CHAPTER IV

Family Coping Index

This chapter presents the Family Coping Index. Family Coping Index provides a foundation for estimating the nursing needs of the family and includes 9 cues that can help us rate the familys ability to cope according to the different criteria set forth in the said index.

Table 2. Family Coping Index of Family Duque CRITERIA Physical Independene IDEAL This category is concerned with the ability to move about, to get out of bed, to ACTUAL The children in the family are physically dependent in terms of personal RATING 3 JUSTIFICATION The rating for this criterion is 3 because all of them are capable of delivering their assigned chores except for some grooming needs of the children like the cutting of nails, the cleaning of ears and the brushing of teeth where the kids are unable to efficiently put into practice yet given their young age. These are some of the areas where the children still need assistance from their parents. 30

take care of daily grooming and grooming, walking, etc. The causes of dependence may vary; lack of physical independence in the family may be due to actual physical incapacity. hygiene. While it is true that the mother tends for them, the personal hygiene and grooming is not given much attention. The children were left to fix their hair and change their clothes and left to study on their own.

Therapeutic Competence

This category is concerned with the knowledge of the procedures or treatment prescribed for the care of illness, such as giving medications, dressings, exercise and relaxation, special diets, etc.

The mother in the absence of medication at the health station would always prefer to seek the services of the hilot for simple fevers, cough and colds of the children. For Mr. Duques diagnosed TB, they utilized the free medications given by the barangay health stations and finished the course for 6 months. However, they failed to have a follow-up x-ray taken due to lack of financial resources. They religiously take their afternoon siesta after their favorite noontime show in TV. The household chores 31

The rating for this criterion is 3 because even if the parents are looking for ways to address the illness in the family, they seek instead the service of an untrained hilot or utilized herbal medication other than bringing their concerns directly to the barangay health station in their area. The fathers vices (drinking, smoking and cockpit derby) are viewed as means of relaxation or diversion from the daily grinds of living. The illeffects of drinking and smoking were known but they do not realize the seriousness of the longtime effects of these vices in their body. The family

and the walks taken in the fields were considered as their form of exercise.

never practiced isolation of sleeping area or separating eating wares of Jun who has an active PTB before treatment and the weeks following treatment where he was still highly infectious. Mrs. Duque was more concerned on the ostracized feelings of Jun than the potential danger it poses to her and their children.

32

Knowledge of This category is Health Condition concerned with the knowledge of the disease or the inability to understand communicability of the disease and modes of transmission, understanding of general patterns of development of newborn baby and the basic needs of the infant for physical care.

The mother claims that whenever the children are sick, she would resort first to a hilot if they do not have money to buy the medicines. They self-medicate for simple fever, cough and colds. She utilizes banaba leaf for hampol (usually placed on the forehead and believed to absorb the heat from the body). She would also prepare calamansi nectar for cough (directly squeezing a mature calamansi juice around a teaspoonful) and administers it for cough. They did not isolate Jun for fear that he will feel ostracized inside their house. 33

The rating for this criterion is 1 because regardless of the health teachings they got from the barangay nurse regarding the infectiousness of Jun, they were unable to apply it in the household because of lack of knowledge about the nature of the disease and how it can be transmitted from one person to another and the gravity the disease can bring to others especially to his household members.

Application of Principles of General Hygiene

This category is concerned with family action in relation to maintaining family nutrition, securing adequate rest and relaxation for family members. Also, the familys ability to maintain cleanliness with their bodies and the surroundings. Meals are wellselected. Habits of sleep and rest are adequate.

The family is used to walking barefooted anywhere along their neighborhood except Mrs. Duque. They are not particular of how they look and how they smell. They can cut nails if they can borrow a nail cutter from their neighbor. The children love to swim in the pond where the carabao takes its bath not far from where they are. Their meals usually consist of rice or cassava if rice is no longer available and affordable, tilapia fish from the pond, and vegetables from their backyard. Dried fish whet their appetite and 34

The rating for this criterion is 1 because the family members has problem regarding general hygiene; from personal hygiene to environmental hygiene. Food intake can be adequate at times but lacked the quality of proper and good nutritional value. Personal hygiene in general is not among their concerns. Infact, as you enter their house, a pack of clutters in assortment will shock you from farming gears, school items, soiled clothes and linens interlacing with newly laundried ones and cobwebs of all sizes

satiates them especially at lunch time where they eat more. They have no proper place for storage of left over foods because they seldom have leftover foods, Mrs. Duque claimed. They sleep soundly at night inside a mosquito net. Their sleep is disturbed only on rainy seasons because some portions of the roof leaks and they would open an umbrella atop the net according to Mrs. Duque and place some collecting pails to areas with bigger leaks.

decorates their ceilings. The family is not also keen in observing personal hygiene. They let the children bath on their own. They allow them to roam around the neighborhood barefooted. They are not really so meticulous with the way they discard their wastes. They simply sweep the area directly around them but they dont mind heaping them up nearby. As air and some dogs scatter the contents of the heaps of garbage, sharp litters are being carried out to where the children usually play. Mosquitoes were all over too in some of the clothing idly set aside.

