Community Health Nursing Case Study

JMJ Marist Brothers
NOTRE DAME OF MARBEL UNIVERSITY

College of Arts and Sciences
Nursing Department
NURSING ASSESSMENT OF FAMILY P AT SITIO

SALKAN, BARANGAY PARAISO, CITY OF KORONADAL
A Case Study Presentation to

The Faculty of the
Nursing Department
Notre Dame of Marbel University
City of Koronadal
In Partial Fulfillment
of the Requirements in
Community Health Nursing-1
Cumbe, Karen Mae P.
October 2019
JMJ Marist Brothers
College of Arts and Sciences - Nursing Department
Koronadal City, South Cotabato
ACKNOWLEDGEMENT
In the process of creating this case study, the researcher underwent various
challenges, hardships, and sacrifices. However, the following people gave the
researcher inspiration and support to overcome this temporary trial. They helped
her motivate herself to continue what she already started. This would not have
been completed without their unending support.
To the Notre Dame of Marbel University President, Bro. Wilfredo Lubrico,
FMS, PhD, she would like to express her gratitude for pushing through the skill
and wisdom development of the students of this institution.
To the Program Coordinator of the Nursing Department, Merna S.
Lebanan, DScN, RN, for providing guidance, knowledge, and skill in the process
of creating this study.
To the Clinical Coordinator, Jan Maverick S. Rabino, RN, who gave her
support and constant enthusiasm in the creation of this study.
To our Clinical Instructor, Lennie Anne S. Flores, RN, MN, for the priceless
support and guidance towards the success of this academic task.
To Sitio Salkan, Brgy. Paraiso, Koronadal City and the Hon. Samuel
Velarde, for allowing her to practice nursing care and to allow her to gather
invaluable data for this study.

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To Family P for whole-heartedly participating and showing hospitality in the
duration of the data gathering process. Your time and effort are much appreciated
as your information served as the foundation of this case study.
To the fellow student nurses of the university, for the encouragements
and motivation. The researcher would like to express her heartfelt gratitude for
their empathy, especially that they also experience the same manner of struggle
as the researcher herself.
To the dearest parents of the researcher, Mr. Zaldy E. Cumbe and Mrs.
Mary Grace P. Cumbe, for the constant support, reassurance, and trust in her
abilities. Without their emotional and financial support, this study is not possible.
To Almighty God, whom the researcher is most grateful to, for sending an
abundance of blessings and for the divine supervision that urged the her to
overcome the trials, reach for her limit, and reach the success of this research.
JMJ Marist Brothers
TABLE OF CONTENTS
Title Page
Acknowledgement
Table of Contents
CHAPTER I: INTRODUCION
Statement of the Objectives
CHAPTER II: INITIAL DATA BASE
Family Structure, Characteristics and Dynamics
Historical Map of the Family
Roles of Members of the Family
Decision Making of the Family
Family Relationships and Dynamics
Socio-economic and Cultural Characteristics
Income and Expenses
Social Involvement and Relationship
CHAPTER III: TYPOLOGY
First Level Assessment
CHAPTER IV: SCALE FOR RANKING
(Problem 1)
(Problem 2)
(Problem 3)
CHAPTER V: FAMILY NURSING CARE PLAN
(NCP for Problem 1)
(NCP for Problem 2)
(NCP for Problem 3)
CHAPTER VI: SUMMARY, CONCLUSION AND RECOMMENDATION
REFERENCES
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APPEDICES
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Chapter I
INTRODUCTION
Community health nursing is a unique division of health care in that its
focus is on populations rather than individuals. In this way, a nurse develops an
awareness of health risks in her clients by assessing the community as a whole.
Unique to community health nursing is the opportunity for nurses to learn and
develop partnership skills with all stakeholders and key actors in their
communities. The concepts and principles of community health nursing are the
family, partnership, change and healthcare delivery system (Dueff, 1995; WHO-
Regional Office for South East Asia, 2010).
According to Estrada-Castro (2012), community health nursing aims to
assist the individual, family and community toward the highest level of holistic
health through multidisciplinary efforts and the supportive relationship between the
people and their physical and social environment.
The concept of family is the major component of the study of community
health. According to Taylor et.al., (1989), family is the basic unit of society.
Families exist in all sizes and configurations and are essential to the health and
survival of the individual members and to society as a whole. As the primary group
for the individual, the family serves as a buffer between the needs of the individual
and the demands and expectations of society. The role of the family is to meet the
needs of society. (as cited by Antipuesto,2009).

