Case Study Community Health Nursing

COMMUNITY HEALTH NURSING CASE STUDY

TABLE OF CONTENTS I. II. III. IV. V. VI. VII. VIII. IX. X. XI.

INTRODUCTION BASELINE INFORMATION INITIAL DATA BASE SPOT MAP FIRST LEVEL ASSESSMENT SECOND LEVEL ASSESSMENT PROBLEM PRIORITIZATION TABLE FAMILY NURSING CARE PLAN HOME VISIT FAMILY COPING INDEX RECOMMENDATION

I.

2 3 4 6 8 11 19 20 28 34 35

INTRODUCTION

It is really surprising that today, in our so-called highly standardized society, an increasing number of people feel rejected, depressed and belong to the poverty line here in the Philippines. And the worst thing is that others are unable to see any meaning in life. Did you ever wonder how these people eat every day? How these situations affect the children of this time? Are they satisfied with what they are experiencing right now? Are they not in pain and hunger as

they continue their journey in life? These children desire to eat and play but they don’t have any option at all. All these questions arose as we witnessed all of these scenarios. For approximately 91, 983, 000 people comprising the total population of the Philippines, 32.9 or 9.67% are below the poverty line and it ranks as the number 59 worldwide. Those families belong to the low-socio economic level is the most affected people. These families have little or no access to health services and education and limited prospects for a better life. We, the nursing students play an important role as we practice our learned concepts about the community health nursing. Community health nursing is centered on the individual and family. With the variety of interventions rendered for them, one general objective is fir the family to become self-reliant. Health workers want to emphasize that they should offer their commitment as well as their full support to their co-members for them to attain good health. We decided to chose family Major to be the focus of our study.

Specifically, we aim to: a) Take note the family’s baseline information. b) Identify their health condition. c) Assess if there are presence of health threat, health deficits, wellness condition and foreseeable crisis. d) Prioritize their health-related problems. e) Render effective family nursing care plan. f) Promote health prevention of possible occurrence of diseases. g) Encourage the family to initiate effective problem solving skills to uphold their quality of health and life.

There is really in need for the government, institutions, as well as us student nurses to focus on how these poor voice out their concerns that can affect their lives. The ways and the means that enable the poor to join and work towards better future are the focus of health and development.

II.

NAME

AGE

SEX

BASELINE INFORMATION

RELATIONSHIP

RELIGION

TRIBE

EDUCATION AL

IMMUNIZATIO N

ATTINMENT

2

Mr. M

48yo

Male

Father

Roman

Bisaya

Elementary graduate

Bisaya

Elementary graduate

Complete

Bisaya

4th year Highschool

Complete

Bisaya

2nd year Highschool

Complete

Bisaya

1st year Highscool

Complete

Bisaya

Grade 5

Complete

Bisaya

Grade 2

Complete

Bisaya

Kinder

Complete

Bisaya

Not yet in school

Complete

Catholic Mrs. M

45yo

Female

Mother

Roman Catholic

Child 1

17yo

Male

Eldest

Roman Catholic

Child 2

15yo

Female

Second

Roman Catholic

Child 3

12yo

Female

Third

Roman Catholic

Child 4

10yo

Male

Fourth

Roman

Complete

Catholic Child 5

9yo

Male

Fifth

Roman Catholic

Child 6

6yo

Female

Sixth

Roman Catholic

Child 7

3yo

Female

Seventh

Roman Catholic

Address: Buenbrazo St. San Isidro, Cotabato City Head of the family: Father Source of income: Works as a baker, Works at tailoring Income: Father- 2,800/month Mother-200/day Behavior: The family was cooperative and hospitable enough during the course of assessment.

III.

INITIAL DATABASE

A. Family structure and Characteristics Family M is a nuclear type of family composed of Mr. and Mrs. M and their 7 children. In their family, Mr. M does the decision making and shoulders the expenses of the family. Mr. M is 48 years old and works at the bakery as a baker. While Mrs. M is 45 years old and works on the tailoring shop. Child 1 is 17years old and he is in 4th year high school, Child 2 is 15years old and she is in 2nd year high school, Child 3 is 12years old and she is in 1st year high school, Child 3

4 is 10 years old and he is in Grade 5, Child 5 is 9years old and he is in Grade 2, Child 6 is 6years old and she is in Kinder and Child 7 is 3years old and she is not in school yet. According to them they can eat three times a day but sometimes due to the inadequate income they only eat two times a day. Sometimes there are inadequacy in terms of the amount and quality of foods they are eating. Vegetables like alugbati, malunggay, and kamote tops are their usual viands. Sometimes they have rice sometimes they don’t have. They don’t have any garden in their house. They buy on market or ask to their neighbors. They also eat fish like bolinao, and matambaka. When the children are free, they usually play with their neighbors at the back of their house. Mrs. M used to stay outside their house under the tree when she wants to rest. Mr. M seldom stays on their house. He always works at the bakery.

