Family Case Study of de Guzman Family

A Family Case Study presented to

Tarlac State University
College of Nursing
Barangay Baras-Baras, Tarlac City

In Partial Fulfillment of Requirements of the Subject

Health Care 1

Presented by:

Selah Grace B. Inalvez

Kirsten Janet S. Nuqui

BSN II-B
Group B4
Table of Contents

I. Introduction
II. Objective of the Study
III. Initial Data Base
A. Family Structure, Characteristics, and Dynamics
B. Socio-economic and Cultural Characteristics
C. Home and Environment
D. Heath Status of Each Member
E. Values and Practices on Health Promotion/ Maintenance and Disease
Prevention

IV. Summary of Scores

V. Problem Prioritization
VI. Family Coping Index
VII. Family Nursing Care Plan
VIII. Recommendations
IX. Learning Derived
X. Definition of Terms
XI. Documentation
INTRODUCTION

From cradle to grave, the family is the Filipino’s rock of ages. In childhood and youth,

it is his rock of support and security; in adulthood, it is home when he marries too early and

cannot cope, insurance for times of need; and then in old age, it is the heart to which he returns.

The Filipino may contract other bonds in the course of his life with the company he

works for, the church he worship in, the neighborhood he lives in, even the foster nation he

swears allegiance to-but the foundation of his strivings is first and foremost his family.

There are three basic family system, the nuclear family which consist of a husband,

wife, and children; the polygamous family which consist of a husband or wife and several

spouses and their children; and the extended family which brings several generations in direct

line and kinship ties built by marriage. The extended type best describes the Filipino family.

The extension can be mesmerizing. Almost every Filipinos thinks of his family as

consisting not only of the nuclear cell of spouse and children; it includes for him the

innumerable relation of grandparents, aunts, uncles, cousins, nieces and nephews.

The state sees the family as “a basic social institution which public policy cherishes

and protects.” This is elaborated in various provisions of the civil code which treats marriage

as inviolate, prohibits divorce, extols the rearing and education of children, obliges couples to

lives together and in fidelity to each other, and emphatically states that “in case of doubt, all

presumptions favor the solidarity of the family.”

Studies of health practices among Filipinos Americans suggest that people originally

from rural areas in the Philippines are more knowledgeable regarding home remedies,

traditional healing techniques, and supernatural ailments, where as those from urban areas rely

more on western medical intervention and over-the-counter drugs. However, in both urban and
rural areas, a variety of indigenous folk practice and modern health care system are utilized

simultaneously. Among the traditional forms of self medication are ointments, which serve as

“cure nails” in relaxing, heating and comforting the muscles, beyond such home remedies,

more serious illnesses typically warrant seeking the help of a local ”healer” who may utilize a

variety of treatments including the use of herbs and roots. Although healers are presumed to

posses a God given gift, their relative popularity and prestige in the community depends a great

deal on their interpersonal relationships with their patients. People in rural areas are

accustomed to friendly and accommodating folk healers and expect the same treatment from

physicians. If these expectations are not met, they avoid Western Health Centers or switch

doctors. Moreover, when healers are viewed with trust and respect, they often are expected to

perform instantaneous healing. If there is no immediate improvement in an illness or related

symptoms, individuals may change doctors.

Nurse- centered Objectives

General Objective

To provide nursing care and to improve the current health condition of the de

Guzman family.

Specific Objectives

After visiting the de Guzman family for __ days, we, as a student nurses will be

able to:

1. Establish rapport and good working relationship with the members of the family.

2. Determine factors relevant to the family’s present condition.

3. Obtain information about their lifestyle and health practices.

4. Help the family in realizing their present condition.

5. Educate and impart knowledge the family about the importance of health

maintenance and promotion.

6. Educate the family about ways in preventing diseases related to the following:

a. home sanitation

b. food preparation and storage

c. personal hygiene

d. water supply

e. breeding sites of vectors

f. unhealthful lifestyle and personal habits

Family-centered Objectives

General Objective

To provide nursing care and to improve the current health condition of the de

Guzman family.

Specific Objectives

The family will be able to:

1. Increase their level of awareness about the persistence of health problems among

family members.

