Chapter

INTRODUCTION

The family is the smallest unit of the society and the natural fundamental core of the community and consequently, it is considered as the primordial recipient of the nursing effort, which is contributory to the development, and progress of the community through active involvement and self responsibilities of each constituent. It is composed of persons, male and female, being molded to be as one, working hand in hand to maintain a good atmosphere among the family members.

A nucleus controls the functions of the entire cell and can be thought as the command center of the cell. The nucleus as well has different components which are all needed in order for it and the cell to function well, same as with the commander or the head of the family and the members who has different functions within the family.

The impression or status of each family will always affect the status of the community as a whole. Community health nursing is a response to the health needs of the people. It does not focus on a particular class or family. It is comprehensive and general in approach. Community health service is not episodic as it requires continuous observation and monitoring of the community as a whole. Promotion and preservation of the health of its different clients(individual, family, group or community) is the primary goal of community healthnursing.

The community is a group of people sharing geographic boundaries and/or values and interests. (Maglaya, 2004) No two communities are alike. A nurse exposed in the community learns how to interact and

adapt to different kinds of people. The family is considered as the basic unit of care in the community health nursing. It is in the family where a member develops his health values, beliefs and practices. The family is a major influence in the health behaviors of an individual. With this, it is important that families in a community are aware of the things and practices pertaining to their health.

It is apt to say that community health nursing has a big role in the nursing education. It is in the community where the student nurse learns nursing apart from the hospital setting as she was exposed to different level of orientation. It is in the community where the saying nursing is an art can be applied as a student nurse tries to give quality service using the available resources in the health center. `

Conducting a family case study is a means by which student nurse reaches and feels the community through its basic structure the family. It is a tool in determining the health status of a family through assessment and critical inspection. Through this, health related problems are identified, thus giving the student nurse a hint on where to act and how to intervene. It is also a means towards improving the health of the community people, making them more productive. To come up with a family case study gives a sense of fulfillment to a2

student nurse as she was given the opportunity to share their skills, knowledge and time to alleviate and uplift the living condition of a family.

The family that was chosen by the student nurse is a picture of the majority of the family here in our country: a family living in a poor environmental condition without enough resources and lacks knowledge on

vital health information and experiences other socio-economic related problems. Though tiring as it is, reaching out to this family and mingling with them makes the student nurse feel the sense of fulfillment as she share her knowledge, skill and time to aid in uplifting the condition of the family. Chapter I

OBJECTIVES OF THE STUDY

This chapter presents the general and specific objectives of this family case study. Setting objectives provides direction for planning a family nursing intervention. It facilitates motivation for the client and the nurse by providing a sense of achievement. (Kozier, Erb et. al., 2004). General Objectives:

At the end of the student nurse-family relationship, the adopted family will be able to improve their health status and become self-reliant in maintaining their health through appropriate interventions in a given time frame. Specific Objectives After 1 month of home visits and student nurse-family interaction, the family should be able to:

Established rapport and trust with the student nurse.

Give pertinent and factual information during surveys and interviews

Participate actively during home visits and assessment interviews

Identify actual and potential problems which may be a hindrance in attaining optimum health.

Categorize the identified health problems as health threat, health deficit or foreseeable crisis through the assistance of their student- nurse.

Prioritize the identified family health nursing problems with the assistance of their student nurse.

Plan possible solutions or nursing actions to the prioritized health problems.

Generate interventions considering the student nurses capabilities, community and the familys resources.

Carry out the planned interventions together with the student nurse

Perform the health teachings taught by the student nurse

Evaluate the effectiveness of the intervention using the set objectives as a basis, and

Evaluate changes in condition after giving intervention

Chapter 3 A.Family structure,dynamic,and characteristic

Mr. V and Mrs. V go hand in hand in terms of decision-making. They consult each other in terms of planning and budgeting for their family. They discuss matters concerning their childrens schooling financially and also with regards to the emotional problems or aspects within the family. When problem arises, they make sure that both of them will handle and solve the problem. But then, in terms of matter concerning health Mrs. V is more dominant. She makes sure that she will comply with the appropriate regimen when certain health issues arise. She has greater awareness concerning health matters compared to Mr. V since of course believing it is her duty as the mother. These health matters include immunization, feeding the right food and caring for the sick member. B. Socio-Economic and Cultural Characteristics

The V familys main source of income is coming from Mr. Vs farming. Mr. V earns about Php 6,000.00 a month. Since Mrs. V does not work, she is in charge of the house and in taking care of the children. Mrs. V budgets the money in terms of food, education and miscellaneous where clothes, shoes and slippers comes in. Out of Mr. Vs earnings, most of it goes to the familys budget for food. The education of the children is free and they can walk from their house to the school so only some school supplies are being bought With Mr. Vs monthly income, the family strives hard to accommodate everything they need for them to live. Usually, there is nothing to be left for the miscellaneous expense.

