Father Saturnino Urios University

Butuan City
Nursing Program

Community Health Nursing

Requirement
Individual Case Study

Submitted by:
Kenneth John G. Torredes
Student Nurse

Submitted to:
Mrs. Corazon O. Galindo, RN MAN
Supervising Clinical Instructor

INTRODUCTION

A family is considered as the most basic unit of the society or in the community. If we happen to
try scanning for definitions in other resources such as books or sites, most probably only words differ or
the construction of sentence but the thought itself lingers. A family as we all know consist of parents
and their children. Some families include their in-laws and their grandparents.
For additional information, there are types of family that we all should be familiar about. One of
the major types of families is the Nuclear Family; this is consisting of a father, mother, and their
child/children only living in one roof. The Extended Family is also one type in which we include one
household near relatives in addition to a nuclear family (e.g Grandparents). The Single Parent is already
self-explanatory. The Compound Type includes two Single Parent type of families together.
But when can we say that this group of people is healthy as one? A healthy family is one that
spends more time together and that never loses the opportunity to interact with each other in an open
manner, where things are discussed in fewer restrictions. A healthy family enjoys open and frequent
communication with each other; in this way misunderstanding in ways can be prevented. As such, the
family is the smallest group that a community can build upon its foundation. The effectiveness of the
community programs are dependent on what the attitudes of the family towards the programs are and
how the families respond, cooperate and participate to it.
I have been assigned to this particular family in a span of 3 home visits within 3 weeks. It wasnt
easy I can say, I have to deal with people whom I dont know; with personalities I dont know if I could
even handle but happily my interaction and asssessments went successful because they were able to
respond and accept me with an open arms. The family that I was able to interact with is an nuclear
family consist of three household members with both Mother and Father still living. The family is living
close to each other and is living harmoniously. Upon my visitations, there were evident problems that I
can see through their surroundings and their living. I have observed objective problems not only to their
health conditions but also to their surroundings. Upon further assessments, the family is eager to fight
back whatever circumstances they may have along the way. The mother even said as verbalized, bisan
ug naa nay trabaho akong anak sa manila, di gihapon ko mag salig saila, mag oma ghapon samtang kaya
pa sa lawas. and that was the moment I realized how lucky I could ever be and it surely did touch my
heart.
As an aspiring nurse, I felt the eagerness to pursue whatever task that I am in; a family in which
their current situation has touched my heart is enough to keep me going.
Our duty as health nurses rises as we ensure the strength of the foundation of the society that
we aim to improve. For us to make the task more manageable, the nurses have to come up with an
effective tool; the Family Nursing Care Plan. This is like a to-do list with the complete details of the
family in focus or the family chosen in the said community. This involves the problems and risk factors
observed by the nurse or the group in charge, their diagnosis, and plans of actions, interventions and
evaluations. The needed informations were gathered upon conducted series of home visits. This is a
scheduled meeting with the family to be observed. Home visitation is done for the nurses to be able to
assess the situation of the family from up close observation, usually through interview of a key member
of the family. One of the most important parts of the home visit is the health teaching. This is done to
give ample knowledge for the family to improve their health and promote healthy lifestyle. Usually, this
is done to the mother or the care taker of the familys health. This way, the health teachings have a
higher chance of being implemented.

For me, I have done a goal met in the task that I was into and for me I did not only satisfy my
self, it was a self-rewarding moment to know that my client as well is satisfied and happy to my life
rewarding task.

