Introduction According to wikimapia, Barangay Tumana is the youngest among the sub-territories in the City of Marikina.

In retrospect, this place is formerly called Sitio of Conception Uno which since on April 10, 2007 it is now known as Barangay Tumana under the Republic Act number 9432 (wikimapia.org). Coming across the word tumana from the people of the community makes us ask, what does tumana really means?. This was explained to us that tumana means farm. When Marikina City was still a rural area, Tumana is one of the rice fields which is close to the River Bank River. Based on the description on wikimapia, this place has been geologically shaped by soil build-up resulting from flooding, erosion, and landslide. Part of the barangay was a component of the riverbank but it has been converted into a fertile land over the centuries, the accretion has been cultivated as rice fields and fruit farms. Apparently, Barangay Tumana, District II is one of the growing areas of Marikina City. This barangay encompasses of 181.97 hectares which is divided into two divisions which they call Kanan Tumana and Kaliwang Tumana. In 2007, there was a 32,071 total number of population at Barangay Tumana. And as of 2010 Census of Population and Housing made by National Statistics Office, there is now a total of 41,809. As many people say, Barangay Tumana is one of the low lying areas in Marikina City which is a flood prone area due to increase water level in major rivers like River Banks River and creeks that end up overflowing when there is heavy rain. In fact people have a lengthier rainy season which starts in June until December, and during January to May, people have shorter dry and warm season. This study focuses in the area of Kanan Tumana, specifically at Singkamas Street which is a Muslim community. Houses are close to one another, and the road is rough, rocky, muddy and non- concrete. Along the street there is a Mosque, where Muslims pray every day.

Eco-map

Social Network Support Map

Family Assessment Guide

Family Name: Harden Family I. Demographic Data

Address : Blk # 43 Singkamas, Kanan Tumana

Household Number: 5 (3 kids)

Barangay Household No: 43

II. Family Data Length of residency: 6 years Place of origin: Marikina Malanday / South Cotabato Province Family size: 5 members (1 Family) Religion: Husband Catholic converted to Muslim Wife Islam

Family Members Chart FAMILY MEMBER AGE SEX CIVIL STATUS POSITION IN THE FAMILY RELATIONSHIP TO THE FAMILY HEAD EDUCATIONAL ATTAINMENT OCCUPA -TIONAL

1. Fahad

29

Married

Father (Head of the family)

Husband

High school undergradu -ate

Vendor

2. Norei Sema

22

Married

Mother

Wife

Grade 2

House wife

3. Isaac

Single

Son

Son

4. Fatima

Single

Daughter

Middle

5. Noriza

2 mos.

Single

Daughter

Youngest

III. Family Characteristics: They have a nuclear type of family. General Family Relationship/ Dynamics

CRITERIA Observable conflicts between family members Characteristic of communication Interaction pattern among members Family History Dietary Habits

STATUS (-)

ADDITIONAL

(+)

(+)

24 Hours Diet Recall: Breakfast: Pandesal, kape / milo Lunch: Monggo and rice Dinner: Egg, sardines and rice Monthly Family Income Source Husband: 300 to 500 per day Monthly Family Income Source Above Php.9, 000 - 15, 000 Family Health Status/Health History
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Children:

Isaac and Fatima Harden had an amoebiasis 5 months ago.

Felt Family Needs (Identified and ranked according to priority) 1. Polluted water supply 2.1 Presence of faulty electrical wiring 2.2 Improper garbage segregation 3 Poor lighting and ventilation 4. Presence of breeding and resting sites of vector 1V. Home and Environment A. B. C. D. E. F. G. H. I. J. K. L. M. N. O. The lot is not being owned but they had constructed their home structure. Mixed type of housing materials(cement,yero, hollow blocks) The living space is adequate. The appliances owned by the family are the following TV, speaker, DVD player, electric fan, rice cooker, airpot and mobile phones. Type of garbage disposal: Collected (3 x a week-MWF) Water Sealed type of waste disposal. Open type of drainage system Bought (Nawasa) type of potable water system. Covered drinking water storage. They used plastic pitchers containers. Food storage/ cooking facilities: covered (always consumed) Rodents, flies and mosquitoes are common household pests found at home. .There are present of breeding sites of insects, rodents etc. No pets/ animals kept in the yard/home. There is presence of accident hazards. 5.1 Presence of rodents 5.2 Fall Hazard 6. Noise Pollution 7. Lack of knowledge of the nature and extent of nursing care needed 8. Improper drainage system

V. Health and health practices A. Common illness encountered for the last 6 months and the treatment applied. No common illness six months ago. B. Midwife, Doctor and health center are whom they consult for their health related problems. C. Other than health problem they consult their Imaam and other friends.
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D. Complete Tetanus Toxoid immunization record for the mother and with ongoing follow up for the newborn. E. They have adequate rest and sleep, exercise, relaxation activities and stress management activities. V1. Environment Kind of neighbourhood Social and health facilities available Communication and Transportation facilities Depressed area where house are congested. Health Center and Barangay Hall They can speak tagalog and visaya as a way of communication. They use pedicab and jeepney as a form of transportation to go to different places.

V11. Awareness of the Community Organization A. They are aware of the existing organization in the community B. Name of the Organization/s they know are Salam, police (watchers /tanod) and health center programs. C. They are a member of this organization. D. They are aware of its activities and projects. E. They attend meetings to get involved in its activities. V111. Name of 5 formal and nonformal leaders of the community whom they think can lead the people. 1. 2. 3. 4. Kagawad Emi Kapitan Fred President Swaile Muslim Community Imaam (Pastor in Muslim)

Family Health Assessment Objectives: To discuss and describe th demographic data, home and home environmental details, and health and health practices, and the awareness on community resources and organizations. I. Family demography The Harden family has 5 household members which include a couple who have 3 children and they reside at Barangay Block No. 43 at Tumana, Marikina City. The family has been residing at Singkamas Street, Barangay Tumana Marikina City for four years (4) years but Norai Sema, the wife of Fahad Harden(the head of the family) has been residing for six (6) years. The place of origin of the Father is from Malanday while the Mother is from Cotabato province. The husband decided to be converted from Catholic to Muslim because the wife is a Muslim from the start. The head of the family is Fahad Harden, 29 years old who is married to Norei Sema for 3 years. He only finished 3rd year high school, and he works as a vendor of fashion items such as shade at different markets in Marikina City and earns P300- 500.00 each day. Norei Sema is the wife and she is 20 years old. Her educational attainment is only elementary level, grade 2. She is a housewife who stays at home and takes care of their house, the chores and their three (3) children. The eldest is Isaac, 2 years old, male; the second is Fatima, 1 year old, female; and the youngest is Noriza, a two month old infant. The type of family that they have is a nuclear family in which the Mother and the Father lives together with their children and no other family members live together with them.

