CHN

A Case StudyPresented to the Faculty of

The Ateneo de Davao UniversityCollege of Nursing

In Partial Fulfilment for the Requirements inNursing Care Management 101 [Related Learning Experience]

A Community Case Study of the C Family

Submitted to:

Clinical Instructor – Community Health Nursing in Purok 2, Tugbok District Mintal

Submitted by:Lim, Stephanie Marie

Madrazo, Benedict EdmundMangitngit, Jeferson

Margaja, Dominique DawnMaulion, John Charls

Mendoza, Kathreen GlaizaNalzaro, Sheena Anne

Omandac, AlyssaOlalo, Angeli M.

BSN 3E; Group 3; College of Nursing

December 2, 2008

TABLE OF CONTENTS

Introduction...............................................................................

Acknowledgement....................................................................

Objectives.................................................................................

Initial Data Base........................................................................

First and Second Level Assessment..........................................

Family Coping Index................................................................

Prioritization of the Problems...................................................

Family Nursing Care Plans.......................................................

Conclusion and Recommendation............................................

References.................................................................................

Appendices................................................................................

INTRODUCTION

Community Health Nursing according to the World Health Organization (WHO)

is concerned with the promotion of health, improvement of conditions in terms of

physical and social environment, rehabilitation and prevention of illness or disability. It

is to render service which the nurses and clients work together to identify specific goals

related to wellness promotion, disease and illness prevention, health restoration, and

coping and altered functioning, which are most important to the client, and to match

them with the appropriate nursing actions.

As of November 2008, the world's population is estimated to be about 6.72

billion (6,720,000,000). In line with population projections, this figure continues to grow

at rates that were unprecedented before the 20th century, although the rate of growth has

almost halved since its peak of 2.2% per year, which was reached in 1963. The world's

population, on its current growth trajectory, is expected to reach nearly 9 billion by the

year 2042; While in the Philippines, the world's 12th most populous country with a

population of 90 million people. Its national economy is the 46th largest in the world

with an estimated 2008 gross domestic product (GDP) of over US $154.073 billion.

There are more than 11 million overseas Filipinos worldwide, about 11% of the total

population of the Philippines. It is a multi-ethnic country. Ecologically, The Philippines

is considered to be among 17 of the most megadiverse countries in the world.

As of 2005, just ten countries account for over 75% of the 27 million children who

remain unimmunized every year. WHO is working closely with these countries to identify the

weaknesses in their immunization systems, and to search for solutions. In large countries it are

often only a few areas that are responsible for most unimmunized children, making it necessary

to take a sub-national, area-tailored approach. It is possible that through GAVI in the future

funding will become available to specifically address the issues faced by these large countries.

For three weeks, BSN 3E were assigned to provide free health services that

address the health needs, problems and concerns of all people in Tugbok District, Davao

City. We implemented buddy system wherein we choose a partner in interviewing our

chosen family with different cultures and backgrounds. For our Case Study, we chose the

C Family because we see them as a cooperative and interesting family. In addition, we

can see what their different perceptions in terms of health are.

ACKNOWLEDGEMENT

First, we would like to thank the Almighty God for giving us guidance, strength

and enlightenment upon doing this case study.

Second, we would like to thank each and everyone’s parents for their undying

support financially, physically and emotionally.

Third, we would like to thank our dearest clinical instructors, Ms. Margie Miano,

Mrs. Loreen Marcelo, Mrs. Neriza Gudoy and Ms. Mary Anne Silvino for guiding us in

choosing the appropriate family for our case study and for giving us some guidelines that

could help us in acquiring necessary information.

Fourth, we would like to thank our groupmates for their cooperation and

determination to finish and learn something from this case presentation.

Fifth, we would like to thank the people of Purok 2, Tugbok Distict for their

warm welcome and appreciation to all our activities and projects.

Lastly, we would like to extend our heartfelt gratitude to the C family for their

willingness to involve themselves openly in this case study.

OBJECTIVES

General Objectives:

To conduct a thorough case study about the C Family residing in Manga St.,

Purok 2, Barangay Tagakpan, Tugbok District, Mintal, Davao City according to data that

was gathered by conducting a series of interviews within a total of 9 days community

exposure [3 days a week for 3 weeks].

Specific Objectives:

* To present the C Family’s Initial Data Base (IDB) containing information which will

reveal the family’s structure and characteristics, socio-economic and cultural practices,

environmental factors, health assessment of each member, and values, habits and

practices on health promotion maintenance and disease prevention.

* To present the family’s Genogram containing information that will help out in tracing

any hereditary risk factors.

* To come up with the Typology of Nursing Problems that will explain which data

from the IDB has the nature of being a hazard to the health of the family.

* To score the initial and final Family Coping Index (FCI) identifying the effectiveness

of the nursing interventions implemented within the time spent with the family.

* To Prioritize the Problems identified within the family data according to how they are

scored by ways of identifying the nature, modifiability, preventive potential and salience

of each problem.

* To present the Family Nursing Care Plans (FNCP) developed for the most prevalent

problems identified in the Typology of Nursing Problems.

* To have our Conclusions and Recommendations about the Case Study.

* To present our Appendices for references.

