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CHAPTER I

INTRODUCTION

“The family is the nucleus of civilization.”

-Ariel and Will Durant The family is the smallest unit of the society and the natural fundamental core of the community and consequently, it is considered as the primordial recipient of the nursing effort, which is contributory to the development, and progress of the community through active involvement and self – responsibilities of each constituent. It is composed of persons, male and female, being molded to be as one, working hand in hand to maintain a good atmosphere among the family members. A nucleus controls the functions of the entire cell and can be thought as the “command center” of the cell. The nucleus as well has different components which are all needed in order for it and the cell to function well, same as with the “commander” or the head of the family and the members who has different functions within the family. The impression or status of each family will always affect the status of the community as a whole. Community health nursing is a response to the health needs of the people. It does not focus on a particular class or family. It is comprehensive and general in approach. Community

health service is not episodic as it requires continuous observation and monitoring of the community as a whole. Promotion and preservation of the health of its different clients (individual, family, group or community) is the primary goal of community health nursing. The community is a group of people sharing geographic boundaries and/or values and interests. (Maglaya, 2004) No two communities are alike. A nurse exposed in the community learns how to interact and adapt to different kinds of people. The family is considered as the basic unit of care in the community health nursing. It is in the family where a member develops his health values, beliefs and practices. The family is a major influence in the health behaviors of an individual. With this, it is important that families in a community are aware of the things and practices pertaining to their health. It is apt to say that community health nursing has a big role in the nursing education. It is in the community where the student nurse learns nursing apart from the hospital setting as she was exposed to different level of orientation. It is in the community where the saying “nursing is an art” can be applied as a student nurse tries to give quality service using the available resources in the health center. Conducting a family case study is a means by which student nurse reaches and feels the community through its basic structure – the family. It is a tool in determining the health status of a family through assessment and critical inspection. Through this, health

related problems are identified, thus giving the student nurse a hint on where to act and how to intervene. It is also a means towards improving the health of the community people, making them more productive. To come up with a family case study gives a sense of fulfillment to a student nurse as she was given the opportunity to share their skills, knowledge and time to alleviate and uplift the living condition of a family. The family that was chosen by the student nurse is a picture of the majority of the family here in our country: a family living in a poor environmental condition without enough resources and lacks knowledge on vital health information and experiences other socio- economic related problems. Though tiring as it is, reaching out to this family and mingling with them makes the student nurse feel the sense of fulfillment as she share her knowledge, skill and time to aid in uplifting the condition of the family.

OBJECTIVES OF THE STUDY

This chapter presents the general and specific objectives of this family case study. Setting objectives provides direction for planning a family nursing intervention. It facilitates motivation for the client and the

nurse by providing a sense of achievement. (Kozier, Erb et. al., 2004).

General Objectives:

At the end of the student nurse-family relationship, the family will be able to improve their health status and become self-reliant in maintaining their health through appropriate interventions in a given time frame.

Specific Objectives:

After 3 days of home visits and student nurse-family interaction, the family should be able to:

• Established rapport and trust with the student nurse. • Give pertinent and factual information during surveys and interviews • Participate actively during home visits and assessment interviews • Identify actual and potential problems which may be a hindrance in attaining optimum health. • Categorize the identified health problems as health threat, health deficit or foreseeable crisis through the assistance of their student- nurse. • Prioritize the identified family health nursing problems with the assistance of their student nurse. • Plan possible solutions or nursing actions to the prioritized health problems. • Generate interventions considering the student nurses’ capabilities, community and the family’s resources.

Carry out the planned interventions together with the student

nurse

Perform the health teachings taught by the student nurse Evaluate the effectiveness of the intervention using the set objectives as a basis, and

Evaluate changes in condition after giving interventions.

CHAPTER III

INITIAL DATA BASE

The initial database includes the information about the family in

various dimensions. It includes the family structure, characteristics and

dynamics, the socio-economic and cultural characteristics, the home

and the environment, the health assessment of each family member,

and the values, habits, practices on health promotion, maintenance

and disease prevention.

A. Family Structure, Characteristics and Dynamics

           

Education

Nam

Ag

Sex

Civil

Position in

Occupati

al

e

e

the Family

on

Attainmen

t

Mr. D

30

Male

Marrie

Father

Farmer

Highschool

d

Mrs.

