In Servitude Veritas

HOLY TRINITY UNIVERSITY

Puerto Princesa City, Palawan

College of Nursing

In Partial Fulfilment of the Requirements In

Community Health Nursing

NCCN 104

Prepared for:

Mr. Roger Castro, RN,

Clinical Instructor

Prepared by:

Rosco, Llewellyn Iris R.

BSN-2D

FIRST SEMESTER A.Y. 2022-2023

 TABLE OF CONTENTS

Introduction ……………………………………………………………………… 3 - 5

Chapter I: Family Nursing Care Assessment …………………………………… 6 - 15

Chapter II: Prioritization of Family Nursing Diagnoses …………………………16 - 17

Chapter III: Family Nursing Care Plan …………………………………………... 18 - 23

Chapter IV: Summary …………………………………………………………… 24- 25

Bibliography …………………………………………………………………….. 26
 INTRODUCTION

According to Loofbourrow Kayle, a family is a group of people who want and choose to be

together and embraced by a bond so powerful and strong that not even the slightest test of trials or

troubles can breach, Family means nobody gets left behind or forgotten (Feb 2016).

The traditional family consists of a father, a mother, and children. This is the nuclear family

often shown on television as the familial standard. However, the 21st century showcases various

family units, some very different from the standard unit of prior decades. Today, children are often

raised in single-parent homes, by grandparents, or by LGBTQ+ parents. Some families opt to have

no children or cannot have children due to medical or emotional barriers (Kristin McCarthy [Link],

2020).

Family dynamics play a significant role in health and well-being, it is critical for nurses to

understand the various types of families that exist within the community. There are numerous types

of families, each has its own set of requirements. Nurses can provide better care to their patients if

they understand the needs of each type of family.

Family nursing is directed at families whose family members are both healthy and ill.

Individual health and collective health will be influenced by any care given to the family. Family

health is not indexed by the degree of individual health or illness. Family nursing requires that the

nurse manipulate the environment to increase the likelihood of family interaction. In addition to

being competent in the treatment of individual health problems, family nurses must recognize the

reciprocity between the health of individual family members and the collective health of the family

(F. A Davis, 2005).

 Environment and income are seen to have a relationship, it is also well-established that

environment and health are positively related. Focuses on the implications of this for the relationship

between health and income. In the early phases of income growth, the gains in health and the losses

in environmental quality could cancel each other out and this challenges the idea that as incomes

increase health would always improve. To empirically analyze these issues, we estimate a two-stage

least squares model that focuses on the impact of income and the environment on health status, with

the environment being an endogenous variable. Our results show that the environmental stress

variable has a significant negative effect on health status (L. Gangadharan, 2001).

An approach to healthcare known as "family-centered care in the community" places an

emphasis on the patient's family's active participation in all facets of their treatment, going beyond

the clinical environment and into the larger community. It is distinguished by a cooperative

relationship between the patient's family and the medical team to meet the patient's social, emotional,

and physical requirements. In this method, medical professionals actively involve and encourage the

patient's family throughout the healthcare process because they understand the critical role they play

in the patient's health and recovery. Along with giving medical care, this also entails educating,

supporting, and encouraging the family to take an active role in the patient's care and general well-

being.
 OBJECTIVE OF THE CASE STUDY

a) GENERAL OBJECTIVE

The nursing student chose to conduct this family case study in order to demonstrate

community health nursing skills, to provide them an opportunity to learn some fundamental health

etiquette, to explain why they should be conscious of health issues, become aware of their own

strength and weaknesses as a family, empower them and teach them practices that allow them to

maintain their wellness independently and categorize the urgency or be aware of hygiene in the

landfill area. Moreover, this study also gave our group the opportunity to effectively learn things

about a family's various problems and needs in developing their environment and maintaining

wellness, in particular, their health status.

b) SPECIFIC OBJECTIVE

Following the nursing process, students should be able to:

1. Establish a rapport with family

2. Provide family health teaching that can be applied in their everyday lives.

3. Collect the information needed to create the family care plan.

4. Classify the recognized health issues as a health threat, a health deficit, or a rising

crisis.

