Family Case Analysis 2

ANGELES UNIVERSITY FOUNDATION Angeles City In Partial Fulfillment of the Requirements in Related Learning Experience

COMMUNITY HEALTH NURSING: FAMILY CASE ANALYSIS

“An Assessment of Griffin Family in Barangay Sapalibutad”

Presented by: GROUP 1- BSN III-1 ANO, CARL ELEXER CALMA, ARIANE CAMILLE DIZON, REQUELITO SOTTO, MICHELLE LOUIE BALILO, NOEL LEONCIO CABRERA, KRISTINA EDNA CUYUGAN, MARY ANN DE JESUS, LUIGI MIGUEL ESTRADA, FLORENCE ANCEL LIBRES, MARY ANGELICA TEOFFY PALCIS, DANIEL VALENCIA, PRECIOSA

Presented to: JOANNE MARIE GALANG, R.N.

I.

INTRODUCTION A family is a unit composed not only of children but of men, women, an occasional animal, and the common cold. ~Ogden Nash Ogden Nash was basically a humorist, but such quote made a lot of sense. To interpret

it, it must mean that the family is a model which, physical manifestations would include the presence of a man one calls father, a woman one calls mother, and of course those sons and daughters running about to get their tasks done as they, undeliberately, grow older. A sleeping dog or a cat basking on the sunlight at the patio would constitute to the occasional animal he was talking about. And as for the common cold, generally, this would mean a highly contagious, self-limiting disease brought about by different strains of viruses with symptoms of sore throat, runny nose, nasal congestion, sneezing and coughing. So how did common cold get to associate itself with the family? One would say, its communicability is the primary factor, yes. Looking beyond the natural scope of things, the predetermined communicability of the common cold lies on the word, common, not as of the ordinary, but as of the shared. Usually, in a family, if one child is coming down with a cold, surely, a sibling will follow, especially if such come from a depressed family devoid of the advantages of nutrients to keep their immune system on the pink of health. Perhaps Nash was only trying to imbibe to us the power of family, that even diseases are shared. A loving family is worth all the riches in the world, for they will always be there for you, no matter what happens. Ergo, no poor family is too poor if they have a family deeply rooted in love and compassion for each other. On a more serious note, In Article 15: The Family, of the 1987 CONSTITUTION OF THE REPUBLIC OF THE PHILIPPINES: “The State recognizes the Filipino family as the foundation of the nation. Accordingly, it shall strengthen its solidarity and actively promote its total development. This reinforces the value of the family in community health nursing, as it plays mediator between the first and third type of clientele, the individual and the society.

The family, being the crucial entity of the society is also deemed as the critical unit of care since it is an efficient and accessible avenue for much of the community health nursing effort. How ironic to say that a family shares a disease to be family! As aspiring nurses, it is the duty of the researches to at least, be there for the family to reinforce health goals and promote self-reliance, that it’s a deliberate nature of the family to share, yes, but not illness. Family Health Nursing is a level of community health nursing practice focused or directed on family as the unit of care/ client, with health as a goal and nursing as a medium or provider of care. Family-centered care is the key concept in community health nursing practice. Family Case Analysis is an instrument utilized by PHN nurses and student nurses alike in delineating all prevailing problems of the community by centering on the families constituting it. Home visits are the number one means in order to accomplish this. In here, the family’s health needs will be assessed and the nurses, or the student nurses, rather, will provide health teachings and render nursing care to accommodate and address their inadequacies and liabilities in terms of family life and do something about them. Before the exposure, the student nurses have a main criteria in choosing a family as a subject; 1.) Depressed, 2.) Lack knowledge about healthy lifestyle, 3.) At least four members of the family, 4.) At least have children who are 7 years old and below and the Griffin family suits are criteria the most. They cannot do health tasks effectively making them at risk with different health hazards. FCA is a tedious and painstaking requirement but it is rewarding enough as it is. It served as a wakeup call for all student nurses, making them witnesses of the poverty and decreasing self-reliance when it comes to healthcare which are becoming ubiquitous in the community at present.. The plain fact that the student nurses were given an opportunity to help these people and make them happy made all working days worth their while. A. Objectives a. Short Term: Student Centered After 2 days of home visit to Barangay Sapalibutad, the student nurses will:  Familiarize themselves with the physical surroundings of the community.  Choose a family that would serve as the center of study for the family case analysis.

 Introduce oneself to the family and stating their purpose and methods.  Obtain consent from the family allowing the student nurses to conduct a study.  Establish rapport to the chosen family.  Gather and obtain pertinent data including demographic, socio-economic, cultural, and environmental data.  Educate the family in the promotion of health and prevention of illness.  Obtain individual health data by: 

Perform health assessment to each family member (IPPA-Cephalocaudal).

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Gather the following information: Mother’s obstetrical history.

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Assess the growth and development of the children and their immunization status.

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Gather and obtain each family’s nutrition status by age, weight and height.

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Gather information about family’s history and present illnesses.

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Acquire data regarding the family’s activities of daily living.

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Identify the existing and potential problems that may affect and aggravate the family’s health status based on the data gathered.

b. Short Term: Client Centered After 2 days of home visit, the family will:  Demonstrate understanding regarding the purpose of home visits to be conducted by the student nurse.  Provide complete and necessary information in relation to all the family members’ history of past and present illnesses, their activities of daily living and their nutritional status, socio-economic, cultural and environmental conditions, sincerely.  Identify the health problems present in their family.  Acknowledge the services rendered by the student nurses.  Establish rapport with the student nurses. c. Long term: Student centered After 2 weeks of home visit, the student nurses will:  Apply the therapeutic communication skills during the interview and gain the cooperation of the family.  Understand the health planning situation and health practices of the family and use these as basis in analyzing and planning future nursling interventions.

 Identify and prioritize the health problems jointly with the family.  Formulate a family coping index.  Plan with the family to solve the identified health and nursing problems.  Implement nursing interventions and provide health teachings.  Encourage every member of the family to participate in the health programs (activities initiated by the student nurses).  Help the family realize the importance of availing health services provided by the community (Brgy. Health Center).  Evaluate family’s response to the interventions and health teachings given.  Reinforce interventions and health teaching if there is a need. d. Long Term: Client Centered After 2 weeks of home visit, the family will:  Identify the health problems present in their family.  Realize the importance of having and maintaining good health practices.  Prioritize the identified health problems.  Identify the ways or the appropriate actions to meet their health needs and health problems.  Comply with the health teachings rendered by the student nurses.  Maintain an environment that is conducive to health and development.  Demonstrate continuous compliance with the health teachings given even after student nurses’ community exposure  B. Entry, Climate of acceptance, first few words 

Group 1’s 4th rotation is in the community of sapalibutad. It is the group’s Second time duty in a community setup but 1st time being in the community of sapalibutad, Although not so quite familiar, the group was able to adopt the environment and cope up with the people of the community.

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Feb 25, 2009 – Wednesday, it was the first day of encounter with the family to adopt for family case analysis. The group scouted the community with eager of knowing the family for their F.C.A. The group went to walk the streets with the sun raised very high to find their family. Although it took a while, the group was able to arrive with a family that passed the criteria for family case analysis accidentally. It was actually the family’s neighborhood that the group is expecting to adopt, but luckily was not there and

instead of acquiring the neighbor, the Griffin family’s mother lois (mother) said that their neighborhood left. So instead the group asked the Griffin family if they ould be the group’s adopt family for family case analysis. 

“Gandng umaga po, Kame po ay taga AUF na naghahanap ng family na puwedeng ma-adapt para sa FCA namen. Puwede po ba ang family niyo?” the group said. “ah sige puwede halika pasok muna kayo” replied by the mother.”Salamat po”comment by the group for accepting them by the family. “ Nay, ano po pangalan niyo?” it was the first question asked by the group to start their assessment. The tension and awkwardness ws immediately abolished and rapports was finally established, The mother was very cooperative to the group, all possible questions were asked without difficulties and able to answer all possible question asked. She even assured the group that they could visit their family case analysis.

  Number of home visits:  First home visit: 

Feb 25, 2009 – Wednesday, it was the first time that the group students will meet their family. They initially started their establishment of rapport by greeting their family warmly, introducing each of the members of their group and explaining to the family their purpose for the visit. The group also identified each members of the family and tried their best to get the trust of the family members. They started questions regarding the needed information data including demographic data, socio-economic and cultural data of he family. The group also gathered the mother, and her son and daughter baseline data assessment without the father because of working time. The group initially identified initial few family problems and conducted a schedule when to come back and to make appropriate appointment for the assessment of the father.

 Second home visit: 

Feb 26, 2009 – Thursday. The 2nd day of the home visit. The group went to their family and greeted the family warmly as they entered the house. The group was able to meet the father of the family because if the set time for meeting. The group was able to assess the father and clarify more things to obtain more specific and reliable data. The group assessed each family members cephalocaudaly for P.A. Each member is very cooperative during the assessment. The group assessed and identify further family problems.

 Third home visit: 

Feb 27, 2009 – Friday, The 3rd day of home visit. The group finalized family problems and obtain data of the living place including windows size measurement, floor plan, house measurements and other data that is relevant for family case analysis, and also the group was able to implement interventions for the family. And able to plan more interventions for future home visit and identify more problems, if any. The group also planned to which is the things needed by the family for their daily livings.

 Fourth home visit: 

March 4, 2009 – Wednesday. The 4th day of home visit. The group continued intervention implementation for the family improvement and also conducted health teaching for the family regarding health and wellness. The group was able to contribute things for daily living that would aid the family towards wellness. The group was able to improve their family hygiene by providing health hygiene kits.

 Fifth home visit: 

March 5, 2009 – Thursday. The 5th day of home visit. The group continued for the interventions needed by the family. The group was again aided the family for hygiene practices by assisting each family members and conducting health teachings. The group prepared for the future home visit to evaluate the implemented intervention and also to identify the improvements of the family and Evaluation followed.

II. Family Constellation Name Brian Griffin

Age 32 yrs. old

Position Father

Lois Griffin

45 yrs. old

Mother

Sex Male

Educational Status Present health status High School Upon assessment Brian (4th yr Griffin was wearing a yellow Undergraduate) long sleeved shirt black pants and a pair of black leather shoes, He is cooperative, coherent and oriented to time, place and person, he has steady gait and shows no difficulty recalling events. He looks exhausted. He stands 168 cm and weighs 63 kg, He has a BMI of 22.34 which is healthy weigh. VS are as follows: Temp: 36 c PR: 73 bpm RR: 21 bpm BP: 100/60 mmHg Sometimes experience dizziness when standing after Prolonged rest. Female Elementary Lois Griffin was wearing a (Grade 3) white shirt and pink pants, her hair is tied up. She is cooperative, coherent and oriented to person, time and place. She has a sense of reality, shows no difficulty recalling past event, she stands 155 cm and weighs 46 kg, her BMI is 19.17 which is healthy weigh. VS are follows: Temp: 36.5 c PR: 75 bpm RR: 17 bpm BP: 110/80 mmHg She has difficulty hearing especially with the use of her right ear.

Meg Griffin

4 yrs old

1st born Female daughter

Never been to school

Stewie Griffin

3 yrs old

2nd born Son

Never been to school

Male

Meg Griffin was wearing a white shirt and green pants and a pair of dirty slippers. She is unable to express herself through speech. She has a steady gait and unkept appearance. She stands 88 cm and weighs 9 kg. VS are as follows: Temp: 36.3 c PR: 89 bpm RR: 22 bpm Often Cough and colds with nasal discharge Stewie was wearing a white shirt and red shorts and a pair of slippers. He is unable to express himself through speech. He has steady gait. He stands 88 cm and weighs 10 kg. VS are as follows: Temp: 36.2 c PR: 90 bpm RR: 20 bpm Episodes of cough and colds

III. HEALTH ASSESSMENT To be a health educator, a community health nurse must be able to determine initially any abnormalities or deviations from clients’ health. Assessing the health status of a client is a major component of nursing care and has two aspects: (1) the nursing health history and (2) physical examination. One way by which health status of the family can be assessed is through physical examination using cephalocaudal approach. It is done using inspection, palpation, percussion and auscultation to identify areas for health promotion and disease prevention. Family assessment begins with a complete health history. It is one of the most effective ways of identifying existing or potential health problems. History is followed by physical assessment of family members (Kozier, 2004). Assessment enhances identification of physical and psychological needs. The amount, depth, and level of assessment skills vary with the knowledge and expertise of a nurse. Data

about the present condition or status of the family are compared against norms or standards of problems.

1. BRIAN GRIFFIN PHYSICAL ASSESSMENT ( February 25, 2009, Wednesday ) Vital signs: T- 36 °C P- 73 bpm R- 21 cpm BP- 100/60 mmHg General Appearance and Mental Status: During the assessment, Brian Griffin was wearing a yellow long-sleeved shirt, black pants and a pair of black leather shoes. He is cooperative, coherent and oriented to person, place and time. He has a steady gait and shows no difficulty in speaking. He also exhibits thought association and has a sense of reality. He has no difficulty recalling past and present events. He looked exhausted. He stands 168 cm and weighs 63 kg. HEAD AND FACE Head His hair is black in color. It is evenly distributed and no presence of dandruff was noted. No presence of infestations were noted. Skull and Face He has normocephalic skull and with smooth skull contour. No nodules and masses were noted upon palpation. His face is symmetrical in shape and there is no abnormal elevation or depression on the face.