27

Femal

Marrie

Mother

Housewife

Elem Grad

M

e

d

(Respondent)

(Grade 6)

Child

12

Femal

Child

Eldest Child

Student

Elem. Level

AV

e

(Grade 5)

Child

Femal

Child

  • 7 Second Child

Student

Elem. Level

BV

e

(Grade 1)

Child

Male

Child

  • 4 Third Child

N/A

N/A

CV

The Family A is considered as an extended type of family. An extended

type is a typical type of family composed of a father, a mother and

child/children and the parents of the father/mother or relatives. This

type of family structure is found in almost all societies, although the

length of time in which the family remains in this form varies even

within the same society.

The extended family can be a nurturing environment in which to raise

children as long as there is love, time spent with children, emotional

support, low stress, and a stable economic environment. In extended

families, both adults and elders are the biological or adoptive parents

of their children (Jay C, 2004,).

The A family resides in Lesbeng, Lubo, Kibungan Benguet. They

have started living there since the late 1990’s. They were a family

whose resident remains.

Mr. D and Mrs. M go hand in hand in terms of decision-making.

They consult each other in terms of planning and budgeting for their

family. They discuss matters concerning their children’s schooling

financially and also with regards to the emotional problems or aspects

within the family. When problem arises, they make sure that both of

them will handle and solve the problem. But then, in terms of matter

concerning health Mrs. M is more dominant. She makes sure that she

will comply with the appropriate regimen when certain health issues

arise. She has greater awareness concerning health matters compared

to Mr. D since of course believing it is her duty as the mother. These

health matters include immunization, feeding the right food and caring

for the sick member.

B. Socio-Economic and Cultural Characteristics

The A family’s main source of income is coming from Mr. D’s

farming. Mr. D earns about Php 500-1000 a month estimated. Since

Mrs. M also joins the farm work, she is in charge of the house and in

taking care of the children as well. Mrs. M budgets the money in terms

of food, education and miscellaneous where clothes, shoes and slippers

comes in. Out of Mr. D’s earnings, most of it goes to the family’s

budget for food. The education of the children is free and they can walk

from their house to the school so only some school supplies are being

bought. Usually, there is nothing to be left for the miscellaneous

expense.

With Mr. D’s monthly income, the family strives hard to

accommodate everything they need for them to live. The total monthly

income of Mr. D is about Php 700- 1000.00 and when divided among

the 7 members, it is only Php 140-150.00, thus, they are considered

poor. Mrs. M also informed the student nurse that they do not have any

financial assets at hand in case of emergency. They typically borrow

money from their relatives and neighbors.

Mr. D works as a farmer, he works from 3 am until 8 pm every day. He

seldom goes home but rather stays in the farm, which is situated

around the family’s house. Mrs. M works as a teacher and stays in their

house. She is the typical housewife where in you can see her wash

clothes, prepare food, sweep the yard and make the house clean.

All of them are affiliates of Roman Catholic. Mrs. M mentioned that they

go to church every Sunday or when they are deemed need it be.

Significant others are called such due to their own role in one’s life.

They are the ones very close to a person or group of persons. For

family A, the significant others in their lives are their relatives and

some neighbors. They usually run to their relatives if they face

hardships and problems. Mrs. M also confirmed how helpful and

welcoming her neighbors are with them.

The family has yet to participate in community activities since

they are new in the place. But they usually partake in community

activities. These activities include parties and carnivals.

The A Family enjoys the community resources since the

community itself provides plenty of resources. The children, though, go

to Lubo Elementary School. The father is usually in their farm while the

mother is teaching. The family uses the river as their means of water

source in washing their clothes. There is also a shallow well built within

the river where the family gets their water source for drinking if they

get lazy in getting water from the faucet, meters away from their

house.

C. Home and Environment

The house is made of wood, mostly bamboo. Mrs. M did not know

the exact measurement of their house. Her husband knows it yet he

was not there during the interview. In order for the house to be

considered as adequate, the total floor area should be divided among

the total members of the family and each should at least have 3.5 m2.

The house only has 6 windows and can sustain the adequate

ventilation needed by the family. Mrs. M told the student nurse that

their house is usually “naimbag” since it is beside the river and the air

goes to and fro freely inside the house.

The house has 2 rooms. The one is the sala/dining room and the other

is the bedroom, with no bed at all. Mr. and Mrs A, together with the

children, sleep in one room. They use “kamen” in sleeping.

The A Family has only one appliance which is the radio powered

by batteries since the place has no electrical supply yet. In terms of

garbage disposal, they either bury or burn their garbage.

Mrs. M uses fire wood and propane tank in cooking. She is the

one who prepares the food. She cooks inside the house at the back

portion. The foods that they usually eat are fish and vegetables. The

family uses plastic plates and stainless spoons in eating. When it

comes to storing their food, they just cover it with a plate. In terms of

cooking facilities the family is equip with pots, “silyasi”, and knives.