B. Socio – economic and Cultural Characteristics According to the family, the sources of their income are their works at the bakery and tailoring shop. The father is a baker and the mother works at the tailoring shop. Mrs. M’s daily income is 200 while Mr. M’s monthly income is 2, 800. This money earned by them are the only means for them to eat three times a day. But sometimes if they are short they eat 2 times a day. Mrs. M is the one who is in charge for the budget of their income. There is a time that their income is not enough for their necessities. Mr. M finished elementary education and his wife also. For the kind of educational attainment they have, they don’t expect much for their family. They just want to live a simple life with their 7 children. The religion of the family is Roman Catholic and they are Bisaya.

C. Home and Environmental Factors They already stayed in their house for almost 10 years. Within that span of time, they are paying 300 pesos every month as a house rental. The family resides at San Isidro, Cotabato City. Approximately, there are 263 steps from Casa Blanca. The house is made up of light materials such as bamboo and low quality woods. Their house was not that organize. There are parts which were not properly fixed and nailed. They have 2 doors and 4 windows located at the front and side of the house. There are holes and defects noted at the floor and ceiling of the house. The area of the house is 135x120 which not a conducive area is for 9 people. The family’s surrounding is prone to accident due to several hazards noted. Inside their house, there are things scattered that can be a cause of an accident. There was no furniture present. They cooked outside beside their garbage area. They used “kaldero” upon cooking. They used “kalan” and woods to make fire. They have a source of light. When they sleep they use banig and mosquito nets. They usually go to sleep at around 9pm. They get their drinking water at the “poso”, and sterilized it. They store it in different galloons. For the garbage disposal, they did not separate biodegradable from non-biodegradable garbage. Their comfort room is located outside and at the back of their house. They have bowl and they need to get water to flash it. Their neighbors are meters away from them.

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D. Health status and Medical history According to the client, her children’s usual complaints are fever, cough, and colds. Mr. M’s usual complain is headache and Mrs. M’s usual complaint is dizziness. These health problems might be related to the weather and everyday’s activities of the family members. The anthropometric data of the family which measures nutritional status where as follows.

Client

Weight

Height

Mrs. M

39 kg

146 cm

Abdominal Girth 66 cm

Child 4

21 kg

125 cm

55 cm

Child 5

18 kg

115 cm

56 cm

Child 6

16 kg

107 cm

54 cm

Child 7

12 kg

89 cm

53 cm

Classification of BMI Emaciation(less than 14.9) Underweight(1518.4) Normal(18.522.9) Overweight(2327.9)

Obese(27.6-40)

Interpretation 18.30 Normal 13.44 Underweight 14.37 Underweight 13.93 Underweight

15.15 Underweight

Morbidly obese(greater than 40) The table shows that only Mrs. M has a normal BMI, and that her children were underweight. These findings indicate that the family suffers from malnutrition. Even though Mrs. M mentioned that they manage to eat three times a day, still it was not enough because their food were insufficient to satisfy the needs of their growing body. The other members of the family were not included in the table, because they were not there during the home visitation.

E. Values, Habits, Practices and Health Promotion When asked about health practices of their family, they said that for them health is very important as the saying says, “Health is wealth”. But because of the unfortunate situation, they cannot afford to maintain check-ups because of lack of financial capacity. They just consult for medical condition if one of them is sick. Sometimes they failed to do so; instead they selfmedicate which is not supposed to be. Fortunately, they all completed their immunizations.

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IV.

SPOT MAP

Legends: Paths: : San Isidro Ave. : Buenbrazo St. Establishments: A

: Casa Blanca

B

: Rafael’s Pension House

C

: House of the Patient

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V.

Cues/ AMB

 Mother verbalizes “Kapag walang pasok, hindi na sila minsan naliligo kasi puro laro na lang ginagawa nila”

FIRST LEVEL ASSESSMENT

Health Problem

Category

Justification

Poor hygiene

Health Threat

Poor hygiene increases the client’s vulnerability to infection or diseases among children. Too much contact outside the house and expose to soil which contains microbes can cause diseases and illness to the children.

Malnutrition

Health Deficit

Health deficit requires immediate intervention to eliminate further consequences. due to inadequate knowledge on proper nutrition and financial capacity, family is unable to avail the nutritional requirement needed by our body to maintain its normal functioning. If this would be left untreated, it can lead to physical and mental disabilities, then would possibly lead to death.

 Untrimmed nails  Untidy dress  Children don’t wash their faces even with dirt.  Mother verbalized “Minsan lang kami makakain ng isda at karne. Wala kasing pera. Minsan toyo lang at suka. Madalas gulay ang pagkain namin.”  Mother sometimes borrows money for them to buy food and baon of her children.  The father seldom gave his

8

income for their home expenses.  Family income of 2,000 Php a month.  Insufficient food intake both in quality and quantity.

 Mother verbalized “Madami nga lamok lalo na kapag nagaulan.”  Presence of uncovered water containers.

