Sample Family Care Study (N107)

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I. INTRODUCTION

A. OVERVIEW

Community refers to a group of people who interact with each other; it is a

social group determined by geographic boundaries, common values and interest. It

functions within a social structure, exhibits and creates norms, values, and social

institution. (Microsoft ® Encarta, 2009)

In Community health nursing, one of the two major fields of nursing in the

Philippines, nursing practice in the community means different things to different

nurses. Its primary goal is the promotion and preservation of health of its client that

could be in the individual, family, population, group and community. In community

health nursing practice includes nursing directed to individuals, families, groups; the

dominant responsibility is the population as a whole. With these, the health of the

people is a reflection of the communities of which they live, play, work and learn.

Communities shape the lifestyle that people adopt and their livelihood of living safe,

fulfilling and productive lives.

Family, basic social group united through bonds of kinship or marriage,

present in all communities. Ideally, the family provides its members with protection,

companionship, security, and socialization. The structure of the family, and the

needs that the family fulfills vary from society to society. The nuclear family—two

adults and their children—is the main unit in some societies. In others, it is a

subordinate part of an extended family, which also consists of grandparents and

other relatives. In a community, the family is considered to be its basic unit.

(Microsoft ® Encarta, 2009)

Our community experience has been founded on the above principle. This

exposure did not only provide an avenue to apply what we have acquired in the

classroom but also provided an opportunity to serve our fellowmen. Because being

in the community is more than meeting the requirements in the Related Learning

Experience (RLE), it is being experience the real world, making real memories and

rendering service with competence, conscience, commitment and care.

This paper presents a case of a nuclear family of five (5) members at The

Tent City, Calaanan, Cagayan de Oro City. As a community health student nurse

assigned in the area, I was given a chance to care for a certain family. After initial

survey of the place, I came across to the XX family.

The objective of the study is to smooth the progress of putting into practice

the concept of family-oriented nursing care and make certain an organized

approach in the delivery of the nursing services to the families in the community,

purposely in the application of the nursing process. It aims to identify the health

problem of a family within the community. As student nurse, I could give and apply

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some nursing interventions that are applicable and attainable within the community

health services.

At the end of two (4) weeks of Community Health Exposure, I will be able to

provide to the XX family nursing interventions to the identified health problems

affecting the family. The health programs of the Department of Health (DOH) for the

promotion of health and prevention of illnesses and the improvement of the

conditions in the social and physical environment will also be imparted to the

family, and also to participate with the family in the over-all health plan affecting

the family, in its implementation and evaluation.

B. SCOPE AND LIMITATION OF THE STUDY

This Family Health Care Study provides information and additional knowledge

about health to the family concerned. The student is focusing only on the XX family,

on their health promotion, prevention of illness and possible ways of alleviating

health problems.

The student also rendered health teachings according to our knowledge of

health care concepts as well as through the culminating and microteaching last

March 01, 2012. The student also emphasized DOH programs offered by the

Department of Health and the services they offered at Barangay Health Centers.

Family care study covers only four (4) weeks of Community Health Nursing. This is

also limited to the family's capabilities and willingness to participate and cooperate

with the nursing interventions.

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II. SPOT MAP

A. NARRATIVE DESCRIPTION

Tent City, Calaanan Relocation Site, Canitoan Cagayan de Oro City, Misamis

Oriental is located Southwest and 7.5 kilometers away from Cagayan de Oro City

proper. Our reference point is from Liceo de Cagayan University-main campus to

Tent City, Calaanan Relocation Site, Canitoan Cagayan de Oro City. From here the

students have to charter a jeepney to transport the group to and from with the fare

of 43 pesos. From the school, the jeepney should turn right on the intersection

going to Patag, passing through the SSS building, GSIS building, Highschool

Department, National Grid of the Philippines. The jeepney will then turn left with the

House of Bulalo as the landmark then going to the Villarin street passing through

the establishments of Department of Telecommunication and National Irrigational

Administration, straight passing the St. Mary’s Academy and Mt. Carmel Church.

Then turn left from the intersection between Macanhan and Upper Carmen passing

Immanuel Mission School and Landfill Zayas, Upper Carmen going downward

passing the Silver Creek Subdivision and St. Therese Chapel. Upon arriving on the

Canitoan Road, the jeepney must turn left to P.N Roa area, going straight passing to

the P.N Roa Elementary school then finally to the Tent City. The Tent were

numbered and arranged by five, the tent of our family is # 273.

B. ALTERNATIVE ROUTE

One may ride a jeepney going to Cogon Market where you will stop near

Petron Gasoline Station facing south you will go then to the street leading to

National Bookstore. At the back of the National Bookstore is where you will the find

the jeepney going to the P.N Roa including Calaanan. Upon riding on that jeepney,

you can pass by the Rotonda circle and Upper Carmen passing Immanuel Mission

School and Landfill Zayas, Upper Carmen going downward passing the Silver Creek

Subdivision and St. Therese Chapel. Upon arriving on the Canitoan Road, turn left to

P.N Roa area, going straight passing to the P.N Roa Elementary school then finally

the Tent City.The Tent were numbered and arranged by five, the tent of our family

is # 273.