Eyes His eyebrows are symmetrically aligned with hair evenly distributed. Eyelashes are also evenly distributed. Skin is intact, no discharges and no discolorations are present at the surface of eyelids. Lids close symmetrically. He has moist mucous membranes and her palpebral conjunctiva is pink in color. His pupils constrict when looking at near objects while they dilate when looking at far objects. Ears His auricles are same as facial color and it is aligned with the outer canthus of the eye. They are mobile, firm and not tender upon palpation. Pinna recoils after it is folded. There is no presence of impacted cerumen. He can hear and respond when he is asked. Nose His nose is straight and his septum is located in the midline. No deviations have been observed in the shape, size and color of the external nose. No discharges were noted and there is the absence of nasal flaring. Also, no nodules and masses were noted upon palpation. Lips and Teeth Outer lips are symmetrical. He exhibits ability to move her lips. Inner lips and buccal mucosa are uniform in color. He has a complete set of teeth and his tongue is in central position and he can move it freely. NECK Neck Muscle Neck muscles are equal in size. No masses and nodules were noted upon palpation. Head movements are coordinated and he can move his head freely. Lymph Nodes Lymph nodes are not palpable and there is no enlargement noted upon observation and palpation. THORAX AND LUNGS Lungs

There is full and symmetrical chest expansion. There is effortless and rhythmic respirations and no adventitious breath sounds were heard upon auscultation. Heart Regular rhythm of apical pulse was noted upon auscultation. Abdomen No distention and presence of lesions and masses were observed. He has normoactive bowel sounds. Skin He has brown-colored skin which is generally uniform except in areas of lighter pigmentation such as the palms, lips and nail beds. No abrasions and edema have been noted. He has good skin turgor, which turned back to previous state in less than 3 seconds when pinched. Extremities Peripheral pulses are in full pulsations. Limbs are not tender and no edema is present at extremities. Fingernails His nail plates are colorless and have concave curves. They are slightly long and untrimmed. His nail beds returned to previous state in less than three seconds after pressure was applied. NUTRITIONAL STATUS Age: 32 years old Height: 168 cm Weight: 63 kg Formula: Body Mass Index (BMI) =

Weight in kilograms (kg) Height in meter squared (m2)

Body Mass Index (BMI) =

63 kg 2.8 m2 =

22.5

Interpretation:

Healthy Weight Legend: BMI Table ( Based on Asia-Pacific Obesity Guidelines ) Underweight Healthy Weight Overweight At risk Obese I Obese II

< 18.5 18.6-22.9 > 23.0 23.0-24.9 25.0-29.9 > 30.0

HISTORY OF PAST ILLNESS According to Brian Griffin, he had measles during his childhood. He stayed for almost three weeks in the hospital. This was managed through medications and rest. He also had episodes of convulsions accompanied by fever last 2003. First he was brought to a secondary level hospital in Angeles City for a check-up, then he was confined in a district hospital in Magalang, Pampanga. During his stay in the said hospital, he also had an elevated blood pressure and he was given an antihypertensive medication which, according to him, was given sublingually. He also uses herbal medicines like Lagundi and Oregano for cough and colds and Paracetamol for fever. HISTORY OF PRESENT ILLNESS Brian Griffin mentioned that he sometimes experiences dizziness when he assumes a standing position after a prolonged period of rest. He also visits the health center for consultation and checking of blood pressure. ACTIVITIES OF DAILY LIVING Brian Griffin usually wakes up at 6:00 in the morning to prepare for work. Before leaving for work, his morning routine usually includes eating breakfast and bathing. His work starts from 8:00 in the morning and he eats lunch at home at around 11:30 a.m. After lunch, he goes back

to work by 1:00 p.m. At around 5:00 p.m, he leaves his work to eat dinner at home, then goes back to work again by 7:00 p.m. His work ends at 12 midnight. He usually sleeps immediately after work. He works from Monday to Saturday. During his free day ( Sunday ), he plays with his children and helps his wife with other household chores. A television set also serves as a form of leisure for Brian and his family. PHYSICAL ASSESSMENT (Final ) ( March 4, 2009, Wednesday ) Vital signs: T- 36.7 °C P- 67 bpm R- 18 cpm BP- 110/70 mmHg General Appearance and Mental Status: During the assessment, Brian Griffin was wearing a white long-sleeved shirt, black pants and a pair of black leather shoes. He is cooperative, coherent and oriented to person, place and time. He has a steady gait and shows no difficulty in speaking. He also exhibits thought association and has a sense of reality. He has no difficulty recalling past and present events. He looked exhausted. He stands 168 cm and weighs 63 kg. HEAD AND FACE Head His hair is black in color. It is evenly distributed and no presence of dandruff was noted. No presence of infestations were noted. Skull and Face He has normocephalic skull and with smooth skull contour. No nodules and masses were noted upon palpation. His face is symmetrical in shape and there is no abnormal elevation or depression on the face. Eyes

His eyebrows are symmetrically aligned with hair evenly distributed. Eyelashes are also evenly distributed. Skin is intact, no discharges and no discolorations are present at the surface of eyelids. Lids close symmetrically. He has moist mucous membranes and her palpebral conjunctiva is pink in color. His pupils constrict when looking at near objects while they dilate when looking at far objects. Ears His auricles are same as facial color and it is aligned with the outer canthus of the eye. They are mobile, firm and not tender upon palpation. Pinna recoils after it is folded. There is no presence of impacted cerumen . He can hear and respond when he is asked. Nose His nose is straight and his septum is located in the midline. No deviations have been observed in the shape, size and color of the external nose. No discharges were noted and there is the absence of nasal flaring. Also, no nodules and masses were noted upon palpation. Lips and Teeth Outer lips are symmetrical. He exhibits ability to move her lips. Inner lips and buccal mucosa are uniform in color. He has a complete set of teeth and his tongue is in central position and he can move it freely. NECK Neck Muscle Neck muscles are equal in size. No masses and nodules were noted upon palpation. Head movements are coordinated and he can move his head freely. Lymph Nodes Lymph nodes are not palpable and there is no enlargement noted upon observation and palpation. THORAX AND LUNGS Lungs There is full and symmetrical chest expansion. There is effortless and rhythmic respirations and no adventitious breath sounds were heard upon auscultation.

Heart Regular rhythm of apical pulse was noted upon auscultation. Abdomen No distention and presence of lesions and masses were observed. He has normoactive bowel sounds. Skin He has brown-colored skin which is generally uniform except in areas of lighter pigmentation such as the palms, lips and nail beds. No abrasions and edema have been noted. He has good skin turgor, which turned back to previous state in less than 3 seconds when pinched. Extremities Peripheral pulses are in full pulsations. Limbs are not tender and no edema is present at extremities. Fingernails His nail plates are colorless and have concave curves. They are still slightly long and untrimmed. His nail beds returned to previous state in less than three seconds after pressure was applied.

2. Lois Griffin PHYSICAL ASSESSMENT ( February 25, 2009, Wednesday ) Vital signs: T- 36.5 °C P- 75 bpm R- 17 cpm BP- 110/80 mmHg General Appearance and Mental Status:

During the assessment, Lois Griffin was wearing a white shirt and pink pants. Her hair is tied up, She is cooperative, coherent and oriented to person, place and time. She has a steady gait and shows no difficulty in speaking. She also exhibits thought association and has a sense of reality. She has no difficulty recalling past and present events. She stands 155 cm and weighs 52 kg. HEAD AND FACE Head Her hair is black in color. It is evenly distributed and presence of dandruff was noted. No presence of infestations was noted. Skull and Face She has normocephalic skull and with smooth skull contour. No nodules and masses were noted upon palpation. Her face is symmetrical in shape and there is no abnormal elevation or depression on the face.

Eyes Her eyebrows are symmetrically aligned with hair evenly distributed. Eyelashes are also evenly distributed. Skin is intact, no discharges and no discolorations are present at the surface of eyelids. Lids close symmetrically. She has moist mucous membranes and her palpebral conjunctiva is pink in color. Her pupils constrict when looking at near objects while they dilate when looking at far objects. Ears Her auricles are same as facial color and it is aligned with the outer canthus of the eye. They are mobile, firm and not tender upon palpation. Pinna recoils after it is folded. There is no presence of impacted cerumen. Her hearing in her right ear is slightly impaired but she was able to respond when asked. Nose Her nose is straight and her septum is located in the midline. No deviations have been observed in the shape, size and color of the external nose. No discharges were noted and there is the absence of nasal flaring. Also, no nodules and masses were noted upon palpation.

Lips and Teeth Outer lips are symmetrical. She exhibits ability to move her lips. Inner lips and buccal mucosa are uniform in color. She has an incomplete set of teeth and her tongue is in central position and she can move it freely. NECK Neck Muscle Neck muscles are equal in size. No masses and nodules were noted upon palpation. Head movements are coordinated and she can move his head freely. Lymph Nodes Lymph nodes are not palpable and there is no enlargement noted upon observation and palpation. THORAX AND LUNGS Lungs There is full and symmetrical chest expansion. There is effortless and rhythmic respirations and no adventitious breath sounds were heard upon auscultation. Heart Regular rhythm of apical pulse was noted upon auscultation. Abdomen No distention and presence of lesions and masses were observed. She has normoactive bowel sounds. Skin She has light brown-colored skin which is generally uniform except in areas of lighter pigmentation such as the palms, lips and nail beds. No abrasions and edema have been noted. She has good skin turgor, which turned back to previous state in less than 3 seconds when pinched.

Extremities Peripheral pulses are in full pulsations. Limbs are not tender and no edema is present at extremities. Fingernails Her nail plates are colorless and have concave curves. They are long and untrimmed. Her nail beds returned to previous state in less than three seconds after pressure was applied.

NUTRITIONAL STATUS Age: 45 years old Height: 155 cm Weight: 52 kg Formula: Body Mass Index (BMI) =

Weight in kilograms (kg) Height in meter squared (m2)

Body Mass Index (BMI) =

52 kg 2.4 m2 =

21.6

Interpretation:

Healthy Weight Legend: BMI Table ( Based on Asia-Pacific Obesity Guidelines ) Underweight Healthy Weight Overweight At risk Obese I Obese II

< 18.5 18.6-22.9 > 23.0 23.0-24.9 25.0-29.9 > 30.0

OBSTETRICAL HISTORY Lois Griffin has two children . She delivered them both via Normal Spontaneous Delivery. She delivered her first child at a secondary level hospital in Angeles City while her second child was delivered by a midwife ( home delivery ). Her first child didn’t reach full term and she had eclampsia during the delivery of her first child. She was also given antihypertensive drugs which were taken sublingually for elevated blood pressure. Her second child reached full term. She has been pregnant and has given birth two times- G2P2 ( T1P1A0L2 ). HISTORY OF PAST ILLNESS According to Lois Griffin, she had Chickenpox and sore eyes during childhood. No interventions were made to manage these. For episodes of fever, she took Paracetamol. She also had eclampsia during the delivery of her first child and she was given antihypertensive drugs for elevated blood pressure which were taken sublingually. HISTORY OF PRESENT ILLNESS According to Lois Griffin, she has difficulty hearing, especially with the use of her right ear. No intervention has been done to manage this. She also uses Lagundi and Oregano for cough and colds and a topical for muscle pains.

ACTIVITIES OF DAILY LIVING Lois Griffin usually wakes up at 5:00 in the morning to prepare breakfast. After that, she boils water for their daily drinking water. At around 8:00 a.m, she starts to do the laundry. After doing the laundry, she performs/ does their household chores. When she’s done with the household chores, she takes care of her children. She usually cooks lunch at around 11:00 a.m but sometimes she doesn’t cook lunch anymore, since Brian brings home lunch. She looks after her children for the rest of the day and sometimes she looks after her neighbors’ children. She eats dinner at around 6:00 p.m or by the time Brian arrives from work. She usually sleeps by 10:00 p.m. A television set serves as a form of leisure and she also plays with her children.

PHYSICAL ASSESSMENT ( Final ) ( March 4, 2009, Wednesday ) Vital signs: T- 36.8 °C P- 78 bpm R- 20 cpm BP- 110/70 mmHg

General Appearance and Mental Status: During the assessment, Lois Griffin was wearing a yellow blouse and brown pants. Her hair is tied up, She is cooperative, coherent and oriented to person, place and time. She has a steady gait and shows no difficulty in speaking. She also exhibits thought association and has a sense of reality. She has no difficulty recalling past and present events. She stands 155 cm and weighs 52 kg. HEAD AND FACE Head Her hair is black in color. It is evenly distributed and presence of dandruff was noted. No presence of infestations were noted. Skull and Face She has normocephalic skull and with smooth skull contour. No nodules and masses were noted upon palpation. Her face is symmetrical in shape and there is no abnormal elevation or depression on the face. Eyes Her eyebrows are symmetrically aligned with hair evenly distributed. Eyelashes are also evenly distributed. Skin is intact, no discharges and no discolorations are present at the surface of eyelids. Lids close symmetrically. She has moist mucous membranes and her palpebral conjunctiva is pink in color. Her pupils constrict when looking at near objects while they dilate when looking at far objects.

