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JMJMarist Brothers
Notre Dame of Dadiangas UniversityCollege of Health Sciences
Department of Nursing
A FAMILY CASE STUDY OF THE HOWLETT FAMILY
In Partial Fulfillment of the Requirements
For Community Health Nursing (CHN 0)
For the degree of Bachelor of Science in Nursing (BSN)
Presented to:
Rebecca J. Dela Cruz, RN, MAN
Rue Flora P. Ruiz, RN, MAN
Jose Vicente Faderon, RN, MAN, MBA
Presented by:
Leje Aimee B. Tanggol, SN
BSN - 2
September 19th, 2014
TABLE OF CONTENTS
Table of Contents …………………………………………………………………… i
Introduction …………………………………………………………………………… ii
Chapter I: Family History …………………………………………………………… 4
Chapter II: Family Database ……………………………………………………… 8
A. Family Structure, Characteristics and Dynamics …………………… 8
B. Socioeconomic and Cultural Characteristics …………………………… 8
C. Home and Environment ………………………………………………… 9
D. Health Status of Each Member ………………………………………… 10
E. Values, Habits, Practices on Health Promotion,
Maintenance and Disease Prevention ………………………………… 11
Chapter III: Family Coping Index ………………………………………………… 12
Chapter IV: Typology of Nursing Problems ……………………………………… 17
Chapter V: Problem Prioritization…………………… 22
Chapter VII: Family Nursing Care Plan ………………………………………… 26
Chapter VIII: Insights ………………………………………… 27
Appendices ………………………………………………………………………… 28
A. Barangay Health Profile ……………………………………………… 28
Bibliography
2
CHAPTER I
INTRODUCTION
According to the U.S. Census Bureau (2005), a family is “a group of
people related by blood, marriage, or adaptation, living together.” It can also be
defined as being “composed of two or more people, who live together in the
same household (usually), share a common emotional bond, and perform certain
interrelated social tasks (Allender & Spradley, 2004).
A traditional family is composed of a father, mother and their children, just
as in a nuclear family. The main difference between the two is that a traditional
family has the father as the sole breadwinner of the family. Nuclear or traditional
families are often considered to be the “ideal” family. However, a family
composed of a husband and wife without children, a same-sex couple, or even
an unrelated group of people who share a common purpose is still considered a
family. Whether joined together by consanguinity or by affiliation, the family is a
collective body of persons who live in one house, and under one head or
manager; a household, including parents, children, and servants, and, as the
case may be, lodgers or boarders.
Each family, no matter what type of family they may be, plays an important
role in society. The family forms the basic unit of society, and without families, a
society cannot be formed. Families differ from one another and thus have their
own ways and means of living, and through it, they achieve their own needs and
fulfill their own dreams. Though a family is unique, we can still consider them to
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share common traits. The most common trait that they possess is the ability to
love one another.
The family is a primary reference group, characterized by face-to-face
contact; bonds of affection; sense of loyalty and concern for each other; a
continuity of past, present and future; and shared goals, identity, values and
behaviors common only to the specific unit. It also performs basic functions such
as providing love, security, a sense of belonging and maintenance of order and
control (Wright-Leahey).
The student nurse chose this family because they fit the criteria needed to
classify families with health problems. This provides the student nurse with an
opportunity to minimize and, if possible, prevent these problems with the full help
and cooperation of the family through the use of community health nursing skills.
In this manner, the student nurse can provide care while empowering the family
by giving them the skills they need to maintain wellness.
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Chapter II
PURPOSE OF THE STUDY
A. General Objectives
After a series of nursing interventions, the family should be able to:
1. Identify their problems and needs and perform the actions necessary to
solve these problems on their own.
2. Become aware of their own strengths and weaknesses in order to cope
with various situations and problems that may arise.
3. Achieve a sense of holistic health, wellbeing, and empowerment.
4. Perform the actions necessary for the maintenance of their health
independently.
B. Specific Objectives
After the nursing process, the nurse should be able to:
1. Establish a rapport with the family.
2. Gather the data necessary for the formulation of the family care plan.
3. Guide the family towards awareness of their problems and possible
solutions to these problems.
4. Implement the family nursing care plan, with the cooperation of the family.
5. Evaluate the success of the implemented actions in dealing with the
family’s problems.
