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 socioeconomic 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 studentnurse.

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 familys 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
Position in
the Family

Occupati
on

Education
al
Attainmen
t

Marrie
d

Father

Farmer

Highschool

Femal
e

Marrie
d

Mother

Housewife

Elem Grad

Femal
e

Child

Femal
e

Child

Male

Child

Nam
e

Ag
e

Sex

Civil

Mr. D

30

Male

Mrs.

27

M
Child

12

AV
Child

BV
Child

(Respondent)
Eldest Child

(Grade 6)
Student

Elem. Level
(Grade 5)

Second Child

Student

Elem. Level
(Grade 1)

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 1990s. 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 childrens 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 familys main source of income is coming from Mr. Ds
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. Ds earnings, most of it goes to the familys
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. Ds 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 familys 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 ones 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 familys 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 dont 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 54 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

immunizations.
kilograms.

the

present

time.

She

has

not

completed

She is 4 feet and 9 inches tall and weighs 30.5

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 wellbeing.

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

and

worry

towards

unspecific

consequences.

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.

Child

Child

Child

AV

BV

CV

Educ.
Attainm
ent

Religion

Positi
on in
the
Famil
y

Imm
.
Stat
us

NS

Roman

Fathe

INC

NA

C. Genogram
1. Total No. of Children: 2
2. List of Household Members

Members

Statu
s

Occupati
on

Mr. D

Marri

Farmer

S
e
x

M Elem.

ed

level

Catholic

Housewif F Elem
e
Grad

Roman
Catholic

Moth
er

INC

NA

Mrs. M

Marri
ed

Child AV

Child

Student

F Elem.
level

Roman
Catholic

1st
Child

COM

NA

Child BV

Child

Student

F Elem.
level

Roman
Catholic

2nd
Child

COM

Child CV

Child

Student

Roman
Catholic

3rd
Child

COM

Elem.
level

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:
The house of Family A is a
bungalow style of house. It is
mainly made up of bamboo and
nipa as its roof. The mother
usually cooks at the back of the
house using wood and charcoal.

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

A. Inability to provide a home

environment conducive to
health maintenance and
personal development due to:
Subjective data:
a. Inadequate family
The mother verbalized
resources; specifically
Daan yan maga
met din
financial
napaspasamak ed mumuyang
constrains/limited
financial resources.
b. Failure to see benefits
of investment in home
environment
Objective data:
improvement.
The income of the family is
about Php 700-1000 per month. B. Inability to make decisions with
There are five members in the
respect to taking appropriate
family
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:
health threat.
Mother verbalized Medyo
adu gamin din daan ay amu mi A. Inability to make decisions
with
respect
to
taking
panggep esa.
appropriate health action
due to:
a. Inaccesability
of
Objective data:
appropriate
resources
The family usually stores
for
care
such
as
their food by covering it with
financial constraints.
plate and leaves it in the table
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.

Objective data:
The familys drainage is
an open type. They just throw it
anywhere. Rice grains are noted
beside the house.

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

Subjective data:
IV.
Poor
home
condition
Mother verbalized man specifically
lack
of
food
manu lang gamin nga ada maala
storage facilities as a health
mi nga ustu pagikabilan makan
threat

Objective data:
The family has no comfort
room. They just defecate and void
anywhere.
Subjective data:
Mother verbalized Iti
kakastuy a lugar, nagadu ti rugit
talaga ngem enya ngay gaurd.

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
c. Inaccesability if
appropriate resources for
care specifically financial
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
river is a carabao taking a bath
and women washing clothes.

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

Subjective data:
Mother verbalized ada met
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
the problem

0.67

This problem is a health

threat

2.
1/2 x 2
Modifiability
of
the
problem

The problem is partially

modifiable. The only way
to solve this problem is
to renovate the house,
thus it needs money.

3. Preventive

0.67

The problem could be

moderately prevented.
This could be done if the
family will be very alert
in
watching
out

potential

2/3 x 1

especially if they are

cooking since the house
could catch fire anytime.
4. Salience

1/2 x 1

0.5

Total Score:

The problem, compared

with the other problems
does
not
need
immediate
attention
since it requires time
and money.
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
the problem

0.67

This problem is a health

threat

2.
0/2 x 2
Modifiability
of
the
problem

The problem could not

be modified at all. The
family size cannot be
trimmed
down
to
smaller size

3. Preventive

1/3 x 1

0.33

The problem may be

prevented but the family
size cannot be trimmed
down.

0/2 x 1

The problem is not

perceived as a problem
at all by the family.

potential

4. Salience

Total Score:

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

Criteria

Computation

Score

Justification

1. Nature of 2/3 x 1
the problem

0.67

This problem is a health

threat

2.
2/2 x 2
Modifiability
of
the
problem

The condition can be

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

3. Preventive 3/3 x 1
potential

The problem can be

prevented if the family is
educated
on
the
importance
of
hand
washing

4. Salience

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

1/2 x 1

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
the problem

0.67

This problem is a health

threat

2.
1/2 x 2
Modifiability
of
the
problem

This problem is partially

modifiable
since
the
family lacks resources
specifically
in
the
financial
aspect.
However,
appropriate
health teachings may
correct this problem

3. Preventive 1/3 x 1
potential

0.33

The problem is low in

preventive
potential
since there is lack of
appropriate
resources
that could solve this.

