Chapter 1 Introduction

Family is composed of two or more persons who live together over a period of time. It is a group of persons united by ties of blood, marriage or adoption which provides for the rearing of children and supplying their needs. This is also the basic unit of society, a group of interlocking network of interpersonal and interdependent relationships. Each one of us is typically living in two different families throughout our lives. One is the family of orientation. The second is the one created when we marry or form a significant and lasting bond. According to composition, family is divided into two types: Nuclear and extended (Leslie D. Atkinson, RN, MS, 1988). Nuclear family is consisting of a mother, father and unmarried children. This is common in urban areas where space and food are at a premium. Extended family, on the other hand, is composed of several nuclear families living together in one household. Family can also be classified according to residence, descent, and authority. As in most societies, family is the institution responsible for physical, economical, emotional, social and religious support of its members. The family then, is the basic institution from which the others have grown as increasing cultural complexity made them necessary (Horton and Hunt, 1984). According to Lundberg, the family regulates reproduction and provides the training in communication and cooperation. It also supplies certain highly value immediate services and satisfaction such as cooperate pursuit of the physical necessities of life, protection, affection, sexual gratification, and the satisfaction of gregarious instincts. (Lundberg, 1963:502-503). Family plays a significant factor in the growth and development of every individual. According to Ackerman, family is the basic unit of growth and experience, fulfillment or failure. Without basic nurture by caring adults, the newborn will not thrive.

Family Background Family Gubat is composed of the mother and father their 7 children. Both Mr. and Mrs. Gubat came from Ladul, Alabel, Saranggani Province. They grew up yhere and got to know each other. In 1992, they decided to live together without getting married. They had their first child a later while after. They stayed in Ladol for 6 years where they had their first and second children. After that, the family decided to transfer to Malungon where the fathers relatives are. They stayed there for so long, where they their children 4 youngest children the father was a farmer there. Due to pursuit of greener pasture, the family transferred here in Gensan just August this year. They stayed in a lot where the mothers uncle is living. A. Family Structure, Characteristics and Dynamics Family Gubat is a nuclear type based on composition and equalitarian in terms of authority. The family is composed of the father, Dodong 37 years of age, mother Inday, 31 years old, and with their 7 children. Their first children, child A female 15 years old, is now staying in her aunt in Padada, Davao del Sur. Her aunt is sending her to school. The second child B female is 11 years old. The third, child C male is 10 years old. The fourth and the fifth, child D and E are identical twins, male and are 7 years old. The sixth, is now 2 years old. The younger, child G, female is 1 year old. B. Socio- Economic and Cultural Characteristics The parents are the one providing income to the family. They are collecting trash and garbages and sell these for a living. For a week, they usually earn 400 pesos but it can vary depending on the garbage they had collected. They spent 75 pesos a day just for the rice. Sometimes, they are forced to eat inadequately and even miss some meals. The mother is the one making financial decisions. The father finished his grade 2 in elementary, while the mother finished grade 5. The eldest is only one going to school. The family is a Roman Catholic. The family

doesnt participate much in community activities, since they just transferred. But when they were in Malungon, they used to make use of community resources, specifically in the Health Care Center, since the mother said that they used to live in near the Health Center. C. House and Environment The family lives in an approximately 3 by 3 in house. That is too small for the family. They lived in the mothers uncles compound, they were allowed by the real owner of the vacant lot to live there for free. The house is just a room that serves as the living room, bedroom and dining room. They used to sleep together since they only have 1 room. Outside the house, garbages are everywhere and flies are present. Foul smell is also alarming, because the mothers uncle have live stocks, horses, cows and pigs. The house is also made of light materials and not properly walled. It doesnt provide privacy to the family. The family uses firewood for cooking. They dont usually store food since their food are just enough for them, inadequate sometimes. They get their water on their neighbors faucet, which is about 25 meters away from the house. They just use a common toilet, owned by the mothers relatives. In terms of garbage disposal, the family just dump their garbage, foul smell was present and there is present of vectors. They dont have a drainage system, the community Health Center is a ride away from their home. When the parents are collecting garbages and selling them, they make use of their cart, but just walk to the junk shop which is quite too far. D. Health Status of Each Family Member The father verbalized that each member of the family didnt experienced any unusual health problem just the common ones, such as colds, coughs and flu. The children didnt have history of measles, mumps, and chicken pox. The mother also verbalized that all children except the youngest have complete immunization. The children was seen to have thin hair and dry and cracked skin.

E. Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention The children, except the youngest, have complete immunization. In terms of eating habits, the mother verbalized that they dont eat adequately. There were times that they are forced to miss meals. The food intake is inadequate in quantity and quality. The parents and children have enough sleep. But in terms of exercise, theyre not so particular with it. The lot theyre living is wide. The kids can play freely, but most of the kids dont have sleepers. They walk barefooted.

Purpose of the Study Goal The case study aims to enhance the family nursing care and health promotive and preventive measures of a family in Leon Llido, Lagao, General Santos City. The study also aims to address any health problem that may arise during the study.

Objectives 1. Gather Initial database regarding the family structure and characteristics, socioeconomic and cultural, environmental characteristics and the familys health status and values and practices placed on health promotion. 2. Identify presence of wellness state, health deficit, health threats and stress points. 3. Identify family nursing problems and prioritize them. 4. Implement nursing interventions through nursing care plan. 5. Evaluate the implemented interventions.

Chapter 2 Typology of Nursing Problem This chapter shows the different health problems manifested by the family such as wellness state, health deficits, health threats, and foreseeable crisis and stress points.

Cues/ Data Mr. Dodong and Inday have 7

Family Nursing Problems A. Family size beyond and Inadequate

children. Namely A whos age is 15 living space. years old, B is 11 years old, the C is 1. Inability to make decisions with respect to 10 years old and the twins D and E whos age is 7 yrs. old. They sleep in a 3 by 3 meters house which is there living room and bed room already. It does not provides privacy. taking appropriate health action due to; a) lack of knowledge as to alternative courses of action open to family. 2. Inability to provide a home environment conducive to health maintenance and personal development due to; a) Inadequate family resources specifically financial constraint and limited physical resources. b) Failure to see benefits of investments in home environment improvement. There children are underweight for B. Malnutrition as a health deficit. there age. (see appendixes) D, E, F and G walks barefooted 1. Inability to recognize the presence of malnutrition in every family member. C. Poor Hygiene 1. Inability to make decisions with respect to taking appropriate health action due; a) Failure to comprehend the nature of the problem.

b) Low salience of the problem. c) Inaccessibility of appropriate resources for care, specifically physical Garbage dumped beside their house and present of flies. Fragmented glass are everywhere. Their house is made up of light materials like plastics, woods and some are clothes. inaccessibility. D. Improper Waste Disposal and Accident hazards as manifested by pointed or sharp broken glass. 1. Inability to provide a home environmental conducive to health maintenance and personal due to; a) Inadequate resources to see the benefits of investments in home environment improvement. They dont have light facilities and they get their water n their neighbors faucet for free. E. Accident Hazards as manifested by poor lighting 1. Inability to provide a home environmental conducive to health maintenance and personal due to; a) Inadequate resources to see the benefits of investments in home environment improvement. Feces of cows are present in there place with foul smelling They just share toilets to the mothers relatives. And they just cooked in the front of F . Poor Environmental Sanitation 1. Inability to provide a home environmental conducive to health maintenance and personal due to; a) Inadequate resources to see the benefits

their house and just leave the excess of investments in home environment improvement. of the cooking materials like kaldero,mga kahoy,stones. b) Low salience of the problem. c) Inaccessibility of appropriate resources

for care, G. Accidental Hazards as manifested by fire hazards. 1. Inability to provide a home environmental conducive to health maintenance and personal due to; a) Inadequate resources to see the benefits of investments in home environment improvement. b) Low salience of the problem. c) Inaccessibility of appropriate resources for care, specifically physical inaccessibility. When we went there child B is the one who takes care of her younger brothers and sisters. She verbalized that wala man akong mama diri nagtrabaho pa sila nagakolekta ug basura. Unya pa sila mag ulimga hapon, akong lng isa naga bantay sa akong mga igsuon. (Tuesday afternoon we went again to the family for further interview). We ask for there income. Family income 400 pesos a week the father verbalized that depende man gud na sya usahay gane wala pa me madawat sa isa kaadlaw.. b) Inadequate resources for care, i.e., responsible family and financial constraint. c)financial resources 2. Inability to provide adequate care to each family member. a) Inadequate family resources for care, specifically; a.1) Inadequate knowledge about child development and care a.2) Absence of responsible member

We saw the cracked skin of child F and eating food with dirty hands.