Genogram of Harden Family

II.

Physical environment The family does not own the lot where their house is standing. The house is made up of wood framing and galvanized plates. The space inside the house is adequate for the family. They have television set, speakers, DVD player, electric fan rice cooker and an airpot. Their garbage is collected three times a week every Monday, Wednesday and Friday. The toilet is a water-sealed type wherein water-sealed toilet bowl is placed instead of a simple platform whole .Water supply is bought by the family. Usually, drinking water is covered in plastic pitchers as their containers. The family do not have a refrigerator. They buy already cooked food. Rodents like rats sometimes pass by the house which may be a source a disease like leptospirosis. There is a stagnant canal just outside the house which is a good breeding place for mosquitoes. The main road going to the market is not concrete which is why it becomes muddy when it rains.

III.

Family social and cultural patterns The family Harden is friendly with their neighbor. In fact during flood, they always help each other. Since they practice Islam religion and culture, there two cores that serves as the foundation. Which are the Shariya, which is the Islamic law that dictates the way of living and the five pillars of Islam which signifies their religious path. In view of this, the way they interact with the society and deal with life is greatly influence by their religious and cultural practices such as not eating pork or any food containing blood. This may also affect their health practices such as only using natural contraceptive and not allowed to use other form of contraception.

Family and Care Plan Family Role and Relationship Pattern In terms of the families role and relationship pattern, they describe it as a ladder, wherein every step of it counts. Mr. Harden stated that every member of his family is important and have a significant role to perform such as being a father, his in charge of earning money and maintain security for the mother; she does the maintenance of the house and its orderliness and cleanliness and does other household chores, and takes care of their children. And as for their children, they are the one that brings happiness to their home. As a family, they support each other through thick and thin and at the same time they have fun while watching television. When it comes to finances, they dont really have any financial resources except themselves. Conflicts are present between the couple but they take these as a challenge and opportunity to know each other well. Mr. Harden leads the family and Mrs. Harden is loyal and she follows her husband. In view of the role and relationship pattern with overall the family have a healthy relationship where Allah is the center of their family. Although they dont have other financial support, they find ways to earn money and be able to survive every day and support each other even things are simple. Based on the general family relationship, there is no conflict and misunderstanding was observed between family members during the time of our duty. The communication between father and mother is good as regards to their interaction with one another. The mother takes care of their infant baby and plays with their toddlers. The couple is aware of their organizations in their community one which they are familiar with are Salam Police or known as tanods and the y are also aware of the Health Center Programs that their health center facility usually provide and they have also confirmed that they are members of these organizations and involved themselves by participating meetings that were held by their organizations. They also know who are their formal leaders within their community especially their President in the Muslim community as well as their leaders in the Barangay. When it comes to monthly family income, the familys financial source is from the revenue the father is earning through selling fashion accessories. It ranges from 300-500/ day or from Php 5,000- 10,000 in a month. Family Cognitive and Perception Pattern During our interview, the couple presented an optimistic outlook in spite of their situation as being financially restricted in resources, for the family as long as they can eat three times a day, especially their children, pay their monthly bills and have their basic needs. They are already contented when it comes to their couples educational attainment, Mr. Fahad only
5