35

Health Attitudes

This category is concerned with the way the family feels

Herbal and other natural products available in the farm are utilized to

The rating for this criterion is 3 because even though the family is aware of the possible cross infection in their family of a highly infectious disease, they intentionally did not take initial actions to separate and isolate Mr. Duque during his most infective stage.

about health care treat fever, cough in general; including preventive services, care of illness and public health measures. and colds. Mrs. Duque has high regard on hilot and would claim 90% of diseases and complaints are addressed faster by the hilot than a prescription can, which usually takes longer to take effect. The health station and health centers were reserved for more serious illness like TB and health centers are viewed mainly as birthing centers and areas where special procedures are done like the removal of her IUD.

36

Emotional Competence

This category has something to do with the maturity and the integrity of the family members. Their ability to cope with the usual stresses and problems in life; and to plan for happy and fruitful living. The degree by which individuals accept the necessary disciplines imposed by ones family and culture; the

When an issue arises, the couple would exchange heated verbal arguments; but as soon as it was vented over, the husband usually leaves the house, while Mrs. Duque continues to nag until the anger and resentment subsides. They will then go through long periods of silence, carrying out their usual tasks without talking to each other for weeks. The children got

The rating for this criterion is 5 because the family is able to cope positively with the problems that arise in the family. They solve their problems by arguing on it but do not result to any violent reactions. Hurts and bitter feelings are not further aggravated because they would talk about their issues after they were both emotionally prepared to face each other. In the height of anger, Mr. Duque usually leaves the house to work in the field while Mrs. Duque tries to pacify her emotions. The couple is aware of their economic capacities too and

development and affected in a way maintenance of individuals responsibility and decision; willingness to meet reasonable obligation, to accept diversity because a little mistake would cost endless reprimand and yelling. The issues were usually resolved by allowing time to pass to calm down 37

with fortitude, to consider the needs of others as well as ones own.

emotions. On the kids part, the usual cause of trouble is fighting over a toy or a candy. The parents due to their meager resources could not afford to give quality food, clothing, shelter, and education to the children. If times are good, they eat 3 times a day. During worse times, they try to eat at least two times a day and make use of root crops to supply their carbohydrate needs. The children fear the discipline of their father which is spanking, so they were more behaved whenever their father is around. 38

would only resort to borrowing money in emergency cases like when there is an emergent need for consultation to a private clinic.

Family Living

This category is concerned with the interpersonal or group aspects of family life. The ways by

The couple gets along well with each other. The spats and bouts of arguments were considered normal

The rating for this criterion is 5 because the decision making involves both. There is an exchange of opinions and choices; and whose ever idea is feasible, it is being carried out for the good of the family. Their children were wellbehaved and it gave us an impression that they discipline their children fairly well. Respect and gestures of affection were evident too as they exchange stories with us and each other.

which they make and unavoidable. decisions affecting the family, the degree with which they support one another or do things as a family, the degree of respect and affection and the ways in which they manage family budget. The husband and wife help each other in chores at home and caretaking responsibilities in the field. The wife holds the money if they have and she allocates it by setting aside important expenses like lot payment, essential needs of the children and their food. They cannot afford to go malling though, if they have extra money from a sale of pork meat, they would bring the kids to Tacurong, a city nearby and 39

shop for shoes and clothes. They have incurred debts because of Juns illness, hence budgeting for their needs had trimmed down. Physical Environment This category is concerned with the home, the community, and the working environment as it affects the familys health. The condition of the house such as the presence of accident hazards, screening, plumbing system, facilities for cooking and privacy. The house needs repair in order to have adequate space for the whole family in which they can have privacy. They sleep altogether in one room under one mosquito net that is very seldom washed, so the likelihood of transmitting communicable diseases is very suitable. The walls and the roof are dilapidated. The rain can profusely leak through it and they can be peeped inside their house 40 1 The rating for this criterion is 1 because their environment has accident hazards like the presence of sharp objects such as nails and broken bamboo sticks with rough and protruding strands that might accidentally be stepped on. The possibility of the children to fall in the irrigation canal which has no cover and the bridge was made with 3 thin old rounded bamboos. The mosquitoes that

through the holes in the walls. Threats for accident are everywhere. The wares inside the house were topsyturvy and sharp objects like a piece of wood with nails or a bamboo stick that is not sand can cause accidental puncture that could jeopardize their health. The waste and other containers contain water that can be ideal breeding sites for vectors of diseases.

became a prominent dweller of their house comfortably breeding on unattended soiled linens piled for long at a corner of their house. The heaps of garbage openly piled in front of their gate, where cats, dogs, and rats dwell and play.