INITIAL DATA BASE

A. FAMILY STRUCTURE AND CHARACTERISTICS

Family Name: C familyAddress: Manga St., Purok 2, Barangay Tagakpan, Tugbok District, Mintal, Davao City

Name Age SexCivil status

Position in the family

Relationship to the head

of the family

Place of residence

Ethnic back-

ground

Mr. A 24 M Married Father Head of the family

Purok 2, Manga St., Tugbok, Davao City

Davaoeno

Mrs. B 22 F Married Mother Wife Purok 2, Manga St., Tugbok, Davao City

Davaoena

Baby girl 2 F Single Eldest child

Daughter Purok 2, Manga St., Tugbok, Davao City

Davaoena

Baby boy 11m

M Single Youngest child

Son Purok 2, Manga St., Tugbok, Davao City

Davaoeno

Type of family structure:

The C family is nuclear according to membership since they all live together and

with no other relatives living with them. In terms of descent, the family is matrilineal

since the members of the family affiliates with a group of relatives who are related to

them through their mother. The family resided near Mrs. B’s mother that is about five

meters away from their house and this makes the family a matrilocal type according to

residence.

Dominant family members in terms of decision-making, especially in matters of

health care:

When it comes to decision-making, especially in matters of health care, they both

have an equal say. Whenever there are misunderstandings and problems in the family,

they get to have mature conversations to solve whatever conflicts they have, thus the C

family shows an egalitarian type when it comes to authority.

General Family Relationship:

It is unavoidable that in every family certain issues arise which causes conflicts

between both parents as well as their children. According Mrs. B, they seldom quarrel

about their financial needs but when they do, they see to it that they get to talk and find

ways to solve their problem. What they usually quarrel about is Mr. A’s drive for sex. As

for their kids, when they are placed in the same crib with toys, this will end up with one

kid taking the toy of the other leading to a tug of war between both kids.

Activities of Daily Living:

Sleeping pattern:

The members of the C family especially the young ones observe 7:00 pm as their

sleeping time while Mr. A and Mrs. B observe 10:00 pm as their sleeping time. The

mother and the father usually wakes up at around 5:00 am to 6:00 am to get their

breakfast ready and wash their dirty clothes. The kids, Baby Girl and Baby Boy, usually

wake up at 7:00 am just in time for breakfast.

Eating pattern:

The family is able to eat three times a day and this includes breakfast served at

7:00 am, lunch at 11:30 am, and dinner at 6:30 pm. What they usually have for their meal

are vegetables, fish, and rice. Sometimes boiled eggs, noodles, sardines, and dried fish

are served.

Leisure time activities:

The family owns a 12 inch television and this is their source of entertainment and

relaxation. Sometimes they would go to Mrs. B’s mother whose house is adjacent to

theirs and they would talk about their problems of there are any.

B. SOCIO-ECONOMIC AND CULTURAL PRACTICES

Family Members

Occupation Place of work

Income Educational attainment

Religion Ethnic background

Mr. A Multiple jobs (e.g.

construction worker)

Tagakpan Php 3600 per month

High school graduate

Roman Catholic

Davaoeno

Mrs. B Housewife N/A N/A High school graduate

Roman Catholic

Davaoena

Baby girl

N/A N/A N/A N/A Roman Catholic

Davaoena

Baby boy

N/A N/A N/A N/A Roman Catholic

Davaoeno

Family Expenses

Food 50.00%

Electrical Bill 4.45%

Water Bill 6.12%

Rent 8.34%

Miscellaneous-clothes-toiletries-transportation-etc.

31.09%

Decision Maker about Financial matters:

In the C family, both the mother and father make the decision when it comes to

allotment of monthly income.

Significant others:

Just about five meters from the house of C family is the house of Mrs. B’s

mother. The family shows a close relationship towards Mrs. B’s mother except for Mr.

A. According to her mother, Mr. A does not work hard enough for his family that’s why

she does not like him that much. But even though she does not like him she still

considers Mr. A part of the family.

Relationship of the family to the larger community:

According to Mrs. B they are not that participative with the barangay activities

and organizations. However, they participate in celebrating their fiesta is they have

money and when they were asked to attend our lecture and culmination day they were

present and they actively participated.

In terms of health care, the family avails some of the government programs for

immunizations and vitamins. Every month a BHW visits every household in their area

and provides medicines for the children.

C. ENVIRONMENTAL FACTORS:

Housing:

The C family rents their house and they pay Php 300/month. It is made up of coco

lumber and bamboo, and woven coconut leaves for their roof. The windows are

unscreened and the roof has some holes on it, that during rainy days, the water drips

inside the house. They use electricity for lighting and for the use of their television with

which they pay Php 160/month.

They have a kitchen and at the same time a dining area, a living room and at the

same time a bedroom, and a room where their television as well as their clothes and

beddings are placed. They have a 12 inch television, 1 long bench, a table with one bench

in their kitchen, and one shelf.

There is inadequacy of living space since they do not really have a specific or

separate area where they can cook, sleep, and watch TV.

The family spreads a mat in the floor where they all sleep together except for

Baby Boy since he sleeps in his hammock or “duyan”. They also use mosquito nets to

protect themselves from mosquito bites.

There are presence of pests inside the house which includes mosquitoes,

cockroaches, lizards, and flies. An open canal is also present outside their house with a

wooden unsteady bridge, and tires were also seen with stagnant water on them which

serves as a good breeding ground for mosquitoes. Protruding nails are also present which

serves as a possible accident hazard.