finished until third year high school and Mrs. Fahad is grade 2 of her elementary as being the highest level attained. Their children are not in school yet because they are not school age. There is no presence of developmental disabilities. When it comes to decision making, the head of the family, who is led by Fahad Harden is the one who makes decision and the wife and his children follows. In analysis, as part of Muslim culture Males/ Father is considered superior than female. With this, they practice patriarchal system where the male leads and decides and the female follows. In their case, since Mr. Harden is older and have attained higher education, this more makes him to be more capable of leading his family. Family Self-Perception/ Self Concept Pattern The Harden family stated that as a family they are united and live life a simple manner. Although, they are just undergraduate if high school and elementary, they are proud to say that they are independent family who doesnt rely on their relatives, friends and other families. Rain or shine, they support each other and fight for their survival. They live life and always ready to face challenges with the help of their Allah. For them, their purpose of their lives is to serve Allah and do his will. They stated that they are a type of family who have strong belief in Allah and strictly practices Muslim culture and religion. In view of their self and family perception and concept, the core concept of them focuses on their belief in Islam culture, beliefs and practices and this greatly influence their perception of themselves and how they live life each day. Their kind of neighborhood is very crowded which different people from different places resides in the area, although health facilities are available but not on their area in which they have to walk a couple of kilometers from their place where the health center is located. Social health facilities are not available. Communication and transportation facilities are available where there mode of transportation is via Pedicab and communication is by their use of mobile phones since they are not able to afford landline units. Family Nutritional-Metabolic Pattern The familys diet is composed of meals that are Halal. Halal in Arabic means permissible, or what is permitted or approved. Halal food is permitted meals that a Muslim brother is able to eat. It is believed that some foods are unclean and one example of it is pork. Recently, twenty four hours ago during the first interview their meal for breakfast, lunch and dinner is composed of: for breakfast; pandesal, coffee and chocolate drink (milo): for lunch; mongo and rice: for dinner; egg, sardines and rice. Most of the time, they buy their food at a carenderia near their home. They sometimes cook their food since they dont have a fridge. They only buy or cook sometimes their meal that is enough for the five of them only.
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Their religious belief for bids them to eat meals especially pork, blood and wine that is halal. Also, they have an appropriate diet that they can eat three times a day. Food and drink have direct effect on their health that is why the Sharia has prescribed to avoid eating pork for its unclean habitat. Family Elimination Pattern During our visit the father stated that he passes out stool once a day every morning characterized as formed with brown in color and no episodes of constipation. He voids two to three times a day with clear yellow color urine, no pain or burning sensation during urination. The mother moves her bowel every morning once a day. The stool is formed and brown in color, no episodes with constipation. She voids two to three times a day with yellow clear urine. No feeling of pain or burning sensation during urination. The two years old son and one year old daughter had history of amoebiasis two months prior to our visit. They were hospitalized for three days at Amang Rodriguez Hospital in Marikina. The two year old daughter passes out stool once a day with formed and brown as stated by her mother she voids two to three times a day with clear yellow colored urine. Pain was felt during urination. The one year old daughter passes out stool once every morning with formed stool no episodes of constipation. She voids two to three times a day with clear yellow colored urine. No pain during urinating according to the mother. The mother changes diaper to her two months old baby two times a day. The color of the stool is light brown in color; the urine color per diaper is yellow. The family has no problem in their elimination pattern during our visit. The problem with amoebiasis of the two years old son and one year old daughter occurred two months prior to our visit and was resolved. Family Activity-Exercise Pattern According to Harden Family, walking is a form of their exercise. Like for example, it takes 1 mile of walk to get to the market to get something that they need. Mrs. Harden Family daily activities, focuses more on the children and their household chores like doing their hand washing laundry and cleaning every day. For Mr. Harden as being the head of the family, his daily activity is selling fashion items like shades in different markets of Marikina City. Aside from working, he does go to the Barangays gym to work out for an hour, three times a week. For their children, Isaac and Fatima, they usually play as each other and barely goes out since they are still young. And of course, since they are practice Islam, as part of their daily activities and pray at the Mosque. During weekends, sometimes they all visits Fahads family at Malanday.
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With the familys activity and exercise pattern they make use of the gym program established by the barangay. This explains that the family knows the benefit of exercise in their health and somewhat takes advantage of the distance as an opportunity for them to exercise in a form of walking. Family Sleep- Rest Pattern The family stated that their sleep and rest pattern is good. Since they hold their time, they really alot a time for their rest and sleep. According to Mr. Harden, they all sleep together as a family at night. Usually around 9:00 pm, they are already asleep and then wake up at 6:00 am every day. The most minimum day of sleep is 6 hours because they have a 2 months old baby who wakes up time to me. Sometimes they sleep in the afternoon for 30 minutes to an hour. They sleep in a bed matres on the floor which they clean it every day. And of course, for the kids they usually sleeps and wakes up when theyre hungry but definitely their children were awake around 8:00 am. In exceptional, during rainy/wet season, Mr Harden stated that when there is a heavy rain his sleep gets interrupted because he needs to check the water level. Overall they have an appropriate hour of sleep, wherein the couple sleeps for about 6 to 9 hours a day. This is good to prepare their body in their daily task. Family Sexuality and Reproductive Pattern According to Mr. and Mrs. Harden, theyve been together for six years, married and had three children. They are happy and they enjoy their sexual life. They are proud that they were able to reproduce three children who are now 2 years old and 1 year old and 2 months. They stated that they are both sexually active but they only practice withdrawal as a natural form of contraception and not allowed to use other forms of contraception. According to Mr. Harden he is faithful to his wife, and both of them never had nor experience any sexually transmitted infection. During menstruation, the couple doesnt engage themselves into sexual intercourse, because they said it is unclean. They are also hygienic in their genitalia. The couples sexuality and reproduction pattern, they are both happy and contented for what they have in their relationship and they are looking forward for a stronger and more mature relationship were Allah is the center of it. Family Value and Belief Pattern Theyre an Islamic family that adheres strictly to Sharia (Islamic Law). They also read Quran, the Islamic Holy Bible that their Prophet is (Muhammad) and their God is Allah. They pray five times a day facing Mecca, the Holy Land of Islam. They fast for a month during Ramadan, at the ninth lunar month of Islamic calendar. Although pregnant mothers, and women whose menstruating, the ill, and children are allowed not to join the Ramadan. Their religious
8

belief is dictated by the Quran that is evident in their behavior and character. It is said that they only do as their way of life is dictated in Sharia. They only eat meals that are allowed (Halal). Their practices like hygiene, sex, and religious events are also dictated in Sharia. Within their community, Fahad Harden is a member of Salam Police. Salam Police is a neighborhood watch that enforces Sharia, the Islamic law. Sharia is composed of rules and regulations and laws. Family Coping Stress Tolerance Pattern When it comes to coping stress tolerance, the family stated that as being Muslims who have strong believed in Allah and strictly practices. Muslim culture, they take stress and problems in life as challenges. Mr. Harden stated that he admits that they are not perfect persons, but they do their best to fight in order to overcome the obstacles. For them, when they are stress they go to their mosque, they pray or consult their imam to relieve their stress. During big problems, the couple practices fasting and pray more and thats how they get their strength to survive each day. This shows that the family had a strong relationship with their Allah. During stress and problems, the family takes these as a challenge which demonstrated their positive outlook in lifes daily obstacles. And they have a support system such as their imam which shows their open mindedness and strong belief in Islamic teachings. Family Health Perception and Health Management Pattern The family Harden stated that for them the great healer is Allah. However, they still go to health center or hospital when they needed and of course they pray. Especially for their children, the couple make sure that they have regular check- ups and gets the immunization shots in time. They also seek consultations and medical advice when they get sick which is very seldom. For the family they said that they think that they are healthy. They barely get sick, never had some very serious disease. Family Health Status/Health History and Health Practice According to the couple, they dont have any illnesses or diseases for the meantime except on their eldest child having an amoebiasis occurring five (5) months ago. The common illness which the family mostly encounters in the past six (6) months is cough and cold and their modalities in treatment would be ingesting a Paracetamol (Biogesic) tablet and Neozep which is an Over- The Counter medication drug. Recently, their eldest child have experienced amoebiasis wherein they gave her an antibiotic. The family often seeks their health concerns in their health center, Midwife and a Doctor in Brgy. Lamuan.
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In terms of their problems other than health, they usually consult their friends and theirImam and goes to the Mosque five times (5) a day. The immunizations of their children are adequate with no miss immunizations. Financing Health Care The Family Harden does not have any health insurance. If any of the members of the family get sick, they usually get their money from emergency savings. Mr. Harden earns Php.300-500 each day from selling fashion items like shades. Their daily expenses cover their daily food for three times a day, a snack and milk and other necessities. This makes them save Php.50-100 a day. On their savings, aside from being a source of emergency money, they also use that to pay Php.500 for their monthly electricity bill (wiretapping from the neighbour) and the water which causes either Php3.00 per gallon or 50 per one hour filling of water. This shows that Mr. Harden earns Php.9000-15,000 per month. In analysis, the monthly revenue of Mr. Harden is just enough for their family. This is because the size of their family is small at the moment. Since the mother does mixed breast feeding and formula, this helps them save money. And also none of their children are going to school since they are all young and they eat just a little bit. With this their expenses is not much.

