Chapter I INTRODUCTION
“The family is the nucleus of civilization.”
-Ariel and Will Durant: Wisdomquotes.com The family is the smallest unit of the society and the natural fundamental core of the community and consequently, it is considered as the primordial recipient of the nursing effort, which is contributory to the development, and progress of the community through active involvement and self – responsibilities of each constituent. It is composed of persons, male and female, being molded to be as one, working hand in hand to maintain a good atmosphere among the family members.
A nucleus controls the functions of the entire cell and can be thought as the “command center” of the cell. The nucleus as well has different components which are all needed in order for it and the cell to function well, same as with the “commander” or the head of the family and the members who has different functions within the family.
The impression or status of each family will always affect the status of the community as a whole. Community health nursing is a response to the health needs of the people. It does not focus on a particular class or family. It is comprehensive and general in approach. Community health service is not episodic as it requires continuous observation and monitoring of the community as a whole. Promotion and preservation of the health of its different clients
(individual, family, group or community) is the primary goal of community health nursing.
The community is a group of people sharing geographic boundaries and/or values and interests. (Maglaya, 2004) No two communities are alike. A nurse exposed in the community learns how to interact and adapt to different kinds of people. The family is considered as the basic unit of care in the community health nursing. It is in the family where a member develops his health values, beliefs and practices. The family is a major influence in the health behaviors of an individual. With this, it is important that families in a community are aware of the things and practices pertaining to their health.
It is apt to say that community health nursing has a big role in the nursing education. It is in the community where the student nurse learns nursing apart from the hospital setting as she was exposed to different level of orientation. It is in the community where the saying “nursing is an art” can be applied as a student nurse tries to give quality service using the available resources in the health center.
` Conducting a family case study is a means by which student nurse reaches and feels the community through its basic structure – the family. It is a tool in determining the health status of a family through assessment and critical inspection. Through this, health related problems are identified, thus giving the student nurse a hint on where to act and how to intervene. It is also a means towards improving the health of the community people, making them more productive. To come up with a family case study gives a sense of fulfillment to a
student nurse as she was given the opportunity to share their skills, knowledge and time to alleviate and uplift the living condition of a family.
The family that was chosen by the student nurse is a picture of the majority of the family here in our country: a family living in a poor environmental condition without enough resources and lacks knowledge on vital health information and experiences other socio-economic related problems. Though tiring as it is, reaching out to this family and mingling with them makes the student nurse feel the sense of fulfillment as she share her knowledge, skill and time to aid in uplifting the condition of the family.
Chapter II
OBJECTIVES OF THE STUDY
This chapter presents the general and specific objectives of this family case study. Setting objectives provides direction for planning a family nursing intervention. It facilitates motivation for the client and the nurse by providing a sense of achievement. (Kozier, Erb et. al., 2004).
General Objectives:
At the end of the student nurse-family relationship, the adopted family will be able to improve their health status and become self-reliant in maintaining their health through appropriate interventions in a given time frame.
Specific Objectives
After 1 month of home visits and student nurse-family interaction, the family should be able to:
• Established rapport and trust with the student nurse.
• Give pertinent and factual information during surveys and interviews
• Participate actively during home visits and assessment interviews • Identify actual and potential problems which may be a hindrance in
• Categorize the identified health problems as health threat, health deficit or foreseeable crisis through the assistance of their student-nurse.
• Prioritize the identified family health nursing problems with the assistance of their student nurse.
• Plan possible solutions or nursing actions to the prioritized health problems.
• Generate interventions considering the student nurses’ capabilities, community and the family’s resources.
• Carry out the planned interventions together with the student nurse • Perform the health teachings taught by the student nurse
• Evaluate the effectiveness of the intervention using the set objectives as a basis, and
Chapter III INITIAL DATABASE
A. Family Structure, Characteristics, and Dynamics
Name Age Sex Civil Position in
the Family Occupation
Educational Attainment Mr.
V
30 Male Married Father Farmer Elem. Level
(Grade 3) Mrs.
V
29 Female Married Mother (Respondent)
Housewife Elem Grad (Grade 6) Child
AV
11 Male Child Eldest Child Student Elem. Level
(Grade 5) Child
BV 10 Female Child Second Child Student Elem. Level(Grade 4) Child
CV 7 Male Child Third Child Student Elem. Level(Grade 3) Child
DV
5 Female Child Fourth Child Student Elem. Level (Grade 1)
The Family V is considered as a nuclear type of family. A nuclear type is a typical type of family composed of a father, a mother and child/children. This type of family structure is found in almost all societies, although the length of time in which the family remains in this form varies even within the same society.
The nuclear family can be a nurturing environment in which to raise children as long as there is love, time spent with children, emotional support, low stress, and a stable economic environment. In nuclear families, both adults are the biological or adoptive parents of their children (Jay C, 2004,).
The V family resides in Purok Daanbanwang, Upper Labay, General Santos City. They have started living their since June of 2009. They were a
family whose resident is always changing. They have been in Nurallah, South Cotabato for 5 years and in Malungon for 3 years.
Mr. V and Mrs. V go hand in hand in terms of decision-making. They consult each other in terms of planning and budgeting for their family. They discuss matters concerning their children’s schooling financially and also with regards to the emotional problems or aspects within the family. When problem arises, they make sure that both of them will handle and solve the problem. But then, in terms of matter concerning health Mrs. V is more dominant. She makes sure that she will comply with the appropriate regimen when certain health issues arise. She has greater awareness concerning health matters compared to Mr. V since of course believing it is her duty as the mother. These health matters include immunization, feeding the right food and caring for the sick member.
B. Socio-Economic and Cultural Characteristics
The V family’s main source of income is coming from Mr. V’s farming. Mr. V earns about Php 6,000.00 a month. Since Mrs. V does not work, she is in charge of the house and in taking care of the children. Mrs. V budgets the money in terms of food, education and miscellaneous where clothes, shoes and slippers comes in. Out of Mr. V’s earnings, most of it goes to the family’s budget for food. The education of the children is free and they can walk from their house to the school so only some school supplies are being bought. Usually, there is nothing to be left for the miscellaneous expense.
With Mr. V’s monthly income, the family strives hard to accommodate everything they need for them to live. According to NEDA, each individual should at least have Php 2768.60 when the total monthly income of the family is divided among the total family members. The total monthly income of Mr. V is about Php 6, 000.00 and when divided among the 6 members, it is only Php 1, 000.00, thus, they can be considered poor. Mrs. V also informed the student nurse that they do not have any financial assets at hand in case of emergency. They typically borrow money from their relatives.