They prepare their food using firewood and charcoal, and uses utensils such as

plastic plates, spoons, forks, and cups when they eat. However, these utensils are not

properly stored and kept in their cupboards and are exposed to vectors which poses a

threat to their health. Their water supply comes from ‘nawasa’ which they use for

bathing, washing their clothes, cleaning their utensils and for drinking. They store their

drinking water in 1 liter plastic bottles which, when observed closely, are not really

clean.

The family has a bathing area but they don’t have their own toilet facility. Their

bathing area is not clean, cannot fully provide privacy when one takes a bath, toiletries

are not properly kept and are exposed to contact with flies, chickens and cats. When they

have to use the toilet, they still have to go to Mrs. B’s grandparents which is

approximately 80 meters from their house and is located across a wide, running river.

According to Mrs. B, the toilet is a water-sealed type.

Kind of Neighborhood

The family’s house is located at Manga St., Purok 2 of Tugbok, Davao City. The

houses in the community are quite congested and not adequately spaced from each other.

Social and health facilities available

The C family was not able to fully avail of the facilities and medicines that should

be available in the health center. This is because every time they go there to ask for

medicines, they were always told that no medicines are available.

Communication and transport facilities

Tugbok can be reached by riding in a jeepney for 30 to 45 minutes from the city

proper. They either ride on PUJs or motorcycles if there is a need to go to a certain place.

They use their cellular phones as their means of communication.

D. HEALTH ASSESSMENT OF EACH MEMBER

Family Member Past illness and health actions taken

Mr. A About 1 year ago Mr. A had seen a pimple-like lump on

his chest with pus present around it. They used an

antibiotic given to them by a friend who used to be a

pharmacist. They also applied the concoction from the

leaves of cacao, mayana, and mansanilyas to treat it.

Mrs. B While Mrs. B was still pregnant, she did not go to the

doctor for her prenatal check-up. According to her, she

was too tired and lazy to have her check-up done. She was

on NSVD when she gave birth to her first and second

child. About two months after she gave birth to her second

child she took trust birth control pills given by her mother

since she does not want to be pregnant for the third time.

She took those pills for 6 months and consumed 6 pads.

By August of 2008 she stopped taking it since she

experienced pain around her breasts. The pain eventually

went after and she did not bother anymore to consult the

doctor.

Baby Girl According to her mother, when Baby Girl was just about

1 year and 2 months old, she experienced itchiness around

her arm. When they went to the doctor and they were

given prescriptions of ointment.

Baby Boy The youngest child of the family did not experience any

serious illness. He only experienced fever, cough, colds,

and flu. The mother consults the “manghihilot” if ever he

has fever.

There are times wherein the family prefers to go to a “manghihilot” rather

than to a doctor. This is because it would take too much time for them to go to a

doctor and it would cost them a lot when compared to a “manghihilot”. There are

also times wherein they self-medicate. However, they also consider seeking help

from a medical practitioner if the situation demands it.

E. VALUES, HABITS, PRACTICES ON HEALTH PROMOTION,

MAINTENANCE AND DISEASE PREVENTION

According to Mr. A, he was completely immunized. He received the needed

immunizations before he reached 1 year old. However, Mrs. B, Baby Girl, and Baby Boy

were not able to receive the needed immunizations. When Mrs. B’s mother was asked

whether Mrs. B was fully immunized or not, she said that she was only given BCG when

she was born. After that, she was not able to receive any other immunizations. The only

immunization that Baby G did not receive is measles and the only immunization that

Baby Boy received was BCG.

When Mrs. B was asked why her children did not receive the needed

immunizations, she said that with Baby Girl she was too lazy to go to the health center

and have her baby immunized. As for Baby Boy, she had misconceptions when one of

her friend’s baby died after being immunized while the baby had fever.

The C family agreed to consult a health care professional after they were

advised to ask whether they be allowed to receive immunizations past the required age.

They were also continuously reminded of the importance of strict sanitation and hygiene

since a strict compliance will greatly protect their family from illnesses and diseases.

TYPOLOGY OF NURSING PROBLEMS

Cues First level assessment

Second level assessment

Subjective:

“Wala man dyud mi nagaaway tungod sa kwarta, nagalalis lang mi pirminti about sa isa ka butang. Dili naman gud ko gusto magkaanak, unya kapoy pa ko pirminti sa mga trabaho sa balay og sa pagbantay sa mga bata. Unya kada uli ni mister or sayo pa sa buntag kay manguhit na siya pero dili naman dyud ko. Mao ng pirmi na lng pud na siya saputon. Pati mga bata kay madamay sa iyahang pagkasapot.” – as verbalized by Mrs.B

Objective:

We observed that Mrs. B’s facial expression is full of emotion and her voice is really sincere and true to her words.

Mrs. B’s mother agreed with what Mrs. B told the interviewers during the interview for she also witnessed the confrontations between the couples.

Unmet sexual urges of Mr. A as foreseeable crisis situation

Inability to provide a home environment which is conducive to health maintenance and personal development due to displacement of frustrations toward the children.



Subjective:

“Kung muulan kay usahay lapok kaayo ang gawas sa balay ug mutaas pud ang tubig sa kanal.” -As verbalized by Mrs. B.

Objective:Outside their house, along the road is an open canal.

Open canal as accident hazard.

Inability to recognize the presence of the condition of the problem due to ignorance towards the issue.

Inability to provide a home environment conducive to health maintenance and personal development due to inadequate family resources.