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Computing and Justifying Scores of Health Problems

Family No. 11-156 Problem # 1: Polluted water supply Criteria Standard

Score Weight

Actual Weight

Justification S: Madalas naman kami magpakulo ng tubig at nilalagay naming ito sa pitchel as verbalized by Mr. Harden. O: Mr. Harden is aware about the water borne diseases and knows the importance of boiling it. History of amoebiasis I: The importance of Water sterilization to prevent them acquiring water borne diseases.

1.) Nature of the Health Problem Deficit Health Threat Foreseeable Crisis

3 2 1 1 0.67

2.) Modifiability Modifiable of the Problem Partially Modifiable Not Modifiable

2 1 2 2

The importance of Water Sanitation is modifiable through water sterilization to prevent water borne diseases.

3.) Preventive Potential

High Moderate Low

3 2 1 1 1

The water problem of the family has a high preventive potential by practicing water sterilization as a preventive measure to lower the risk for health threat.

4.) Salience of Needs the Problem immediate attention Does not

Water is one of the essential needs in life. The client and his familys water condition need an immediate attention especially there was a history of amoebiasis and they
11

need immediate attention Not problem a

have very young children to protect from any harm. 0

TOTAL SCORE: 4.67

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Family No. 11-156 Problem #2.1: Presence of faulty electrical wiring Criteria Standard Score Weight Actual Weight Justification S: Oo hindi nga maayos ang pagkakagawa nila ng linya ng kuryente as verbalized by the father. O: The electrical wiring is not properly installed. Some parts that were used in proper electrical wiring installation were replaced. Nails were used instead of electrical tacks. The electrical outlet on the wall was placed about one foot above the floor. I: This is a health threat because improper electrical wiring installation can bring danger. The nails that was used to mount the electrical wire to the wall may rub against the nail which may break the installation and may produce spark and eventually cause fire and also the place easily gets flooded their electric outlet can be immersed to water.

1.) Nature of the Problem

Health Deficit Health Threat Foreseeable Crisis

3 2 1 1 0.67

2.) Modifiability of the Problem

Modifiable Partially Modifiable

2 1 2 2

It is modifiable because the family is aware of the problem in their electrical wiring installation.
13

Not Modifiable

3.) Preventive Potential

High Moderate Low

3 2 1 1 1

It is preventable because the father has knowledge in fixing simple electrical wiring problems.

4.) Salience of the Problem

Needs immediate attention Does not need immediate attention Not a problem

0.5

It does not need immediate attention because it does not have an immediate effect to the familys health status but should be considered.

TOTAL SCORE: 4.17

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Family No. 11-156 Problem #2.2: Improper garbage segregation Criteria Standard Score Weight Actual Weight Justification

1.) Nature of the Health Deficit Problem Health Threat Foreseeable Crisis

3 2 1 1 0.67

S: Ang aming barangay ay lagging nangungulekta ng basura as verbalized by Mr. Harden. O: The father is not segregating their garbage into biodegradable and non-biodegradable which should be segregated accordingly. I: The problem is a health threat because their improper waste disposal could be a breeding or resting place.

2.) Modifiability Modifiable of the Problem Partially Modifiable Not Modifiable

2 1 2 2

It is easily modifiable because we can simply give them instructions to perform proper garbage segregation and disposal.

3.) Preventive Potential

High Moderate Low

3 2 1 1 1

It has a high preventive potential because the family can use preventive measures by segregating their own garbage accordingly when the barangay garbage collector it. It is being
15

picked up 3 times a week which by minimizing the stock of the garbage that maybe breeding or resting place of vectors. 4.) Salience of the Problem Needs immediate attention Does not need immediate attention Not a problem 2 Does not need immediate attention which the family disposes their garbage on time but unable to segregate their garbage.

0.5

TOTAL SCORE: 4.17

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Family No. 11-156 Problem #3: Poor lighting and ventilation Criteria Standard Score Weight Actual Weight Justification S: Isa lang ang ilaw na ginagamit naming at may bintana naman kami as verbalized by Mr. Harden O: The family is located in a depressed area in which their house is congested. They have only one (1) light for the whole house which is a threat to their family that can cause accident. Poor ventilation is also a health threat that can be given that they live in a depressed area where houses are congested. I: The family is a health threat in which is the family is at risk of acquiring respiratory diseases and at risk of injury in which low light can cause injury to client due to low visibility. I: On this familys condition this shows that they dont focus on their lighting and ventilation due to lack of financial and resources. And this is partially modifiable due to their problem by providing health teachings about proper lighting and ventilation.
17

1.) Nature of the Problem

Health Deficit Health Threat Foreseeable Crisis

3 2 1 1 0.67

2.) Modifiability of the Problem

Modifiable Partially Modifiable Not Modifiable

2 1 2 0.5

3.) Preventive Potential

High Moderate Low

3 2 1 1 2

I: They need more teaching with regard to their risk of acquiring diseases and provide information about preventive measures. I: As the clients family was interviewed, they dont give prioritization in regards the problem due to lack of resources and they dont care about the risk of different injuries and health risk.