INITIAL DATA BASE FOR FAMILY HEALTH NURSING PRACTICE

A. FAMILY STRUCTURE AND CHARACTERISTICS
1. Members of the Household and relationship to the Head of the Family

Family Members
Tibursio Lariba
Florita Lariba
Nilda Lariba

Age
24
22
14

Sex
M
F
F

Position
Father
Mother
Daughter

2. Place and Residence of Each Member

P-1 Barangay Salvacion, Butuan City.
3. Type of Family Structure
Nuclear Family.
4. Dominant Family Members in Terms of Decision Making Perstaining to Health Matters
Both Mother and Father is the Dominant in terms of decision making.
5. General Family Relationship
The family is very close to each others as verbalized by the mother during the interview.
B. SOCIO-ECONOMIC AND CULTURAL FACTORS
1. Income and Expenses
a. Occupation, Place of Work, and Income of Each Working Members
Father and Mother Farmer in a nearby Farm earning approximately 200 250 pesos per day.
b. Adequacy to Meet Basic Needs
Adequate enough to maintain food for day due to farming their own crops.
c. Who makes decision about money spending
Mother makes the decision about money spending.
2. Ethnic background and religious affiliation
Roman Catholic goes to church every sunday.

3. Educational attainment of each member

Father attained only Elementary graduate
Mother attained only Elementary graduate
Daughter currently on grade 7 on Pigdaulan Elementary School

4. Relationship of family to the community

The Family and the Community especially on Purok 1 are close to each others.

C. ENVIRONMENTAL FACTORS
1. Housing
A. Adequacy of living space
Adequate space of living. Have a (1) living space, (1) dirty kitchen, (2) occupied bedroom, (1)
comfort room, and (1) waiting shed.
B. Sleeping arrangement
Mother and Father sleep together on one room and the daughter sleeps on the other room.
C. Adequacy of furniture
They have flower and herbal garden, some furniture inside the house.
D. Presence of insects and rodents
Presence of breading sites of mosquito outside the house. Mosquitos are observed and no
rodents and seen.
E. Food storage and cooking facilities
Mostly dont have left overs. Have a dirty kitchen which they uses firewood taken at near wood
forest.
F. Water Supply
Jetmatic pump (drinkable) is 10 meters away from the house.
G. Toilet facilities
Has a toilet room inside the house with septic tank. (close drainage)
H. Garbage and refuse disposal
Garbage placed in a pail, disposed by burning the garbages in a certain area outside the house
when the pail is full.
I.

Drainage system

No drainage system.
2. Kind of neighborhood
Friendly and sometime shares food with each other and has a good relationship verbalized by
the client and my clients neighbor.
3. Social and health facilities
Have radio set fully functional.

4. Communication and transportation facilities available

Thirty to thirty five pesos consumed when a member is to travel from the barangay to city;
Forty five pesos consumed when a member is to travel from barangay to langihan and
one cellular phone owned by both head of the family to call for their sons and daughter on
manila.
D. HEALTH ASSESSMENT OF EACH MEMBER
1. Medical and Nursing history of past significant illness
The mother of the family and members of her family (maternal side) such as grandmother,
mother and her brother has history of Hypertension; Sairos Toyco as a result from the
assessment gathered is concluded as Malnourished
Whom to approach in times of illness
In times of severe illness, the family approaches the health center for consultations and
medications.
2. Nutrional Assessment
A. Anthropometric Data
Name
Denisa Toyco
Princess Deroy
Lady Jane Toyco
Sairos Toyco

Height
146.5 cm
104 cm
82 cm
71.5 cm

Weight
46 kg
17 kg
12 kg
10 kg

BMI
26.1
15.7
17.9
19.6

B. Dietary History
Most of the time eats fish and vegestables (usually picked from a garden nearby planted by
them but the garden itself is not owned).
C. Eating/Feeding Habits
Most of the times they eat three times a day; children eats junk foods sometimes.
3. Current health status indicating the presence of illness
Sairos, as verbalized by the mother and evident also from my previous home visit is experiencing
mild fever whenever finished taking a bath accompanied by his mother. Other than sairos, no
other member of the family is having a present illness.
E. VALUE PLACED ON PREVENTION OF DISEASE
1. Immunization status of children
The family was able to complete all the immunization during childhood except for Princess
Apple for she has no health records in the health center.
2. Use of proper preventive Services
They used mosquito net that was given by the barangay but no longer uses.