G Improper Hygiene 1. Inability to make decisions with respect to taking appropriate health action due; a) Failure to comprehend the nature of the problem. b) Low salience of the problem. c) Inaccessibility of appropriate resources for care, specifically physical inaccessibility. 2. Inability to provide adequate care to each family member.

Chapter 3 Prioritization of Family Nursing Problem Presented in this chapter is the computation of prioritization of the problems identified according to nature, modifiability, preventive potentiality of the problem and the familys salience to it. This is determining which problem should be attended first.

Accidental hazards manifested by Fire hazards ACTUAL CRITERIA 1. Nature of the 2/3 x 1 problem .66 COMPUTATION SCORE The problem is a health threat due to the possible instances that will put their lives in danger JUSTIFICATION

It is not modifiable due to the 2. Modifiability of the 0/2 x 2 problem 0 critical condition of both the home and the environment they are living.

It can be prevented moderately 3. Preventive Potential 2/3 x 1 .66 they can fix the cooking facilities afterwards. They put no great attention to 4. Salience of the Problem TOTAL SCORE x1 0.50 the possible occurrence of the problem, since they are used to it. 1.82 Malnutrition as health deficit

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CRITERIA

COMPUTATION

ACTUAL SCORE

JUSTIFICATION The problem is a health deficit

1. Nature of the problem

3/3 x 1

since it signifies the declination of the normal health status of the family members. It is partially modifiable since.

2. Modifiability of the problem

1/2 x 2

Due to financial constraint they have to double time their work for the good of their children It is highly preventable if the

3. Preventive Potential

3/3 x 1

family eat nutritious foods beforehand. It is felt as a problem but they

4. Salience of the Problem TOTAL SCORE

x1

.50

dont implement proper interventions to improve their status.

4.50

CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION The problem is a health threat 1. Nature of the problem 2/3 x 1 .66 since it can cause diseases that might risk the health status of the family. It is easily modifiable by 2. Modifiability of the problem 2/2 x 2 2 implementing proper organization and cleanliness inside and outside their home.

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It is highly preventable the family can arrange the garbage 3. Preventive Potential 3/3 x 1 1 in an appropriate manner and they can clean there surroundings. 4. Salience of the Problem TOTAL SCORE 2/2 x 1 1 4.66 It is strongly felt by the family

Inadequate living space ACTUAL SCORE

CRITERIA

COMPUTATION

JUSTIFICATION The problem is a health threat

1. Nature of the problem

2/3 x 1

.66

that can cause to cross contamination of micro organisms to each other.

2. Modifiability of the problem

1/2x 2

It is partially modifiable if the family has its resources. It is moderately modifiable if they can provide the resources.

3. Preventive Potential

2/3x 1

.66

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4. Salience of the Problem TOTAL SCORE

2/2 x 1

1 2.35

It is strongly felt by the family

Poor Hygiene ACTUAL SCORE

CRITERIA

COMPUTATION

JUSTIFICATION The problem is a health threat

1. Nature of the problem

2/3 x 1

.66

since it can cause diseases that might risk the health status of the family. It is easily modifiable by

2. Modifiability of the problem

2/2 x 2

implementing proper hygiene to their children

3. Preventive Potential

3/3 x 1

It is highly preventable if they can do immediate intervention.

4. Salience of the Problem TOTAL SCORE

2/2 x 1

1 4.66

It is strongly felt by the family

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Ranking the Family Nursing Problem This chapter will reveal the identified Health problems with their corresponding ranks according to the level of priority. 1.A Poor Hygiene 2. Malnutrition as a health deficit 3. Inadequate living space 4. Accidental hazards manifested by Fire hazards 4.66 4.50 2.35 1.82

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Chapter 4 Family Coping Index This chapter designs the family Coping Index. The Purpose of this is to provide a basis for estimating the nursing needs of a particular family. This contains the familys health status, threats and problems. Each criterion for the Family Coping Index was then rated and justified.

