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Community Health Nursing Family Case Study

Community Health Nursing Family Case Study as a study guide and lectur...

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DE LA SALLE LIPA

COLLEGE OF NURSING

A CASE

STUDY on

Family M

TITLE PAGE

CHAPTER I -------------------------------------------------------------------------------------

Introduction

Acknowledgements

Dedication

CHAPTER II-------------------------------------------------------------------------------------

Objective of the Study

General Objectives

Specific Objectives

CHAPTER III ---------------------------------------------------------------------------------

Initial Data Base

Family Structure, Characteristics, and Dynamics

Socio-Economic and Cultural Characteristics

Home and Environment

Health Assessment of Each Family Member

Past and Present Illness

Family Assessment based on Functional Health Pattern

Values, Habits, Practices on Health Promotion

Maintenance and Disease Prevention

CHAPTER IV -------------------------------------------------------------------------------

Family Background

Family History

DataBase of the Respondent

Family Structure

General Household Data

CHAPTER V---------------------------------------------------------------------------------------

Family Coping Index

Findings

Chapter I INTRODUCTION

In the dictionary, a family is defined as a relationship between parents and their children. Community is a group of people in a specific location that includes places where people live and work. According to Catherine Jones, family relationships greatly influence each member of the family and mold who they become throughout their life. Because of this, children's perception, behavior and practices are affected. Moreover, perception is the understanding of the happenings in the surroundings and this creates a connection between people, thus planning decisions avoiding harm to one's own health.

Family is the natural community in which humanity is experienced from childhood to adulthood, individuals learn moral values in which the family life initiates into life in society. Where family and the general good of the community are interdependent which one cannot flourish without the other. Therefore, family as a community of persons is the human of the society considered as the very heart of the common good.

Community health nursing is the utilization of the nursing process in the different levels of clientele-individuals, families, population groups and communities, concerned with the promotion of health, prevention of disease and disability and rehabilitation. ( Maglaya, et al). This is the promotion of health and prevention of disease that provides health education to people and encourages authority of each family to build a stronger foundation in nurturing of health in the community. Which is vital to nurses to improve their experiences in providing optimum care for individuals and their families.

In the province of Batangas, San Jose is one of the cities, with 33 barangays including the one that was chosen by the group of student nurses , Barangay Palanca. On the 9th day of September 2021, the student nurses interviewed with the Family M. Family M has seven members, comprising five adults and two children.

One of the main focuses of our case study is to assess the health status of each member of the family. In line with this, proper evaluation and intervention with proper planning is the duty of the student nurses in which a nursing care plan and interventions regarding the health concern of the family are provided. This is to improve the lifestyle of the family from their usual habit.

ACKNOWLEDGEMENT

The study provided our group the opportunity to learn the problems and be able to make an intervention for the needs of the family regarding their health status. But all of these could not be completed without the assistance of the people who helped us throughout the study.

For this fulfillment of the study, the student nurses want to give their appreciation and genuine gratitude to the people who constantly guide us and give their complete support section is for all of them.

The group would like to thank the following:

First of all, we would like to give our gratitude to our clinical instructor Mrs. Gleniz Silva Subano for guiding us in this family case study and for the opportunity to improve our knowledge on Community Health Nursing.

Second, we would like to extend our thanks and appreciation to our beloved family for their complete support and encouragement.

Third, we would like to extend our deepest thanks to Family M for the cooperation and willingness to be part of our study.

Fourth, is to thank our group mates for their cooperation and determination for the completion of our case study to acquire knowledge and skill.

And especially to Our Almighty God for giving us guidance, strength upon doing this case study and love that inspires us to help people.

DEDICATION

This study is dedicated to the faculty of the College of Nursing of De La Salle Lipa, community partners, and the student nurses for giving us the chance to acquire knowledge and skill. Also to our beloved family for the complete support and encouragement that inspires us to help other people. To our healthcare frontliners for being the guiding light that gives us the reason to hope. We salute you for your hardwork and kindness. And most especially to our Almighty God for consistently giving us the strength, guidance and love that serves us to be a helping hand to other people.