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C. ILLUSTRATION/DIAGRAM OF THE MAP

Spot Map of The Tent City, Calaanan Relocation Site, Canitoan, Cagayan de Oro City, Misamis Oriental

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III. FAMILY PROFILE

Client’s Name: Mr. XX

Position in the Family: Head

Gender: Male

Age: 27 years old

Civil Status: Married

Birth date: April 08, 1984

Birth place: Punong, Gingoog City

Citizenship: Filipino

Religion: Roman Catholic

Occupation: Motor- rela driver

Monthly income: P 1,500.00

Client’s Name: Mrs. XX

Position in the Family: Wife

Gender: Female

Age: 22 years old

Civil Status: Married

Birth date: May 14, 1989

Birth place: Punong, Gingoog City



Occupation: Housewife

Monthly income: None

NO PICTURE TAKEN

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Client’s Name: XX1

Position in the Family: 1st Child

Gender: Female

Age: 4 years old

Civil Status: Child

Birth date: January 23, 2008

Birth place: Northern Mindanao

Medical Center, CDOC




Position in the Family: 2nd Child

Gender: Female

Age: 2 years old

Civil Status: Child

Birth date: May 07, 2009





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Position in the Family: 3rd Child

Gender: Male

Age: 1 year old

Civil Status: Child

Birth date: October 26, 2010





IV. FAMILY HEALTH HISTORY

1. Client Mr. XX

Mr. XX is 27 years of age, and is presently residing with his whole family now

at the Tent City, Calaanan Relocation Site, CDO; Tent No. 273. He had common

colds and cough last month and doesn’t have any chronic illness as claimed. He was

fully immunized during his childhood days since his mother was a BHW in their

place. Last 2005, he suffered from Urinary Tract Infection thus consulted and

admitted at NMMC which lasted for 5 days. He had heredofamilial diseases of

asthma, diabetes mellitus II and hypertension. No known food and drug allergy.

2. Client Mrs. XX

Mrs. XX is 22 years of age, a housewife. She had her first menstruation at the

age of 12 years old and had a regular monthly period. She was immunized

completely during childhood. She claimed that she was positive for Hepatitis B when

she was carrying her 2nd child on her womb (4 years ago) after a blood test was

performed. She was in denial at that time, she did request another test but the

result was still the same. She had no idea where she got the dreadful disease. She

knows how the disease was transmitted. Now she’s in a stage of acceptance as she

claimed.

She has no known food and drug allergy and don’t have any history of

diseases in their family line. She delivered her children through normal spontaneous

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vaginal delivery at Northern Mindanao Medical Center. She had her prenatal check-

up at same institution. So far she had no complications experienced for her past

pregnancy.

Gynecology History

Menarche at 12 y.o. regular subsequent menses, 5 days (-) dysmenorrhea

Obstetric History

G1- (January 23, 2008) XX1- NSVD, NMMC

G2- (May 07, 2009) XX2- NSVD, NMMC

G3- (October 26, 2010) XX3- NSVD, NMMC

Hospital Confinement

UTI admitted at NMMC for 4 days (2008)

3. Client XX1

Client XX1, a 4 year old female child, was delivered through normal

spontaneous vaginal delivery at Northern Mindanao Medical Center. She was fully

immunized. The child was hospitalized when she was about 6 months old at NMMC

for a week due to Acute Gastroenteritis with Moderate Dehydration.

4. Client XX2

Client XX2, a 2 year old female child, was delivered through normal

spontaneous vaginal delivery at Northern Mindanao Medical Center. She was fully

immunized. Like her older sister, she was hospitalized when she was about 6

months old at NMMC for 4 days due to Acute Gastroenteritis with Moderate

Dehydration.

5. Client XX3

Client XX3, a 1 year old male child, was delivered through normal

spontaneous vaginal delivery at Northern Mindanao Medical Center. He was fully

immunized now. Like his older sisters, again he was hospitalized when he was about

6 months old at NMMC for just 4 hours for hydration purposes due to severe

dehydration. Their mother did say that her children experienced the same disease

when they were about 6 months old. Coincidence?

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V. PRESENT HEALTH STATUS

A.

1. Client Mr. XX

Mr. XX claimed that he doesn’t have any illnesses at the moment. His cough

and colds subsided a month ago. He works as a motor-rela driver. No history of

drinking alcoholic beverages and non-smoker. Vital signs was taken last February

02, 2012 with a Pulse: 88 bpm RR: 21cpm BP: 130/80 mmHg Temp: 36.2 o C.

2. Client Mrs. XX

Mrs. XX claimed that he doesn’t have any illnesses but do have troubled

sleeping at night when they transferred at their tent. She’s a housewife and always

taking care of their young ones, making sure that they’re safe and sound. No history

of drinking alcoholic beverages and non-smoker as claimed. Vital signs was taken

last January 20, 2012 with a Pulse: 78 bpm RR: 23cpm BP: 110/80 mmHg

Temp: 36.5

3. Client XX1

During assessment, cough and colds with whitish sputum was noted with

client XX1. Her mother said that her cough and colds was intermittent for the past 4

weeks. The child does take Vitamin C and Multivitamins given by the clinic for free

after consultation. Vital signs: Pulse: 97 bpm RR: 25cpm BP: no pedia cuff avail,

Temp: 36.3 0 C

4. Client XX2

No illness was noted with client XX2. She’s playful, energetic and cheerful

during the course of assessment. The child also takes Vitamin C and Multivitamins.

Vital signs: Pulse: 89 bpm RR: 23cpm BP: no pedia cuff avail. Temp:

36.3 o C

5. Client XX3

Cough and colds with whitish sputum was noted with client XX3 with no

respiratory distress, just like her eldest sister. The mother said that his cough and

colds was intermittent for the past 2 weeks and was given Vitamin C and

Multivitamins after consulting the clinic. Vital signs: Pulse: 94 bpm RR: 24cpm

BP: no pedia cuff avail. Temp: 36.2 o C

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B. NURSING ASSESSMENT (SYSTEM REWIEW CHART)

LEGEND:

EENT:𓀿 Impaired vision 𓀿 blind 𓀿 pain 𓀿 reddened 𓀿 drainage𓀿 gums 𓀿 hard of hearing 𓀿 deaf𓀿 burning 𓀿 edema 𓀿 lesion 𓀿 teethAsses eyes, ears, noseThroat for abnormality √ no problemRESP.𓀿asymmetric 𓀿 tachypnea𓀿 apnea 𓀿 rales 𓀿 cough 𓀿 barrel chest𓀿 bradypnea 𓀿 shallow 𓀿 rhonchi𓀿 sputum 𓀿 diminished 𓀿 dyspnea𓀿 orthopnea 𓀿 labored 𓀿 wheezing𓀿 pain 𓀿 cyanoticAsses resp. rate, rhythm, depth, patternbreath sounds, comfort √ no problemCARDIO VASCULAR𓀿 arrhythmia 𓀿 tachycardia 𓀿 numbness𓀿 diminished pulses 𓀿 edema 𓀿 fatigue𓀿 irregular 𓀿 bradycardia 𓀿 murmur𓀿 tingling 𓀿 absent pulses 𓀿 painAssess heart sounds, rate, rhythm, pulse, bloodpressure, etc., fluid retention, comfort √ no problemGASTRO INTESTINAL TRACT𓀿 obese 𓀿 distention 𓀿 mass𓀿 dysphagia 𓀿 rigidity 𓀿 painAsses abdomen, bowel habits, swallowing, bowel sounds, comfort √ no problemGENITO-URINARY and GYNE