According to NEDA, each individual should at least have Php 2768.60 when the total monthly income of the family is divided among the total family members. The total monthly income of Mr. V is about Php 6, 000.00 and when divided among the 6 members, it is only Php 1, 000.00, thus, they can be considered poor. Mrs. V also informed the student nurse that they do not have any financial assets at hand in case of emergency. They typically borrow money from their relatives.

Mr. V works as a farmer, he works from 3 am until 8 pm everyday. He seldom goes home but rather stays in the farm, which is situated far away from the familys house. Mrs. V doesnt work and stays in their house. She is the typical housewife where in you can see her wash clothes, prepare food, sweep the yard and make the house clean.

All of them are affiliates of Protestantism. Mrs. V mentioned that they do not go to church anymore since they have lived in Purok Daanbanwang for the reason that of the distance they have to travel from their place to the church.

Significant others are called such due to their own role in ones life. They are the ones very close to a person or group of persons. For family V, the significant others in their lives are their relatives and some neighbors. They usually run to their relatives if they face hardships and problems. Mrs. V also confirmed how helpful and welcoming her neighbors are with them.

The family has yet to participate in community activities since they are new in the place. But way back in Nurallah, they usually partake in community activities. These activities include fiesta, parties and carnivals.

The V Family barely enjoys the community resources since the community itself lacks resources. The children, though, go to Purok Daanbanwang Elementary School. The father is usually in their farm while the mother is in the house doing household chores. The family uses the river as their means of water source in washing their clothes. There is also a shallow well built within the river where the family gets their water source for drinking if they get lazy in getting water from the faucet, meters away from their house.

C. Home and Environment

The house is made of wood, mostly bamboo. Mrs. V did not know the exact measurement of their house. Her husband knows it yet he was not there during the interview. In order for the house to be considered

as adequate, the total floor area should be divided among the total members of the family and each should at least have 3.5 m2.

The house only has 2 windows and can sustain the adequate ventilation needed by the family. Mrs. V told the student nurse that their house is usually presko since it is beside the river and the air goes to and fro freely inside the house.

The house has 2 rooms. The one is the sala/dining room and the other is the bedroom, with no bed at all. Mr. and Mrs V, together with the children, sleep in one room. They use banig in sleeping.

The V Family has only one appliance which is the radio powered by batteries since the place has no electrical supply yet. In terms of garbage disposal, they either bury or burn their garbage.

Mrs. V uses wood and charcoal in cooking. She is the one who prepares the food. She cooks inside the house at the back portion. The foods that they usually eat are fish and vegetables. The family uses plastic plates and stainless spoons in eating. When it comes to storing their food, they just cover it with a plate. In terms of cooking facilities the family is equip with pots, sandok, and knives.The river is the familys main source of water. They wash their clothes and

gets their drinking water supply there. They put their water in a big container with cover. They usually dont go and get water from the faucet in the purok since, according to Mrs. V, it is far from their house. They usually dont sterilize their drinking water supply.

V Family has no comfort room. They usually urinate and remove bowels anywhere near their house. They have not yet built their own comfort room since, according to Mrs. V, they are still new in the community and has no enough budget for it yet. The drainage system of the family is an open type where in the drainage flows anywhere and is continuous. It is dirty and has a stinky smell. There is some rice grains noted. There is no obstruction present at the drainage system since it is open and flows anywhere.

The family does not own any transportation facilities. They ride on a jeepney or truck in going to the city proper. When they go to their farm or any purok within Upper Labay, they usually walk kilometers. The family has one chicken and a dog. There are vegetables planted near the house some rice grains noted. There is no obstruction present at the drainage system since it is open and flows anywhere.