4.) Salience of the Problem

Needs immediate attention Does not need immediate attention Not a problem

1 1

0.5

TOTAL SCORE: _3.67_

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Family No. 11-156 Problem #4: Presence of breeding or resting site of vector Criteria Standard Score Weight Actual Weight Justification S: Maraming daga, ipis at lamok dito sa amin kasi malapit kami sa ilog at barado ang kanal na daluyan ng tubig as verbalized by Mr Harden. O: This problem is considered as a health threat because of improper drainage system. The area where the family is residing is near the river which is a susceptible site for the breeding of the vector. I: The problem is health threat in which the family could possibly acquire a disease which caused by a vector -that was present and breeding in their surroundings. 2.) Modifiability Modifiable of the Problem Partially Modifiable Not Modifiable 2 1 2 1 It is partially modifiable for we can teach the family to clean their surrounding and drainage canal to prevent the water from stagnation that may cause possible place for the breeding or resting place of the vector.
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1.) Nature of the Health Deficit Problem Health Threat Foreseeable Crisis

3 2 1 1 0.67

3.) Preventive Potential

High Moderate Low

3 2 1 1 0.67

It is moderately preventable implementing preventive measures such as cleaning their surrounding that will benefit them by preventing the multiplication of the vector that may cause disease. The family is aware of the problem as being a health threat. They just need to clear their surroundings, fix the drainage system to minimize the breeding place of the vector by preventing the occurrence of water stagnation.

4.) Salience of the Problem

Needs immediate attention Does not need immediate attention

0 Not a problem

TOTAL SCORE: 3.34

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Family No. 11-156 Problem #5.1: Presence of rodents Criteria Standard

Score
Weight

Actual Weight

Justification S: Ang problema namin ay yung mga daga, minsan nga dumadaan dito sa bahay, as verbalized by Mrs. Harden. O: Since Ms. Harden is always home, she sees the rats passing by their house. This happened for a couple of times. She cannot do anything about it because she knows there is no food existing inside the house. As long as it doesnt stay inside the house and harm my children. I: The presence of rodents may impose a health threat that could cause harm and disease to their family especially to their children.

1.) Nature of the Health Problem Deficit Health Threat Foreseeable Crisis

3 2 1 1 0.67

2.) Modifiability Modifiable of the Problem Partially Modifiable Not Modifiable

2 1 2 1

I: The presence of rodents can partially be modified by preventive measures such as hygienic measures and daily sanitation practices of their own environment. Closing the doors of the house all the time could also prevent the rat from passing by inside the house.

3.) Preventive Potential

High Moderate Low

3 2 1 1 0.67

I: The presence of rodents have moderate preventive potential due to houses are side by side with each other, and congested but they could take action by cleaning their house and not leaving any food on their table. And make sure they close their doors to prevent rodents from
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getting inside the house. I: The familys environmental condition inside the house is tidy and clean. Their house is a studio type where they just allotted an area for their tiny area for kitchen, and the rest is the area of bedroom. They dont stock food inside the house.

4.) Salience Needs Of the immediate Problem attention

1 Does not need 0 immediate attention Not problem a

0.5

TOTAL SCORE:

2.84

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Family No. 11-156 Problem # 5.2: Fall Hazard Criteria Standard Score Weight Actual Weight Justification
S: Maaring maaksidente kami dahil madulas at maputik and daanan dahil katatapos lang ng baha as verbalized by the couple. O: Muddy area in front of their house slippery floor area due to wet environment. I: The problem has been a threat because the client may fall and cause injury due to wet and muddy floor area thus, having their safety at risk.

1.) Nature of the Problem

Health Deficit Health Threat Foreseeable Crisis

3 2 1 1 0.67

2.) Modifiability of the Problem

Modifiable Partially Modifiable Not Modifiable

2 1 2 1

It is modifiable because the nurses can provide health teaching about cleaning the floors and making sure that the floors are dry enough so that they will prevent injury or falls.

3.) Preventive Potential

High Moderate Low

3 2 1 1 0.67

The client is aware on the problem but does not do anything to clean their area therefore, their prevention of the problems is moderate.

4.) Salience of the Problem

Needs immediate attention

2
The patient does not need immediate attention because there are much more 23

Does not need immediate attention Not a problem

0.5

prioritized problems than of hazard fall.

TOTAL SCORE: __2.84___

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Family No. 11-156 Problem #6: Noise Pollution Criteria Standard Score Weight Actual Weight Justification
S: Madalas talag maingay dito sa lugar namin dahil maraming tambay kahit madaling araw as verbalized by Mr. Harden. O: The place is crowded with several people roaming around everyday talking with their neighbours and houses are placed side by side along the road. I: This is considered a health threat because the place is crowded and presence of so much noise within the area, chances that there will be a possibility of acquiring diseases on the area and there will be alterations on the family's activities and their sleeping will also be affected.

1.) Nature of the Problem

Health Deficit Health Threat Foreseeable Crisis

3 2 1 1 0.67

2.) Modifiability of the Problem

Modifiable Partially Modifiable Not Modifiable

2 1 2 1

The family is unaware of the problem because they are used to it and considers it as a daily activities happening in their place and aside from that, they don't mind whether the place is filled with noise.

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3.) Preventive Potential

High Moderate Low

3 2 1 1 0.33

People in the place are already settled and houses are already built on the area. I: Prevention is low meaning that if we apply interventions immediately, the problem will not be easily resolved at once.

4.) Salience of the Problem

Needs immediate attention Does not need immediate attention Not a problem

1 1

0.5

Since the problem will not be resolved at once, it doesn't need immediate attention because the place is really crowded and noisy and there are many people who reside in the area.

TOTAL SCORE: ____2.5___

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Family No. 11-156 Problem #7: Lack of knowledge of the nature and extent of nursing care needed. Criteria Standard Score Weight Actual Weight Justification
S: Kadalasan hindi na kasi kami nakakapaghugsas ng kamay bago kumain dahil lalabas pa kami ng bahay para mag-igib sa poso at dahil pagod na rin sa paguwi hindi na rin kami nakakaligo bago matulog as verbalized by Mr. Harden. O: The family is eating without washing their hands, their children's clothes were not wash thoroughly, and they prefer not to take a bath before going to bed. I: It is considered as a health threat because of a high possibility of acquiring diseases in which there will be alterations on the health of the family.

