Family Case Study

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

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(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

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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.

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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 attaining optimum health.

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•

Categorize the identified health problems as health threat, health deficit or foreseeable crisis through the assistance of their studentnurse.

•

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

•

Evaluate changes in condition after giving interventions.

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Chapter III INITIAL DATABASE

A. Family Structure, Characteristics, and Dynamics Name

Age

Sex

Civil

Mr. V Mrs. V Child AV Child BV Child CV Child DV

30

Male

Married

29

Female Married

Position in the Family Father

Occupation Farmer

11

Male

Child

Mother (Respondent) Eldest Child

Housewife

10

Female

Child

Second Child

Student

7

Male

Child

Third Child

Student

5

Female

Child

Fourth Child

Student

Student

Educational Attainment Elem. Level (Grade 3) Elem Grad (Grade 6) Elem. Level (Grade 5) Elem. Level (Grade 4) Elem. Level (Grade 3) 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

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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.

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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.

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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.

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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

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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

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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

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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 13

•

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.

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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

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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.

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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

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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 NAME OF HUSBAND:

Mr. V

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B. Family Tree

Mrs. V

Mr. V

Child AV

Child BV

Child CV

C. General Household Data 1. Total No. of Children: 2 2. List of Household Members S Educ. e Attainment x M Elem. level F Elem Grad M Elem. level

Protestant Protestant Protestant

Student

F

Elem. level

Protestant

Child

Student

F

Elem. level

Protestant

Child

Student

F

Elem. level

Protestant

Members

Status

Occupation

Mr. V Mrs. V Child AV

Married Married Child

Farmer Housewife Student

Child BV

Child

Child CV Child DV

Religion

Positio n in the Family Father Mother 1st Child 2nd Child 3rd Child 4th Child

Imm. Status

NS

INC INC INC

NA NA NA

INC

N

INC

N

COM

N

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Chapter 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

CRITERIA

IDEAL

1. Physical Independenc e

Is concerned with ability to move about, to get out of bed, to take care of daily grooming, walking, etc.

2. Therapeutic Competence

Includes all of the procedures or treatments prescribed for the care of illness such as giving medications, using appliances, dressing, exercise,

ACTUAL

Rating

behavior.

The members are all able to move 5 without assistance and difficulty. They do their activities of daily living without aid. They are independent in moving about and using their musculoskeletal system. The parents are 3 aware on what to do if a member fells ill. However, due to financial problems and distance of the health center, they cannot

JUSTIFICATION

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.

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

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relaxation, diets, etc.

special 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 2 knowledgeable on salient health issues and responsibilities. Yet due to financial problems, health issues are overlooked.

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 2 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.

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.

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and preparing food).

of

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 1 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.

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 5 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.

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.

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obligations, to accept adversity with fortitude, to consider the needs of others as well as one’s own. 7. Family Living

8. Physical Environment

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 3 concern within the family, especially with regards to their interrelationship with others. The parents discuss decision- making.

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 2 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

The children are not yet open for suggestion to decision-making since they are still young and difficult to comprehend their current situations.

Others respect individual relationships of each member of the family. Decisionmaking 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.

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

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9. Use of Community Facilities

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,.

Degree of the family use and awareness of the available community facilities for education and welfare.

The mother is 3 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

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.

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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: I. Accident hazards specifically fire The house of Family V is a hazard, as a health threat. bungalow style of house. It is mainly made up of bamboo and nipa as its A. Inability to provide a home roof. The mother usually cooks at the environment conducive to health back of the house using wood and maintenance and personal charcoal. development due to: a. Inadequate family Subjective data: resources; specifically The mother verbalized “Kaning financial constrains/limited among balay dugay na ni siya. Gibuhat financial resources. ni siya sa pamilya sa akoang bana. b. Failure to see benefits of Puro kahoy na siya ug nipa ug mga investment in home patay na dahon sa saging. Dira ko environment improvement. galuto sa may likod. Mao ra jud ni among makaya kay siyempre kulang B. Inability to make decisions with sa budget. Ang among ipahimo ug respect to taking appropriate action balay, ikaon na lang namo diba” 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

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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.”