Subjective:

“Wala man gud natarong panday amoang balay kay gina rentahan raman gud namo ni.” -as verbalized by Mrs. B.

Objective:

Protruding nails in their living room and kitchen in one.

Exposed nails from the wooden walls as accident hazard.

Inability to provide a home environment conducive to health maintenance and personal development due to inadequate knowledge and initiative for preventive measures.



Subjective:“Muadto baya ko og Malaysia karong January para magtrabaho. Mamiss dyud nako ang mga bata pati akoang asawa.” -as verbalized by Mrs. B.

Objective:Mrs. B will leave her whole family to work as a domestic helper in Malaysia this coming January 2009. The mother of Mrs. B also agrees with what Mrs. B told us.

Resettlement in a new community and separation from the family as foreseeable crisis situation.

Inability to provide a home environment which is conducive to health maintenance and personal development due to single parenthood.

Subjective:“Wala nabakunahan og anti measles si Baby Girl. Si Baby Boy kay hantod BCG lang pud. Nahadlok man gud ko maparehas sila sa namatay na anak sa akoang amiga nagpabakuna mintras nay kalintura human namatay. Unya, wala pa dyud mi natagaan ug tambal para sa filariasis.”-as verbalized by Mrs. B.

Objective: according to the Purok leader, the community has not yet been given prophylaxis against filariasis.

Lack of immunization/inadequate immunization status especially of children as presence of health deficit.

Inability to make decisions with respect to taking appropriate health action due to failure to comprehend the nature/magnitude of the problem/condition.

Failure to utilize community resources for health care due to misconceptions and fears.



Subjective: “Naa pud mi problema sa kwarta kay kulang man pud sweldo sa akoang asawa pero dili gyud ingon na mag away mi tungod ana kay dali man lang pud mi makapangita ug pamaagi.” -as verbalized by Mrs. B.

Objective:

They don’t have rice as of the moment. The milk supply for the baby is not enough. They are experiencing scarcity most of the time for their daily needs.

Family resources not adequate for family needs as a stress point.

Inability to provide home environment conducive to health maintenance and personal development due to limited financial resources.

Subjective:

“Pasensya na ha, gamay og gubot dyud mi og balay. Hugaw pa dyud” -as verbalized by Mrs. B.

Objective:Poor home facilities and resources. Unsanitary environment,Inadequate living space, there are garbage’s around and stagnant water with wrigglers in an unused water container.

Inadequate living space, presence of breeding or resting sites of vectors of diseases such as mosquitoes, cockroaches and rodents; improper garbage disposal and unsanitary waste disposal as health threat.

Inability to make decisions with respect to taking appropriate health action due to lack of community resources.

Inability to provide home environment conducive to health maintenance and personal development due to inadequate knowledge of importance of hygiene, sanitation and preventive measures.



Subjective:“Nagainom man gud akoang bana pero wala siya naga panigarilyo.” -as verbalized by Mrs. B.

Drinking alcohol as unhealthy lifestyle and personal habits/practices.

Inability to recognize the presence of the condition or problem due to lack of or inadequate knowledge.

Subjective:“Dili man close sila mama ug akoang bana. Dili man dyud gusto ni mama akoang bana.” -as verbalized by Mrs. B.

Objective: The mother of Mrs. B agrees with what Mrs. B told the interviewers.

Interpersonal conflicts between family members as stress provoking factors.

Inability to provide a home environment which is conducive to health maintenance and personal development due to unhealthy family relationship.

Subjective:

“Pagmagkasakit akoang mga anak kay ginapalitan dayon nako sila ug tambal ug ginapainom dayon. Usahay, ginapahilot nalang pud namo.” -as verbalized by Mrs. B.

Self-medication as unhealthy lifestyle and personal habits/practices.

Failure to utilize community resources for health care due to lack of/inadequate knowledge of community resources for health care.

FAMILY COPING INDEX

The family coping index is the profile of the family’s capacity to deal with problems associated with health care. Its

purpose is to provide a basis for estimating the nursing needs of the family. The following tables represent the nine areas

comprising the family coping index of C family during our community exposure at Purok 2 Tugbok district, Mintal D.C.

during our exposure last November 13-29, 2008.

Date Coping Area Initial Score

Justification Health Teachings Date Final Score

Justification

PHYSICAL INDEPENDENCE

5 All the family members can perform activities of daily living such as taking a bath and doing household chores. The family is also able to attend to the needs of other members especially to the needs of the children. Each and every one of the members is capable of caring for themselves.

Encourage the family must ensure that adequate physical care is given to one another without the cost of neglecting the need of one member. Also the mother must train her children especially the eldest one to perform simple task appropriate for her age such as eating and drinking by herself.

5 The family members are capable of performing the activities of daily living and can attend to the need of other family members especially the children. There is no presence of any physical disabilities present among the family members.

THERAPEUTIC COMPETENCE

3 The Family can carry out some but not all of the procedures on treatment for the care of illness and maintenance of health. They usually take OTC drugs when they rae suffering from from cough, fever, colds, diarrhea, headache and muscle pains. They sometimes use herbal meds such as malunggay and pau d’ arco.

Teach the family that administering or taking over the counter drugs is not advisable especially without the recommendation of a health care professional because it may not be effective and may alter the effects of other drugs taken by them.

3 The family had been informed regarding the benefits of carrying out the treatments prescribed by a health professional if ever an illness occurs and not treat mild sickness using OTC drugs only advised by their relatives and friends.