Ears Her auricles are same as facial color and it is aligned with the outer canthus of the eye. They are mobile, firm and not tender upon palpation. Pinna recoils after it is folded. There is no presence of impacted cerumen . Her hearing in her right ear is slightly impaired but she was able to respond when asked. Nose Her nose is straight and her septum is located in the midline. No deviations have been observed in the shape, size and color of the external nose. No discharges were noted and there is the absence of nasal flaring. Also, no nodules and masses were noted upon palpation. Lips and Teeth Outer lips are symmetrical. She exhibits ability to move her lips. Inner lips and buccal mucosa are uniform in color. She has an incomplete set of teeth and her tongue is in central position and she can move it freely. NECK Neck Muscle Neck muscles are equal in size. No masses and nodules were noted upon palpation. Head movements are coordinated and she can move his head freely. Lymph Nodes Lymph nodes are not palpable and there is no enlargement noted upon observation and palpation. THORAX AND LUNGS Lungs There is full and symmetrical chest expansion. There is effortless and rhythmic respirations and no adventitious breath sounds were heard upon auscultation. Heart Regular rhythm of apical pulse was noted upon auscultation.

Abdomen No distention and presence of lesions and masses were observed. She has normoactive bowel sounds. Skin She has light brown-colored skin which is generally uniform except in areas of lighter pigmentation such as the palms, lips and nail beds. No abrasions and edema have been noted. She has good skin turgor, which turned back to previous state in less than 3 seconds when pinched. Extremities Peripheral pulses are in full pulsations. Limbs are not tender and no edema is present at extremities. Fingernails Her nail plates are colorless and have concave curves. They are long and untrimmed. Her nail beds returned to previous state in less than three seconds after pressure was applied.

3.Meg Griffin PHYSICAL ASSESSMENT ( February 25, 2009, Wednesday ) Vital signs: T- 36.3 °C P- 89 bpm R- 22 cpm

General Appearance and Mental Status: During the assessment, Lois Griffin was wearing a white shirt and green pants. She is unable to express herself through speech. She has a steady gait and unkempt appearance. She stands 88 cm and weighs 9 kg.

HEAD AND FACE Head Her hair is slightly dark brown to black in color. It is evenly distributed and no presence of dandruff was noted. No presence of infestations were noted. Skull and Face She has normocephalic skull and with smooth skull contour. No nodules and masses were noted upon palpation. Her face is symmetrical in shape and there is no abnormal elevation or depression on the face. Eyes Her eyebrows are symmetrically aligned with hair evenly distributed. Eyelashes are also evenly distributed. Skin is intact, with discharges in minimal amount and no discolorations are present at the surface of eyelids. Lids close symmetrically. She has moist mucous membranes and her palpebral conjunctiva is pink in color. Her pupils constrict when looking at near objects while they dilate when looking at far objects. Ears Her auricles are same as facial color and it is aligned with the outer canthus of the eye. They are mobile, firm and not tender upon palpation. Pinna recoils after it is folded. There is no presence of impacted cerumen . She can hear and respond only through movements. Nose Her nose is straight and her septum is located in the midline. No deviations have been observed in the shape, size and color of the external nose. Discharges in minimal amount were noted and there is the absence of nasal flaring. Also, no nodules and masses were noted upon palpation. Lips and Teeth Outer lips are symmetrical. She exhibits ability to move her lips. Inner lips and buccal mucosa are uniform in color. She has an incomplete set of teeth and her tongue is in central position and she can move it freely.

NECK Neck Muscle Neck muscles are equal in size. No masses and nodules were noted upon palpation. Head movements are coordinated and she can move his head freely. Lymph Nodes Lymph nodes are not palpable and there is no enlargement noted upon observation and palpation. THORAX AND LUNGS Lungs There is full and symmetrical chest expansion. There is effortless and rhythmic respirations and no adventitious breath sounds were heard upon auscultation. Heart Regular rhythm of apical pulse was noted upon auscultation. Abdomen No distention and presence of lesions and masses were observed. She has normoactive bowel sounds. Skin She has brown-colored skin which is generally uniform except in areas of lighter pigmentation such as the palms, lips and nail beds. A small wound was found on her right knee. She has good skin turgor, which turned back to previous state in less than 3 seconds when pinched. Extremities Peripheral pulses are in full pulsations. Limbs are not tender and no edema is present at extremities.

Fingernails Her nail plates are colorless and have concave curves. They are slightly dirty and untrimmed. Her nail beds returned to previous state in less than three seconds after pressure was applied. NUTRITIONAL STATUS Age: 4 years old Height: 88 cm Weight: 9 kg Interpretation: ( Based on FNRI ) Malnourished GROWTH AND DEVELOPMENT Erik Erikson’s Psychosocial Stage Meg Griffin is considered to be under the Autonomy vs. Shame and Doubt, although her age should be under the Initiative vs. Guilt stage. Meg can’t express herself through speech. Also, according to Lois, her mother, she is having temper tantrums and exhibits separation anxiety. She also cries loudly and demandingly and sometimes rejects any attempts to be comforted. Sigmund Freud’s Psychosexual Stage Meg Griffin is considered to be under the Anal phase. She says the word “ihi” to tell her mother that she needs to void. She is learning to control urination and defecation. HISTORY OF PAST ILLNESS According to Meg’s mother, Lois, Meg had erratic parasitism a few weeks before the assessment. No intervention was done to manage this. Meg has no history of hospitalization or any other serious childhood illness. HISTORY OF PRESENT ILLNESS Most often, Meg acquires cough and colds and the family manages this through a herbal medicine, Lagundi. Nasal discharges were noted on the assessment.

ACTIVITIES OF DAILY LIVING Meg usually wakes up at 7:00 a.m. She eats breakfast first, then she plays or watches television with her brother. She takes a nap usually around 9:30 or 10:00 a.m and wakes up by 11:00 or 11:30 a.m to eat lunch. She does most of her leisure activities in the afternoon like playing with their neighbors and sometimes she also takes afternoon naps. She eats dinner at around 6:30 p.m or by the time her father arrives sform work. She usually sleeps at around 9:00 or 10:00 p.m. PHYSICAL ASSESSMENT ( Final ) ( March 4, 2009, Wednesday ) Vital signs: T- 36.5 °C P- 85 bpm R- 24 cpm General Appearance and Mental Status: During the assessment, Lois Griffin was wearing a long white dress. She is unable to express herself through speech. She has a steady gait and unkempt appearance. She stands 88 cm and weighs 9 kg. HEAD AND FACE Head Her hair is slightly dark brown to black in color. It is evenly distributed and no presence of dandruff was noted. No presence of infestations were noted. Skull and Face She has normocephalic skull and with smooth skull contour. No nodules and masses were noted upon palpation. Her face is symmetrical in shape and there is no abnormal elevation or depression on the face.

Eyes Her eyebrows are symmetrically aligned with hair evenly distributed. Eyelashes are also evenly distributed. Skin is intact, with no discharges and no discolorations present at the surface of eyelids. Lids close symmetrically. She has moist mucous membranes and her palpebral conjunctiva is pink in color. Her pupils constrict when looking at near objects while they dilate when looking at far objects. Ears Her auricles are same as facial color and it is aligned with the outer canthus of the eye. They are mobile, firm and not tender upon palpation. Pinna recoils after it is folded. There is no presence of impacted cerumen . She can hear and respond only through movements. Nose Her nose is straight and her septum is located in the midline. No deviations have been observed in the shape, size and color of the external nose. No discharges were noted and there is the absence of nasal flaring. Also, no nodules and masses were noted upon palpation. Lips and Teeth Outer lips are symmetrical. She exhibits ability to move her lips. Inner lips and buccal mucosa are uniform in color. She has an incomplete set of teeth and her tongue is in central position and she can move it freely. NECK Neck Muscle Neck muscles are equal in size. No masses and nodules were noted upon palpation. Head movements are coordinated and she can move his head freely. Lymph Nodes Lymph nodes are not palpable and there is no enlargement noted upon observation and palpation.

THORAX AND LUNGS Lungs There is full and symmetrical chest expansion. There is effortless and rhythmic respirations and no adventitious breath sounds were heard upon auscultation. Heart Regular rhythm of apical pulse was noted upon auscultation. Abdomen No distention and presence of lesions and masses were observed. She has normoactive bowel sounds. Skin She has brown-colored skin which is generally uniform except in areas of lighter pigmentation such as the palms, lips and nail beds. A small wound was found on her right knee. She has good skin turgor, which turned back to previous state in less than 3 seconds when pinched. Extremities Peripheral pulses are in full pulsations. Limbs are not tender and no edema is present at extremities. Fingernails Her nail plates are colorless and have concave curves. They are trimmed and short. Her nail beds returned to previous state in less than three seconds after pressure was applied. 4. Stewie Griffin PHYSICAL ASSESSMENT ( February 25, 2009, Wednesday ) Vital signs: T- 36.2 °C P- 90 bpm R- 20 cpm

General Appearance and Mental Status: During the assessment, Stewie was wearing a white shirt and red shorts, and a pair of blue slippers. He is unable to express himself through speech. He has a steady gait. He stands 88 cm and weighs 10 kg. HEAD AND FACE Head His hair is dark brown in color. It is evenly distributed and no presence of dandruff was noted. No presence of infestations were noted. Skull and Face He has normocephalic skull and with smooth skull contour. No nodules and masses were noted upon palpation. His face is symmetrical in shape and there is no abnormal elevation or depression on the face. Eyes His eyebrows are symmetrically aligned with hair evenly distributed. Eyelashes are also evenly distributed. Skin is intact, no discharges and no discolorations are present at the surface of eyelids. Lids close symmetrically. He has moist mucous membranes and her palpebral conjunctiva is pink in color. His pupils constrict when looking at near objects while they dilate when looking at far objects. Ears His auricles are same as facial color and it is aligned with the outer canthus of the eye. They are mobile, firm and not tender upon palpation. Pinna recoils after it is folded. There is no presence of impacted cerumen . A small wound was found at the lower pinna of his left ear. He can hear and respond through head movements. Nose His nose is straight and his septum is located in the midline. No deviations have been observed in the shape, size and color of the external nose. No discharges were noted and there is the absence of nasal flaring. Also, no nodules and masses were noted upon palpation.

Lips and Teeth Outer lips are symmetrical. He exhibits ability to move her lips. Inner lips and buccal mucosa are uniform in color. He has an incomplete set of teeth and his tongue is in central position and he can move it freely.

NECK Neck Muscle Neck muscles are equal in size. No masses and nodules were noted upon palpation. Head movements are coordinated and he can move his head freely. Lymph Nodes Lymph nodes are not palpable and there is no enlargement noted upon observation and palpation.

THORAX AND LUNGS Lungs There is full and symmetrical chest expansion. There is effortless and rhythmic respirations and no adventitious breath sounds were heard upon auscultation. Heart Regular rhythm of apical pulse was noted upon auscultation. Abdomen No distention and presence of lesions and masses were observed. He has normoactive bowel sounds. Skin He has light brown-colored skin which is generally uniform except in areas of lighter pigmentation such as the palms, lips and nail beds. No abrasions and edema have been noted. He has good skin turgor, which turned back to previous state in less than 3 seconds when pinched.

Extremities Peripheral pulses are in full pulsations. Limbs are not tender and no edema is present at extremities. Wounds are present on both lower extremities and right hand. Fingernails His nail plates are colorless and have concave curves. They are dirty and untrimmed. His nail beds returned to previous state in less than three seconds after pressure was applied.

NUTRITIONAL STATUS Age: 3 years old Height: 88 cm Weight: 10 kg Interpretation: ( Based on FNRI ) Malnourished GROWTH AND DEVELOPMENT Erik Erikson’s Psychosocial Stage Stewie is considered to be under the Autonomy vs. Shame and Doubt stage. He likes to be carried by his mother and also has temper tantrums. According to Lois, his mother, he is just silent and has less facial expressions. Sigmund Freud’s Psychosexual Stage Stewie is considered to be under the Anal phase. He is able to go to the bathroom when he needs to void and defecate but still needs assistance from his mother or father. HISTORY OF PAST ILLNESS According to Lois, Stewie did not have any history of childhood illness except for fever. This was managed through tepid sponge bath.

