INTRODUCTION

A family is a group of individuals who needs improvement, enhancement or help with

regards to their health and their environment whether it is stated by the family or observed
by the health worker. The family is a very important social institution, they have two very
important function namely, reproduction and socialization. It is generally considered as the
basic unit of care in community health nursing for many reasons. It may contribute
knowingly or unknowingly to the development of health problems of its members. It also
performs health-promoting, health maintaining and disease preventing activities. Maglaya
(1997). In many cases the family is the locus of decision making on health matters. It is the
source of the most solid support to its members particularly to the young, the elderly, the
disabled and the chronically ill.

A family health care plan is a blueprint of the care that the nurse designs to systematically
minimize or eliminate the identified health and family nursing problems through explicitly
formulated outcomes of care and deliberately chosen set of interventions, resources and
evaluation criteria, standards, methods and tools.

Primary health worker or the nurse formulates a family health care plan for his or her family
client to individualize and focus the care since every family differs from one another. One
may have a problem that is the same with the other but the intervention may vary due to
the different levels of resources available in the family client. The nursing model for family is
that of the individualized care that is focused on the physical, social and psychological
needs of the total family unit. Nursing care emphasizes delivery of safe , quality care that
optimizes family unity. Therefore, family centered care includes all the family members
namely; the spouses, parents, children, siblings in as many aspects of care and decisions
about care as possible. Family members are an excellent source of patient history and are
essential for effective discharge planning. Information gained from family members is
valuable to the care of the hospitalized patient. The role of the nurse includes listening,
advising, advocating, teaching, encouraging and supporting.

Patient and family centered care is an approach to the planning, delivery and evaluation
of health care that is grounded in mutually beneficial partnerships among health care
providers, patients and families. It redefines the relationships between and among
consumers and health providers. Patient and family centered practitioners recognize the
vital roles families play in ensuring the health and wellbeing of infants, children, adolescents
and family members of all ages. They acknowledge the emotional, social and
developmental aspects which are integral components of health care. They promote the
health and wellbeing of individuals and families and restore dignity and control to them.
Patient and family centered care is an approach to health care that shapes policies,
programs and facility design and staff day to day interactions. It leads to better health
outcomes and wiser allocation of resources, and greater patient and family interactions.
A nurse needs to formulate a family health care plan for his/her clients to determine how to
prevent, reduce, or resolve the identified problems of the family; to support the strengths of
the family; to implement nursing interventions in an organized, individualized and goal
directed manner.

Formulating a health care plan is not simply a means of working for the family;it is more on
working with the family. In participatory planning, the nurse promotes the individualization of
care to the clients.

We should formulate a participatory family health care plan establishing these following
standards:

1. Involve patients and families in all aspects of the planning delivery and evaluation of
health care services.
2. Recognize families as important members of the health care team. Encourage and
support families in planning of care and decision-making.
3. Support patients in involving their families in their health care experiences in ways they
choose.
4. Welcome family members at all times regardless of rounds, change of shifts or other
events on the units.
5. Encourage and support family members to be present during procedures and
treatment, if this is the preference of the patient.
6. Provide information, in ways that patients and families would find helpful empowering
and supportive in nurturing care giving and decision making.
7. Provide easy and accessible opportunities for patients and families to ask questions of
doctor and nurses.
8. Provide care that respects clients’ values, preferences and expressed needs.
9. Coordinate and integrate the care for the patient-coordinate services (i.e. tests,
consultation and procedures).
At the end of our health worker-family client relationship, we expect the following to
happen: to be able to establish a friendly and trusting relationship with the BANA family,
to be able to establish a friendly and trusting relationship with the BANA family , to be
able to help or at least partially solve the health problems of the BANA family and to be
able to make a correct and comprehensive family healthcare plan for the BANA family.