2. Apply the skills and knowledge learned about health promotion and diseases

prevention in their daily living.

I. Family Structure, Characteristics and Dynamics

Table 1: de Guzman Family Constellation

Family Member Position Se Birthday Age Marital Status

x
Orlando de Guzman Father M November 7, 40 Married

1968
Carmelita de Guzman Aunt F October 7, 1951 47 Married
Eric de Guzman 1st son M November 5, 17 Single

1992
nd
Ronnie de Guzman 2 son M February 21, 1993 16 Single
Aileen de Guzman 1st daughter F June 16, 1994 15 Single
Irene de Guzman 2nd daughter F May 11, 1996 13 Single
Orlando de Guzman, Jr. 3rd son M February 16, 1999 10 Single
Isabelle de Guzman 3rd daughter F October 13, 2005 4 Single
Amante de Guzman 4th son M October 13, 2005 4 Single

Observation:

The de Guzman Family is an extended family residing at Purok Pinagpala, Brgy. Baras-

Baras, Tarlac City for almost one year and two months. The father, Orlando, the head of

the family is the one who usually makes decisions for the family, hence making the family

patricentric. The family lives without the presence of the mother who died on April 2009.

With regard to this, the father needs to work for the daily necessities of his family. He

works as a sack dealer in Tarlac. He usually leaves early in the morning for his work and

arrives home not too late in the evening in the same day. One of his sons, Eric is recently

living in Isabela with his aunt for employment purposes. Mr. Orlando communicates with

his son through the use of cell phone owned by his cousin. Ronnie and Ailene were adopted

by some of the relatives of Mr. Orlando because he cannot supply all the needs of his

children. Three of his remaining children stay with him. With the household chores, Ailene,
the 1st daughter is the one responsible for this. She also takes good care of the twins in the

absence of her father.

Norms:

The family is referred to as “mag-anak” in Filipino. It is typically monogamous. In its

extended form, the Filipino family includes a wide circle of relatives consisting of

grandparents, aunts, uncles, and cousins from the husband’s and wife’s sides. In effect, the

families of orientation of both husband and wife are integrated into a family circle within

which most of the relating is done. Thus the Filipino’s definition of family (pamilya) in its

extended form includes the families of orientation and families of procreation. The Filipino

extended family is characterized by a strong sense of solidarity. Mutual financial and

emotional aid, pooling of resources, and sharing of responsibilities keep the bond strong.

Close ties are also preserved by continuous residence in the community. Traditionally,

young people grow up and stay in the same community where they were born, allowing

constant reciprocal visits and close interaction which strengthen the bond among the

extended family members. The nuclear family, however, has been found to be the most

prevalent residential unit in Filipino society who classifies the Filipino family as

“residentially nuclear but functionally extended”. That is, the modal household is nuclear

but the family is extended in so far as relationships are concerned.

Analysis:

The family cannot be considered as a typical family because of the absence of the

mother who was died on April 2009. The children live without the presence of their

mother. The father doesn’t have much time for his children because of his work. The
children in the family cannot appreciate being children because some of them also works to

help their father.

II. Socio-economic and Cultural Characteristics

Observation:

The father is the breadwinner of the family. With the help of his aunt, Mrs. Carmelita,

he provides for the family’s entire income. The father doesn’t have regular work.

Sometimes, he works as a sack dealer and in times of harvest in their community, he works.

But in this moment of his life, as the head of the family, he needs to work in order to

supply his family’s needs. He started working as a sack dealer in Tarlac City last

________. He earns _____. He works from eight o’clock early in the morning to five

o’clock in the afternoon usually, with a one hour lunch break, from twelve o’clock noon to

one o’clock in the afternoon, which totals for __ a day. Mrs. Carmelita also works as a sack

dealer in Kumintang, Tarlac.

The father reached his secondary education (2nd year). His son Eric is in Isabela for

employment purposes and definitely, he is not studying. His daughter Airene who was

adopted by Aling Carmelita was a grade 1 pupil for this time. His three remaining children

are living with him and none of them is studying.

The de Guzman family is all members of the Iglesia ni Cristo (INC).

