Family Case Analysis

I. Introduction Family, as defined by Encarta, is a group of people who are closely related by birth, marriage or adoption, functioning as a single household, and usually consisting of parents and their children. While on the other hand, a family case analysis is a determination of the nature of a problem occurring in families and implying some possible solutions about the problem, and to analyze some observable cases of that particular family, who may be in need of medical intervention and attention. And so, as student public health nurses currently taking up HECA-101A, our assignment is to conduct family case analyses on families residing in several Barangays in Olongapo City. We were assigned to hold a family case analysis to one of the families living in Old Cabalan, Olongapo City. As early as 8:00 in the morning, a day so wet because of the rain brought by typhoon Hannah, the group, amidst the bad weather, has decided to continue the trip down to Old Cabalan. The trip will not mean an enjoyable one! Though can be tagged as an “enjoyable journey” through adventures waiting for us – and we guess these may include wet steep streets of slop 45◦, houses to look for, and the selection of the right home for the right family case analysis. And our guess was right, as we arrived at our destination, Sir Serano introduced as to some Barangay staff, present there at Old Cabalan Barangay hall. To look for the house of the right family is our first main task. Old Cabalan is not just a four-cornered room-sized barangay. To find the right family is not an easy task, but how lucky we are that as we walked to the mountainous terrain of Old Cabalan, we found a humbled home consisting of a hospitable family who are willing to cooperate for the task that we are going to render.

II. Family Structure and Organization

Family Name: Omagap Family Address: #2186 Narra Lane, Purok II Old Cabalan, Olongapo City Family Data: Length of residency: 1987 Family Size: 11 Religion: Husband: Iglesia ni Cristo Wife: Iglesia ni Cristo Place of Origin: Husband: Ilo-ilo Wife: Leyte Type of Family Structure: Patriarchal, Extended General Family Relationship/Dynamic: Criteria 1. Observable conflicts between Family Members a. Wife Husband Beating b. Frequent quarreling c. Child abuse 2. Characteristics of Communication a. Open communication among family members b. Swearing or use of insults when talking to each other

Yes

No √ √ √

√ √

The chart below represents the Family Structure of Mr. Omagap’s family. Name Ricardo Omagap Leoncia Omagap Leorilyn Omagap Richard Omagap

Ag e

Se x

Civil Status

Educational Attainment

Position

49 M

Married

Father

45 F

Married

Mother

23 F

Married

Eldest

2nd year High school 1st year High school 4th year High school

22 M

Single

2nd Eldest

6th Grade

Occupation Construction Worker/ Painter Laundry Woman Factory Worker Construction Worker

Mark Ron Omagap Maria Mae Omagap Maria Rica Omagap Greggy Omagap Dennis Omagap Mary Omagap Christian Omagap Jody Omagap

21 M

Single

3rd Eldest

19 F

4th Eldest

17 F

Single Live in

5th Eldest

1st year High school 2nd year High school 1st year High school

16 M

Single

6th Eldest

6th Grade

14 M 13 F

Single Single

7th Eldest 8th Eldest

6th Grade 6th Grade

12 M 1 F

Single Single

Youngest 6th Grade Grandchild

Construction Worker Snack Vendor

The Omagap family, as any other basic unit of the society, is lead by a responsible father personified by Mr. Ricardo Omagap. By definition, this large family composed of twelve members, can be classified as patriarchal for the main existing fact that most of the matters relating to the conclusive judgment of the family such as health decisions, and everyday life decisions are vested upon more to the authority of the father. Mr. Ricardo and Mrs. Leonicia, at the age of 49 and 45 respectively, are already grandparents to the child of their fifth sibling – Maria Rica Omagap, 17 – whose live-in partner does not live in the same residential address of the family. But this situation could be tagged as “Extended”. It also fits the criteria of an extended family, and can be classified under this category. Maria Rica and her daughter Jody Omagap still reside in the home of the Omagaps. Adding more spaces and seeking for support. While on the other hand, the eldest sibling of the Omagap family, Lerylin, was already married and that they have separated themselves from the family. Although Mang Ricardo heads a family of many members, this large number has not impeded the formation of a peaceful and organized family. No observable conflict among family members, and that there are no impaired communications nor there any communication – isolated cases evident in some members. These were observed at the date and time of the home visit. III. Socioeconomic and Cultural factors Monthly Family Income Source Husband: Php 220 Wife: Php 300