HISTORY OF PRESENT ILLNESS Stewie Griffin has no history of present illness. Only intermittent episodes of cough and colds are experienced by the patient. This were managed through the use of Lagundi and water therapy. ACTIVITIES OF DAILY LIVING Stewie usually wakes up by the time his mother wakes up, and that is at around 5:00 a.m. He eats his breakfast at around 7:00 a.m and takes his nap at around 9:30 or 10:00 a.m up to 11:00 or 11:30 a.m. At around 11:30 a.m or 12:00 noon, he takes his lunch. He usually spends his afternoon doing leisure activities such as watching tv and playing with their neighbors, and sometimes, he also takes afternoon naps. He eats dinner at around 6:30 p.m or by the time his father arrives from work. He usually sleeps at around 9:00 or 10:00 p.m. PHYSICAL ASSESSMENT ( Final ) ( March 4, 2009, Wednesday ) Vital signs: T- 36 °C P- 81 bpm R- 20 cpm General Appearance and Mental Status: During the assessment, Stewie was wearing a white shirt and green shorts, and a pair of blue slippers. He is unable to express himself through speech. He has a steady gait. He stands 88 cm and weighs 10 kg. HEAD AND FACE Head His hair is dark brown in color. It is evenly distributed and no presence of dandruff was noted. No presence of infestations were noted.

Skull and Face He has normocephalic skull and with smooth skull contour. No nodules and masses were noted upon palpation. His face is symmetrical in shape and there is no abnormal elevation or depression on the face. Eyes His eyebrows are symmetrically aligned with hair evenly distributed. Eyelashes are also evenly distributed. Skin is intact, no discharges and no discolorations are present at the surface of eyelids. Lids close symmetrically. He has moist mucous membranes and her palpebral conjunctiva is pink in color. His pupils constrict when looking at near objects while they dilate when looking at far objects. Ears His auricles are same as facial color and it is aligned with the outer canthus of the eye. They are mobile, firm and not tender upon palpation. Pinna recoils after it is folded. There is no presence of impacted cerumen . He can hear and respond through head movements. Nose His nose is straight and his septum is located in the midline. No deviations have been observed in the shape, size and color of the external nose. No discharges were noted and there is the absence of nasal flaring. Also, no nodules and masses were noted upon palpation. Lips and Teeth Outer lips are symmetrical. He exhibits ability to move her lips. Inner lips and buccal mucosa are uniform in color. He has an incomplete set of teeth and his tongue is in central position and he can move it freely. NECK Neck Muscle Neck muscles are equal in size. No masses and nodules were noted upon palpation. Head movements are coordinated and he can move his head freely.

Lymph Nodes Lymph nodes are not palpable and there is no enlargement noted upon observation and palpation. THORAX AND LUNGS Lungs There is full and symmetrical chest expansion. There is effortless and rhythmic respirations and no adventitious breath sounds were heard upon auscultation. Heart Regular rhythm of apical pulse was noted upon auscultation. Abdomen No distention and presence of lesions and masses were observed. He has normoactive bowel sounds. Skin He has light brown-colored skin which is generally uniform except in areas of lighter pigmentation such as the palms, lips and nail beds. No abrasions and edema have been noted. He has good skin turgor, which turned back to previous state in less than 3 seconds when pinched. Extremities Peripheral pulses are in full pulsations. Limbs are not tender and no edema is present at extremities. Wounds are present on both lower extremities and right hand. Fingernails His nail plates are colorless and have concave curves. They are dirty and untrimmed. His nail beds returned to previous state in less than three seconds after pressure was applied.

IV. SOCIO-ECONOMIC, CULTURAL AND ENVIRONMENTAL ASSESSMENT A. Type of Family Structure The Griffin Family is a nuclear type of family, composed of parents: Brian and Lois, and children: 4-year old Meg, and 3-year old Stewie. Brian and Lois are married for 5 years now. Although the family is not lucky enough to have a wealthy and comfortable living, they still manage to surpass every challenging situation that they encounter by having a positive outlook in life. B. Dominant family members in terms of decision making especially to health care In terms of decision making, whether heath care-related or not, it is Brian Griffin who usually do it, although he still considers the suggestions and preferences of Lois, his wife.

C. Source of Income, Expenditures The family’s source of income is Brian Griffin’s wage from being a construction worker, earning Php275/day or Php8250/month. That would denote each member of the household spends Php2062.50 monthly. According to NEDA, a family with an average income of less than P 2768.60 per individual per month is considered poor. Ergo, one can classify the Griffin family as poor. The family admits that the total earnings do not always suffice for their basic needs such as food, clothing, extra expenses, electricity and water bill. Summary of their estimated monthly expenses is as follows:

EXPENSES

AMOUNT

Food

Php6000

Clothing and other expenses

2000

Electricity

200

Water

250 Total: Php8450

According to Griffin family, in case of emergency in medical-related needs, they do not have anyone to ask for help. They just hope that perhaps, a kind neighbor or two will be willing to lend them some money.

D. Working Hours Brian Griffin is the breadwinner of the household. He works from 6 am to 10 pm, 16 hours a day, Mondays to Saturdays. He is given a lunch and a dinner break, where he goes home to eat around 12-1pm and 6-7pm, respectively. E. Ethnic background and Religious Affiliation Brian is a Kapampamangan native, whilst Lois is an Illongga woman. The family’s religion is Roman Catholic, so very few restrictions are being implemented, almost negligible. According to Lois, they attend the Holy Mass during Sundays. F. Significant other’s roles in the family Life Basically, the significant others’ roles in the family life is almost negligible. Lois’s relatives are also struggling for food in the province of Negros, whilst Brian’s family of orientation has already died. Ergo, there is really no one to help them in times of crises. Their only hope is basically, each other. G. Health habits/ Health Beliefs The assessment of the health beliefs of the family would help student nurses to recognize the family’s method on how they handle health problems. The family resorts to herbal medicines due to shortage of money. Some of these would include oregano and lagundi for colds, pounded guava leaves for diarrhea and they also take into consideration the practice of the herbolarios specifically the manghihilots and mananawas. They also pay a visit or two at the barangay health center for consultation in case of fever or other minor health complaints. Selfmedication with paracetamol and NSAIDS is also a practice. These health beliefs and customs are considered factors that may greatly affect the children’s upbringing and health status. H. Family’s involvement in Community activities According to Lois, she often participates in seminars being held in the barangay health center. They also make use of its services in times of minor health complaints. I. Family’s utilization of Community Resources Community resources in the barangay include the health center, and the chapel.. The family makes use of the health center for the vaccination of their children and goes there in cases of fever, coughs and cold, which can’t be managed by self-medication. Nobody in the

family goes to school as of the moment. The church is also utilized by the family as they conscientiously attend the Holy Mass every Sunday.

J. Housing Condition The Griffin family lives in a one-bedroom semi-concrete shack. Sheets of boards from Brian’s previous employer were topped against each other to form the walls of the humble bungalow. In the front yard, one can see a table where dining takes place. Plants and flowers stand on the right corner. For protection, they lined their lot with a simple dark blue picket fence. The receiving area for guests is the front porch. The bedroom has the largest area in the house with wooden bed and a television for entertainment purposes. Immediately on the left is the kitchen devoid of cooking facilities as Lois cooks occasionally using charcoal outside the house. In there, one can find plates and utensils for cooking and eating. The toilet facility is at the back of the house. According to the National Building Code of the Philippines (2000) the minimum size of room required for human habituation individually is 3.5 square meters (adult) and 1.5 square meters (child). For information regarding the adequacy of living space, the student nurses measured each room’s total fixtures area and subtracted it from total floor area. Afterwards, the available living space (resulting value) is less 3 square meters (1.5 sqm each) because of Meg and Stewie, the children in the family. Then, the remaining space will be divided among the 2 adults in the family. The total available space is 16.92 sq m, which is minus 3 square meters as required by Meg and Stewie. The resulting value is 13.92 which is further divided by the 2 adults in family who are Brian and Lois, comprising of 6.96 sqm per adult family member. Ergo, the family has adequate living space. As for adequacy of ventilation, the total window area should be at least 10% of the total floor area. The house has only one window, measuring only 0.27 sqm. The total floor area is 16.92. This measurement didn’t make it to the 10%. This goes to show that the house is under poor ventilation. For the lighting conditions, the family use incandescent bulbs as their source of light during evenings. However, inadequacy in daytime lighting is very evident, as there is only one window and the walls of their house are not painted, adding to the dark feel of the atmosphere.

Sleeping arrangements constitute of the one bedroom they all sleep in. Brian and Stewie sleep on a mat on the floor, whilst Lois and Meg occupy the bed they have. Both of which are quite hard on the back as there is no mattress available. The family is aware of the presence of vermin like cockroaches. Buzzing mosquitoes at night are also of a common occurrence. Last month, their front porch was burned because of the cooking facility left unattended. Such would then be a big fire hazard as an evidence of a history of fire has occurred. K. Food Sources, Storage and Cooking Facilities For breakfast, lunch and dinner, the family always buy home-cooked meals from the canteen where Brian Griffin works. They also buy from sari-sari stores and the market near their place. Lois only prepares the rice, and the viands will be taken cared of Brian. Food storage comprises of food in covered casseroles or plates. Since they do not have refrigerator to keep their leftovers, they just eat it up on the next meal. Usually, they just use homemade charcoal stove or grill with wood to cook their rice in the front yard. L. Water Supply (source, ownership, potability, storage) The family has a level 3 water system. They own such water supply facility. Adults in the family drink the water from the household tap, whilst the water to be drank by the children should be boiled first. Their type of drinking water storage is pitchers or jars with cover. M. Toilet Facility (type, ownership, sanitary condition) Their toilet facility is at the rear of the house. Its nature is of a septic tank without water carriage so naturally, it has to be mechanically flushed by pouring water in it. It is observed to be in good condition because of the surrounding area of the toilet bowl is clean and no discoloration or foul odor is evident. N. Drainage System (type, sanitary, condition) and Garbage Disposal Their drainage system is located on the other side of the road. Its type is of open and flowing nature. The garbage disposal container is sack and it is covered. Garbage collectors get their household garbage twice a week.

O. Social and Health Facilities Available The community where the family resides has various social and health facilities. They have the chapel wherein masses are celebrated; the elementary school and day care center wherein most of the children in the barangay study; they have basketball court wherein certain activities such as sports fest are being carried out; and the Barangay Sapalibutad Health Center which offers an array of services such as immunization, family planning programs, perinatal care and the like. Carinderias, bakeries, and sari-sari stores are also found in the vicinity of the community. P. Communication and Transportation Facilities In the community, the families who can afford have telephone lines installed and own their own transportation vehicle. However, the Griffin family can’t, so they just have to deal with commuting, riding a bicycle, a tricycle or public utility jeepney to go places. They can also walk if the destination is just considerably near. Their primary means of communication is the actual familial interaction. Their family seemed closed-knit anyway they communicate with their family in Negros through their neighbor’s cellphone.

V. PROBLEM IDENTIFICATION A. List of Problem Identified

No.

Problems Identified

Score

Rank

1

Presence of Health Deficit: Cough and Colds

4.67

1

2

Poor Environmental Sanitation: Presence of Vermin, Rodents and Flies

4.34

2

3

Presence of Health Deficit: Parasitism

4.17

3

4

Poor Personal Hygiene

3.84

4

5

Family size beyond what family resources can adequately provide: Inadequate Family Resources

3.34

5

6

Presence of Accident Hazard: Fire Hazard

3

6

7

Poor Environmental Sanitation: Lack of Food Storage Facilities

2.84

7.5

8

Poor Daytime Lighting Condition

2.84

7.5

9

Presence of Developmental Delay

2.33

9

10

Poor Ventilation due to Economic/ Cost Implication

1

10

B. Priority Setting Problem# 1: Presence of Health Deficit: Cough and Colds Actual Criteria Computation Justification score The problem is a health deficit, cough and colds are deemed to be a normal reaction of 1. Nature of the the body against microorganism which has 3/3 x 1 1 problem invaded the body, and this is by expelling these microorganisms through coughing reflex. 2/2 x 2 2 Upon the observation of the criteria 2.Modifiability of the regarding the modifiability aspect of the problem problem, the student nurses was able to deem that that the problem has a highly modifiable aspect AEB the justifications Current  stated below: knowledge Family  > The family has a current knowledge of the Resources problem as during the interview the Mrs. Lois SN  was able to verbalize the presence of the Resources problem Community  "inuubo tsaka sinisipon sila"(they have Resources cough and colds) > The family's manpower and physical resources are available AEB the family's willingness to cooperate and comply with the Student Nurses health teachings and as verbalized by Mrs. Lois she has a management for the problem AEB her statement: “kapag inuubo sila, gumagamit ako nung lagundi, minsan yung oregano pag walng lagundi” (when they have cough and colds, I tend to give them lagundi extracts and if not I use oregano as alternative) > The Student Nurses are well informed and knowledgeable about the mechanism of cough reflex and the management to be done to prevent the occurrence of complications thus making them enable to impart this knowledge to the family, another thing is the Student Nurses willingness to help the family to minimize if not to eradicate this problem. > The Barangay Health Center offers Mother's Class and conducts information

dissemination on how to properly manage such problem and when to seek medical attention. Prevention of aggravating these conditions have a moderate potentiality as reflected by the criteria the Student Nurses have observed:

3. Preventive Potential Severity

▼

Duration

▲

Current Management High -risk Group

> The problem is already severe as both of the children are affected.