The family does not own any transportation facilities. They ride on a jeepney or truck in going to the city proper. When they go to their farm or any purok within Upper Labay, they usually walk kilometers. The family has one chicken and a dog. There are vegetables planted near the house. D. Health Assessment of Each Family Member D1. PAST AND PRESENT ILLNESS 1. Health Assessment on Each Member
A.Mr.

V The student nurse has never met Mr. A since he was in their farm

during the interview. Mrs. V, however, told us that she thinks her husband has never undergone immunizations at all since it was not that important before. Mrs. V said that her husband is about 54 tall and weighs about 55 kilograms. His BMI reveals normal weight with a value of 20.8. Mrs. V told the student nurse that her husband has no genetic or hereditary illness known. He is not a smoker. He drinks alcohol rarely since they have no budget for that.
B.Mrs.

V She has no degenerative, chronic, or infectious diseases as of

the present time. She has also not completed immunizations. When she was still 4 years old, she experienced chicken pox. She is 5 feet and 3 inches and weighs 60 kilograms. Her BMI reveals normal weight with a value of 23.4. She has no complaints as of the present time and has not taken any medications . .

as of the moment. At times of illness, she would just drink paracetamol for fever and mefenamic acid for pain or treat wounds with crushed plants coming from their backyard. The family is not using family planning anymore.
C.Child

AV has no any degenerative, chronic, or infectious diseases as of BV has no any degenerative, chronic, or infectious diseases as of BV has no any degenerative, chronic, or infectious diseases as of DV has no any degenerative, chronic, or infectious diseases as of

the present time. He has not completed immunizations. He is 4 feet and 10 inches and weighs 38 kilograms. He likes to eat vegetables and fish.
D.Child

the present time. She has not completed immunizations. She is 4 feet and 7 inch tall and weighs 36.5 kilograms.
E.Child

the present time. He has not completed immunizations. He is 4 feet and weighs 33 kilograms.
F.Child

the present time. She has complete immunizations. She is 3 feet and 11 inches tall and weighs 17 kilograms. She appears thin. This child has many allergies and there are rashes still seen on her legs. FAMILY ASSESSMENT BASED ON FUNCTIONAL HEALTH PATTERN 1. Health Perception-health management patterns

With no known vices like smoking and drinking except for Mr. V who drinks alcohol rarely.

Was able to recognize the importance of having a healthy well-being.

Uses herbal plants, though not approved by the DOH, from their backyard
12

2. Nutritional-metabolic pattern

Do not take any food supplements or vitamins

Daily food intake is mainly rice, fish and vegetables

Children eat junk foods whenever they were given money

Children have poor appetite according to Mrs. V 3. Elimination pattern

Eliminates everyday with an average frequency of urine: 5 times

According to Mrs. V, all of the family members have no difficulty in voiding.

The family members defecate everyday and some, every other day with no difficulty in defecating noted. 4. Activity-exercise pattern

Dili nami makaexercise kay daghan mi trabaho labi na pagbuntag verbalized by the mother.

Family preferred to stay at home and take a nap if they have free time while their children play with other children in the community after class. 5. Sleep-rest pattern

Family usually has 7-8 hours of uninterrupted sleep according to the mother.

They usually sleep at around 9 in the evening and wake up at around 4 to 5 in the morning.

They also take a nap at free time. 6. Cognitive-perceptual pattern Was oriented to time, place and is able to identify people and significant others by their first names.

Was able to respond accordingly and correctly to questions. Retaliates as soon as he can and was able to rationalize. Verbal pattern and spontaneity normal

Memory intact

No sensory defects 7. Self-perception/self-concept

Showed apprehension and worry towards unspecific consequences.

Perceived situations (health deficits) to be very stressful but remain passive about things and condition. 8. Roles and relationship

Family members have an open communication and able to discuss their problems according to the mother. 9. Sexual reproductive

Both parents are still in the reproductive age

The parents are separated as of the moment since the father is in their farm and the mother is in the house.

10. Coping Stress Gains strength in the assurance and guarantee provided by familyMembers.

11. Values/ Beliefs Pattern

The family is Protestant in faith. Expressed great belief and faith in God. Is certain that the Divine providence would protect them from any unidentified and possibilities of harm. Does not go anymore to church since they are situated far away from the place of worship they atten

11. Values/ Beliefs Pattern

The family is Protestant in faith. Expressed great belief and faith in God. Is certain that the Divine providence would protect them from any unidentified and possibilities of harm. Does not go anymore to church since they are situated far away from the place of worship they attend E. Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention. The children in the family has not all completed their immunization. All the children in the family were dewormed last March 2008.