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One of the aims of community health nursing, is the changing of health
behaviors among the individual and their families. According to Nola Pender’s
“Health Promotion Model”, person has unique personal characteristics and
experiences that affect subsequent actions. The set of variables for behavioral
specific knowledge and affect have important motivational significance. These
variables can be modified through nursing actions. Health promoting behavior is
the desired behavioral outcome and is the endpoint in the Health Promotion Model
(Gonzalo, 2019).
STATISTIC ON THE PROBLEM
Statement of the Objectives:

JMJ Marist Brothers
The study aims to obtain the initial data base and assess the health of the
Family P and their household from Sitio Salkan, Barangay Paraiso, City of
Koronadal specifically, to:
1. Acquire the Initial Data Base of Family P, the family structure,
characteristics, and dynamics
2. Identify nursing problems based on the family’s presence of wellness
and condition, presence of health threats, presence of heath deficits,
and presence of foreseeable crisis
3. Categorize the priority nursing problems by utilizing the scale for ranking
health condition or problems
4. Create a family nursing care plan according to the identified priority
nursing problems
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Chapter II
INITIAL DATA BASE
The Initial Data Base (IDB) describes the Family Structure Characteristics
and Dynamics, Socio-economic and Cultural Characteristics, Home Environment,
Health Status of Each Family Member, and Values, Habits, Practices on Health
Promotion, Maintenance and Disease Prevention. The Family Structure
Characteristics and Dynamics and Socio-economic and Cultural Characteristics
focuses on how the family came to be and answers to what their status in the
community that they are in. The Home Environment describes the structural
integrity of the house, its safety features and risk factors. Health Status of Each
Family Member, as the name implies, concerns with the health of each member of
the family as well as tracing any condition brought about by hereditary. Finally, the
Values, Habits, Practices on Health Promotion, Maintenance and Disease
Prevention deals with the health behaviors exhibited by the family, primarily in the
aspect of health promotion.
A. Family Structure, Characteristics and Dynamics
Table 1.
Name Relationship to Date of Age Sex Civil Status Place of residence

the head of the Birth
family
A.P. Head of the 08-01-84 35 F Single Sitio Salkan, Brgy.

family Paraiso,
Koronadal City
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G.P. Daughter 09-04-03 16 F Single Bulacan
M.P. Son 05-35-06 13 M Single Bulacan
J.C. Partner 12-11-82 36 M Separated Municipality of