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 To conduct a thorough case study about the M Family residing in Sitio Centro South, Barangay Palanca, San Jose, Batangas. This is to provide the family a plan for intervention and nursing care to improve their lifestyle, especially their health status and to become self-reliant in maintaining their health.

SPECIFIC OBJECTIVES

Get to know the family and maintain rapport.
Gather information needed such as the family medical and health history.
Illustrate the genogram of the family that will help in tracing patterns of heredity.
Explain the family Apgar score that shows the relationship of family function.
Determine the different nursing theories that are related to Mr and Mrs. M health conditions.
Find out for possible disadvantages in attaining optimum health.
Provide health teachings about possible chances of developing disease.
Formulate medical solutions and nursing care to prioritize health problems.

Chapter III

INITIAL DATABASE

This chapter presents the family structure, characteristics, and dynamics such as the demographic information of each family member outlining their names, age, sex, civil status, occupation, educational attainment, position in the family, and date and birth of place. Also, Descriptions of the family with regard to their socio-economic status, physical environment, past and present history and family assessment based on functional health patterns.

A. Family Structure, Characteristics, and Dynamics

responsibilities with one another, they make sure that every member has their fair share just like in performing the different household chores.

B. Socio-Economic and Cultural Characteristics Five out of seven members of the family are currently staying at the residence of Family M and fortunately, all of the adults have their own sources of living despite the occurrence of the global pandemic. Mrs. JDM stated that her husband, Mr. PPM is a contractor who earns a monthly income of 50,000 pesos while she is a housewife who owns a rental property and receives a monthly income of 25,000 pesos. Child JADM, who is a college graduate of BS Computer Science, is a Senior Associate Manager in the IT department of the new company she’s working at. She has an estimated monthly income of 70, 000 pesos. Child JPMC, who is a college graduate of BS Accountancy is working as a Certified Public Accountant abroad, particularly in Papua New Guinea. She is earning an estimated monthly income of 195, pesos. Child JMDM, PMDM, and granddaughter AJM are currently studying at De La Salle Lipa. Child JMDM is a 2nd year college student who is taking up the course BS Nursing while child PMDM is a grade 8 junior high school student. Granddaughter ADM is currently in her 9th grade of junior high school.

When totalled, the estimated monthly income of the family is around 340,000 pesos. According to secretary Pernia of NEDA, stated in an article published by The Philippine Star (2018), an average Filipino family which consists of 5 members would need at least two persons earning 42,000 pesos as monthly income in the family to live above the poverty line. Since family M consists of seven members, their monthly income should at least reach an estimated value of 58,000 pesos for them to live above the poverty line. However, the family’s financial expenses are not limited to the essential needs only. Education and Health are two major factors that should also be considered in the family. Given that the estimated monthly income of the adults in their family is 340,000 pesos, they can be considered as an average or middle class family since there are still two children and one granddaughter studying at a private school.

All members of the family are Roman Catholic and they all have a strong faith in God. Mr. PPM and Mrs. JDM are unit leaders in the CFC - Couples For Christ group in their community in San Jose. Child JADM also attends masses during Sundays before the pandemic. Child JPMC attends a bible study group while she is in Papua New Guinea. Child JMDM is a former member of the YFC - Youth for Christ sector in their community while Child PMDM and Granddaughter ADM are former members of the KFC - Kids for Christ community in their school.

The M family also often participates in the activities of their communities, as they have said that they are part of their culture and tradition. These activities include fiesta, parties, carnivals that their community organizes. The family also enjoys and benefits from the resources of the barangay.

C. Home and Environment The house of the family M is very stable and great to live in, even though there are 7 family members living here. The type of construction material of the house is made out of concrete which makes their house strong and stable.