▲

>The problem has existed for not so long time ago, since this problem just existed 2-3 days ago therefore this can still be managed through home care.

▲

2/3 x 1

4. Salience of the problem

Total Score

2/2 x 1

.67

1

>The family has a current management on the problem, “kapag inuubo sila, gumagamit ako nung lagundi, minsan yung oregano pag walng lagundi” (when they have cough and colds, I tend to give them lagundi extracts and if not I use oregano as alternative) as verbalized by Mrs. Lois upon interview. > The children are the high risk group of the problem, since their not well develop immune system and their lifestyle as a child makes them susceptible in acquiring such conditions. Prior to the interventions and health teachings, the family has already viewed this as a problem, which needs an immediate action.

4.67

Problem# 2 Poor Environmental Sanitation: Presence of Vermin, Rodents and Flies Actual Criteria Computation Justification score Presence vermin, rodents, flies and mosquitoes are good vector of diseases; 1. Nature of the 2/3 x 1 .67 presence of these vectors increases the problem susceptibility of acquiring diseases, thus imposing a health threat to the Griffin Family.

The problem is highly modifiable AEB the following criteria observed:

2.Modifiability of the problem Current knowledge Family Resources

> The family has a current knowledge of the problem as during the interview the Mrs. Lois was able to verbalize the presence of the problem "ay oo may mga daga dito tsaka ipis ganyan"(oh yes there are rats and cockroach here)

 

SN Resources



Community Resources



2/2 x 2

2

> The family's manpower and physical resources are available AEB the family's willingness to cooperate and comply with the Student Nurses health teachings and as verbalized by Mrs. Lois they minimize presence of such mosquitoes by physical means. > The Student Nurses are well informed and knowledgeable about vector borne diseases and the management to be done to prevent the occurrence of these diseases and on how to eradicate those rodents and insects, thus making them enable to impart these knowledge to the family, another thing is the Student Nurses willingness to help the family to minimize if not to eradicate this problem. > The Barangay Health Center offers Mother's Class and conducts information dissemination on how to prevent the multiplication of these vectors and insecticides are also available in the community.

3. Preventive Potential

2/3 x 1

Severity

▲

Duration

▼

Current Management

▲

High -risk Group

▲

.67

Prevention of these vectors has a moderate potentiality as reflected by the criteria the Student Nurses have observed: > The problem is not yet severe since no one on the family was affected by the problem, the rodents bit no one, no one has acquired any of the vector borne diseases. >The problem has existed for a long time ago, this has already existed approximately for almost 5 years as verbalized by Mrs. Lois that there were already rodents and insects the moment they transferred to their house

>The family has a current management on the problem this is through physical means, "pinapatay namin yung lamok sa kamay" (we kill them by clapping our hands against them) as verbalized by Mrs. Lois upon interview.

4. Salience of the problem

2/2 x 1

Total Score

1

> The children and even Mr. Mrs. Griffin are all at risk to be affected of the problem, since they all live on the house. Prior to the interventions and health teachings, the family has already viewed this as a problem, which needs an immediate action.

4.34

Problem# 3 Presence of Health Deficit: Parasitism Actual Criteria Computation Justification score Parasitism are health deficits brought about by poor personal hygiene wherein helminthes invade a child’s body more 1. Nature of the 3/3 x 1 1 particular of the gastrointestinal tract, thus, problem leading to infection and poor nutritional status. 2/2 x 2 2.Modifiability of the problem Current knowledge Family Resources

 

SN Resources



Community Resources



2

As reflected by the criteria below, it shows that the problem on presence of parasitism has a high modifiability status. > Mrs. Lois Griffin is fully aware of the problem as she has mentioned the following statement during the interview: “si meg nung kamakailan lang nagsuka ng bulate”(meg vomited a worm just recently)

> The family has manpower resources that enable them to easily bring their children to the barangay health center for proper management. > With the student nurses knowledge and childhood illness background the student nurses can provide the family health teachings about the importance of preventing this condition to promote good nutritional status

> The barangay health center provides free dewormer that would manage the family problem regarding parasitism.

The problem of the Griffin family regarding parasitism has a moderate preventive potential after the student nurses has considered the following criteria presented below.

3. Preventive Potential Severity

▲

Duration

▼

Current Management

▼

High -risk Group

▲

> The problem is not that severe as meg is the only one affected by the said condition. > The problem approximately exists long ago as Meg was already able to manifest erratic parasitism. 2/3 x 1

.67 > The family does not manage the problem as Lois is afraid of giving dewormer to Meg due to misinterpretation of the said intervention AEB by her statement: “yung kapitbahay kasi naming nung pinurga nya yung anak nya namatay kasi lumabas sa bibig yung bulate, kaya natatakot ako purgahin si Meg”(I am afraid to deworm Meg as when my neighbor dewormed her child, her child died because the worms came out on his mouth)

> Meg is the primary high risk group of the said problem. 4. Salience of the problem

1/2 x 1

Total Score

Criteria 1. Nature of the problem

.5

Prior to the student nurses verbalizing the problem to the family, the family is already aware of this but for them it does not need an immediate action.

4.17

Problem# 4 Poor Personal Hygiene Actual Computation Justification score 2/3 x 1 .67 Poor Personal hygiene is a health threat to the family as this problem predisposes to health deficits such as parasitism, cough and colds and other hygiene – related health

deficit. Upon the observation of the criteria regarding the modifiability aspect of the problem, the student nurses was able to deem that that the problem has a highly modifiable aspect AEB the justifications stated below:

2.Modifiability of the problem Current knowledge Family Resources SN Resources Community Resources

 

>Lois is fully aware of the said problem especially to her children.

 

2/2 x 2

2

> The family has physical resources specifically cleaning articles such as soap, shampoo and the like. > The student nurses knowledge will enable them to provide the family with health teachings regarding personal hygiene such as cutting their finger and toenails, washing their hands and the like. >The community offers Mother’s Class where the family could learn about good personal hygiene. After the Student nurses have analyzed the criteria on determining the Preventive Potential of the problem, it suggests that the problem has a moderate preventive potential.

3. Preventive Potential Severity

▼

Duration

▼

Current Management High -risk Group

▲

> The problem is already severe as the almost of the family members are observed to have a poor personal hygiene and one of the family member already manifesting a hygiene – related illness. (Meg- parasitism)

▲

2/3 x 1

.67

> The problem on poor personal hygiene approximately exists for 5 months already as Mrs. Lois tries to limit all of their consumption due to limited financial resources, thus affecting the family hygiene. > as a management the family still make sure that they take a bath for at least once a day.

4. Salience of the

1/2 x 1

.5

>All of the family member are the high risk group of the said problem as all of them has a poor personal hygiene thus all of them are susceptible to acquire health deficit. Prior to the student nurses do their

interventions; the family does not see their poor personal hygiene as a problem at all.

problem Total Score

3.84

Problem# 5 Family size beyond what family resources can adequately provide: Inadequate Family Resources Actual Criteria Computation Justification score The problem is a health threat, inadequacy of the family resources to suffice their daily 1. Nature of the needs may result to serious health problems 2/3 x 1 .67 if not corrected e.g. malnutrition which is problem now actually evident in the family since the children are all underweight. The problem is partially modifiable as 1/2 x 2 1 reflected by the criteria being considered: 2.Modifiability of the problem > The family has a current knowledge of the problem, as Mrs. Lois was able to verbalize Current  knowledge this problem during the interview when the Student Nurses asked her of what are their Family Resources  problems in their house SN Resources  "...haaay syempre mahirap ang buhay ngaun kaya pera ang pinakaproblema Community  Resources namin” (of course with the increasing financial problem, money is our main problem) as verbalized by Mrs. Lois. > Family's physical and manpower resources are not enough to correct the problem. Mr. Brian's income is not enough to suffice their needs. >The Student Nurses can pinpoint some tips on how they are going to minimize their water and electric consumption and enumerate some foods that are nutritious yet cheap which may help in lowering their expenses. Examples of this are:  Use fluorescent lamp instead of light bulbs.  Close the faucet when not in use  Remove barriers on the windows to let the sunlight enter the house so that they may minimize the use of electricity for lighting.  Foods such as vegetables, tofu and the like. > Community Resources are not available,

since if the community would manage the family problem, they also have to help the other families which have the said problem and the community’s budget is not enough to respond on this problem. The problem has a moderate preventive potential as reflected by the following criteria:

3. Preventive Potential Severity

▼

Duration

▲

Current Management

▲

High -risk Group

▲

> The family's monthly income is really small and would not suffice their needs and if to compare with the NEDA prescribed share amount of money that each of the family members must have it is really far behind. NEDA- P2, 768.60 Griffin family- P8250 (P8250/4 = P2062.50/ individual) And to analyze their expenses it would show that they spend more of what they can adequately provide:

2/3 x 1

.67

Food – P6000 Miscellaneous – P2000 Electricity P200 Water P250 TOTAL P8450 >The problem existed for almost 5 months ago after Brian lost his job. > The family has a current management on the problem since Mr. Brian was able to find a job on a construction firm at the city vicinity.

4. Salience of the problem Total Score

2/2 x 1

1

> All of the family members with emphasis on the children are the risk group of the problem as they have all their basic need that must be sufficed. The family sees this as a problem, which is for them, needs an immediate action AEB when the Student Nurses did their interview Mrs. Lois was able to verbalize their problem financially.

3.34

Problem# 6 Presence of Accident Hazard: Fire Hazard Actual Criteria Computation Justification score

1. Nature of the problem

2/3 x 1

.67

2.Modifiability of the problem Current knowledge



Family Resources



SN Resources



Community Resources



Accident hazards are health threat to the family; on the griffin family’s case their faulty wirings are fire hazards wherein if fire happens on their house brought about by this faulty wirings, fatality is mostly to occur. After the student nurses have considered the following criteria below, it reflected that the problem is moderately modifiable. > the family has a current knowledge of the problem AEB Lois statement during the interview: “madaling magkasunog dito, nasunugan na kami nung January 30”(this house can easily be damage by fire, we have experienced it last January 30)

1/2 x 2

1

> The family’s financial resources will not be able to suffice the expenses needed to fix the problem, since they are already experiencing financial shortage for their daily needs. > The student nurses could inform the family about the existence of the problem and site some possible consequences that may arise brought about by faulty wirings such as fire.

3. Preventive Potential

1/3 x 1

Severity

▼

Duration

▼

Current Management

▼

High -risk Group

▲

.33

> There are no available community resources since if the community will do something about the problem they also have to do the same actions they have done to the Griffin family. After the student nurses have considered the following criteria below, it reflected that the problem has a low preventive potential. > The problem is severe as observed by the student nurses as majority of the electrical wiring are exposed, and as aforementioned by Lois, they have already experience fire accident last January 30, and their neighbor experienced it too. > The problem approximately exists for about 5 years since the problem have existed when Mrs. Lois and her family transferred to that house. “nung lumipat kami dito ganito na yung itsura ng bahay” (when we transferred here the house physical structure was already like

this.)

> The family does not have any current management to the problem due to lack of financial resources.

4. Salience of the problem

2/2 x 1

Total Score

1

> All of the family members are exposed to the problem, since all of them resides on that house. Prior to the student nurses conduct their interventions; the family sees it as a problem which according to Lois needs an immediate attention.

3

Problem# 7.5: Poor Environmental Sanitation: Lack of Food Storage Facilities Actual Criteria Computation Justification score The Griffin Family’s problem on lack of food storage facilities is considered to be a health threat as it predisposes the family to Gastrointestinal problems such as diarrhea, 1. Nature of the Acute Gastroenteritis and other food borne 2/3 x 1 .67 problem diseases, since improper storage of food predisposes contamination of the food thus leading to the said Gastrointestinal problems. Upon the observation of the criteria 2.Modifiability of the regarding the modifiability aspect of the problem problem, the student nurses was able to deem that that the problem has a partially modifiable aspect AEB the justifications stated below:

1/2 x 2

1

> the family has a current knowledge of the said problem AEB Lois statement: “tinatakpan ko na lang ng pinggan yung tira namin na pagkain kung meron, nilalangaw kasi, wala naman ako paglalagyan”(I just cover it with plates if ever we have left over foods, to prevent those flies going on to the food, we don’t have any food storage to utilize) > The family does not have any physical resources such as articles like Tupperware that they can use to store their foods, and also the family does not have enough

financial resources to suffice the expenses they need for them to b able to buy those storage facilities mentioned. > With the equipped knowledge that the student nurses have, the student nurses are capable enough to provide health teachings to the family such as the consequences that may arise due to lack of food storage facilities such as contamination of the food they eat ant the ingredients they use in cooking. > the community is not directly related to address the problem, the problem is more of a family oriented problem therefore, a family oriented action would be helpful in managing the problem. Upon the assessment of the following criteria mentioned below, the problem on lack of storage facilities yields a moderate preventive potential.

