Family Case Analysis

I. Introduction

Family, as defined by Encarta, is a group of people who are closely related by birth, marriage or adoption, functioning as a single household, and usually consisting of parents and their children. While on the other hand, a family case analysis is a determination of the nature of a problem occurring in families and implying some possible solutions about the problem, and to analyze some observable cases of that particular family, who may be in need of medical intervention and attention. And so, as student public health nurses currently taking up HECA-101A, our assignment is to conduct family case analyses on families residing in several Barangays in Olongapo City.

We were assigned to hold a family case analysis to one of the families living in Old Cabalan, Olongapo City. As early as 8:00 in the morning, a day so wet because of the rain brought by typhoon Hannah, the group, amidst the bad weather, has decided to continue the trip down to Old Cabalan. The trip will not mean an enjoyable one! Though can be tagged as an “enjoyable journey” through adventures waiting for us – and we guess these may include wet steep streets of slop 45◦, houses to look for, and the selection of the right home for the right family case analysis.

And our guess was right, as we arrived at our destination, Sir Serano introduced as to some Barangay staff, present there at Old Cabalan Barangay hall. To look for the house of the right family is our first main task. Old Cabalan is not just a four-cornered room-sized barangay. To find the right family is not an easy task, but how lucky we are that as we walked to the mountainous terrain of Old Cabalan, we found a humbled home consisting of a hospitable family who are willing to cooperate for the task that we are going to render.

II. Family Structure and Organization

Family Name: Omagap FamilyAddress: #2186 Narra Lane, Purok II Old Cabalan, Olongapo City

Family Data:Length of residency: 1987Family Size: 11

Religion:Husband: Iglesia ni CristoWife: Iglesia ni Cristo

Place of Origin:Husband: Ilo-iloWife: Leyte

Type of Family Structure: Patriarchal, Extended

General Family Relationship/Dynamic:

Criteria Yes No1. Observable conflicts between Family Members a. Wife Husband Beating √b. Frequent quarreling √c. Child abuse √2. Characteristics of Communication a. Open communication among family members √ b. Swearing or use of insults when talking to each other √

The chart below represents the Family Structure of Mr. Omagap’s family.

NameAge

Sex

Civil Status Position

Educational Attainment Occupation

Ricardo Omagap 49 M Married Father

2nd year High school

Construction Worker/ Painter

Leoncia Omagap 45 F Married Mother

1st year High school

Laundry Woman

Leorilyn Omagap 23 F Married Eldest

4th year High school

Factory Worker

Richard Omagap 22 M Single 2nd Eldest 6th Grade

Construction Worker

Mark Ron Omagap 21 M Single 3rd Eldest


Maria Mae Omagap 19 F Single 4th Eldest

2nd year High school

Maria Rica Omagap 17 F

Live - in 5th Eldest


Greggy Omagap 16 M Single 6th Eldest 6th Grade

Construction Worker

Dennis Omagap 14 M Single 7th Eldest 6th Grade Snack Vendor

Mary Omagap 13 F Single 8th Eldest 6th Grade Christian Omagap 12 M Single Youngest 6th Grade

Jody Omagap 1 F Single Grandchild

The Omagap family, as any other basic unit of the society, is lead by a responsible father personified by Mr. Ricardo Omagap. By definition, this large family composed of twelve members, can be classified as patriarchal for the main existing fact that most of the matters relating to the conclusive judgment of the family such as health decisions, and everyday life decisions are vested upon more to the authority of the father.

Mr. Ricardo and Mrs. Leonicia, at the age of 49 and 45 respectively, are already grandparents to the child of their fifth sibling – Maria Rica Omagap, 17 – whose live-in partner does not live in the same residential address of the family. But this situation could be tagged as “Extended”. It also fits the criteria of an extended family, and can be classified under this category. Maria Rica and her daughter Jody Omagap still reside in the home of the Omagaps. Adding more spaces and seeking for support. While on the other hand, the eldest sibling of the Omagap family, Lerylin, was already married and that they have separated themselves from the family.