41

Use of Community Facilities

This category has to do with the degree of the familys use and awareness of the available public facilities for health education and welfare.

The family utilizes the barangay health stations and centers as needed only for what they considered as major illnesses like Juns TB infection. Before that, they

The rating for this criterion is 3 because even if there are resources available in the barangay, they fail to utilize it to meet their health needs. They reason that physical distance most of the time hinder them from seeking the help of the barangay center in Tacurong City. They claimed that the stations nearby always run out of medical supplies when they need it so they would rather access the service of an untrained hilot (no formal training, just known to have skills in treating ailments, usually from superstition like gihiwitan or gibuyagan) who is just few houses

This includes the had made ways in which they would use the services of private physicians clinic, hospital, welfare organizations, churches and other facilities offered by the community. consultation in a private hospital in Tacurong City after a neighbor had lent them money for the said consult. They sought the help of the center after he was positively diagnosed. They got Mr. Duques TB medication regimen at the center. Mrs. Duque had her IUD removed too in that center after consulting a private doctor regarding her 42

complaints of lower abdominal pain and spotting and yellowish discharges. On what they consider as minor and common illness like fever, cough and colds; they just seek help from hilot and do some herbal interventions if paracetamol and antibiotics are not available or if their resources are depleted.

away from them and can deliver relief as well. They seldom go to church claiming it is far and it is too hot to walk toward it sometimes. Mrs. Duque claimed that her children had been recipients of some health services by the government and private organizations like the Ligtas Tigdas and feeding programs in school.

43

CHAPTER V

Typology of Nursing Problem

This chapter presents the different health problems manifested by the family such as wellness state, health deficits, health threats, foreseeable crisis and stress points as well as their computations to determine their highest to lowest priority.

Cues or Data

Family Nursing Problems I. Tuberculosis as a health deficit.

Subjective Data: Mrs. Duque stated Nag sige man balik balik Inability to make decisions with respect to ang TB ni Jun. Kaliwat man abi ini nila. Tatay taking appropriate health actions due to: kag nanay nya amo ini ang kinamatyan amo nga ginahambalan ko gid si Jun magpabulong a. Failure to comprehend the nature, scope, tong nagdupla sya sang dugo. She further magnitude and extent of infectiousness of the added magsige lang baya na sya inom kag disease. sigarilyo mam. Mga napulo ka stick gid ang maubos nya sa is aka adlaw lay maluo-ran daw b. Inaccessibility of appropriate resources for sya. care due to cost constraints or

economic/financial inaccessibility. Objectve Data: X-ray readings read active PTB both lung fields. Pads of rifampicin and isoniazid were shown to us and a positive sputum exam result. Jun assumes a kyphotic posture very typical for TB patients.

44

II. Tuberculosis as a health threat to family Subjective Data: members.

When asked as to why Mr. Duque was not Inability to provide a home environment separated from them (area of sleeping and conducive to health maintenance and personal eating utensils) during its infectious state? Mrs. development due to: Duque answered Ginhambalan ko man sya kag ginhambalan man sya didto sa sentro pero a. Ignorance of the importance of observing nahiubos man sya sa akon pag abot diri sa preventive measures like isolation and

balay. Magtalikod lang kuno sya sa amon kag separation of eating utensils during the first hugasan lang gali ang mga plato kag kutsara two weeks of treatment to prevent crosssang maayo, ngaa lainon pa gid sya? Naakig infection. sya sa akon mam, ti wala na lang ehbahala na lang. b. Lack of or inadequate knowledge in carrying out measures to improve home environment Objective Data: like thorough cleaning and proper waste

The entire family sleeps together in one room disposal, washing of linens and mosquito nets under one mosquito net that had been regularly, separating soiled clothes from newly discolored since it has not undergone laundry laundried ones and washing of the dishes and for quite a period of time. Their plates and not allowing it to stand unwashed for long utensils were seen one on top of the other period of time where flies and cockroaches can unattended. leave their wastes and other contaminants.

c. Unsanitary environmental conditions like allowing garbage to pile up and rot directly in front of their household emitting foul odor that can aggravate respiratory ailments.