5. Give the family nursing care that they need.

 CHAPTER 1
FAMILY NURSING CARE ASSESSMENT

FAMILY SURVEY FORM

Name Ordinal Birthday Age Sex Civil Occupation Highest Religion

position (mm/dd/ status Education
yy) attainment

E. B. Head of the 03-24-1968 55 Male Married Farmer 2nd year Junior INC
Jr. Household High school.

P. B. Mother/ 01-01-1975 48 Female Married Farmer Elementary INC

Grandmother graduate.

I. B. Daughter 03-16-2007 16 Female Single Student Junior high INC

school

A. L. Granddaughter 04-30-2013 8 Female Single Student Elementary. INC

B.

The data shows the age, birthday, sexuality, civil status, occupation, education attainment,

and religion of the family. The host family consists of 4 members; they are citizens of Purok Unang

Lahi, Barangay Sta. Lourdes, Puerto Princesa City, Palawan Province. The head of the household is

Mr. E. B. Jr., and with his authority, he’s with his wife, Mrs. P.B., and they both take care of and

love their children and granddaughter under their supervision; their daughter’s name is I. B. and their

granddaughter is D. D. All of the members of the family are Iglesia ni Cristo. The common health

problems of the host family are loose bowel movements, fever, coughs, and colds, as well as

influenza.

The family’s way to dispose of their waste is through dump truck collection; then the water

supply for the family is NAWASA; the distance of the water supply from the toilet facilities is 5

meters. The family owns a toilet in their house, and the house drainage is close. The B. family owns

the house where they live as well as the land where their house is built. The type of housing for the B

family is semi-concrete with two rooms.

 The house is a partially concrete house and constructed using different materials such as

cement as their foundation and floor; wood planks, kawayan, and plywood as their walls; yero that

serves to be their roof; and other materials such as floormats, tela, and telon that were observed in the

area as part of their house structures. In the data on community participation, the family consulted

the barangay health worker first if there was any case of illness, and then the family regularly went to

a barangay health center or hospital for a check-up. In terms of the family’s activeness in the

community, they have rarely participated in the community or barangay activities.

INITIAL DATABASE

A. FAMILY CHARACTERISTICS, MOBILITY, AND DYNAMICS

Name Age Relationship to Head of Household

E. B. Jr. 55 Head of the household

P. B. 48 The wife of the Head/ Mother/ Grandmother

I. B. 16 Daughter

A. L. B. 8 Grandchild/granddaughter

The data above shows the names of the individuals in the family of Mr. E. B. Jr. as well as

the age and position of each individual in the family. From the data above, it is evident that the

family is an extended type of family. According to Michele Meleen, a [Link]., this form of family

relationship is described as complex, joint, and multi-generational, where people live together or

have close connections. This multi-generational family shares a home, sharing responsibilities such

as raising their child and keeping up with household chores, but they are not just limited to a father

or mother; this family could include aunts, uncles, cousins, or other relatives. The emotional bonds

within the family of Mr. E. B. Jr. are strong, joyful, and have a supportive environment with each

other’s passions and dreams, especially for their daughter and granddaughter’s academics. They

found eating together and talking about some stuff as their strength as a family and a medium to
communicate with each other. Both Mr. E.B. and Mrs. P. B. are in positions of authority and power

within the family, but all voices of individuals in the family are heard.

In the family, the decision was made by talking and deciding thoroughly in order to think

about what was best for everyone; this happens through open and personal talking. In terms of

division of labor, everyone has a unique task; older members are responsible for financial aspects,

while younger members are responsible for household chores and light work. Mr. E. B. Jr. and Mrs.

P. B. are the ones who earn the money, but Mrs. P. B. is in charge of the money. Both partners are

sincere in their parental responsibilities and show good parenting. The B. family talks in a composed

manner while beaming with joy.

B. SOCIOECONOMIC AND CULTURAL

Two adults and two children occupy the family's house. The languages that are spoken by the

family are English and Filipino, and beside from that, the family can speak their own dialect, which

is Cuyonon. They can read and write in Tagalog or English. They get along well with their neighbors

because they are close to each other, especially when there is a special event. The host family only

attends church on significant occasions like Christmas and New Year's Eve. Additionally, they are

always open to engaging themselves in barangays, social organization events, or different cultures.