The house has 2 bedrooms, 1 bathroom/comfort room, a clean kitchen, a living room, and a dining room. The first bedroom, Mr. PPM, Mrs, JDM, and family M’s youngest child is sleeping here while the second bedroom is for Child JMDM and her nephew. Both bedrooms have comfortable beds to sleep in. As for the eldest child, she is living in Taguig while the second eldest is living abroad. All rooms have all the appliances which each specific room needs, such as electric fans, air conditioners, ovens, microwaves, etc. The family’s comfort rooms are

also clean, comfortable, and have complete supplies, such as toilet paper, toothpaste, etc. Family M also have pet dogs, 5 Siberian Huskies and 1 Toy Poodle. They have their own cages and places to play in. The family is always packed with dog food and toys for their pets.

The main water source of the family is from a waterworks system or has their own individual house connection. They use it for personal needs, hygiene, cleaning, doing dishes, or for food. They also store their water in a covered container so that they are prepared when the water system is not working properly. However, in terms of drinking water, the family M is getting their drinking water from a water refilling station.

They also have a good drainage system in their community. It does not flood because the water will easily flow through the canals and into the sewage system. The sink and bathrooms of the house also connect to the water drainage system.

Furthermore, in terms of waste disposal, the family M segregates all the garbage and uses garbage bins which are properly covered and labeled. They separate all the recyclables, biodegradables, and non-biodegradables. Then, they use open burning as their method of disposal which burns all of their garbage on a specific area.

Moreover, their house is 1 km away from the nearest hospital and 5 km away from the next nearest hospital, which are the San Jose District Hospital and Metro San Jose Medical Center. From this, it will be easier to go there since the family has a car and jeepneys and tricycles are easily accessible in their community. It is also convenient because the availability of the hospital or health care center is 24 hours a day.

D. Health assessment of Each Family Member

D1. PAST AND PRESENT ILLNESS

1. Health Assessment on Each Member a. Mr. PPM - During the student nurse interview, Mr. PPM is not there but according to Mrs. JDM, her husband has experienced symptoms such as shortness of breath, dizziness, and chest pains. These were later determined by their family physician to be signs of an increase in the triglycerides and cholesterol levels of Mr. PPM as reflected on his laboratory results. Mrs. JDM also said that Mr. PPM is allergic to poultry foods such as eggs and chicken, as well as seafoods. He is currently taking maintenance medications such as Clopidogrel, AUDRA, Zyrova, and Hepatec. Mr. PPM weighs about 72 kilograms with a height of 160 cm. His BMI classification is overweight with a value of 28 kg/m 2. Since he is 57 years of age, he doesn’t prefer to drink alcohol that much anymore compared to when he was in his younger years. He also doesn’t smoke and has complete immunization of vaccines including the vaccination for covid-19. b. Mrs. JDM - Mrs. JDM is diagnosed with type II Diabetes by their family physician. Before she had her check-up, she said that she was experiencing some symptoms such as pain at the back of the neck and numbness in her right foot. Due to this, she is currently taking her maintenance medications also such as Metformin and Hepatec. Mrs. JDM doesn’t have any food allergies unlike her husband. She weighs 73 kg with a height of 152 cm. She belongs to the obesity classification with a BMI value of 31 kg/m 2. She also doesn’t drink alcoholic beverages anymore except for