Presence of breeding/ resting sites of vector

Health Threat

It is classified as health threat because mosquito can bring diseases such as dengue Fever and Malaria which can harm the body. The shown cues can be a site for the mosquito to breed. Since that mosquito have the capability to transmit virus, it should have an immediate action.

 Presence of stagnant water in pots.

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 Mother verbalizes “Dito kami nagluluto. Iniingatan na lang naming baka kasimakaabot ang apoy sa bahay naming.”

Accident hazard specifically fire hazard.

Health Threat

Risk for fire poses grave danger not only to health but to life as well. It can happen when the family finishes cooking and the fire is left unattended especially at night.

Health Threat

It is classified as health threat because the children were fun of going upstairs. And even if they wear their slippers, still it is not a protective gear for them, because nails are sharp enough to penetrate in the feet and other parts of the body of the person.

Health Threat

It is classified as health threat because of inadequate knowledge about parenting, there is an increase number of child in the family, thus can lead to inability to support the entire member of the family.

 Kitchen was situated beside their house. House was made up of light materials (Wood)  They use stairs in climbing on their house. The stairs don’t have a handle.

Risk for Injury

 There are large irregular-shaped stones in their ground.

 Mother verbalizes “Marami talaga sila magkakapatid. Pito sila. Tapos ang tatay nila minsan lang magbigay ng pera.”

Ineffective parenting

 Mother refuses to have tubal ligation.

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 Failure to do handwashing before and after eating.

Risk for food and waterborne diseases

Health Threat

The problem it classified as health threat because many disease causing microbes or pathogen that can be acquire through contaminated water. Diseases which can harm the client include amoebiasis, typhoid fever and Hepatitis. This said diseases can harm and can alter the body’s normal functioning.

Inadequate living space

Health Threat

It is classified as health threat because congested living space promotes the easy transmission of diseases.

 Unclean water container.  Food and water were not covered.  Eating utensils were not properly kept.  Mother verbalizes “Kapag matulog kami ditto lang. Kaya sikipan talaga kami.”  9 members of the family are living in a house with a dimension of 135 inches length and 120 inches width.  Family income of 2,000 Php per month. VI. Cues/AMB

Health Problem

Category

SECOND LEVEL ASSESSMENT

Family Nursing Problem

Computation

Justification

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Malnutrition  Mother verbalized “Minsan lang kami makakain ng isda at karne. Wala kasing pera. Minsan toyo lang at suka. Madalas gulay ang pagkain namin.”  Mother sometimes borrows money for them to buy food and baon of her children.  The father seldom gave his income for their home expenses.  Family income of 2,000 Php a month. Insufficient food intake both in quality and quantity.



Mother verbalizes “Kapag

Poor hygiene

Health Deficit

Inability to provide adequate nursing care to family suffering from malnutrition due to: a. Inability to recognize the presence of the problem due to inadequate knowledge on proper diet and consequences of the problem. b. Inadequate resources for care such as responsible family member and financial restraint.

Health Threat

Inability to make decisions with respect to taking

1. Nature of the Probem:



3/3x1=1 2. Modifiability of the Problem:



2/2x2=2  3. Preventive Potential:



3/3x1=1

Health deficit that requires immediate intervention to eliminate further consequences due to inadequate knowledge on proper nutrition and financial capacity. If left untreated malnutrition can lead to mental or physical disability illness and possibility of death. The problem is easily modifiable since there are student nurses, community and family resources are available. It is preventable if the family especially the mother is knowledgeable on proper nutrition for each family member. Proper growth and development could be achieved. The problem is not recognized by the family due to unawareness of its magnitude.

4. Salience : 0/2x1=0 Total Score: 4

1. Nature of the Probem:



It is a health threat since poor hygiene increases clients vulnerability to diseases especially among children 12

walang pasok, hindi na sila minsan naliligo kasi puro laro na lang ginagawa nila” 

appropriate health action due to low salience of the problem.

Untidy dress



Children don’t wash their faces even with dirt

2. Modifiability of the Problem:

 

2/2x2=2 

Untrimmed nails



2 /3 x 1 = 0.67

The alternative resources and interventions are available to the family making the problem highly modifiable Through reinforcement and health teachings and client’s willingness to cooperate on the occurrence of the diseases brought about by poor hygiene could be prevented The family recognizes it as a problem but their financial resources are limited

3. Preventive Potential: 2 / 3 x 1 = 0.67 4. Salience : 1 / 2 x 1 = 0.5 Total Score: 3. 84



They use stairs in climbing on their house.

Risk for injury

Health Threat

Inability to provide a home environment

1. Nature of the Probem:



It is classified as health threat because the children were fun of going upstairs. And even if they wear their slippers, still it is not a 13

The stairs don’t have a handle. 

conducive to health maintenance and personal development due inability to foresee possible threats in the construction materials

There are large irregularshaped stones in their ground.

2 / 3 x 1 = 0.67 2. Modifiability of the Problem: 2 /2x2=1

  

3. Preventive Potential:

protective gear for them, because nails are sharp enough to penetrate in the feet and other parts of the body of the person. The problem is easily modifiable because preventive measures can be done if they want to. It has a moderate preventive potential since the resources can be easily acquired. The problem was observed by the family but they do not perceive it as something that needs an immediate attention.