KNOWLEDGE OF HEALTH

CONDITION

3 The family has some general knowledge regarding the health condition but was unable to understand fully the risks of the illness if not attended well. They would let days pass before attending to any sickness experienced by one of their family members. Thus resulting to further complications.

Encourage the family to ask questions or visit the health centyer for information about thje different diseases that are required if the community surroundings is not kept well inorder for them to have reliable info and be able to take preventive measures before a disease may occur.

5 The family became well informed regarding the risks of not attending immediately to an illness.

APPLICATION OF PRINCIPLES OF

GENERAL HYGIENE

3 The family sometimes forgets to wash their hands during meal times and when they prepare their food. Also when a child urinates in bed or while they are being carried, they simply wipe the wet area with damp cloth and do not wash it with water.

Encourage the family to wash their hands before and after eating and also advice them to bath their kids often because since they are still young they do not care where they urinate or defecate to keep them clean and infection free.

5The family realized the importance of proper hygiene and now puts in mind the need to wash hands before and after doing anything, and keeping their children always clean to prevent infections and diseases.

HEALTH ATTITUDES

3 The family understands and recognizes the need for medical care in illnesses and for the preventive services but sometimes because of some misconceptions heard from friends and relatives by the mother, the two children did not received complete immunizations.

Explain to the mother the importance of immunizations and the need to complete them while they are young. Also tell them to consult physician if the children are still allowed to take immunizations even though they are already older than the age required for each.

3 The mother understands the need and importance of completing her children’s immunizations but still she haven’t consulted any health professionals regarding her children’s situation.

EMOTIONAL COMPETENCE

3 The family solves the problem calmly, as what Mrs. B said because it is not good to fight and it would only add misfortune to their lives. Even in financial matters they do not fight, they just talk with each other and solve it. On the other hand, Mrs. B said that there is only one problem which causes fight with Mr.

Tell Mr. A to become more understanding and sensitive to the feelings of his wife and their children. Also tell Mr. A not to displace his being angry to their children.

3 The way the family solves their problem are still the same, they do it in a calm way.

B. she said that every time Mr. A wants to have sex with her she refuses and so Mr. A got angry. When he is angry about it he sometimes displaces it to their children but not physically.

FAMILY LIVING 3 In terms of decision, they both talk about it and decide on what to do or not. The family gets along well with each other to the point that they do not usually go out and just stay at home. They do not let their children play outside their compound. As Mrs. B said, they are afraid that if they let them play outside they can get bad habits like saying bad words.

Emphasize to the family the importance of closeness in the family and talking with each other about their decision to make. In addition, tell Mrs. A and Mr. B to let their children play outside because it may possibly cause negative effects like developing mistrust.

3 Even though that they do not let their children play outside some children go there and the family welcomes them to play with their children. Mrs. B usually stays with their children especially when other kids are around.

They have poor

PHYSICAL ENVIRONMENT

1 physical environment because their house is in poor condition. Upon interview and ocular survey, we have observed and saw some protruding nails, the window is not screened, there are mud noted in the floor, and the place were they cook can cause danger not only to the house but also to their children because it isn’t that high that their children can reach it.

Stress to them the importance of cleanliness and safety to prevent from having foreseeable problems in illnesses and harm.

1 When we come back to have another interview their house was still the same. There still some garbage near there house.

USE OF COMMUNITY FACILITIES

1The Family does not involve themselves in the activity in the community and health center. Their reason is that it is tiring and crowded to go their. But if there are some people in the center going to their house they welcome it and avails the program of the center.

Inform them that the services offered in the community are free. They just have to be patient in going to their community health center to avail it.

3After the week we interviewed on the next week we went their Mrs. B said that they went to the Mintal gym to avail the program of DOH about filariasis.

PRIORITIZATION OF THE PROBLEMS

1. Inadequate hygiene Criteria Computation Actual Score Justification

Nature of the Problem 2/3 x 1 2/3 It is a health threat. These may cause untoward consequences to the family.

Modifiability of the Problem 2/2 x 2 2 The problem is highly modifiable since basic hygienic products are readily available in the community.

Preventive Potential 3/3 x 1 1 The problem is highly preventable because the family is capable of learning better ways of observing hygiene; They are also physically independent.

Salience of the Problem 1/2 x 1 1/2 The family considers it as a problem, but they don’t pay much attention to it.

TOTAL SCORE 4.17

2. Unmet sexual urges of Mr. ACriteria Computation Actual Score Justification

Nature of the Problem 1/3 x 1 1/3 The problem is a foreseeable crisis situation.

Modifiability of the Problem 2/2 x 2 2 The problem is highly modifiable because contraceptives are available in the community and one resource to solve the problem is the couple's choice to abstain.

Preventive Potential 2/3 x 1 2/3 The problem is partially preventable because Mr. A can understand why Mrs. B does not want to have sex with him; however, Mr. A will be able to displace his frustrations on their children while Mrs. B is not around.

Salience of the Problem 2/2 x 1 1 Mrs. B is really concerned about this problem and she wants to be sure that their children are safe with Mr. A.

TOTAL SCORE 4

3. Incomplete immunization of childrenCriteria Computation Actual Score Justification

Nature of the Problem 3/3 x 1 1 It is a health deficit because the children are more susceptible to get sick and this will bring about very grave consequences to the family.

