I.

INTRODUCTION Family is a basic unit of Society. It consists of those individuals, male and female, youth or adult, legally or not legally related, genetically or not genetically related, who are considered by the others to represent their significant persons. In a field of nursing, interest in a family unit and its impact on health, values, and productivity of individual family members is expressed by family centered nursing that considers the health of a Family as a unit addition to the health of individual family members. The Economic resources needed by the Family are secured by the Adult members. The Family protects the physical health of its members by providing adequate nutrition. And health care services. Nutritional and Lifestyle practices of a Family also directly affect the developing health attitude and life style practice of children. Part of the nursing course is the Community Health Nursing where the students were exposed in the different areas in the community it can be in the health center, home visits and other health care services of the Government. The students were required to have a Family Case Study where they will have an actual exposure to the family. The students will identify the problem, explore and help the family find the solutions to such problems or shortcomings. Through this case study the presenter was able to help a family and explore the Town of Lucban.

II. FAMILY DATA A. FAMILY STRUCTURE, CHARACTERISTICS AND DYNAMICS

FAMILY MEMBERS AGE SEX CIVIL STATUS POSITION IN THE FAMILY RELATIONSHIP IN THE FAMILY PLACE OF

RESIDENCE

Ronnie Hari Galleno Jocelyn

37

M F M F M M M M

M M S S S S S S

Head Mother Eldest 2nd child 3rd child 4th child 5th child

of Wife Son Daughter Son Son Daughter Son

37 Interior

the family Deapera 37 17 15 14 6 5 1 Galleno Mark Anthony Mary Ann Michael Angelo Mark Andrew Mary Joy Micko John Ron

Mabini St. Brgy. 7

Youngest

Galleno family is a typical example of a nuclear family in which it is composed of father, mother and children. The table shown that this family is considered as a big family. Mang Ronnie, the head of the family was married to Aling Jocelyn. They are blessed with six children. Most of the time the head of the family, Mang Ronnie was on his job while Aling Jocelyn was the one responsible to household chores and taking care of the children. There is no obvious observable conflict between the members of the family. The relationship of each members of the family toward each other was good. For them siblings rivalry is normal. The couple equally shared decisions. They have open communications within the family, parents allowed the children to speak up and share their ideas in decision making. But still the final decisions were made by Mang Ronnie and Aling Jocelyn. The children also said that they are more afraid on their father but also shows their respect to him. B. SOCIO-ECONOMIC AND CULTURAL CHARACTERISTICS

FAMILY MEMBERS

OCCUPATION

PLACE WORK

OF

MONTHLY INCOME

EDUCATIONAL ATTAINMENT

RELIGION

Ronnie Galleno Jocelyn Galleno Mark Anthony Mary Ann Michael Angelo Mark Andrew Mary Joy Micko John Ron

Farmer Helper -------------

Lucban Manila -------------

3,000 ---------------

High High graduate High graduate High Elementary graduate

School Roman catholic catholic School Roman Catholic School Roman Catholic Roman Catholic Roman Catholic Roman Catholic Roman Catholic School Roman

undergraduate

undergraduate

Non Schooling Non Schooling Non Schooling

Mang Ronnie has no regular income. He only had it whenever there is available job in the farm. Hes income only ranges from 500 to 750 per week. Since he does farming, he brings vegetables in their house to lessen their expenses. Their usual income was adequate only for their basic needs making them hard to buy other important needs. Due to low amount of income they werent able to send all their children in school. Their eldest is high school graduate while the youngest is not yet schooling. At the moment, Aling Jocelyn is now working in Manila as a helper. She only started this month, to be exact she stated on March 1, leaving all her responsibilities to her husband most especially to her eldest son and daughter who are still minors. Their father goes to work early in the morning and comes back home late in the afternoon which means the responsibilities are all in the eldest children.