The family has adequate rest and sleep. They sleep early and wake up early, the usual time of sleeping is 9pm and they wake up at around 4 to 5am. Mrs. V stated that farming, doing the household chores, and walking are their ways of exercise. The father is in the farm. The mother usually does the household works and talks with the neighbors during free time. The children are either in school or are playing with other children in the community.

The mother recognizes the importance of health in the family, however, because of financial constraints made them ignores any major health problems that may arise. Furthermore, they were not able to sustain sufficient supplies of medication or articles which they would need related to their health care needs. They often use alternative medicines or herbal medicines for treating their illness and habitually self-medicate if OTC medications are available. The family believes in the power of herbal plants. They occasionally use herbal plants lodged near the house in treating diseases or symptoms in the family since their transfer from Nurallah. Mrs. V said that she had no choice but to use these plants for the reason that the barangay health center is far away from their home. But if the symptoms manifested by the family member become severe, they immediately go to the health center or to the hospital.

Chapter IV FAMILY BACKGROUND

This chapter illustrates the family background of the study which includes, Database of the Respondent, Family Tree, General Household Data, Activities of Daily Living which could be an indicative for the present health status of the family as it continues to influence the each of the family member. Family History

Family V is composed of 6 members Mr. V is the father, Mrs. V as the mother, children AV, BV, CV and DV are the kids. Mr. V is the head of the family. He is 30 years old. Mrs. V, his wife is 29 years old. Child AV, as the eldest son is 11 years old, child BV is 10 years old, child CV is 7 years old and child DV is 5 years old.

Mr. V was born and grew up in Purok Daanbanwang, Upper Labay, General Santos City. His father was a farmer and his mother was a housewife. He has 9 siblings and he is the eldest. He is a Blaan. He was able to go to school up to grade 3 year level. After that he did not continue schooling in order to help his parents look for money for their household expenses.

Mrs. V was born and grew up in Malungon, Sarangani Province. Her father is a farmer and her mother is a housewife. She has 2 siblings. She was able to go to school and graduated elementary school. She did not continue schooling due to financial constraints. Instead she helped her parents in doing household chores and in looking money for their household Chapter IV FAMILY BACKGROUND

This chapter illustrates the family background of the study which includes, Database of the Respondent, Family Tree, General Household Data, Activities of Daily Living which could be an indicative for the present health status of the family as it continues to influence the each of the family member. Family History

Family V is composed of 6 members Mr. V is the father, Mrs. V as the mother, children AV, BV, CV and DV are the kids. Mr. V is the head of the family. He is 30 years old. Mrs. V, his wife is 29 years old. Child AV, as the eldest son is 11 years old, child BV is 10 years old, child CV is 7 years old and child DV is 5 years old.

Mr. V was born and grew up in Purok Daanbanwang, Upper Labay, General Santos City. His father was a farmer and his mother was a housewife. He has 9 siblings and he is the eldest. He is a Blaan. He was

able to go to school up to grade 3 year level. After that he did not continue schooling in order to help his parents look for money for their household expenses.

Mrs. V was born and grew up in Malungon, Sarangani Province. Her father is a farmer and her mother is a housewife. She has 2 siblings. She was able to go to school and graduated elementary school. She did not continue schooling due to financial constraints. Instead she helped her parents in doing household chores and in looking money for their household

Chapter V FAMILY COPING INDEX

This chapter depicts the actual observation of the family behavior and practices in contrast to the ideal family attitude and behavior. It includes an assessment on how the family handles various stressors. The observations are analyzed to see occurrence of health problems or negative attitudes and behavior.

Chapter VI TYPOLOGY OF NURSING PROBLEM

This chapter discusses about the problem that were identified during assessment and interview with the family. It includes the cues/data, the family nursing problem and the nursing diagnosis. The problems identified are categorized into presence of wellness state, health deficits, health threats, foreseeable crisis and stress points.

Chapter VII PRIORITIZING PROBLEMS

This chapter shows the setting of priorities of family health problems that has been identified. It includes a computation on how priorities were shown with their corresponding justification.

Chapter VIII NURSING CARE PLAN

This chapter shows the identified and prioritized problems in a ranking order. This chapter also presents the family care plan formulated by the student nurse together with the family.

