Family Case Study

In Partial fulfillment of the requirements in Community Health Nursing

Submitted to: Ms. Amy Athena Bardenas, RN, MN Ms. Tracy Ansula, RN, MN Ms. Ana Mae Quezon, RN, MN

Submitted by: BSN 4A

Group II Richard Ejorcadas Rene John Francisco Joffrey Jay Garrido Liza Marie Gatuslao Nicolas Gabriele Gatuslao Francesa Antonnet Hinolan Ma. Jemaimah Isubal Kevin Kee Sheena Joy Lobaton Ma. Angelica Macrohon Jayvee Mangana Sarah Jean Medina Aljay Charyl Mingay Kcyl May Montao Mary Joyce Montibor

December 20, 2012

Table of Contents Chapter I Chapter II Chapter III Chapter IV Chapter V Chapter VI Chapter VII Chapter VIII Chapter IX Bibliography Appendices A Appendices B Appendices C Introduction... Objectives of the Study. Initial Database of Adopted Family.... Family Background.. Family Coping Index... Typology of Nursing Problems Prioritizing Problems Family Nursing Care Plan Summary, Evaluation, and Recommendation . Barangay Health Profile Family Health Data Card...... Process Recording.. 3 5 7 16 19 26 29 32 33 36 38 41 42

Chapter I Introduction The family is both the fundamental unit of society as well as the root of culture. It is a perpetual source of encouragement, advocacy, assurance, and emotional refueling that empowers a child to venture with confidence into the greater world and to become all that he can be. -MARIANNE E. NEIFERT, Dr. Mom's Parenting Guide Family as of the majority may define it as the functioning unit of the society where all events in a community start with. A fundamental structure a society has which can be related to the cells of our body as building blocks of life that without such, life could never be existed. A family serves as the starting point of all stimuli and is primarily the factor of influencing and shaping the individual as he/she grows and develop to a mature being, thus affecting the person holistically. According to My Agriculture Information Bank (2011), the family carries out certain recreational activities for the benefit of young children and thus educates and broadens their outlook, contributes towards preservation and enrichment of cultural heritage. Family nourishes its member with their needs including the whole aspects of the person including mutual love and affection thus gearing towards the path to wellness state. The community is a group of people sharing geographic boundaries and/or values and interests (Maglaya, 2004). Community, we can say that it is a group of interacting organisms sharing an environment. The intent, belief, resources, preferences, needs, risks and a number of other conditions may be present and common among those living within that community. A community is like a ship, everyone ought to be prepared to take the helm. And as nurses this is part of duty, to transform the community to become a self-reliant and united group of people. With our roles as nurses, being exposed in such a community allows us to assess the community in terms of being their way of living and various practices in order for us to come up with a plan of action to help improve their health statuses.

With regards to health, community health nursing aims to improve these various complications and practices in order to prevent the spread of diseases and promote health. Moreover what is good about community health nursing is that it emphasizes the health promotion and illness prevention activities like what the popular motto says, An ounce of prevention is always better than a pound of cure. Conducting a family case study is an essential tool in order to know the profile as well as the health of each members and the family as a whole. Through this, it may dig up health problems that could hinder a family to achieve health and does it can make awareness that there is an existing problem that needs to be entertained and then outlines specific interventions to provide solutions of such health problems. As of the year 2007 census taken in Zamboanga Web site (2012), the population of Bago City reached up to 159,933 people compared to the previous years and the city ranks 2nd class component city and partially urban thus implicates that there is so much to be done when it comes to health implementation and dissemination due to the number of people. The family we chose for our family case study resides in Purok Violeta II Barangay Don Jorge Central Ma-ao Bago City, a nuclear type of family and like any other families that lives in a poor environment and needs further health guidance. With the help of our community profile, we can determine health problems, deficits, threats and possibly a foreseeable crisis that are common in the community. This information will then allow us to create a plan of care or to minimize or totally eliminate these problems. It is through these exposures that we student nurses are able to implement and carry out these plans in order to achieve our goal of creating a self-reliant and healthy community.

Chapter II 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, 2004). General Objective After one (1) hour of family case presentation, the student nurses will be able to: Apply the already acquired knowledge and skills about assessing family health status and prioritizing family health problems in the community for the formulation of a family care plan which aims to prevent diseases and promote overall health of the family. Specific Objectives After one (1) hour of family case presentation, the student nurses will be able to: Knowledge/ Cognitive Identify the family structure, socioeconomic and culture behavior, home and present environmental sanitation with the values, belief and practices of the family which contribute to their present health status. Recognize the present problems or health risk factors of the family which may affect their health. Skills/Psychomotor List the priority health problems through scaling from highest to lowest rank. Discuss interventions and preventions which was conducted together with the family for the identified health problems and risk factors with the use of available resources.

Assess the activities and procedures such as health teaching in promoting health and prevention of communicable diseases.

Attitude/ Affective Show importance on the discussion of family case study from bringing the identified and prioritized health needs to formulation of a family care plan in aiding the health problems.

Chapter III Initial Database of Adopted Family This chapter presents the family structure, characteristics and dynamics such as the demographic information of each family member outlining their names, age, sex and civil status, their position in the family, occupation, and educational attainment. Descriptions also of the family with regard to their socio-economic status, physical environment, past and present history and family assessment based on functional health patterns.

A. Family Structure, Characteristics, and Dynamics Name Mr. R Mrs. R Child R Age Sex 25 Male 34 Female 3 Male Status Married Married Child Position in the Family Head Wife Child Occupation Laborer Housewife N/A Educational Attainment High School High School N/A