Others: 2nd Eldest: Php 220, 6th Eldest: Php 220, 7th Eldest: Php 100 Total: Below Php 5,000 Felt Family Needs: 1. Trabaho/ dagdag na kita 2. Gamot 3. Pagkain 4. Bahay Though Mang Ricardo heads a family of twelve members including him, this large number has not impeded the formation of a peaceful and organized family. It is pretty obvious that because of the low education attainment of all members, this unfortunate fate has resulted in a problem of not having enough financial support for the family. And that the loss of a permanent job for the legal-age members of the family is the main consequence of that previous problem. As indicated in the table under the topic family structure, characteristics and dynamics, only five members of the family have their own jobs. Unfortunately, Leorilyn, the eldest sibling of the family has already separated and now working as a factory worker for her family. But even these jobs could not be considered as “jobs” for they are not permanent; for they could not earn enough money to support the physiological and basic needs of the family. Approximately, the average monthly income of the family changes form less than or equal to Php 8,000 to less than or equal to Php 10,000. Mrs. Leoncia only earns Php 300/ week from her laundry. Mang Ricardo on the other hand should earn Php 5280/ month if, and only if, he is a regular construction worker. The same is true with his two sons. Unfortunately, this is not what is happening. The truth is, they’re just few of the victims of the “not so good” system in the Philippines. Financial resources problem is getting serious. It has resulted in chain problems vested upon the loss of a job. “…gusto ko talaga number one ang trabaho”, uttered by Mang Ricardo as we asked him about the top ten needs of the family, a very smart answer to a question which most people would definitely put financial needs on the number one spot. “Kung may trabaho ka, magkakaroon ka ng pera at kung ano pa ang gugustuhin mo”, he concluded. IV. Home and Environmental Factors House: Others: Caretaker Type of Housing Material: Mixed

What appliances are owned by the family? Television, Radio, Cellular phone Type of Garbage Disposal: Collected Type of Toilet Facility: Water sealed Type of drainage system: Open Source of Water Supply: Shared Source of Drinking Water: Tap Water Food Storage: Covered Is there presence of breeding sites for Pests? Yes What Common household pest is present in the household? Cockroach, Rats, Lizards, Ants Where does the family keep their pets? Household Are there accident hazards present? Yes, stairs; whole structure of the house. Kind of Neighborhood Social and Healthy Facilities Available Facilities

Urban Brgy. Center, Basketball Court, Plaza Jeepneys

Awareness of Community Organization Are you aware of existing organizations in your community? No Are you a member of any of these organizations? No Name community members whom you think are able to lead the people 1. Kagawad Alba 2. Purok Leader 3. Manugang As defined in Dorland’s Dictionary, 28th Edition, an environment is the sum total of al conditions and elements which make up the surroundings and influence the development and actions of an individual. Making this definition as basis, the student public health nurses therefore foresee that