3. Preventive Potential

Severity

▼

Duration

▼

Current Management

▲

High -risk Group

▲

> The problem of the family on lack of food storage facilities is considered to be severe as evidenced by the observations of the student nurses upon the assessment of the housing and environmental sanitation of the house the student nurses was able to observe that the storage facility that the family uses is very dirty as evidenced by soil particles and flies present on the storage facility. > The problem is already long duration since they do not really have enough utensils and storage facilities even before (5 years approximation)

2/3 x 1

4. Salience of the problem

1/2 x 1

.67

.5

> As a management to the problem Lois uses plates to cover their left over foods if any. > High- risk group are all the family members of the Griffin family since all of them benefit on the said food. The family see this as a problem but it does not need an immediate action as they have more prioritized problem compared to this.

2.84

Total Score

Problem# 7.5: Poor Daytime Lighting Condition Criteria

Computation

1. Nature of the problem

2.Modifiability of the problem Current knowledge



Family Resources



SN Resources



Community Resources



Actual score

2/3 x 1

.67

1/2 x 2

1

Justification The family’s problem on poor lighting is considered to be a health threat to the family, since with poor lighting condition, it may bring strain on the eyes which may lead to eye problem such as blurring of the vision, another thing is this may lead to accidents since without the use of enhancement for lighting condition such as lamps the family member cannot see their home environment clearly thus may lead to accidents such as sliding and the like. After considering the criteria below, the Student Nurses have arrived to a result that shows that the problem of the Griffin family is moderately modifiable. > The family has a current knowledge on the problem as shown with the behavior of Mrs. Lois wherein the student nurses have observed Mrs. Lois invites the student nurse to just stay on the outside. “pasensya na kayo dito na lang tayo sa labas madilim kasi”(let’s stay here outside it is too dark inside). > The family has limited financial resources in which the family cannot suffice the expenses in improving their lighting condition. > The student nurses are well equipped of the knowledge about having a good lighting condition thus, the student nurses can provide the family some health teachings to the family regarding the importance of having a good lighting condition such as it prevent straining the eye and making their environment more visible, they can also pinpoint some articles that contribute to the problem such as the curtain that blocks the

light coming in on their small window. > The community itself has limited resources to address this problem, as observed, most of the household on the community suffers from this problem, thus the community must respond to the problem of the other members of the community if the community will respond to the problem of the Griffin Family. The Griffin family’s problem on poor lighting condition has a moderate preventive potential as reflected by the criteria shown below:

3. Preventive Potential

> The problem is severe as evidenced by upon entering the house the student nurse have observed that it is impossible to see without the aid of electricity, the house is so dark.

Severity

▼

Duration

▼

Current Management

▲

High -risk Group

▲

>The problem has exist for approximately about almost 5 years, as stated by Mrs. Lois: “dati ang madilim dito, kahit nung paglipat pa lang namin dito” (this situation was the same even the first day we were here when we transferred, it is really dim inside the house)

2/3 x 1

4. Salience of the problem Total Score

1/2 x 1

.67

.5

>The family uses light bulbs and open their window to manage the problem. > All of the family members of the Griffin family are exposed to this problem as they were all living on that house. Poor lighting condition is viewed by the family as a problem upon interview with Lois and does not need immediate action prior to the student nurses conduct their health teachings.

2.84

Problem# 9: Presence of Developmental Delay Actual Criteria Computation Justification score Developmental Delay is a health deficit as a 1. Nature of the delay in the developmental years would 3/3 x 1 1 only indicate an abnormal physiological problem function of the body.

The problem is partially modifiable upon the consideration of the following criteria:

2.Modifiability of the problem Current knowledge



Family Resources



SN Resources



Community Resources



>The family does not have any current knowledge on the problem AEB Mrs. Lois just regard the problem as if it is just only normal for Meg as she is a preterm child.

1/2 x 2

1

> Family manpower resources are available; the family can go to the Barangay Health Center for proper referral. > Student Nurses are well equipped with knowledge and skills enabling them to impart information about the presence of the problem so that the family could address this problem properly and avoid aggravation of the said condition. > Community has NGO’s and government hospitals for proper medical management of the problem. The problem has a low preventive potential as reflected on the following criteria the Student Nurses considered:

3. Preventive Potential Severity

▼

Duration

▼

Current Management

▼

High -risk Group

▲

> The problem is considered to be severe due to the following reasons:  The awareness of the family to this problem is not evident.  With Meg’s age, her actions are inappropriate AEB she still doesn’t know how to speak which is not expected for children like her with the same age.

1/3 x 1

.33

>The problem exists for so long already approximately 3 years as she meg is already 4 years old now and the things she does is only normal for a child with 1 year of age. >They family do not have any management on this problem since their awareness to this problem is not evident. >The main risk group of the problem is Meg; Lois is also affected especially on doing her ADL’s since she has to attend with Meg’s needs.

4. Salience of the problem

0/2 x 1

0

The family does not view Meg’s developmental delay as a problem since they are not aware of the existence of this problem prior to the Student Nurses informing them about this problem.

2.33

Total Score

Problem# 10 Poor Ventilation due to Economic/ Cost Implication Actual Criteria Computation Justification score The problem is basically a health threat to the Griffin Family as poor ventilation condition predisposes cross contamination since there is an inadequate air circulating 1. Nature of the 2/3 x 1 .67 on their home environment, another thing is problem that with poor ventilation condition, the family members may suffer to respiratory problems since there is minimal amount of air circulating on their house. After the student nurses have considered the 2.Modifiability of the following criteria below, it reflected that the problem problem is highly modifiable. Current knowledge Family Resources



SN Resources



Community Resources



> The family has no current knowledge of the said problem AEB upon interview, Mrs. Lois told the student Nurses that: “hindi naman problema yan ganyan nay an dati pa, tsaka ok lang yan presko naman napasok naman ang hangin eh”(it’s not a problem anymore, it is just the same when we transferred here, anyway it is cool here)



0/2 x 2

0

> The family has limited resources especially financial resources since they are currently financially challenged. > With the skills, initiative and knowledge of the student nurses, the student nurses can provide the family with health teachings regarding the importance of having a good ventilation condition such as it will promote relaxation and prevent cross contamination of diseases. > The community has no adequate resources on resolving the problem, since it would be of too much cost on the community funds.

3. Preventive Potential

After the student nurses have considered the following criteria below, it reflected that the problem has a low preventive potential.

Severity

▼

Duration

▼

Current Management

▼

High -risk Group

▲

> The measurement of the windows of the house of the Griffin Family have not passed the standard of the National Building code of the Philippines R.A 6541 as evidenced by the total measurement of the windows of the house yield 0.27m2 which is less than 1/10th of the total floor area of the house (16.92m2), making their ventilation condition poor. 1/3 x 1

.33

> The problem on poor ventilation condition of the Griffin Family existed for approximately almost 5 years ago, as verbalized by Mrs. Lois on her statement: “nung lumipat kami dito ganyan na yan” (when we transferred here the windows are already like that) > The family does not have any current management of the problem due to low salience of the problem.

4. Salience of the problem Total Score

0/2 x 1

0 1

> All of the family members are all affected of the problem since all of them is living together on that house. Mrs. Lois does not regard this as a problem.

VI. FAMILY NURSING CARE PLAN (in order of priority)

Problem# 1: Presence of Health Deficit: Cough and Colds CUES

>Presence of nasal discharges (meg an stewie) >Verbal reports by Lois Griffin

FAMILY NURSING PROBLEM

OBJECTIVE S

INTERVENT IONS

RATIONALE

>Inability to make decisions with respect to taking appropriate health action due to inability to decide which action to take. >Inability to provide adequate nursing care to the sick, dependent members of the family due to lack of knowledge about health condition and necessary intervention/

Short Term: >After 1-2 hrs. Factors that can contribute to its occurrence. Long Term: >After the end of the 5th home visit, the members of the family will have changes in lifestyle to prevent coughs and colds.

>Determine factors that can contribute to its occurrence. >Assess for Family’s current knowledge. >Reinforce non pharmacolog ic measures such as water therapy. >Identify community resources and facilities for support. >Teach deep breathing exercises and coughing

> to determine contributing factors/ etiologies. >To obtain baseline data.

>to promote wellness

>To increase immune system >To prevent increasing mucus consolidatio n

METHOD OF FAMILY CONTACT Home Visit

RESOURC ES

EVALUATION

>Time and effort of the student nurses and the family

>After 1-2 hours of home visit, the members of the family shall have verbalized different ways to manage cough colds. >At the end of 5 home visits, the members of the family shall have demonstrated changes in lifestyle to prevent coughs and colds.

treatment/ care.

exercises >Advice client to eat vit. C rich food >Prevent from drinking milk

Problem# 2: Poor Environmental Sanitation: Presence of Vermin, Rodents and Flies CUES

FAMILY NURSING PROBLEM

OBJECTIVE S

INTERVENT IONS

RATIONALE

METHOD OF FAMILY CONTACT

RESOURC ES

EVALUATION

>presence of cockroaches mostly in kitchen >absence of accessible sink in the kitchen >kitchen and storage are in dose proximity

>Inability to provide a home environment conducive to health maintenanc e due to inadequate family resources specifically financial constraint and limited physical resources

Short Term: >After 1hrs. Nursing intervention the family will verbalize different methods to minimize presence of vermin. Long Term >After 3 days of Nursing Intervention family will minimize and control the presence of cockroaches .

>Assess family’s environment al conditions. >Discuss and explain importance of environment al sanitation >Discuss use of pesticides and other physical method to reduce number of pests in the house >Encourage immediate plates and kitchenware before and after use. >Encourage proper hand washing before and after eating

>To obtain baseline data for planning appropriate intervention s >having a clean environment greatly reduces the chance of breeding vermin >Inhibits and kills the pests and thus lessening occurrence of vermin. >Prevent unpleasant smell and areas of infestations. >Prevent ingestion of microorgani sm carried by pests.

Home Visit

>Cooperati on of both family members and student nurses >knowledg e of student nurses >use of cleaning agents such as house bleach or Lysol >Pesticides

Short Term >After 1 hours of Nursing Intervention, family shall have verbalized of the importance of environmental sanitation. Long Term After 3 days of home visits and Nursing Intervention, family shall have

Problem # 3: Presence of Health Deficit: Parasitism

CUES

S> “Ayaw nila mag tsinelas pag naglalaro” O> -The Children are not wearing their slippers when playing outside. -The father and his children have untrimmed and dirty fingertips and toenails. -improper hand washing when

FAMILY NURSING PROBLEM -Inability to ,ake decisions with respect to taking appropriate health action due to misconcepti ons or erroneous information

OBJECTIVE S

INTERVENTI ONS

SHORT TERM: After 1-2 hours of home visit, the family will enumerate ways to prevent parasitism

- Assess for history of parasitism

LONG TERM: At the end of the 5th home visit, the family will practice measures to prevent parasitism and identify support groups in the community

-Determine factors associated to parasitism -Discuss the importance of having good personal hygiene.

-Give health teachings regarding different practices on good personal hygiene. -Discuss the

RATIONALE

-to know past medical history -to identify contributing factors -to provide health teachings that will let them maintain a good personal hygiene. -to provide general comfort and clean body.

-to minimize

METHOD OF FAMILY CONTACT Home visits

RESOURC ES REQUIRED Time & effort of the family and the student nurse.

EVALUATION

After 1-2 hours of home visit, the members of the family shall have enumerated ways to prevent parasitism

At the end of the 5th home visit, the family members shall have practiced measures to prevent parasitism and identify support groups in the community

eating.

following:

-Instruct them to frequently wash hands and trimmed fingernails & toenails. - Perform the interventions to the client like teaching them to wear their slippers always, trimmed the nails of the children, and washing the hands of the children when eating.

the occurrence of cross infection and parasitism. -to minimize the occurrence of cross infection and parasitism.

-to minimize the occurrence of cross infection and parasitism.

-Perform usage of the fork and spoon when eating. Problem # 4 HEALTH THREAT: UNHEALTHY LIFESTYLE HABIT: POOR PERSONAL HYGIENE

CUES

S> Ø O> -The members are seen wearing dirty clothes -The members of the family have long and dirty fingernails and toenails -The members of the family has dirty skin as a sign of not taking a bath

FAMILY NURSING PROBLEM -Inability to take appropriate health actions due to: -lack of adequate knowledge regarding proper hygiene -inadequate financial resources to avail proper hygiene practices and resources

OBJECTIVE S

INTERVENTI ONS

SHORT TERM: After 2 hours of home visits, the family will verbalize understandi ng about the importance of good personal hygiene to their health

-Assess for signs of poor personal hygiene

-to know health threats

-Determine factors associated with poor personal hygiene

-to know factors contributing to health threat

-Discuss the importance of having good personal hygiene.