Mr. V works as a farmer, he works from 3 am until 8 pm everyday. He seldom goes home but rather stays in the farm, which is situated far away from the family’s house. Mrs. V doesn’t work and stays in their house. She is the typical housewife where in you can see her wash clothes, prepare food, sweep the yard and make the house clean.
All of them are affiliates of Protestantism. Mrs. V mentioned that they do not go to church anymore since they have lived in Purok Daanbanwang for the reason that of the distance they have to travel from their place to the church.
Significant others are called such due to their own role in one’s life. They are the ones very close to a person or group of persons. For family V, the significant others in their lives are their relatives and some neighbors. They usually run to their relatives if they face hardships and problems. Mrs. V also confirmed how helpful and welcoming her neighbors are with them.
The family has yet to participate in community activities since they are new in the place. But way back in Nurallah, they usually partake in community activities. These activities include fiesta, parties and carnivals.
The V Family barely enjoys the community resources since the community itself lacks resources. The children, though, go to Purok Daanbanwang Elementary School. The father is usually in their farm while the mother is in the house doing household chores. The family uses the river as their means of water source in washing their clothes. There is also a shallow well built within the river where the family gets their water source for drinking if they get lazy in getting water from the faucet, meters away from their house.
C. Home and Environment
The house is made of wood, mostly bamboo. Mrs. V did not know the exact measurement of their house. Her husband knows it yet he was not there during the interview. In order for the house to be considered as adequate, the total floor area should be divided among the total members of the family and each should at least have 3.5 m2.
The house only has 2 windows and can sustain the adequate ventilation needed by the family. Mrs. V told the student nurse that their house is usually “presko” since it is beside the river and the air goes to and fro freely inside the house.
The house has 2 rooms. The one is the sala/dining room and the other is the bedroom, with no bed at all. Mr. and Mrs V, together with the children, sleep in one room. They use “banig” in sleeping.
The V Family has only one appliance which is the radio powered by batteries since the place has no electrical supply yet. In terms of garbage disposal, they either bury or burn their garbage.
Mrs. V uses wood and charcoal in cooking. She is the one who prepares the food. She cooks inside the house at the back portion. The foods that they usually eat are fish and vegetables. The family uses plastic plates and stainless spoons in eating. When it comes to storing their food, they just cover it with a plate. In terms of cooking facilities the family is equip with pots, “sandok”, and knives.
The river is the family’s main source of water. They wash their clothes and gets their drinking water supply there. They put their water in a big container with cover. They usually don’t go and get water from the faucet in the purok since, according to Mrs. V, it is far from their house. They usually don’t sterilize their drinking water supply.
V Family has no comfort room. They usually urinate and remove bowels anywhere near their house. They have not yet built their own comfort room since, according to Mrs. V, they are still new in the community and has no enough budget for it yet.
The drainage system of the family is an open type where in the drainage flows anywhere and is continuous. It is dirty and has a stinky smell. There is
some rice grains noted. There is no obstruction present at the drainage system since it is open and flows anywhere.
The family does not own any transportation facilities. They ride on a jeepney or truck in going to the city proper. When they go to their farm or any purok within Upper Labay, they usually walk kilometers.
The family has one chicken and a dog. There are vegetables planted near the house.
D. Health Assessment of Each Family Member D1. PAST AND PRESENT ILLNESS
1. Health Assessment on Each Member
A. Mr. V – The student nurse has never met Mr. A since he was in their farm during the interview. Mrs. V, however, told us that she thinks her husband has never undergone immunizations at all since it was not that important before. Mrs. V said that her husband is about 5’4 tall and weighs about 55 kilograms. His BMI reveals normal weight with a value of 20.8. Mrs. V told the student nurse that her husband has no genetic or hereditary illness known. He is not a smoker. He drinks alcohol rarely since they have no budget for that.
B. Mrs. V – She has no degenerative, chronic, or infectious diseases as of the present time. She has also not completed immunizations. When she was still 4 years old, she experienced chicken pox. She is 5 feet and 3 inches and weighs 60 kilograms. Her BMI reveals normal weight with a value of 23.4. She has no complaints as of the present time and has not taken any medications
as of the moment. At times of illness, she would just drink paracetamol for fever and mefenamic acid for pain or treat wounds with crushed plants coming from their backyard. The family is not using family planning anymore.
C. Child AV – has no any degenerative, chronic, or infectious diseases as of the present time. He has not completed immunizations. He is 4 feet and 10 inches and weighs 38 kilograms. He likes to eat vegetables and fish.
D. Child BV –has no any degenerative, chronic, or infectious diseases as of the present time. She has not completed immunizations. She is 4 feet and 7 inch tall and weighs 36.5 kilograms.
E. Child BV –has no any degenerative, chronic, or infectious diseases as of the present time. He has not completed immunizations. He is 4 feet and weighs 33 kilograms.
F. Child DV – has no any degenerative, chronic, or infectious diseases as of the present time. She has complete immunizations. She is 3 feet and 11 inches tall and weighs 17 kilograms. She appears thin. This child has many allergies and there are rashes still seen on her legs.
FAMILY ASSESSMENT BASED ON FUNCTIONAL HEALTH PATTERN 1. Health Perception-health management patterns
• With no known vices like smoking and drinking except for Mr. V who drinks alcohol rarely.
• Was able to recognize the importance of having a healthy well-being. • Uses herbal plants, though not approved by the DOH, from their backyard
2. Nutritional-metabolic pattern
• Do not take any food supplements or vitamins • Daily food intake is mainly rice, fish and vegetables • Children eat junk foods whenever they were given money • Children have poor appetite according to Mrs. V
3. Elimination pattern
• Eliminates everyday with an average frequency of urine: 5 times
• According to Mrs. V, all of the family members have no difficulty in voiding.
• The family members defecate everyday and some, every other day with no difficulty in defecating noted.
4. Activity-exercise pattern
• “Dili nami makaexercise kay daghan mi trabaho labi na pagbuntag” verbalized by the mother.
• Family preferred to stay at home and take a nap if they have free time while their children play with other children in the community after class. 5. Sleep-rest pattern
• Family usually has 7-8 hours of uninterrupted sleep according to the mother.
• They usually sleep at around 9 in the evening and wake up at around 4 to 5 in the morning.
• They also take a nap at free time. 6. Cognitive-perceptual pattern
• Was oriented to time, place and is able to identify people and significant others by their first names.
• Was able to respond accordingly and correctly to questions. Retaliates as soon as he can and was able to rationalize. Verbal pattern and spontaneity normal
• Memory intact • No sensory defects
7. Self-perception/self-concept
• Showed apprehension and worry towards unspecific consequences.