The family lives near the house of their relatives; specifically their grand mother who is just a few steps away from their house. They just go to their grandmother whenever they need something when their father is not around. When it comes to religious affiliation, the family is all Roman Catholic, the eldest son admitted that they only go to church when there is an occasion like Christmas. Mary Ann, on the other hand is the one who are more frequent to go to church among the siblings, she brings her youngest brother with her wherever she goes, be it on the church or just hanging out with friends. They have maintained good relationship with their neighbors. The qualified members of the family participate in election, local and national level but are not involved in other activities of the community or barangay such as segregating waste, Mary Ann also admitted that they just throw their garbage in the lake near their house.

C.

HOME AND ENVIRONMENT Their house is made up of woods and bamboo from flooring to wall. And considering the big number of the family, and the space is about 4mx5m, it is too small for them. In that little space, when you enter you can already see the whole house, the flooring which has spaces in between the woods can cause accident or injury to any members. They have Television but the electric supply is connected to their grandmothers house. They do not have proper sullage system for their waste. Their water is from communal faucet system. They wash their dishes outside their house coz there is an available faucet outside. They cook food and store them in proper container. There is presence of accident hazards inside and outside the house, the stepladder which can be slippery and the back door has no proper security once they were doing something their youngest sibling has the possibility to fall outside the house. They are also near a river which is the usual dump area of some of the residents there which may cause flood when it rain hard and may be a nest for different pests. They also have a pet cat and dog which they have reported leaving fur on seats and bed covers. The family has a good neighborhood with few gossipers around. They usually talked with them and the children play with other children. The infrastructures nearby is

BHS of Barangay 7. They travel by walking when the destination is a walking distance or by tricycle which is always available in the area.

D.

HEALTH STATUS OF EACH MEMBER FAMILY MAMBERS Ronnie Galleno Jocelyn ILLNESSES Hari Muscle ache STAGE 1-2 days 5 days 3 day 3 days 3 days 5 days 3 days 5 days HEALTH ACTION Rest Rest Self medications Self medications Self medications Self medications Self medications Consulted to BHS in Banahaw

Deapera Cough and colds Cough and colds Cough and colds Cough and colds Cough and colds Cough and colds Cough and colds; Diarrhea

Galleno Mark Anthony Mary Ann Michael Angelo Mark Andrew Mary Joy Micko John Ron

The family experiences common illness such as cough and colds which they relate to the cold, rainy weather. Parents did not consult their felt sicknesses in the RHU, only the younger children were brought to center for management esp. the youngest child who experienced diarrhea and when their child needs an immunization. Since cough and colds were the problems and these were consulted only when they can no longer manage these at home. The family eats 3 times a day but the quantity and the quality of foods sometimes were not enough to give them nutrition. They cooked meat or fish if budget would allow. As a result of low income the family was not able to provide complete balanced diet to the members. Their usual meals are rice and dried fish, can goods, egg, squash and ampalaya. Micko John Ron is bottle fed with am because he experience diarrhea once fed with milk.

E. VALUES AND PRACTICE ON HEALTH PROMOTION/ MAINTAINANCE AND DISEASE PREVENTION DPT 2 HEPA B 1 2 3 OPV 2 MEASELS 3

NAME AGE Mary Joy 5 Micko John 1 Ron

BCG

The couple doesnt let their children without complete immunization. They understand the importance of complete immunizations. They are aware that it is given free in the health center so they took the opportunity to give the rights of their children. Mr. and Mrs. Galleno usually have 5-6 hours of sleep at night, waking at 4-5 in the morning to do household chores. Children usually sleep after watching television and wake up at 5:30-6 A.M esp. the eldest son and daughter to prepare their foods. They do not do exercise and believed that working and doing tasks in the house are enough exercise. The young siblings always have afternoon nap. The children are observed to be walking barefoot outside the house and inside wherein the floor is dirty.