6. Provide health teachings for the family to apply to their daily lives.
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Chapter III
INITIAL DATABASE
A. Family Structure, Characteristics and Dynamics
The Howletts’ household is located in Purok 8B, Angie II Village, Barangay
Kawas, Alabel, Sarangani Province. It is comprised of 4 members: Mr. Howlett,
Mrs. Howlett, Young Howlett, and Baby Howlett. The father, Mr. Howlett, is a 23
year-old male and the head of the family. He is married to Mrs. Howlett, a 21
year-old female. Young Howlett and Baby Howlett are Mr. and Mrs. Howlett’s
daughters, and are, respectively, 2 years old and 2 months old.
The Howlett family is a traditional family, with Mr. Howlett as the sole
breadwinner of the family and head of the family. While he works, Mrs. Howlett
takes care of their two daughters and their home.
B. Socioeconomic and Cultural Characteristics
Mr. and Mrs. Howlett both graduated from high school, and their
daughters Young and Baby have not started school yet. Mr. Howlett works as a
carpenter in Lagao, and usually brings home between PHP 3,000 to 4,000 every
month. On weekdays, he leaves early in the morning for work at around 6:00 AM,
and comes home in the evening, at 6:00 PM. Mrs. Howlett is a housewife, and so
does not contribute to their family’s income.
The majority of the Howlett family’s income goes towards their food and
savings. The water in Angie II is free and comes from a deep well, shared by the
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whole community. The Howletts do not have household appliances, and so do
not pay for electricity. They mainly eat rice, vegetables, and fish, and only eat
meat on special occasions or when they can afford it. They do not eat pork,
because they are Muslim. Mrs. Howlett converted to Islam after marrying Mr.
Howlett, and their whole family now practices Islam as well. They mainly speak
Bisaya at home, but understand and speak Tagalog as well.
Mrs. Howlett is active in the community, and takes part in the community
assemblies, often in place of Mr. Howlett because he works during the week.
They spend their weekends together, as a family.
C. Home and Environment
The Howletts own the lot they live on, which was given to them by Mrs.
Angelina Mayol, who made “Angie II” as a relocation area for people living by the
shore to provide them with better jobs and easier living. Their house is made of
light materials, and was built by Mr. Howlett himself. Their lot is 10 meters by 8
meters, and their house is 6 meters by 4 meters. The house is divided into three
areas: a kitchen and dining area, a living room, and a single bedroom where all
four of them sleep. The family cooks inside the house, over a charcoal fire. Holes
in the roof allow smoke from the fire to escape, and there is no running water
inside the house. The floor is unevenly packed dirt and bumpy, making the
furniture (such as the kitchen table) unstable. There are planks of wood stacked
inside the kitchen area, which Mrs. Howlett says Mr. Howlett will use to reinforce
their roof. The planks make it easy for Young Howlett to climb on to and off the
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table, especially when her mother is not watching. The container of water used
for washing dishes and the like was left uncovered, but their drinking water was
covered. There were some toys scattered around the living room area on the
floor, but the whole home was kept relatively tidy. The bedroom has one bed that
takes up most of the space, and there is a hammock hanging from the ceiling for
Baby Howlett to sleep in.
The Howletts keep guinea pigs in a cage outside as pets, and also own
two dogs that are not allowed in the house. They have a small coconut tree and a
guava tree in their front yard, and some small flowering plants along their front
fence. They also have a squash plant, but no herbal plants. The toilet is a water-
sealed toilet with a septic tank, located adjacent to the house, and is flushed by
pouring water into it.
Drinking water is taken from a deep well up in the mountains, but non-
potable water comes from a flowing source within the community, which is free of
charge. The people of Angie II gather around the two sources of non-potable
water to bathe and do laundry. Water for use in the home is taken from these
sources and kept in large plastic containers.
D. Health Status of Each Family Member
The Howletts have no known hereditary sicknesses, such as diabetes
mellitus. According to Mrs. Howlett, she and her husband have no history of
diabetes or hypertension, and do not drink alcohol or smoke. When the student
nurse conducted a urinalysis exam, her urine tested negative for both glucose
and albumin. However, the student nurse was unable to test Mr. Howlett’s urine
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because he was at work during the home visits, and thus unavailable. Mrs.
Howlett had a blood pressure of 110/70 mmHg, a pulse rate of 60 beats per
minute, a respiration rate of 16 breaths per minute, and a temperature of 36.4 〬C.
She had good skin turgor (skin immediately returned to its position after being
pinched) and good capillary refill (less than 2 seconds) as well.