Category 1. Physical Independence

Ideal The family members are independent in a way that each is able to help other members in grooming, cleaning, and other

Actual The second eldest daughter takes care at her younger siblings, in the absence of their parents due to their work and of the eldest daughter. The children were too young to take

Scale 2

Justification In the absence of their parents and the eldest daughter, the second eldest takes care of her younger siblings, but she is just still 11 years old. She cant take care of them all, knowing she has to take of the baby.

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tasks. The family members received and given the needed care. All of the members shares and works together to be able to have physical family 2. Therapeutic Competence independence. The family accepts the procedures of treatments prescribed for the care of illness. Care and medications are given appropriately, safely and efficiently. There is understanding of the purposes, symptoms of illness, and other principles of medicine. The family members give confidence and willingness to render care. They The mother verbalized that they had not gone to the health center since then transferred here in Gensan. Whenever sickness occurs, they just buy over the counter drugs. But she said, when they were still in Malungon, they always consult the health workers in the center , sice they lived near it. 3 They hadnt gone to the health center ever since, but knowing that theyre just new to the community. But when they still in Malungon, they seek medical care immediately. care of themselves. The children were so young to take care of themselves.

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consider the factors that could affect illness and diseases with in the family. The family members are well informed and they know facts about the members health condition. They know the cause, symptoms, 3. Knowledge of Health Condition prevention or the underlying principles behind the illness and disease. Necessary actions are done in order to solve the condition. Also, they know the reason for giving 4. Application of Principles of General Hygiene care. They carry out actions to maintain diet and have a good nutrition. Foods are selected according to the needs of the members and is prepared and They eat nutritious food; they have vegetable plant in their yard. Usually they didnt store a food because the food is good for the family. The family gives time to rest after their 17 3 We give them 3 because they eat nutritious food and also their children completed their immunization and they rest after their work but their problem their children walks barefooted and has a dry and cracked skin. In actual they are in good conditions since then the blood pressure of Mr Dodong and Mrs Inday are in normal range, and their children also are in good condition. They said that they follow the Doctors order. And if they feel something wrong they went to health Center for check up. 3 A scale of 3 is given for them because they immediately went to the health center if one of their family member feels something wrong and also sccording to them they follow the Doctors order.

stored properly. The family gives time for the rest and relaxation but not doing overwork. They wear proper clothes that are fitted according to the weather. They give credit to immunization. They believe on the promotion, prevention and restoration of health through services and measures. They accept health care 5. Health Attitude and its importance. The members trust doctors and dont believe in superstitious and quack doctors. The family members follow diagnosis and techniques of 6. Emotional Competence doctors. The members of the family cope up The family has no arguments/issues 18 4 The family is coping with conflicts and even with their Due to financial constraint they are unable to do so. But the when the common illnesses occurs they just ignore it. Mother verbalized that often goes to the health center when they are still in Malungon. 3 The family is submissive to health practitioners. Its just that due to financial constraints, they are unable to do so. The parents, knowing that theyre elementary, undergraduate, and have little knowledge with health principles. work. They wear proper clothes and according to the mother her children have completed their immunization except to the youngest. But the skin of children is dry and cracked and walks barefooted.

with the problems and stresses they are facing. They value discipline and they are responsible for their actions and emotions for better living. They face realities and dispel myths and superstitious. There is willingness to meet obligations. They convey consideration on the emotions of others. The family do things together, each member acts for the good of the 7. Family Living family as a whole; children respect their parents and vice-versa; family task shared evidence of 8. Physical Environment planning. The family is staying or living in The family stays in a good condition, but 19 2 We give them 2 because of poor sanitation and also The mother and father both share the responsibility of deciding of the family. Arguments are not often. 4 They agree and get along with one another. Arguments are not often, the children have fights sometimes, but these are just common. unresolved. Arguments are also less common. They dont have any conflict with the mothers relatives and neighbours. Children have fight sometimes. status. Fights among children are just common.