1.) Nature of the Problem

Health Deficit Health Threat Foreseeable Crisis

3 2 1 1
0.67

2.) Modifiability of the Problem

Modifiable Partially Modifiable Not Modifiable

2 1 2 0.5

It is partially modifiable because the family had lack of knowledge with regards to the importance of hand washing before and after eating. We, as healthcare provider, we can teach the family on proper way of hand washing and its importance for them to prevent the different kinds of diseases.

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3.) Preventive Potential

High Moderate Low

3 2 1 1 0.67

It is moderately because it can easily correct in proper giving of knowledge and educating them for the cause and effect.

4.) Salience of the Problem

Needs immediate attention Does not need immediate attention Not a problem

0.5

It doesnt need immediate attention because proper hand washing is not difficult to teach to the family for them to get the knowledge that they need. Everyone can do the proper way of hand washing as long as they follow the right steps in doing it.

TOTAL SCORE:

2.34

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Family No. 11-156 Problem #8: Improper drainage system Criteria Standard
Score
Weight

Actual Weight

Justification S: Isa sa mga malaking problema naming dito ay ang baha. Kasi kailangan talaga naming na lumikas kasi lubog talaga yung bahay namin at malaki talagang perwisyo, as verbalized by Mr. Harden. O: According to the family, Barangay Tumana, Singkamas Street is a flood prone area where family Harden has been residing for 6 years. During rainy season, Mr. Harden barely sleeps and his vendor business needs to be put aside because he needs to check the progress level of the flood and prioritize the family. According to them there are times that their neighbours who have second floor let them stay for a while during the calamity. The flood usually takes to completely subside from 1 day to 3 days the minimum depending on how high is the level. I: The flood during rainy season interferes with Mr. Hardens livelihood and could be a health threat to their family. This just gives room to stagnant water, infestations of vectors, and piling of mud and garbage. The improper drainage system of the community could probably a result of impaired sewage system as well. Since the family lives in a squatters area, the location is congested which means that there are great numbers of families who uses the drainage
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1.) Nature of the Problem

Health Deficit Health Threat Foreseeable Crisis

3 2 1 1 0.67

system. With this, it gives opportunity for communicable diseases to occur. 2.) Modifiability of the Problem Modifiable Partially Modifiable Not Modifiable 2 1 2 0 I: The problem of improper drainage system causing flood cannot be modified that easily. Even though the family is aware about the problem, they still prefer to live in the same house and the same area due to their financial restrictions.

3.) Preventive Potential

High Moderate Low

3 2 1 1 0.33

I: The preventive potential of flooding is low because it is a squatter area, and it is close to River Bank river. There are different levels of flood wherein a yellow stand for warning, orange is alert for evacuation, and red is force evacuation. When the flood reaches the alarming level of 17 to 18, the river is overflowing which is color coded as red. This means that all families will be forced to evacuate. I: The familys environmental condition does not need an immediate attention. This is because the flood only occurs during rainy season when the rain is strong and continuously outpouring. The improper drainage system cannot be change or solve easily. During a calamity, it is important that the family could just focus on preventing themselves in acquiring a disease especially they have younger children and provide a safe area to evacuate as being a basic need.

4.) Salience of the Problem

Needs immediate attention Does not need immediate attention Not a problem

2 1 1 1

TOTAL SCORE:

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Ranking of Health Problems According to Priority Legend: 1st Prioritized Problem 2nd Prioritized Problem 3rd Prioritized Problem

PRIORITY 1 2.1 2.2

PROBLEM Polluted water supply Presence of faulty electrical wiring Improper garbage segregation and waste disposal Poor lighting and ventilation Presence of breeding or resting sites of vector Presence of rodents Fall Hazard Noise Pollution Lack of knowledge of the nature and extent of nursing care needed Improper drainage system

SCORE 4.67 4.17 4.17

3 4 5.1 5.2 6 7

3.67 3.34 2.84 2.84 2.5 2.34 2

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Top 3 Problems of Harden Family Ranking Health Problems of the Family in Barangay Kanan Tumana, Sinkamas Street_ PRIORITY 1. 2.1 2.2 3. 4. 5. 1 5. 2 6. 7. FAMILY NAME Harden Harden Harden Harden Harden Harden Harden Harden Harden PROBLEM Polluted water supply Presence of faulty electrical wiring Improper garbage segregation and waste disposal Poor lighting and ventilation Presence of breeding and resting sites of vector Presence of rodents Fall Hazard Noise Pollution Lack of knowledge of the nature and extent of nursing care needed SCORE 4.67 4.17 4.17 3.67 3.34 2.84 2.84 2.5 2.34

8.

Harden

Improper drainage system

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Priority Family for Follow-up PRIORITY FAMILY IN BARANGAY Family Name HARDEN Level of Functioning Adolescent Is an essentially normal family but has more than the healthy and usual amount of conflicts and problems. (Jane Antilla Tapia, 1973) KANAN TUMANA__ Justification The Harden family is a muslim family who has great faith in their Alah and strictly practices their rituals and other spiritual beliefs that they have. According to the family, their faith in Alah makes them strong. They follow rules of the community and have regular check-upfor their children. Mr. and Mrs. Harden doesnt really get sick, usually if they will get sick it is just cough and colds. Based on their statements that were given during our interview, it shows that with their basic values and faith adopted from Muslim culture, this explains the way their responses on everyday circumstances. The influence of their Muslim values and faith molds them to have a thinking that everything will be alright as per Mr. Harden. That is why during crisis, they continuously pray together as a family regularly and do the best that they can to survive. Mr. Harden also mentioned that it saddens him because as being a Muslim the other people and community around them believes in the stereotype that Muslims are war freaks and troublemakers, but he claims that this is not true at all especially for their family. For them, what matters is they know themselves and they can prove that they are better than other people in the community. They just rather focus on improving themselves, be in good condition, and be able to live life each day to overcome the obstacles along their way. Even Mr. Harden earns P300-500.00 a day, the family budgets and makes sure that they could eat three times a day especially their children. And also Mr. Harden makes sure that he can put aside P50100.00 a day depending on the revenue. This shows that they have financial resources during emergency.