45

III.

Family

size

beyond

what

family

resources can adequately provide. Subjective Data: Mrs. Duque exasperatedly verbalized kulang Inability to make decisions with respect to man abi ang kita sa harvest.di gid makaya taking appropriate health actions due to: paabuton na naman apat ka bulan bag-o na naman makakwarta ti indi nabudlayan gid kami a. Lack of knowledge as to what alternative subong nga nagadalagko na ang mga bata courses of action open to the family like sexual buntis na naman ako subong, kunsabagay apat abstinence or pills during the time after her na ka tuig si toto (Kris Mark) puede na sundan IUD was removed. pero abaw dugang na naman ini na gastusan. b. Lack of personal will to make necessary Objective Data: interventions to avoid getting pregnant at a After the removal of Jennifers IUD last June time when the couple is not ready for an 2011, the couple did not immediately decide to additional member in the family. take alternative family planning methods, hence the unplanned pregnancy .

46

IV. Improper waste disposal Subjective Data: When asked about why they do not do Inability to utilize the available community something about the mound of garbage in front resources to address the garbage disposal of their gate, Mrs. Duque replied hindi lang problem due to: man ina amon basura, tanan dira man gahaboy, ti ngaa kami lang abi manglimpyo sina? Kung A Lack of knowledge about the possibility of kis-a kung pisanan kami ti ginasunog namon acquiring diseases since garbage is suitable ang sa babaw na mga papel kag kahoy pero breeding places of vectors such as insects and ang sa dalom ti bulok naman ina ah. We rats. pointed out that the garbage is emitting a foul odor which can bring about some respiratory b. Lack of initiative to perform clean-up problems, she answered naanad na man lang drives actions to terminate the potential kami ah, daw wala naman bahokung source of health threats. maghulaw lang ang ulan ti ga usbong eh. c. Failure to seek the assistance of the garbage Objective Data: collection facility in the community due to lack

Presence of mounds of garbage in front of their of initiative to organize or report and summon bamboo gate and at the back of their house. It the help of the barangay response team to contained all sorts of debris from animal address garbage problems in their vicinity and manure to spare woods with nails, plastic community as a whole. materials, dried leaves, bamboo stems, candy and biscuit wrappers.

47

V. Malnutrition as a heath deficit Subjective Data: Okay man lang ang mga kabataan. Gakaon Inability to provide nursing care to the man bisan ano lang ah, bisan hilaw na kamatis dependent members of the family due to: sawsaw sa toyo ayos na ina na sud-an nila. When asked how often do the children drink a. Lack of adequate resources to provide the milk or whats their protein source? She necessary food for a well-balanced nutrition. answered malaka lang kami ka kaon karne ka baboy o di gani baka. Panagsa kung may b. Lack of knowledge about the nature, magpautang karne diri ti maka kuha man kami magnitude and scope of malnutrition. sang pila ka kilo o di gani kung may birthday ti paihaw kami manok. Kung kis-a gapanarap c. Lack of knowledge and means to monitor lang kami da sa pond ka tag iya ka lupa sang the progress of weight and growth of the tilapia, kung kis-a may haloan man nga children since they fail to view malnutrition as madakop ti maka isda kami. She added gatas a problem. lang bear brand kung may kuarta di gani mangutang sa tyangge sang liberty condensada kay gina sagol sang mga bata sa kan-on, pero lagsik man sila, natural lang man na sa ila nga niwang kay palahampang

Objective Data: Tonette 7 years old weighs 15 kilos when she is ideally 17 to 23 kilos. Kris Mark 4 years old is only 10 kilos when he is supposedly between 12 to 18 kilos for his age. The children are skinny and pale looking. They have poor performances in school when we scanned their workbooks.

48

VI. Inadequate living space Subjective Data: Mrs. Duque viewed home improvement as Inability to make decisions with respect to the least of their concerns for now. Much as taking appropriate health actions in home they want to, other more important concerns improvement due to: like their daily sustenance, clothing,

medication and meeting up payments for the a. Inadequate financial resources to provide lot and personal debts come first. She additional living space. verbalized Gusto man unta namon

magdugang extension pero ti kay pigado man, b. Inadequate knowledge as to take initiative to sakto lang ibayad utang ang kita. She promote privacy among family members like furthered that di man kabalo mamanday si utilizing blankets to make partitions of one Jun, tani kung kabalo sya puede man area from the other. mahinayhinayan unta biskan sako lang anay ang dingding. c. Low salience of the problem attributing home improvement as unnecessary expense for Objective Data: Scarcity is visible and the family. palpable in their home. They only have one room and sleep together under one mosquito net.