home and environmental factors reflects and greatly affects the health condition of an individual and family living on a certain area. The humble home of the Omagap family is located at # 2186 Nara Lane, Purok II, Old Cabalan, Olongapo City. They have been residing at this mixed type house structure made mostly of wood for almost twenty years. Although they do not own the house and lot, and are named as caretakers, it has been home to them for quite some time. A television, a radio and a mobile phone are the appliances that they own which serve as their source of leisure and fun when there are household chores to accomplish. As a productive family, continuous waste disposal is frequent. They have appropriate garbage receptacles and that garbage is being collected during Wednesdays and Saturdays by garbage collectors. Their toilet facility is not located inside the house. A water sealed toilet, no lighting and scarce toiletries are all to be seen inside. Their drainage system is open, meaning to say that the wastes which are being disposed by the family is directly open to the external environment for there are no pipes conducting the wastes to the proper disposal area. The water they are using for their daily use are not owned by them, they are sharing water from their neighbor who is subscribing to Subic water Inc. and like any other family living in that area, they are using tap water as their daily source of drinking water. Despite the fact that their home appliances are only a television, a radio and a mobile phone, they have no appropriate means of food storage like a refrigerator. Their only means of food storage are disposable plastic containers and sometimes, they don’t even have a chance to store their food because they just prepare food that is enough for the family in the span of a day. Pests such as cockroaches, rats, lizards and ants obviously cannot be avoided, but they have their cats to fight these health threatening pests. A lactating bitch of nine puppies, named Punying, is present and has found a place beneath the steep staircase of the house. The external environment is filled with a small farm, some greenery and oxygen giving trees which is good for the health. The sidewalks in the community are clean but are occasionally present with dog feces and there are proper receptacles of garbage. The neighborhood is very friendly to the family, and they have said that some of them have helped during their times of shortcomings. The barangay health center is just a few blocks away from the Omagap family’s home and a doctor is present in the center only once a week, which may not be sufficient to handle the health problems of the residents of Old Cabalan. As student Public health nurses, assessment plats a big role in the family case analysis for us to determine if some factors may be health threatening. Accident hazards are present in their environment because of the location of their house is on the foot of the mountain, which may be prone to landslides and their house being old, materials are continuously aging making the house’s foundation weak.

V. Health Assessment Family Dietary Habits Your Diet usually composes of? Breakfast: Sinangag, Pandesal, Tuyo, Kape Lunch: Talbos, Malunggay, Kanin Supper: Same in Lunch sometimes Family Health History Name of Family Member Ricardo Omagap Jody Omagap

Health History TB, Kidney Stone Bronchopneumonia

Health and Health Practices Common Illness encountered for the last six months and treatment rendered Illness Treatment Colds Medicines; Herbal Medicines Fever Who do you consult for health related problems? Nurse For problems other than health who do you consult? Relatives Immunization Status of the Family Family Member All family Members

Type of Immunization Complete Immunization

Do your family members have enough? 1. Rest and Sleep? Yes If yes, how many hours/night? 8 hours 2. Exercise? Yes If yes, what type of exercise? Lakad-lakad lang 3. Relaxation Activities? Yes 4. Stress Management activities? Yes A. Present Illness Name

Problem

Belief

Medical Attendance

Remarks

Ricardo Omagap

Untreated Tuberculosi s

Prolonged Cough

Jody Omagap

Asthma, Allergies cough and and colds weather condition

Partial

He had undergone treatment but is was discontinued due to economic problem Due to weather changes from time to time, she experience cough and cold and wasn’t able to cure well because of lack of knowledge

Partial

B. Past Ilness Name

Problem

Belief

Medical Attendance With

Jody Omagap

Bronchopneumoni a

Ricardo Omagap

Kidney stone

Neglected perspiratio n at the back From salty With Foods

Remarks Treated

treated

C. Infant Feeding All children experienced breastfeeding and also given milk through bottle feeding when their mother is not around D. Immunization Status According to Ricardo, all of his children had completed the vaccines during their infancy from the Barangay Health Center VI. Awareness of Community Organization As Iglesia ni Cristo members, the Omagap family isn’t aware of any existing community organizations. They have told us that the reason that they are not aware because organizations have a political influence which is not allowed in their sect. although they have nothing against other organizations, they just want to protect what they believe in. that is why, if ever they are aware of any organizations, they would definitely not become a member of it. But they are aware of the projects existing in their community, but not of the organizations that have provided them. VII. Values Attitudes, Beliefs and Practices