Although Mang Ricardo heads a family of many members, this large number has not impeded the formation of a peaceful and organized family. No observable conflict among family members, and that there are no impaired communications nor there any communication – isolated cases evident in some members. These were observed at the date and time of the home visit.III. Socioeconomic and Cultural factors

Monthly Family Income Source

Husband: Php 220 Wife: Php 300

Others: 2nd Eldest: Php 220, 6th Eldest: Php 220, 7th Eldest: Php 100

Total:Below Php 5,000

Felt Family Needs:1. Trabaho/ dagdag na kita2. Gamot3. Pagkain4. Bahay

Though Mang Ricardo heads a family of twelve members including him, this large number has not impeded the formation of a peaceful and organized family. It is pretty obvious that because of the low education attainment of all members, this unfortunate fate has resulted in a problem of not having enough financial support for the family. And that the loss of a permanent job for the legal-age members of the family is the main consequence of that previous problem. As indicated in the table under the topic family structure, characteristics and dynamics, only five members of the family have their own jobs. Unfortunately, Leorilyn, the eldest sibling of the family has already separated and now working as a factory worker for her family. But even these jobs could not be considered as “jobs” for they are not permanent; for they could not earn enough money to support the physiological and basic needs of the family. Approximately, the average monthly income of the family changes form less than or equal to Php 8,000 to less than or equal to Php 10,000. Mrs. Leoncia only earns Php 300/ week from her laundry. Mang Ricardo on the other hand should earn Php 5280/ month if, and only if, he is a regular construction worker. The same is true with his two sons. Unfortunately, this is not what is happening. The truth is, they’re just few of the victims of the “not so good” system in the Philippines.

Financial resources problem is getting serious. It has resulted in chain problems vested upon the loss of a job. “…gusto ko talaga number one ang trabaho”, uttered by Mang Ricardo as we asked him about the top ten needs of the family, a very smart answer to a question which most people would definitely put financial needs on the number one spot. “Kung may trabaho ka, magkakaroon ka ng pera at kung ano pa ang gugustuhin mo”, he concluded.

IV. Home and Environmental Factors

House: Others: Caretaker

Type of Housing Material: Mixed

What appliances are owned by the family?Television, Radio, Cellular phone

Type of Garbage Disposal: Collected

Type of Toilet Facility: Water sealed

Type of drainage system: Open

Source of Water Supply: Shared

Source of Drinking Water: Tap Water

Food Storage: Covered

Is there presence of breeding sites for Pests? Yes

What Common household pest is present in the household?Cockroach, Rats, Lizards, Ants

Where does the family keep their pets? Household

Are there accident hazards present? Yes, stairs; whole structure of the house.

Kind of Neighborhood UrbanSocial and Healthy Facilities Available

Brgy. Center, Basketball Court, Plaza

Facilities Jeepneys

Awareness of Community Organization

Are you aware of existing organizations in your community? No

Are you a member of any of these organizations? NoName community members whom you think are able to lead the people

1. Kagawad Alba2. Purok Leader3. Manugang

As defined in Dorland’s Dictionary, 28th Edition, an environment is the sum total of al conditions and elements which make up the surroundings and influence the development and actions of an individual. Making this

definition as basis, the student public health nurses therefore foresee that home and environmental factors reflects and greatly affects the health condition of an individual and family living on a certain area.