4. Salience

0.5

The problem is not

needing
immediate
attention according to
the family

1/2 x 1

Total Score:

2.5

V. Poor environmental sanitation

drainage disposal as a health threat
Criteria

Computation

specifically

improper

Score

Justification

1. Nature of 2/3 x 1
the problem

0.67

This problem is a health

threat

2.
2/2 x 2
Modifiability
of
the
problem

The problem is easily

modifiable by teaching
the
family
the
importance of having a
proper drainage.

3. Preventive 2/3 x 1
potential

0.67

This
is
highly
preventable if the family
has
learned
the
importance of having a
clean drainage.

4. Salience

0.5

With regards to the

familys perception, the
problem does not need
immediate attention

1/2 x 1

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
the problem

0.67

This problem is a health

threat

2.
1/2 x 2
Modifiability
of
the
problem

The
problem
is
moderately
modifiable
since this problem can
only be solved with
money.

3. Preventive 2/3 x 1
potential

0.67

This can be highly

preventable if the family
had
prioritized
in
building a toilet

4. Salience

0.5

According to the family,

it
plays
not
much
importance in their life

1/2 x 1

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
the problem

0.67

This problem is a health

threat

2.
2/2 x 2
Modifiability
of
the
problem

The problem is highly

modifiable since it could
be solved if the family
knows the importance of
sterilization.

3. Preventive 3/3 x 1
potential

The
problem
is
preventive
because
there are ways and
resources present in the
community where in the
family can have a clean
water supply

4. Salience

0.5

The
problem,
with
accordance
to
the
familys perception, is

1/2 x 1

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
the problem

0.67

This problem is a health

threat

2.
1/2 x 2
Modifiability
of
the
problem

The
problem
is
moderately
modifiable
since there are available
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
potential

0.67

The
problem
is
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

The family knows how

important immunization
is specially for the
children

2/2 x 1

Total Score:

3.34

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

4.17
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.
Poor home condition specifically
lack of food storage facilities as
a health threat
Family size beyond what family
resources
can
adequately
provide as a health threat.

2.84
2.50

FAMILY NURSING CARE PLAN

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

CUES

Subjective
data:
Mother
verbalized
Medyo han
unay gamin
masursurut
nu
agugas
da ti im ima
da.
Objective
data:
The hands of
the children
are unclean
when
they
ate
they
meal.
- Dirty and
long finger

ANALYSIS
OF THE
PROBLEM
Inability to
make
decisions with
respect to
taking
appropriate
health action
due to:

Low
salience
of the
problem.
Negative
attitude
towards
health
problem

INTERVENTION PLAN
OBJECTIVE
S
After 1 day of
community
exposure, the
family will be
able to:
Employ clean
hands
and
finger
nails
before
and
during eating
meals
Specifically:
Discuss the
importance
and need
for
hand
washing
Demonstra
te proper
hand

NSG.
INTERVENTIO
NS

RATIONALE

>Assess the
familys ideas on
food handling and
hand washing

> To obtain how

much the family
knows on these
issues

>Discuss with the

family the
importance and
need for hand
washing

>To educate the

family about
proper hand
washing

>Demonstrate
proper hand
washing technique
>Inform the family
about
communicable
diseases especially
the ones

> To show the

proper hand
washing
technique and
for better
understanding
on it
> To make the
family aware of

METH
OD
H
O
M

RESOURCE
S
REQUIRED
>Manpower
resources
such as time
and effort.

V
I
S
I

>Physical and
chemical
resources
such as soap,
water, pail
and clean
towel

EXPECTED
OUTCOME
After 1 day of
community
exposure,
the
family has able
to:
Employ
clean
hands and finger
nails before and
during
eating
meals
Specifically:

Discuss
the
importance
and need for
hand washing

Demonstrate
proper hand
washing

nails noted

washing
techniques

transmitted if hand
washing is not
reinforced

the diseases
they are prone
of.

>Explore the
familys reaction
about the health
teachings given.

> To measure
the
understanding of
the health
teachings
presented.

techniques

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 familys main source of income is coming from Mr. Ds 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. Ds

34

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 familys 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 dont 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
35

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:

36

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 mothers class.

The A family should persevere to perform proper waste segregation and

disposal of their garbage as it was presented during the mothers 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.

37

CHAPTER XI
REFERENCES

Books
Cuevas, F. et. al. Public Health Nursing in the Philippines. 10th ed.
Philippines:2007
Maglaya, A. Nursing Practice in the Community. Marikina City:
Argonauta Corp., 2004.
Untalan, A. Concepts and Guidelines in COPAR. 1st ed. Manila:
Educational Publishing House, 2005.

Internet Sources
Jay C. Published: 6/23/2004. http://www.buzzle.com/editorials/6-232004-55793.asp
http://wisdomquotes.com
http://psychology.about.com/od/theoriesofpersonality/ss/psychosexuald
ev.htm
http://psychology.about.com/od/theoriesofpersonality/a/psychosocial.ht
m

38

CHAPTER XII
APPENDICES

A. Photo Documentations

39