Norms:

According to the 2003 National Statistics Office (NSO) Family Income and

Expenditure Survey,
 Analysis:

The salary of the father is not enough and insufficient for the family’s expenditure. The

father cannot change his current job to a higher paying one because of his educational

attainment. The father is barely able to budget the money he earns to meet the family’s basic

needs like food, water and living allowances. If this continues, the unmet health needs of the

family can pose as a threat to their well-being and health.

III. Home and Environment

Observation:

The house and lot where the de Guzman family resides is owned by the aunt of the

father, Mrs. Carmelita. The type of housing material of de Guzman’s house is a makeshift.

Entry of the house is only through the side door located in the kitchen which serves also as

their living room. The house has only one room with one window and the father with his

children sleep in the same room, with ___ meters with cartons laid on the floor. They don’t

have electric light source which is a health threat for the family. They only use candles at night

as their light, and sometimes when no budget, they don’t have light at night. The house is

usually untidy. They do not have cabinets for their clothes, and they store their clothes in a

box. There are also health threats that can be found in their room. The woods that are

removable are played by the children that can lead them to have illness.

They do not have a hamper for dirty clothes; dirty clothes are usually seen lying on a

corner of their kitchen, and in some corner of their room, or even mixed with clean clothes.

Laundry is hung outside the house to dry on sunny days and inside the house when it is raining.

The family cooks using firewood inside the house. The kitchen doesn’t have a dish cabinet and

they have a sink without faucet. Kitchen utensils are usually piled up on the sink. The family
doesn’t have enough utensils and any plates, glasses, spoon and forks. The jag without cover is

beside the sink and soap bar. The family doesn’t also have a table and chairs. Pests like flies

are observed in the kitchen. Mosquitoes are also observed in the house (kitchen and bedroom).

The drainage system is open and has a distance of 2.5 meters from the house and is producing

foul smell. The family doesn’t have own toilet and they only go to their neighbors for their

waste and bath purposes. The family has own water source from a manual water pump 1.5

meters from the house. Water for washing dishes is stored in medium-sized pails. Drinking

water is also from the water pump and is kept in an uncovered jag. Unsegregated garbage is

accumulated in a garbage sack hung outside the house. Garbage is collected weekly during

Sunday morning. The walkway from the street to their house is unpaved. It is usually muddy

when it rains and puddles of water are observed to form after the rain. The health center is

about ___m from their house.

There are breeding sites of insects and rodents which can cause illness in the family.

There is also accident hazards present in the house of de Guzman family.

Norms:

Analysis:

The family’s house has poor ventilation because it only has one window. When it

comes to the inside appearance of the house, it is untidy as there’s a lot of things scattered.

Their open drainage system has a foul odor which is not conducive to the health of the children

and might be the breeding sites of mosquitoes and other disease vectors. There are also flies,

mice, and cockroaches observed in the kitchen and in their bedroom. The family lacks an

appropriate food storage facility. Accident hazards in their backyard can also pose as a threat to

the family’s safety.

IV. Health Status of each Member

Observation:

Norms:

Analysis:

V. Values and Practices on Health Promotion/ Maintenance and Disease Prevention

Observation:

Norms:

Analysis:
Table __Summary of Scores

Problem Score Rank

Boils 5.00 1
Lack of Food Storage 4.34 2
Malnutrition 4.00 3
Poor personal hygiene 3.84 4
Poor lighting and ventilation 3.34 5
Inadequate Living Space 2.66 6
Presence of breeding sites of vectors of disease 2.34 7
Inadequate footwear 8
Problem Prioritization

Boils
Criteria Com Actual Justification
putati Score
on
1. Nature of the 3/3x1 1 The problem is a health deficit and requires more
Problem immediate intervention.
2. Modifiability of the 2/2x2 2 The family and nurse’s time and effort are available.
Problem The nurse also has the resources in teaching the father
of the right treatment and management.
3. Preventive 3/3x3 1 The spread of infection will be prevented. The risk of
Potential being transmitted of this disease will be prevented.
4. Salience of the 2/2x1 1 The family perceives this as a problem and needs
Problem immediate attention.
TOTAL 5