𓀿 pain 𓀿 urine color 𓀿 vaginal bleeding 𓀿 hematuria 𓀿 discharge 𓀿 nocturia

Assess urine freq., control, color, odor, comfort/Gyn-bleeding, discharge √ no problemNEURO

𓀿 paralysis 𓀿 stuporous 𓀿 unsteady 𓀿 seizures 𓀿 lethargic 𓀿 comatose 𓀿 vertigo 𓀿 tremors 𓀿 confused 𓀿 vision 𓀿 grip

Assess motor function, sensation, LOC, strength, grip, galt, coordination, orientation, speech √ no problemMUSCULOSKELETAL and SKIN

𓀿 appliance 𓀿 stiffness 𓀿 itching 𓀿 petechiae 𓀿 hot 𓀿 drainage 𓀿 prosthesis 𓀿 swelling 𓀿 lesion 𓀿 poor turgor 𓀿 cool 𓀿 deformity 𓀿 wound 𓀿 rash 𓀿 skin color 𓀿 flushed 𓀿 atrophy 𓀿 pain 𓀿 ecchymosis 𓀿 diaphoretic 𓀿 moist

Asses mobility, motion, galt, alignment, joint function /skin color, texture, turgor, integrity √ no problem

-slightly elevated blood pressure of 130/80 mmHg-dirty fingernails

-dirty toenails

Name: XX, Mr. XX Date: February 02, 2012Vital Signs:Pulse: 88 bpm BP: 130/80 mmHg Temp: 36.2 o C Height: 5’5’’ Weight: 77 kg

Place an (√) in the area of abnormality. Comment at thespace provided. Indicate the location of the problem inthe figure if appropriate, using (√)

1ST WEEK

2ND WEEK

3RD WEEK

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LEGEND:








-pale in appearance

-difficulty sleeping-(+) Hep. B

Name: XX, Mrs. XX Date: January 20, 2012Vital Signs:Pulse: 78 bpm BP: 110/80 mmHg Temp: 36.5 o C Height: 5’2’’ Weight: 58 kg


4TH WEEK

1ST WEEK

2ND WEEK 4TH WEEK

3RD WEEK

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LEGEND:








- tooth decay all throughout the assessment

-cough and colds with whitish sputum in minimal amount

- Moderate personal hygiene

- Dirty nails

Name: XX, XX1 Date: January 26, 2012Vital Signs:Pulse: 97 bpm BP: no pedia cuff avail, Temp: 36.3 o C Height: 103 cm Weight: 13.2 kg


1ST WEEK

2ND WEEK 4TH WEEK

3RD WEEK

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LEGEND:








-tooth decay all throughout the assessment

-moderate personal hygiene -dirty fingernails

Name: XX, XX2 Date: January 26, 2012Vital Signs:Pulse: 89 bpm BP: no pedia cuff avail. Temp: 36.3 o C Height: 97cm Weight: 14 kg


1ST WEEK

2ND WEEK 4TH WEEK

3RD WEEK

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LEGEND:








-cough and colds with whitish sputum in minimal amount

-moderate personal hygiene-dirty fingernails

Name: XX, XX3 Date: January 26, 2012Vital Signs:Pulse: 94 bpm BP: no pedia cuff avail. Temp: 36.2 o C Height: 79cm Weight: 49 kg


1ST WEEK

2ND WEEK 4TH WEEK

3RD WEEK

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VI. INTERGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI)

MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARS

Date: January 26, 2012

Child’s name: XX3 Age: 1 year old Sex: Male Weight: 9.5 kg Temp:

36.2˚C

ASK: What are the child’s problem? Cough and colds all throughout the

assessment (WEEK 2-WEEK4)

Initial visit and Follow-up Visit

ASSESS CLASSIFY

CHECK FOR GENERAL DANGER SIGNS

NOT ABLE TO DRINK OR BREASTFEED

VOMITS EVERYTHING

CONVULSIONS

ABNORMALLY SLEEPY OR DIFFICULT TO AWAKEN

YES___

NO_√_

DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING? Yes_√_ No___

For how long?

Count the breaths for one minute. _26_breaths per minute. Fast breathing?

Look for chest indrawing? Look and listen for stridor.

No Pneumonia: Cough and Cold

DOES THE CHILD HAVE DIARRHEA? Yes___ No_√_

For how long? ___days

Is there blood in the stools?

Look at the child’s general condition. Abnormally sleepy or difficult to awaken?

Restless or irritable?

Look for sunken eyes. Offer the child fluid. Is the child: Not able to drink or drink poorly?

Drinking eagerly, thirsty?

Pinch the skin of the abdomen. Does it go back: Very slowly (longer than 2 seconds)?

Slowly?

No Dehydrati

on

DOES THE CHILD HAVE FEVER? (by history/feels hot/temperature 37.5C or above) Yes__ No_√__

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Decide Malaria Risk

Does the child live in malaria area? No Has the child visited a malaria area in the past 4 weeks? NoIf malaria risk, obtain a blood smear.

Look or feel for stiff neck. Look for runny nose. + Pf Pv - Not done

For how long has the child had fever? __days If more than 7 days, has fever been present every day? Has the child had measles within the last 3 months?Look for signs of MEASLES

Generalized rash and One of these: cough, runny nose. Or red eyes.

………………………………………………………………………………………………………………………….

If the child has measles now or within the last 3 months:

Look for mouth ulcers If yes, are they deep and extensive?