As we approached the family, Mary, the second youngest welcomed us with warmth and respect. Their father, Ricardo, accepted and cooperated with us without hesitation. He even made us felt comfortable which shows the hospitality of the Filipinos. The members of the family are all Iglesia ni Cristo. They go to their church twice a week and they are very religious. Their faith to God is the only thing that they can be proud of. They also value education but because of indigence, they can’t send all their children to school. When one of the family members got sick, they don’t go to quack doctors because it is against their religion. And because of poverty, they can’t afford to go to doctors for check-up. They will just go to the ministers of their church and will pray for the sick. They also use herbal medicine to cure their illness. Maybe because of an existing fact that the Omagap family has acquired the values and traditions of becoming an Iglesia ni Cristo, a religion which on the perception of many people has lived the strict compliance of rules set by the most high authority of their church for the benefits of their general members, one could almost say that this family is really a religious unit of the society. They knew the meaning of the word “samahan” (organization). They knew that there are certain “samahan” existing in their barangay. Ask if they knew the functions and purposes of the said organizations, they will give you the sure yes! Ask for the specific names of those organizations, they will give you an innocent answer, as if organizations were not existent. But ask if they are affiliated with such organizations and that they are attending their programs and activities, they will give you a very simple answer – “Bawal po sa amin! May bahid po kasi ng pulitika ang mga samahan!” a proof of values capacitated by the family. VIII. Family Health Problem Problem 1. Cough and Cold

First Level Second level Assessment Assessment Health Threat Failure to utilize community resources for health due to lack of or inadequate family resources, specifically financial resources such as cost of medicine prescribed

2. Untreated Tuberculosis

Health Deficit

Failure to utilize community resources for health due to lack of or inadequate family resources, specifically financial resources such as cost of medicine prescribed

3. Threat of cross Health Threat infection from a communicable disease case

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

4. Family size Health Threat beyond what family resources can adequately provide

Failure to utilize community resources for health due to lack of or inadequate family resources, specifically financial resources such as cost of medicine prescribed

5. Accident hazards hazards)

Inability to provide a home/ environment conducive to health maintenance and personal development due to lack of inadequate knowledge of preventive measures and inadequate family resources specifically financial constraints/ limited financial resources Failure to utilize community resources for health due to lack of or inadequate family resources, specifically financial resources such as cost of medicine prescribed

Health Threat (fall

6. inadequate food Health Threat intake both in quality and quantity

7. Family habits

eating Health Threat

Failure to utilize community resources for health due to lack of or inadequate family resources, specifically financial resources such as cost of medicine prescribed

8. Poor home/ Health Threat environmental condition/ sanitation specifically inadequate living space

Inability to provide a home/ environment conducive to health maintenance and personal development due to lack of skill in carrying out measures to improve home environment and inadequate family resources specifically financial constraints/ limited financial resources.

9. Unhealthy Health Threat lifestyle and personal habits/ practices specifically cigarette smoking 10.Loss of Job Foreseeable Crisis

Inability to recognize the presence of the condition or problem due to attitude/ philosophy in life which hinders recognition/ acceptance of a problem Inability to make decisions with respect to having appropriate action due to feeling of confusion, helplessness and/or resignation brought about by perceived magnitude/ severity of the situation / problem

IX. Physical Assessment Name: Ricardo Omagap Age: 49 years old Vital Signs: BP: 120/70 mmHg RR: 16cpm PR: 63 bpm Temp: 36.4 ° C Skin: dry and wrinkled skin, brown complexion Scalp: no infection or infestation Hair: presence of alophecia, thin, smooth Eyes: symmetrical, pinkish conjunctiva, normal ocular movement Ears: symmetrical, color is same as facial skin, cerumen is dry Nose: symmetrical, moist mucosa, presence of colds Mouth: presence of cavities, incomplete number of teeth, dry oral mucosa, brownish lips Throat: no inflammation of tonsil and throat Neck: neck muscles are equal in strength Heart: heart sounds are audible with the use of stethoscope