-to provide health teachings that will let them maintain a good personal hygiene.

LONG TERM: At the end of the 5th home visit, the family will demonstrat e maintenanc e of good personal hygiene as evidenced

-Give health teachings regarding different practices on good personal hygiene. -Discuss the

RATIONALE

-to provide general comfort and clean body.

-to provide a

METHOD OF FAMILY CONTACT Home visit

RESOURC ES REQUIRED

EVALUATION

Family resources: -open to new information and involvemen t of nursing interventio ns

SHORT TERM: The family shall have verbalized understanding about the importance of good personal hygiene to their health

Student nurses resources: -Time & effort to explain proper hygiene practices and adequate knowledge about the diseases in a poor personal hygiene

LONG TERM: The family shall have demonstrated maintainance of good personal hygiene and applied health teachings given as evidenced by taking a bath everyday, and proper cleanliness in their bodies.

by taking a bath daily and wearing comfortable clothing, trimmed fingernails and toenails.

following:

presentable look.

-Instruct them to take a bath at least once a day. -Instruct them to frequently wash hands and trimmed fingernails & toenails. -Instruct tooth brushing at least twice a day.

- Perform the interventions to the client like bathe the children, trimmed the nails of the children, and brushed the teeth of the

-to minimize the occurrence of cross infection and parasitism.

-to prevent formation of cavities/ plaques and to maintain a good oral hygiene and prevent bad breath.

children. Problem #5: Family size beyond what family resources can adequately provide: Inadequate Family Resources CUES S> ∅ O> The group found out that the total monthly budget of the family is P8,250.00 which gives every member a monthly allowance of P2,062.50. It is not enough for the family’s everyday needs.

ANALYSIS OF THE PROBLEM Inability to sustain their basic needs due to lack of family resources and failure to have a high paying job.

NURSING INTERVENTI ONS

RATIONALE

Short term: After 1-2 hrs of home visit, the family will be able to identify ways on how to properly budget their monthly income.

• Establish rapport with the family members.

• To gain trust and cooperatio n of the family.

Long term: At the end of the 5th home visit, the family will be able to find ways on how to earn extra income sufficient to the needs of the family.

• Assess the family’s sources of income.

OBJECTIVES

• Compute for the family expenses and salary.

• Provide the family information on different methods of earning an extra

• Provides comparison of data and determines deficiency in financial status. • Provides baseline data and determine other possible sources. • Provides creativity in the family and raising

METHOD OF FAMILY CONTACT

RESOURCES REQUIRED

EXPECTED OUTCOME

Home Visit

Family resources: Understandi ng and cooperation of the family.

Short term: The members of the family shall have identified ways to properly budget their monthly income.

Student nurses resources: Skills, knowledge, time, effort and motivation of the students.

Long term: The members of the family shall have maintained practice measures to prevent fire hazards.

income. • Encourag e the family to engage in activities that would promote livelihood such as planting vegetables. • Explore ways on proper budgeting and possible extra sources of income.

extra income.

• To allow money for daily needs and to save extra money.

• To maximize the money earned by the parent.

Problem #6: Presence of Accident Hazard: Fire Hazard CUES S> “Nasunuga n kami nung Jan. 31.” As

ANALYSIS OF THE PROBLEM

OBJECTIVES

Inability to make decisions with respect to

Short term: After 1-2 hrs of home visit, the members of

NURSING INTERVENTIONS • Assess for the history of the event. • Determine

RATIONALE • To obtain baseline data.

METHOD OF FAMILY CONTACT

RESOURCE S REQUIRED

EXPECTED OUTCOME

Home Visit

Time and effort of the student nurses and the family.

Short term: The members of the family shall

reported by Lois O> presence of damaged improvised roof

taking appropriate health actions due to inaccessibili ty of appropriate resources for care specifically cost constraints or economic/ financial inaccessibili ty and failure to comprehen d the nature/ magnitude of the problem.

the family will enumerate measures to prevent fire hazards. Long term: At the end of the 5th home visit, the members of the family will maintain to practice measures to prevent fire hazards.

factors which can contribute to the occurrence of such.

• To determine contributin g factors.

• Enumerate ways to prevent fire hazards:

• To prevent occurrenc e of fire hazards.

Establishmen t of safe cooking facilities. Objects which can contribute to its occurrence should be properly stored. Careful utilization of objects/ equipment that can cause fire hazards.

have enumerate d measures to prevent fire hazards. Long term: The members of the family shall have maintained practice measures to prevent fire hazards.

Problem #7.5 Poor Environmental Sanitation: Lack of Food Storage Facilities

Cues

S: Ø O: >The Family has no refrigerat or >They don’t have cabinet for food storage > Leftover foods were left

Problem Analysis

Inability to recognize the presence of the problem due to:

Objectives

>Inadequat e knowledge about the consequen ce of the problem

Short term: After 2 hours of nursing intervention the family will verbalize understandi ng on the importance of proper storage of food

>Inadequat e financial

Long term: After 1 of

Nursing Interventions

>Establish raport >Assess Food Storage Facilities >Discuss to the family the possibilities of contaminating the food if not properly stored. >Explain the possible consequences and

Rationale

>to gain trust >to obtain baseline data >to develop awareness to the family about the prevention and intervene about it

>to increase their awareness that this could bring about complication to their

Method of Family Contac t Home visits

Resourc es Required

Family Resource s: >plates and plastic food covers Student nurse’s resources : >time and effort with the cooperati on and

Expected Outcome

Short term: The family shall have verbalized understandi ng on the importance of proper storage of food Long term: The family shall have complied with the health teaching

on the table in a plate with cover

resources to avail food storage facilities

home visit, the family will comply with the health teaching given on proper food storage.

complication they may acquire from contaminated food due to improper storage >Encourage covering of food properly with plates or any appropriate

health.

participati on of the family and student nurse.

given on proper food storage..

>to prevent easy spoilage and contamination of the foods

Problem #7.5 Poor Daytime Lighting Condition

Cues

S: Ø

Problem Analysis

Inability to provide a O: home >Upon environme entering nt which is the conducive house it to health was quite maintenanc

Objectives

Short term: After 1 hour of nursing intervention the family will verbalize

Nursing Interventions

Rationale

>Assess lighting condition

>to obtain baseline data

>Allow the family to verbalize some ways to

>to assess family’s compliance on the health teachings given

Method of Family Contac t Home visits

Resourc es Required

Expected Outcome

>Knowled ge and communi cation skills of the student nurse

Short term: The family shall have verbalized understandi ng on the health teaching

dark and there was insufficie nt number of light bulbs >Use of 2 incandes cent lights >Hard to read when inside the house during daytime

e due to inadequate family resources specifically: >Financial constraints/ limited financial resources >Limited physical resources (e.g. bulbs)

understandi ng on the health teaching given regarding the importance of adequate lighting Long term: After 3 of home visits, the family will demonstrat e implementa tion of the means the identified such as opening windows

improve their source of lighting >Identify with the plans to alleviate poor lighting >Instruct the mother to keep the door open during daytime

>Particip ation and acceptanc e of family members

>to include the family in planning and increasing awareness >to provide enough light

>time and effort with the cooperati on and participati on of the family and student nurse.

>to provide enough light

>Encourage mother to open the widows and remove obstruction such as curtains

given regarding the importance of adequate lighting Long term: The family shall have demonstrate d implementat ion of the means the identified such as opening windows

Problem #10: Poor Ventilation due to Economic/ Cost Implication CUES

FAMILY NURSING

OBJECTIVES

NURSING INTERVENTI

RATIONALE

METHOD OF

RESOURCE S

EVALUATION

ANALYSIS S> Ø O>the house has only one window measuring to 60cm x 45cm or 0.27m2 such measurement is less than 10% requirement posited by national building code of the Philippines as The total Floor area is 16.92 m2 >it is quite warm inside the house.

> poor ventilation due to low salience of the problem >lack of adequate knowledge of the importanc e of proper ventilation .

ONS SHORT TERM: After 1 hour, the family will be able to verbalize understandin g about the importance of having adequate ventilation and consequences if having poor ventilation. LONG TERM: After the 3 days of home visit, the family will be able to demonstrate techniques on how to improve proper ventilation.

>Discuss to the family the importance of having good ventilation >Explain the possible consequences of having poor ventilation >Provide health teachings about the significance of adequate ventilation >encourage to Remove unnecessary obstruction which are contained in the windows. >Plan with the family in thinking on ways to improve

>To analyze and realize the ideas regarding the matter >For the family to become aware of the possible consequences >To provide knowledge and realize the benefits of having adequate ventilation >To allow passage of air inside the house.

>Develop participation

FAMILY CONTAC T Home Visits

REQUIRED >knowledge and communicati on skills of the nursing students. >Participatio n and Acceptance of family members >Time and effort of the student nurse and the family.

SHORT TERM: GOAL MET, After 1 hour, the family will verbalized understandin g about the importance of having adequate ventilation and consequences if having poor ventilation. LONG TERM: GOAL MET, After the 3 days of home visit, the family demonstrated techniques on how to improve proper ventilation.

ventilation

on part of the family.

VII. FAMILY COPING INDEX

Category

1. PHYSICAL INDEPENDENCE This category is concerned with the ability to move about, to get out of bed, to take care of daily grooming, walking, etc. Note that it is the family competence that is measured- even though an individual is independent, if the family is able to compensate for this. The family is important-hence, if the focus of care is poor, for instance, if the mother is giving care to a handicapped child that she shared with other members of the family, the independence might be considered incomplete. The causes of independence may vary however. Lack of independence in the family may be due to actual physical incapacity, the inability of “know-how”, the willingness or fear of doing necessary tasks.

Initial 1

3

Final 5

1

3

Justification

5

Initial:



The Family has moderate physical independence ask evidenced by the mother

Is able to provide the family

need on basic needs such a s food preparation nurturing of the children, grooming and the like, but still the mother still lack some more information to proper render this care, because at times the children are still important.



Final: After the health teachings and interventions given by the student nurse the mother’s physical independence increase to an efficient level AEB she was able to maintain her children hygiene.

2. THERAPEUTIC COMPETENCE



Initial: Initially the family has very low therapeutic competence, as the mother

This category includes all the procedures or treatment prescribed for the care of illness, such as giving medications and using appliances, dressings, exercises, and relaxation and special diets.

does not necessary manage the illness of the members in the family, she lacks information on “How to” do such procedure, the family relies on OTC drugs.



Final: On the final visit, After giving all the necessary intervention to correct them previous believe and practices the family was able tom increase their therapeutic

competence.

This

was

supported by the mother as she readily responds to the question given by the student

nurse

regarding

certain

situation. 3. KNOWLEDGE ON HEALTH CONDITION This category is concerned with the particular health condition that is the occasion for care, knowledge of the disease or disability, understanding of communicability of diseases and modes of transmission, understanding of general patterns of development of a newborn baby and the basic needs of infants for physical care and tender loving care.

Initial:



Upon assessing the family knowledge

about

certain

disease,

condition especially those of common diseases. The mother was able to responds on some of the question but still lack of knowledge on how to properly manage such diseases.



Final: Upon final visits with the health teachings given and reinforcement of the knowledge, the family was able to

verbalize on how to manage these disease in case it happen to occur in their family. 4. APPLICATION OF PRINCIPLES OF GENERAL HYGIENE

Initial:



In terms of application of principles of general hygiene the family has an

This is concerned with family action in relation to maintaining family nutrition, securing adequate rest and relaxation for family members and carrying out accepted preventive measures such as immunizations, medical appraisal and safe homemaking habits in relation to storing and preparing food.

idea on how to properly procedure

they

knowledge

on

also the

do the

have

the

importance

of

completing the EPI program



Final: After

health

teaching

were

given

appropriate intervention, during the final visit the family is now knowledgeable on properly do the procedures, application of

procedure

in

general

of

its

importance. 5. HEALTH ATTITUDES This category is concerned with the way the family feels about health care in general, including preventive services, care of illness and public health measures.

Initial:



The family has a bright idea about health are, only they do not know how to improve and practice this activity



Final: The final visits the family has able to verbalize the health teaching render, eg. It is important to address antibiotics about health care must be definitely to the health centre for clarification

6. EMOTIONAL

COMPETENCE This category has to do with the maturity and integrity with which the members of the family are able to meet the usual stresses and problems of life, and to plan for happy and fruitful living. This involves the degree to which individuals accept the necessary disciplines imposed by one’s family and culture; the development and maintenance of individual responsibility and decision; and willingness to meet reasonable obligations, to accept adversity with fortitude, and to consider the needs of others as well as one’s own.





Initially, the student nurses observed that the family has a high emotional competence AEB how the family face their problem with enthusiasm and positive behavior no matter how difficult the problem is in which the family was able to maintain up to the last visit.

7. FAMILY LIVING This category is concerned largely with the interpersonal or group aspects of family lifehow well the members of the family get along with one another, the ways in which they make decisions affecting the family as a whole, the degree to which they support one another and do things as a family, the degree of respect and affection the show for one another, the ways in which the manage the family budget, the kind of discipline that prevails.