III. FAMILY NURSING PROBLEMS A. IDENTIFICATION FAMILY NURSING PROBLEMS Health Problems Cough and Cold as Clues/Cues Most of the kids 1st Level of Assessment Health Threat 2nd Level of Assessment Threat of cross infection from communicable disease case as health

Threat of cross infection from communica ble disease case

had cough and colds for not more than 5 days Naghkakahawaha n kasi pag may sipon ung isa nagkakaroon na din ung iba, as verbalized by Daughter Family lives in about 4m by 5m house Family seldom practices covering mouth when coughing or sneezing and doing handwashing

threat due to: 1. Inability to recognize presence of health threat 2. Inability to provide home conducive to health due to: a.Inadequate family resources b.Inadequate knowledge regarding importance of proper handwashing c. Inadequate knowledge regarding preventive measures like covering mouth when coughing or sneezing

Health Problems Accident hazards such as fall and poisoning

Clues/Cues Slippery pathway leading to the house especially when raining The house is located near the river The back door is open and no railings or stairs Medicine bottles are kept on top of a cabinet which is within reach of children

1st Level of Assessment Health Threat

2nd Level of Assessment Accident hazards as health threat due to: 1. Inability to recognize presence of health threat due to: a. Lack of adequate knowledge regarding accident promoting practices and condition 2. Inability to make decisions with respect to taking appropriate health actions due to: a. failure to comprehend the nature of the problem b. low salience of the problem c. absence of parents

Health Problems Accident hazards such as fall and poisoning

Clues/Cues Slippery pathway leading to the house especially when raining The house is located near the river The back door is open and no railings or stairs Medicine bottles are kept on top of a cabinet which is within reach of children

1st Level of Assessment Health Threat

2nd Level of Assessment Accident hazards as health threat due to: 1. Inability to recognize presence of health threat due to: a. Lack of adequate knowledge regarding accident promoting practices and condition 2. Inability to make decisions with respect to taking appropriate health actions due to: a. failure to comprehend the nature of the problem b. low salience of the problem c. absence of parents

Health Problems Improper Garbage Disposal

Clues/Cues Garbage are dumped at the river Flies are observed outside the house

1st Level of Assessment Health Threat

2nd Level of Assessment Improper Garbage Disposal as health threat due to: 1. Inability to recognize presence of health threat due to: a. Lack of adequate knowledge regarding proper segregation and waste disposal

Health Problems Unhealthy lifestyle and personal practices such as walking barefoot, seldom handwashin g and lack of exercise

Clues/Cues The children walked barefoot sometimes outside the house The pathways are slippery and muddy The house floor is unkempt The family reported that they

1st Level of Assessment Health Threat

2nd Level of Assessment Unhealthy lifestyle and personal practices as health threat due to: 1. Inability to recognize presence of health threat due to: a. Lack of adequate knowledge regarding consequences of such practices or habits 2. Inability to make decisions with respect to taking appropriate health actions due to: a. failure to comprehend the

seldom do handwashing

nature of the problem b. low salience of the problem c. misconceptions 3. Inability to provide home conducive to health due to: a. Inadequate family resources b. Failure to see benefits of improvement c. lack of knowledge regarding importance of frequent and proper handwashing d. lack of knowledge regarding preventive measures e. negative attitude which is not conducive to health threat

B. SCORING OF EACH FAMILY NURSING PROBLEM

1. Cough and Cold as Threat of cross infection from communicable disease case Criteria 1. Nature of the Problem presented Computation 2/3x1 Actual Score 0.67 Justification It is a health deficit that requires immediate interventions t prevent the transfer to other family members Problem is easily modifiable since knowledge regarding mode of transmission, proper hygiene and other preventive measures are available. Proper foods should be given like plenty of fluids and Vit. C such as Calamansi juice Moderately preventive since preventive measures are available but environmental condition such 4.Salience Total Score 1/2 x 1 0.50 3.84 as limited space is present Family perceived the condition not needing immediate attention