Polomok
J.C. Daughter 05-04-18 1 F Single Sitio Salkan, Brgy.
Paraiso,
Koronadal City
The table above describes the family structure of Family P. The family is a
matriarchal family structure. Client A.P. is the head of the household with three
children, only one of her children stays with her at Sitio Salkan while her two elder
children is in Bulacan under the care of their father. A.P. is in a relationship with a
man called J.C. who is the father of her youngest child. Her partner is not a resident
of Sitio Salkan but visits the household every two weeks.
Historical Map of the Family
The story of Family started when A.P. started living in Manila. She lives with
her aunt who mistreated her which caused her to leave her aunt. A.P. reported that
her life in Manila was difficult and she must work multiple jobs to sustain herself.
She met her previous partner (whom A.P. does not want to name) as well as the
father of her elder children (G.P. and M.P.) when she was 16. He offered her a
house and promised to take care of her when she lived-in with him. A.P. made that
choice because she would rather have to live-in with a man than selling herself for
sexual favors. They live-in together for 10 years until she decided to leave him
because of his gambling addiction. The A.P. left with her children and moved to
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Sitio Salkan to start a new life. She went to the Middle East as a housemaid. She
returned and met her current partner, the father of her youngest child (J.C.). A.P.
tried venturing into business (swimming pool), to sustain her family’s needs, but it
failed due to lack of funds. She sent off G.P. and M.P. to her ex-partner in Bulacan
as she cannot able to provide for them. Currently, A.P. and her youngest child, live
together in Sitio Salkan and her current partner occasionally visits them every 2
weeks for 3-4 days.
Roles of Members of the Family
A.P. played the head of the household. She manages the daily activities of
the family which is to manage her mother’s sari-sari store. She also manages the
funds of her family to provide for her youngest child. She also serves as the father
to her daughter whenever he is not around. J.C. is a corn farmer in Polomok and
the father of the youngest child of A.P. He occasionally visits his daughter in Sitio
Salkan and stays for three to four days. He would give some cash to A.P. to support
for the child’s need but sometimes he would give none because he only bought
money for his fare.
Decision Making of the Family
According to A.P., major decisions are oftentimes made her, especially on
the financial aspect. Occasionally, she would ask her partner for advice when it
comes to money. Picking schools for the children was a decision made by her and
her previous partner before. Minor decisions such as household chores, buying
JMJ Marist Brothers
food, and maintaining the home was made by A.P.as she believes that the woman
should decide on the little things around the house
Family Relationships and Dynamics
The family relationship, according to A.P., is “complicated”. The client
claimed that she is not married to both her previous and current partner and
believes that she has no luck with men. She stated that she does not want to marry
her current partner because he is married to someone else and believes it is wrong.
She also feels he lives like a bachelor (“buhay binata”) and is unsuitable to be her
husband. J.C., her current partner, lives in the Municipality of Polomok as a corn
farmer. He visits his daughter every two weeks for 3-4 days. However, in the time
of the interview, A.P. claimed that he did not visit them for almost two months and
she is struggling to provide for their daughter. Her relationship to her 1st and 2nd
child remained the same even though they are away from her. A.P. keeps contact
with her first children via Messenger or text. A.P. mentioned that her previous
partner is now married to a woman who has the same gambling addiction as him.
B. Socio-economic and Cultural Characteristics
Table 2.
Name Educati Religious Ethnic Occupation Income Source of Contributio

onal Affiliation Backgro Income n of each
Level und family
member
A.P. College Alliance T’boli- Housewife Php Reselling Php 800

Level B’laan 800
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J.C College Alliance B’laam Farmer Php Agriculture Php 2000

Level 1000
(twice a
month)
A.P. and J.C. both provide income to provide the needs of their child. A.P.
manages the sari-sari store of her mother and makes approximately Php 800 a
month. J.C. works in a corn field in Polomolok and gives at least Php 1000 in his
visits to Sitio Salkan. The family makes around Php 2,800 monthly and A.P. admits
that this amount of money is not enough to support her and her daughter. A.P.’s
mother provides for their food and other basic needs. The money serves as a form
of extra fund to provide for their other needs.
Relationship with Extended Family
The relationship with the extended family is good. They are also neighbors.
The family relies on A.P.’s mother.
Relationship with Neighbors
The relationship of the family with their neighbors is neutral (except from
extended family). They are not close, and they keep themselves private.
Relationship with Friends
The family is private/secretive to their friends.
Church Involvement
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When the family is still Roman Catholic, they do not participate with the
church but when they converted to Alliance, they became more active.
Clubs and Organizations Involvement
The family does not belong to any clubs or organizations
Community Involvement
The family only involve themselves in the community sometimes.
C. Home and Environment
Housing
Family P owns a concrete house with a galvanized steel roof and a water
sealed toilet bowl that is adequate for a family of 2 (sometimes 3). The house
has two bedrooms, a living room and a kitchen. The floor of the house is 10.38
m in length and 5.66m in width with a total of 56.75 sqm. The furniture is
adequate for the family, they have a set of chairs in the living room with a coffee
table at the center. The living room also has a drawer to keep personal things.
They also have a sink in the kitchen. They acquire their water from the spring
on top of the mountain. They store their water in a gallon.
A.P. and her daughter sleep together in one bedroom while J.C. sleeps in
the other bedroom whenever he comes to visit. Sometimes, the three of them
share one bedroom. The type of bed they have is a wooden bed frame with
foam with two pillows for each member of the family.