The data above shows the age, sex, status, position in the family, occupation and educational attainment of family R. From the data above it is evident that family R is a nuclear type of family, which consists of the father, the mother and their son. They have a small family since there are only three members. Family R lives in Purok Violeta II Barangay Don Jorge Central Ma-ao Bago City. Mr. and Mrs. R have been married for about four years now and at the moment they dont have a plan on having more kids due to financial matters. Moreover, Mr. R works as a laborer at various barangays while Mrs. R, on the other hand is a housewife and at the same time sells native goods to the residents in their purok during her spare time. B. Socio-Economic Status Family Rs main source of income comes from the native goods sold by Mrs. R. they have an estimated monthly income of 8,500/ month good for the members to be fed with food and other needs. When it comes to the socioeconomic status of family R, they are currently experiencing some financial difficulties since Mr. R currently dont have a job. So to compensate his current unemployment, Mrs. R sells baye-baye, bitso-bitso, bitchocoy, kalamayhati and other native foods to the other members of the community in the morning and the afternoon. Mrs. R

receives these native goods from her aunt and when she sells these snacks she was able to get a small portion of money, porsyento, usually ranging from P200 P500 a day depends on the number of goods sold.. Mrs. R usually starts selling at around 6 a.m. roaming and shouting on the streets on their purok baye-baye bitso-bitso kamo da in order to attract customers. At around 10 a.m. she does her lunch break to fill up her stomach and after which, she continues to sell until all her native goods have been sold which is usually at around 5 p.m. She tries to help the family to have a good income and budget for their needs but Mr. R, as claimed by Mrs. R, often feels disappointed that he cannot support well and uplift the status of their family and as a result causes him to feel stressed and sometimes even trigger arguments between the two. Aside from the income that Mrs. R earns, they are currently living with Mr. Rs parents who also help support them with whatever needs they can provide for the family. So with the situations at hand, most of the decisions related to money and the family itself are made by Mr. Rs mother. C. Physical Environment There are currently three members of the chosen adopted family and at the moment, they all live in one house with two rooms and were made of cement and wood. The house has five (5) windows and can sustain the adequate ventilation needed by the family. Their home also has a backyard in which rooted there were herbal plants use to treat certain illnesses such as lagundi, oregano, ampalaya, pito-pito and tsaang gubat. Mrs. R together with her son Child R both sleep in one room that has a full sized bed while Mr. R often sleeps in the living room. Their house was furnished suitably with chairs, tables, beds as well as drawers and cabinets for their clothes and other items. They also have electricity, which allows them to watch television and listen to the radio for any news and updates; also a source of lighting during the night. The family was able to obtain their source of water from a deep well located few meters outside their house in which they used it to wash their clothes, for bathing and for drinking. Regarding the open well as their source of water for drinking, first and foremost, they boil it until boiling point was reached such by presence of bubbles in order to make sure that it is potable to drink for sanitary and safety purposes. At the moment they dont have a refrigerator to store their

food so they usually placed it in a bowl or plate with a cover on it, same as true with their jug of water with cover placed above it. As mandated by the law about disposing garbage properly to their right place, Family R practiced this segregation practices by placing their garbage into their specified categories: Mapuslan (still usable), Madunot (easily rot) and Indi madunot (do not easily rot/ destroyed) placing it on a sack, which is then collected and thrown away by the garbage collector every week . If the garbage seems to be too much, Family R sometimes burns it so that they can minimize the amount of garbage being thrown and usually most of the stuffs are papers and fallen leaves. The drainage system of the family is an open type where in the drainage flows anywhere and is continuous. For example, their sink consists of a basin, which flows outside of their house. Unlike with their body waste/ excreta, they have their own toilet located at the back of their house which is a water-sealed type toilet and is privately owned by the family. The family raised pets in their place such as chicken and ducks. For transportation, there are number of vehicles going to and fro in their streets such as jeepneys and Motor tricycle. Family R take jeeps in moving to far areas such as going to Bacolod City premises and other areas while in near distant places like the Barangay Health Station, market place, etc. they usually take a ride to a motortricycle.

D. Past and Present History D.1) Health Assessment/Status of each Household Member A. Mr. R is currently twenty-five years old and is quite thin in appearance. Mr. Rs weight is about 47 kilograms and his height is 54. His BMI reveals that he is underweight with a value of 17.8. He has received all his immunizations when he was a child making him a fully immunized person. Mr. R stated that he does not have any genetic or hereditary illnesses. On the other hand, there was one occasion where he had an allergic reaction to the Anti Tetanus Serum Vaccine. Storied by Mr. R, about 2 years ago he visited Bago City Hospital to receive an injection for the

Tetanus Toxoid vaccine. Skin test was performed prior to instilling it intramuscularly to note for any allergic reaction after 15 minutes and noticed that the nurse checks his arm less than the scheduled time and preceded the intramuscular injection of Anti Tetanus Serum thinking Mr. R dont have a any allergies to the vaccine that led to the development of a severe allergic reaction that almost killed him and according to him, this was the first time he ever experienced this type of allergic reaction. Mr. R had an experience of loose bowel movement due to intake of contaminated water. Currently, Mr. R does not smoke but likes to drink whiskey every once in awhile or in any special celebrations/ occasions. B. Mrs. R is currently thirty-five years old, weighs 56 kilograms and her height is 411, giving her a BMI score of 24.8 which shows that she is within the normal weight range. She is currently fully immunized and receives booster shots when necessary. Mrs. R said that she has a family history of slight problems in the ears, such as hearing difficulties and ear infections. When she was a child she had a problem with her ear wherein a callus had formed within her ear and she had no choice but to submit herself for surgical removal of the callus. Mrs. R also experienced an injury on her left arm and fractured it when she fell down to the stairs which was the reason why her left arm is smaller in appearance than her right. Previously Mrs. R had an experience of urinary tract infection during the end of her pregnancy to Child R. In addition, Mrs. R often has UTI due to her increase of soft drink consumption within the past few months. Had an experience of loose bowel movement after ingesting contaminated water. On the other hand, she currently is in good health and has not had any severe illnesses experienced. C. Child R is currently three years old, weighs 19 kilograms and has a height of 311, giving him a BMI score of 13.4 which shows that he is underweight. Child R is also fully immunized and received booster vaccines whenever they are available or necessary. Child R has no chronic diseases but lately, he experienced having an ear infection where pus came out of his ears. His mother stated that he had a cough and cold when suddenly his snot came out of his ear rather that his nose. Child R also experience loose bowel after ingesting contaminated water. On another note Child R currently has no severe illnesses aside from the common cough and cold that he experiences every once in awhile.