FAMILY COPING INDEX

COPING AREA
1. Physical Independence

2. Therapeutic Independence

The family only goes to the health

center when severe illness occurs
but if not they only stay at home and
uses OTC medicines.

3. Knowledge
Condition

Health

The family knows their condition

and gives immediate interventions
but not the proper techniques given
to the condition.

4. Application
of
Health
Principle on Personal Hygiene

The family members apply poor

principle of hygiene; the house is in
fair condition but stairs is detachable
and may be a cause for hazzard fall.

5. Health care attitude

Only goes to health centers if severe

immediate action is needed. They
only buy medication if money is
present and if needed.

6. Emotional Competence

All family members were able to

express theyre ideas and feelings to
each other. If there are problems,
they talk about it.

7. Family Living Patterns

They work together and supports

each other most especially in their
expenses at home. Respect can be
been in the area. They dont yell at
anybody and anyone.

8. Physical Environment

The house needs some repair most

especially in their stairs because it
may cause fall to any member of the
family. But some parts are still good
and functional.

9. Use
of
Community
Resources/Facility

The family knows when and who to

call for help in case of emergency or
if they need something because they
can always go to their barangay
health center or office.

of

RATING
3
5

JUSTIFICATION
Members are able to do all physical
activities they may have in everyday.
They bathe themselves and go to
work or go to school every Monday
to saturday and rest in Sunday.

PRIORITIZATION OF PROBLEM

PROBLEM: Presence of breeding or resting sites of mosquitos.

CRITERIA
1. Nature of the Problem

COMPUTATION
2/3 X 1
=
0.66

2. Modifiability of the
Problem

3/3 X 2
=
2

3. Preventive Potential

2/3 X 1
=
0.66

4. Salience of the
Problem

X1
=
0.5

JUSTIFICATION
Health threat due to open
drainage sink under and buckets
with rain water in their house
that mostly breading sites for
mosquitos.
It is easily modifiable in which the
student nurse can teach and
instruct the family how to dispose
the breading sites of mosquitoes.
It is highly preventable by the
implementation or preventive
measures which are easy to
perform, there by minimizing the
occurrence of the mosquitoes.
they recognized the problem but
does not need urgent attention.

= 3.82

PROBLEM: Accident Hazard (e.g. stairs without handle).

CRITERIA
1. Nature of the Problem

2. Modifiability of the
Problem

COMPUTATION
2/3 X 1
=
0.66

3/3 X 2
=
2

JUSTIFICATION
S:nah katong nanganhi mo nga
pag lakaw ninyo na tagak akong
kagamayan.
It is health threat that
requiresimmediate intervention
to eliminate the possible injury to
the number of thefamily that can
alter to his/her functioning to the
family.
It is easily modifiable in which the
student can educate and advice
thefamily to utilize the available
resources present in their
surroundings. Educating the
family to made a handrails
around the stairs to protect the
safety of every family member.

3. Preventive Potential

4. Salience of the
Problem

3/3 x 1
=
1

X1
=
0.5

The possibility of fall hazards

ishighly preventable through
theimplementation of the
interventionsgiven by the student
nurse.
The family perceives it as a nonthreatening situation.

= 4.16
PROBLEM: improper hygiene (e.g. handwashing).
CRITERIA
1. Nature of the Problem

COMPUTATION
2/3 X 1
=
0.66

JUSTIFICATION
S:Mangaon lage mi usahay
nga way hugasay. labi na ng
bata kay magdula-dula tas
mukaon ra diretso di
manghugas. Di man sad nako
mabantayan kay daghan
kaayo sila.
The problem is a health
threat inwhich the family can
possibly acquirediseases
which could be transmitted
byunwashed hands and
contact with dirt,which could
alter and hinder
their performance of the
activities of dailyliving

2. Modifiability of the
Problem

2/2 X 2
=
2

3. Preventive Potential

3/3 X 1
=
1

It is easily modifiable in which

thestudent nurse can teach
and instruct thefamily to
perform hygienic
practicessuch as handwashing
beforeconsumption of meals
and bathing atleast once a day.
It is highly preventable by
theimplementation o
preventive measureswhich
are easy to perform,
therebyminimizing the
occurrence of the diseaseand
spread of infection.
The family is aware of the
problemexisting in their
home. However, they donot
carry out the practices
andknowledge about hygiene
measures andthey arent
aware of what danger
it brings them due to having
poor hygiene practices.