2. Modifiability of the Problem

2/2x1

3. Preventive Potential

2/3 x 1

0.67

2. Family Size beyond what family resources can adequately provide

Criteria 1. Nature of the Problem presented 2. Modifiability of the Problem

Computation 2/3x1 2/2x2

Actual Score 0.67 2

Justification It is a health threat that requires attention It is modifiable if Mrs. Ofelia will have a job to support and help family in financial resources The available family resources can be utilized t o encourage growth promoting experience for members The family recognized the problem as a serious and needing immediate attention

3. Preventive Potential

3/3x1

4. Salience

1/2x1

0.50

Total Score

4.17

3. Unhealthy lifestyle and personal practices Criteria Nature of the Computation 2/3 x 1 Actual Score 0.67 Justification A health threat that does not need

Problem Modifiability of the Problem Preventive Potential Salience Total Score

2/2 x 2

immediate attention Problem is easily modifiable since knowledge regarding healthy lifestyle are

3/3 x 1

available Consequences of unhealthy practices such as COPD, parasitism, increase risk for

1/2 x 1

0.50 4.17

heart problem and others are preventable Family perceived the condition not needing immediate attention

4. Accident hazards Criteria Nature of the Problem Modifiability of the Problem 2/2 x 2 2.00 Computation 2/3 x 1 Actual Score 0.67 Justification A health threat that does not need immediate attention Problem is easily modifiable since preventive measures such as institution of

railings (may be improvised) and clearing of molds on slippery pathways Preventive Potential Salience Total Score 3/3 x 1 0/2 x 1 1.00 0.00 3.67 could be done Preventive measures are available Not perceived as a problem

5. Improper Garbage Disposal Criteria Nature of the Problem Modifiability of the Problem 2/2 x 2 2.00 Computation 2/3 x 1 Actual Score 0.67 Justification A health threat that does not need immediate attention Problem is easily modifiable since knowledge regarding proper waste management are Preventive Potential 3/3 x 1 1.00 available Communicable

diseases carried by flies and rodents Salience 1/2 x 1 0.50 could be prevented Family perceived the condition not needing immediate attention Total Score 4.17

C. LIST OF HEATH PROBLEMS ACCORDING TO RANK Rank 1 2 3 4 5 Identified Nursing Problem Improper garbage disposal Unhealthy lifestyle and practices Family size beyond family resources can adequately provide Cough and colds Accident hazards Score 4.17 4.17 4.17 3.84 3.67

IV. PLAN OF CARE

HEALTH PROBLEM FAMILY PROBLEM NURSING GOAL OF CARE OBJECTIVE OF CARE INTERVENTION PLAN NURSING INTERVENTION METHOD OF NURSE RESOURCES REQUIRED

FAMLIYCONTACT

Unhealthy A. Inability to At the end lifestyle and recognized of nursing personal problem due intervention practices to fear on its s family will consequences be able to like economic know the cost and the importance lesser of healthy knowledge of lifestyle and the extent of personal the problem. hygiene B. Inability to provide needed materials for the maintenance of personal hygiene like slippers and soap due to financial problem.

After the nursing intervention family will be able to: Identify diseases caused by the condition . Develop positive changes of behavior regarding personal hygiene. Include personal hygiene in their family budget. Apply informati on about the condition .

Help the Home family in visit identifying the problem. Involve the young members in the discussion. Discuss the following: -importance of having good nutrition -encourage to avoid can goods -Diseases that poor hygiene and walking may cause. -Importance of personal hygiene in preventing those diseases. -Way of rendering personal hygiene. Discuss within the family the course of action open to them: -Provide everyday bath on dependent family members. -Assign the older siblings to do the responsibility when parents

Material resources: Visual aids Pamphlets Human resources: Family cooperatio n time and effort of student nurse. Financial resources: Money for the nurse travel expense.

are not around. -Provide strict or proper implementation of frequent hand washing and wearing of slippers always. Explore with the family other ways of maintaining proper personal hygiene despite of limited facilities.
HEALTH PROBLEM FAMILY PROBLEM NURSING GOAL OF CARE OBJECTIVE OF CARE INTERVENTION PLAN NURSING INTERVENTION METHOD OF NURSE FAMLIYCONTACT RESOURCES REQUIRED

Cough Colds

and A. Inability to recognized problem due to fear on its consequences like economic cost and the lesser knowledge of the extent of the problem. B. Inability to provide needed materials for the maintenance of medications due to financial problem.