E. Family Assessment Based on Functional Health Patterns E.1) Health Perception - Heath Management Patterns In general the family has no chronic illnesses and they rarely get sick and usually if they do get sick it is usually minor fever or colds. So in situations where one of the family members does get sick and it seems to be mild, they often prefer herbal remedies than medications but in cases when the herbal plants do not suffice, they seek consultation on their Barangay Health Station and seek medical advice from the doctor. Their household does not take any room for chances when it comes to their health so Mrs. R is sure to use methods that will benefit the health of their family. She believes that the best cure for any minor illness, such as a cough or cold, is an increase in fluid intake especially water. The family tries to maintain good health at all times by practicing good hygiene by doing one of the most important procedures that most people tend to take for granted these days, hand washing. E.2) Nutritional-Metabolic Pattern Family R eats three times a day and on a daily basis they usually eat fish and vegetables with white rice once in awhile, seldom they are able to have meat such as chicken. None of the members in the family are malnourished. Mr. R have allergies to sea foods such as shellfish, crabs and shrimps while Mrs. R have none. Child R has mild allergies to chicken and eggs as claimed by Mrs. R. Child R takes vitamins such as Tiki-Tiki or Cherifer syrup if they have enough money to buy it. Similarly Mr. R and Mrs. R also took vitamin supplements such as Fern-C when available. Mrs. R stated that Child R usually has a very good appetite and she has no problem feeding him. During the day, Ms R allows Child R to eat a few junk foods such as biscuits, candy or chips whenever they have extra money. According to Picard (2012), a nutritionist, the average person should receive 30-35% of your calories should come from protein, 50-60% from carbohydrates and 10-15% from fats. On the other hand, vitamins and minerals should be taken in small amounts to support the chemical reactions of the cells to live. So in relation to the family, they were able to take protein, carbohydrate and vitamins in their meal. They were able to provide proper nutrition most especially to their child thus is very essential to prevent any kind of diseases.

E.3) Elimination Pattern Elimination patterns describe the regulation, control, and removal of by-products and wastes in the body. The term usually refers to the movement of feces, urine, and sweat from the body( Dugdale, 2009). Family R has no difficulties with urination or defecation. Mr. R is able to defecate at least once a day and the same goes for Mrs. R. Child R currently is also potty trained and has no problems with his elimination pattern. When it comes to urinary tract infections, previously Mrs. R had an experience of urinary tract infection during the end of her pregnancy to Child R. In addition, Mrs. R often has UTI due to her increase of soft drink consumption within the past few months. She explained that she experiences pain during urination and aware that she must increase her fluid intake. From NANDA Nursing Interventions, the patient with UTI should be encourage to increased fluid intake in order to increase hydration thus, will flush the bacteria. Also, take action to keep the urine acid: increase input berry juice and give medicines to increase urine amount and acidity thus inhibit the growth of germs. There also cases when the family members have experienced loose bowel movement or diarrhea due to their consumption of contaminated water which paved them to consult medical assistance and was advised to drink Oresol and increase their fluid intake. E.4) Activity-Exercise Pattern Exercise is an important aspect of maintaining a healthy lifestyle and in the context of family R all members are able to get their daily dose of exercise in their own way. Mr. R likes to play basketball once a week with his friends at the communitys basketball court. Mrs. R, on the other hand gets her exercise when she walks around the community selling her native goods. Since Child R is an only child he likes to play with other children in their community, which is his form of exercise. E.5) Sleep-Rest Pattern When it comes to their sleeping pattern, all the members in the family are able to get the required 6-8 hours of sleep every day. The family sleeps at night at around 10:00 pm 11:00pm after eating their dinner and watching television as their siesta time to bond together. Mrs. R and

Child R joins together in a one bed when sleeping while Mr. R sleeps on their living room. Family R claimed no sleeping problems and difficulties except for Child R who sometimes bed wets the bed. They usually wake up at around 5:00am most specially to Mrs. R who prepares early in the morning with her native goods while Child R at 8:00am to fully regain his energy. Family R takes afternoon naps for just a short while if time permits. They claimed they do have a balanced of work and rest activities such like if they felt that they are stressed or overworked out, they rest for awhile by taking naps or just sit on a sofa/ chair to relax their muscles. E.6) Cognitive-Perceptual Pattern During the assessment of the family, Mr. R and Mrs. R were very cooperative and oriented to the time and place. Since they are both young, they have no problems identifying people and their names. Both were able to answered questions accordingly and at the same time were able to fully express themselves openly to their problems with regards to health. There were no speech difficulties noted in Mr. and Mrs. R and they had no problem recalling past events in their lives. Moreover, Child R is also able to respond to simple questions that are asked with a simple Hu oh or Indi. In addition, Child R was able to identify colors, animals, sounds, names, food and objects. E.7) Self Perception/Self Concept The family as claimed by Mrs. R is adjusted to their living condition from the attainment of their needs to the relationship within. Mr. R being the head of the family sometimes feels disappointed or depressed because of inability to find a job, with that to find an outlet of his feelings he sometimes argue with his wife and seeks comfort in drinking alcohol with his friends. Mrs. Rs self perception is positive and she was able to cope with the difficult situations that may come about. Her main motivation is her son, Child R is the main reason why Mr. R and Mrs. R must maintain harmony with one another, since if they do get into arguments their son is the one who will be affected to the point that he gets sick. Currently, Mr. R does not have a stable job making Mrs. R the breadwinner of the family. E.8) Roles and Relationship

Mr. R and Mrs. R are currently going through difficulties in their relationship. Mrs. R expressed that recently they have been having arguments and are having communication problem with Mrs. R. Unfortunately, she also said that if given the chance she would want to move out on their house and go to Manila with Child R and live with her sister there. As of right now, things between Mr. R and Mrs. R may not be at its best but they are as much as possible, trying to work things out for the good of their family. As much as possible Mrs. R wants Child R to have a father figure in his life that will teach him discipline and how to become a good man. When it comes to Mrs. R and her relationship with her son, the statement A mothers love for her child is unconditional is what comes into play. She does not only care for him but also tries to educate him with simple things such as what certain objects are called to like how to wash his hands and brush his teeth. Mrs. R also stated that if she were to have it her way, her dream is to have Child R go to college and become an architect. E.9) Sexual-Reproductive Since both Mr. R and Mrs. R are still within their reproductive age. Mrs. R is currently on birth control and receives her family planning from the Barangay Health Center. Mrs. R prefers the Depo-Provera shots as family planning method. She stated that she does not plan on having a child any time soon since she and Mr. R are not only experiencing financial problems but problems with their relationship as well. E.10) Coping Stress In times of stress, Mr. R likes to play basketball or have a drink with friends in order to relieve his stress. But the idea of drinking for Mrs. R only increases her level of stress so she likes to read pocket books and watch TV as a way of diverting herself away from her problem. In their family, they mostly experience stressful situations when Mr. R goes home drunk causing them get into an argument late at night. After that, it usually takes them a few days or even weeks to make peace with one another since in most situations, Mrs. R refuses to speak or even be around with Mr. R. In addition, they also experience stressful situations when Child R gets sick and if they are experiencing financial problem.