The river is the family’s main source of water. They wash their clothes

and gets their drinking water supply there. They put their water in a

big container with cover. They usually don’t go and get water from the

faucet in the purok since, according to Mrs. M, it is far from their house.

They usually sterilize their drinking water supply.

A Family has two comfort rooms. They have recently built

another comfort room, according to Mrs. M.

The drainage system of the family is an open type where in the

drainage flows anywhere and is continuous. It is dirty and has a stinky

smell. There is no obstruction present at the drainage system since it is

open and flows anywhere.

The family owns two transportation facilities namely a 2000

model jeepney and an Isuzu Elf Drop side 4wheeler. They use it to

transport their harvest and every time they go to the city proper. When

they go to their farm or any subsitio within Lubo, they usually walk

kilometers.

The family has 5 chickens and 2 dogs. There are vegetables

planted near the house.

D. Health Assessment of the Family

1. Health Assessment on Each Member

  • A. Mr. D – The student nurse has never met Mr. D since he was in

their farm during the interview. Mrs. A, however, told us that she

thinks her husband has never undergone immunizations at all since

it was not that important before. Mrs. M said that her husband is

about 5’4 tall and weighs about 55 kilograms. His BMI reveals

normal weight with a value of 20.8. Mrs. M told the student nurse

that her husband has no genetic or hereditary illness known. He is

not a smoker. He drinks alcohol rarely since they have no budget for

that.

B.

Mrs. M – She has no degenerative, chronic, or infectious diseases

as of the present time. She has also not completed immunizations.

When she was still 4 years old, she experienced chicken pox. She is

5 feet and 3 inches and weighs 60 kilograms. Her BMI reveals

normal weight with a value of 23.4. She has no complaints as of the

present time and has not taken any medications as of the moment.

At times of illness, she would just drink paracetamol for fever and

mefenamic acid for pain or treat wounds with crushed plants coming

from

their

backyard.

The

family

is

not

using

family

planning

anymore.

 

C.

Child

AV

has

no

any

degenerative, chronic, or infectious

diseases as of the present time. He has not completed

immunizations. She is 4 feet and 5 inches and weighs 38 kilograms.

She likes to eat vegetables and fish.

 

D.

Child

BV

–has

no

any

degenerative,

chronic,

or

infectious

diseases as of the present time. She has not completed

immunizations.

She

is

4

feet

and

9

inches tall and weighs 30.5

kilograms.

E.

Child

BV

–has

no

any

degenerative,

chronic,

or

infectious

diseases

as

of

the

present

time.

He

has

not

completed

immunizations. He is 3 feet and 8 inches tall weighs 33 kilograms.

FAMILY ASSESSMENT BASED ON FUNCTIONAL HEALTH PATTERN

  • 1. Health Perception-health management patterns

With no known vices like smoking and drinking except for Mr. D

who drinks alcohol rarely.

Was able to recognize the importance of having a healthy well-

being.

Uses herbal plants, though not approved by the DOH, from their

backyard

  • 2. Nutritional-metabolic pattern

Do not take any food supplements or vitamins

Daily food intake is mainly rice, fish and vegetables

Children eat junk foods whenever they were given money

Children have poor appetite according to Mrs. M

  • 3. Elimination pattern

Eliminates everyday with an average frequency of urine: 5 times

According to Mrs. M, all of the family members have no difficulty

in voiding.

The family members defecate everyday and some, every other

day with no difficulty in defecating noted.

  • 4. Activity-exercise pattern

“Wada san ubla mi ed garden, ya Kaman exercise metlang di

kamnidi” verbalized by the mother.

 

Family

preferred

to

stay

at

home

or

engage

in

home

improvement if they have free time while their children play with

other children in the community after class.

  • 5. Sleep-rest pattern

Family usually has 7-8 hours of uninterrupted sleep according to

the mother.

They usually sleep at around 9 in the evening and wake up at

around 4 to 5 in the morning.

They also take a nap at free time.

  • 6. Cognitive-perceptual pattern

Was oriented to time, place and is able to identify people and

significant others by their first names.

Was able to respond accordingly and correctly to questions.

Retaliates as soon as he can and was able to rationalize. Verbal

pattern and spontaneity normal

Memory intact

No sensory defects

7.

Self-perception/self-concept

Showed apprehension

consequences.

and

worry

towards

unspecific

Perceived situations (health deficits) to be very stressful but

remain passive about things and condition.

  • 8. Roles and relationship

Family members have an open communication and able to

discuss their problems according to the mother.

  • 9. Sexual reproductive

Both parents are still in the reproductive age

The parents are separated as of the moment since the father is

in their farm and the mother is in the house

10.