INITIAL DATA BASE

A. Family structure, characteristics and dynamics.
The Bana family has a nuclear type of family composed of the father, Mr
RAYANbana (31y/o), the mother, Mrsvilma Bana (31y/0) and their children, MR
Trebabana(9y0) , Mr Christian Bana (1y/o). They are currently residing at 10
teachers camp, Baguio city. The type of family according to family head,
 decision making and bread –earning is patriarchal. The family have harmonious
relationship towards each other and there is no presence of readily observed
conflict between the members. The children respect their parents and they also
help one another when one of them is in need.
B. SOCIO- ECONOMIC AND CULTURAL CHARACTERISTICS:
The family has an income of P15000 a month. One thousand is allotted for food
and the actual expense per month is 5000, 1000 allocated for health, 3000 for
education ,1000 for feeding, the excess is saved for future use. According to the
mother, the income of her husband is adequate to meet their basic needs. As for
the educational attainment of the family, the father finished his college
education and the mother also finish her college education, the first child is
currently in elementary school, the second child is one year old and stays at
home. The mother was baptized in Ilocos and the rest of them are baptized at
st.--------------- They do not go to mass regularly. They are roman catholic. The
father is from ILOCOS, and the mother is from baguio. When they got married,
they had already stayed in Baguio, the father is a office worker and the mother
as a house wife.
C. HOME AND ENVIRONMENT
The family generally has a clean environment but has presence of breeding site
for vectors, specifically mosquitoes and the house is located close to the cliff
hence the children are at risk for falls especially that they play outside the house
near the cliff. The house of the family has 2 bedroom single bed, size of the
sleeping bed 6 sq m. The type of materials used for the house is concrete walls
and galvanized roof. The food is stored in a refrigerator, a medicine cabinet is
absent, the keep poisons under the cabinets under the sink. They are using a gas
range with a safety device. There is no stairs present in the house, they do not
have a habit of leaving sockets with plugs still connected. They always make
sure that when they leave, the gas stove is turned off and all the electric wirings
are checked. The family members always wear shoes when going outside the
house and when using the comfort room. There is no presence of slippery floor.
They have a dog present. The water supply is from Baguio water district, but the
source for drinking is from the purified water delivery. Thewater is stored in a
water dispenser and the water used for cooking is readily from the faucet. Water
used in the house is boiled. The toilet facility is water system toilet owned. The
toilet has no foul odor, no presence of flies. Garbage disposal is collected every
Tuesday; classification of garbage collection is practiced by the family. Their
drainage system is open and stagnant. Urban is the type of neighborhood that
the family has and the houses has a distance of approximately 3ft apart, there is
presence of broken pipes in the environment. The area is generally congested.
Social and government facilities that are available are the convention centers.
D. HEALTH STATUS
Mrs. Vilma Bana had pre-natal check-ups done every month of all pregnancies
before on her 1st and 2nd child. She gave birth to all her children at Baguio
General Hospital. All were normal delivery. Presently there is no sick member of
the family. The usual content of their food during breakfast is noodles and lunch
is rice with viands or rice with chicken, during dinner, also varied viands with two
to three cups of rice. They are not smokers but they consume alcohol
occasionally.
E. VALUES AND PRACTICES ON HEALTH PROMOTION/ MAINTENANCE AND DISEASE
PREVENTION.
The children in the family have completed all the immunizations. The first
child received BCG, 1ST, 2ND, 3RD Hep B, OPV, DPT, PCV, PENTA, 1st and 2nd
MMR. The second child received BCG, 1st, 2nd and 3rd Hep B, OPV, DPT,
MMR. Mrs. Vilma reason for submitting her child for immunization is for
protection of her children against disease. She had a complete
immunization for Tetanus Toxoid. Most parent do not know if they had a
complete immunization during their childhood. Mrs. Vilma is currently using
a family planning method IUD. Mrs. Vilma has a 6 hours of sleep a day. Mr.
Bana has 7 hours of sleep which is continuous. The children has a 8 hours
of sleep which is only continuous. Naps are present for all except for the
father because of his work. Mrs. Vilma’s relaxation activity is sleeping and
watching TV, the children also relaxed through watching TV and playing
games. They exercise by walking once a week every Sunday.

IDENTIFIED HEALTH STRENGTHS/ PTENTIALS AND IDENTIFIED HEALTH

NEEDS PROBLEMS
1. Regular exercise Risk for accidental
Subjective: hazards.
 Clients claimed that they Objective
exercise once a week by  Presence of
means of walking. broken pipes
around the house.
Objective:  House is located 3
 Family looks fit ft close to a cliff.
 Absence of obesity  Children playing in
a cliff.
2. Good personal hygiene Presence of breeding
O: and resting sites for
 Clean nails vectors.
 No body odor Subjective:
 Clean clothes  “We have a lot of
mosquitoes and
flies around.
Objectives:
 Open drainage
and stagnant
water.
 Mosquitoes seen
flying around
doors a nd
windows.
 PRIORITIZATION OF IDENTIFIED HEALTH PROBLEMS

Health Problem: Threat of cross infection from a community disease r/t open drainage
system.

CRITERIA SCORE JUSTIFICATION COMPUTATION ACTUAL SCORE

GIVEN
Nature of the condition or the 2 The problem is 2/3x1= 0.66 0.66
problem present a health threat
and requires
immediate
attention.

Modifiability of the condition or

problem

a. Current knowledge, 3 There is no 3/2x2= 3 3

technology and adequate
intervention. knowledge
about
harboring
infectious
diseases from
their
environment.

b. Resources of the 2 There is no 2/2x2= 2 2

community where the enough
family lives. resources in
the community
such as steel
bars, cement
and etc. to be
used to fix the
drainage
system.

c. Resources of the family 3 The family has 3/2x2= 3 3

no enough
financial
support to fund
the situation to
improve the
drainage
system.
 The nurse 1/2x2= 1
d. Resources of the Health 1 could help in
worker terms of man
power.

Preventive Potential The family 1/3x1= 0.33 0.33

a. Gravity/Severity of the 1 haven’t
problem experienced
any diseases
related to the
problem.

All of the 2/3x1= 0.66 0.66

b. Duration of the Problem 2 family
members are
risk in
acquiring
diseases such
as dengue,
malaria, and
etc.