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.

Objective data: III. Unsanitary food handling as a The hands of the children are presence of health threat. unclean when they ate they meal. A. Inability to make decisions with Subjective data: respect to taking appropriate Mother verbalized “Ay mga health action due to: tamad na sila manghugas ug kamot. a. Low salience of the problem. Wala tay mahimo kay gahi man jud ug b. Negative attitude towards ulo.” health problem Objective data: IV. Poor home condition specifically The family usually stores their lack of food storage facilities as a food by covering it with plate and health threat leaves it in the table A. Inability to make decisions with Subjective data: respect to taking appropriate Mother verbalized “Dira ra man health action due to: namo na ginabutang. Wala man mi a. Low salience of the problem. butanganan na lain. Daghan lagi kayo b. Negative attitude ug langaw” towards health problem c. Inaccesability if appropriate resources for care specifically financial constraints Objective data: V. Poor environmental sanitation The family’s drainage is an specifically improper drainage open type. They just throw it disposal as a health threat

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anywhere. Rice grains beside the house.

are

noted A.

Subjective data: Mother verbalized “Dira ra man namo pud namo na ginalabay”

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

Objective data: VI. Poor environmental sanitation The family has no comfort specifically unsanitary waste room. They just defecate and void disposal as a health threat anywhere. A. Inability to make decisions with Subjective data: respect to taking appropriate Mother verbalized “Mao jud na health action due to: karon kay wala pa mi kahimo. Wala a. Low salience of the problem. pay kwarta. Dra ra mi gaihi, galibang b. Negative attitude towards kanang walay tao” health problem c. Inaccesability if appropriate resources for care specifically financial constraints 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.

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

Subjective data: Mother verbalized “Dira mi sa B. balon gakuha ug tubig. Wala na namo ginasterilize. Ok naman na siya. Layo man gud kaayo ang gripo diri sa amua”

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:

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a. Inaccessibility of required service due to physical inaccessibility (location of facility) Objective data: VII. Lack of immunization status Not all children have completed specially of children as a health their immunizations. threat Subjective data: A. Inability to make decisions with Mother verbalized “Isa ra lagi respect to taking appropriate ang nakakumpleto sa bakuna ba. Layo health action due to: pa jud ang center.” 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)

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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 1. Nature of the 2/3 x 1 problem 2. Modifiability of 1/2 x 2 the problem

Score 0.67

Justification This problem is a health threat

1

3. Preventive potential

2/3 x 1

0.67

4. Salience

1/2 x 1

0.5

The problem is partially modifiable. The only way to solve this problem is to renovate the house, thus it needs money. 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. 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 1. Nature of the 2/3 x 1 problem 2. Modifiability of 0/2 x 2 the problem

Score 0.67

Justification This problem is a health threat

0

3. Preventive potential

0.33

The problem could not be modified at all. The family size cannot be trimmed down to smaller size The problem may be prevented but the family size

1/3 x 1

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4. Salience

0/2 x 1

0

Total Score:

1

cannot be trimmed down. The problem is not perceived as a problem at all by the family.

III. Unsanitary food handling as a presence of health threat. Criteria Computation 1. Nature of the 2/3 x 1 problem 2. Modifiability of 2/2 x 2 the problem

Score 0.67

Justification This problem is a health threat

2

3. Preventive 3/3 x 1 potential

1

4. Salience

1/2 x 1

0.5

The condition can be highly modifiable. If the family receives the right health teaching, attitude can be changed for the better The problem can be prevented if the family is educated on the importance of hand washing 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 1. Nature of the 2/3 x 1 problem 2. Modifiability of 1/2 x 2 the problem

Score 0.67

Justification This problem is a health threat

1

3. Preventive 1/3 x 1 potential

0.33

4. Salience

1/2 x 1

0.5

This problem is partially modifiable since the family lacks resources specifically in the financial aspect. However, appropriate health teachings may correct this problem The problem is low in preventive potential since there is lack of appropriate resources that could solve this. The problem is not needing immediate attention according to the family

Total Score:

2.5

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V. Poor environmental sanitation specifically improper drainage disposal as a health threat Criteria Computation 1. Nature of the 2/3 x 1 problem 2. Modifiability of 2/2 x 2 the problem

Score 0.67

Justification This problem is a health threat

2

3. Preventive 2/3 x 1 potential

0.67

4. Salience

1/2 x 1

0.5

The problem is easily modifiable by teaching the family the importance of having a proper drainage. This is highly preventable if the family has learned the importance of having a clean drainage. 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 1. Nature of the 2/3 x 1 problem 2. Modifiability of 1/2 x 2 the problem

Score 0.67

Justification This problem is a health threat

1

3. Preventive 2/3 x 1 potential

0.67

4. Salience

1/2 x 1

0.5

The problem is moderately modifiable since this problem can only be solved with money. This can be highly preventable if the family had prioritized in building a toilet 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 1. Nature of the 2/3 x 1 problem 2. Modifiability of 2/2 x 2 the problem

Score 0.67

Justification This problem is a health threat

2

3. Preventive 3/3 x 1 potential

1

The problem is highly modifiable since it could be solved if the family knows the importance of sterilization. The problem is preventive because there are ways and

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4. Salience

1/2 x 1

0.5

Total Score:

4.17

resources present in the community where in the family can have a clean water supply The problem, with accordance to the family’s perception, is not much important.

VIII. Lack of immunization status specially of children as a health threat Criteria Computation 1. Nature of the 2/3 x 1 problem 2. Modifiability of 1/2 x 2 the problem

Score 0.67

Justification This problem is a health threat

1

3. Preventive 2/3 x 1 potential

0.67

4. Salience

2/2 x 1

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 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. The family knows how important immunization is specially for the children

Total Score:

3.34

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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 Unsanitary food handling as a presence of health threat. Poor environmental sanitation specifically polluted water supply as a health threat Poor environmental sanitation specifically improper drainage disposal as a health threat Lack of immunization status specially of children as a health threat Poor environmental sanitation specifically unsanitary waste disposal as a health threat Accident hazards specifically fire hazard, as a health threat. Poor home condition specifically lack of food storage facilities as a health threat Family size beyond what family resources can adequately provide as a health threat.

Score

4.17 4.17 3.84 3.34 2.84 2.84 2.50 1

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FAMILY NURSING CARE PLAN Problem# 1 Unsanitary food handling as a presence of health threat. CUES

Subjective data: Mother verbalized “Ay mga tamad na sila manghugas ug kamot. Wala tay mahimo kay gahi man jud ug ulo.”

INTERVENTION PLAN

ANALYSIS OF THE PROBLEM

Inability to make decisions with respect to taking appropriate health action due to: • Low salience of the problem. • Negative attitude Objective towards data: health The hands problem of the children are unclean when they ate they meal.

OBJECTIVES NSG. INTERVENTIONS

After 1 day of community exposure, the family will be able to: Employ hands finger before during meals

clean and nails and eating

•

>Discuss with the family the importance and need for hand washing

>Demonstrate proper hand washing Discuss the technique importance and need for hand washing >Inform the Demonstrat family about e proper communicable

Specifically: •

>Assess the family’s ideas on food handling and hand washing

RATIONALE

> 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

METHOD

H O M E V I S I T

RESOURCES REQUIRED

EXPECTED OUTCOME

>Manpower resources such as time and effort.

After 1 day of community exposure, the family has able to:

>Physical and chemical resources such as soap, water, pail and clean towel

Employ hands finger before during meals

clean and nails and eating

Specifically: •

Discuss the importance and need for hand washing

•

Demonstrate proper hand

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- Dirty and long finger nails noted

hand washing techniques

diseases especially the ones transmitted if hand washing is not reinforced

they are prone of.

>Explore the family’s reaction about the health teachings given.

> To measure the understanding of the health teachings presented.

washing techniques

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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

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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.

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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

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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.

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•

They should be encouraged to verbalize their concerns with regard to the

community so that resolutions can be made.

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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/6-23-200455793.asp http://wisdomquotes.com http://psychology.about.com/od/theoriesofpersonality/ss/psychosexualdev. htm http://psychology.about.com/od/theoriesofpersonality/a/psychosocial.htm

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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 PERSONAL DATA Name of respondent: Mrs V I.