Modifiability of the Problem 1/2 x 2 1 The problem is partially modifiable because the correction of the misconception of Mrs. B requires intensive explanation and convincing.

Preventive Potential 2/3 x 1 2/3 This problem is partially preventable because Baby Boy is 1 month from his 1st birthday; by then it will be too late to have Baby Boy completely immunized; however, immunizations after his first birthday can help out significantly.

Salience of the Problem 2/2 x 1 1 Mrs. B is truly concerned for the health of their children.

TOTAL SCORE 3.67

4. Mrs. B with future plans of going to Malaysia Criteria Computation Actual Score Justification

Nature of the Problem 1/3 x 1 1/3 It is a foreseeable crisis situation because the planned date is still on January of 2009.

Modifiability of the Problem 2/2 x 2 2 The resources required to modify the problem can be found within Mrs. B's choice.

Preventive Potential 2/3 x 1 2/3 The problem is partially preventable because the prevention of future problems that the departure of Mrs. B will bring can only be accomplished by the husband having the capacity to take care of himself and their two children.

Salience of the Problem 1/2 x 1 1/2 They know it's a problem, but they have to go through this so that their financial problems will be lessened.

TOTAL SCORE 3.5

5. Open canal, exposed nails and wires and slippery soil as accident hazardCriteria Computation Actual Score Justification


Modifiability of the Problem 1/2 x 2 1 This problem is partially modifiable since the means to solve it is available but the initiative of the family is needed.

Preventive Potential 3/3 x 1 1 The problem is highly preventable because family can improve their carefulness by paying more attention to their environment.

Salience of the Problem 1/2 x 1 1/2 The family recognizes it as a small problem and they are used to it.

TOTAL SCORE 3.17

6. Open canal and stagnant water as breeding ground for vectors of diseaseCriteria Computation Actual Score Justification


Modifiability of the Problem 1/2 x 2 1 This problem is partially modifiable since the means to solve it is available but the family has no initiative to solve it.

Preventive Potential 3/3 x 1 1 The problem is highly preventable family can work together with other people to clear up the blockages that promote stagnant water in the canal.

Salience of the Problem 1/2 x 1 1/2 The family recognizes it as a small problem.

TOTAL SCORE 3.17

7. Interpersonal conflicts between family members

Criteria Computation Actual Score Justification

Nature of the Problem 1/3 x 1 1/3 The problem is a foreseeable crisis situation because some family members might develop the tendency to hold grudges.

Modifiability of the Problem 2/2 x 2 2 The problem is highly modifiable because disagreements between family members are most often resolved peacefully by talking personally.

Preventive Potential 2/3 x 1 2/3 The problem is partially preventable because disagreements between family members can never be excluded in family dynamics.

Salience of the Problem 0/2 x 1 0 The family does not recognize this as a problem because for them, it is normal.

TOTAL SCORE 3

8. Family resources not adequate for family needs


Nature of the Problem 1/3 x 1 1/3 The problem is a foreseeable crisis because prolonged inadequacy of family resources will have a cumulative effect on the family.

Modifiability of the Problem 1/2 x 2 1 The problem is partially modifiable because the family can find ways and means of getting needed money, but most of the jobs that are available to them are temporary.

Preventive Potential 2/3 x 1 2/3 The problem is partially preventable because the family needs all the money that they get and they tend to spend it all too quickly.

Salience of the Problem 1/2 x 1 1/2 The family considers it as a problem; but as of the moment, their attention is elsewhere.

TOTAL SCORE 2.5

9. Unhealthy lifestyle practice of Mr. A: Drinking


Nature of the Problem 1/3 x 1 1/3 It is a foreseeable crisis that does not need immediate attention.

Modifiability of the Problem 1/2 x 2 1 The problem is partially modifiable because the solution is from the willingness of Mr. A to stop drinking and can only be accomplished if Mr. A truly does abstain.

Preventive Potential 2/3 x 1 2/3 The problem is partially preventable because Mr. A can choose to abstain from drinking, but might not be able to.

Salience of the Problem 1/2 x 1 1/2 The family recognizes it as a small problem.

TOTAL SCORE 2.5

10. Inadequate living space


Nature of the Problem 2/3 x 1 2/3 It is a health threat that does not demand immediate action.

Modifiability of the Problem 1/2 x 2 1 The problem can be modified, but they do not have enough resources to do any modifications.

Preventive Potential 2/3 x 1 2/3 They can maximize the spaces in the house and refrain from having an additional family member.

Salience of the Problem 0/2 x 1 0 They do not mind if they live in a house that is

small.

TOTAL SCORE 2.34

11. Self-medication as unhealthy lifestyle and personal habits/practices


Nature of the Problem 2/3 x 1 2/3 The problem is a health threat because it can bring forth harmful effects.

Modifiability of the Problem 1/2 x 2 1 The problem is partially modifiable because the resources for the proper promotion of health are readily available to them but they will have to spend money for it.

Preventive Potential 2/3 x 1 1/3 The problem is partially preventable because the family will always consider using alternative cures for illnesses due to their low income.

Salience of the Problem 0/2 x 1 0 The family does not consider this as a problem since alternative medicine has always yielded good results for them.