Mr. E. B. Jr. did enroll in high school admission but wasn’t able to finish it, while Mrs. P. B.

did not enroll in high school admission. Both Mr. E. B. Jr. and Mrs. P. B. did not enroll in college

admission, and both are elementary graduates, and Mr. E. B. Jr. is a junior high school undergraduate

as of now. Their daughter is in junior high school, and their granddaughter is at the elementary level.

More than that, Mr. and Mrs. B have previously worked as farmers.
 Monthly Income Monthly Expenses
Family's
Electrical Bill Savings
4% Bill
8% Water
4%
Other Stuffs
25%

50% 50%

Weekly Groceries
60%

Electrical Bill Water Bill Weekly Groceries

Mr. E. B. Jr. Salary Mrs. P. B Salary Other Stuffs Family's Savings

The monthly income for the B. family is twenty thousand pesos (20,000). Mr. E. B. Jr. earns

ten thousand pesos (10, 000) from farming, as does Mrs. P. B. There is no other way the host family

earns money; they only rely on their salary on farming. In the family’s expenses, they spend their

money paying electrical bills of one thousand pesos (1,500) monthly, water bills of eight hundred

pesos (800) monthly, twelve thousand pesos (12, 000) for weekly groceries, five thousand pesos

(5,000) for other expenses like children’s school meals or other unforeseen stuff, while the remaining

seven hundred pesos (700) are for the family’s saving.

The B. family enjoys spending time together at home, playing with their children and

grandchildren, helping them with their homework, and having a deep conversation. As a family that

loves spending time together, there are some occasions that the family loves to celebrate together

including Christmas, New Year's Eve, and birthdays. The B. The family eats vegetables at every

meal as much as possible, such as malunggay, eggplant, potatoes, and okra. according to Mrs. P. B.

After cooking some noodles, she will add some malunggay. The young occasionally have a cough

and fever every time the weather is uncertain and constantly changes. In their backyard, the B family

grows herbs, including oregano for colds and fevers and malunggay, which has been used in soups to

boost the immune system.

C. HOME AND FAMILY ENVIRONMENT

Mr. E. B. Jr. and his wife were living in Unang Lahi, Barangay Sta. Lourdes since when they

get married, they living in the house with their daughter Irish and Althea, their granddaughter. Their

house was built with combined light and concrete materials, such as cement as their foundation and

floor; wood planks, kawayan, and plywood as their walls; yero that serves as their roof; and other

materials such as floormats, fabrics, and telon that were observed in the area as part of their house

structures. Those materials make the house safe and comfortable for the residents and their families.

Their home is divided into three sections: the living room, which serves as their kitchen too, comfort

room and two bedrooms where they all sleep together. The floor of their house is unevenly packed

with cement, bumpy, and has so many cracks, which Mrs. P. B. herself covered with a floor mat,

making the position of the house and furniture unbalanced.

The water source is along with their house and is easy to reach because it is not that far from

their house's toilet and kitchen. The water that they use is sanitized by Mrs. P. B. before use because

they get it from a water district, or NAWASA. They have a clean container that is sealed for drinking

water, as well as a container for washing dishes and so on, which is also covered.

Mr. E. B. Jr. and Mrs. P. B alternately take charge of preparing the food; they use wood to

cook it when they use pugon. Because the family is on a cliff, they do not intend to store food for

such a long period of time because it can easily contaminate, so they feed it to the dogs, but if they

store food, they just use clean containers and put it in their drawer. In terms of garbage disposal, they

gathered their waste in a black bag and brought it to garbage collectors. The B family usually doesn’t

go out just to use the bathroom because they have it in their house.
 Based on the state of Mrs. P. B, the barangay conducts a program to do pest fogging. and she

said that, as far as they could, they made sure they sealed all the water supply so that the mosquitoes

would not occur. Mr. E. B. Jr. and Ms. P. B’s home is in a densely forested area. The B family is at

risk of disease brought by vectors because they live near a landfill and the environment of the area is

jungly. Mr. and Mrs. B. works as a farmer, so they are exposed to health risks because they are

exposed to the great heat of the sun. In addition, the livelihood of the neighborhood is making

charcoal, which can endanger the family's health, especially the children. Since the environment is

very forested, sharp objects and shattered glasses may also put the family at great risk. According to

Mrs. P. B., they run to the barangay health center if it is truly an emergency, but because it is so far

away, they sometimes just do home care for cough and cold, giving them over-the-counter drugs or

make their own decocted herbal medicine made from lagundi, malunggay, ginger, or oregano.