At the end of nursing intervention s family will be able to know ways and techniques on how to prevent cough and colds and to avoid contaminati on of other members of the family

After the nursing intervention family will be able to: Identify diseases caused by the condition . Develop positive changes of behavior regarding preventio n to be infected Include vit. C

Help the Home family in visit identifying the problem. Involve the young members in the discussion. Discuss the following: -importance of having good nutrition esp. having adequate intake of fluids and vit. Rich foods -instruct to cover mouth when coughing or sneezing

Material resources: Visual aids Pamphlets Human resources: Family cooperatio n time and effort of student nurse. Financial resources: Money for the nurse travel expense.

rich foods in their family budget. Apply informati on about the condition .

-Importance of personal hygiene in preventing those diseases. -Way of rendering personal hygiene. Explore with the family other ways of maintaining proper personal hygiene despite of limited facilities.
INTERVENTION PLAN METHOD OF NURSE FAMLIYCONTACT RESOURCES REQUIRED

HEALTH PROBLEM

FAMILY PROBLEM

NURSING

GOAL OF CARE

OBJECTIVE OF CARE

NURSING INTERVENTION

Family size A. Inability to At the end After beyond what recognized of nursing the the family condition due intervention nursing resources to attitude in s family will interventi can life which be able to on the adequately hinders make couple provide. recognition appropriate will be and actions to able to: acceptance of maintain Identify the problem. family size the B. Inability to based on a existence make sense of and decisions with responsibilit extant of respect to y for love the taking and life. problem. appropriate Identify actions due to their Inadequate responsibi knowledge lity to as to their alternative children

Help the Home visit couple identify the existence of the problem Analyze to the couple their responsibili ty to their children. Discuss with the family the different alternative courses. Explain and analyze with the couple the

Material resources: Visual aids Pamphlets Human resources: Family cooperatio n time and effort of student nurse. Financial resources: Money for the nurse travel expense.

courses of action opens to them. Fear of consequen ces of action like economic cost and physical health. C. failure to utilize community resources for health due: Fear of consequen ces of action like economic and physical consequen ces. Negative philosoph y in life that hinders the effective utilization of communit y services.

in relation advantages to love and and life. disadvantag es of each To method. enumerat e the Encourage different to utilize ways/ existing method of services I family the health planning. center. Select a Inform method couple in they both the hour of decide consultation after . knowing the advantage and disadvant ages of each.

HEALTH PROBLEM

FAMILY PROBLEM

NURSING

GOAL OF CARE

OBJECTIVE OF CARE

INTERVENTION PLAN NURSING INTERVENTION METHOD OF NURSE FAMLIYCONTACT RESOURCES REQUIRED

Improper waste disposal

A. Inability to recognize problem and make action due to economic cause and failure to comprehend the possible outcome of improper way to dispose wastes B. Inability to provide clean environment. C. Failure to see benefits of abiding the rules.

After the After nursing the intervention nursing s family will interventi be able to on family decide will be appropriate able to action in identify segregating condition waste and as a maintain problem. clean Enumer environment ate ways on how to use other materials in providing clean envi.

Help the Home visit family identify the existence of the problem. Analyze to the family the ways to follow in disposing of waste Allow family the enumerate the different ways on achieving the goal like:

Material resources: Visual aids Pamphlets Human resources: Family cooperatio n time and effort of student nurse. Financial resources: Money for the nurse travel expense.