2 / 3 x 1 = 0.67 4. Salience : 1 / 2 x 1 = 0.5 Total Score: 3.84



Mother verbalizes “Dito kami

Accident hazards specifically fire

Health Threat

Inability to provide a home environment

1. Nature of the Probem:



Problem is classified as health threat since Risk for fire poses grave danger not only to health but to life as well. It can happen when 14

nagluluto. Iniingatan na lang naming baka kasi makaabot ang apoy sa bahay naming.” 

Kitchen was situated beside their house.



House was made up of light materials (Wood)

hazards

conducive to health maintenance and personal development due to inadequate family resources

2 / 3 x 1 = 0.67 2. Modifiability of the Problem: 1/2x1=1

  

3. Preventive Potential:

the family finishes cooking and the fire is left unattended especially at night. Lack of enough financial resources makes the problem partially modifiable. Preventive measure can be done like putting of the gas range after cooking . The problem is recognized but the family didn’t see it as something serious to be acted upon immediately.

3/3x1=1 4. Salience : 1 / 2 x 1 = 0.5 Total Score: 3.67



Mother verbalized “Madami nga

Presence of breeding/ resting sites of vector

Health Threat

Inability to make decision with respect to taking appropriate

1. Nature of the Probem:



It is classified as health threat because mosquito can bring diseases such as dengue Fever and Malaria which can harm the body. 15

lamok lalo na kapag nagaulan.” 



health action due to low salience of the problem

2 / 3 x 1 = 0.67 2. Modifiability of the Problem:

Presence of uncovered water containers.



2/2x2=2  3. Preventive Potential:

Presence of stagnant water in pots.



3/3x1=1

The shown cues can be a site for the mosquito to breed. Since that mosquito have the capability to transmit virus, it should have an immediate action. The problem is easily modifiable since they can easily modify their place to lessen or eliminate the sites of the vector. It is a high preventive potential since there are a lot of preventive measures they can do for this situation. The problem was observed but the family didn’t see it as something that needed to be acted immediately.

4. Salience : 1 / 2 x 1 = 0.5 Total Score: 3.17



Failure to do handwashing before and

Risk for food and water borne diseases

Health Threat

Inability to make decision with respect to taking appropriate

1. Nature of the Probem:



The problem is classified as health threat because many diseases causing microbes or pathogen that can be acquire through 16

after eating.  



health action due to low salience of the problem

Unclean water container.

2 / 3 x 1 = 0.67 2. Modifiability of the Problem:

Food and water were not covered.



2/2x2=2  3. Preventive Potential:

Eating utensils were not properly kept.



contaminated water. Diseases which can harm the client include amoebiasis, typhoid fever and Hepatitis. This said diseases can harm and can alter the body’s normal functioning. Problem can be managed through health teachings on sanitation and proper food handling. Proper food handling, preparation and personal hygiene could be encouraged to prevent the occurrence of this health problem. The family is not aware by this problem.

2 / 3 x 1 = 0.67 4. Salience : 1 / 2 x 1 = 0.5 Total Score: 2.84



Mother verbalizes “Kapag

Inadequate living space

Health Threat

Inability to provide home environment which is

1. Nature of the Probem:



It is classified as health threat because congested living space promotes the easy transmission of diseases. 17

matulog kami ditto lang. Kaya sikipan talaga kami.” 



conducive to health maintenance and personal development due to inadequate family financial resources.

9 members of the family are living in a house with a dimension of 135 inches length and 120 inches width.

2 / 3 x 1 = 0.67 2. Modifiability of the Problem:





1/2x2=1  3. Preventive Potential:

The family’s income cannot compensate the renovation since it requires more financial expenditures, however things inside the house can be rearrange to allow more space. Possible transmission of communicable diseases can be minimized by means of proper health teaching. The problem is recognized by the family but because of lack of stable financial resources, family is unable to find a solution to the problem.

2 / 3 x 1 = 0.67

Family income of 2,000 Php per month

4. Salience : 1 / 2 x 1 = 0.5 Total Score: 2.83



Mother verbalizes “Marami

Ineffective Parenting

Health Threat

Inability to make decisions with respect to taking appropriate

1. Nature of the Probem:



It is classified as health threat because of inadequate knowledge about parenting, there is an increase number of child in the family, 18

talaga sila magkakapatid. Pito sila. Tapos ang tatay nila minsan lang magbigay ng pera.” 

Mother refuses to have tubal ligation.

health action due to low salience of the problem.

2 / 3 x 1 = 0.67 2. Modifiability of the Problem: 2/2x2=1 3. Preventive Potential:

  

thus can lead to inability to support the entire member of the family. It can be modifiable if the parents could be given a health teaching regarding proper parenting management. The problem could be preventive by proper health teaching to the parents regarding an effective parenting. The problem is recognized by the family or the parents didn’t see it a see it as something to be acted immediately.