● The family has been able to recognize the importance of healthy wellbeing. b. Nutritional-metabolic pattern ● Everyone in the family is taking vitamins, particularly Bewell C and Cherifer for the kids while USANA is taken by the adults. ● Everyone in the family consumes junk foods and soft drinks but in moderation and with limitations. ● Child PMDM has a good appetite but is sometimes a picky eater, stated by Mrs. JDM. ● Child PMDM and Granddaughter AJM have poor tolerance when it comes to eating some vegetables. Mrs. JDM stated that they often persuade the two to eat vegetables when eating together. ● Rice, meat/fish, and vegetables are part of the family’s daily meals. They also consume fruit from time to time. ● The daily fluid intake is 8-10 glasses of water. c. Elimination pattern ● There is no problem with their urine. ● Some of the family members suffer from constipation or diarrhea sometimes. ● Mrs. JDM, Child JPMC, JMDM, and PMDM are sometimes lactose intolerant. ● Eliminates standard pee recurrence regularly: 3-4 times a day d. Activity-exercise pattern ● Mrs. JDM stated that she and Mr. PPM performs activity exercises such as zumba and treadmill running. Child JADM workouts from time to time while Child JPMC uses tiktok dancing as her form of exercise with her husband. Child JMDM, PMDM, and granddaughter AJM perform exercises as required in their physical education subjects. ● Child PMDM sometimes go biking with his cousins. ● The spare time activities of the kids are playing online games, watching netflix, and browsing social networking sites. Sometimes they do physical activity too like playing street games or playing sports like badminton and basketball. e. Sleep-rest pattern ● Mrs. JDM stated that his husband suffers from sleep paralysis sometimes. ● Mrs. JDM and Mr. PPM usually sleeps around 9-10 pm and wakes up at 5-7 am. ● Child JADM and JPMC sleep at around 11-12 pm. ● Mrs. JDM stated that Child JMDM, PMDM, and granddaughter AJM often sleep late at night especially when there are no classes the next day but they also wake up late at noon time or in the afternoon. ● Granddaughter AJM often takes a nap around 4-6 pm in a day. f. Cognitive-perceptual pattern ● Mrs. JDM stated that every member of the family has no sensory defect. ● As the respondents, Mrs. JDM were able to respond to the questions appropriately and accurately. ● Mrs. AJV has stated that her children can respond when called. ● The memory is intact. g. Self-perception/self concept

● Mrs. JDM stated that the things that can make her easily mad or angry are when her children have not followed her. ● Appeared trepidation and stress towards unspecific outcomes. h. Roles and relationship ● Mrs. JDM stated that they are currently not facing any problems regarding the relationship of the family members. i. Sexual reproductive ● Mrs. JDM is nearly reaching her menopause stage. ● Parents are active in sex. ● Child JPMC and her husband are sexually active. j. Coping stress ● Family M spends time together by watching netflix, sharing chores, keeping communication channels open, and sitting down for lunch and evening meals together several times a week to cope with stress. ● They do not take any medication to relieve stress. k. Values/ belief Pattern ● The religion of the family is Roman Catholic. ● They often go to church on Sundays. Mr. PPM and Mrs. JDM often attend CFC related activities in service of the Lord. ● The family also believes in a quack doctor and a fake healer. ● They also have values and beliefs in their religion. E. Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention The family is fully equipped and knows all about the family’s health conditions and problems. They also know about where the nearest hospital or healthcare centers are if ever one of them is not feeling well. Mr. PPM and Mrs JDM always inform their family members where the medicines are and teach them how to drink/take their medications. Moreover, they encourage each other to create a family meal plan and perform daily exercises to strengthen the body and burn calories. They also have the right amount of sleep or rest. They usually do 8 - 10 hours of sleep Family M also consults a physician at the nearest healthcare facility to let them undergo laboratory tests to check their health conditions and ask what medications the family needs to take. They will come back if necessary or if one of the family members is still not feeling well. The family also uses herbal medicines and goes to quack doctors or “albularyo” when one of the family members is sick. Furthermore, Family M always reminds each other to follow the protocols in avoiding COVID-19. The family members only go out when it is necessary, such as buying groceries, medicines, and other necessities in the house. After going out, the family members always remember to disinfect themselves and take a bath immediately. Even though the family is fully vaccinated, they are still following the protocols so that they can prevent the spread of the virus and also avoid catching COVID-19.

Chapter IV

FAMILY BACKGROUND

This chapter illustrates the family background of the study which includes, Database of the Respondent, Family Structure, General Household Data, Activities of Daily Living which could be an indicator for the present health status of the family as it continues to influence each of the family members.

Educational Attainment: College Level

Estimated Monthly Income: Php 25, 000

Name of Husband: Mr. PPM

C. Family Structure

D.