4. Salience of the
Problem

X1
=
0.5

= 4.16

FAMILY NURSING CARE PLAN

Problem Identified: Accident Hazard (e.g. stairs without handle).

Cues:
S:
nah katong nanganhi mo nga pag lakaw ninyo na tagak akong kagamayan.
O:
steep stairs
no handrails
Family Nursing Problems:
Inability to recognize the presence of the condition or problem due to attitude/philosophy in life
which hinders recognition/acceptance of a problem.
Goal of Care:
After nursing intervention the family will decide on appropriate action(s) to modify the stairs for
the familys safety.
Objectives:
within 2 hours of nursing intervention the family will be able to:
a. understand the importance of safety for every member of the family;
b. know the possible risk cause by stairs without handrails;
c. identify the risk factors on the actual condition and make plans to;
d. provide preventive measures for all the family;
e. modify the stair ways and to prevent any accident.
Interventions:
1. Analyze with the family the importance of safety especially in children.
2. Discuss with the family the possible risk or the danger brought by the steep stairs.

3. Emphasize to the family the importance of solving the problem and on maintaining an
environment which is safety at home.
4. Implement with the family the ways or preventive measures for the family.
5. Evaluate the familys plan or course of action they are going to make.
Resources required:

Pen and paper

Time and effort for the student nurse and family

Evaluation:
After 2 hours of nursing interventions, the family was able to understand the importance of
safety for every member of the family; know the possible risk cause by stairs without handrails; and
identify the risk factors on the actual condition.
The stairs without handle can cause accident in the family.

FAMILY NURSING CARE PLAN

Problem Identified: improper hygiene (e.g. handwashing).

Cues:
S:
Mangaon lage mi usahay nga way hugasay. labi na ng bata kay magdula-dula tas mukaon ra
diretso di manghugas. Di man sad nako mabantayan kay daghan kaayo sila.
O:

Family eating bear hands

Children eating junk foods without washing hands.

Family Nursing Problem:

Inability to maintain personal hygiene which is conducive to health maintenance and personal development
due to lack of adequate knowledge of the importance of hygiene and sanitation.
Goal of Care:
After nursing intervention the family will haveknowledge about proper hygiene.
Objectives:
within 2 hours of nursing intervention the family willbe able to:
a. have a knowledge about proper hygiene;
b. recognize theimportance of proper hygiene;

c. recognize the possible risk factors with regards to the condition identified;
d. enumerate various ways on maintaining safety and reducing spread of microorganisms;
e. identify the positive outcomes upon planning the solution to the problem.
Interventions:
1. Assess the hygiene practice of each of the family member.
2. Discuss the possibledisease that might occur due to poor hygiene.
3. Provide proper Health teachings in maintaining good hygiene within their scope
of environment.
4. Demonstrate the proper hand washing to the family.
5. Let the family demonstrate the proper hand washing.
Resources Required:

Water and soap

Pen and paper
Time and effort of the student nurse and the family

Evaluation:
After 2 hours of nursing intervention, the family was able to have knowledged about proper
hygiene; recognized the importance of proper hygiene; recognized the possible risk of factors with
regards to the condition identified; enumerated the various ways on maintaning safety and reducing
spread of microorganisms; and identified the positive outcomes upon planning the solution to the
problem.
The family was able to perform proper handwashing.

FAMILY NURSING CARE PLAN

Problem Identified: Presence of breeding or resting sites of mosquitos.