E.11) Values/Beliefs Pattern With regards to their religious affiliation, all members of the family are Catholic. Although they are Catholic, they do not go to church as often as they used to. Mrs. R explained that since their family is experiencing problems in their relationship she feels that going to church does not have any positive effect on their relationship since after that the arguing still exist. But even though the family does not go to mass, they always pray daily right when they wake up and before they sleep at night. Mr. R and Mrs. R believe in the power of prayer and that with God anything is possible. They also believe that everything happens for a reason and that God will always provide on what things they need. E.12) Values Habits, Practices on Health Promotion, Maintenance and Disease Prevention All the members of Family R were fully immunized and received boosters when available or necessary. The family has no problems in their health status, which shows that they are able to meet the adequate necessities of living. When it comes to adequate rest, they usually sleep at around eight in the evening and wake up at around four in the morning allowing them to get the amount of rest that is necessary. They are able to get their exercise from their daily activities of living such as washing clothes, cleaning, walking and engaging in sports. They are all well clothed and Mrs. R expressed that they do no not buy clothes very often since most of the time their relatives also gave them clothes that have outgrown them. They were able to eat their meals three times a day with good source of nutrients such as vegetables, white rice and meat. Within the barangay, they make use of the health facilities such as the health station and first aid services offered to them. They also took advantage of various services such as medical missions and what we student nurses have to offer to them. They believe in both herbal remedies and drugs prescribed and over the counter as means to cure their illness. They religiously take the prescribed medicines by the doctor as to the prescribed dose and time.

Chapter IV Family Backgorund This chapter illustrates the Family Background, Database of the family, Family Tress, General Household Data, Activities of Daily Living and Present Health Status of the Family 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 R is composed of three members, Mr. R is the father, Mrs. R. is the mother and they have only one child, Child R. Mr. R is the head of the family and he is currently twenty-five years old. Mrs. R, his wife is thirty-four years old. Their one and only son, Child R is currently 3 years old. Mr. R was born and grew up in Purok Violeta II, Don George Araneta, Central Ma-ao, Bago City, Negros Occidental. His father is a farmer and his mother earns money for a living helping those who live in the community. He is the youngest of four boys and one of his brothers passed away three years ago in a motorcycle accident. Currently, his highest educational attainment is his high school diploma. Mrs. R was also born and grew up in Don George Araneta, Central Ma-ao, Bago City, Negros Occidental. Her father is a laborer and her mother is a housewife. She is the youngest of four girls. She was able to attain her high school diploma, but was not able to go to college due to financial problem. Instead, she helped her parents at home and doing chores and taking care of her other siblings. Child R was also born at Bago City Hospital and lives with his parents. At the moment he is the only child and once he reaches four years of age, his mother plans on sending him to school.

B) Database of the Respondent: Name: Mrs. R Age: 34 Gender: Female Address: Purok Violeta II Barangay Don Jorge Central Ma-ao Bago City Negros Occidental Religion: Catholic Occupation: Housewife Civil Status: Married Nationality: Filipino Ordinal Number of Children: 1 Educational Attainment: High School Diploma Estimated Monthly Income: P 8,500

C) Family Tree

D) General Household Data 1. Number of Children: 1 2. List of Household Members: 3 Household Members Mr. R Status Married Occupation Laborer Sex M Educational Attainment High School Diploma Mrs. R Married Housewife F High School Diploma Child R Child N/A M N/A Catholic Child Complete Catholic Mother Complete Religion Catholic Position in Family Father Immunization Status Complete

Chapter V Family Coping Index This chapter includes the actual observation of family behavior and practice in contrast to the ideal family and behavior, assessment and how family handles various stressors. The purpose is to provide a basis for estimating the nursing needs of a particular family. Coping capacity is rated from 1 (totally unable to manage this aspect of family care) to 5 (able to handle this aspect of care without help from community sources) (RNPedia, 2012). The observations are analyzed to see occurrence of health problems or negative attitudes and behavior. Criteria 1. Physical Independence Ideal Is concerned with ability to move Actual All the members in the family are able to perform their activities of daily living with the exception of Child R who needs assistance since he is only 3 2. Therapeutic Competence Includes all of the procedures treatments prescribed for the care of illness such as giving or years old. The parents are aware on what to do if one of the members gets sick. In the instance where one member gets sick they utilized the herbal medicines present in their backyard and seek consultation from the health center or 5 The members of the family put health as their main priority and are willing to do whatever it takes to live and maintain a healthy lifestyle. Rating 5 Justification The members in the family have no problems carrying out their ADLs and there are no noted disabilities in their movement.

about, to get out of bed, to take care of daily grooming,

walking, etc.

medications, using appliances, dressing, exercise, relaxation, special diets, etc.

3. Knowledge of

Concerned

with

hospital. The parents of the family are aware of their past and present illnesses. They are also aware of what needs to be done in order to prevent further diseases. 5

The mother is aware that she needs to keep her son away from areas with too much smoke since it may trigger his ear infection. The mother and father are also able to understand the process of simple illnesses.

Health Condition the health

particular condition

that is the occasion for care such as knowledge of the disease or inability to understand

communicability of diseases and of

mode transmission.