• Perceived situations (health deficits) to be very stressful but remain passive about things and condition.
8. Roles and relationship
• Family members have an open communication and able to discuss their problems according to the mother.
9. Sexual reproductive
• Both parents are still in the reproductive age
• The parents are separated as of the moment since the father is in their farm and the mother is in the house
10. Coping Stress
• Gains strength in the “assurance and guarantee” provided by family members.
11. Values/ Beliefs Pattern
The family is Protestant in faith. Expressed great belief and faith in God. Is certain that the Divine providence would protect them from any unidentified and possibilities of harm.
Does not go anymore to church since they are situated far away from the place of worship they attend
E. Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention.
The children in the family has not all completed their immunization. All the children in the family were dewormed last March 2008.
The family has adequate rest and sleep. They sleep early and wake up early, the usual time of sleeping is 9pm and they wake up at around 4 to 5am. Mrs. V stated that farming, doing the household chores, and walking are their ways of exercise. The father is in the farm. The mother usually does the household works and talks with the neighbors during free time. The children are either in school or are playing with other children in the community.
The mother recognizes the importance of health in the family, however, because of financial constraints made them ignores any major health problems that may arise. Furthermore, they were not able to sustain sufficient supplies of medication or articles which they would need related to their health care needs. They often use alternative medicines or herbal medicines for treating their illness and habitually self-medicate if OTC medications are available. The family
believes in the power of herbal plants. They occasionally use herbal plants lodged near the house in treating diseases or symptoms in the family since their transfer from Nurallah. Mrs. V said that she had no choice but to use these plants for the reason that the barangay health center is far away from their home. But if the symptoms manifested by the family member become severe, they immediately go to the health center or to the hospital.
Chapter IV
FAMILY BACKGROUND
This chapter illustrates the family background of the study which includes, Database of the Respondent, Family Tree, General Household Data, Activities of Daily Living which could be an indicative for the present health status of the family as it continues to influence the each of the family member.
Family History
Family V is composed of 6 members Mr. V is the father, Mrs. V as the mother, children AV, BV, CV and DV are the kids. Mr. V is the head of the family. He is 30 years old. Mrs. V, his wife is 29 years old. Child AV, as the eldest son is 11 years old, child BV is 10 years old, child CV is 7 years old and child DV is 5 years old.
Mr. V was born and grew up in Purok Daanbanwang, Upper Labay, General Santos City. His father was a farmer and his mother was a housewife. He has 9 siblings and he is the eldest. He is a B’laan. He was able to go to school up to grade 3 year level. After that he did not continue schooling in order to help his parents look for money for their household expenses.
Mrs. V was born and grew up in Malungon, Sarangani Province. Her father is a farmer and her mother is a housewife. She has 2 siblings. She was able to go to school and graduated elementary school. She did not continue schooling due to financial constraints. Instead she helped her parents in doing household chores and in looking money for their household
Mr. V and Mrs. V met in Malungon, Sarangani Province through friends of friends. They become a couple and after 3 months, they got married. They resided in Malungon for 3 years, then transferred to Upper Labay for 6 months. They again transferred to Nurallah, South Cotabato and stayed there for another 5 years and came back Upper Labay just this June of 2009
Data Base of the Respondent
The respondent upon interview is the mother in the family.
NAME : Mrs. V
AGE : 29 years old
GENDER : Female
ADDRESS : Purok Daanbanwang, Upper Labay, General Santos City
BIRTH PLACE : Malungon, Sarangani Province
RELIGION : Protestant
OCCUPATION : Housewife
CIVIL STATUS : Married
NATIONALITY : Filipino
NO. OF CHILDREN : 4
EDUCATIONAL ATTAINMENT: Elementary Graduate ESTIMATED MONTHLY INCOME: none
B. Family Tree
C. General Household Data 1. Total No. of Children: 2 2. List of Household Members
Members Status Occupation Se x Educ. Attainment Religion Positio n in the Family Imm. Status NS Mr. V Married Farmer M Elem. level Protestant Father INC NA Mrs. V Married Housewife F Elem Grad Protestant Mother INC NA Child AV Child Student M Elem. level Protestant 1st
Child INC NA
Child BV Child Student F Elem. level Protestant 2nd
Child INC N
Child CV Child Student F Elem. level Protestant 3rd
Child INC N
Child DV Child Student F Elem. level Protestant 4th
Child COM N
Mrs.
V
Mr.
V
Child AV Child BV Child CVChapter V
FAMILY COPING INDEX
This chapter depicts the actual observation of the family behavior and practices in contrast to the ideal family attitude and behavior. It includes an assessment on how the family handles various stressors. The observations are analyzed to see occurrence of health problems or negative attitudes and behavior.
CRITERIA IDEAL ACTUAL
R a ti n g JUSTIFICATION 1. Physical Independenc e Is concerned with ability to move about, to get out of bed, to take care of daily grooming, walking, etc.
The members are all able to move without
assistance and difficulty. They do their activities of daily living without aid. They are independent in moving about and
using their musculoskeletal system. 5 There are no abnormalities in the physical independence of the family members. Every member has no noted disabilities or disparities in moving and/or doing their ADL.
2.
Therapeutic Competence
Includes all of the
procedures or
treatments
prescribed for the care of illness such
as giving
medications, using appliances,
dressing, exercise,
The parents are aware on what to do if a member fells ill. However, due to financial problems and distance of the health center,
they cannot
3 The parents are aware of their lapses in therapeutic
competence. They are sentient of their financial difficulties, which is the primary reason for not having or following the
relaxation, special diets, etc. provide enough and/or appropriate interventions. Although, they use herbal plants, those plants are not approved by the DOH.
appropriate procedure or treatment, having appliances and even enough clothes for the children.
3.
Knowledge of Health Condition
Concerned with the particular health condition that is the occasion for care such as knowledge of the disease or
inability to
understand
communicability of diseases and mode of transmission. Understanding the general pattern of development of newborn baby and basic needs of infants for physical care. The mother is knowledgeable on salient health issues and responsibilities. Yet due to financial problems, health issues are overlooked.
2 Though the mother recognizes pertinent health issues, she does not regard it as important at all. This could be detrimental to the lives of the members especially the children. 4. Application of Principles of General Hygiene Concerned with family action in relation to maintaining family nutrition, securing adequate rest and relaxation for family members, carrying out accepted preventive measures (immunizations, medical appraisal, safe home-making in relation to storing
The family sleeps well and eats nutritious food everyday. But their source of water is not healthy at all. They do not practice sterilization nor healthy habits in food storage and preparation.