D. FAMILY HEALTH AND HEALTH BEHAVIOR

Both Mr. and Mrs. B. have diabetes and high blood pressure; other than that, the family

seems to have no other hereditary genetic disorders. According to Mrs. P. B., the wife of Mr. E. B.

Jr., and her partner, both parents have a history of diabetes and an abnormal blood pressure range of

130/90 mmHg to 140/100 mmHg, the family has no history of smoking, but the older members of

the family drink alcohol occasionally.

When the student nurse conducted the taking of the vital signs of Mr. and Mrs. B. had

abnormal findings, Mr. B had a blood pressure of 130/90 mmHg, a pulse rate of 66 beats per minute,

a respiration rate of 18 breaths per minute, and a temperature of 36.2 C. while Mrs. B. had a blood

pressure of 140/100 mmHg. Aside from taking vital signs, the student nurse also takes the blood

glucose level of Mr. B. which is 300 mg/dL. However, the student nurse was unable to assess and

test Irish and Althea because they were unavailable due to having a class during the home visit.
 Both household children are showing signs of malnutrition, such as being underweight.

Althea had a visible scar and wound on her hands and feet that appeared to be from sharp things or

caused by shard grass while they were playing outside. When the student nurse conducted a physical

assessment of the skin, hair, and nails of Irish and Althea, they appeared to have dry skin due to

excessive exposure to the sun or to products that had been used on them by Mrs. B.

Mrs. B. said that they seldom go to the barangay clinic for their health needs and for

checkups because the distance from their home to the center is far and the trail to get down is so

slippery and risky. Moreover, Mrs. B. stated that she plants malunggay and oregano in their

backyard. And they use malunggay and oregano as their herbal medicine to treat colds, fevers, et

cetera. The family is prone to diseases caused by vectors and such risks as loose bowel movement,

skin irritation, and accidents with sharp objects like shattered glass and protruding metals in their

environment because they are living in a forested area.

According to Mrs. B, after her husband goes to work, she prepares herself and her children

and grandchildren for school. She cooks their food over a kalan with wood inside their house, which

is one of the risks for their family because their house was partially made from light and flammable

materials.
 HOME VISIT FORM

Name of Age Vital signs Immunization Nursing Present Medical History

Family Status History
Member

E. B. Jr. 55 Temp: 36.2 Unrecalled Diabetic and Hypertension and Diabetic

Pulse rate: 66 bpm unstable blood Type 2
Respiration rate: pressure.
18 bpm
Blood pressure:
130/90 mmHg
SPO2: 98%

P. B. 48 Blood pressure: Complete Urinary Tract Frequently experiencing

140/100 mmHg Infection. headache.
SPO2: 99%
Diabetes Hypertension and Diabetic

I. B. 16 Not able to get VS Complete Asthma and Malnutrition (underweight,

easily to get BMI 16.1)
short breath.

A. L. B. 8 Not able to get VS complete None Malnutrition (underweight,

BMI 12), allergic and skin
irritation sun exposure and
forested environment.

FAMILY HEALTH ASSESSMENT AND FAMILY NURSING DIAGNOSIS

FIRST LEVEL ASSESSMENT CAUSES IDENTIFIED FAMILY NURSING DIAGNOSIS

Objectives: I. Health threats for vector-borne diseases

● The resident of the family is near to related to Poor Home/ Environmental
landfill. Condition/ Sanitation as evidence by presence
● Forested environment/ area. of breeding or nesting sites of vectors of
● Stock waters on bottles or old steer wheels. diseases.
● The family's house doesn’t have any
screen to their windows and doors that
make the vectors easily to get inside the
 house.

