to before any before using any t -time and effort
R respect to taking importance of
tambal tapos knowledge prescriptions can medicines. of student nurses
appropriate health consulting
barrier due to be carried out and family
ginapainom dayon actions due to: health care
lack of providers or
nako. Usahay - explain and
20, a. failure to knowledge and personnel, yet
ginapahilot pod enumerate the
comprehend the misconception were not able
possible side and Financial
nako sila. nature/magnitude of s. to apply or
adverse effects of resources:
the problem practice it.
self medicating.
2 -money for the
b. low salience of the
student nurses’
problem
0 transportation
a. inaccessibility of
0 appropriate resources
for care specifically
8 financial
inaccessibility
Date Cues Health Family Nursing Goal of Care Objective of Care Nursing Intervention Method of Resources Evaluation
Problem Problem Family
contact

N Objective:size of Inadequacy of Inability to make The family, The family, after a 1. Discuss with the H
the house ______ living space. decisions with after a week of week of nursing family the need of
O respect to taking nursing intervention, will be having adequate O Human Goal Met
appropriate health intervention, able to; space for daily resources:
- number M
V action due to; lack of will be able to activities.
of family 1. verbalize -time and
insight as to decide on E After a week
understanding of the 2. Provide adequate effort of
E members: alternative courses of appropriate of intervention,
importance of having knowledge on the student nurses
___ action open to them. actions to the family was
adequate living space various ways of and family
M maximize their able to use the
- low for their daily maintaining order in V
living space space occupied
ceiling that will activities. the house.
B I before the bed
- one-room facilitate easy for their leisure
2. select a method 3. Discuss the
E performance S and other
house most appropriate for advantages and
of their daily locomotive
- income them in cleaning disadvantages of the
working I activities.
R clutters and arranging methods to encourage
of the activities.
furniture to maximize better decision- T
family: their living space. making on the most
____ per appropriate method
20, 3. decide on efficient to have adequate
day ways of maintaining living space.
- occupatio adequate space for
their daily activities. 4. Help the family
n of
rearrange the
2 husband: furniture to provide
______ bigger space.5.
0
- unstable Explore with the
family ways of
0 house
encouraging growth-
structure promoting leisure and
8
relaxation activities.
CONCLUSION AND RECOMMENDATION
 Conclusion

Family

We conclude that since the first day of our exposure with our assigned family, we

have noted problems that affect their current health status and lifestyle. During the

course of our duty, we rendered our health teachings according to the observed

problems. In our last contact with the family, we noticed improvements in their lifestyle.

They are now participative in the activities and programs supported by the Barangay

Health Center.

Exposure

We conclude that this whole rotation of community health nursing has been very

fruitful and worth experience for. The community has given us opportunity to explore

and be more productive, skillful, creative, and make us more sociable. The case study

has given us opportunity to penetrate the private life of a very vulnerable family. The

family is very open and ready to achieve the highest level of state or function of health

and wellness.
 Recommendation

To the C family:

We recommend that they continue to comply with the health teachings rendered

to them. They must improve the cleanliness inside and outside their house to prevent

future problems, especially when it comes to their health. They should apply the basic

principles of general hygiene. They should be active enough to participate in the

activities and programs being conducted and sponsored by the Barangay Health Center

or by the DOH.

To the Barangay Health Center and workers:

We recommend that they should improve their way of providing health education

to a more lively and productive way. They should also properly disseminate information

so that the people in the community will be aware of their scheduled activities.

To the Clinical Instructors:

We recommend that they would pass a proposal to the College of Nursing

regarding the continuation of the classes’ project about proper waste disposal in Purok 2,

Tugbok District, Mintal, Davao City.

To the Student Nurses:

We recommend that to the next student nurses that will be assigned at the same

area to continue providing health teachings and to monitor and check if there are

improvements to our implemented project.