Cues:
S:
nay mga planggana diha nga na pondohan ug tubig naa say mga lamok mamaak pero panagsa
ra pud.
O:

Stagnant water in the canal

Uncovered water storage
Presence of mosquitos

Family Nursing Problem:

Inability to provide a home environment conducive to health maintenance and personal
development due to lack/inadequate of knowledge of preventive measures.
Goal of Care:
After nursing intervention the client will understand the importance of maintaining a healthy
environment towards a healty family.
Objectives:

Within 2 hours of nursing intervention, the family will be able to:

a. understand the importance of a healthy environment;
b. know the threat of possible risk of having or presence of breeding or resting site of
vectors of disease;
c. gain idea about preventive measures on increasing number of mosquitos and flies;
d. understand the importance of safety for every members of the family;
e. identify the positive outcomes upon planning the solution to the problem.
Interventions:
1. discuss with the client about the selience of the problem.
2. explore with the family the ways of implementing sanitation measures such as:
clearing the bottles that was unused but with water
cleaning the house thoroughly
remove cubwaves
sweep every corner of the floor
etc.
3. Discuss with the family the possible risk or the diseases that might cause with the
mosquitoes and flies.
4. Provide knowledge about the importance of a healthy environment maintaning a clean,
fresh, free from mosquitoes and flies.
5. Evaluate the familys plan or course of action they are going to make.
Resources required:

Pen and paper

Time and effort by the student nurse and the family

Evaluation:
after 2 hour of nursing intervention, the family was able to understand the importance of a healthy
environment; know the threat of possible risk of having or presence of breeding or resting site of vectors
of disease; gain idea about preventive measures on increasing number of mosquitos and flies;
understand the importance of safety for every members of the family; identify the positive outcomes
upon planning the solution to the problem.
Learning Outcome
You can never really achieve your goal if you do not go through hardships, sometimes the best
way is to take for success is the longer path than shorter one; it will bring out the best in you more than
you could ever imagine.
In a span of 3 weeks exposure at the community I was able to learn things I never expect to sink
in within me. I was never a talkative person, I stutter and mess things up whenever I try to talk, and I
sometimes prefer not to talk. But things change these past few days, I should be honest, to talk is never
really in my genre, but because I am considered now as a health care provider, I simply try to adjust with
things and yes, it happened.
Facing my client with ease and confidence is to me a big effort, but surprisingly I was able to
overcome and established rapport to my very first community client. The family that I interviewed is an
extended family, some of the household members were not in the house when I started my assessment
thats why I was encouraged to talk to the Mother of the family.
She was very hospitable and caring towards my entire visitation, she tried offering me things so
that I could be of comfort the whole duration of stay, but I simply smiled and refused.

Seeing the situation of the family that I was able to assess made me realize that even little things
count, even those unworthy of your attention is still worth the look if you look closely. In todays
generation, people tend to put things to waste and disregard those they think doesnt matter anymore.
In relation to that, I have learned to value things the way they should be because it the most
important value that I have learned in my stay, they made me realize that even how hopeless the
situation may become, there is still way and hope to fix things and make it better again.
I have enjoyed the whole exposure and truly, I would definitely not forget this kind of
experience.

Kenneth John G. Torredes

N20

Reflection paper

A family is two or more people united by a common goal to create a physical, cultural,
spiritual and nurturing food. In the community, a healthy family is important because it reflects
a healthy community. Every family reflects the whole community.

Among the nurses role in the family care provider the most is being an educator,
educator acts as a health educator which is one of the important roles of being a community
health nursing. He/she provides the knowledge, skills, and attitudes needed by the family for
self-efficacy in making decisions and empowerment. He/she helps the client to make informed
decisions, identifies populations, at risk and explores new garning strategies. While the least is
being a manager, a family always work together, but in different areas, managing thier time for
health wont be as easy as it is.