SECOND LEVEL ASSESSMENT CAUES IDENTIFIED FAMILY NURSING DIAGNOSIS

Inability to provide a home environment

Subjective Data:
conducive to health maintenance and personal
development due to:
According to Mrs. P. B. “Problema talaga
a) Failure to see benefits of investment in home
naming paligid naming kasi
environment improvement;
napakamasukal”, “Dumadami ang lamok, lalo na
b) Lack of/inadequate knowledge of preventive
kapag ganitong panahon maulan”, “Wala rin kasi
measures.
kaming oras maglinis, hindi mo rin maiasa iyan
c) Lack of supportive relationship among family
sa mga bata kasi pumapasok sa skwela at kami
members
laging nasa bukid.”.

FIRST LEVEL ASSESSMENT CAUES IDENTIFIED FAMILY NURSING DIAGNOSIS

Objectives: II. Poor Sanitation: Improper garbage disposal

● Overflowing trash bins – not emptied as the presence of health threats to the family.
regularly and left without cover.
● Lack of knowledge regarding to proper
segregation of garbage.
● Presence of pest like cockroaches and flies.

SECOND LEVEL ASSESSMENT CAUES IDENTIFIED FAMILY NURSING DIAGNOSIS

Subjective: Inability to provide a home environment

“Dahil na rin siguro diyan kaya nagkakatae tae conducive to health maintenance and personal
ang mga bata kasi andaming langaw na nalipad. development due to:
Hindi ko rin kasi madali dali itapon iyan kasi sa a) Lack and inadequate knowledge of
taas pa kami at mahirap bitbitin kapag walang importance of hygiene and sanitation.
collector” as verbalized by Mrs. P. B. b) Lack of skill in carrying out measures to
improve home environment.
 c) Inadequate family resource.

FIRST LEVEL ASSESSMENT CAUES IDENTIFIED FAMILY NURSING DIAGNOSIS

Objectives: III. Malnutrition as a health deficit

● I. B. BMI
Height – 1.57 m
Weight – 40 kg
BMI = 16.1
● A. L. B. BMI
Height - 91.44
Weight -10
BMI = 12.0
● Children’s skin is dry.
● Thin muscle and fat appearance of body.
● The family's residence is located near a
landfill and dumpsite in deforested area.

SECOND LEVEL ASSESSMENT CAUES IDENTIFIED FAMILY NURSING DIAGNOSIS

Subjective: Inability to recognize the presence of the problem

“bumaba nanaman po iyong timbang ng mga due to lack and inadequate knowledge.
bata gawa ng lagi po silang nagtatae tae, tapos Inability to provide adequate care, recognize and
lagnat din at ubo kapag ganitong panahon ulan maintain the environmental condition of the
araw ulan”, and “mahihilig po kasi iyan sila sa family due to:
coke at chichirya” as verbalized by Mrs. P. B. a) Inadequate knowledge about the health
condition.
b) Inadequate family resources of care.
c) Altered role.
d) Lack of skill in carrying out measures to
improve health.
 CHAPTER II

PRIORITIZATION OF THE FAMILY NURSING DIAGNOSIS

I. Health threats for vector-borne diseases related to Poor Home/ Environmental Condition/
Sanitation as evidence by presence of breeding or nesting sites of vectors of diseases.

CRITERIA COMPUTATION ACTUAL JUSTIFICATION

SCORE

1. Nature of the 3/3x1 1 The problem is about health threats

problem

0. Modifiability 1/2x1 1 The problem is partially modified

of the problem because they live near the landfill
and it needs financial resource to
improve the given problem

0. Preventive 2/3x1 0.66 The problem has a moderate

potential preventive potential, as the solution
to the problem is to provide their
own environment and improve the
area.

0. Salience of the 2/2x1 1 The family shows that it is a

problem problem.

TOTAL SCORE 3.66

II. Poor Sanitation: Improper garbage disposal as the presence of health threats to the family.

CRITERIA COMPUTATION ACTUAL JUSTIFICATION

SCORE

1. Nature of the 3/3x1 1 The problem of is about the risk for

problem the health of the family.