Understanding the general pattern of development of

newborn baby and basic infants physical care. 4. Application of Principles of General Hygiene Concerned with All the members of the family practice 3 The parents in the family are old enough to be able to know how to practice good hygiene but since their son is still too young to be able to care for himself fully, his parents assist him in hand washing as well as tell needs of for

family action in relation

to general hygiene. From washing their hands

maintaining family

nutrition, securing before and after eating adequate rest and relaxation family carrying for and after using the toilet every day. Unfortunately, sometimes their son

members, out

accepted preventive measures (immunizations, medical appraisal, safe home-making in relation to and

refuses to wear slippers when roaming around and forgets to wash his hands.

him to always wear his slippers especially when going outside of the house.

storing

preparing of food). 5. Health Activities Concerned with The parents are concerned about the 5 Parents as much as possible want to provide the best for their children and protect them from harm. But if they are lack the money, all they can do is provide what they can.

the way the family

feels about health health of the members care in general, of the family and they participate actively in maintaining their optimum health, especially when it comes to their son. On the other hand if they have financial problems, they are 6. Emotional Competence Has to do with the maturity integrity which and with the unable to provide. The parents of the family often have their misunderstandings that can affect their 3

including preventive services, care of illness, and public health measures.

Overall, they live in a home were the parents can communicate with each other. But when the parents get into an argument, they can go for days not speaking to each

members of the

family are able to son. At the same time, meet the usual when they get along

stresses

and

they are able to work as a family to overcome the problems they face.

other.

problems of life, and to plan for happy and fruitful living. The degree to which

individuals accept the necessary

disciplines imposed by ones family and culture. The development of the individuals responsibilities and decision. to

Willingness meet

reasonable to

obligations, accept

adversity

with fortitude, to consider the needs of others as well as ones own. 7. Family Living Concerned the with In terms of making decisions, the parents are responsible for making the decisions. There are times when they are able to agree 3 Since the father of the family has trouble finding a stable job, they often get into arguments leaving the mother to make the decisions. Yet,

interpersonal

or group aspect of family life. The family members

get along with one

another, the ways in which they

on an idea but there are also times when they disagree.

no matter what happens, the decisions they make are always for their son.

make affecting

decisions the

family, the degree to which they one and do

support another

things as family, the degree of and

respect

affection, and the ways in which

they manage the family budget. 8. Physical Environment Concerned home, community with the and Aside from the minor casualties of their home, their house environment is fitted for them. But on the other hand, the outside of their house has an open well that is covered by a thin net. This can be a threat since it may be harboring mosquitoes and insects. They also have a backyard, 3 The familys house space is adequate enough for the three of them. There is a separate room for the kitchen where they cook their food using wood and charcoal. They have their own eating utensils, plates and cups. Their rooms also have mosquito nets, which they use on a daily basis. Their home itself is made out of wood and concrete

work environment as its affect family health. The

condition of the house pressure accident screening, plumbing, system, facilities of such as of hazards,

cooking, privacy,

level community (deteriorated neighborhood,

of

which their son can play in, and they also have a living room where the whole family can sit and watch television.

and seems sturdy, but not sturdy enough to survive a storm if ever.

presence of social hazards, pests), of and

transportation schools availability. 9. Use of Community Resources Degree family of use

the and

The family is aware of the available sources in the community, both in health and education. 5

When other schools go to the community for medical missions, especially dental medical missions, the family always grabs the opportunity. The community also has a basketball court where the father plays at, at least once a week. It is also very easy to access transportation, if they travel, in the community since there are many motor tricycles and jeeps within the area.

awareness of the available community facilities education welfare.

for They usually avail the and programs and services that are given at the health centers and medical missions. The community resources are also easily accessible for them and they are able to get to these sources by walking or riding a motor tricycle.

Chapter VI Typology of Nursing Problem This chapter discusses about the problem that were identified during assessment and interview together 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. Cues or Data Objective Data: - Their son often plays in the soil and dirt, wearing no shoes or slippers. Family Nursing Problems 1. Poor personal hygiene as a Health Threat

Subjective Data: - The mother verbalized, Halin sang una, namian na siya mag hampang sa balhas. Feeling ko indi pa na siya kabalo mag lakat if wala cya namun gin sugtan mag hmpang sa balhas. Asta subong indi siya namian mag suksuk slippers. Yawan na kami hmbal cya na ma suksuk cya. Objective Data: - At the moment Mr. R, doesnt have a stable job leaving Mrs. R as the breadwinner. Mrs. R only makes p8,000/month for the family. 2. Low income as a Health Threat

Subjective Data: -The mother verbalized, Si Mr. R, wala na cya ga ubra subong ako na lang para may ma bantay kay Child R. Okay man lang na sakon, pero kis-a ga inaway kami tungod sa kwarta kay indi ya ma accept na ako ang ga earn para samun nga tatlo.

Objective Data -Presence of an open well dug out in their backyard in the ground without any blocks on the sides with just a bunch of logs being put together to create a barrier. -Mosquitoes breeding in the open well were also present

3. Poor Environment Sanitation specifically presence of breeding or resting sites of vectors as a Health Deficit

Subjective Data: The mother verbalized, Gin tabunan lang namon da kag gin butangan kahoy kay waay na namon ginagamit kag para indi madagdag ang mga bata kung magdinalagan kag waay may ma aksidente. Gusto na namun e pa kayo pero wala pa kami budget. Objective Data: -There have been many instances where Mr. R would come home drunk and would lead to arguments between Mr. R and Mrs. R. They would go for days without talking and even though things were at peace, they would argue again. 4. Stress provoking factor specifically strained marital relationship as a Health Threat

Subjective Data: - The mother verbalized, Tak-an na ko kisa kay c Mr. R, permi ya upod iya migo. Pero kun ara lang di sya sa balay, wala gid kaso. Kay kun ma inom na siya ka gahod na cya, grabe siya mag wakal. Kis-a si Child R ara gid sa tunga namun ga hibi. Tani lang ma untat cya para wala na problema sa

mga away-away na.. Objective Data: -Child R is now 3 years old and will be attending school next year. He has trouble speaking since the children around his neighborhood do not know how to speak that well either. Mrs. R is worried that he will have a hard time adapting to the school environment. In addition Mrs. R is unaware if she will have enough money to send him to school.

5. Entrance at school as a Foreseeable Crisis

Subjective Data: - The mother verbalized, Worried ko para kay Child R kay indi pa siya mayo ka storya kay i yang mga upod ya mag hampng daw pitla sila tapos wala sila mayo ga hmbal. Tapos next year if ma school na siya tapos wala pa ubra si papa ya ambot kun diin ko ma kwa kwarta para siya. Gusto ko gd cya ya ipa school, kag dream ko gid na nga ma attend siya college tapos ma kwa architecture.