2 Even though aware of hygiene’s importance, the family does not practice good hygienic skills. Yes they take a bath everyday but their source of water, eating
habits and
maintenance of
healthy lifestyle are not taken into consideration that much.
and preparing of food).
5. Health Attitudes
Concerned with the way the family feels about health care in general, including preventive services, care of illness, and
public health
measures.
The parents are concerned about the health of the members of the family yet they do not participate actively in maintaining optimum health due to financial constraints. Also, the family lacks information regarding healthy lifestyle and healthful ways toward improvement of life. 1 Parents, as much as possible, want to protect their children from any harm but then, they lack money and information for them to carry out the right health care for the family
6. Emotional
Competence Has to do with the maturity and integrity with which the members of the family are able to meet the usual
stresses and
problems of life, and to plan for happy and fruitful living. The degree to which individuals accept
the necessary
disciplines imposed by one’s family and
culture. The development of the individual’s responsibilities and decision. Willingness to meet reasonable
The family are competent
enough
emotionally. They see stress just like any other family does. The parents take responsibility for the children. They discipline them and teach them the morals of life.
5 The family lives harmoniously at home. Even though conflicts arise, they really see to it that they would discuss each concern in a calm manner.
obligations, to accept adversity with fortitude, to consider the needs of others as well as one’s own.
7. Family
Living Concerned with the interpersonal or group aspect of family life. The family members get along with one another, the ways in which they make decisions affecting the family, the degree to which they support one another and do things as family, the degree of respect and affection, and the ways in which they manage the family budget.
There is high concern within the family, especially with regards to their
interrelationship with others. The parents discuss decision- making. The children are not yet open for suggestion to decision-making since they are still young and difficult to comprehend their current situations.
3 Others respect
individual relationships of each member of the family. Decision-making is shared among its members except on young member. Each has his or her own part or role in the family, which is well respected. 8. Physical Environment Concerned with home, the community and work environment as its affect family
health. The condition of the house such as pressure of accident hazards, screening, plumbing, system, facilities of cooking, privacy, level of community (deteriorated neighborhood, presence of social The family’s house space is not good enough for the family.
There are
presence of
insects, rodents and other vectors. Their house is also located near a creek. They cook their food outside their house wherein they just use earthly pot and used wood as
2 The house
environment is not fitted for them especially for the children, because of the presence of pests and accident hazards in their community. Also their house is in poor condition, that they can possibly
acquire serious
diseases. Their food storage is unsanitary. Though it is covered with cloth, sometimes insects and other
hazards, pests), transportation of
schools and
availability.
fuel. Also a nail attached on the wood on inverted position was noted. Bottles of liquor and decomposing woods were noted as well. They live in a place wherein it’s not congested but
then the
distances
between their neighbors are not that so far from each other
small animals could crawl inside the dish organizer. Also, the cloth that they used was dirty. The storage of water has a cover, but it is still unsanitary due to the presence of dirt on the outside of the container.
Having a eartly pot near the house is really a fire hazard because some of the coal fire might come in contact with their bamboo wall and the nails attached to wood gives the possibility that some of their family members might stepped into it,.
9. Use of Community Facilities
Degree of the family use and awareness of the available community facilities for education and welfare. The mother is aware of the available resources in the community, both in health and education. But they cannot utilize
the health
facilities since it is far from their house
3 The school is the only community facility the family uses. They cannot go to the health center since they have to walk kilometers just to get there.
Chapter VI
TYPOLOGY OF NURSING PROBLEM
This chapter discusses about the problem that were identified during assessment and interview with the family. It includes the cues/data, the family nursing problem and the nursing diagnosis. The problems identified are categorized into presence of wellness state, health deficits, health threats, foreseeable crisis and stress points.
Table 4. Typology of Nursing Problems identified in Family X
Cues or Data Family Nursing Problems
Objective data:
The house of Family V is a bungalow style of house. It is mainly made up of bamboo and nipa as its roof. The mother usually cooks at the back of the house using wood and charcoal.
Subjective data:
The mother verbalized “Kaning among balay dugay na ni siya. Gibuhat ni siya sa pamilya sa akoang bana. Puro kahoy na siya ug nipa ug mga patay na dahon sa saging. Dira ko galuto sa may likod. Mao ra jud ni among makaya kay siyempre kulang sa budget. Ang among ipahimo ug balay, ikaon na lang namo diba”
I. Accident hazards specifically fire hazard, as a health threat.
A. Inability to provide a home environment conducive to health maintenance and personal development due to:
a. Inadequate family
resources; specifically financial constrains/limited financial resources.
b. Failure to see benefits of investment in home environment improvement. B. Inability to make decisions with
respect to taking appropriate action due to:
a. Failure to comprehend the nature, scope, and magnitude of the problem. b. Negative attitude towards
the health problem.
c. Low salience of the problem
Objective data:
The income of the family is about Php 3000 per month. There are five members in the family
Subjective data:
Mother verbalized, “Gamay ra jud ang income intawon. Di na gain mi kapalit sa mga sanina sa bata. Mga kinahanglan nila. Luoy kayo. Ang among pagkaon ginatama tama lang para sa amua. Isda ug mga gulay dira sa kilid among sud-an pirmi.”
Objective data:
The hands of the children are unclean when they ate they meal. Subjective data:
Mother verbalized “Ay mga tamad na sila manghugas ug kamot. Wala tay mahimo kay gahi man jud ug ulo.”
Objective data:
The family usually stores their food by covering it with plate and leaves it in the table
Subjective data:
Mother verbalized “Dira ra man namo na ginabutang. Wala man mi butanganan na lain. Daghan lagi kayo ug langaw”
Objective data:
The family’s drainage is an open type. They just throw it
II. Family size beyond what family resources can adequately provide as a health threat.
A. Inability to make decisions with respect to taking appropriate health action due to:
a. Inaccesability of appropriate resources for care such as financial constraints.
III. Unsanitary food handling as a presence of health threat.
A. Inability to make decisions with respect to taking appropriate health action due to:
a. Low salience of the problem. b. Negative attitude towards
health problem
IV. Poor home condition specifically lack of food storage facilities as a health threat
A. Inability to make decisions with respect to taking appropriate health action due to:
a. Low salience of the problem. b. Negative attitude towards health problem c. Inaccesability if appropriate resources for care specifically financial constraints
V. Poor environmental sanitation specifically improper drainage disposal as a health threat
anywhere. Rice grains are noted beside the house.
Subjective data:
Mother verbalized “Dira ra man namo pud namo na ginalabay”
Objective data:
The family has no comfort room. They just defecate and void anywhere.