Coping Stress

Gains strength in the “assurance and guarantee” provided by

family members.

11.

Values/ Beliefs Pattern

The family is Protestant in faith. Expressed great belief and faith

in God. Is certain that the Divine providence would protect them

from any unidentified and possibilities of harm.

Does not go anymore to church since they are situated far away

from the place of worship they attend

E. Values, Habits, Practices on Health Promotion, Maintenance

and Disease Prevention

The children in the family completed all their immunizations. All the children in the family were dewormed last March 2010.

The family has adequate rest and sleep. They sleep early and wake up early, the usual time of sleeping is 9pm and they wake up at around 4 to 5am. Mrs. M stated that farming, doing the household chores, and walking are their ways of exercise. The father is in the farm. The mother usually does the household works and talks with the neighbors during free time. The children are either in school or are playing with other children in the community.

The mother recognizes the importance of health in the family, however, because of financial constraints made them ignore any major health problems that may arise. Furthermore, they were not able to sustain sufficient supplies of medication or articles which they would need related to their health care needs. They often use alternative medicines or herbal medicines for treating their illness and habitually self-medicate if OTC medications are available. The family believes in the power of herbal plants. They occasionally use herbal plants lodged near the house in treating diseases or symptoms in the family. Mrs. M said that she had no choice but to use these plants for the reason that the barangay health center is far away from their home. But if the symptoms manifested by the family member become severe, they immediately go to the health center or to the hospital.

CHAPTER IV

FAMILY BACKGROUND

This chapter illustrates the family background of the study which

includes, Database of the Respondent, Family Tree, General Household

Data, Activities of Daily Living which could be an indicative for the

present health status of the family as it continues to influence the each

of the family member.

A. Family History

Family A is composed of 5 members Mr. D is the father,

Mrs. M as the mother, children AV, BV and CV are the kids. Mr. D is the

head of the family. He is 30 years old. Mrs. M, his wife is 29 years old.

Child AV, as the eldest son is 11 years old, child BV is 10 years old,

child CV is 7 years old and child DV is 5 years old.

Mr. D was born and grew up in Lubo, Kibungan. His father was a

farmer and his mother was a housewife. He has 9 siblings and he is the

eldest. He is a Kankanaey. He was able to go to school up to grade 3

year level. After that he did not continue schooling in order to help his

parents look for money for their household expenses.

Mrs. M was born and grew up in Atok, Benguet. Her father is a

farmer and her mother is a housewife. She has 2 siblings. She was able

to go to school and graduated elementary school. She did not continue

schooling due to financial constraints. Instead she helped her parents

in doing household chores and in looking money for their household

Mr. D and Mrs. M met in Kibungan through friends of friends.

They become a couple and after 3 months, they got married. They

resided in Lesbeng since then.

  • B. Family Tree

Mr. Mrs. D M
Mr.
Mrs.
D
M
   
Mrs. M was born and grew up in Atok, Benguet. Her father is a farmer and
Mrs. M was born and grew up in Atok, Benguet. Her father is a farmer and
Child BV
Child
BV
Child AV
Child
AV
Child CV
Child
CV
  • C. Genogram

1. Total No. of Children: 2

2. List of Household Members

           

Positi

Imm

 

S

Educ.

on in

Members

Statu

Occupati

Attainm

Religion

the

.

e

Stat

NS

 

s

on

x

ent

 

Famil

us

y

Mr. D

Marri

Farmer

M

Elem.

Roman

Fathe

INC

NA

 

ed

level

Catholic

r

Mrs. M

Marri

Housewif

F

Elem

Roman

Moth

INC

NA

ed

e

Grad

Catholic

 

er

Child AV

Child

Student

F

Elem.

Roman

 

1

st

COM

NA

level

Catholic

Child

Child BV

Child

Student

F

Elem.

Roman

2

nd

COM

N

level

Catholic

Child

Child CV

Child

Student

M

Elem.

Roman

3

rd

COM

N

level

Catholic

Child

CHAPTER V

TYPOLOGY OF NURSING PROBLEMS

This chapter discusses about the problem that were identified

during assessment and interview with the family. It includes the

cues/data, the family nursing problem and the nursing diagnosis. The

problems identified are categorized into presence of wellness state,

health deficits, health threats, foreseeable crisis and stress points.

Table 4. Typology of Nursing Problems identified in Family X

Cues or Data

Family Nursing Problems

Objective data:

 

I.

Accident

hazards

 

The house of Family A is a

specifically fire hazard, as a

bungalow style

of

house.