Chapter VII Prioritizing Problems I. Poor personal hygiene as a Health Threat Computation Score 2/3 x 1 0.7 1/2 x 2 1 Justification This problem is a health threat. The problem is partially modifiable since it their son who is at risk when it comes to poor personal 3/3 x 1 2/2 x 1 1 1 3.7 hygiene. By simply teaching their son about proper personal hygiene, future illnesses can be prevented. The parents needs to educate their soon immediately in order to prevent the occurrence of future illnesses. TOTAL

Criteria 1. Nature of the Problem 2. Modifiability of the Problem 3. Prevention Potential 4. Salience

II.

Low income as a Health Threat Computation Score 2/3 x1 0.7 1/2 x 2 1 2/3 x 1 0.7 Justification The problem is a health threat. The problem is partially modifiable since it can be rather difficult to find a stable job. By increasing their monthly income, the parents will be able to provide adequate food, vitamins and medications in cases when a family member gets

Criteria 1. Nature of the Problem 2. Modifiability of the Problem 3. Prevention Potential

4. Salience

1/2 x 1

0.5

sick. The parents dont perceive this as something that needs urgent attention since at the moment they are already able to buy enough food and medications if necessary.

TOTAL

2.9

III.

Poor Environment Sanitation specifically presence of breeding or resting sites of vectors as a Health Deficit

Criteria

Computation

Score

Justification

1. Nature of the Problem 2. Modifiability of the Problem 3. Prevention Potential

3/3 x 1 1/2 x 2

1 1

The problem is a Health Deficit The problem is partially modifiable since fixing this problem entails financial resources that will fix the

3/3 x 1

open well in their backyard. By fixing the open well in their backyard, not only can they eliminate the resting sites of vectors but they can also prevent children accidentally falling into the

4. Salience

1/2 x 1

0.5

open well. The family doesnt see this problem as something that needs immediate attention since it has been there for a few years now and they dont have the money to fix it.

TOTAL

3.5

IV.

Stress provoking factor specifically strained marital relationship as a Health Threat

Criteria 1. Nature of the Problem 2. Modifiability of the Problem 3. Prevention Potential 4. Salience

Computation 2/3 x 1 1/2 x 2

Score 0.7 1

Justification The problem is a Health Threat. The problem is partially modifiable since, in order to fix their relationship, both parents need to cooperate

2/3 x 1

0.7

with one another. By fixing their relationship, they can prevent further problems from arising and likewise be able to work

2/2 x 1

together for the benefit of their family. Both parents dont see this problem as something that needs immediate attention because both of them prefer to put their problems aside than solve it.

TOTAL

3.4

V. Criteria

Entrance at school as a Foreseeable Crisis Computation Score Justification

1. Nature of the Problem 2. Modifiability of the Problem 3. Prevention Potential 4. Salience

1/3 x 1 1/2 x 2

0.3 1

The problem is a foreseeable crisis. The problem is partially modifiable since it is quite difficult for Mr. and Ms. R to find a job that will be

1/3 x 1

0.3

able to sustain their familys needs. If they are able to successfully send their son to school he will be able to learn and get a good

1/2 x 1

0.5

education. Currently, the parents do not see this as a problem needing immediate attention since they still have a few months to find a solution to the problem.

TOTAL

2.1

Chapter VIII Family 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. A) Problem List Problems Identified I. Poor personal hygiene as a Health Threat Score 3.7

II.

Poor Environment Sanitation specifically presence of breeding or resting sites of vectors as a Health Deficit

3.5

III.

Stress provoking factor specifically strained marital relationship as a Health Threat

3.4

IV.

Low income as a Health Threat

2.9

V.

Entrance at school as a Foreseeable Crisis

2.1

Chapter IX Summary, Evaluation, and Recommendation Presented in this case study is the different characteristics and health condition of family R. 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 living condition of the family.

Summary and Evaluation Family R. is considered a nuclear type of family, which is composed of a father, mother, and a child. Family R. resides in Purok Violeta II, Barangay Don Jorge, Central Ma-ao, Bago City. They currently live in a house made of cement and wood, and with 5 windows to provide them adequate ventilation. Their house only has one bedroom where Mrs. R and Child R sleep in while Mr. R sleeps in the living room. They also have a decent amount of furniture suited for their simple way of living. Their backyard contains herbal plants such as lagundi, oregano, ampalaya, and tsaang gubat. They have electricity and water which they get from a deep well, and they boil their water for drinking. They dont have a proper drainage yet they provide a water sealed toilet. Mrs. R is the familys breadwinner because Mr. R currently has no job. Mrs. R earns money through selling native goods and snacks, she is able to earn a decent amount of money which ranges from 8,000-8,500php a month. Mr. Rs parents also provide them support and money, so Mr. Rs mother is in charge with money matters. Family R is identified to have poor environmental sanitation. With this situation and family condition, many problems were identified such as health threats and health deficits which include Poor personal hygiene, Poor Environmental Sanitation specifically presence of breeding

or resting sites of vectors. Family also faces low income, marital status and entrance at school of child R. Nursing care plans are then formulated to address the different problems identified. The family has the ability to improve their health conditions. They just have to maximize their available resources to be used for them to improve their health conditions and lessen the health threats identified. And with the help of other people especially the health care providers and the student nurses who would provide them with proper education and alternative interventions to their problem they will be able to solve their health problems through their participation and willingness to cooperate. Together with the family, the student nurses were able to recognize and prioritize the health problems present within the family. The student nurses helped them through motivating them to modify their lifestyle and improve their health status by minimizing stressors and practicing proper hygienic practices. And in line with this identified problem, the student nurses were able to provide health teaching to the family based on the health problems being prioritized for them to become an independent individual, family and community. Recommendations The student nurse have identified and prioritized problems and needs together 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 recognized by both the student nurse and family: 1. Maintain an open communication with each other so that there will be an understanding with one another. 2. Children should be monitored for any health threats in order to take preventive measures if there are any present. 3. Continue to have good nutrition habits, such as eating fruits and vegetables on a regular basis and include calcium-rich foods in their diet. 4. Take time to rest every now and then to reduce the amount of stress on the body, which may make them at risk in their health.