Subjective data:
Mother verbalized “Mao jud na karon kay wala pa mi kahimo. Wala pay kwarta. Dra ra mi gaihi, galibang kanang walay tao”
Objective data:
The family gets their water source in the man-made shallow well in the river. Near the river is a carabao taking a bath and women washing clothes.
Subjective data:
Mother verbalized “Dira mi sa balon gakuha ug tubig. Wala na namo ginasterilize. Ok naman na siya. Layo man gud kaayo ang gripo diri sa amua”
A. Inability to make decisions with respect to taking appropriate health action due to:
a. Low salience of the problem. b. Negative attitude towards health problem
VI. Poor environmental sanitation specifically unsanitary waste disposal as a health threat
A. Inability to make decisions with respect to taking appropriate health action due to:
a. Low salience of the problem. b. Negative attitude towards health problem
c. Inaccesability if appropriate resources for care
specifically financial constraints
VII. Poor environmental sanitation specifically polluted water supply as a health threat
A. Inability to recognize presence of condition or problem due to: a. Lack of knowledge
B. Inability to make decisions with respect to taking appropriate health action due to:
a. Low salience of the problem. b. Negative attitude towards health problem
d. Inaccesability if appropriate resources for care
specifically financial constraints
C. Failure to utilize community resources for health care due to:
Objective data:
Not all children have completed their immunizations.
Subjective data:
Mother verbalized “Isa ra lagi ang nakakumpleto sa bakuna ba. Layo pa jud ang center.”
a. Inaccessibility of required service due to physical inaccessibility (location of facility)
VII. Lack of immunization status specially of children as a health threat
A. Inability to make decisions with respect to taking appropriate health action due to:
a. Inaccesability if
appropriate resources for care specifically financial constraints
B. Failure to utilize community resources for health care due to:
a. Inaccessibility of required service due to physical inaccessibility (location of facility)
Chapter VII
PRIORITIZING PROBLEMS
This chapter shows the setting of priorities of family health problems that has been identified. It includes a computation on how priorities were shown with their corresponding justification.
I. Accident hazards specifically fire hazard, as a health threat. Criteria Computation Score Justification 1. Nature of the
problem 2/3 x 1 0.67 This problem is a health threat 2. Modifiability of
the problem
1/2 x 2 1 The problem is partially modifiable. The only way to solve this problem is to renovate the house, thus it needs money.
3. Preventive potential
2/3 x 1 0.67 The problem could be moderately prevented. This could be done if the family will be very alert in watching out especially if they are cooking since the house could catch fire anytime.
4. Salience 1/2 x 1 0.5 The problem, compared with the other problems does not need immediate attention since it requires time and money.
Total Score: 2.84
II. Family size beyond what family resources can adequately provide as a health threat.
Criteria Computation Score Justification 1. Nature of the
problem
2/3 x 1 0.67 This problem is a health threat 2. Modifiability of
the problem
0/2 x 2 0 The problem could not be modified at all. The family size cannot be trimmed down to smaller size
3. Preventive potential
1/3 x 1 0.33 The problem may be prevented but the family size
cannot be trimmed down. 4. Salience 0/2 x 1 0 The problem is not perceived
as a problem at all by the family.
Total Score: 1
III. Unsanitary food handling as a presence of health threat. Criteria Computation Score Justification 1. Nature of the
problem
2/3 x 1 0.67 This problem is a health threat 2. Modifiability of
the problem
2/2 x 2 2 The condition can be highly modifiable. If the family receives the right health teaching, attitude can be changed for the better
3. Preventive potential
3/3 x 1 1 The problem can be prevented if the family is educated on the importance of hand washing 4. Salience 1/2 x 1 0.5 The problem is not perceived
as a problem requiring immediate attention according to the family since there are other health problems more important
Total Score: 4.17
IV. Poor home condition specifically lack of food storage facilities as a health threat
Criteria Computation Score Justification 1. Nature of the
problem
2/3 x 1 0.67 This problem is a health threat 2. Modifiability of
the problem
1/2 x 2 1 This problem is partially modifiable since the family lacks resources specifically in the financial aspect. However, appropriate health teachings may correct this problem
3. Preventive potential
1/3 x 1 0.33 The problem is low in preventive potential since there is lack of appropriate resources that could solve this. 4. Salience 1/2 x 1 0.5 The problem is not needing
immediate attention according to the family
V. Poor environmental sanitation specifically improper drainage disposal as a health threat
Criteria Computation Score Justification 1. Nature of the
problem
2/3 x 1 0.67 This problem is a health threat 2. Modifiability of
the problem
2/2 x 2 2 The problem is easily modifiable by teaching the family the importance of having a proper drainage. 3. Preventive
potential 2/3 x 1 0.67 This is highly preventable if the family has learned the importance of having a clean drainage.
4. Salience 1/2 x 1 0.5 With regards to the family’s perception, the problem does not need immediate attention Total Score: 3.84
VI. Poor environmental sanitation specifically unsanitary waste disposal as a health threat
Criteria Computation Score Justification 1. Nature of the
problem
2/3 x 1 0.67 This problem is a health threat 2. Modifiability of
the problem
1/2 x 2 1 The problem is moderately modifiable since this problem can only be solved with money.
3. Preventive potential
2/3 x 1 0.67 This can be highly preventable if the family had prioritized in building a toilet
4. Salience 1/2 x 1 0.5 According to the family, it plays not much importance in their life
Total Score: 2.84
VII. Poor environmental sanitation specifically polluted water supply as a health threat
Criteria Computation Score Justification 1. Nature of the
problem
2/3 x 1 0.67 This problem is a health threat 2. Modifiability of
the problem
2/2 x 2 2 The problem is highly modifiable since it could be solved if the family knows the importance of sterilization. 3. Preventive
potential
3/3 x 1 1 The problem is preventive because there are ways and
resources present in the community where in the family can have a clean water supply 4. Salience 1/2 x 1 0.5 The problem, with accordance
to the family’s perception, is not much important.
Total Score: 4.17
VIII. Lack of immunization status specially of children as a health threat Criteria Computation Score Justification
1. Nature of the problem
2/3 x 1 0.67 This problem is a health threat 2. Modifiability of
the problem
1/2 x 2 1 The problem is moderately modifiable since there are available resources such as in the health center yet the family cannot easil go to the health center because of its long distance from Daan Banwang 3. Preventive
potential
2/3 x 1 0.67 The problem is moderately preventive since the family could have had immunization way back in Malungon but also due to negative attitude and financial constraint, the family did not seem to mind at all. 4. Salience 2/2 x 1 1 The family knows how
important immunization is specially for the children
Chapter VIII NURSING CARE PLAN
This chapter shows the identified and prioritized problems in a ranking order. This chapter also presents the family care plan formulated by the student nurse together with the family.