TOTAL SCORE 2

Summary:

Problem Score:

1. Inadequate hygiene..................................................................................................4.17

2. Unmet sexual urges of Mr. A....................................................................................4.00

3. Incomplete immunization of children........................................................................3.67

4. Mrs. B with future plans of going to Malaysia ..........................................................3.50

5. Open canal, exposed nails and wires and slippery soil as accident hazard..............3.17

6. Open canal and stagnant water as breeding ground for vectors of disease.............3.17

7. Interpersonal conflicts between family members.....................................................3.00

8. Family resources not adequate for family needs......................................................2.50

9. Unhealthy lifestyle practice of Mr. A: Drinking..........................................................2.50

10. Inadequate living space..........................................................................................2.34

11. Self-medication as unhealthy lifestyle and personal habits/practices.....................2.00

Family Nursing Care Plans

Date

Cues Health Problem

Family Nursing Problem

Goal of care Objectives of care

Nursing Interventions

Methods of

family-nurse

contact

Resources Evaluation

NOVEMBER

20,

2

0

0

8

Objective:

Presence of an open canal near their house.

Health Threat;

Presence of accident hazards.

Inability to recognize the presence of the problem due to ignorance of the facts.

After our four weeks of rendering care, the family would be able to take appropriate action towards avoiding any harmful accidents from the canal.

After our 6 hours span of care, the family would be able to:

1. See the disadvantages of what would be the danger threats of having an open canal.

2. become more aware of their surrounding especially things that can harm them

3. Find ways of fixing or closing the canal.

1. Established rapport.

® To gain the family’s trust and established a well-functioning relationship.

2. Educated the family about the danger posed by an open canal that can possibly cause injuries to family especially the children.

® To make the family realize the dangers of not doing anything about the present problem.

3. Encouraged the family to think ways on how to solve the

H

O

M

E

V

I

S

I

T

Human Resources:

Time and effort of the student nurses, family and the people in the area.

Knowledge/ information that nurse will impart to the family.

Goal Partially Met.

The family was able recognize the problem of having an open canal as an accident hazard; The family expresses their awareness of how careful they must be around the open canal; However, the canal remains an open canal and still poses a threat to ignorant individuals.

problem.

® To promote the family’s independence and to make them more responsible to provide solutions to their problem.

4. Asked the family to mention the possible sanitary modifications that they have come up with and praise them for making such solutions on their own.

®To give a boost to their esteem and further encourage them to be independent and resourceful enough to solve their problems.

5. Gave them more solutions that they might have missed.

®To educate them of more courses of action that are open to them.

6. Educated the parents that their children should not play near the open canal.

® To prevent accidents.

7. Inform the people in the surrounding areas to realize the dangers of having an open canal.

® To enlighten them about how to prevent the occurrence of accidents caused by the open canal.

8. Encourage the family and the people in the community to carry out the solutions that they have come up with.

®To effectively reduce the frequency of accidents in the community.

D

a

t

e

Cues Health problem

Family nursing problem

Goal of care

Objective of care

Nursing intervention

with rationale

Methods of family

nurse contact


NOVEMBER

20,

2

0

Objective:

Rainwater stagnates around the house. These serve as breeding grounds for insects such as mosquitoes and flies.

Presence of breeding places of insects and rodents as a health threat.

Inability to provide a home environment conducive to health and personal development due to lack of knowledge towards the issue.

After discussing with the family the risks of the presence of breeding places of insects and rodents the family is expected to identify breeding ground and show ways

of eliminating such.

After the nursing intervention the family will be able to:

1. realize that the presence of breeding grounds is a health threat to the family;

2. identify existing places as breeding ground for insects and rodents; and

1. Discussed with the family possible breeding places present in their surroundings ® To develop awareness in the family.

2. Discussed with the family risks and threats of the presence of breeding places such as risks for infection, cross-contamination and disease.

® To further elaborate the dangers of

H

O

M

E

V

I

S

I

T

Time and effort of both the nurse and the family.


Goal met:

The family was able to eliminate the breeding sites of insects as evidenced by

:

1. removal of unnecessary containers; and

2. use of mosquito nets and insect repellants to protect children

0

8 3. show ways to eliminate breeding grounds of insects and rodents such as regular cleaning and arranging properly of things.

having breeding sites near the home.

3. Explained the threatening effects of insects or rodents to family’s health.

® To stress the importance of knowledge towards the issue.

4. Provided ways to lessen and if possible eliminate the insects and rodents.

® To help the family gain independent actions towards the prevention of diseases.

5. Discussed the advantages and

from insect bites

disadvantages of the methods to encourage better decision-making on the most appropriate measure to lessen the household pests.

® To be able to adjust the ways and means of disease prevention for the family’s convenience.

Date

Cues Health Problem


Goal of care Objectives of care

Nursing Interventions

Methods of family-nurse

contact


NOVEMBER

20,

2

0

0

8

Objective:

Uncombed hair

Oily skin in face and arms

Dirty fingernails, toenails and feet

Poor personal hygiene

Inability to make decisions with respect to taking appropriate health action due to:

Ignorant attitude towards the health problem.

After our four weeks of rendering care, the family would be able to have a positive attitude towards having good personal hygiene.

After our 6 hours span of care, the family would be able to:

1. verbalize the advantages of personal hygiene;

2. determine the importance of personal hygiene;

3. identify the need of a pleasing appearance for good social interaction; and

1. Established rapport.

® To gain the family’s trust and established a well-functioning relationship.

2. Provided the family with knowledge about taking a bath with the use of clean water and a bathing soap.

® To impart our knowledge about the importance of cleanliness.