5. Have an open and honest relationship so that current problems can be fixed and future problems avoided. 6. 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. 7. The family should maintain a healthy and clean environment. They must clean their surroundings to avoid the presence of vectors of diseases.

Chapter X Bibliography Books: Cuevas, F. P. (2007). Public Health Nursing in the Philippines. Manila: National League of Philippine Government Nurses, Incorporated. Kozier, B., & et.al. (2004). Kozier and Erb's Techniques in Clinical Nursing: Basic to Intermediate Skills. USA: Pearson Inc. Maglaya, A. (2004). Nursing Practice in the Community. Marikina City: Argonauta Corp.

Internet Sources: My Agriculture Information Bank. (2011). Retrieved December 14, 2012, from ProWebs Web site: http://www.agriinfo.in/default.aspx?page=topic&superid=7&topicid=592 NANDA Nursing Interventions. (2012, May 29). Retrieved December 18, 2012, from http://nanda-nursinginterventions.blogspot.com/2012/05/nursing-interventions-forurinary-tract.html RNPedia. (2012). Retrieved December 18, 2012, from RNPedia Web site: http://www.rnpedia.com/home/notes/community-health-nursing-notes/family-copingindex

Zamboanga. (2012, October 22). Retrieved December 17, 2012, from Zamboanga Web site: http://www.zamboanga.com/z/index.php?title=Bago_City,_Negros_Occidental,_

Philippines#People_of_Bago_City.2C_Negros_Occidental.2C_Philippines Picard, D. (2012). Bodybuilding for Real People. Retrieved December 18, 2012, from Get Big Web site: http://www.getbig.com/articles/faq-dav2.htm

Physical activity. (2012) Retrieved December 17, 2012 from World Health Organization http://www.who.int/topics/physical_activity/en/

S.M., et al. (2012, November). How Much Sleep Do You Need?. Retrieved December 17, 2012 from http://www.helpguide.org/life/sleeping.htm

(n.d.)

Retreieved

December

16,

2012

from

Scribd:

http://www.scribd.com/doc/16621899/Family-Nursing-Practice

(n.d.)

Retreieved

December

16,

2012

from

Scribd:

http://www.scribd.com/doc/47339664/Family-Coping-Index

Chapter XI Appendices Appendices A Barangay Health Profile

Barangay/Purok: Purok Violeta II Barangay Don Jorge Central Ma-ao Bago City PERSONAL DATA Respondent: Mrs. R Birthday: February 17, 1978 Status: Married Educational Attainment: High School Diploma

I. GENERAL HOUSEHOLD DATA A. Total Number of Children: 1 B. List of household members:

Household Members Mr. R Status Married Occupation Laborer Sex M

Educational Attainment High School Diploma Religion Catholic

Position in Family Father

Immunization Status Complete

Mrs. R

Married

Housewife

High School Diploma

Catholic

Mother

Complete

Child R

Child

N/A

N/A

Catholic

Child

Complete

II. Economic Data A. Sources of income: Selling of Native Goods B. Estimated monthly income: P8,500/month C. Land: Owned D. Products, if land is farmed: None E. Type of Housing: Wood & Concrete F. Household appliances: Radio, TV G. Animal Raising: Chicken and ducks H. Transportation Facilities: Jeep, Motor tricycle I. Water: Free III. ENVIRONMENTAL DATA A. Toilet: Shared B. Source of Drinking Water: Deep well C. Drainage: None D. Garbage Disposal: Segregated, burned, collected E. Home: Herbal garden

IV. MEDICAL DATA A. Common diseases/Common treatment: cough, cold, fever; Herbal remedies B. Immediate sources of Medical Care: Barangay Health Center C. Family Planning: Depo-provera injection D. Pregnancy: No E. Lactating: No F. Death in the Family: None

G. Disable members of the family: None

Appendices B Family Health Data Card Health Indicators Family Planning Prenatal Immunization Nutrition Water Garbage Disposal Toilet Alcoholism Smoking Mr. R Yes N/A Complete Good Deep well Practice Septic Tank Yes No Mrs. R Yes Yes Complete Good Deep well Practice Septic Tank No No Child R N/A N/A Complete Good Deep well Practice Septic Tank No No

Appendix C Process Recording 1. Orientation Phase (December 11, 2012) Objectives After an 8-hour shift of community health nursing exposure in Purok Violeta II Don Jorge Barangay Central Ma-ao Bago City, the client will be able to: Activities 5:30AM-6:00AM Assembly in the Health Science CampusAmphitheatre 6:00AM-7:00AM Preconference - Morning Prayer - Checking of Attendance - Giving out of final instructions for the day - Submission of individual requirements (HVR # 1) - Group meeting if any Small Break Assembly at the school bus Preparation of all things before departure Travel time going to Central Maao, Bago City Evaluation After 2 hours of community health nursing exposure in Purok Violeta II Don Jorge Barangay Central Ma-ao Bago City, the client was able to:

1. Re-establish rapport towards the student nurse.

1. Goal Met: Upon our arrival to the area, the client was able to greet me with a smiling face and recall my name and when our last visit was. My client was also able to verbalize, Hoy! Merry Christmas Liz! Ara namn

7:00AM- 7:30AM

7:30AM- 8:00AM

8:00AM-9:30AM

Going to Bago City kamo d gali! Pungko lang Health Station and Barangay health station da anay tapuson ko lang di in Maao for Courtesy call Meeting of adopted family in their house - Reestablish rapport - Conduct a group bible reading - Monitoring family health by taking vital signs ang gna luto ko.

9:30AM11:00AM 2. Coordinate effectively to the student nurse in identifying current/ potential problems present

2. Goal Met: During the student-client interview and the course of updating our Worksheet C, Mrs. R

in the household.

and Identify current health problem Update the Worksheet C

was able to verbalize, Wala man gid kami di problema. As usual si Child R man lang ang may problema kisa kay ga maskakit cya. Pero indi man laman ka lain nga masakit. Usually ga hilanat cya tapos ma ubo kag sipon. Tapos si Mr. R, man dyapon eh, kisa ma abtan lang na cya kag ma pangakig eh. Pero other than that wala man gid d

11:00AM11:30AM

Prepare all requirement before leaving - Signing by the client of the forms (DPA #1 and Worksheet C) - Verbalizing out tomorrows time and date of arrival the planned itinerary for tomorrows activities - Thanking the family for their time and cooperation

11:30AM12:30PM

Assembly at the school bag-o ah. bus Travel time going back to HSC-USLS extension 3. Goal Met: Todays Lunch Break Post Conference - Evaluating todays activities - Updates on the preparation for the upcoming activites - Lay out instructions by the area facilitators - Making of ARAS #1 Dismissal activities were related to re-establishing rapport and updating our worksheet C. All throughout our conversation, Mrs. R was able to give her full attention and put her tasks for the day on hold.