The family 2/3x1= 0.66 0.66

c. Presence & 2 observed
Appropriateness of cleanliness of
current management the drainage.
initiated by the family

Some 2/3x1= 0.66 0.66

d. Exposure of any 2 members of
vulnerable/ high risk the family is
group. school aged,
infant and
adult.

The family 1/2x1= 0.5 0.5

Salience 1 thinks the
situation
doesn’t need
immediate
action.

TOTAL 12.47
 Health Problem: Accidental hazards related to broken pipes and broken stairs.

CRITERIA SCORE JUSTIFICATION COMPUTATION ACTUAL SCORE

GIVEN
Nature of the condition or the 2 The problem 2/3x1= 0.66 0.66
problem present is a health
threat it
doesn’t
require
immediate
attention.

Modifiability of the condition or

problem

a. Current knowledge, 2 There’s an 2/2x2= 2 2

technology and adequate
intervention. knowledge
and
technology
on how to fix
broken stairs
and remove
broken pipes.

b. Resources of the 2 There is 2/2x2= 2 2

community where the enough
family lives. resources in
the
community
such as rocks
that can be
used for the
stairs and
only
sacrificing
time to
remove the
broken pipes.

c. Resources of the family 1 The family 1/2x2= 1 1

can able to
financially
support to
fund this
situation but
 with
assistance
coming from
the
community
especially
man power.

d. Resources of the Health 1 The nurse 1/2x2= 1 1

worker could help in
terms of man
power.

Preventive Potential
a. Gravity/Severity of the 2 The children 2/3x1= 0.66 0.66
problem are playing
outside the
house.

b. Duration of the Problem 3 All of the 3/3x1= 1

family
member are
prone to
accident.

c. Presence & 0 The family 0/3x1= 0 0

Appropriateness of current haven’t done
management initiated by anything to
the family solve the
problem.

d. Exposure of any 3 The family 3/3x1= 1 1

vulnerable/ high risk group. members are
school aged,
and infant.
 1 The family 1/2x1= 0.5 0.5
Salience thinks that the
situation
doesn’t need
immediate
action.

TOTAL 9.82

Health Problem: Risk for infection related to presence of breeding site for vectors

Criteria Score Justification Computation Actual

Given Score
Nature of the condition or the 3 The problem 3/3x1= 1 1
problem present is health
deficit it
requires
immediate
attention.

Modifiability of the condition or

problem

a. Current knowledge, 1 They are 1/2x2= 1 1

technology and aware on
intervention. some of the
programs
and
practices of
DOH such as
“operation
taob” and
“Sabayang 4
o’clock
habit”.
 b. Resources of the 1 There are 1/2x2= 1 1
community where the NDP’s that
family lives. are going to
the
community to
inspect every
household
and to
educate the
family.

They have 1/2x2= 1 1

c. Resources of the family 1 knowledge
needed to
improve the
situation.

The nurse 1/2x2= 1 1

d. Resources of the Health 1 could help in
worker terms of
knowledge to
educate the
family.

Preventive Potential
a. Gravity/Severity of the 1 The family 1/3x1= 0.33
problem members
haven’t
experienced
diseased
caused by
vectors such
as dengue,
malaria.

b. Duration of the 2 The family 2/3x1 2

Problem are at risk for
diseases
caused by
infections
related to
 vectors.
c. Presence & 1 They haven’t 1/3x1= 0.33 0.33
Appropriateness of done
current management anything to
initiated by the family improve the
problem.

d. Exposure of any 3 The family 3/ 3x1= 1 1

vulnerable/ high risk members are
group. school aged,
infant and
adults.

Salience 1 The mother 1/3x1= 0.33

recognized
the problem.

TOTAL 8.99

Complete list of prioritized family problems

Family Problems Score

1. Threat of cross infection from a community disease r/t open 12.47
drainage system.

2. Accidental hazards related to broken pipes and broken stairs. 9.82

3. Risk for infection related to presence of breeding site for vectors 8.99
Risk for infection

HEALTH FAMILY NURSING GOAL/OBJECTIVE INTERVENTION RATIONALE EVALUATION

PROBLEM PROBLEM
Risk for - Inability to Short term goals - Teach - to improve Family was
infection perceive it - To teach family environme able to
as health family that how to ntal undersatand
threat there clean sanitation the
- Lack of
drainage breeding importance o
knowledge
about
may sites, such environmenta
what flies become as open sanitation,
and breeding drainages keep
rodents sites for . drainage
could insects - Teach the - to closed and
cause to which adult increase clean,
the carry member their The family
family’s diseases the knowledg demonstrate
health. and can advantag e about proper
harm the es of breeding method of
family. having a sites for cleaning
- To teach clean vectors drainages.
family environm
how to ent in
stop relation of
breeding eliminatin
sites from g the
building breeding
up. site.
- Discuss - To create
disease awareness
they can \and
acquire improve
from their
insects knowledg
and e
rodents
and how
they can
prevent it.