Caring for a poor family, and being a catalyst for the family to become a self-relient and
self-sustaning family is through providing health teachings to the family. Making the family
understand and dig deeper into its important on maintaning their health and environmental
sanitation clean will help them improve their family, community and most importantly thier
selves.

Spot map Macro

There are three roads to travel to barangay Salvacion, which is going to tiniwisan, pigdaulan
which is a rough road, and tagabaca which there is to roads to travel from.
While in the barangay salvacion, the means of transportation is a single-motored vehicle which
called habal-habal.
Transportation fees :

Barangay Salvacion to Butuan City costs 30-35 pesos;

Barangay Salvacion to Langihan costs 45 pesos;
Barangay Salvacion to Pigdaulan costs 25 pesos.

Terminals:

Outside freedom park

Tiniwisan tricycle terminal

The two sisters of mr. Toyco travels to Pigdaulan High School with a motorcycle every school
days and they walk going home.

Spot map Micro

The largest store in purok 1 is located at the right side of the salvacion elem. School. The type of
soil in the barangay is rocky, muddy clay like soil. In my assigned family, outside of their house is
abundant with vegetables like, ganas, tangkong, etc. And the jetmatic pump is located 5 meters in front
of their house but it is not drinkable.

FAMILY DEVELOPMENTAL TASK

STAGE
Family with todler
(Sairos toyco of 2 years)

NORMAL
MANIFESTATION
-Children belonging to
this levelmanifests
autonomy or act
of being independent.
They do notwant to be
interfered
or interrupted, or even
assumedfrom
their activity. They
alwayswant to do things
by themselves

ACTUAL
MANIFESTATION
SC: na kaning bataa
grabe ka kurawan mao
nang akong bantayan
pirmi kay basin ug mang
guba palang pariha
aning cellphone nga
gilangkat-langkat ang
keypad.

INTERPRETATION
-Safety and risk-taking
strategies must be
balanced to permit
growth.

-During this stage,

parents mustknow how
to deal with thechilds
needs. The
mothersshould give
ample time to letthe
child finish his activity

STAGE 1: LIVING-IN
During the first stage of family development, Mr. And Mrs. toyco work to establish a mutually
satisfying relationship, learn to relate well to their families of orientation, and if applicable, engage in
reproductive life planning. Establishing a mutually satisfying relationship includes merging the values
that the couple brings into the relationship from their families of orientation. This includes not only
adjusting to each other in terms of routine but also sexual and economic aspects.
STAGE 2: EARLY CHILDBEARING
The Lady Jane which is the first baby is usually both an exciting and a stressful event because it
requires both economic and social role changes. It is a further developmental step for family Toyco to
change from being able to care for a well-baby to being able to care for an ill one. One way of
determining whether they made this change to ask what the new parent has tried to do to solve a childrearing or health problem. Parents who have difficulty with this step need a great deal of support and
counseling from health care providers to be able to care for an ill child at home or to manage a difficult
pregnancy.

GENOGRAM

Mr. and Mrs. Toyco living together, without being married had 3 chidren named lady jane,
sairos, and princess apple which the eldest one is adopted. Mr. toyco has no history of illness or
diseases, which his sister and father has the history of ulcer and her mother died undiagnosed and her
other siblings are not specified due to lack of information about them.
While Mrs. Toyco as verbalized kalooy sa dios, ako rajud ang walay sakit sakong mga igsuon.
Which is their eldest siblings alvin had been diagnosed to be a schistosomiasis patient experiencing
regular sezuire when had an overload work. While her 2nd eldest sibling jenny was recently diagnosed
of leukemia but, as verbalized by mrs. Toyco, okay naman siya sa manila naga tumar lang jud siya ug
vitamins daw. While the youngest of their sibling named jerry genetically born with disability like no
arms and legs. The 2nd to the youngest sibling named jessery was not indicated. Two of her brother died
of highblood which their grandmother has a history of hypertension which carried by their mother.