General Household Data

Total Number of Children: Four (4)

List of Household Members

MembersStatusOccupationSexEducational Attainment

ReligionPosition in the Family

Immunization Status

Mr. PPM Married Contractor M College Graduate Roman Catholic

Father - Husband of Respondent

Complete

Mrs. JDM Married Housewife - Landlady

F College Level Roman Catholic

Mother - Wife (Respondent)

Complete

Child JADM Single Senior Associate Manager

F College Graduate Roman Catholic

First Child Complete

Child JPMC Married Certified Public Accountant

F College Graduate Roman Catholic

Second Child Complete

Child JMDM Single Student F 2nd Year College Roman Catholic

Third Child Complete

Child PMDM N/A Student M Grade 8 High School

Roman Catholic

Fourth Child Complete

Granddaughter AJM

N/A Student F Grade 9 High School

Roman Catholic

Granddaughter - Daughter of Ms. JADM

Complete

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 of how the family handles various stressors. The observations are analyzed to see the occurrence of health problems or negative attitudes and behavior.

Scaling: 1- No Competence 3 - Moderately Competence 5 - Complete Competence

CRITERIA IDEAL ACTUAL RATING JUSTIFICATION

1. Physical Independence

Is involved with the ability to move around, get out of bed, take care of daily hygiene, walking, etc.

The members of the family can move around and do their everyday duties without trouble or without any aid. They are self-determining and their musculoskeletal system roles fit.

5 All family members are receiving the necessary care that they need to maintain cleanliness and have no incapacities in doing their daily activities.

2. Therapeutic Competence

Requires all techniques or medications approved for the treatment of sickness, such as medicine drugs, uses, dressing, physical activity, stress relief, diet plans, etc.

The family members are aware of what to do in a situation when an individual feels sick. They also have the accurate apparatus to monitor diabetes for Mrs. JDM. They also have a first aid kit in their house. The family members go to

5 The family is well aware and educated on how they will respond in a situation. The family is well enough to provide for the things that they need when a family member is unwell. They have the resources to buy

Attitudes family believes about health care in general, with preventive facilities, health concerns, and community health activities.

physician when someone in the family is ill. They usually go to the hospital, health centers and the albularyo for consultations. They rely on the hospital, health center and the media for medical information.

understands the need for health care, they usually go to a physician but they also consult an albularyo at times.

6. Emotional Competence

It has to do with the responsibility and honesty with which the members of the family can handle the typical pressure and difficulties of life, and to develop for a joyful and successful life. The scope to which people distinguish the proper disciplines enforced by their own family and culture. Improving the obligations and outcomes of the individual. A willingness to see practical concerns, to recognize hardship, to respect the needs of others as well as one's own.

The family members are emotionally healthy, they are in control of their thoughts, feelings, and behaviors. They're able to cope with life's challenges. The head of the family Mr. PPM and Mrs. JDM has disciplined their children well. The family respects one another.

5 The family has a healthy relationship with one another and this helps them to be emotionally healthy. They can control their emotions and they feel good about themselves.

7. Family Living

Affected about the personal or social group part of family life. The members of the family get along with each other, the strategy in which they get choices that impact the family, the amount to which they encourage each other and make matters as a family, the level of manners and love, and the approach in which they manage the family savings.

The family members have no difficulty or concerns with their interrelationship with each other and decision making includes all the members of their family. They are near adequate to support one another when somebody is in need. They are contributing to keeping the adequate health and fit of each family member.

5 The family has a good and healthy relationship with one another, they get along well. They do things together and each family member acts for the good of the family. The children respect their parents and vice- versa, and the family tasks are shared.

8. Physical Environment

House involves the home, community, and workout environment as it impacts family health conditions. House conditions such as crash accidents, risk pressure, screening, sanitation, system, food facilities, privacy, community intensity (deteriorated neighborhood, presence of social hazards, pests), school transportation, and availability.