a house with a good condition, safe, clean and comfortable. It is safe against accident and social hazards. The house has privacy for the family. Transportation is not a problem in their place. Activities that would increase social learning are found with in the 9.Use of Community Facilities community. They are able to identify and use the available community facilities. They use clinics, health care centers, and welfare organizations. They are aware of the services available. The family member knows whom to

poor in hygiene. They are prone to fire hazards and their garbage pile is not organized there are some fragmented broken glass beside in their house and feces of the cows is present with foul smelling. Due to financial constraint their house is too small for them. That they cant provide privacy. And they dont join community activities. They are not that aware to the benefit they can get whenever they seek help to the available community facilities. Because they are just newcomer in the place. But when they era in the Malungon they utilize the available community facilities. 3 We rated them 3 because when they are in Malungon they utilize the facilities in the community. But here in Gensan they are unaware with use of facilities in the community because they are just a newcomer in the place. their house is too small for them and they are 9in the family that they cannot sleep comfortably. They do not join activities.

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contact in cases of emergency. Thus, they are capable of utilizing services in the community.

Chapter 5 FAMILY NURSING CARE PLAN This chapter contains a system of augmenting the need to answer specific health problems of the family through nursing interventions after having made an interview/survey on the health profile of the subject. This system that is planned and is to be implemented is known as Family Nursing Care Plan. Intervention of Plan Method Health Problem Family Nursing Problem 1. Inability to recognize of the problem. a. Lack of Goal of Care Objectives of Care Nursing Interventio n After nursing n and teaching, the family will be After the nurses consecutive home visits, the family will be able to: 1. Broaden the knowled ge of the family about proper Time and effort of the nurse and the family. of NurseFamily Contact Home Visit Resource Required

1. Poor home sanitatio n and condition

Material resources: Visual aids

the presence interventio

21

knowl edge

able to provide a good home sanitation, conducive to health maintenan ce and personal developm ent of each member of the family.

1. Carry out measures to improve home condition. 2. Clean the house and dispose garbage properly through the different ways. 3. To use available resources in maintaining the cleanliness and organization

sanitation and its benefits. a. Discus s the proper organiz ation of things. b. Discuss the consequ ences of failure to take appropri ate action. Available resources inside the home Transportation expenses of the nurse.

2. Inability to provide a home environm ent, which is conduciv e to health maintena nce and personal develop ment.

a. e family

of the house. 4. To know the importance and benefits of cleanliness and proper sanitation to

nadequat resources especially financial constrain s. b.

2.Discuss with the family the appropriate course of action. 3. Help the family to recognize the existing

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Lack of inadequat e knowledg e of importanc e of sanitation.

their wellness.

problem. 4. Help the family to decide what action should be implemen ted.

c. Lack of knowledg e in carrying out measures to improve home environm ent.

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Health Problem 1. Poor Hygiene

Family Nursing Problem 1. Inability to recognize the presence of the problem. a. lack of

Goal of Care After nursing interventio n and teaching, the family will be able to provide a proper hygiene conducive to health maintenan ce and personal

Objectives of Care After the nurses consecutive home visits, the family will be able to: 1. The importance of proper hygiene 2. What is the proper way of hygiene

Intervention of Plan Method Nursing of NurseResource Interventio Family Required n Contact 1. Broaden Home Material the knowledge of the family with regards to personal hygiene and sanitation, specifically. Discuss with the family the significance of having proper Available resources inside the Transportation expenses of the nurse. Time and effort of the nurse and the family. Visit resources: Visual aids

knowledge. 2. Inability to make decisions with respect to taking appropriate health action due; a) Failure to comprehend the

24

developm ent of nature of the problem. b) Low salience of the problem. c) Inaccessibility of care, specifically physical inaccessibility. appropriate for resources each member of the family. 3. Encourag e the members of the family in maintaini ng their personal hygiene consistent ly. hygiene and sanitation. Enumerate to the family proper ways in maintaining personal hygiene existing problem.

home

25

Appendix A

Our first interview with Child B. Their parents were not around that day.

Their house

26

Improper waste disposal

Poor environment sanitation

27

Appendix B Name Mr. Dodong Mrs. Inday Child A Child B. Child C Child D Age 37years old 31 years old Height 52 52 Weight 58 kg 50 kg

not around she stay in her aunt 11 years old 6 years old 6 years old 4 3 35 kg 13 kg

his not around that day 28

Child E Child F Child G

3 years old 2 years old 11 months

1 1

8 kg. 6 kg 6 kg.

29