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Family Nursing Problem Objectives: List down possible causes of health problems of identified priority through first and second level of assessment Family name: HARDEN_ Health Problems Family Nursing Problems First Level Second Level Assessment Assessment Inability to provide home environment to health maintenance due to inadequate knowledge of importance of hygiene and sanitation. Inability to provide home environment conducive to health maintenance due to inadequate family resources in terms of financial constraints.

1. Poor home/environmental condition Presence of Health /sanitation specifically: polluted water Threat: Inability to supply. make decisions with respect to taking appropriate health actions.

Inability to provide home environment which is conducive to health maintenance and development.

2.1 Accident/Hazard specifically: presence Presence of Health of faulty electrical wiring Threat: Inability to recognize the existence of a condition that is conducive to accident or may result to failure to maintain wellness. 2.2 Poor home/environmental condition/ sanitation specifically: improper garbage segregation Presence of Health Threat: Inability to recognize the

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

Inability to provide home environment to health maintenance due to inadequate knowledge of

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existence of a problem due to lack of knowledge with presence of possible resting or breeding sites of vectors that could cause cross 3.Poor home/ environmental/sanction infection from a specifically: poor lighting and ventilation communicable disease

importance of hygiene and sanitation.

Presence of Health Threat: Inability to make decisions with respect to taking appropriate health actions

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

(Nursing Practice in the Community by Maglaya)

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Day to Day Basis Day 1 As part of our first day as being a public health nursing students, prior to going to the assigned area of exposure we had an orientation in our school for the components and activities of Community/Family Health Nursing. In the afternoon, our first stop was at the Marikina Health Center where our clinical instructor oriented us about the barangays health center system and given us the basic information about Barangay Tumana. We had learned about their organizational chart, mission, vision, and the basic background history of Barangay Tumana, and its demographic data. We also had a small discussion about our primary goals and health teachings that we have to carry out once we are in the community as part of our orientation. For our second stop for the day, we went to the office of Barangay Tumana. We were introduced by our clinical instructor to the Barangay Chairman and other officials, and we had expressed our mission for the two weeks of our community and family interaction. After that, we had explored the community specifically focusing at Singkamas Street, Kanan Tumana and spoke to the people and their families in order for us to find the family that well be interviewing for two weeks and oriented them on our activities that we will be doing. Day 2 Initially, we had a group meeting with our clinical instructor and provided us the required forms that we have to fill out. And also we had generated a plan regarding our interview process in order to get to know our selected family. Before we went to our respective family, we went to visit the Barangay Tumana Health Center at around 8:00 am there is a humongous crowd in front of the center waiting in line. Obviously, the center was very busy and so are the Health Center Team. In spite of their busyness, they were able to welcome us. Our clinical instructor informed them that well be assisting them in the morning for the immunization day. After our stop at the Barangay Tumana Health Center, we all went at Singkamas Street Kanan Tumana to meet our selected families. As part of our initial step, we continuously build up rapport with Harden family. They are very nice and willingly opened their doors and had provided chairs and tables to make us feel comfortable. We started our interview with the use of our family assessment guide tool and preformed our physical inspection and observation. Day 3

36

It is the third day of our shift in Barangay Tumana, first hand, our clinical instructor meet us near the Health Center and after the members of the group were completed, we went again to our duty at Singkamas Street, before we head to our respective families, our clinical instructor provided us with some last minute instructions and afterwards we went to our respective families to provide home visit and as well as health teachings for the whole family. First, we conducted our health teaching for the family about the importance of caring for their children, proper hygiene and then it lasted for about thirty minutes to one hour for each of the family, then lunch time came and we had our break for atleast four hours then after the break, we immediately resumed our activities for each of the family health teaching and then demonstration coming from us student nurses. Afternoon care and the last activity we had in our assessment of the problems of each of the families and later on had our dismissal by four in the afternoon. Day 4 Fourth day of our community visit at barangay Tumana for our continuing care and evaluation for our chosen families. We went directly to Singkamas Street, to conduct assessment on our chosen family and then formulate the priority problems that are existing within the community. Immediately, we had our visit to check the family status and then assisted them on their health needs, giving them on the spot check- up of their blood pressure, providing health teaching for the family. Afterwards, we had our break and then proceed as usual to the area and then obtained the data needed for the survey. By 4:00 pm we had completed our assessment and had our way again for dismissal. Day 5 Fifth day of our community visit at Singkamas Street Barangay Tumana, before going to Singkamas Street we drop by at Tumana health Center for a post conference meeting with the health center staffs and our Clinical Instructor. He discuss about our agenda and gave a brief discussion about what to do. After he had given us the instruction needed, we proceed to Singkamas Street to visit our respective families and provide interventions for the whole family such as, vital signs taking, blood pressure checking and assistance to the family in any cause regarding their health. By 12:00 noon we had our lunch break until 1:00 pm. Then we back again to the area and continue our interventions. Day 6 This is our last day in the community and at 8:00 am, we went to Singkamas Street, Tumana Marikina City and this we conducted our final assessment and data gathering for the community. At 10:00 am we went to Tumana Health Center to assist the staff for the immunization day. After then we went back to Barangay Singkamas for our final assessment and we bid goodbye to our family
37

Nurse Patient Interaction NURSE Magandang tanghali po! Ako po si LJ, kasama ko po si Roldan at Michael. Taga Delos Santos-STI College po kami. Puwede po ba kaming maginterview? (smile) LJ: Meron lang po sana kaming mga ilang katanungan sa inyo tungkol sa inyong pamilya lalong lalo na po tungkol sa inyong kalusugan. OK lang po ba? LJ: Sandali lang naman po ito. Bago po ang lahat ano po ba ang inyong buong pangalan? Roldan: Ilang taon na po sila? Michael: Pwede po bang malaman kung sinu-sino ang kasama nyo sa bahay? PATIENT Norai: Magandang umaga din po. Cge po wala naman po kaming masyadong ginagawa. Pasok kayo. (nag-offer ng mga upuan) ANALYSIS The patient is very accommodating and has showed willingness in participation in the interview.

Norai: Sige. Ano po ba yun? The patient shows interest in the topic.

Norai: Norai Harden at ang asawa ko ay si Fahad Harden.