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The house has almost no vectors of disease except for mosquitoes since
their house is situated near a canal. The family disposes biodegradable wastes,
such as dried leaves, into a pile and turn it into compost. Non-biodegradable
garbage, like plastic wrappers, are disposed in a sack. The surrounding area
of the house is relatively clean.
There are some accident hazards in the house such as the slippery and
steep ground surrounding the house. There is also the electric fan blade which
A.P.’s daughter can reach with her fingers.
Their neighborhood is a rural and they have access to play which is the
nearby plaza, accessibility of health facilities which is the Barangay Health
Station of Brgy. Paraiso, a church is located at the back of the house, Salkan
Elementary School is nearby and A.P. have a nephew who has a motorcycle.
D. Health and Medical Status
History
Family P has a history of injury (skip disc), hypertension, blurred vision, and
chronic ulcer.
Present Illness
Table 3.
Name Illness Medication

Name Dosage Frequency Duration
J.C. Cough and Lagundi syrup 2ml Once a 1 week
Cold day
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J.C., the youngest child of A.P. is suffering from cough and cold. A.P.
mentioned that J.C. often get sick usually once a month. The condition can range
to fevers to cold. J.C. is taking 2ml Lagundi syrup once a day for one week.
However, the student nurse observed that the dosage of Lagundi for J.C. is wrong.
The student nurse informed A.P. that J.C. should take 2.5 ml Lagundi syrup three
times a day – this is according to the packaging of the medication. Health teaching
has been provided to read the labels and follow the instruction for the medications
properly.
Health and Nutrition Assessment
Table 4.
Name Age Height Weight BMI

A.P. 36 147 cm 45 kg 20.82
J.C. 1 71 cm 10 kg 19.84
A.P and J.C. have a BMI of 20.82 and 19.84 respectively. Both the mother
and the daughter’s BMI are normal. J.C., the partner of A.P., is not present during
the assessment of height and weight and was not able to obtain his data.
24-hour Family Food Intake
Table 5.
Meal Time Food taken

Breakfast 6:00 AM Boiled Bananas (Sab-a), Rice, Dried Fish
Lunch 12:00 NN Rice, Sardines
Dinner 6:00 PM Rice, Dried Fish, Vegetables
Snacks None No snacks
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A.P. is fond of eating dried fish in their meals which contains high amount
of sodium or salt. This is particularly unhealthy because family P has a history of
Hypertension. Salt makes the body retain water and eating too much salt in the
diet retains enough water to raise blood pressure. The family does not have any
allergies. They wash their hands before meals, use eating utensils when eating
and they store their leftovers in a Tupperware container.
E. Values, Habits, Practices on Health Promotion, Maintenance and Disease
Prevention
Immunizations of Family Members
A.P. does not recall her own immunization status. Her first child is
completely immunized but she received her measles vaccine when she was more
than 1 year old. A.P. stated that she finds it more difficult to comply her first child’s
immunizations because it was her first time. Her second and third child were
immunized on time and were complete when they reach 1 year old.
Vices
The family does not smoke nor drink alcohol. They do not partake in vices
because they believe it is wrong.
Personal Hygiene
The members of the family bathe twice a day during hot days, once during
cold days and a half-bath at night. they brush their teeth twice a day.
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Sleep
Table 6.
Name Bedtime Waking Time Rest Periods Usual Hours

of Sleep
A.P. 9:00 PM 4:00 AM 1 to 2 hours 7 hours
J.C. 8:00 PM 4:00 AM 3 to 4 hours 8 hours
A.P. usually sleeps an hour late to her daughter since she has to manage
the store. The pair usually wake up at 4:00 AM because this is the time that people
around their community purchase food in their store.
Exercise
The family does not engage in exercise. A.P. stated that her exercise is her
doing household chores and managing the store. However, participating in
activities of daily living is not considered an exercise.
Rest and Recreation
The family usually rest at the afternoon and they occupy their rest time by
using their gadgets (scrolling Facebook, messenger, YouTube).
Health Supervision
The family approach the barangay health station for health supervision.
They believe that the best way to ask for supervision about health is through the
health center.
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Knowledge Regarding Health
A.P. is knowledgeable about her family’s health. She is good in giving care
to the health of her daughter but lacks in giving health care to herself.
Health Problems
Table 7.
As perceived by the family As perceived by the nurse