-not throwing garbage in the river - segregating the waste properly - maintaining clean environment

HEALTH PROBLEM

FAMILY PROBLEM

NURSING

GOAL OF CARE

OBJECTIVE OF CARE

INTERVENTION PLAN NURSING INTERVENTION METHOD OF NURSE FAMLIYCONTACT RESOURCES REQUIRED

Accident / A. Inability to fall hazards recognize problem and make action due to economic cause and failure to comprehend the possible hazard. B. Inability to provide environment conducive to health maintenance due to inadequate financial resources. C. Failure to see benefits of investment in home environment.

After the After nursing the intervention nursing s family will interventi be able on family demonstrate will be appropriate able to action in identify preventing condition fire hazards. as a problem. Enumer ate ways or courses of actions.

Help the Home visit family identify the existence of the problem. Analyze with the family the extent and magnitude of the problem. Analyze to the family the need of preventive and safety measures. Involve the family in

Material resources: Visual aids Pamphlets Human resources: Family cooperatio n time and effort of student nurse. Financial resources: Money for the nurse travel expense.

identifying the ways of prevention . Cleaning of the pathways Have enough lighting inside and outside the house. Encourage to save money for the materials needed.

V. PROGRESS NOTES Heath Problems Cough and Colds Assessment and Evaluation

Discuss with the family the possible ways to prevent cough and colds keeping their back dry, to have rest and by giving rich in Vit. C such as calamansi juice Discuss with the family the complication of cough and colds Explain the importance of daily changing of clothing Evaluation-Resolved Poor personal hygiene They take a bath every other day Discuss the important of proper personal hygiene. Advice to take a bath every day Discuss the consequences if they disregard the importance of proper personal hygiene. Evaluation-Their habits on personal hygiene was develop Family size beyond family Having a big number of children resources can adequately Encourage to have family planning Evaluation-Unresolved Improper waste disposal Assess the sanitary condition of the environment Note al the observation seen Determine factors affecting these condition Explain the importance of sanitation to the family health emphasize e consequences that may occurs if unsanitary

Accident or fall hazard

condition persist Make plan with the family about appropriate action taken Evaluation-Unresolved There once an accident on their bamboo stairs Advice to reconstruct their bamboo stairs Avoidance of children to play on stair. Evaluation-Accident was avoided

VI. SUMARY, CONCLUSION AND RECOMMENDATION This family case study represents the Galleno family residing at 3 A. Interior Mabini St. Brgy. Lucban, Quezon. The family is composed of Mr. Ronnie the head of the family, Mrs. Jocelyn his wife and their 6 children. Due to financial problems, they just live in a small house with inadequate home facilities, and not pleasant environment. Other problems identified were the poor personal hygiene of their children and having couch and cold as a common illnesses that they have and inadequate living space to their family. The researchers became interested to choose this family as their study. After the problems were identified, family nursing care plan were made and implemented. Through the proper supervision and health teachings given, health problems of the family were simultaneously resolved due to their willingness and participation in the management and treatment of their problem. The researchers recommended that follow up care to the family be provided so that other identified problems which were no given much attention during the study be solved. The researchers also recommended to succeeding student to have further comprehensive family nursing care plan to be implemented on the same family.

CONCLUSION

After making this study, the presenters concluded that the family despite the financial constraints was able to make small changes for the improvement of their living. Though the children were left alone in the house, you can see that they were able to take care of each other. The mother decided to work and because of that the children expressed their excitement to come back in the school. After careful analysis and thorough examinations, the researcher is able to conclude that family problem stems out from poverty coupled with ignorance and aggravated even more by their attitude of negligence and disregard.

RECOMMENDATION Based on the conclusions the students recommend: 1. Motivation for the improvement of their health status. 2. Similar study on the same family giving greater priorities to problems which are not resolved. 3. Encourage to utilize the free health services of the government by regular consulting in the health center. 4. Continuous home visit should be done for accurate assessment of the health status of each member of the family.