Lack of Food Storage

Criteria Com Actual Justification
putati Score
on
1. Nature of the 2/3x1 0.67 It is a health threat. Leftover foods that are uncovered
Problem can be contaminated with microorganisms and vectors
which can cause illness.
2. Modifiability of the 2/2x1 2 It is easy modifiable. Nurse can help the family on
Problem effective storage of facilities and educate the family
how important the storage of food is.
3. Preventive 2/3x1 0.67 The possibility of contracting food-borne diseases can
Potential be minimized or prevented.
4. Salience of the 2/2x1 1 The family perceived the condition as a problem and
Problem needing immediate attention.
TOTAL 4.34

Malnutrition
Criteria Com Actual Justification
putati Score
on
1. Nature of the 3/3x1 1 It is a health deficit that requires immediate
Problem management to eliminate untoward consequences.
2. Modifiability of the 2/2x2 2 The problem is easily modifiable since the nurse’s
Problem resources are available; nurses can help develop the
skills of other members to achieve good nutrition-
proper food selection and preparation, and feeding
 practices.
3. Preventive 3/3x1 1 Susceptibility to other diseases and infections can be
Potential prevented if malnutrition is eliminated; normal growth
and development can thus be achieved.
4. Salience of the 0/2x1 0 It is not felt as a problem.
Problem
TOTAL 4

Poor personal hygiene

Criteria Com Actual Justification
putati Score
on
1. Nature of the 2/3x1 0.67 The children’s nails are untrimmed and dirty. The
Problem twins are not properly groomed and sometimes not
taking a bath which may lead to hygiene- related
illness.
2. Modifiability of the 2/2x2 2 The needed resources for both of the nurses and the
Problem family are available such as soap and nail cutter.
Knowledge and time needed to educate the family
about the proper hygiene is also available.
3. Preventive 2/3x1 0.67 By improving the personal hygiene of the family, the
Potential occurrence of disease such as diarrhea, the existence of
intestinal parasites and the infection of wounds can be
minimized or eliminated.
4. Salience of the 1/2x1 0.5 The family perceives the condition as a problem but
Problem not needing immediate attention.
TOTAL 3.84

Poor lighting and ventilation

Criteria Com Actual Justification
putati Score
on
1. Nature of the 2/3x1 0.67 It is a health threat and it may lead to illness of the
Problem family members.
2. Modifiability of the 2/2x2 2
Problem
3. Preventive 2/3x1 0.67
Potential
4. Salience of the 0/2x1 0 The family does not consider it as a problem because
Problem they do not take actions to address the problem.
TOTAL 3.34
Inadequate Living Space
Criteria Com Actual Justification
putati Score
on
1. Nature of the 2/3x1 0.66 It is a health threat that does not demand immediate
Problem action.
2. Modifiability of the 1/2x2 1 The family’s resources are presently not adequate.
Problem Increasing the living space will require quite a
financial expenditure.
3. Preventive 3/3x1 1 Increasing the living space will reduce possibility of
Potential transferability of communicable diseases, provide for
privacy to members and provide bigger space to allow
adequate movements.
4. Salience of the 0/2x1 0 Not perceived as a problem by the family.
Problem
TOTAL 2.66

Presence of breeding sites of vectors of disease

Criteria Com Actual Justification
putati Score
on
1. Nature of the 2/3x1 0.67 The environment which the family lives on harbors
Problem vectors which carry diseases which poses as a health
threat to the family’s health.
2. Modifiability of the 1/2x2 1 Resources needed to solve the problem include
Problem knowledge, effort and time which are available.
Financial resources needed to fix the current drainage
cannot be afforded by the family.
3. Preventive 2/3x1 0.67 Vector-borne diseases can be minimized or eliminated
Potential if the problem is solved. Financial strains resulting
from the medical bills of these diseases are also
eliminated.
4. Salience of the 0/2x1 0 The family does not consider it as a problem because
Problem they do not take actions to address the problem
properly.
TOTAL 2.34

Inadequate footwear
Criteria Com Actual Justification
putati Score
on
1. Nature of the
Problem
2. Modifiability of the
Problem
3. Preventive
Potential
4. Salience of the
Problem
TOTAL