B-Day: 12/17/1973

Educational Attainment: Grade 6

GENERAL HOUSEHOLD DATA A. Total number of children: 4 B. List of household members:

Members

B-Day (mm/dd/yyyy)

Occupation

Sex

Mr V Mrs V AV BV

11-14-79 10-09-80 07-11-98 10-19-99

Farmer, Housewife Student Student

CV DV

04-16-02 05-23-05

Student Student

II.

Status: M

Household No.

M F M F

Eductl Attainment Grade 3 Elem Grad Grade 5 Grade 4

Religion Protestant Protestant Protestant Protestant

M F

Grade 3 Grade 1

Protestant Protestant

Rel. to Resp. Husband son son

Imm. Status INC INC INC

Deworming Date 2008 2008

son daughter

INC COM

2009 2009

Weight

NS

56 kgs 50 kgs 38 kgs 36.5 kgs 33 kgs 17 kgs

N N N N N N

ECONOMIC DATA A. Sources of Income: Occupation: Farming Estimated Monthly Income: P6, 000

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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

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APPENDIX B FAMILY HEALTH DATA CARD

INDICATOR FAMILY PLANNING PRENATAL IMMUNIZATION NUTRITION WATER GARBAGE DISPOSAL TOILET ALCOHOLISM SMOKING

THIRD QUARTER OOOOOO OOOOOO OOOOOO OOOOOO OOOOOO OOOOOO OOOOOO OOOOOO OOOOOO

QUARTER FOURTH QUARTER OOOOOO OOOOOO OOOOOO OOOOOO OOOOOO OOOOOO OOOOOO OOOOOO OOOOOO

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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 “Maayong buntag diay Ma’am” (Waves and smiles)

Client “Maayong buntag sad. Dali sulod mo oi.” (Smiles)

“Salamat Ma’am. Ako diay si Mylene Ma’am. Nursing student sa NDDU. Pwede mabal-an unsa inyong pangalan?”

“Ahh. Ako diay si Emie.”

“Ay hello diay Ma’am Emie. Mao ning inyong balay?”

“O. Amua ni siya. Bag-o ra jud mi diri. Tong June lang mi ngbalhin diri”

Remarks The student nurse greeted the respondent and the respondent welcomed the student nurse in their house.

The student nurse verified if the respondent

Rationale 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

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was a member and trust. It can “Ahh. Mao ba. Aha “Ang akong bana of the begin with a man pud inyong naa man sa bukid community. greeting (“Good pamilya?” gud nag-uma. Didto morning Sir!”) or na siya gapuyo jud. self-introduction Ginaadtuan lang (“Good morning! namo sa mga bata. I’m a nursing Ang mga bata naa student”) man sa eskwelahan accompanied by kay nay klase. nonverbal gestures Unya pato taod2 such as smile, a inig udto kay diri to handshake, and a sila mukaon” friendly manner. Giving recognition, “Ay ma’am. Pwede “Okey ra kaayo uy. The student in a nonjudgmental ko mag-interview Walay problema. nurse way, of a change in sa inyuha? Maayo gani ni. informed the behaviour, an Kanang kamo man Hehe” respondent on efftort the client has gud ang akong her purpose made, or a napili na iadopt na for coming contribution to family. Okey ra and the communication. ma’am?” interview. Acknowledgment may be with or “Salamat kaayo “Hala. Dalia ra man The student without ma’am ha. Kanang pud diay noh. nurse told the understanding, hantod October mi Matulog pud mo diri respondent verbal or nonverbal. maginterview eh? Wala baya the time (Barbara Kozier) interview. Mubalik suga diri.” duration of mi mga November their stay in na. Mga December the daw mi community. 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.”

“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)

The respondent approves of the student nurse’s purpose and acknowledged her presence.

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Working Phase Student Nurse Ay kanang ma’am unsa inyong apelyido?

Client Yata. Wala baya akong bana diri ay.

Remarks

Sige lang ma’am. Ikaw lang akong interbyuhon. Unsa napud inyong edad ug sa inyong bana? Kanus-a pud inyong mga bday?