2 / 3 x 1 = 0.67 4. Salience : 1 / 2 x 1 = 0.5 Total Score: 2.83

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VII.

PROBLEM PRIORITIZATION

PROBLEM

RATING

1. Malnutrition

4

2. Poor hygiene

3. 84

3. Risk for injury

3.84

4. Accident hazards specifically fire hazards

3.67

5. Presence of breeding/ resting sites of vector

3.17

6. Risk for food and water borne diseases

2.84

7. Inadequate living space

2.83

8. Ineffective Parenting

2.83

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Cues/AMB  Mother verbalized “Minsan lang kami makakain ng isda at karne. Wala kasing pera. Minsan toyo lang at suka. Madalas gulay ang pagkain namin.”  Mother sometimes borrows money for them to buy food and baon of her children.  The father seldom gave his income for their home expenses.  Family income of 2,000 Php a month.  Insufficient food intake both in quality and quantity.

Health Problem Malnutrition

VIII. FAMILY NURSING CARE PLAN Nursing Interventions Objectives Inability to At the end of  Measure the height and provide nursing weight of the family adequate intervention: members. nursing care to  Mother will family suffering state the  Advise the mother to from importance of seek help in their malnutrition proper barangay health center due to: nutrition. for referral to avail  Family will medical assistance. a. Inability to  enumerate recognize the  some effects  Provide information that presence of the  of malnutrition is a great problem due to  malnutrition risk to one’s growth and inadequate  and surviving it decreases the resistance knowledge on  needs. of the body. proper diet and   Mother will consequences of  identify  Let the mother enumerate the problem. economical effects of malnutrition. b. Inadequate food rich in resources for nutrients.  Encourage mother to care such as think of food rich in responsible nutrients that are family member economical. and financial

Nursing Problem

restraint.

Method of Contact  Home visit  Lecture  Discussion

Resources  Family  Student nurses

Evaluation Goal met: The mother stated the importance of proper nutrition by verbalizing “Mahirap talaga kapag may malnutrition. Maghina ang resistensiya ng katawan. Madaling Magkasakit mga anak ko.” Goal met: The family was able to enumerate some effects of malnutrition by verbalizing “Kapag malnourish ang bata payat talaga tapos madali magkasakit. Goal met: The family was able to identify economical food rich in vitamins as verbalized by “Naglinis nga ako kanina diyan kay taniman ko ng gulay. Para diyan na lang kami magkuha. Importante din ang gulay sa katawan.”

 Advise mother to tell her children not to buy “junk food”

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Cues/AMB  Mother verbalizes “Kapag walang pasok, hindi na sila minsan naliligo kasi puro laro na lang ginagawa nila”  Untrimmed nails  Untidy dress  Children don’t wash their faces even with dirt.

Health Problem  Poor Hygiene

Nursing Problem  Inability to  make  decisions with  respect to  taking  appropriate  health action  due to low  salience of the  problem.

Nursing Objectives  At the end of nursing intervention:  The family will verbalize the importance of proper hygiene in promoting health.  Mother will enumerate ways on how to maintain proper hygiene.

Interventions  Provide information that poor hygiene can cause body odor, skin disease and infection.  Provide techniques on proper hygiene maintenance especially after toilet use, regular bathing, oral care and trimming of nails.  Encourage mother to enumerate ways on how to improve proper hygiene.  Demonstrate on proper oral care, bathing and hand washing.

Method of Contact  Home visit  Discussion  Demonstrat ion

Evaluation Resources  Family  Goal met: The mother verbalized  Student “Importante man talaga nurses ang maligo para malinis at  Hand makaiwas sa sakit ang mga washing, anak ko.” and oral care materials  Goal met: The mother enumerated ways on how to maintain proper hygiene by verbalizing “Maligo dapat araw-araw. Tapos dapat mag-iwas sa dumi. Magtoothbrush din dapat para hindi magkaroon ng bad breath. Tsaka maghugas ng kamay bago magkain at pagkatapos.

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Cues/AMB

Health Problem

 They use stairs  Risk for in climbing on injury as their house. health threat The stairs don’t have a handle.  There are large irregularshaped stones in their ground.

Nursing Problem  Inability to  provide a  home  environment  conducive to  health  maintenance  and personal  development  due inability  to foresee  possible  threats in the  construction  materials.

Nursing Objectives  At the end of the nursing intervention, the family will be able to:

Interventions  Provide information that the non-handle stairs and irregular stones in the ground can cause injury to any family member.

 Provide measures that  The family can prevent the will know the occurrence of accident. importance of  Encourage mother to environment assist the little ones in free from climbing the stair. hazards and accidents.  Advise the children to wear slippers when going  The family out to prevent stone will puncture. enumerate some  Facilitate on the removal measures to of sharp stones in their prevent place. accidents.

Method of Contact  Home visit  Discussion

Resources  Family  Student nurses  Broom stick

Evaluation

 Goal met: The family knew the importance of environment free hazards by verbalizing “Dapat talaga maayos ang bahay kasi mahirap na madisgrasya.”