The humble home of the Omagap family is located at # 2186 Nara Lane, Purok II, Old Cabalan, Olongapo City. They have been residing at this mixed type house structure made mostly of wood for almost twenty years. Although they do not own the house and lot, and are named as caretakers, it has been home to them for quite some time. A television, a radio and a mobile phone are the appliances that they own which serve as their source of leisure and fun when there are household chores to accomplish. As a productive family, continuous waste disposal is frequent. They have appropriate garbage receptacles and that garbage is being collected during Wednesdays and Saturdays by garbage collectors. Their toilet facility is not located inside the house. A water sealed toilet, no lighting and scarce toiletries are all to be seen inside. Their drainage system is open, meaning to say that the wastes which are being disposed by the family is directly open to the external environment for there are no pipes conducting the wastes to the proper disposal area. The water they are using for their daily use are not owned by them, they are sharing water from their neighbor who is subscribing to Subic water Inc. and like any other family living in that area, they are using tap water as their daily source of drinking water. Despite the fact that their home appliances are only a television, a radio and a mobile phone, they have no appropriate means of food storage like a refrigerator. Their only means of food storage are disposable plastic containers and sometimes, they don’t even have a chance to store their food because they just prepare food that is enough for the family in the span of a day. Pests such as cockroaches, rats, lizards and ants obviously cannot be avoided, but they have their cats to fight these health threatening pests. A lactating bitch of nine puppies, named Punying, is present and has found a place beneath the steep staircase of the house. The external environment is filled with a small farm, some greenery and oxygen giving trees which is good for the health. The sidewalks in the community are clean but are occasionally present with dog feces and there are proper receptacles of garbage. The neighborhood is very friendly to the family, and they have said that some of them have helped during their times of shortcomings. The barangay health center is just a few blocks away from the Omagap family’s home and a doctor is present in the center only once a week, which may not be sufficient to handle the health problems of the residents of Old Cabalan.

As student Public health nurses, assessment plats a big role in the family case analysis for us to determine if some factors may be health threatening. Accident hazards are present in their environment because of the location of their house is on the foot of the mountain, which may be prone to landslides and their house being old, materials are continuously aging making the house’s foundation weak.

V. Health Assessment

Family Dietary Habits

Your Diet usually composes of?

Breakfast: Sinangag, Pandesal, Tuyo, KapeLunch: Talbos, Malunggay, KaninSupper: Same in Lunch sometimes

Family Health History

Name of Family Member Health HistoryRicardo Omagap TB, Kidney StoneJody Omagap Bronchopneumonia

Health and Health Practices

Common Illness encountered for the last six months and treatment renderedIllness Treatment

Colds Medicines; Herbal MedicinesFever

Who do you consult for health related problems? NurseFor problems other than health who do you consult? Relatives

Immunization Status of the FamilyFamily Member Type of ImmunizationAll family Members Complete Immunization

Do your family members have enough?1. Rest and Sleep? Yes

If yes, how many hours/night? 8 hours

2. Exercise? YesIf yes, what type of exercise? Lakad-lakad lang

3. Relaxation Activities? Yes

4. Stress Management activities? Yes

A. Present Illness

Name Problem Belief Medical Remarks

AttendanceRicardo Omagap

Untreated Tuberculosis

Prolonged Cough

Partial He had undergone treatment but is was discontinued due to economic problem

Jody Omagap

Asthma, cough and colds

Allergies and weather condition

Partial Due to weather changes from time to time, she experience cough and cold and wasn’t able to cure well because of lack of knowledge

B. Past Ilness

Name Problem Belief Medical Attendance

Remarks

Jody Omagap

Bronchopneumonia

Neglected perspiration at the back

With Treated

Ricardo Omagap

Kidney stone From salty Foods

With treated

C. Infant Feeding

All children experienced breastfeeding and also given milk through bottle feeding when their mother is not around

D. Immunization Status

According to Ricardo, all of his children had completed the vaccines during their infancy from the Barangay Health Center

VI. Awareness of Community Organization

As Iglesia ni Cristo members, the Omagap family isn’t aware of any existing community organizations. They have told us that the reason that they are not aware because organizations have a political influence which is not allowed in their sect. although they have nothing against other organizations, they just want to protect what they believe in. that is why, if ever they are aware of any organizations, they would definitely not become a member of it. But they are aware of the projects existing in their community, but not of the organizations that have provided them.