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.

Demographic data was given completely.

Okey ra ma’am uy. Hehe. Kanang. Unsa pud mga Pangalan sa inyong anak ug ilang mga bday?

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.

Ahh. Layo layo pud ilahang mga agwat noh.

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 ma’am uy. Maayo gani ma’am nainform mo ug ing-ana

Lagi. Naa man pud gud health center didto sa Malungon ug Nurallah.

Kanang ma’am mangutana ko kung unsa inyong nahuman sa eskwela?

Elementary graduate ko, akong bana kay hantod grade 3 lang. Unsaon ta man

Rationale

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

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lisod kaayo ang kinabuhi.

very difficult if you lack education.

Ang mga bata ma’am?

Mga bata maayo man kay nay eskwelahan diri. Si AV grade 5, si BV grade 4, si CV grade 3, si DV maggrade 1.

Respondent was glad the children have a chance in education.

Kamo ra jud diri sa mga bata ma’am? Bale balay jud ni ninyo?

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

She was able to express her concerns about the household, including the environment.

Due to financial constraints, the family has not able to provide an adequate and a safe house for the family.

Nag-ingon ka ma’am na nagauma imong bana. Unsa pa mga lain ninyong ginakwaan para income?

Ay mao ra jud na. Wala nay lain.

Kanang pila pud inyong maincome sa usa ka bulan?

Mga Php6,000 pud. Gamay ra jud ang income intawon. Di na gain mi kapalit sa mga sanina sa bata. Mga kinahanglan nila.

Respondent put on much emphasis on financial issues.

Poverty is an issue in every Filipino family since it is the major factor that affects their way of living.

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Luoy kayo. Ang among pagkaon ginatama tama lang para sa amua. Isda ug mga gulay dira sa kilid among sudan pirmi. Kanang inyuhang banyo? Ug kung asa mo gakuha ug tubig?

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.

The respondent explained how they manage with their elimination even without a toilet facility. She also explained their ways of getting water for drinking.

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.

Ang inyong mga lamaw ma’am o mga hugaw gikan sa kusina, aha ninyo ginalabay?

Dira ra man namo pud namo na ginalabay. (Points at the ground beside the house).

Respondent explains how they manage their drainage disposal

Kanang butangan sa inyong pagkaon na wala nahurot?

Dira ra man namo na ginabutang. Wala man mi butanganan na lain. Daghan lagi kayo ug langaw

Respondent shows how they put their left overs.

Daghan kaayo mga langaw? Mga lamok?

Ay daghan pud. Pero naa man mi mosquitero.

Respondent explains that although there are many mosquitoes in the place, they have protection from it.

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Kanang sa bakuna sa mga bata ma’am?

Isa ra lagi ang nakakumpleto sa bakuna ba. Layo pa jud ang center. Sa panahon namo dili man pud na uso gud.

Respondent points out that the health center is quite far from their place.

Immunization is an important protection and prevention of some diseases.

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?

Ay mga tamad na sila manghugas ug kamot. Wala tay mahimo kay gahi man jud ug ulo.”

Respondent shows that she disapproves of the children’s behavior but feels she can’t do anything about it.

Knowing the ways of health helps the student nurse what to educate the family and what kind of improvement on health they need.

Kanang bisyo ma’am?

Ay maayo jud. Wala jud bisyo akong bana.

Respondent feels proud of her husband not having vices.

No disturbances were found.

Respondent shows the student nurse their mini vegetable garden and that they have herbal plants around.

Having a vegetable and herbal garden helps the family in terms of healthy food and also disease management

Remarks The respondent appreciated our presence and was open

Rationale Expressing gratitude makes the respondent feel that they did something good. Giving

Naa pud ba moy Naa. Didto o. Mga mga gulay o herbal kangkong. Ang na ginatanom? herbal naa sa ilalom. Mga asunting.

Termination Phase Student Nurse Ay ma’am salamat kaayo ma’am ha. Balik ra ko. Salamat jus kaayo.

Client Walay problema. Adto lang gud diri. Balik balik mo ha. Suroy suroy pud mo ba.

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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.

51