Problem List
Problems Score
Unsanitary food handling as a
presence of health threat.
4.17
Poor environmental sanitation specifically polluted water supply as a
health threat
4.17
Poor environmental sanitation specifically improper drainage
disposal as a health threat
3.84
Lack of immunization status specially
of children as a health threat
3.34
Poor environmental sanitation specifically unsanitary waste disposal
as a health threat
2.84
Accident hazards specifically fire
hazard, as a health threat.
2.84
Poor home condition specifically lack of food storage facilities as a health
threat
2.50
Family size beyond what family resources can adequately provide as
FAMILY NURSING CARE PLAN
Problem# 1 Unsanitary food handling as a presence of health threat.
CUES ANALYSIS OF THE PROBLEM OBJECTIVES
INTERVENTION PLAN
NSG. INTERVENTIONS RATIONALE METHOD RESOURCES REQUIRED EXPECTED OUTCOME Subjective data: Mother verbalized “Ay mga tamad na sila manghugas ug kamot. Wala tay mahimo kay gahi man jud ug ulo.” Objective data: The hands of the children are unclean when they ate they meal. Inability to make decisions with respect to taking appropriate health action due to: • Low salience of the problem. • Negative attitude towards health problem After 1 day of community exposure, the family will be able to: Employ clean hands and finger nails before and during eating meals Specifically: • Discuss the importance and need for hand washing • Demonstrat e proper >Assess the family’s ideas on food handling and hand washing >Discuss with the family the importance and need for hand washing >Demonstrate proper hand washing technique >Inform the family about communicable > To obtain how much the family knows on these issues >To educate the family about proper hand washing > To show the proper hand washing technique and for better understanding on it > To make the family aware of the diseases H O M E V I S I T >Manpower resources such as time and effort. >Physical and chemical resources such as soap, water, pail and clean towel After 1 day of community exposure, the family has able to: Employ clean hands and finger nails before and during eating meals Specifically: • Discuss the importance and need for hand
washing • Demonstrate
- Dirty and long finger nails noted hand washing techniques diseases especially the ones transmitted if hand washing is not reinforced >Explore the family’s reaction about the health teachings given.
they are prone of. > To measure the understanding of the health teachings presented. washing techniques
Chapter IX
SUMMARY, EVALUATION AND RECOMMENDATION
Presented in this case study is the different characteristics and health condition of family V. This case study presents the family structure, socio – economic and cultural factors, home and environmental factors, health assessment of each member. It also contains data about identified problems on the living condition of the family.
Summary and Evaluation
The Family V is considered as a nuclear type of family. A nuclear type is a typical type of family composed of a father, a mother and child/children. The V family resides in Purok Daanbanwang, Upper Labay, General Santos City. They have started living their since June of 2009.
Their house is made of wood, mostly bamboo. Mrs. V did not know the exact measurement of their house. Her husband knows it yet he was not there during the interview. In order for the house to be considered as adequate, the total floor area should be divided among the total members of the family and each should at least have 3.5 m2. The house only has 2 windows and can sustain the adequate ventilation needed by the family.
The V family’s main source of income is coming from Mr. V’s farming. Mr. V earns about Php 6,000.00 a month. Since Mrs. V does not work, she is in charge of the house and in taking care of the children. With Mr. V’s monthly income, the family strives hard to accommodate everything they need for them to
live. According to NEDA, each individual should at least have Php 2768.60 when the total monthly income of the family is divided among the total family members. The total monthly income of Mr. V is about Php 6, 000.00 and when divided among the 6 members, it is only Php 1, 000.00, thus, they can be considered poor. Mrs. V also informed the student nurse that they do not have any financial assets at hand in case of emergency. They typically borrow money from their relatives.
All of them are affiliates of Protestantism. Mrs. V mentioned that they do not go to church anymore since they have lived in Purok Daanbanwang for the reason that of the distance they have to travel from their place to the church. The family has yet to participate in community activities since they are new in the place.
The V Family barely enjoys the community resources since the community itself lacks resources. The children, though, go to Purok Daanbanwang Elementary School. The father is usually in their farm while the mother is in the house doing household chores.
The river is the family’s main source of water. They wash their clothes and gets their drinking water supply there. They put their water in a big container with cover. They usually don’t sterilize their drinking water supply.
V Family has no comfort room. They usually urinate and remove bowels anywhere near their house. The drainage system of the family is an open type where in the drainage flows anywhere and is continuous.
The V family is identified to have plenty of environmental problems in which it is evident that they practice poor environmental sanitation. With this situation and family condition, many problems were identified such as health threats which include fire hazards, poor home and environmental sanitation, and improper drainage system as well as health threats which are improper personal practice as improper hygiene. A nursing care plan then is formulated to address the different problems identified.
Nevertheless, the family has chances to improve their health condition. There still have that ability to meet the desired characteristics in their structure and maximize their health potential of optimum wellness. They are cooperative and participative to the different issues and interventions they are confronted. Hence, they are willing to submit themselves for the impartation of information and basic knowledge regarding family health.
The objectives of identifying family nursing problems were only partially achieved due to security reasons for the part of the student nurse. Together with the family, the student nurse as an agent has helped the family through motivation and support to change their lifestyle and improve their health status. Although the allotted time for the student nurse was not enough to attend to all those problems, the family is now equipped with fair knowledge which they could use anytime as the need arises.
Recommendations
The student nurse have identified and prioritized problems and needs with the family. The student nurse have also created a care plan on how to deliver the
best nursing care for the family to address their needs. The following below are propositions and commendations recognized by both the student nurse and family:
• The V family should maintain a healthy and clean environment. They must clean their surroundings to avoid the presence of vectors of diseases.
• The family should also maintain proper hygiene such as taking a bath regularly, trimming their nails, frequent changing of clean clothes especially when come in contact with filthy objects or experienced wetness of the back, refraining from walking barefooted, brushing of teeth frequently, and proper and regular hand washing.
• They must also reorganize their cooking practices in terms of food preparation and handling as well as keeping their kitchen utensils in a covered storage to avoid getting it contaminated by insects or pests. In addition to that, they should also cover their food storage.
• The family should also be advised to not wait for the ailment to become severe before seeking medical help.
• The family must also be educated and follow the proper preparation of herbal medicines as it was presented during the mother’s class.
• The V family should persevere to perform proper waste segregation and disposal of their garbage as it was presented during the mother’s class.