It

is

health threat.

 

mainly made up of bamboo and

 

nipa

as

its

roof.

The

mother

A. Inability to provide a home

usually cooks at the back

of the

environment conducive to

house using wood and charcoal.

 

health maintenance and personal development due to:

Subjective data:

   

a.

Inadequate family

The mother verbalized “Daan yan maga met din napaspasamak ed mumuyang”

 

resources; specifically financial constrains/limited financial resources.

Objective data:

   

b.

Failure to see benefits of investment in home environment improvement.

 

The income of the family is

 

about Php 700-1000 per month. There are five members in the family

B. Inability to make decisions with respect to taking appropriate action due to:

 

a.

Failure to comprehend

Subjective data:

   

the nature, scope, and

 

Mother verbalized, “.”

 

magnitude of the problem.

   

b.

Low salience of the problem

 

Objective data:

The hands of the children

 

are unclean when they ate they

II. Family

size beyond

what

meal.

family

 

resources

 

can

adequately

provide

as

a

Subjective data:

Mother verbalized “Medyo

health threat.

 

adu gamin din daan ay amu mi

A.

Inability

to

make

decisions

panggep esa.”

with

respect

to

taking

appropriate

health

action

due to:

 

Objective data:

 

a.

Inaccesability

 

of

The family usually stores

 

appropriate

resources

their food by covering it with

for

care

such

as

plate and leaves it in the table

financial constraints.

Subjective data:

   

Mother verbalized “Wen met gamin, medyo narugit san pan

aan mi si makan”

 

III. Unsanitary food handling

as

a

presence

of

health

threat.

 

A.

Inability to make decisions

with respect to taking appropriate health action due to:

Objective data:

 

a.

Low salience of the problem.

The family’s drainage is an open type. They just throw it anywhere. Rice grains are noted beside the house.

b.

Negative attitude towards health problem

Subjective data:

IV.

Poor

home

condition

Mother verbalized “man

specifically

lack

of

food

manu lang gamin nga ada maala mi nga ustu pagikabilan makan”

storage facilities as a health threat

A.

Inability to make decisions

with respect to taking appropriate health action due to:

Objective data:

 

a.

Low salience of the problem.

 

The family has no comfort room. They just defecate and void

b.

Negative attitude towards health problem

anywhere.

c.

Inaccesability if

Subjective data:

 

appropriate resources for care specifically financial

Mother verbalized “Iti kakastuy a lugar, nagadu ti rugit talaga ngem enya ngay gaurd.”

constraints

V.

Poor

environmental

sanitation

 

specifically

improper drainage disposal as

a health threat

 

Objective data:

The family gets their water source in the man-made shallow well in the river. Near the

A. Inability to make decisions with respect to taking appropriate health action due to:

river is a carabao taking a bath and women washing clothes.

 

a.

Low salience of the problem.

   

b.

Negative attitude

Subjective data:

Mother verbalized “ada met

towards

health problem

kitdi

ngem

awan

ngamin ti

 

mangiparit”

 
 

VI.

Poor environmental

sanitation

specifically

unsanitary waste disposal as

a health threat

 

A.

Inability to make decisions with respect to taking appropriate health action due to:

 

a.

Low salience of the problem.

b.

Negative attitude

towards

health problem

Objective data:

   

Not all children have completed their immunizations.

 

c.

Inaccesability if appropriate resources for care specifically financial constraints

VII.

Poor

environmental

 

sanitation

specifically

polluted

water

supply

as

a

health threat

 

A. Inability to recognize presence of condition or problem due to:

 

a. Lack of knowledge

 
  • B. Inability to make decisions with respect to taking appropriate health action due to:

 
  • a. Low salience of the problem.

 
  • b. Negative attitude

towards

health problem

 
  • d. Inaccesability if appropriate resources for care specifically financial constraints

  • C. Failure to utilize community resources for health care due to:

 

a. Inaccessibility of required service due to physical inaccessibility (location of facility)

VII. Lack of immunization status specially of children as a health threat

  • A. Inability to make decisions with respect to taking appropriate health action due

 
   

to:

a. Inaccesability if appropriate resources for care specifically financial constraints

B.

Failure to utilize community resources for health care due to:

a. Inaccessibility of required service due to physical inaccessibility (location of facility)

CHAPTER VI

PRIORITIZATION OF PROBLEMS

This chapter shows the setting of priorities of family health problems

that has been identified. It includes a computation on how priorities

were shown with their corresponding justification.

I. Accident hazards specifically fire hazard, as a health threat.

Criteria

 

Computation

Score

Justification

 

1.