0. Modifiability of 2/2 x 1 1 The problem is modified because it

the problem can be change through proper
 segregation and proper waste
disposal.

0. Preventive 3/3x1 1 The problem has a preventive

potential potential, as the solution to the
problem is to proper segregation and
waste disposal.

0. The salience of 1/2x1 0.5 The family sees the problem as not
the problem that serious or didn’t need
immediate attention.

TOTAL SCORE 3.5

II. Malnutrition as health deficit

CRITERIA COMPUTATION ACTUAL JUSTIFICATION

SCORE

0. Nature of the 3/3x 1 1 The problem is about health threats

problem because of unhealthy lifestyles, and
the inadequate health can affect the
family’s life.

0. Modifiability 2/2x1 1 The problem is easily modified

of the problem because there are opportunities
offered by the barangay that ca to
improve the given problem

0. Preventive 1/3x1 0.33 The problem has a low preventative

potential potential, as the family is so busy
and they can’t perform action to
have solution to the problem.

0. Salience of the 2/2x1 1 The family sees the problem as

problem serious level and need an immediate
action.

TOTAL SCORE 3.33

RANKING OF FAMILY DIAGNOSIS RANK

3.66 Health threats for vector-borne diseases related to Poor Home/ Environmental 1
Condition/ Sanitation as evidence by presence of breeding or nesting sites of
vectors of diseases.
3.5 Poor Sanitation: Improper garbage disposal as the presence of health threats to 2
the family.

3.33 Malnutrition as health deficit 3

 CHAPTER 4

SUMMARY

The B. family is an extended type of family; it comprises not only a father, mother, and

children; it could also consist of aunts, uncles, and grandchildren. However, the setup of the family is

extended due to the multi-generational relatives living in the same house. The dissemination of roles

in the house is even, and even practicing parenthood is still evident. Sharing responsibilities in the

household is not neglected; the members are more than one family. They are residents of Purok

Unang Lahi, Barangay Sta. Lourdes, Puerto Princesa City, Palawan Province. The daily route of the

family is that they work and go to school; the older members are working as farmers, while the

young ones are still studying. The main income that sustains the family comes from the salaries of

Mr. and Mrs. B, and if we sum up, the total income they will get is twenty thousand pesos (20,000

pesos) monthly, which indicates that the family falls below the poverty line.

The B. family regularly goes to the clinic for checkups and frequently participates in

community activities held by the barangay. However, the lack of financial resources and the reason

that they lived in the dumpsites led the family to several problems, one of which was impaired home

maintenance, poor environmental conditions, malnutrition, and a self-care deficit.

The family's access to the water supply is not that difficult, for they own their own faucet and

toilet. With that, they can fetch some water and put it in their container easily, which they will use to

take bath and wash clothes, dishes, and food. The family’s drinking water source is mineral water,

which they will need to buy once in a while.

CONCLUSION

After a series of health teachings, the B family were able to improve their way of life, they

recognize the importance of promoting the health of their family and taking care of their health

which help them to prevent each member of the family from any illness or diseases. The

improvement of their practices and characteristics is evident, they had a hard time adjusting to

changes but they still accomplished improvement in their well-being.

The student nurse was able to recognize the family health issues and provide health

teachings, encouraging and educating the Barcarse family regarding their situation. Moreover, the

team is able to lay down to the host family the possible solution to their problems. And with the

family’s cooperation and willingness to learn, change, and improve their lifestyle the goal of this

study was met.

 BIBLIOGRAPHY

● Amy G. “ List of Family Values” | LoveToKnow. [Link]

values. (2011, March 2).

● Kaylee L.,”The True Meaning Of Family”.The Odyssey Online |

[Link] (2016)

● McCarthy K. [Link]. The Meaning of Family

[Link]://[Link]/about-family-values/meaning-family. (2011,
June 3)

● StudyCorgi. Orem’s Self-Care Deficit Theory in Nursing Practice. Retrieved

from[Link] (2021,
October 1).

● Ellices J. A Family Case Study | Ellices Juan - [Link].

[Link]