12:30PM-1:30PM 3. Demonstrate attentiveness in todays activities. 1:30PM-3:00PM

3:30PM

2. Working Phase (December 12- 13, 2012) Objectives After an 2 hours of community health nursing exposure in Purok Violeta II Barangay Don Jorge Central Ma-ao Bago City, the client will be able to: Activities 5:30AM-6:00AM Assembly in the Health Science CampusAmphitheatre 6:00AM-8:00AM Preconference - Morning Prayer - Conduct a group bible reading - Checking of Attendance - Staff Development Program c/o PHNs and PCIs - Giving out of final instructions for the day - Submission of individual requirements (HVR # 2) - Group meeting for the Group Planting Small Break Assembly at the school bus Preparation of all things before departure Travel time going to Central Maao, Bago City Meeting of adopted family in their household - Monitoring family health by taking vital signs and Identify current health problem Evaluation After an 2 hours of community health nursing exposure in Purok Violeta II Barangay Don Jorge Central Ma-ao Bago City, the client was able to:

1. State the purpose of this days exposure which is to conduct health teaching planned by the student nurse.

1. Goal Met: When we arrived the student nurse was able to give the plan of the day and the client was able to verbalize, Ahh sige ma tudlo-tudlo namn kamo. Wala gid kaso ah. Namian man ko na gani kay damu man ma learn ko.

8:00AM- 8:30AM

2. Define the topic for the health teaching plan which is Rheumatoid Arthritis

2. Goal Met: During the health teaching the client was open to the topic and asked questions when necessary. The client was also able to verbalize, Amu na gali ang disease na ma kwa mo if wala ka ga wear slippers mag lakat-lakat ka

8:30AM-9:30AM

9:30AM11:00AM

Update the Worksheet C Conduct health Teaching

sa duta. Tapos delikado gd na para sa bata gali.

11:00AM11:30AM 3. Participate actively all throughout the activities for the day.

4. Show importance on the discussion made by the student nurse.

Prepare all requirement before leaving - Signing by the client of the forms (DPA #2) - Informing about tomorrows time and date of arrival and the planned itinerary for tomorrows activities (Herbal Gardening and Alay Linis/ Alay Ligo) - Thanking the family for their time and cooperation Assembly at the school bus Travel time going back to HSC-USLS extension Lunch Break Post Conference - Continuation of Staff Development Program c/o PHNs and PCIs - Evaluating todays activities - Updates on the preparation for the upcoming activities - Lay out instructions by

3. Goal Met: The client was able to set aside her activites for the day and was willing to participate in the days activities.

4. Goal Met: After the health teaching the client was able to verbalize, Importante gid mag suksok slippers always kay wala

11:30AM12:30PM

lang ta kabalo, basi damu higko tiil ta tapos if ma sulod ta sa balay basi gna dala ta man ang higko. Tapos ang pinaka importante ang mag hinaw antes kag tapos kaon.

12:30PM-1:30PM 1:30PM-3:00PM

5. Goal Met: As the days went by and the working phase was coming to and end the client was able to verbalize, Ahay ka subo

5. Display attentiveness as the implementation (phase out) goes along the way.

3:30PM

the area facilitators Group Meeting Giving out of ARAS #2 questions

man ni man. Pila na lang kamo di ka adlaw. Ka dasig lang sang time. Daw sano lang kamo d nag start. Indi nyo gid kami limtan ha. Damu man kami na learn sa inyo tanan.

Dismissal

3. Termination Phase (December 14, 2012)

Objectives After 2 hours of community health nursing exposure in Purok Violeta II Barangay Don Jorge Central Ma-ao Bago City, the client will be able to: 1. Recall all the things learned during our past visits.

Activities 5:30AM-6:00AM Assembly in the Health Science CampusAmphitheatre 6:00AM-8:00AM Preconference - Morning Prayer - Conduct a group bible reading (Group 1) - Checking of Attendance and Paraphernalia - Staff Development Program c/o PHNs and PCIs - Giving out of final instructions for the day - Submission of individual requirements (HVR # 3 and ARAS #3 and HVR #4) - Calling the groups who will handle the mothers class and mental feeding to assess the readiness Small Break Assembly at the school bus Preparation of all things before departure Travel time going to Central Maao, Bago City

Evaluation After 2 hours of community health nursing exposure in Purok Violeta II Don Jorge Barangay Central Ma-ao Bago City, the client was able to: 1. Goal Met: Client was able to verbalize, Wala lang dugay ba, na dumduman ko pa sang una indi ka pa mayo mag Ilonggo. Tapos ga health teaching ka parte sa diarrhea, ear infection, proper environmental sanitation. Pero subong sagad ka na and damu gd ya na learn ko cmu kag sa tanan kamo. 2. Goal Met: Client was able to verbalize,Ang isa ka topic na indi ko gid ma limtan ang ear infection kay bag-o lang to si Child R ga ayo tungod sa ina. Te nami gid to kay damu ko na balan na bag-o kag na inchindihan ko gid na-a may ear infection cya to sang last.

2. Identify one lesson learned from the past three years of our exposure. 8:00AM- 8:30AM

8:30AM-9:30AM

3. Describe ways in which they will put the lessons learned into practices.

9:30AM11:00AM

Meeting of adopted family in their household - Monitoring family health by taking vital signs - Accompanying client to the venue for mental feeding and mothers class

3. Goal Met: Client was able to verbalize, Subong, sa tanan nag n teach mo ang himuon ko gd is to remind si Child R na dapat ma suk-suk gid na xa tsinelas kada gwa ya and maskn ara cya sa balay. Tapos dpat halongan gid cya namun sa may deep

Discussion proper of well nga area kay delikado low cost nutritional meal