Nature

of

2/3 x 1

0.67

This problem is a health

the problem

threat

2.

1/2 x 2

1

The problem is partially

Modifiability

 

modifiable. The only way

of

the

to solve this problem is

problem

to renovate the house, thus it needs money.

3.

Preventive

2/3 x 1

0.67

The

problem

could

be

potential

 

moderately

prevented.

This could be done if the

 

family will be very alert

in

watching

out

     

especially if they are cooking since the house could catch fire anytime.

 

4.

Salience

1/2 x 1

0.5

The problem, compared

 

with the other problems

does

not

need

immediate

attention

since

it

requires

time

and money.

 
 

Total Score:

2.84

II. Family size beyond what family resources can adequately provide as a health threat.

Criteria

 

Computation

Score

Justification

 

1.

Nature

of

2/3 x 1

0.67

This problem is a health

 

the problem

threat

2.

0/2 x 2

0

The problem

could not

Modifiability

be modified

at

all. The

of

the

family

size

cannot

be

problem

trimmed

down

to

 

smaller size

 

3.

Preventive

1/3 x 1

0.33

The

problem may be

potential

 

prevented but the family size cannot be trimmed down.

4.

Salience

0/2 x 1

0

The

problem

is

not

 

perceived as a problem at all by the family.

 

Total Score:

1

III. Unsanitary food handling as a presence of health threat.

Criteria

 

Computation

Score

Justification

 

1.

Nature

of

2/3 x 1

0.67

This problem is a health

 

the problem

threat

2.

2/2 x 2

2

The condition can be

Modifiability of the problem

highly modifiable. If the family receives the right health teaching, attitude can be changed for the better

3.

Preventive

3/3 x 1

1

The

problem

can

be

potential

 

prevented if the family is

 

educated

on

 

the

importance

of

hand

washing

 

4.

Salience

1/2 x 1

0.5

The

problem

is

not

 

perceived as a problem

requiring

immediate

attention

according

to

the

family

since

there

are

other

health

problems

more

important

 

Total Score:

4.17

IV. Poor home condition specifically lack of food storage facilities as a health threat

Criteria

 

Computation

Score

Justification

 

1.

Nature

of

2/3 x 1

0.67

This problem is a health

 

the problem

threat

2.

1/2 x 2

1

This problem is partially

Modifiability

modifiable

since

the

of

the

family

lacks

resources

problem

specifically

in

 

the

 

financial

aspect.

However,

appropriate

health

teachings

may

correct this problem

3.

Preventive

1/3 x 1

0.33

The

problem is

low

in

 

potential

 

preventive

 

potential

 

since there

is

lack

of

appropriate

 

resources

that could solve this.

 

4.

Salience

1/2 x 1

0.5

The

problem

 

is

not

 

needing

immediate

attention

according

to

the family

 
 

Total Score:

2.5

V. Poor environmental sanitation specifically improper drainage disposal as a health threat

Criteria

 

Computation

Score

Justification

 

1.

Nature

of

2/3 x 1

0.67

This problem is a health

 

the problem

threat

2.

2/2 x 2

2

The

problem

is

easily

Modifiability

modifiable

by

teaching

of

the

the

family

 

the

problem

importance of having a

 

proper drainage.

 

3.

Preventive

2/3 x 1

0.67

This

is

highly

potential

 

preventable if the family

 

has

learned

 

the

importance of having a

clean drainage.

 

4.

Salience

1/2 x 1

0.5

With regards

 

to

the

 

family’s perception, the problem does not need immediate attention

 

Total Score:

3.84

VI. Poor environmental sanitation specifically unsanitary waste disposal as a health threat

Criteria

Computation

Score

Justification

1.

Nature

of

2/3 x 1

0.67

This problem is a health

 

the problem

threat

2.

1/2 x 2

1

The

problem

is

Modifiability

moderately

modifiable

of the

since this

problem can

problem

only

be

solved

with

money.

 

3.

Preventive

2/3 x 1

0.67

This

can

be

highly

potential

 

preventable if the family

 

had

prioritized

in

building a toilet

4.

Salience

1/2 x 1

0.5

According to the family,

 

it

plays

not

much

importance in their life

 

Total Score:

2.84

VII. Poor environmental sanitation specifically polluted water supply as a health threat

Criteria

 

Computation

Score

Justification

 

1.

Nature

of

2/3 x 1

0.67

This problem is a health

 

the problem

threat

2.

2/2 x 2

2

The

problem

is

highly

Modifiability

modifiable since it could

of

the

be solved if the family

problem

knows the importance of sterilization.

3.