49

CHAPTER VI

Prioritization

This chapter shows the prioritization scoring for each health deficits and health threats identified afflicting the Duque family.

Tuberculosis as a health deficit

Criteria 1. Nature Of the problem

Computation 3/3 x 1

Actual Score 1

Justification The problem is a health deficit that requires immediate action, intervention and evaluation after 6 months of treatment to ensure that pulmonary tuberculosis had been completely treated and controlled.

2. Modifiability of the problem

2/2 x 2

The community resources interventions necessary available to the family.

and are

3. Preventive Potential

3/3 x 1

The possibility of cross infection of tuberculosis to the other members of the family is preventable if the disease is completely treated. The family recognizes the existence of the problem and the importance of its immediate treatment.

4. Salience of the problem

2/2 x 1

Total Score

50

Tuberculosis as health threat to family members

Criteria 1. Nature Of the problem

Computation 2/3 x 1

Actual Score 2/3

Justification It is a health threat that does not demand an immediate action for the family.

2. Modifiability of the problem

2/2 x 2

Current knowledge and interventions are available to resolve the problem.

3. Preventive Potential

3/3 x 1

4. Salience of the problem

2/2 x 1

The possibility of preventing cross infection to family members by acting on the intervention like isolating the infected person and separating its personal belongings can reduce or stop the spread of infection. The family perceives it can lead to serious problems and that it needed attention to ensure that cross infection of tuberculosis can be arrested.

Total Score

4 2/3

51

Family size beyond what family resources can adequately provide

Criteria 1. Nature Of the problem

Computation 2/3 x 1

Actual Score 2/3

Justification It is a health threat.

2. Modifiability of the problem

2/2 x 2

Resourcefulness and willingness of the family can be tapped to solve the problem.

3. Preventive Potential

3/3 x 1

The available family resources can be utilized to bring about growth promoting experiences for each family member. The family recognizes it as a problem but it does not view the problem as needing an immediate action.

4. Salience of the problem

x1

1/2

Total Score

4.2

52

Improper waste disposal

Criteria 1. Nature Of the problem

Computation 2/3 x 1

Actual Score 2/3

Justification It is a health threat that does not demand immediate action.

2. Modifiability of the problem

2/2 x 2

With initiative and industriousness, the family can easily modify the problem by utilizing the community resources available to address the garbage problem. Communicable diseases that can be transferred by mosquitoes, cockroaches, rodents and other insects can be prevented. The family perceives it as a health threat but does not consider it as something to be given an immediate action.

3. Preventive Potential

3/3 x 1

4. Salience of the problem

x1

0.5

Total Score

4.2

53

Malnutrition

Criteria 1. Nature Of the problem

Computation 3/3 x 1

Actual Score 1

Justification It is a health deficit that requires intervention to promote normal growth and development of the children.

2. Modifiability of the problem

2/2 x 2

3. Preventive Potential

3/3 x 1

The problem is easily modifiable since it only requires for the mother to be oriented with food substitutes available in the community and to promote proper sleep and rest as well as hygiene practices that can eradicate parasitic infestation to the young members of the family. Susceptibility to other diseases and infection can be prevented if malnutrition is addressed, thereby promoting normal growth and development. It is not felt as a problem.

4. Salience of the problem

0/2 x 1

Total Score

54

Inadequate living space

Criteria 1. Nature Of the problem

Computation 3/3 x 1

Actual Score 1

Justification It is a health threat.

2. Modifiability of the problem

x2

Increasing the living space will entail financial expenditure and the family is not ready for any home improvement given their current economic status. Increasing the living space would mean reducing the chance of cross infection of communicable disease like tuberculosis among family members. It will also give the couple some privacy. A one-room affair is perceived to be a health threat however, financial demands and constraints stop them from taking any immediate action.

3. Preventive Potential

3/3 x 1

4. Salience of the problem

x1

0.5

Total Score

3.5

55

The Prioritized Health Problems

The list of health condition or problems ranked according to priorities is presented:

1. Tuberculosis as a health deficit 2. Tuberculosis as health threat to family members 3. Family size beyond what family resources can adequately provide 4. Improper waste disposal 5. Malnutrition 6. Inadequate living space

5 4 2/3 4.2 4.2 4 3.5

56