• The family should be aware that organizations in the community are open and present for their problems to be addressed properly.
• They should be encouraged to verbalize their concerns with regard to the community so that resolutions can be made.
BIBLIOGRAPHY
Books
Cuevas, F. et. al. Public Health Nursing in the Philippines. 10th ed. Philippines:2007
Maglaya, A. Nursing Practice in the Community. Marikina City: Argonauta Corp., 2004.
Untalan, A. Concepts and Guidelines in COPAR. 1st ed. Manila: Educational Publishing House, 2005.
Internet Sources
Jay C. Published: 6/23/2004. http://www.buzzle.com/editorials/6-23-2004-55793.asp
http://wisdomquotes.com
http://psychology.about.com/od/theoriesofpersonality/ss/psychosexualdev. htm
APPENDICES APPENDIX A
BARANGAY HEALTH PROFILE
Department of Health
Notre Dame of Dadiangas University- College of Nursing
Barangay/ Purok: Daanbanwang, Upper Labay, General Santos City Household No.
PERSONAL DATA
Name of respondent: Mrs V B-Day: 12/17/1973 Status: M Educational Attainment: Grade 6
I. GENERAL HOUSEHOLD DATA
A. Total number of children: 4 B. List of household members:
Members B-Day
(mm/dd/yyyy) Occupation Sex AttainmentEductl Religion Rel. to Resp. StatusImm. Deworming Date Weight NS
Mr V 11-14-79 Farmer, M Grade 3 Protestant Husband - - 56 kgs N
Mrs V 10-09-80 Housewife F Elem Grad Protestant INC - 50 kgs N
AV 07-11-98 Student M Grade 5 Protestant son INC 2008 38 kgs N
BV 10-19-99 Student F Grade 4 Protestant son INC 2008 36.5
kgs N
CV 04-16-02 Student M Grade 3 Protestant son INC 2009 33 kgs N
DV 05-23-05 Student F Grade 1 Protestant daughter COM 2009 17 kgs N
II. ECONOMIC DATA
A. Sources of Income: Occupation: Farming Estimated Monthly Income: P6, 000
B. Land 1. Owned ( ) Rented ( ) Tenanted ( X ) 2. No. of Hectares: ____. Type: Plain ( X ) Rolling ( ) C. Products, if land is farmed: corn
D. Type of Housing: Concrete ( ) Ordinary ( X ) Rented ( ) Scrap ( ) E. Household Appliances: radio
F. Animal Raising: chicken
G. Transportation Facilities: Owned ( X ) Rented or Others( ) H. Water: Bought ( ) Free (x )
III. ENVIRONMENTAL DATA
A. Toilet facilities: Owned ( ) Shared ( ) None ( X ) Anywhere
B. Source of Drinking Water Supply: Shallow well C. Drainage: none
D. Garbage Disposal: Burying and/or Burning E. Home: Herbal ( ) Vegetable ( x) None ( )
IV. MEDICAL HEALTH DATA
A. Common diseases/ Commen Treatment: cough, colds and fever; Herbal e.g Mayana and Kataka- taka B. Immediate Sources of Medical Care: BHW
C. Family Planning: Continuous; Pills D. Pregnancy: No
E. Lactating: No
F. Death in the Family: None
G. Other pertinent observations/informations like presence of personality disturbances: None H. Disable member of the family: None
APPENDIX B
FAMILY HEALTH DATA CARD
INDICATOR
QUARTER
THIRD QUARTER FOURTH QUARTER
FAMILY PLANNING OOOOOO OOOOOO
PRENATAL OOOOOO OOOOOO
IMMUNIZATION OOOOOO OOOOOO
NUTRITION OOOOOO OOOOOO
WATER OOOOOO OOOOOO
GARBAGE DISPOSAL OOOOOO OOOOOO
TOILET OOOOOO OOOOOO
ALCOHOLISM OOOOOO OOOOOO
APPENDIX C Process Recording
This appendix represents the course of interaction between the student and the family during each phase of interview. It also includes the reactions of the family or how they respond on the questions that were lift during the entire interview.
Purpose:
1. To be able to have a specific data on how the interview was conducted
2. To be able to interpret or analyze the answers given by the respondent
3. To document pertinent data and how they responded to questions that were raised
Orientation Phase
Student Nurse Client Remarks Rationale
“Maayong buntag diay Ma’am” (Waves and smiles)
“Salamat Ma’am. Ako diay si Mylene Ma’am. Nursing student sa NDDU. Pwede mabal-an unsa inyong pangalan?” “Ay hello diay Ma’am Emie. Mao ning inyong
balay?”
“Maayong buntag sad. Dali sulod mo oi.” (Smiles)
“Ahh. Ako diay si Emie.”
“O. Amua ni siya. Bag-o ra jud mi diri. Tong June lang mi ngbalhin diri” The student nurse greeted the respondent and the respondent welcomed the student nurse in their house. The student nurse verified if the respondent
The opening can be the most important part of the interview because what is said and done at that time sets the tone for the remainder of the interview. The purposes of the opening are to establish rapport and orient the interviewee.
Establishing rapport is a process of creating goodwill
“Ahh. Mao ba. Aha man pud inyong pamilya?”
“Ay ma’am. Pwede ko mag-interview sa inyuha?
Kanang kamo man gud ang akong napili na iadopt na family. Okey ra ma’am?”
“Salamat kaayo ma’am ha. Kanang hantod October mi maginterview interview. Mubalik mi mga November na. Mga December daw mi
magculmination” “Lagi daw ma’am. Lisod daw ang suga. Pero
challenge na siya sa amua eh. Lingaw man pud na siya (Client and SN laughs).
Kanang
manghangyo ko sa inyong cooperation ma’am ha.”
“Ang akong bana naa man sa bukid gud nag-uma. Didto na siya gapuyo jud. Ginaadtuan lang namo sa mga bata. Ang mga bata naa man sa eskwelahan kay nay klase. Unya pato taod2 inig udto kay diri to sila mukaon”
“Okey ra kaayo uy. Walay problema. Maayo gani ni. Hehe”
“Hala. Dalia ra man pud diay noh. Matulog pud mo diri eh? Wala baya suga diri.”