Both Young and Baby appear to be healthy, without displaying signs of
malnutrition such as being underweight, hair loss, brittle bones, etc. Young
Howlett had several open wounds on her legs that appeared to be from bug
bites. When asked about these wounds by the student nurse, Mrs. Howlett called
them “katol” and said Young Howlett got them from playing outside with her
friends.
E. Values, Habits, Practices on Health Promotion, Maintenance and
Disease Prevention
Both of the Howletts’ daughters, Young and Baby, are completely up to
date on their immunizations, and Young was recently dewormed in June of this
year. Mrs. Howlett said that they usually go to the barangay health center for
their health needs, but she gave birth to Baby Howlett at home because she was
unable to reach the lying-in center in time. She is currently breastfeeding Baby
Howlett, and is currently using no other form of contraception. However, she
stated that she plans to get a Depo Provera shot the next time it is made
available by the barangay health workers. She stated that she and her husband
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do not drink alcohol or smoke, and that their family usually eats rice, vegetables,
and fish.
They cook their food over a charcoal fire inside the house, which is at risk
of fire since it is completely made of light, flammable materials. They also leave
their non-potable water uncovered and open to vectors like mosquitos.
The Howletts segregate their garbage and waste, but due to a lack of
garbage-collection services in the community, their main method for disposing of
waste is open burning.
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Chapter IVFAMILY COPING INDEX
Category Ideal Actual Rating Justification
1. Physical Independence
The family members work independent of each other, and
the parents guide their children in
performing their activities of daily living.
They help each other to perform tasks, cleaning the house and good grooming
within each member of the
family.
The family members work
independently of each other, with clearly defined
roles in the family. The
mother performs most of the household
chores while her husband is at work, but he
helps out when he is home.
5 A scale of 5 is given because
the family members work
independently of each other and have their own tasks, but still
help each other out.
2. Therapeutic Competence
The family accepts the
procedures of treatments concerning their own wellness. There is a
better understanding
about the symptoms and causes of the
certain disease/illness
and other principles of medications.
The family is cooperative and
willingly underwent
procedures to assess their
wellness. However, they
failed to demonstrate a
clear understanding
about the causes of certain
diseases/illnesses.
3 A scale of 3 is given because the family failed to demonstrate
a clear understanding
about the causes of
certain diseases.
3. Knowledge of Health condition
The family has adequate
information about their
The family has some knowledge
about the symptoms and
3 A scale of 3 is given because the family failed
to take
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health status and their
health condition.
They know the symptoms,
reasons and prevention on the underlying
principles behind the disease.
Necessary actions are
done in order to cure and solve the condition.
prevention of disease, but failed to take the actions
necessary to prevent the
condition. For example, they had uncovered water containers in the
home.
measures to prevent the condition.
4. Application of Principles of
General Hygiene
The family has an
understanding of the
principles of general
hygiene. The members of the family
apply these principles
regularly, and are well
groomed.
The mother and children are
generally well groomed, and bathe daily.
However, the eldest daughter plays outside
often, and gets dirty very easily.
The student nurse noted dirt in her open wounds
during physical assessment.
Before eating a snack, neither
Mrs. Howlett nor Young Howlett washed their hands before
handling the food. Food was also left uncovered on the table, and open to vectors like flies.
3 A scale of 3 is given because the members of the family failed
to apply the principles of
general hygiene regularly.
5. Health Attitude
The family believes in the
Mrs. Howlett stated that they
5 A scale of 5 is given because
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prevention of illness and in the promotion
of health. They accept
the significance of
health care. They trust in the members of the health care team, and use the
available barangay
health services for their health
needs.
use the services available at the barangay health center for their
health problems, particularly when
they are sick. They also use
preventive measures like the immunization and
deworming programs.
the family trusts in the members
of the health care team, and
uses the barangay
health services available in the
community.
6. Emotional Competence
They can cope with problems and stressors.
The family values
discipline, are responsible for their emotions, and are willing to fulfill their obligations.
The Howletts have a strong familial
bond, and Mr. and Mrs. Howlett talk
over their problems with each other to come up with
solutions.
5 A scale of 5 is given because
the family is tightly knit, with each member
helping the others out.
7. Family Living
The family helps each
other in their daily tasks as a whole. The
children respect their parents, and
the family members
motivate and support each
other.
The family works together as a cohesive unit.
Mrs. Howlett takes care of the
household chores while her husband is at work, but Mr. Howlett helps out when he is home.