 Goal met: The family has enumerated several measures to prevent accidents like removing the sharp stones in their ground, assisting the little ones during climbing, discouraging their children to play near the stair.

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Cues/AMB  Mother verbalizes “Dito kami nagluluto. Iniingatan na lang naming baka kasimakaabot ang apoy sa bahay naming.”  Kitchen was situated beside their house.  House was made up of light materials (Wood)

Health Problem  Accident hazards specifically fire hazards

Nursing Problem  Inability to provide a home environment conducive to health maintenance and personal development due to inadequate family resources.

Nursing Objectives  At the end of the nursing intervention, the family will be able to:  Recognize the presence of the risk factors.  Identify fire preventive measures.

Interventions  Discuss with the family what are the risk factors that may cause fire.  Encourage the family to enumerate ways on how to prevent fires.  Provide information on fire safety and precaution.

Method of Contact  Home visit  Discussion

Resources  Family  Student nurses

Evaluation  Goal met: The family was able to recognize presence of risk factors that may cause fire.  Goal met: The family identified fire preventive measures like putting off the fire after using, don’t make too big fires, never put things beside the stove that can be burned easily.

 Advise the family not to leave the fire in their kitchen unattended.  Never let the children play fire.  Advise the family to put off the fire when not in use and keep away flammable liquids.

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Cues/AMB  Mother verbalized “Madami nga lamok lalo na kapag nagaulan.”  Presence of uncovered water containers.  Presence of stagnant water in pots.

Health Problem

Nursing Problem

 Presence of  Inability to breeding/resti make ng sites of decision with vector respect to (mosquitoes) taking appropriate health action due to low salience of the problem.

Nursing Objectives

Interventions

 At the end of the nursing intervention, the family will be able to:

 Assess if the problem can be modify right away.  Discuss some diseases transmitted by insects like dengue fever.

 Identify ways  Provide information how on how to get can the family prevent rid of the breeding of mosquitoes mosquitoes. and other insects.  Let the mother enumerate measures how to get rid  Remove pots mosquitoes and other and cover the insects. water containers.  Advised the family to use mosquito net.

Method of Contact  Home visit  Discussion

Resources

Evaluation

 Family  Student nurses

 Goal met: The family has identified ways to get rid mosquitoes by verbalizing “Dapat walang mga pwedeng tirhan ng lamok. Tapos lagi maglinis.”

 Goal met: The family, together, with the student nurses removed the pots with stagnant water and covered the water container.

 Facilitate in general cleaning activity.  Encourage the family to keep their environment clean.

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Cues/AMB  Failure to do handwashing before and after eating.  Unclean water container.  Food and water were not covered.  Eating utensils were not properly kept.

Health Problem  Risk for food and water borne diseases.

Nursing Nursing Interventions Method of Problem Objectives Contact  Inability to  At the end of  Provide information about  Home visit make decision the nursing the importance of proper  Lecture with respect to intervention, food handling and  Discussion taking the family will preparation. appropriate be able to health action recognize the  Discuss the effects of due to low importance of improper handling and salience of the sanitary food preparation of food. problem. handling and preparation.  Advice the family to boil their water before drinking for at least 15 minutes.  Encourage the family members to do proper handwashing before and after eating.

Resources  Family  Student nurses

Evaluation  Goal met: The family was able to recognize importance of sanitary food handling and preparation through reinforcement on their knowledge regarding proper handwashing, boiling of drinking water and instructed them to immediately wash used eating utensils.

 Cover your food left in the table.  Keep the eating utensils in a clean place or container.

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Cues/AMB  Mother verbalizes “Kapag matulog kami ditto lang. Kaya sikipan talaga kami.”  9 members of the family are living in a house with a dimension of 135 inches length and 120 inches width.  Family income of 2,000 Php per month.

Health Problem Inadequate living space

Nursing Problem

Nursing Objectives

 Inability to  At the end of provide home the nursing environment intervention, which is the family conducive to will be able health to: maintenance  Identify and personal disadvantage development s of due to congested inadequate living family financial  Arrange resources. things in the house and dispose unnecessary materials inside the house to allow more space.

Interventions  Discuss the disadvantages of congested living space.  Ask the mother what they can do about it.  Instruct to remove unnecessary things to allow more space.  Facilitate a cleaning session.

Method of Contact  Home visit  Discussion  Cleaning session

Resources

Evaluation

 Family  Student nurses  Cleaning materials.

 Goal met: The family was able to identify disadvantages of congested living space by verbalizing “Hindi maganda yung tulog naming kasi sikipan. Tsaka mahirapan yung mga bata.”  Goal met: The family was able to arrange and dispose unnecessary materials inside their house.

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Cues/AMB  Mother verbalizes “Marami talaga sila magkakapatid. Pito sila. Tapos ang tatay nila minsan lang magbigay ng pera.”  Mother refuses to have tubal ligation.