“Ay wala nay problema gang. Pasalamat gani mi naa mo diri karon para mutabang namo. Siyempre importante gud na naa mi mabal-an sa sakit sakit. Dapat lang jud mucooperate mi eh” (Smiles) was a member of the community. The student nurse informed the respondent on her purpose for coming and the interview. The student nurse told the respondent the time duration of their stay in the community. The respondent approves of the student nurse’s purpose and acknowledged her presence.
and trust. It can begin with a greeting (“Good morning Sir!”) or self-introduction (“Good morning! I’m a nursing student”) accompanied by nonverbal gestures such as smile, a handshake, and a friendly manner. Giving recognition, in a nonjudgmental way, of a change in behaviour, an efftort the client has made, or a contribution to communication. Acknowledgment may be with or without understanding, verbal or nonverbal. (Barbara Kozier)
Working Phase
Student Nurse Client Remarks Rationale
Ay kanang ma’am unsa inyong apelyido?
Sige lang ma’am. Ikaw lang akong interbyuhon. Unsa napud inyong edad ug sa inyong
bana? Kanus-a pud inyong mga bday?
Okey ra ma’am uy. Hehe. Kanang. Unsa pud mga Pangalan sa inyong anak ug ilang mga bday?
Ahh. Layo layo pud ilahang mga agwat noh.
Lagi ma’am uy. Maayo gani ma’am nainform mo ug ing-ana
Kanang ma’am mangutana ko kung unsa inyong nahuman sa eskwela?
Yata. Wala baya akong bana diri ay.
Ay sige. 29 nako. Akong bana kay 30. October 9 ko nya November 14 na siya. 4 tanan among mga anak. Wala baya sila diri kay nageskwela. Si Child AV 11, si BV 10, si CV 7 unya si DV 5. Si AV July 1998 na siya. Si BV kay October 1999. Si CV April 2002 unya si DV May 2005. Gafamily planning man jud gud mi tong una pa sa Malungon pa mi. Nagsunod sunod lang ang 2 ka una pero after ana nagpills nako. Lisod na baya kinabuhi ron.
Lagi. Naa man pud gud health center didto sa Malungon ug Nurallah.
Elementary
graduate ko, akong bana kay hantod grade 3 lang. Unsaon ta man Demographic data was given completely. Respondent was proud to be a family planning follower. Respondent blames poverty for their lack of education. Education is an important aspect in every human life especially now that job hiring could be
Ang mga bata ma’am?
Kamo ra jud diri sa mga bata ma’am? Bale balay jud ni ninyo?
Nag-ingon ka ma’am na naga-uma imong bana. Unsa pa mga lain ninyong
ginakwaan para income?
Kanang pila pud inyong maincome sa usa ka bulan?
lisod kaayo ang kinabuhi.
Mga bata maayo man kay nay eskwelahan diri. Si AV grade 5, si BV grade 4, si CV grade 3, si DV maggrade 1.
O. akong bana tu-a sa bukid. Kami ra jud diri. Kaning among balay dugay na ni siya. Gibuhat ni siya sa pamilya sa akoang bana. Puro kahoy na siya ug nipa ug mga patay na dahon sa saging. Dira ko galuto sa may likod. Mao ra jud ni
among makaya kay siyempre kulang sa budget. Ang among ipahimo ug balay, ikaon na lang namo diba
Ay mao ra jud na. Wala nay lain.
Mga Php6,000 pud. Gamay ra jud ang income intawon. Di na gain mi kapalit sa mga sanina sa bata. Mga kinahanglan nila. Respondent was glad the children have a chance in education.
She was able to express her concerns about the household, including the environment. Respondent put on much emphasis on financial issues.
very difficult if you lack education.
Due to financial constraints, the family has not able to provide an adequate and a safe house for the family.
Poverty is an issue in every Filipino family since it is the major factor that affects their way of living.
Kanang inyuhang banyo? Ug kung asa mo gakuha ug tubig?
Ang inyong mga lamaw ma’am o mga hugaw gikan sa kusina, aha ninyo ginalabay? Kanang butangan sa inyong pagkaon na wala nahurot? Daghan kaayo mga langaw? Mga lamok?
Luoy kayo. Ang among pagkaon ginatama tama lang para sa amua. Isda ug mga gulay dira sa kilid among sud-an pirmi.
Mao jud na karon kay wala pa mi kahimo. Wala pay kwarta. Dra ra mi gaihi, galibang kanang walay tao Dira mi sa balon gakuha ug tubig. Wala na namo ginasterilize. Ok naman na siya. Layo man gud kaayo ang gripo diri sa amua.
Dira ra man namo pud namo na ginalabay. (Points at the ground beside the house). Dira ra man namo na ginabutang. Wala man mi
butanganan na lain. Daghan lagi kayo ug langaw
Ay daghan pud. Pero naa man mi mosquitero. The respondent explained how they manage with their elimination even without a toilet facility. She also explained their ways of getting water for drinking. Respondent explains how they manage their drainage disposal Respondent shows how they put their left overs. Respondent explains that although there are many mosquitoes in the place, they have
protection from it.
The family has not yet build a toilet facility since they were new to the place and have no budget for it.
Drainiage disposal is an important factor since vectors or insects may hover and affect their health.
Kanang sa bakuna sa mga bata
ma’am?
Kanang diri sa panimalay ma’am unsa pud ng ugali sa mga bata na makaapekto sa ilang lawas. Parehas ng ilang paghugas o paggamit ug tsinelas? Kanang bisyo ma’am?
Naa pud ba moy mga gulay o herbal na ginatanom?
Isa ra lagi ang nakakumpleto sa bakuna ba. Layo pa jud ang center. Sa panahon namo dili man pud na uso gud.
Ay mga tamad na sila manghugas ug kamot. Wala tay mahimo kay gahi man jud ug ulo.”
Ay maayo jud. Wala jud bisyo akong bana.
Naa. Didto o. Mga kangkong. Ang herbal naa sa ilalom. Mga asunting.
Respondent points out that the health center is quite far from their place. Respondent shows that she disapproves of the children’s behavior but feels she can’t do anything about it. Respondent feels proud of her husband not having vices. Respondent shows the student nurse their mini vegetable garden and that they have herbal plants around. Immunization is an important protection and prevention of some diseases.
Knowing the ways of health helps the student nurse what to educate the family and what kind of
improvement on health they need.
No disturbances were found.
Having a vegetable and herbal garden helps the family in terms of healthy food and also disease management
Termination Phase
Student Nurse Client Remarks Rationale
Ay ma’am salamat kaayo ma’am ha. Balik ra ko.
Salamat jus kaayo.
Walay problema. Adto lang gud diri. Balik balik mo ha. Suroy suroy pud mo ba.
The
respondent appreciated our presence and was open
Expressing
gratitude makes the respondent feel that they did something good. Giving
in answering all the questions. recognition, in a nonjudgmental way, of a change in behaviour, an efftort the client has made, or a contribution to communication. Acknowledgment may be with or without understanding, verbal or nonverbal.