J.C.’s recurrent fevers every month Dysfunctional family process
Slip disc of A.P. Hypertension of A.P.
Hypertension of A.P. Fear of consequence for Hypertension
Ineffective parenting of J.C. (A.P.’s
current partner)
JMJ Marist Brothers
Chapter III
TYPOLOGY
First Level Assessment
A. Presence of Health Threats
1. Unhealthful nutritional habits
a. Excessive intake of Sodium/Salt
Supporting cues:
 Eats dried fish frequently. Dried fish has high salt content
 Prefers to eat dried fish rather than meat or vegetables.
 A.P. claims that vegetables are expensive and could only
afford eating dried fish.
2. Stress-provoking factors
b. Strained marital relationship
Supporting cues:
 Partner visits the household every two weeks for three to
four days.
 “Ambot ma’am, a daw buhay binata bi na” (I do not know,
ma’am he lives like a bachelor), as stated by A.P.
 J.C. did not visit the household for two months.
 A.P. expresses doubt about the ability of her partner to
be a good husband/partner and father

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B. Presence of Health Deficits
1. Elevated Blood Pressure
 Blood pressure of A.P. taken during interview: 140/90 mmHg
 “Taas gid man ang dugo ko ma’am” (My blood pressure is high,
ma’am), as verbalized.
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Chapter IV
SCALE FOR RANKING FAMILY HEALTH CONDITIONS AND PROBLEMS
ACCORDING TO PRIORITIES
UNHEALTHFUL NUTRITIONAL HABITS: EXCESSIVE INTAKE OF
SODIUM/SALT
ACTUAL JUSTIFICATION
COMPUTATION
CRITERIA
SCORE
The problem is a
health threat
1. Nature of the because the
(2/3) x 1 0.7 family has a
Problem history of
Hypertension
which is a
lifestyle disease
It is easily
modifiable
2. Modifiability of the
because it only
(2/2) x 2 2
requires the
Condition
change of
behavior of the
client
The problem has
a high
3. Preventive
preventive
(3/3) x 1 1
potential if the
Potential
client makes
better dietary
choices
The family does
not recognize
4. Salience scale (1/2) x 1 0.5 this as a
problem that
need immediate
attention
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PRESENCE OF HEALTH DEFICITS: ELEVATED BLOOD PRESSURE
COMPUTATION
CRITERIA
SCORE
The problem is a
health deficit
because an
1. Nature of the
elevated blood
(3/3) x 1 1
pressure could
Problem
lead to other
serious illness
like stroke or
heart disease.
It is partially
modifiable
2. Modifiability of the
because the
(1/2) x 2 1
interventions are
Condition
feasible but the
resources are
limited.
Elevated blood
pressure can be
3. Preventive
easily managed
(3/3) x 1 1
if proper
Potential
treatment is
immediately
given.
The family
recognizes the
4. Salience scale (2/2) x 1 1 condition and
needs
immediate
action
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STRESS-PROVOKING FACTORS: STRAINED MARITAL RELATIONSHIP
COMPUTATION
CRITERIA
SCORE
The problem is a
health threat
1. Nature of the because it
(2/3) x 1 0.7 greatly affects
Problem the function of
the family and
the development
of the child.
The student
2. Modifiability of the nurse cannot be
(0/2) x 2 0 able to modify
Condition this threat. This
is often referred
to a councilor.
It has a low
preventive
potential
3. Preventive
because it
(1/3) x 1 0.33
requires the
Potential
intervention of a
professional that
specializes in
social welfare.
The family
recognizes this
4. Salience scale (2/2) x 1 1 problem that
needs
immediate
attention.
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Chapter V
FAMILY NURSING CARE PLAN
(SEPARATE FILE UWU)