Look for pus draining from the eye Look for clouding of the cornea.

………………………………………………………………………………………………………………………….

Decide Dengue Risk:

Yes__ N o__√_

If dengue risk, then ask:

Has the child had any bleeding form the nose or gums or in the vomitus or stools? No

Has the child had black vomitus or black stool? No Has the child had abdominal pain? No Has the child been vomiting? No Look for bleeding from nose or gums. None Look for skin petechiae. None Feels for cold and clammy extremitites. None Check capillary refill ___seconds. Perform tourniquet test if child is 6 months or older and has no other

signs and has fever for more than 3 days.

DOES THE CHILD HAVE AN EAR PROBLEM?

Yes___ No__√_

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Is there ear pain? No Is there ear discharge? No

If yes, for how long? ___days

Look for pus draining from the ear. None Feel for tender swelling behind the ear. None

No Ear Infection

THEN CHECK FOR MALNUTRITION AND ANEMIA

Look for visible severe wasting. Yes. Look for edema of both feet. No. Look for palmar pallor. Severe palmar pallor? Some palmar pallor? None

Determine weight for age Very Low? Low.

No Anemia and low weight

CHECK THE CHILD’S IMMUNIZATION STATUS Circle immunization needed today

_√__ _√__ __√_ __√__

BCG DPT1 OPV1 HEPB1

__√__ _√__ __√_ ____√___

DPT2 OPV2 HEPB2 MEASLES

_√___ __√__ __√___

DPT3 OPV3 HEPB3

Return for next

immunization on:

(date)

CHECK THE VITAMIN A SUPPLEMENTATION STATUS for children 6 months or older

Is the child six months of age or older? Yes_√_ NO___

Has the child received Vitamin A in the past six months? Yes_√___ No___

Vitamin A needed today

Yes___ No_√__

ASSESS CHILD’S FEEDING if child has ANEMIA OR VERY LOW WEIGHT or is less than 2 years old.

Do you breastfeed your child? Yes__ No__√__If Yes, how many times in 24 hours? _n/a__ times. Do you breastfeed during the night? Yes___ No_n/a __

Does the child take any other food or fluids? Yes_√__ No___If Yes, what food or fluids? _Bear brand milk, fruits, noodles, canned goods, rice

How many times per day?_3__ times. What do you use to feed the child? _spoon and fork_

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If very low weight for age: How large are servings?___child is within normal weight___

Does the child receive his/her own serving? yes __ Who feeds the child and how?_mother, spoonfeeding; child feeds on his own most of the time

During the illness, has the child’s feeding changed? Yes _√__ No___If yes, how? Fair appetite

ASSESS OTHER PROBLEMS: Moderate personal hygiene



Child’s name: XX2 Age: 2yrs Sex: Female Weight: 14 kg Temp: 36.3˚C

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ASK: What are the child’s problem? None all though out the assessment

(WEEK 2- WEEK 4)

Initial visit and Follow-up visit

ASSESS CLASSIFY



VOMITS EVERYTHING

CONVULSIONS


YES___

NO_√_

DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING? Yes__ No_√__

For how long?



No Pneumoni

a









Slowly?

No Dehydrati

on


Decide Malaria Risk



For how long has the child had fever? __days

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If more than 7 days, has fever been present every day? Has the child had measles within the last 3 months?Look for signs of MEASLES


………………………………………………………………………………………………………………………….




………………………………………………………………………………………………………………………….

Decide Dengue Risk: Yes__ N o__√_






Yes___ No__√_




No Ear Infection


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Look for visible severe wasting. Yes. Look for edema of both feet. No. Look for palmar pallor. Severe palmar pallor? Some palmar pallor? None


No Anemia and low weight


_√__ _√__ __√_ __√__

BCG DPT1 OPV1 HEPB1

__√__ _√__ __√_ ____√___


_√___ __√__ __√___

DPT3 OPV3 HEPB3

Return for next

immunization on:

(date)





Yes___ No_√__

ASSESS CHILD’S FEEDING if child has ANEMIA OR VERY LOW WEIGHT or less than 2 years old.

Do you breastfeed your child? Yes_ _ No__√__If Yes, how many times in 24 hours? _n/a__ times. Do you breastfeed during the night? Yes___ No_n/a

Does the child take any other food or fluids? Yes_√__ No___If Yes, what food or fluids? _noodles, milk, fruits, rice and canned goods


If very low weight for age: How large are servings?_ n/a _____

Does the child receive his/her own serving? yes __ Who feeds the child and how?_child herself, spoonfeeding


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ASSESS OTHER PROBLEMS: Tooth decay and moderate personal hygiene



Child’s name: XX1 Age: 4yrs Sex: Female Weight: 13.2 kg Temp:

36.7˚C

ASK: What are the child’s problem? Cough and colds all throughout the

assessment (WEEK 2-WEEK4)

Initial visit and Follow-up visit

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ASSESS CLASSIFY



VOMITS EVERYTHING

CONVULSIONS


YES___

NO_√_

DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING? Yes__ No_√__

For how long?



No Pneumonia: Cough and Cold









Slowly?

No Dehydrati

on


Decide Malaria Risk



For how long has the child had fever? __days If more than 7 days, has fever been present every day? Has the child had measles within the last 3 months?Look for signs of MEASLES

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………………………………………………………………………………………………………………………….




………………………………………………………………………………………………………………………….

Decide Dengue Risk: Yes__ N o__√_






Yes___ No__√_




No Ear Infection


Look for visible severe wasting. Yes. Look for edema of both feet. No. Look for palmar pallor.

No Anemia and low

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Severe palmar pallor? Some palmar pallor? None


weight


_√__ _√__ __√_ __√__

BCG DPT1 OPV1 HEPB1

__√__ _√__ __√_ ____√___


_√___ __√__ __√___

DPT3 OPV3 HEPB3

Return for next

immunization on:

(date)





Yes___ No_√__

ASSESS CHILD’S FEEDING if child has ANEMIA OR VERY LOW WEIGHT or less than 2 years old.