Preventive

3/3 x 1

1

The

problem

is

potential

 

preventive

because

 

there

are

ways

and

resources present in the community where in the family can have a clean water supply

4.

Salience

1/2 x 1

0.5

The

problem,

with

 

accordance

to

the

family’s

perception,

is

 

not much important.

 

Total Score:

4.17

VIII. Lack of immunization status specially of children as a health threat

Criteria

 

Computation

Score

Justification

 

1.

Nature

of

2/3 x 1

0.67

This problem is a health

the problem

threat

2.

1/2 x 2

1

The

problem

is

Modifiability

moderately

modifiable

of

the

since there are available

problem

resources such as in the

 

health

center

yet

the

family cannot easil go to

the

health

center

because

of

its

long

distance

from

Daan

Banwang

 

3.

Preventive

2/3 x 1

0.67

The

problem

is

potential

 

moderately

preventive

 

since

the

family

could

have had immunization

way back

in

Malungon

but also due to negative

attitude

and

financial

constraint, the family did not seem to mind at all.

4.

Salience

2/2 x 1

1

The family knows

how

 

important

immunization

is

specially

for

the

children

 
 

Total Score:

3.34

CHAPTER VII

COMPREHENSIVE PATHOPHYSIOLOGY

Unsanitary food source

CHAPTER VII COMPREHENSIVE PATHOPHYSIOLOGY Unsanitary food source

CHAPTER VIII

FAMILY NURSING CARE PLAN

This chapter shows the identified and prioritized problems in a

ranking order. This chapter also presents the family care plan

formulated by the student nurse together with the family.

Problem List

 

Problems

Score

Unsanitary food handling as a presence of health threat.

4.17

Poor environmental sanitation specifically polluted water supply as a health threat

4.17

Poor environmental sanitation specifically improper drainage disposal as a health threat

3.84

Lack

of immunization status

 

specially of children as a health threat

3.34

Poor environmental sanitation specifically unsanitary waste disposal as a health threat

2.84

Accident hazards specifically fire hazard, as a health threat.

2.84

Poor home condition specifically lack of food storage facilities as a health threat

2.50

Family size beyond what family resources can adequately provide as a health threat.

1

FAMILY NURSING CARE PLAN

Problem# 1 Unsanitary food handling as a presence of health threat.

 

ANALYSIS

 

INTERVENTION PLAN

 

CUES

   

OBJECTIVE

NSG.

   

RESOURCE

 

OF THE

PROBLEM

 

S

INTERVENTIO

RATIONALE

METH

OD

S

 

EXPECTED

OUTCOME

   

NS

REQUIRED

 

Subjective

Inability to

After

1

day

of

>Assess the

> To obtain how

H

>Manpower

After

1

day

of

data:

make

community

 

family’s ideas on

much the family

resources

community

Mother

 

decisions with

exposure,

the

food handling and

knows on these

O

such as time

exposure,

the

verbalized

respect to

family

will

be

hand washing

issues

M

and effort.

family

has

able

“Medyo han

unay gamin

masursurut

taking

appropriate

health action

able to:

Employ

hands

clean

and

>Discuss with the family the

>To educate the family about

E

to:

Employ

clean

hands and finger

nu

agugas

due to:

finger

 

nails

importance and

proper hand

>Physical and

nails before

and

da ti

im

ima

before

and

need for hand

washing

chemical

during

eating

da.”

Low

during

eating

washing

V

resources

meals

Objective

data:

The hands of

salience

of the

meals

Specifically:

Discuss the

>Demonstrate proper hand

>Inform the family

> To show the proper hand washing

I

such as soap, water, pail and clean

Specifically:

Discuss

the

the

are

when

ate

children

unclean

they

they

problem.

Negative

attitude

towards

health

 

importance

and

for

need

hand

washing

washing technique

about

technique and for better understanding on it

S

I

T

towel

 

importance

and

need for

hand washing

meal.

problem

Demonstra

communicable

Demonstrate

- Dirty and

 

te

proper

diseases especially

> To make the

proper

hand

long finger

hand

 

the ones

family aware of

washing

nails noted

 

washing

transmitted if hand

the diseases

   

techniques

techniques

washing is not reinforced

they are prone of.

>Explore the family’s reaction about the health teachings given.

> To measure the understanding of the health teachings presented.

CHAPTER X

CONCLUSION AND RECOMMENDATIONS

Presented in this case study is the different characteristics and health

condition of Family A. This case study presents the family structure, socio –

economic and cultural factors, home and environmental factors, health

assessment of each member. It also contains data about identified problems

on the living condition of the family.