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Chapter VI
SUMMARY, CONCLUSION AND RECOMMENDATION
Summary
Conclusion
Recommendation
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REFERENCES
Antipuesto, D. J. (2009, July 9). Concept of a Family. Retrieved from Nursingcrib:

https://nursingcrib.com/nursing-notes-reviewer/concept-of-a-family/
Dueff, M. M. (1995). Concepts in Community Health Nursing: A Family Study.
University of Tennessee Honors Program.
Estrada-Castro, C. (2012). Community Health Nursing and Community Health
Development. Manila: Educational Publishing House.
Gonzalo, A. (2019, August 21). Nola Pender: Health Promotion Model. Retrieved
from Nurseslabs: https://nurseslabs.com/nola-pender-health-promotion-
model/#What-is-Health-Promotion-Model
World Health Oragnization-Regional Office for South-East Asia. (2010). A
Framework for Community Health Nursing Education. New Delhi: World
Health Organization.

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JMJ Marist Brothers

NOTRE DAME OF MARBEL UNIVERSITY

NURSING ASSESSMENT OF FAMILY P AT SITIO

A Case Study Presentation to

Cumbe, Karen Mae P.

been completed without their unending support.

To the Notre Dame of Marbel University President, Bro. Wilfredo Lubrico,

and wisdom development of the students of this institution.

To the Program Coordinator of the Nursing Department, Merna S.

of creating this study.

support and constant enthusiasm in the creation of this study.

support and guidance towards the success of this academic task.

invaluable data for this study.

To Family P for whole-heartedly participating and showing hospitality in the

as your information served as the foundation of this case study.

To the fellow student nurses of the university, for the encouragements

as the researcher herself.

Community health nursing is a unique division of health care in that its

focus is on populations rather than individuals. In this way, a nurse develops an

awareness of health risks in her clients by assessing the community as a whole.

Regional Office for South East Asia, 2010).

According to Estrada-Castro (2012), community health nursing aims to

people and their physical and social environment.

The concept of family is the major component of the study of community

needs of society. (as cited by Antipuesto,2009).

One of the aims of community health nursing, is the changing of health

“Health Promotion Model”, person has unique personal characteristics and

specific knowledge and affect have important motivational significance. These

variables can be modified through nursing actions. Health promoting behavior is

STATISTIC ON THE PROBLEM

Statement of the Objectives:

Koronadal specifically, to:

1. Acquire the Initial Data Base of Family P, the family structure,

characteristics, and dynamics

2. Identify nursing problems based on the family’s presence of wellness

and condition, presence of health threats, presence of heath deficits,

and presence of foreseeable crisis

health condition or problems

4. Create a family nursing care plan according to the identified priority

INITIAL DATA BASE

and Dynamics, Socio-economic and Cultural Characteristics, Home Environment,

Promotion, Maintenance and Disease Prevention. The Family Structure

Characteristics and Dynamics and Socio-economic and Cultural Characteristics

Values, Habits, Practices on Health Promotion, Maintenance and Disease

aspect of health promotion.

A. Family Structure, Characteristics and Dynamics

Name Relationship to Date of Age Sex Civil Status Place of residence

A.P. Head of the 08-01-84 35 F Single Sitio Salkan, Brgy.

G.P. Daughter 09-04-03 16 F Single Bulacan

M.P. Son 05-35-06 13 M Single Bulacan

J.C. Partner 12-11-82 36 M Separated Municipality of

of Sitio Salkan but visits the household every two weeks.

Historical Map of the Family

weeks for 3-4 days.

Roles of Members of the Family

money for his fare.

Decision Making of the Family

According to A.P., major decisions are oftentimes made her, especially on

should decide on the little things around the house

Family Relationships and Dynamics

The family relationship, according to A.P., is “complicated”. The client

B. Socio-economic and Cultural Characteristics

Name Educati Religious Ethnic Occupation Income Source of Contributio