Do you breastfeed your child? Yes_ _ No__√__If Yes, how many times in 24 hours? _n/a__ times. Do you breastfeed during the night? Yes___ No_n/a

Does the child take any other food or fluids? Yes_√__ No___If Yes, what food or fluids? _noodles, fruits, rice and canned goods_


If very low weight for age: How large are servings?_ n/a

Does the child receive his/her own serving? yes __ Who feeds the child and how?_the child herself, spoonfeeding


ASSESS OTHER PROBLEMS: Tooth decay and moderate personal hygiene

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VII. HOME AND ENVIRONMENT

1. Housing

All families who were victims of the typhoon Sendong, including family XX

were sent at Calaan Relocation Site, Canitoan, Cagayan de Oro City

(known as the Tent City) and were also given a tent (known as the

Shelter box) by the

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government where they will temporarily reside. The family was on Tent

No. 273.

The whole covering (doors, flooring, and small windows) of the Tent is

made up of polyester cloth which is a specialized kind of cloth that can

stand heat and rain, and can’t be easily tear or damage. They were given

a special mat additional for their flooring inside the tent. Two doors, the

back and front have a pair of zippers used to lock their houses when

they’re not around. Windows are widely open at night time. The family

said that when its day to noontime (around 9am-3pm) it’s totally hot

inside the tent, and very cold at nighttime to dawn (around 10pm-5am).

Inside the tent, at the center of it is where their little sala is seen, and the

left and right compartments serve as the rooms where they usually sleep,

change clothes and for the privacy of the couple.

Clothes hanging inside are noticeable also (resting sites of vectors of

diseases such as mosquitoes).

Uses no electricity for their lighting facilities and other electrical devices (

cell phone charger, electric flashlight, electric fan, radio)

Has proper ventilation when the doors and windows are widely open

2. Water supply

Water comes from the

common source where they

usually have to walk and fetch

from the water station (25

meters away from their tent-

washing clothes and dishes,

taking baths)

They use pail and plastic

containers as storage of water

for washing the dishes.

Uses plastic gallons as storage

for purified drinking water

where it’s usually free and

delivered by DUAL NARRA. If

their supply is already consume, they then usually buy purified drinking

water at the nearest drinking water system.

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3. Toilet facility

The LGU’s, NGO’s and

other private sectors

donated these portalette, a

portable toilet where the

people urinates and expel

their wastes. Every day it

is cleaned by a “poso

negro” personnels.

The walls are made up of

special concrete plastic

thing.

Antipolo type

After three weeks of visit, the toilet facility was changed from a portalet into a

water sealed type for a better and more sanitized toilet for all.

4.

Kitchen

Doesn’t have sink, they usually wash dishes at the water station 25 meters

away from their tent

Uses firewood/charcoal for cooking

Washes their dishes using pail as storage of water

Foods are placed on the table outside the tent; leftovers are covered with plates

only and a special covering device was noted

5. Garbage/waste disposal

The family does not segregate their

wastes.

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Uses plastic cellophane container then throws it when its already full at the big

barrel for garbage collection

6. Domestic Animals

They don’t have any domesticated animals and pets in their tent.

7. Neighborhood

Their neighbors are

composed mostly of low-

income families and all of

them were victims of the

typhoon Sendong. Most of

these families are friendly

and show concern for one

another especially when

there is a problem among

them.

The health center is near

and no need to spend money for fare

No fresh air and trees that give shade to the surrounding

VIII. FAMILY COPING INDEX

The objective of this indicator is to present a benchmark for approximating

the nursing needs of the particular family, thus Family Coping Index. It is the

coping capacity and not the underlying problem that is being rated, and it is

designed to record family rather than individual coping capacity. The family cannot

be seen only as a factor that affects health; rather, the family is the patient.

Legend:

1 – No competence

3 – Moderate competence

5 – Complete competence

CATEGORY SCALE JUSTIFICATION1. Physical Independence

5 All family members are physically fit and

physically capable of performing independently.

The family provides needs to its members. The

father works as a motor-rela driver to provide the

needs of his family. The mother takes care of the

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children and is responsible for bathing, grooming

and making their children clean and safe.

2. Therapeutic Competence

3 The family’s initial treatment was the use of

herbal medication to treat existing diseases. They

consult to the physician only if referred from the

barangay health center and if immediate medical

attention is required due to financial problems.

3. Knowledge of Health Condition

3 Has some general knowledge of the disease or

condition, but has not grasped the underlying

principles, or is only partially informed and does

not know how to lessen & prevent the disease.

4. Application of Principles of General Hygiene

5In terms of hygiene, the family was consciously

practicing and applying hygiene principle as part

of their lifestyle. Based on the objective

observation, as well as assessment gathered.

They usually attends seminars about health and

hygiene as stated by the mother when there is

time.

5. Health Attitudes 3 Accepts health care in some degree but with

reservations. Most of the time, the family does

not seek the help of medical professionals only if

symptoms persists and intensifies.

6. Emotional Competence

3 The family was able to maintain a fair degree of

emotional calm, face up to illness realistically and

hopefully; their problem was only lack of financial

support that was not able to sustain what are

those family needs.

7. Family Living 3 Family’s does things together and act for the

good of the family as a whole and they have good

interpersonal relationship. The children do

respect their parents as what I’ve observed.

8. Physical Environment

3 The house is generally in good condition and

safe. But they don’t have a proper drainage. The

environment possibly has vectors that can cause

diseases such as dengue or filariasis.

9. Use of Community Facilities

3 Family is aware of and uses of the health services

offered in their place. Their children had received

already full immunization.