Lungs: no adventitious sound Extremities: body parts are proportioned with one another, no abnormalities Name: Leonicia Omagap Age: 45 years old Vital Signs: BP: 130/90 mmHg RR: 15 cpm PR: 64 bpm Temp: 36.5° C Skin: dry and wrinkled skin, brown in complexion Scalp: presence of infestation Hair: dry, thin Eyes: symmetrical, pinkish conjunctiva, normal ocular movement Ears: symmetrical, color is same as facial skin, cerumen is dry Nose: symmetrical, no discharge, moist mucosa Mouth: presence of cavities, dry oral mucosa Throat: no inflammation of tonsil and throat Neck: neck muscles are equal in strength Heart: heart sounds are audible with stethoscope Lungs: no adventitious sound Extremities: body parts are in proportion with one another, no abnormalities Name: Richard Omagap Age: 22 years old Vital Signs: BP: 120/80 mmHg RR: 17 cpm PR: 62 bpm Temp: 36.8° C Skin: brown complexion Scalp: no infection or infestation Hair: dry Eyes: symmetrical, pale conjunctiva, normal ocular movement Ears: symmetrical, color is same as facial skin, dry cerumen Nose: symmetrical, no discharge, moist mucosa Mouth: presence of cavities Throat: no inflammation of tonsil and throat Neck: neck muscles are equal in strength Heart: heart sounds are audible with the use of stethoscope Lungs: no adventitious sound Extremities: body parts are proportion with one another, no abnormalities Name: Mark Ron Omagap Age: 21 years old Vital Signs: BP: 110/70 mmHg RR: 16 cpm PR: 62 cpm Temp: 36.7° C Skin: brown complexion Scalp: presence of infestation, dandruff Hair: dry Eyes: symmetrical, pinkish conjunctiva, normal ocular movement Ears: symmetrical, color is same with facial skin, cerumen is dry Nose: symmetrical, no discharge, moist mucosa Mouth: presence of cavities Throat: no inflammation of tonsil and throat

Neck: neck muscles are equal in strength Heart: heart sounds are audible with the use of stethoscope Lungs: no adventitious sound Extremities: body parts are in proportion with one another, no abnormalities Name: Maria May Omagap Age: 19 years old Vital Signs: BP: 100/70 mmHg RR: 17 pm PR: 75bpm Temp: 36.5° C Skin: brown complexion Scalp: no infection or infestation Hair: dry Eyes: symmetrical pinkish conjunctiva, normal ocular movement Ears: symmetrical, color is same as facial skin, cerumen is dry Nose: symmetrical, no discharge, moist mucosa Mouth: presence of cavities Throat: no inflammation of tonsils and throat Neck: neck muscles are equal in strength Heart: heart sounds are audible with stethoscope Lungs: no adventitious sound Extremities: body parts are in proportion with one another, no abnormalities Name: Maria Rica Omapag Age: 17 years old Vital Signs: BP: 100/700 mmHg RR: 16 cpm PR: 74 bpm Temp: 36.4° C Skin: brown complexion Scalp: presence of infestation Hair: dry Eyes: symmetrical, pinkish conjunctiva, normal ocular movement Ears: symmetrical, color same as facial skin, cerumen is dry Nose: symmetrical, no discharge, moist mucosa Mouth: presence of cavities, incomplete number of teeth Throat: no inflammation of tonsils and throat Neck: neck muscles are equal in strength Heart: heart sounds are audible with the use of stethoscope Lungs: no adventitious sound Extremities: body parts are in proportion with one another, no abnormalities Name: Dennis Omagap Age: 14 years old Vital Signs: BP: R110/70 mmHg RR: 17 cpm PR: 74 bpm Temp: 36.6° C Skin: brown complexion Scalp: presence of itchiness and lesion Hair: dry Eyes: symmetrical, pinkish conjunctiva, normal ocular movement Ears: symmetrical, color is same as facial skin, cerumen is dry Nose: symmetrical, no discharge, moist mucosa