VII. Values Attitudes, Beliefs and Practices

As we approached the family, Mary, the second youngest welcomed us with warmth and respect. Their father, Ricardo, accepted and cooperated with us without hesitation. He even made us felt comfortable which shows the hospitality of the Filipinos.

The members of the family are all Iglesia ni Cristo. They go to their church twice a week and they are very religious. Their faith to God is the only thing that they can be proud of. They also value education but because of indigence, they can’t send all their children to school.

When one of the family members got sick, they don’t go to quack doctors because it is against their religion. And because of poverty, they can’t afford to go to doctors for check-up. They will just go to the ministers of their church and will pray for the sick. They also use herbal medicine to cure their illness.

Maybe because of an existing fact that the Omagap family has acquired the values and traditions of becoming an Iglesia ni Cristo, a religion which on the perception of many people has lived the strict compliance of rules set by the most high authority of their church for the benefits of their general members, one could almost say that this family is really a religious unit of the society.

They knew the meaning of the word “samahan” (organization). They knew that there are certain “samahan” existing in their barangay. Ask if they knew the functions and purposes of the said organizations, they will give you the sure yes! Ask for the specific names of those organizations, they will give you an innocent answer, as if organizations were not existent. But ask if they are affiliated with such organizations and that they are attending their programs and activities, they will give you a very simple answer – “Bawal po sa amin! May bahid po kasi ng pulitika ang mga samahan!” a proof of values capacitated by the family.

VIII. Family Health Problem

Problem First Level Assessment

Second level Assessment

1. Cough and Cold Health Threat Failure to utilize community resources for health due to lack of or inadequate family resources, specifically financial resources such as cost of medicine prescribed

2. Untreated Tuberculosis

Health Deficit Failure to utilize community resources for health due to lack of or inadequate family resources, specifically financial resources such as cost of medicine prescribed

3. Threat of cross infection from a communicable disease case

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

4. Family size beyond what family resources can adequately provide

Health Threat Failure to utilize community resources for health due to lack of or inadequate family resources, specifically financial resources such as cost of medicine prescribed

5. Accident hazards (fall hazards)

Health Threat Inability to provide a home/ environment conducive to health maintenance and personal development due to lack of inadequate knowledge of preventive measures and inadequate family resources specifically financial constraints/ limited financial resources

6. inadequate food intake both in quality and quantity


7. Family eating habits


8. Poor home/ environmental

Health Threat Inability to provide a home/ environment conducive to health

condition/ sanitation specifically inadequate living space

maintenance and personal development due to lack of skill in carrying out measures to improve home environment and inadequate family resources specifically financial constraints/ limited financial resources.

9. Unhealthy lifestyle and personal habits/ practices specifically cigarette smoking

Health Threat Inability to recognize the presence of the condition or problem due to attitude/ philosophy in life which hinders recognition/ acceptance of a problem

10. Loss of Job Foreseeable Crisis Inability to make decisions with respect to having appropriate action due to feeling of confusion, helplessness and/or resignation brought about by perceived magnitude/ severity of the situation / problem

IX. Physical Assessment

Name: Ricardo OmagapAge: 49 years oldVital Signs: BP: 120/70 mmHg RR: 16cpm PR: 63 bpm Temp: 36.4 ° CSkin: dry and wrinkled skin, brown complexionScalp: no infection or infestationHair: presence of alophecia, thin, smoothEyes: symmetrical, pinkish conjunctiva, normal ocular movementEars: symmetrical, color is same as facial skin, cerumen is dryNose: symmetrical, moist mucosa, presence of colds Mouth: presence of cavities, incomplete number of teeth, dry oral mucosa, brownish lipsThroat: no inflammation of tonsil and throatNeck: neck muscles are equal in strengthHeart: heart sounds are audible with the use of stethoscopeLungs: no adventitious soundExtremities: body parts are proportioned with one another, no abnormalities