To identify the client and to know some personal data

Norai: 22 ako at 29 si Fahad. Norai: Kami lang magasawa at yung tatlo naming anak na may edad na 2 taon, 1taon, at 2 months yung bunso. Norai: Yung mister ko ang nagta-trabaho, si Fahad. Nagtitinda siya ng mga sun glasses. Fahad: Kumikita ako ng 300 hanggang 500 sa isang araw.

To identify the age of the recipient. To identify the members of the family and to know them better

LJ: Maari po bang malaman kung sino ang nagta-trabaho at kung magkano ang kita sa isang araw?

To identify the head of the family and source of income

LJ: Ano po ba ang natapos Norai: Si mister hanggang ni mister pati na rin po 3rd year high school lang,

To know the educational

38

kayo?

ako naman hanggang grade 2. Norai: Anim na taon na kong nakatira dito.

background of the client. To know the length of stay in the community

Roldan: Ilang taon napo kayong naninirahan dito? Roldan: Saang probinsya po kayo nanggaling?

Norai: Taga-Cotabato ako. Fahad: Taga-Malanday ako

To identify the ethnic background of the family

Michael: Ano po ang relihiyon ninyo? LJ: Ano po ang karaniwang nagiging sakit ng inyong pamilya?

Fahad: Islam po.

To identify their religious affiliation To know their health condition or usual health problems.

Norai: Ubo, sipon at kung minsan lagnat. Bihira-bihira naman po kami magkasakit sa awa ni Allah. Norai: Nung nakaraang limang buwan, nagkaron ng sakit na Amoebiasis yung panganay kong anak. Norai: Oo sa Amang Rodriguez Hospital. Norai: Simula nun, nagpapakulo na kami ng tubig sa inumin. Pag maliligo naman, bumibili na kami ng tubig, hindi na kami sa poso umiigib. Fahad: Kami ang nagpatayo ng bahay pero itong lote hindi pa samin.

LJ: May naranasan na po ba kayong sakit sa pamilya?

To know their medical history.

LJ: Dinala niyo po ba siya sa ospital? Roldan: Nung gumaling po ang anak niyo, ano po ang ginawa niyo para maiwasang maulit yung sakit?

To know their health practice

To know their ways on preventing the disease

LJ: Nangungupahan po ba kayo? O sa inyo po itong bahay at lupa? LJ: Yung basura po ninyo saan ninyo tinatapon? Binubukod niyo po ba ang nabubulok sa hindi nabubulok?

To identify their residency

Norai: Hindi kami To know the type of garbage nagbubukod. Sama-sama disposal and whether they lang sa plastic. Tapos segregate or not kinukulekta ng trak tatlong beses sa isang linggo tuwing umaga, MWF. (may lumabas na daga sa
39

basurahan) LJ: Namamamalengke po ba kayo araw-araw? LJ:E saan ninyo po tinatago ang pagkain ninyo? LJ: Ano po ang madalas niyong kinakain? Norai: Hindi e. Bumibili lang kami ng lutong ulam. Norai: Walang natitirang pagkain, bumibili lang ako ng kaya naming ubusin. Norai: Pag sa almusal, milo at pandesal sa mga bata at kape naman saming magasawa. Pag sa tanghali naman, munggo ang madalas naming ulamin. At pag gabi, itlog at sardinas ang madalas nming ulamin Norai: Natural method kami, withdrawal lang. To know health practices.

To know health Practices

To know the family dietary habits

LJ: Nagpa-family planning po ba sila ni mister? Roldan: Pag nagkakasakit po kayo, saan po kayo nagpupunta?

To identify if they are aware of family planning and the method they use. To identify health practices and where they consult

Norai: Sa health center, tapos pag grabe na ang sakit, sa Amang Rodriguez Hospital. Fahad: Cellphone lang ang meron kami. Fahad: Pedicab at jeep doon sa kanto.

Roldan: May telepono po ba kayo o cellphone? LJ: Kapag po may pupuntahan po kayo ano po ang sinasakyan ninyo? LJ: Magkano po ang bayad niyo sa kuryente kada buwan? (napansin yung wiring na nakalawlaw lang) Roldan: Isa lang po ba ang ilaw niyo? (medyo madilim at maiinit dahil isa lang ang bintana at maliit pa)

To know their means of communication To know their means of transportation

Norai: 500 pesos pero nakatap lang kami.

To know their expenses in regards to electric bills

Fahad: Oo kasi bawal kami magdagdag ng gamit, isang bumbilya lang ang gamit namin. Dagdag bayad pag nagdagdag kami ng gamit.

To identify their lighting and ventilation

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Roldan: Araw-araw po ba naliligo ang mga anak niyo?

Norai: Hindi kasi mahal ang tubig.

The identify their practice on personal hygiene

Roldan: Yung tubig niyo Norai: Oo. ba, iniipon niyo lang po ba sa isang lalagyan? (napansin na walang takip ang lalagyan) LJ: Hindi po ba kayo nahihirapan dumaan sa kalsada sa labas? (ang daan ay baku-bako) LJ: Nakakatulog naman po ba kayo ng maayos? Norai: Mahirap nga dumaan lalo na sa mga bata.

To identify the breeding sites of vectors

To identify accident hazards in the surroundings.

Norai: Hindi kami masyado makatulog kasi maingay sa labas. Tambayan kasi tong tapat namin.

To identify if there is a noise hazard

LJ: Ah ganun po ba? Ano Norai: Minsan lang po ang ginagawa niyo pinagsasabihan ko yung pag maingay sila? mga tambay na wag sila masyadong maingay kasi may natutulog. LJ: Yung kanal niyo po ba nililinis niyo po ba lagi? Norai: Ay hindi kasi madalas tapunan ng mga kapitbahay at mga tambay. Kahit anong linis nmin nagbabara pa rin. Norai: Sige OK lang, walang problema.

To identify their response regarding the noise hazard.

To identify their awareness towards community in regards to sanitation.

LJ: Maraming maraming salamat po kasi pumayag po kayo mag-painterview. Puwede pa po ba kami bumalik pag may kelangan pa po kaming itanong?

Termination phase.

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42