Chapter IX SUMMARY, EVALUATION AND RECOMMENDATION

Presented in this case study is the different characteristics and health condition of family V. This case study presents the family structure, socio economic and cultural factors, home and environmental factors, health assessment of each member. It also contains data about identified problems on the living condition of the family. Summary and Evaluation

The Family V is considered as a nuclear type of family. A nuclear type is a typical type of family composed of a father, a mother and child/children. The V family resides in Purok Daanbanwang, Upper Labay, General Santos City. They have started living their since June of 2009.

Their house is made of wood, mostly bamboo. Mrs. V did not know the exact measurement of their house. Her husband knows it yet he was not there during the interview. In order for the house to be considered as adequate, the total floor area should be divided among the total members of the family and each should at least have 3.5 m2. The house only has 2 windows and can sustain the adequate ventilation needed by the family.

The V familys main source of income is coming from Mr. Vs farming. Mr. V earns about Php 6,000.00 a month. Since Mrs. V does not work, she is in charge of the house and in taking care of the children. With Mr. Vs monthly income, the family strives hard to accommodate everything they need for them to

live. According to NEDA, each individual should at least have Php 2768.60 when the total monthly income of the family is divided among the total family members. The total monthly income of Mr. V is about Php 6, 000.00 and when divided among the 6 members, it is only Php 1, 000.00, thus, they can be considered poor. Mrs. V also informed the student nurse that they do not have any financial assets at hand in case of emergency. They typically borrow money from their relatives.

All of them are affiliates of Protestantism. Mrs. V mentioned that they do not go to church anymore since they have lived in Purok Daanbanwang for the reason that of the distance they have to travel from their place to the church. The family has yet to participate in community activities since they are new in the place.

The V Family barely enjoys the community resources since the community itself lacks resources. The children, though, go to Purok Daanbanwang Elementary School. The father is usually in their farm while the mother is in the house doing household chores.

The river is the familys main source of water. They wash their clothes and gets their drinking water supply there. They put their water in a big container with cover. They usually dont sterilize their drinking water supply.

V Family has no comfort room. They usually urinate and remove bowels anywhere near their house. The drainage system of the family is an open type where in the drainage flows anywhere and is continuous

The V family is identified to have plenty of environmental problems in which it is evident that they practice poor environmental sanitation. With this situation and family condition, many problems were identified such as health threats which include fire hazards, poor home and environmental sanitation, and improper drainage system as well as health threats which are improper personal practice as improper hygiene. A nursing care plan then is formulated to address the different problems identified.

Nevertheless, the family has chances to improve their health condition. There still have that ability to meet the desired characteristics in their structure and maximize their health potential of optimum wellness. They are cooperative and participative to the different issues and interventions they are confronted. Hence, they are willing to submit themselves for the impartation of information and basic knowledge regarding family health.

The objectives of identifying family nursing problems were only partially achieved due to security reasons for the part of the student nurse. Together with the family, the student nurse as an agent has helped the family through motivation and support to change their lifestyle and improve their health status. Although the allotted time for the student nurse was not enough to attend to all those problems, the family is now equipped with fair knowledge which they could use anytime as the need arises.

Recommendations The student nurse have identified and prioritized problems and needs with

the family. The student nurse have also created a care plan on how to deliver the best nursing care for the family to address their needs. The following below are propositions and commendations recognized by both the student nurse and family:

The V family should maintain a healthy and clean environment. They must clean their surroundings to avoid the presence of vectors of diseases.

The family should also maintain proper hygiene such as taking a bath regularly, trimming their nails, frequent changing of clean clothes especially when come in contact with filthy objects or experienced wetness of the back, refraining from walking barefooted, brushing of teeth frequently, and proper and regular hand washing.

They must also reorganize their cooking practices in terms of food preparation and handling as well as keeping their kitchen utensils in a covered storage to avoid getting it contaminated by insects or pests. In addition to that, they should also cover their food storage.

The family should also be advised to not wait for the ailment to become severe before seeking medical help.

The family must also be educated and follow the proper preparation of herbal medicines as it was presented during the mothers class.

The V family should persevere to perform proper waste segregation and disposal of their garbage as it was presented during the mothers class.

The family should be aware that organizations in the community are open and present for their problems to be addressed properly

They should be encouraged to verbalize their concerns with regard to the community so that resolutions can be made.