Name: Leonicia OmagapAge: 45 years oldVital Signs: BP: 130/90 mmHg RR: 15 cpm PR: 64 bpm Temp: 36.5° CSkin: dry and wrinkled skin, brown in complexionScalp: presence of infestationHair: dry, thinEyes: symmetrical, pinkish conjunctiva, normal ocular movementEars: symmetrical, color is same as facial skin, cerumen is dryNose: symmetrical, no discharge, moist mucosaMouth: presence of cavities, dry oral mucosaThroat: no inflammation of tonsil and throatNeck: neck muscles are equal in strengthHeart: heart sounds are audible with stethoscopeLungs: no adventitious soundExtremities: body parts are in proportion with one another, no abnormalities

Name: Richard OmagapAge: 22 years oldVital Signs: BP: 120/80 mmHg RR: 17 cpm PR: 62 bpm Temp: 36.8° CSkin: brown complexionScalp: no infection or infestationHair: dryEyes: symmetrical, pale conjunctiva, normal ocular movementEars: symmetrical, color is same as facial skin, dry cerumenNose: symmetrical, no discharge, moist mucosaMouth: presence of cavitiesThroat: no inflammation of tonsil and throatNeck: neck muscles are equal in strengthHeart: heart sounds are audible with the use of stethoscopeLungs: no adventitious soundExtremities: body parts are proportion with one another, no abnormalities

Name: Mark Ron OmagapAge: 21 years oldVital Signs: BP: 110/70 mmHg RR: 16 cpm PR: 62 cpm Temp: 36.7° CSkin: brown complexionScalp: presence of infestation, dandruffHair: dryEyes: symmetrical, pinkish conjunctiva, normal ocular movementEars: symmetrical, color is same with facial skin, cerumen is dryNose: symmetrical, no discharge, moist mucosaMouth: presence of cavitiesThroat: no inflammation of tonsil and throatNeck: neck muscles are equal in strengthHeart: heart sounds are audible with the use of stethoscope

Lungs: no adventitious soundExtremities: body parts are in proportion with one another, no abnormalities

Name: Maria May OmagapAge: 19 years oldVital Signs: BP: 100/70 mmHg RR: 17 pm PR: 75bpm Temp: 36.5° CSkin: brown complexionScalp: no infection or infestationHair: dryEyes: symmetrical pinkish conjunctiva, normal ocular movementEars: symmetrical, color is same as facial skin, cerumen is dryNose: symmetrical, no discharge, moist mucosaMouth: presence of cavitiesThroat: no inflammation of tonsils and throatNeck: neck muscles are equal in strengthHeart: heart sounds are audible with stethoscopeLungs: no adventitious soundExtremities: body parts are in proportion with one another, no abnormalities

Name: Maria Rica OmapagAge: 17 years oldVital Signs: BP: 100/700 mmHg RR: 16 cpm PR: 74 bpm Temp: 36.4° CSkin: brown complexionScalp: presence of infestationHair: dryEyes: symmetrical, pinkish conjunctiva, normal ocular movementEars: symmetrical, color same as facial skin, cerumen is dryNose: symmetrical, no discharge, moist mucosaMouth: presence of cavities, incomplete number of teethThroat: no inflammation of tonsils and throatNeck: neck muscles are equal in strengthHeart: heart sounds are audible with the use of stethoscopeLungs: no adventitious soundExtremities: body parts are in proportion with one another, no abnormalities

Name: Dennis OmagapAge: 14 years oldVital Signs: BP: R110/70 mmHg RR: 17 cpm PR: 74 bpm Temp: 36.6° CSkin: brown complexionScalp: presence of itchiness and lesionHair: dryEyes: symmetrical, pinkish conjunctiva, normal ocular movementEars: symmetrical, color is same as facial skin, cerumen is dryNose: symmetrical, no discharge, moist mucosaMouth: oral mucosa is moist and pinkThroat: no inflammation of tonsil and throat

Neck: neck muscles are equal in strengthHeart: heart sounds are audible with the use of stethoscopeLungs: no adventitious soundExtremities: body parts are in proportion with one another, no abnormalities