Young Howlett also helps her mother—the
student nurse noticed Young Howlett putting
5 A scale of 5 is given to the
family because they help each
other throughout the
day. Each member of the family has their assigned roles,
and this contributes to the health of
the family as a whole.
13
her own toys away when they were scattered on the
floor.8. Physical
EnvironmentThe family
lives in a safe, clean house
that is in good condition and comfortable.
Transportation is not a
problem, and there is a safe place nearby for children’s recreational
activities.
The family lives in a house made of light materials, located on flat
terrain. The floor is made of packed dirt, and is bumpy and uneven. The
house is clean and comfortable, but small for their needs.They cook their meals over a
charcoal fire inside the house,
and burn their garbage. They travel by foot
within Angie II, but there are tricycles available to take them to the main roads and city.
There is a basketball court
outside the house, where the children
play, and a daycare for those
old enough to attend.
1 A scale of 1 is given to the
family because of the condition
of the environment they live in.
9. Use of Community
Facilities
The family is aware of and
uses community
facilities such as the health centers and
welfare organizations,
and possesses
The family visits the barangay health center when health
problems arise, and take
advantage of the available
programs like family planning, immunizations,
3 The family usually uses the barangay health center
for their health needs
14
adequate knowledge about the persons to contact in case of
emergency. Moreover, they are
capable of utilizing the
services within the
community.
and deworming. However, Mrs. Howlett also
stated that she gave birth to Baby Howlett at home, instead of a lying-
in center.
15
Chapter VTYPOLOGY OF NURSING PROBLEMS
Cues/Data Health Problems Family Nursing Problems
Subjective Data “Okay man kay
gagawas ang aso sa
taas,” as verbalized by
Mrs. Howlett.
Objective Data The cooking area is
made of wood, and
the family cooks over
a charcoal fire that is
surrounded by sand.
Smoke escapes from
the fire via holes in the
roof directly above the
cooking area, but still
spreads throughout
the home. The
cooking area is
elevated to waist
height, and the
family’s garbage is
Failure to maintain a home environment conducive to health maintenance
Unsafe cooking facilities1. Inability to recognize
the presence of the condition or problem due to lack of knowledge
2. Low salience of the problem
16
contained in plastic
bags that hang from a
post by the cooking
area.
The rest of the house
is also constructed of
wood and other light
materials, like
bamboo.
Subjective Data “Lisod man gud
magkuha ug tubig kay
layo kayo.” as
verbalized by Mrs.
Howlett.
Objective Data Water needs to be
sourced from one of
the two flowing
sources available in
the community, and
brought back to the
home in large plastic
containers.
Inadequate hygiene habits Failure to maintain proper hygiene habits
1. Difficulties in sourcing
water from the
community due to
distance from the
home
2. Scarcity of water in the
community
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Mrs. Howlett and
Young Howlett did not
wash their hands
before eating. Young
Howlett played on the
ground first before
eating.
The family bathes
daily at the flowing
source of water close
by, but Young Howlett
plays outside and gets
dirty easily.
Young Howlett had
open wounds on her
legs from insect bites,
and had dirt in the
open wounds
Subjective Data “Ginasunog lang
namo among basura
kay wala man naga-
kolekta diri,” as
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verbalized by Mrs.
Howlett.
Objective
The family segregates
their garbage, and
burns the
biodegradable waste.
Bottles and metal
waste are sold, but
other non-
biodegradable waste
is also burnt.
Garbage is stored in
plastic bags that hang
from a post next to the
cooking area
Improper waste management Unsanitary living conditions1. High salience of the
problem
2. Lack of waste
collection services
within the community
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Community Problems:
1. Failure to maintain a home environment conducive to health
maintenance related to risk of fire.
2. Inadequate hygiene habits
3. Unsanitary living conditions due to improper waste management and
disposal
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Chapter VI
PROBLEM PRIORITIZATION AND PROBLEM RANKING
A. Failure to maintain a home environment conducive to health
maintenance related to risk of fire
Criteria Computation Actual Score Justification
1. Nature of the
Problem
2/3 x 1 0.66 This is a health
threat because
this condition
brings a risk of
causing fire, and
with it the potential
of bodily harm.
2. Modifiability of
the Problem
1/2 x 2 1 The problem is
partially modifiable
since the cooking
area is built into
the side of the
home, but the
kalan can be
moved outside, to
reduce the risk of
fire.
3. Preventive
potential
3/3 x 1 1 The risk of fire
decreases if the
kalan is moved
outside, and thus
further away from
the flammable
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materials the
house is made of.