Summary and Evaluation

The Family A is considered as a extended type of family. A extended

type is a typical type of family composed of a father, a mother and

child/children and relatives. The A family resides in Lesbeng, Lubo, Kibungan.

Their house is made of wood, mostly bamboo. Mrs. M did not know the

exact measurement of their house. Her husband knows it yet he was not

there during the interview. In order for the house to be considered as

adequate, the total floor area should be divided among the total members of

the family and each should at least have 3.5 m 2 . The house only has 2

windows and can sustain the adequate ventilation needed by the family.

The A family’s main source of income is coming from Mr. D’s farming.

Mr. D earns about Php 700- 1000.00 a month. Since Mrs. M does not work,

she is in charge of the house and in taking care of the children. With Mr. D’s

monthly income, the family strives hard to accommodate everything they

need for them to live. According to NEDA, each individual should at least

have Php 2768.60 when the total monthly income of the family is divided

among the total family members. The total monthly income of Mr. D is about

Php 700- 1000.00 thus, they can be considered poor. Mrs. M also informed

the student nurse that they do not have any financial assets at hand in case

of emergency. They typically borrow money from their relatives.

The

A

family

barely

enjoys

the

community resources since the

community itself lacks resources. The children, though, go to Lubo

Elementary School. The father is usually in their farm while the mother is in

the house doing household chores.

The river is the family’s main source of water. They wash their clothes

and gets their drinking water supply there. They put their water in a big

container with cover. They usually don’t sterilize their drinking water supply.

A family has no comfort room. They usually urinate and remove bowels

anywhere near their house. The drainage system of the family is an open

type where in the drainage flows anywhere and is continuous.

The A family is identified to have plenty of environmental problems in

which it is evident that they practice poor environmental sanitation. With this

situation and family condition, many problems were identified such as health

threats which include fire hazards, poor home and environmental sanitation,

and improper drainage system as well as health threats which are improper

personal practice

as

improper

hygiene.

A

nursing

care

plan

then

is

formulated to address the different problems identified.

Nevertheless, the family has chances to improve their health condition.

There still have that ability to meet the desired characteristics in their

structure and maximize their health potential of optimum wellness. They are

cooperative and participative to the different issues and interventions they

are confronted. Hence, they are willing to submit themselves for the

impartation of information and basic knowledge regarding family health.

The objectives of identifying family nursing problems were only

partially achieved due to security reasons for the part of the student nurse.

Together with the family, the student nurse as an agent has helped the

family through motivation and support to change their lifestyle and improve

their health status. Although the allotted time for the student nurse was not

enough to attend to all those problems, the family is now equipped with fair

knowledge which they could use anytime as the need arises.

Recommendations

The student nurse have identified and prioritized problems and needs

with the family. The student nurse have also created a care plan on how to

deliver the best nursing care for the family to address their needs. The

following below are propositions and commendations recognized by both the

student nurse and family:

The A family should maintain a healthy and clean environment. They must

clean their surroundings to avoid the presence of vectors of diseases.

The family should also maintain proper hygiene such as taking a bath

regularly, trimming their nails, frequent changing of clean clothes

especially when come in contact with filthy objects or experienced

wetness of the back, refraining from walking barefooted, brushing of teeth

frequently, and proper and regular hand washing.

They must also reorganize their cooking practices in terms of food

preparation and handling as well as keeping their kitchen utensils in a

covered storage to avoid getting it contaminated by insects or pests. In

addition to that, they should also cover their food storage.

The family should also be advised to not wait for the ailment to become

severe before seeking medical help.

The family must also be educated and follow the proper preparation of

herbal medicines as it was presented during the mother’s class.

The A family should persevere to perform proper waste segregation and

disposal of their garbage as it was presented during the mother’s class.

The family should be aware that organizations in the community are open

and present for their problems to be addressed properly.

They should be encouraged to verbalize their concerns with regard to the

community so that resolutions can be made.

Books

CHAPTER XI

REFERENCES

Cuevas, F. et. al. Public Health Nursing in the Philippines. 10 th ed.

Philippines:2007

Maglaya,

A.

Nursing

Practice

in

the

Community.

Marikina

Argonauta Corp., 2004.

City:

Untalan, A. Concepts and Guidelines in COPAR. Educational Publishing House, 2005.

1 st

ed.

Manila:

Internet Sources

m

CHAPTER XII

APPENDICES

A. Photo Documentations

CHAPTER XII APPENDICES A. Photo Documentations 39
CHAPTER XII APPENDICES A. Photo Documentations 39
CHAPTER XII APPENDICES A. Photo Documentations 39
CHAPTER XII APPENDICES A. Photo Documentations 39