The family house is great enough and in good condition for the members of the family who live in it. It provides confidentiality in their atmosphere. They have a good water source as well. Their means of waste disposal somehow contribute to a good physical environment since they throw the garbage properly with proper segregation. They also recycle the recyclables and sell other recyclables as scrap along with the non-biodegradable waste. However, the use of the open burning method is unhealthy for the environment since it contributes to the production of greenhouse gasses. Also, the family members have

3 The House is in a very good condition and it provides the family’s privacy. It is also free from hazards such as accidents and pest hazards. They somehow contribute to a good physical environment however, they still use the open burning method which is harmful for the environment.

action due to: a. Failure to comprehend the nature and magnitude of the problem. b. Low salience of the problem.

Objective data: There are protruding nails in Family M’s kitchen. Also, there is the presence of an

open canal near the residency.

Subjective data:

The mother stated: “Open ang mga kanal at may mga times na umaalingasaw ang amoy ng kanal lalo kapag malakas ang ulan. Delikado rin ito dahil pwede itong pamugaran ng mga lamok”

II. Open canal and exposed nails from the wooden walls as an accident hazard. A. Inability to recognize the presence of the condition of the problem due to: a. ignorance towards the issue. B. Inability to make decisions with respect to taking appropriate action due to: a. Failure to comprehend the nature and magnitude of the problem. b. Low salience of the problem C. Inadequate knowledge and initiative for preventive measures.

Objective data: The house of the family is clean inside however, the environment outside their house especially where the dog cages are located is unmaintained. Also, a poultry is just beside the family’s home. This causes flies to enter their home whenever they are having a meal.

Subjective data:

The mother said: “Madumi ang labas ng aming bahay dahil sa aming alagang aso at poultry sa kalapit na bahay.”

III. Poor home condition specifically due to animal waste that serves as a breeding site for vectors of diseases, as a health threat. A. Inability to provide home environment conducive to health maintenance and personal development due to: a. Lack of skill in carrying out measures to improve the home environment. b. Failure to see benefits (specifically long-term ones) of investments in home environment improvement.

Objective data: Family M’s method of waste disposal is through burning their garbage at the side of their house.

Subjective data: The mother verbalized: “Ang paraan ng aming waste disposal ay ang pagsisilab ng mga basura sa aming bakuran”

IV. Poor home condition specifically due to improper garbage disposal as a health threat. A. Inability to provide home environment conducive to health maintenance and personal development due to: a. Lack of skill in carrying out measures to improve the home environment.

Objective data:

Mr. PPM The patient has the following history: High cholesterol level and high triglycerides

● Blood Pressure: 140/90 mmHg ● Pulse rate: 103 bpm ● Respiratory rate: 25 bpm

● Temperature: 37 C ● BMI: 28. ● Cholesterol level: 242 mg/dL ● Triglyceride level: 501 mg/dL

Known Food Allergies: Subjective data: The mother said: “May food allergies ang husband ko sa seafoods”

V. Comorbidity is specifically High Cholesterol, High Triglycerides, Food Allergy, as a health deficit. A. Inability to make decisions with respect to taking appropriate health actions due to: a. Failure to comprehend the nature of the problem. B. Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable/at-risk family member due to: a. Inadequate knowledge and skill in carrying out the necessary care.

Objective data:

Mrs. JDM The patient has the history: Diabetes

● Blood Pressure: 135/85 mmHg ● Pulse rate: 81 bpm ● Respiratory rate: 25 bpm ● Temperature:37 C ● BMI: 25.

● Blood Glucose level: 162 mg/dL

Subjective data:

Mother stated: “May diabetes ako at hangga’t maaari ay maingat ako sa mga food na kinakain ko, lalo na sa mga matatamis. Iniisip ko kung pano ko macocontrol ang aking pagkain para hindi ito lumalala.”

VI. Comorbidity is Diabetes, as a health deficit. A. Inability to make decisions with respect to taking appropriate health actions due to: b. Failure to comprehend the nature of the problem. B. Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable/at-risk family member due to: a. Inadequate knowledge and skill in carrying out the necessary care.

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