4. Salience 0/2 x 1 0 The family does
not see it see it as
a problem, since
there is sand
placed around the
kalan to prevent
the flames from
spreading to the
rest of the house.
Total = 2.66
B. Inadequate hygiene habits
Criteria Computation Actual Score Justification
1. Nature of the
Problem
2/3 x 1 0.66 It is a health threat
because it may
result to failure to
maintain wellness
and are conducive
to disease.
2. Modifiability of
the Problem
2/2 x 2 2 The problem is
easily modifiable
because the family
gets water every
day from the
source for use
around the house,
and so can
develop proper
22
hygiene habits.
3. Preventive
potential
3/3 x 1 1 Development of
proper hygiene
habits can prevent
a multitude of
diseases, such as
diarrhea.
4. Salience 0/1 x 1 0 The family does
not see this as a
problem, since
none of them are
sick at the
moment.
Total = 3.66
C. Unsanitary living conditions due to improper waste management and
disposal
Criteria Computation Actual Score Justification
1. Nature of the
Problem
2/3 x 1 0.66 There are health
threats because
this condition
provides a
tendency to
acquire disease
and fail to maintain
wellness.
2. Modifiability of
the Problem
1/2 x 2 1 It is partially
modifiable
23
because of the
lack of garbage
collection services
in the community.
There is no way
for the family to
dispose of non-
biodegradable
waste, but they
can dispose of
their
biodegradable
waste through
composting.
3. Preventive
potential
3/3 x 1 1 Proper waste
management and
disposal has a
high preventive
potential because
it will improve the
sanitary conditions
in the home and
reduce the risk of
disease.
4. Salience 2/2 x 1 1 The family sees it
as a problem
needing immediate
attention, but have
no other methods
of disposing of
their garbage.
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Total = 3.66
25
Chapter VII
Family Nursing Care Plan
Health Problem
Family Nursing Problem
Goal of Care
Specific Objectives
of Care
Intervention Plan Evaluation
Nursing Intervention
Methods of
Nurse Family Contac
tA. Unsanita
ry living conditions due to improper waste management and disposal
1. Improper garbage disposal
Inability to recognize the presence of the condition or problem due to lack of inadequate knowledge
2. Inability to provide a home environment conducive to health maintenance and personal development due to
After nursing intervention and teaching, the family will be able to value the importance of proper garbage disposal in the promotion and maintenance of health, along with the prevention of disease.
After 6 days of nursing intervention, the family will be able to:a. Recognize that burning garbage is not a healthy habit.b. Find other
ways and means of disposing their garbage
c. Be aware of the consequences of burning garbage.
1. Discuss to family the benefits of proper garbage disposal.2. Teach the family different methods of garbage disposal, such as composting3. Enumerate different consequences if garbage is burned.
Home Visit
Goals Partially Met.Family was able to realize the consequences of burning garbage in relation to health. However, they still could not find an alternative for disposing their garbage, since the lack of a garbage collection system in the community means there is no other
26
27
Chapter VIII
SUMMARY AND CONCLUSION
Summary
The Howlett family is a traditional family composed of a father, mother,
and their two children. They are residents of Angie II Village, Purok 8B, Barangay
Kawas, Alabel, Sarangani Province. The mother and children stay at home while
the father works as a carpenter in Lagao. The father’s small income is all that
sustains their family, and they fall below the poverty line. This lack of financial
resources led to a host of problems, one of which was unsanitary living
conditions due to improper waste management and disposal.
After a series of health teachings, the Howletts were able to recognize the
importance of promoting the health of their family and preventing illness.
However, they had difficulty implementing the changes necessary to solve their
problems due to constraints such as the lack of a garbage collection system
within the community.
Conclusion
The student nurse was able to provide health teachings to the Howlett
family regarding their situation, and discussed possible solutions to their
problems. Although the Howletts were unable to fully implement the solutions
discussed due to various constraints, they still absorbed the knowledge imparted
through the health teachings. Thus, the goal of this study was partially met.
28
BIBLIOGRAPHY
Cuevas, Frances Prescilla, et al. (2007). Public Health Nursing in the Philippines. Publications Committee, National League of Philippine Government Nurses Inc.
Maglaya, Araceli S. (2004). Nursing Practice in the Community: 4th Edition. Argonauta Corporation, Makati City.
Udan, Josie Quiambao. (2009). Mastering Fundamentals of Nursing Concepts and Clinical Application. Giuani Prints House. Malabon, Philippines
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