Health Problem  Ineffective Parenting

Nursing Problem  Inability to  make  decisions with  respect to  taking  appropriate  health action  due to low  salience of the  problem.

Nursing Objectives  At the end of the nursing intervention, the family will be able to know the importance of effective parenting.

Interventions  Assess the status of the family.  Discuss the problems encountered as parents.  Ask the family what are their ways in dealing with this problem.  Encourage mother to do alternative ways that can help her raise some money for their family.

Method of Contact  Home Visit

Resources  Family  Student nurses

Evaluation  Goal met: The family already knew the importance of effective parenting by verbalizing “Mahirap talaga ang buhay kaya dapat hindi na dagdagan ang mga bata lalo na wala kami masyadong mapagkuhaan ng pera.”

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X. HOME VISIT HOME VISIT PLAN # 1 General Objective: At the end of 35minutes, the family will be able to establish rapport with the student nurses and give pertinent baseline information. Time Allotment

Specific Objective

Activity

Content

Resources

2 minutes

The family will be able to recognize the presence of student nurses.

Greeting the client, showing house courtesy.

“Magandang araw po, mga 4rth year nursing students po kami ng notre dame university”

Family, student nurse

5 minutes

The family will be able to express willingness to cooperate with the student nurses.

Self introduction, Interview, Stating the purpose of the home visitation, contract setting.

“mga nursing student po kmi n nandito para makausap po kayo upang itanong ang kalagayan ng kulusugan nyo kasama na ang asawa at mga anak nyo po at pangaraw-araw na pamumuhay nyo bilang pamilya, okey lng po b? kooperasyon lng nyo ang nais nmin maam”

Family, student nurses

Evaluation Goal met. The family was able to recognize the presence of sudent nurses.

Goal met. The family verbalized “oo nman, mkikipagcooperate ako basta alam ko.“

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25 minutes

The family will be able to Interview, VS taking, show cooperation in health assessment, identify gathering baseline health-related needs. information and initial assessment.

Ask questions about family member’s name, age, sex, occupation, civil status, educational attainment, religion, source of income and immunization. Then, obtain the initial VS.

Family, student nurses, BP apparatus, thermometer

3 minutes

Contract setting, The family will be able to expression of gratitude “maam babalik po kmi bukas mga Family, student verbalize acceptance of ganitong oras po para po mapagpatuloy nurses appointment set for the ang naumpisahan po namin. Maraming follow up care of student salamat po. Aalis n po kmi.” nurses

Goal met. The family was able to give baseline information about their family.

Goal met. Thefamily verbalized “okey, sige balik lang kayo para nandito rin ibang anak ko”.

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HOME VISIT PLAN #2 General Objective: Within the 45 minute visit, the Family will be able to identify potentially health problems and be able to enumerate resources that sufficient and effective to their development in problem solving skills. Time Allotment

Specific Objective

Activity

Content

Resources

1-5 minutes

The family will be able to Greeting the client, “Magandang umaga po”. recognize the presence of showing house courtesy. student nurses.

1-5 minutes

The family will be able to Integration by asking what “Kumusta nman po kayo? Ang mga anak have a conversation with they are doing and nyo po kumusta po?” Family, the student nurses. helping them in household nurses chores, if any.

2-5 minutes

The family will be able to participate in the conversation and identify potentially risky factors that will affect their health condition.

Family, nurses

“Ano po ang problema natin dito?paano Asking questions, list at saan po kayo nagluluto ng makakain down important details, ninyo? Ang palikuran nyo po sariling Family, maintaining eye contact. sainyo po?” nurses.

Evaluation

student Goal met. The family was able to recognize the presence of sudent nurses. student Goal met. The family was able to have conversation with the student nurses. student Goal met. The family was able to identify some of the factors that may affect their health.

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10-20 miniutes

The family will be able to Accepting their feelings on “Ano po ang mga nararamdaman ninyo s Family, verbalize any difficulties certain problem, eye mga problemang yon?” nurses as they encounter those contact problems.

1-2 minutes The family will be able to identify resources to accommodate their needs and also they will be able to verbalize their management on those problems. 2-5 minutes The family will be able to receive basic care from the student nurses.

“Ano po gingawa nyo pagmalamok po? Recognizing their opinion Iwasan lng po o tanggalin lng natin nga Family, on how do they manage to puwedeng pamugaran ng mga lamok po.” nurses accommodate their needs. Giving health teaching. Discussion. BP taking

“okey na po bah?may mga katanungan po kayo? Mahalaga lng po na huwag natin pabayaan ang ating kalusugan.” Family, nurses

student Goal met. The family was able to share their difficulties as they encountered those problems.

student Goal met. The family was able to identify resources to accommodate their needs.

student Goal met. The family was able to receive basic care given by the student nurses.

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HOME VISIT PLAN # __3__ General Objective: Within the 45 minute visit, the family will be able to participate in the assessment or interview process about their problem and be abel to receive health teachings from student nurses regarding those identified problems and accept the end of the home visits. Time Specific Objective Activity Content Resources Evaluation Allotment 1-3 minutes

The family will be able to Greeting recognize the presence of courtesy. student nurses.