Mouth: oral mucosa is moist and pink Throat: no inflammation of tonsil and throat Neck: neck muscles are equal in strength Heart: heart sounds are audible with the use of stethoscope Lungs: no adventitious sound Extremities: body parts are in proportion with one another, no abnormalities Name: Mary Omagap Age: 13 years old Vital Signs: BP: 110/70 mmHg RR: 17 cpm PR: 86 bpm Temp: 36.6° C Skin: fair complexion, smooth Scalp: presence of infestation Hair: dry Eyes: symmetrical, pinkish conjunctiva, normal ocular movement Ears: symmetrical, color is same as facial skin, cerumen is dry Nose: symmetrical, no discharge, moist mucosa Mouth: presence of cavities Throat: no inflammation of tonsil and throat Neck: neck muscles are equal in strength Heart: heart sounds are audible with the use of stethoscope Lungs: no adventitious sound Extremities: body parts are in proportion with one another, no abnormalities Name: Christian Omagap Age: 12 years old Vital Signs: BP: 90/60 mmHg RR: 16 cpm PR: 58 bpm Temp: 36.4 ° C Skin: brown complexion Scalp: presence of infestation Hair: smooth Eyes: symmetrical, pinkish conjunctiva, normal ocular movement Ears: symmetrical, color is same as facial skin, cerumen is dry Nose: symmetrical, no discharge, moist mucosa Mouth: presence of cavities, incomplete number of teeth Throat: no inflammation of tonsil and throat Neck: neck muscles are equal in strength Heart: heart sounds are audible with the use of stethoscope Lungs: no adventitious sound Extremities: body parts are in proportion with one another, no abnormalities X. Family Health Problem Prioritization Accident Hazards (e.g. Fall Hazards) Criteria Computation Nature of the 2/3 x 1

Total Score 2/3

Justification It is a health threat

Problem Modifiability the Problem

of

Preventive Potential Salience Problem Total =

of

the

2/2 x 2

2

3/3 x 1

1

0/2 x 1

0 3 2/3

Threat of cross-infection from a communicable disease Criteria Computation Total Score Nature of the 2/3 x 1 2/3 Problem Modifiability of 1/2 x 2 1 the Problem

Preventive Potential Salience Problem

of

the

2/3 x 1

2/3

2/2 x 1

1

Total =

Justification It is a health threat They can practice health measures to prevent the spread of communicable disease. There are interventions to prevent the problem. They recognize it as a problem that does not need an immediate attention

3 1/3

Inadequate food intake both in quantity and quality Criteria Computation Total Score Nature of the 2/3 x 1 2/3 Problem Modifiability of ½x2 1 the Problem Preventive Potential Salience Problem

There are interventions to solve the problem. They can utilize preventive measures to avoid this at home. The family do not see this as a problem

of

the

2/3 x 1

2/3

2/2 x1

1

Justification It is a health threat They can provide somehow but still lack. It can be prevented somehow but resources are limited. The family sees it as a problem that requires immediate attention.

Total =

3 1/3

Cigarette/Tobacco Smoking Criteria Computation Nature of the 2/3 x 1 Problem Modifiability of 2/2 x 2 the Problem Preventive Potential Salience Problem Total =

of

the

Total Score 2/3 1

2/3 x 1

2/3

0/2 x 1

0

Justification It is a health threat There are interventions to solve the problem. Smoking can be prevented even little by little. The father does not perceive it as a problem.

3 1/3

Family Size beyond what family resource can adequately provide Criteria Computation Total Score Justification Nature of the 2/3 x 1 2/3 It is a health threat Problem Modifiability of 1/2 x 2 1 There are still more the Problem alternative for food sources that are considered cheap but nutritious. Preventive 1/3 x 1 1/3 They cannot have a Potential stable job. Salience of the 2/2 x 1 1 The family perceives Problem it as a problem needing attention Total = 3 Presence of Stress points / Foreseeable Crisis Situations - Loss of Job Criteria Computation Total Score Justification Nature of the 1/3 x 1 1/3 It is a foreseeable Problem crisis. Modifiability of 1/2 x 2 1 They can only apply the Problem jobs that are contractual. Preventive 2/3 x 1 2/3 They cannot acquire Potential a stable job because of low educational attainment. Salience of the 2/2 x 1 1 The family perceives

Problem Total =

it as problem that requires immediate attention. 3

Poor environmental sanitation e.g. inadequate living space Criteria Computation Total Score Justification Nature of the 2/3 x 1 2/3 It is a health threat Problem Modifiability of 1/2 x 2 1 Some interventions the Problem are available to solve the problem. Preventive 2/3 x 1 2/3 They have a big Potential family size so it is hard to prevent. Salience of the 0/2 x 1 0 The family does not Problem perceive it as problem. Total = 2 1/3