3. Discussed with them the strokes used in a good tooth

H

O

M

E

V

I

S

I

T

Human Resources:

Time and effort of the student nurses, and members of the family.


Goal Met.

The family was able to verbalize: “Gibuhat nako katong gi-ingon ninyo sa akoa about sa pag-alaga sa lawas.”

Hair of the client was combed and the nails are cleaned. No foul odor was smelled.

4. apply measures in doing good personal hygiene including skin care, taking a bath, combing the hair and brushing of teeth.

brushing technique.

® To promote good oral hygiene.

4. Discussed the significance of good appearance as part of pleasing personality.

® To show how hygiene can boost self-confidence.

5. Explored with the family the possible ways of maintaining good personal hygiene despite limited physical facilities.

® To show that their situation does not hinder their access to good health.

Date Cues Health Problem


Goal of Care Objective of Care

Nursing Intervention

Method of

Family contact


N

O

V

E

M

B

E

R

20,

2

0

Subjective:

-Mother

verbalized, “Kung

magkasakit akong

mga anak,

ginapalitan dayon

nako sila og

tambal tapos

ginapainom dayon

nako. Usahay

ginapahilot pod

nako sila.

Self-medication practices as health threat.

Inability to recognize the presence of problem due to:

a. ignorance of facts

Inability to make decisions with respect to taking appropriate health actions due to:

a. failure to comprehend the nature/magnitude of the problem

b. low salience of the problem

After nursing intervention, the family may be able to identify probable side effects and possible health complications in relation to knowledge barrier due to lack of knowledge and misconceptions.

After the nursing intervention, the family may be able to:

- recognize the importance of consulting health care provider before any prescriptions can be carried out

- explain and enumerate the possible side and adverse effects of self medicating.

-Teach family about the advantage and disadvantage of self medications.

-Encourage the family to consult a health care provider or a physician before using any medicines.

Home Visit

Material resources:

-visual aids

Human resources:

-time and effort of student nurses and family

Financial resources:

-money for the student nurses’ transportation

Goal Partially Met

The family was able to recognize the importance of consulting health care providers or personnel, yet were not able to apply or practice it.

0

8

a. inaccessibility of appropriate resources for care specifically financial inaccessibility

Date Cues Health Problem


Goal of Care Objective of Care Nursing Intervention Method of Family contact


N

O

V

E

M

B

E

R

20,

Objective:size of

the house ______

- number

of family

members:

___

- low

ceiling

- one-room

house

- income

of the

family:

____ per

day

- occupatio

n of

husband:

Inadequacy of living space.

Inability to make decisions with respect to taking appropriate health action due to; lack of insight as to alternative courses of action open to them.

The family, after a week of nursing intervention, will be able to decide on appropriate actions to maximize their living space that will facilitate easy performance of their daily working activities.

The family, after a week of nursing intervention, will be able to;

1. verbalize understanding of the importance of having adequate living space for their daily activities.

2. select a method most appropriate for them in cleaning clutters and arranging furniture to maximize their living space.

3. decide on efficient ways of maintaining adequate space for their daily activities.

1. Discuss with the family the need of having adequate space for daily activities.

2. Provide adequate knowledge on the various ways of maintaining order in the house.

3. Discuss the advantages and disadvantages of the methods to encourage better decision-making on the most appropriate method to have adequate living space.

4. Help the family rearrange the

H

O

M

E

V

I

S

I

T

Human resources:

-time and effort of student nurses and family

Goal Met

After a week of intervention, the family was able to use the space occupied before the bed for their leisure and other locomotive activities.

2

0

0

8

______

- unstable

house

structure

furniture to provide bigger space.5. Explore with the family ways of encouraging growth-promoting leisure and relaxation activities.

CONCLUSION AND RECOMMENDATION

Conclusion

Family

We conclude that since the first day of our exposure with our assigned family, we

have noted problems that affect their current health status and lifestyle. During the

course of our duty, we rendered our health teachings according to the observed

problems. In our last contact with the family, we noticed improvements in their lifestyle.

They are now participative in the activities and programs supported by the Barangay

Health Center.

Exposure

We conclude that this whole rotation of community health nursing has been very

fruitful and worth experience for. The community has given us opportunity to explore

and be more productive, skillful, creative, and make us more sociable. The case study

has given us opportunity to penetrate the private life of a very vulnerable family. The

family is very open and ready to achieve the highest level of state or function of health

and wellness.

Recommendation

To the C family:

We recommend that they continue to comply with the health teachings rendered

to them. They must improve the cleanliness inside and outside their house to prevent

future problems, especially when it comes to their health. They should apply the basic

principles of general hygiene. They should be active enough to participate in the

activities and programs being conducted and sponsored by the Barangay Health Center

or by the DOH.

To the Barangay Health Center and workers:

We recommend that they should improve their way of providing health education

to a more lively and productive way. They should also properly disseminate information

so that the people in the community will be aware of their scheduled activities.

To the Clinical Instructors:

We recommend that they would pass a proposal to the College of Nursing

regarding the continuation of the classes’ project about proper waste disposal in Purok 2,

Tugbok District, Mintal, Davao City.

To the Student Nurses:

We recommend that to the next student nurses that will be assigned at the same

area to continue providing health teachings and to monitor and check if there are

improvements to our implemented project.

Documents

CHN