5-10 minutes

The family will be able to receive health teachings Discussion, from the student nurses. teachings.

10-30 minutes

,

showing “Magandang umaga po, nandito naman Family, po kami para interview kayo ulit”. nurses

student Goal met. The family was able to recognize the arrival of sudent nurses.

“ Mainam po na kung naglalaro po ang health mga anak nyo ay sa baba na lang po dahil Family, delikado pong akyat baba sila ng nurses hagdanan nyo po”

Goal met. The family student was able to participate in the health teachings rendered by the student nurses.

The family will be able to verbalized their feelings “Pag may problema po kayo in facing problems they Asking open-ended pinaguusapan nyo poi to ng asawa nyo? Family, encouter. questions, accepting their ano po nararamdaman nyo tungkol dito? nurses. opinion, listening.

Goal met. The family student said that they can cope up with any problems they encountered.

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10-15 miniutes

The family will be able to VS taking, trimming the “kukuhan ko po kayo ng BP” receive basic care from nails of the children the student nurses.

Family, nurses

student Goal met. The family and student nurse were both occupied with their assessment and interview process.

515minutes

The family will be able to Asking them to do return “Sige po maam kayo naman po ang verbalized understanding demonstration. gumawa para mlaman ntin kung Family, of health teachings given. naintindihan nyo po.” nurses

Goal met. The family student was able to show and verbalized understanding on the health teachings given.

3-5 minutes

The family will be able to Leaving the depart ways with the thanking them student nurses properly.

Goal met. The family and the student nurses student departed properly.

family, “Maam aalis na po kami, heto n po ang huling pagbisita naming.maraming Family, salamat po” nurses

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IX. Category Physical environment

FAMILY COPING INDEX Description Poor

Justification It is poor because as we noticed, their environment is not healthy; as the mother verbalized there was an accident where her son and daughter were victims of Dengue Fever 1 week ago and hospitalized.

Use of Community Facilities

Fair

The family uses their available community facilities; they sometimes had checkups in the community health center. They also use herbal medicine as alternative medicine.

Health attitude

Fair

The family consults to the barangay health center whenever there is a sick member of the family.

Family living

Poor

It is related to low income of both parents which does not met the basic needs of the family. Also sometimes the father didn’t share his income to the family, children are sent to school but their educational supply is not enough to sustain their studies. They have P300.00 house rental per month.

Knowledge to the family

Fair

The family was able to identify their existing problems but they cannot do something about it due to inadequacy of income. But those environmental problems were tend to sustain by cleaning their backyard

Emotional competence

Fair

The mother verbalized “nagaaway kmi minsan, wala ako asahan sa sweldo niya, hindi yon nagbibigay para sa bayarin dito sa bahay kaya minssan umuutang na lang ako sa amo ko para pambayad sa rental ng bahay”. As we observed from the verbalization of the mother, it only shows that their children are only relying to her 35

incomes, household chores and other payments. Application of the Principles of General hygiene.

Fair

XI.

As we observed, the mother was able to instruct their children to take a bath everyday but the children were not able to do it properly. They have dirty nails because they are playing outside and sometimes they do not performing handwashing.

RECOMMENDATION

Family Every individual has different emotional reaction in terms of their conditions. Through this we would like to recommend the family to practice a healthy environment by cleaning their backyard to prevent acquiring of vector borne diseases since they already it to their two children. Also their hygiene; they should be taught about the proper hand washing before and after meals and proper bathing to prevent further complications. They should have proper storage of food and water. The emphasis of this is to maintain a clean drinking water and food which is greatly stressed to prevent bacteria and other microorganisms that may jeopardize their health. Finally the Family should impose proper disposal of waste products from them to prevent harmful insects and other pest for this may become their breeding grounds. College of Health Sciences and Sero Elementary School To have an illness is a serious public health problem. Most of the people die because of the food borne and air borne diseases. The most victims are the children and older adults who suffer from gastrointestinal infections. We would like to recommend the College of Health Sciences to double their implementations of health promotion when conducting health education to different schools. This health education should be effective and comprehensive to the pupils so that they can apply what they have learned. Barangay Health Center The main concern of the public health nurse is the prevention of diseases, prolonging life, promoting health and efficiency through organized community effort. We would like to tap the Barangay Health Center to facilitate more programs that regards to the sanitation and other health promotion activities that will greatly encourage them to stand on their own since selfreliance is the ultimate goal of the community health nursing. Furthermore, we recommend the Barangay Health Center to have an effective health education to the community so that it would be possible that people would apply what they have learned. We are hoping that they make facilities in the center available to render quality care. Government The environmental health services of the department are responsible for the promotion of healthy environmental strategies. The programs will help towards the elimination and control of environmental factors that causes disease transmission to the people of the community. The collaboration from government agencies is important is disease prevention and promotion of health of the members of the family. We would like to catch the attention of the government agencies responsible for the health and livelihood of the residence of this country.

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