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IX. SCHEMATIC PRESENTATION OF THE FAMILY HEALTH PROBLEM

SOCIO-CULTURAL FACTORS

Economic Political

FATHER MOTHER

High school undergraduate

High School undergraduate

Cultural

NONE NONE

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Motor- rela driver

Housewife

Financially unstable with a monthly income of

Php 1, 500

HEALTH THREAT:

- Family size beyond what family resources can adequately provide (financially unstable)

No other additional expense for the Family

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BIOLOGICAL FACTORS

Psychosocial

Physical

Genetic

- Typhoon Sendong took away so many things from them, but they were able to adjust in the new environment they have. They’re in the stage of acceptance

-Express anxiety over budget compensation for additional budgets

Father Mother Children

- Long dirty fingernails and toenails

- Slightly elevated BP of 130/80mmhg

- Difficulty sleeping

- Lack of sleep- (+) Hep. B


- Dirty nails- Tooth decay- Cough and colds

Hypertension. DM II and asthma on

paternal side

HEALTH THREAT


- Heredito-familial diseases: hypertension, asthma and DM II

- Dirty nails- Tooth decay

HEALTH DEFICIT

- Lack of sleep- Hepatitis B

disease- Elevated blood

pressure- cough and

colds

FORESEEABLE CRISIS

- infection- hospitalization- death

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ENVIRONMENTAL

Home and Sanitation

TENTS:

-No proper division.- No privacy.-Fire Hazard (made up polyester cloth)

Water Supply

Water Source is 25 meters away from the tent.

Community faucets used for bathing and washing

dishes and clothes.

Uncovered water containers and

storage

Toilet

Communal toilet

Antipolo Portalet and Water

sealed type of toilet

Garbage Disposal

Waste segregation not practiced. The family hangs a plastic bag

adjacent to the tent for their garbage and

throws it when full at a big barrel of garbage

- presence of vectors for diseases such as mosquitoes and flies

Kitchen

Dirty kitchen adjacent to their

tent

Prone to fire accdients

HEALTH THREAT- presence of breeding or resting sites of vectors of

diseases- improper garbage disposal- making fire at children’s reach may cause burns and

injuries- inadequate living space

The family is given a galloon of purified drinking waterInadequate living

space, no proper sleeping grounds, room for

FORESEEABLE CRISIS

- infection- hospitalization- death

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X. FAMILY HEALTH PLANCUES HEALTH

PROBLEMFAMILY

NURSING PROBLEM

GOAL OF CARE

OBJECTIVES OF CARE

INTERVENTION PLAN EVALUATIONNursing

InterventionsMethod

of Nurse-Family Contact

Resources Required

Subjective:

“Kani lagi sila akong mga anak kay gipang ubo ug sip on,” as verbalized by the wife

Objective:

-productive cough with whitish sputum in minimal amount

- colds

- not in respiratory

Cough and colds as health deficit

1. Inability to make decisions about taking appropriate action due to:

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

b. Fear of consequences of action, specifically economic consequences.

2. Inability to provide

At the end of nursing intervention,

The children in the family with cough and colds will be relieved.

At the end of nursing interventions, the family will:

a. gain knowledge on the management of cough and colds;

b. bring the child to the health center for consultation;

c. be able to carry out appropriate interventions to relieve the child’s cough

1. Taught the mother the ways to soothe the throat and relieve cough with a safe remedy such as tamarind, calamansi and ginger.

2. Instructed the mother not to use cough syrups and other decongestants if not prescribed by the doctor.

3. Instructed the mother to increase the

Home Visit

Material resources:

-tamarind, calamansi or ginger

Time and effort of the nurse and the family

Expenses for transportation of the student nurses

Goal partially met

At the end of nursing interventions, the family:

a. gained knowledge on the management of cough and colds;

;

b. was able to carry out appropriate interventions to relieve the child’s cough and colds.

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distress adequate nursing care to a member suffering from cough and colds due to:

a. inadequate knowledge regarding the health condition;

b. lack of knowledge on the nature and extent of nursing care needed;

and colds; child’s fluid intake.

4. Instructed the mother to keep the child’s back dry.

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CUES HEALTH PROBLEM

FAMILY NURSING

CARE

GOAL OF CARE

OBJECTIVES OF CARE

INTERVENTION MEASURES

MODE OF

NURSE-FAMILY CONTAC

T

RESOURCES NEEDED

EVALUATIONS

Subjective: “Gaibutang ra namo among mga pagkaon sa lamesa dayon takluban ug palto” as verbalized by the wife

Objective: -no other storage facilities to secure their uncooked and left over foods

Presence of health threat due to poor condition as evidenced by lack of food storage facilities

-Inability to provide a home environment conducive to health maintenance and personal development due to: a. inadequate family resources specially financial constraints or limited financial resources

At the end 30 minutes of nursing interventions, the family will be able to:a. Verbalize understanding about the importance of having better food storage.

b. Place their food in a safe place away from pests.

After the nursing intervention carried out, the family will at least have better containers or cover to secure their foods and from contamination.

1.Assess knowledge of the family towards the pending problem.2.Discuss possible threats to the family’s health due to these containers.3.Discuss the advantages which will bring about the partial solution to their problem.4.Plan appropriate action to the problem.

Home visit

Food storage

Time and effort of the nurse and actual participation and empowerment of the family

Financial Resources

After 30 minutes of nursing interventions, the family was able to:a.Verbalized understanding about the importance of having better food storage.

b. Placed their food in a safe place away from pests.

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CUES HEALTH PROBLEM

FAMILY NURSING

PROBLEMS

GOAL OF CARE

OBJECTIVES OF CARE


METHODS OF

FAMILY-NURSE

CONTACT

RESOURCES REQUIRED

EVALUATION

Subjective:

“Wala lage me saktong butanganan sa mga plato ug uban pang materyles sa pagpreparar sa pagkaon” as verbalized by the wife

Objective:

Unwashed utensils

Unorganized placements of utensils

Exposed stencils to pest and rodents

Unsanitary food handling as a health threat

Inability to decide about taking appropriate actions due to failure to comprehend the identified problem as a health threat

After 4 weeks of rendering nursing interventions, the family will be able to practice the proper ways on handling food and recognize the importance of proper food handling

After 4 weeks of rendering nursing interventions, the family members will be able to:

1. Recognize the risk factors that will contribute to the identified problems;

2. identify the different measures to prevent the arousal of the risk factors of the

1. Assess the family concerning their practices on handling and preparing the food

2. Discuss with the family the health problems that will occur if improper food handling will persist and lead to undesirable illnesses such as diarrhea