Initially, the family was observed that they have an excellent family living AEB the family regards a high respect to one another, they support one another and do things as a family especially when it comes to decision making. The family was able to maintain this up until the final visit.

8. PHYSICAL ENVIRONMENT



Initial: Initially,

This category is concerned with the home and community or work environment as it affects family health. This includes the conditions for housing, presence of accident hazards, screening, plumbing, facilities of cooking and for privacy; level of community (deteriorated or modern, presence of social hazards such as bars, street gangs, delinquency, pest such as rats, etc.), availability and conditions of schools and transportation.

the

family’s

physical

environment has a fair grade. This is due

to

the

presence

of

accident

hazards, level of storage facilities. Transportation is also difficult; the family

uses

the

public

mode

of

transportation.



Final: An improvement was observed after the health teachings.

9. USE OF COMMUNITY FACILITIES This category has to do with the degree to which family members know about and the wisdom with which they use available community resources for health, education, and welfare. The coping ability does not indicate the level of the need for services, but rather the degree to which they can cope when they must seek such aid.



Initial: Initially, the family does not have enough knowledge on what are the available programs in the community that they could avail, though they have



some ideas of the barangay programs. Final: During

the

final

visit,

of

the

dissemination programs

that

they

after

the

barangay could

avail

especially of that health related, the family is now knowledgeable of this and has

developed

programs.

interest

on

these

VIII. LEARNING DERIVED I personally learned the importance of the family in the society, as the basic unit of the society, it is important to maintain the health of the family. Comparing the family with the human body, as when one part of the body is infected, later on the whole body will be affected systemically, just like with the family and society, when a family is considered ill, later on the society will be systemically affected. I also learned the importance of good communicating skill. With the absence of a good communicating skill the student nurse will not be able to establish rapport with his/ her client, thus affecting the assessment process, making the problem identification and prioritization be difficult, thus, altering the maximum care you may give to the family. Assessment is the very crucial part of doing the family case analysis, with all the data that you will gather throughout the assessment process, there you will derived the problems you will intervene to correct this problems. The most important thing that a student nurse must have is the initiative, time, effort, and patience, without those things you will not be able to gather all the information you need, the client’s cooperation and compliance is also a vital ingredients for the success of making a family case analysis. Carl Elexer Ano

At first, it was again, quite difficult for me to adjust from hospital environment to community setting. After 2 consecutive rotations in the ward, all I could ever think of was doing SOAPIEs and charting, making endless nursing care plans, administering meds- you get the idea. However, in making Family Case Analysis, I realized that I could be of more help if I would focus more on the family rather than the individual or the community as a whole, as this fundamental unit making up the society is a buffer between the latter two, giving rise to a more efficient catalyst I hope to become, even in just my small ways. Finding a family was hard, and the intolerable heat was unnerving, and didn’t help at all. It was quite of a feeling of hopelessness and lose that we weren’t able to find a family on the first day, or let me rephrase that, “a SUITABLE family…” The first foster family we had was so depressed that we ourselves weren’t sure if we could help them. The mother wasn’t also much of a reliable source of information for she must have mental problems based on her words and actions. Our second foster family- the Griffin family, was really nice and accommodating. They were an inspiration to us, especially Mother Lois. She always has this hopeful note in her words that everything will be all right when the time comes, and despite the fact they are poor, that wouldn’t hinder her to always wear a smile and face the world with happiness and courage. In making the FCA for the second time, it was a real reinforcement of establishing rapport with the family as we have to visit them for two weeks. Perhaps, it was hard for them to treat us like we weren’t a bother at all; as of course, people always have better things to do. Still, I’ve learned the value of kindness and optimism through them, beyond physical examinations, problem identification and priority setting. However trite this may sound, I can say that somehow, God has made the family an instrument so I will bear in mind the fact that some families have real problems, and I was chosen to try to do something about them.  Ariane Camille M. Calma

In Sapalibutad you can learn many things if you put yourself into it”. The lesson that I have learned in the community and to our adopted family because through them I came to realize that simple things could be a meaningful one. At first, I was wondering how to adjust myself to different situations that I will be going to experience. But moreover, I was able to appreciate more things because of these experiences. I learned to value those, which are essential, and the family had taught me that the value of simplicity of life does not hinder a person to maintain happiness and always can smile through life passes. Requelito A. Dizon Jr

Family Case Analysis is not just about accomplishing the paper but it involves more of indulging or integrating yourself into the life of the family you adopted so that you personally discover problems which will allow you to do your nursing role. The student nurses have learned that a Family Case Analysis entails hard work. Thorough assessment is truly important to identify the problems of the family with appropriate nursing interventions. Through the student nurses’ exposure to various families, they also learned that community health nurses, are the key persons in the provision of comprehensive and continuous family health care. Thus, a genuine concern and proper coordination is needed for the efficacious delivery of care.

Michelle Louie Sotto

“There is no higher Religion than human service to work for the common good is the greatest creed” –George Shinn Community Health Nursing has made me recognized the importance of nurses and health care providers especially in rendering health to the public. Indeed I felt so very importance to the family. I also had experienced living in the resettlement areas in which they have to live in the narrow alley. I never knew how lucky I was not until I experienced it. I also felt the warmth with the family worked with us so that they would be able to sustain and maintain wellness. I believe that in order for all the people to reach the top we have to work hand in hand. It was good to see how much we change and impact their lives. Indeed helping other people is never been a vain. Noel Leoncio Q. Balilo

The family is a social group, is universal and it is significant element in man’s social life. In every part of the world it consists of family. This family case analysis has given us another new experience. It given us a chance not only to learn and to put into practice all the things that we learn from school but it has also provided us an opportunity to help people who are really in need. This is a activity which will make you realize many reality in our life. It made me understand how lucky I am with the family I have, a family which is so perfect for me to say. After being immerse in this kind of activity, there are many thing that I have learned about life. Upon on what we have witness on the family that we had encountered. Life is not that easy. You must make some effort in order to survive. It’s not the material things, the fame, fortune and power that makes us completely happy, but the thought of having helped someone who is in great need of us. We honestly haven’t been happier that we are right now, because of the pleasure we have knowing that we have helped people in our own little way.

Kristina Edna C. Cabrera

Through family case analysis, the student nurses learned how to develop communication skills and how to deal with every individual in the proper way. Moreover, with the family’s economic condition, the student nurse learned that being poor is not a hindrance to achieve and build relationships and a healthy and satisfying life.

Doing a Family Case Analysis proved that theories are not enough to have the courage to face all the trials in life. Basically, it was an experience that served as an eye opener for the student nurses to deeply feel the true impact of poverty. This activity also served as an opportunity for them to enhance their critical thinking and socialization to understand and somewhat abate a family’s certain condition. Luigi Miguel H. de Jesus

As I was exposed in the community for almost 9 days, I’ve encountered a lot of people and I had the chance to assess either pregnant women, sick children or hypertensive individuals. I had the chance to see the deficits, threats to health of the family we have adopted. I also learned how to properly assess a house and its family members, on how important health is with the family. Through interacting with the family we adopted, I’ve implied different nursing interventions taught to us, we had health teachings to promote health and prevent illness, and also we cleaned the environment together with them to maintain proper management of the surroundings. In the community, we are able to meet the health needs of the people in our own little ways; we are able to help them even in small ways. With that, I have learned that nursing is not just a profession taught to gain income rather it is giving compassion and service to our countrymen. I also learned a lot in the different techniques on how to establish rapport to families and how to teach them regarding family planning, proper hygiene and prevention of communicable diseases. I’ve learned that many of us are lacking knowledge regarding promotive and preventive measures to maintain good health, so it is indeed necessary for us nurses to render care and give appropriate interventions and management for them to achieve health. To sum it all up, in my exposure in the community, I’ve learned so much on how to be a competent community health nurse through the experiences I had. -Florence Ancel Estrada

I realized the importance of having a stable job in order to adequately provide the individuals needs of family members. It is also equally important to plan on how many children that the couple could support with their present resources. I have also pondered on the family’s situation which made me thankful n where I am right now. Discrimination aside, I appreciate the efforts of my parents in providing me all that they could give for me to have a better future. It has been seen by our group how the children are undernourished and how inadequate their housing condition is. This has made me realize the implications on what could happen if a family would not be able to meet their individual needs. The children are always the one who suffers greatly for their health and education are always compromised with such poor condition. It must be responsibility of both parents to give their best in supporting their children. I have been and still fortunate that parents had given me the opportunity to be educated even though they are having difficulties in working. This made me realize that as a student nurse. I could help change the community by exerting efforts to educate the families on how to improve their condition amidst the lack of financial resources. It is true, indeed that the primary responsibility in shaping an individual’s value of health comes from their own families. Being a PHN is also like handling a patient in a hospital, the only difference is that you handle the whole family itself that you adopted. And the main goal is not just curing the patient but also helping the family in preventing other potential problems that may arise, and to also help them in coping from the instances in this fast paced world. Mary Angelica Teoffy R. Libres

Through this experience, I have learned, discovered, and appreciated many things. I have learned the importance of proper communication in dealing with the family or other individuals and I also learned the importance of health teachings and how it can affect the behavior and viewpoints of the family. Since the family are total strangers, importance has to be emphasized on building trust, this may be a vital point in coordinating with the family and in achieving the plans you have made with the family. Since the period of the home visits consists only of a few days, it is important to give your best in achieving self-reliance and also compliance to every health teaching given. Compliance is an important thing I saw through this experience, seeing the family have a change in behaviour even without reminding them is a something when achieved very satisfying. There are so much to learn in immersing yourself in an economically depressed area but the most important thing is to be thankful with our condition in life because not all people experiences the good life we have. Daniel T. Palcis

Community Health Nursing is not a simple act or Nursing service rendered by either Registered Nurses or Student Nurses. The primary objective of community Health Nursing in a large sense is to promote the primary level of prevention, Health promotion, and also continuation of Health care from the Hospital. Community Health Nursing provides awareness and knowledge regarding the current health situation of he community. As student Nurses, and as members of the health care team, our responsibility is to promote and provide quality care. Even if we are still student nurses, we already have the capacity to change, manipulate or improve the health situation of the community. We should always take part and take in to consideration all of the nursing tasks that we perform. Student nurses should love their craft or the art of nursing per se in order to provide efficient nursing care. The community health should be one of the primary objectives of a nurse. A healthy mind and body contributes to the over-all heath of a person. As student nurses we should always take part and never ignore the current over-all status of the community because a healthy community also reflects the health service provided by the health sectors or providers. Preciosa C. Valencia

IX. SOCIOGRAM:

This chapter illustrates graphic representation of the several home visits made, including the interactions of the student nurses with the families, the assessment, planning, interventions and evaluation done.

Legends:

Student Nurses

Griffin Family

Home

Assessment & Nursing Interventions

Implementations

Health Teachings

Satisfaction

Rapport

Finding a family to fit the criteria, or are more than willing to be a part of the student nurses’ education is quite of a dilemma. The student nurses had a hard time doing so, but all complaints dissolved when they have found one. The student nurses firstly, established rapport with family they chose to study. On the succeeding days, health teachings were dispensed, thorough assessment and nursing interventions were done and implementations to address problems were executed to help alleviate the condition of the family, even just for a bit. Finally, on the last day of visit they’ve evaluated each problem’s progress in terms of its degree compared to their first day of visit and in here they’ve found out that some problems such as personal hygiene and home environment had improved, leading to an increased family satisfaction.

X. SPOT MAP AND DOCUMENTATION

FLOOR PLAN

Entrance

Small Garden

Door Window Cooking Area Bedroom /Living Room Bedroom/ Livingroom

Kitchen Kitchen

Bed

Wall Comfort ComfortRoom Room

Backyard/Garden

Griffin family’s humble abode

Entertainment corner

Interview with Mother Lois

The comfort room where laundry is

Cookware devoid of cooking facility

Homemade cooking facility using charcoal or wood

Wound Dressing

Vital signs taking

Aftermath of an unattended cooking

The house’s only window

Wound Dressing Part II

Stewie taking a bath on the heat of summer

Meg also in for a refreshing bath

The student nurse with some home essentials for the family.

Coolness!

Hairdressing stint for Meg

The Griffin family with the student nurses

Sweeping the floor.

XI. BIBLIOGRAPHY

Untalan, A. Concepts and Guidelines in COPAR. 1st ed. Manila: Educational Publishing House, 2005. Maglaya, A. Nursing Practice in the Community. Marikina City: Argonauta Corp., 2004. Cuevas, F. et. al. Public Health Nursing in the Philippines. 10th ed. Philippines: 2007 http://wisdomquotes.com http://psychology.about.com/od/theoriesofpersonality/ss/psychosexualdev.htm http://psychology.about.com/od/theoriesofpersonality/a/psychosocial.htm

Handouts from: Primary Health Care II (2007-2008)