Name: Mary OmagapAge: 13 years oldVital Signs: BP: 110/70 mmHg RR: 17 cpm PR: 86 bpm Temp: 36.6° CSkin: fair complexion, smoothScalp: presence of infestationHair: dryEyes: symmetrical, pinkish conjunctiva, normal ocular movementEars: symmetrical, color is same as facial skin, cerumen is dryNose: symmetrical, no discharge, moist mucosaMouth: presence of cavitiesThroat: no inflammation of tonsil and throatNeck: neck muscles are equal in strengthHeart: heart sounds are audible with the use of stethoscopeLungs: no adventitious soundExtremities: body parts are in proportion with one another, no abnormalities

Name: Christian OmagapAge: 12 years oldVital Signs: BP: 90/60 mmHg RR: 16 cpm PR: 58 bpm Temp: 36.4 ° CSkin: brown complexionScalp: presence of infestationHair: smoothEyes: symmetrical, pinkish conjunctiva, normal ocular movementEars: symmetrical, color is same as facial skin, cerumen is dryNose: symmetrical, no discharge, moist mucosaMouth: presence of cavities, incomplete number of teethThroat: no inflammation of tonsil and throatNeck: neck muscles are equal in strengthHeart: heart sounds are audible with the use of stethoscopeLungs: no adventitious soundExtremities: body parts are in proportion with one another, no abnormalities

X. Family Health Problem Prioritization

Accident Hazards (e.g. Fall Hazards) Criteria Computation Total Score JustificationNature of the Problem

2/3 x 1 2/3 It is a health threat

Modifiability of 2/2 x 2 2 There are

the Problem interventions to solve the problem.

Preventive Potential

3/3 x 1 1 They can utilize preventive measures to avoid this at home.

Salience of the Problem

0/2 x 1 0 The family do not see this as a problem

Total = 3 2/3

Threat of cross-infection from a communicable diseaseCriteria Computation Total Score JustificationNature of the Problem


Modifiability of the Problem

1/2 x 2 1 They can practice health measures to prevent the spread of communicable disease.


2/3 x 1 2/3 There are interventions to prevent the problem.


2/2 x 1 1 They recognize it as a problem that does not need an immediate attention

Total = 3 1/3

Inadequate food intake both in quantity and qualityCriteria Computation Total Score JustificationNature of the Problem



½ x 2 1 They can provide somehow but still lack.


2/3 x 1 2/3 It can be prevented somehow but resources are limited.


2/2 x1 1 The family sees it as a problem that requires immediate attention.

Total = 3 1/3

Cigarette/Tobacco SmokingCriteria Computation Total Score JustificationNature of the Problem



2/2 x 2 1 There are interventions to solve the problem.


2/3 x 1 2/3 Smoking can be prevented even little by little.


0/2 x 1 0 The father does not perceive it as a problem.

Total = 3 1/3

Family Size beyond what family resource can adequately provideCriteria Computation Total Score JustificationNature of the Problem



1/2 x 2 1 There are still more alternative for food sources that are considered cheap but nutritious.


1/3 x 1 1/3 They cannot have a stable job.


2/2 x 1 1 The family perceives it as a problem needing attention

Total = 3

Presence of Stress points / Foreseeable Crisis Situations - Loss of JobCriteria Computation Total Score JustificationNature of the Problem

1/3 x 1 1/3 It is a foreseeable crisis.


1/2 x 2 1 They can only apply jobs that are contractual.


2/3 x 1 2/3 They cannot acquire a stable job because of low educational attainment.


2/2 x 1 1 The family perceives it as problem that requires immediate

attention.Total = 3

Poor environmental sanitation e.g. inadequate living space Criteria Computation Total Score JustificationNature of the Problem



1/2 x 2 1 Some interventions are available to solve the problem.


2/3 x 1 2/3 They have a big family size so it is hard to prevent.


0/2 x 1 0 The family does not perceive it as problem.

Total = 2 1/3

Documents

Family Case Analysis