3. Teach the family to do proper hand washing and encourage them to perform it before and after handling foods

arise

4. Discuss to the family on how to

Home visit Participation and empowerment of the family

Time and effort of the nurse and family member

At the end of 4 weeks, the family was able to practice proper ways about handling food and recognized the importance of proper food preparation and food handling

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Improper food storage and handling, foods exposed to flies

problem

3. determine the importance of preparing and handling the food properly;

4. practice and apply the techniques of food handling and preparation;

5. keep their kitchen clean and free from insects an rodents

handle the food properly:

5. Encourage the family to keep the house clean specially the kitchen area

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CUES HEALTH PROBLEM

FAMILY NURSING

PROBLEMS

GOAL OF CARE

OBJECTIVES OF CARE


METHODS OF FAMILY-

NURSE CONTACT

RESOURCES REQUIRED

EVALUATION

Subjective:

“Hugaw jud ang amu palibot, cge man ko panlimpyo pero mahugaw ra jpon” as verbalized by the wife

Objective:

-unclean environment

-clothes

Poor home environmental condition as a health threat

Inability to provide a home environment conducive to health maintenance and personal development due to failure to comprehend the identified problem as a health threat

After 4 weeks of rendering nursing interventions, the family will be able to recognize the problem as a threat and will be able to recognize the importance keeping the home clean

After 4 weeks of rendering nursing interventions, the family members will be able to take action in cleaning their tent area and maintaining its cleanliness.

1. Encourage the every family member to participate in cleaning

2. Discuss the importance of keeping the home/tent clean

3. Discuss the possible health condition that may arise

4. Encourage the family members to maintain the

Home visit Participation and empowerment of the family

Time and effort of the nurse and family member

At the end of 4 weeks, the family was able to:

a. Recognize the importance of home environmental sanitation

B. Family members participated in maintain the cleanliness of their place

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hanging inside the tent

-Presence of flies and mosquitoes flying the house

cleanliness in their home/tent

CUES HEALTH PROBLEM

FAMILY NURSING

PROBLEMS

GOAL OF CARE

OBJECTIVES OF CARE

INTERVENTION

MEASURES

METHODS OF

FAMILY-NURSE

CONTACT

RESOURCES REQUIRED

EVALUATION

Subjective cue:

”Sa cellopane nalang namu ginatambak tanan, then amu gnalabay sa barrel nga

Improper garbage disposal as a health threat

Inability to provide home environment conducive to health maintenance and personal development due lack of knowledge of

At the end of nursing interventions, the family will be able to realize the harmful effects of improper garbage disposal and

Short term objectives:

At the end of 15 minutes, the family will receive health teachings about importance of proper waste

Health teachings with emphasis on the importance of waste management.

Human waste and diseases. It is very important to keep human waste out of water supplies.

Home visitations of the student for six visits within 6 weeks

Family Interaction

Time and effort of the student and the family members

Fare for the students

At the end of 4 weeks ,the goal partially met. The family was not able to apply the proper waste

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basurahan, kwaon raman daun sa mangulekta ug basura ” as verbalized by the wife.

Objective cues:

Presence of flies and mosquitoes

Unsegregated way of garbage disposal and dumping in a cellophane bag

proper garbage disposal

benefits of clean and healthy environment

disposal

Long term objectives:

At the end of 4 weeks , the family will be able to adopt proper waste mangement

Human waste (faeces, poo, kuma, urine, wee) contains diseases that make people sick. Human waste can get into the local water supplies from leaking septic tanks, releasing contaminated water from sewerage treatment plants, dirty nappies, leaking sewerage pipes and people using local creeks as a toilet.

Injury and disease. People can get diseases like tetanus and leptospirosis if they cut or scratch themselves on pieces of metal, nails or glass. Children can be seriously hurt by playing with old car

disposal. But the family intermittently followed the waste management.

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batteries or household cleaners that they find lying around.

Litter can be a problem. Broken bottles and tins, for example, can cause injury. Mosquitoes and other vectors can breed in water trapped in old tyres and bottles.

CUES HEALTH PROBLEM

FAMILY NURSING

PROBLEMS

GOAL OF CARE

OBJECTIVES OF CARE

INTERVENTION

MEASURES

METHODS OF FAMILY-

NURSE CONTACT

RESOURCES REQUIRED

EVALUATION

Subjective cue:

“ Dili jud maigo ang sweldo sa akong bana, gamay kaayo. ” as

Low family income as a health threat

Inability to provide home environment conducive to health maintenance and personal development

At the end of nursing interventions, the family will be able to recognize or realize ways that will help

Short term objectives:

At the end of 20 minutes, the family will be able to recognize ways in saving money

Establish a family budget.

Spend Less.Try to never waste money and make every purchase a considered purchase.

Home visitations of the student for six visits within six weeks

Family

Time and effort of the student and the family members

Fare for the student

At the end of 4 weeks , the goal was partially met. The family recognized ways in saving their money but

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verbalized by the wife.

”Wala pod ko trabaho ” as verbalized by the wife

Objective cues:

Father – P1,500/month income

Poor family living

due to inadequate family resources specifically financial constraints/financial resources

in maximizing their money.

through giving adequate information.

Long term objectives:

At the end of 4 weeks , the family will be able to apply measures in saving money.

Use less. If could all use and consume less there would be less waste, less power consumption, and the benefits for you are SAVING MONEY.

Save Money.Each week or each month get into the habit of putting an amount, however small into your savings. Start by saving a very small fixed amount each time and then move to putting in larger amounts once you begin to save money from your other money saving strategies.

Shop Wisely. Consider markets, superstores, farmer's markets, local shops, marts and stores.

Buy used. There are huge money savings

Interaction needs to be applied in longer duration for sufficient results.

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to be made in buying used

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XI. ACTUAL IMPLEMENTATION

WEEK 1: January 19-21, 2012 (Orientation Phase)

The first encounter with my family was last

January 20, 2012 when we started our family

profiling and somehow after gathering data, this

family fitted the criteria for the family case study.

As always, I greeted Mrs. XX and introduced

myself. I stated the purpose of the visit and

eventually asked permission using a consent

letter if it is okay for them to be a part for the

family case study. Then, I explained to her the

whole course of the study, its purposes, benefits

and all: family profile, assessment for 4 weeks,

implementation of care and health teachings and

documentations.

I also assessed the family about their coping as for what had happen during

the typhoon Sendong. We talked a lot. She did express her feelings and verbalized

her thoughts.

WEEK 2: January 26-28, 2012 (Working

Phase)

During this week I continued my

assessment and put my attention to their 3

children. I assessed them individually using my

nursing skills and with the used of the IMCI

booklet. Problems were identified and made me

plan for the succeeding days to come. Same with

Mrs. XX, problems were raised and explanations of

such diseases were discussed. The whole week,

implementations done and health teachings were

imparted to the family. The importance of hygiene

to achieve a healthy well being was emphasized;

bathing, grooming and cutting long and dirty

fingernails were performed with the family members.

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WEEK 3: February 02-04, 2012 (Working Phase)

The third week of the

exposure here at the Tent City, I

finally assessed the head of the

family Mr. XX. He’s not always at

their tent since he’s the only one

working as a motor- rela driver for

the needs and provision of his

family. After the assessment and

interview, health teachings were

again imparted to him since he

has an elevated blood pressure.

He also claimed that they do have

a family history of hypertension,

asthma and DM II which makes

him more at risk.

Cleanliness not only to their bodies but also to their environment was

stressed out. The disease conditions that one can get from improper handling of

food, improper garbage disposal, and uncleanliness made the family more

conscious about their health and hygiene. The family did raise many questions and I

did answer them based on the books I read.

WEEK 4: February 17-18, 2012 (Termination Phase)

The fourth week and termination phase has already come. Together with the family, we

evaluated the course of home visits and asked the family what they’ve learned for the past

weeks. Same with them, I thanked the family for the hospitality and time they had given to me.

Finally, I invited them to come and join the income generating activity and microteaching this

coming March 01, 2012.

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XII. EVALUATION AND RECOMMENDATION

Community Health Nursing has been a part of every student nurse’s life. It is

a nurse’s duty to bring to the people the health programs of the government. To

provide immediate health care to the community people’s health problems before

going to the higher health care facilities. Prevention is our primary task so it is our

duty to do every means in order to educate the people.

After four weeks of visitation, I had identified several family health problems

and environmental problems as well. As included in the whole process of assessing,

imparting health teachings and rendering care to the family members, I recommend

that the family should give first priority to their health and avail the services offered

by the local government at the Tent City for proper referrals and further

intervention of their disease conditions in which they are not familiar with. I am

hoping and looking forward that the XX family will apply the things that the student

nurse imparted to promote health and well being.

Overall, the intervention that was implemented to family made a difference

on their perception towards promoting health, and preventing illness. As a

practicing health care giver, the experience that I have gain during the rotation had

improved my understanding about community health nursing, not only that I have

implemented interventions but the feeling of being accepted as a health care

provider and helped in the improvement of others’ lives is very heartwarming and

gave me a sense of accomplishment. For me, the concept of Community Health

Nursing is not all about fulfilling the requirements to pass or just intervening the

problems identified, it’s how the health care giver touches others lives and be one

of them in attaining the solution of the problem, it’s about empathy and motivation

towards one self and the community to perform such task pertaining to promoting

health and preventing disease. This exposure inculcates to us lots of learning and

values which would eventually help us to become competent health care providers

as future nurses.

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XIII. BIBLIOGRAPHY

Maglaya, A., & Earnshaw , R., Nursing Practice in the Community.

Community Health Nursing by DOH

Kozier, et al. Fundamentals of Nursing. Singapore: Pearson Education Asia

Ltd., 2004

Smeltzer, S. Medical-Surgical Nursing. Manila, 1996.

Reyala, A. et al. Community Health Services in the Philippines. Manila: Na-

tional

League of the Philippine Government Nurses, Inc., 2000

Maglaya, A. Nursing Practice in the Community. Philippines: Argonauta Corp.

Microsoft® Encarta® 2009 . © 1993-2008 Microsoft Corporation.

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XIV. APPENDICES

A. LETTER OF CONSENT FOR CARE STUDY AND TAKING OF PICTURES

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B. PRIORITIZING HEALTH CONDITION AND PROBLEMS (ACTUAL COMPUTATION)

RANK 1

Problem: Cold and Cough as health deficit

Criteria Computation Actual Score JustificationNature of the condition or problem presented

3/ 3 x 1 = 1 1 Health deficit problem

Modifiability of the condition or problem

2/ 2 x 2 = 2 2 Easily modifiable

Preventive potential 3/ 3 x 1 = 1 1 Highly preventableSalience 2/ 2 x 1 = 1 1 Needing immediate

attentionTotal Score and Rank 5 Highest weight

RANK 2

Problem: Presence of health threats due to poor food sanitation as evidenced by lack of food storage facilities


2/ 3 x 1 = 0.66 0.66 Health threat problem




attentionTotal Score and Rank 4.66 Highest weight

RANK 3

Problem: Unsanitary food handling as health threat


2/ 3 x 1 = .66 0.66 Health threat problem




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RANK 4

Problem: Poor home and environmental condition as health threat





Preventive potential 3/ 3 x 1 = 1 1 Highly preventableSalience 1/ 2 x 1 = 0.5 0.5 Problem not really

perceived needing change

Total Score and Rank 4.16

RANK 5

Problem: Improper garbage disposal as a health threat





Preventive potential 3/ 3 x 1 = 1 1 Highly preventableSalience 1/ 2 x 1 = 0.5 .5 Not needing immediate


RANK 6

Problem: Low family income as a health threat




1/ 2 x 2 = 2 1 Partially modifiable

Preventive potential 1/ 3 x 1 = 0.33 0.33 Low preventableSalience 2/ 2 x 1 = 1 1 Needing immediate


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Sample Family Care Study (N107)

Documents