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TABLE OF CONTENTS

I.

INTRODUCTION

II.

OBJECTIVES

III.

NARRATIVE REPORT

IV.

RECORDS AND REPORTS

V.

PROBLEMS IDENTIFIED ACCORDING TO PRIORITY

VI.

RECOMMENDATION

VII.

FAMILY CARE PLAN

VIII. BIBLIOGRAPHY AND REFERENCES

I.

INTRODUCTION

A body of people having common rights, privileges, or interests, or living in the same place under the same laws and regulations is known as the community. It functions with in a particular sociocultural context and is regarded as an organism because it undergoes stages of development that it may be fast or slow. It is characterized by its distinct geographic boundaries, the common or shared interest that binds the members together and the population aggregate concept. We all know that a healthy community recognizes and respects for the existence of the subgroups, solves the problem right away, is prepared to meet any crisis, sets disputes through legitimate mechanisms and has a high-degree of wellness among its members. Through Community Health Nursing, we can be easily differentiate the healthy community from an unhealthy one, can assess and identify existing and anticipated problems, and able to provide the care that is necessary to maintain an optimum health of each of the family member, the family as a whole and the wellness of the community. The term family came from the Latin word “familia” which means “household”. It is the basic unit of the society and consists of those individuals, male or female, youth or adult, legally or not legally related, genetically or not genetically related, who are considered by the others to represent their significant others. It is important because family is the unit of care in community health nursing and is an effective channel for much of the community health nursing efforts which means the student-nurse or the nurse can carry out certain activities in community level through contacts with the family. The family has a great influence in its members that is why the way you act, the attitude you have reflects the kind or the type of family you came from. It indicates how your parents raised you. This is where members of the family were nurtured physically and emotionally and has values and beliefs that are unique. The family is sacred and a gift. It is very powerful for we all know that Filipino community has a strong family ties. Every step we take, every decision we make, we always consult it to our family. When a family is broken, it can’t be denied that every family member is looking for something that they feel is missing and that is why it is very important that as much as possible a family should be kept intact. Community health nursing is a field of nursing that is a blend of primary health care and nursing practice with public health nursing. This is where the community health nurse conducts a continuing and comprehensive practice that is preventive, curative, and rehabilitative. The attitude of care is based on the belief that care directed to the individual, the family, and the group contributes to the health care of the population as a whole that is why the study of CHN is very important and a great benefit to student nurse, the family and the community as a whole.

To the student nurse, it will be a great advantage because it will give them the chance to develop their skills, and help them realize the real situation of some people living in far flung areas. It will also develop their attitude towards dealing with people and improving their client- nurse interaction. To the family and the community, it will be an opportunity to help them assess, identify and solve problems with regards to their health and also in the promotion of their health. It will also be a good way of developing their trust to the health providers and to make them feel that they are an important citizenry and that they should take care of their health because health is wealth. The appropriate and preferred tool in assessing family health status, identifying nursing and health problems, implementing the activities in order to prevent and solve the problems identified is the Family Case Study. This will be of a great help in promoting and maintaining the health of the family. And it should be kept in mind that a community can only be healthy as the families comprising the community.

II.

OBJECTIVES

GENERAL OBJECTIVES:

AFTER FOUR DAYS OF NURSE – CLIENT INTERACTION THE STUDENT NURSE WILL BE ABLE TO:


Correlate the material she has learned in assessing family health status and

prioritizing family health problems in the community for health care, promotion and prevention.


Create ways and strategies to be able to resolve identified family health and

nursing problems. SPECIFIC OBJECTIVES: AFTER FOUR DAYS OF NURSE – CLIENT INTERACTION THE STUDENT NURSE WILL BE ABLE TO:

• • •


Assess present family health problems thoroughly. Identify and prioritize family health problems. Formulate family nursing care plan for the priority family health problems Carry out the plan for evaluating care

III.

NARRATIVE REPORT

A. Family Structure & Characteristics Mrs. Carmelita Educalan is a mother of nine. She is already widow for 11 years, thus, she is said to be the head of the family. She is the one responsible in terms of decision making. Her children are very dependent on her and they really follow and respects whatever their mother tells them. The type of their family structure is matriarchal. The eldest among her children is Thrupy Educalan. She is now 32 years old, a female, happily married with one daughter living in Metro Manila together with her husband. Albert is the second child of Mrs. Carmelita. He is now 30 years old and is still single. Raquel is the third child, ages 26, a female and is happily married. Mrs. Carmelita’s other children were Ritchelle, 25, single; Ji-ar ages 21, male and single; Gloria, 18, single; John Paul, 16, male and single; Manilyn, 15, female and single and the youngest is Mia, 9, female and single. Albert, Ritchelle, Ji-ar, John Paul, Manilyn and Mia lives together with their mother. Their other siblings are living and working in Metro Manila. Nathan Rod is the grandson of Mrs. Carmelita, son of Raquel, is now living with them too since May 21, 2009. Nathan is 1 year and 6 months old. They are seven living together in their house. They lived in Purok Kamunsil, Brgy. Canroma, Pontevedra for 32 years.

B. Socio-economic & Cultural Factors Mrs. Carmelita, an elementary graduate, works as a coffee seller in the said community. Her “kapehan” is situated just outside of their house. Aside from selling coffee all day long, she is the one who does the household chores with the help of her son Ji-ar. Every day, she wakes up early 4 in the morning to prepare hot water, cook rice and clean the house. Ji-ar is the one who washes their clothes. Ji-ar, a high school undergraduate works also as a farmer in Pontevedra. He is helping her mother with the expenses and he is the one who gives school allowances to his siblings Mia and Manilyn. Albert, an elementary graduate, works as a farmer and is also helping her mother financially. John Paul, Manilyn and Mia go to school and every weekday’s rides into tricycle in order to arrive at the school. Ritchelle is the one who takes care of her nephew Nathan. She is a high school graduate and works before as a house helper in Manila. She went home last May 21, 2009 together with Nathan because they found out only last year that Ritchelle has a Rheumatic Heart Disease. Thus, in order for her to be closely monitored and be given the ample care by her mother, Mrs. Carmelita wants her to go home. Their monthly income is Php. 2,000.00. The income they have is not that sufficient to meet their basic needs because they are many in the house. They are able to eat three times a day and they usually cooked vegetables as their viand. Her other children who works in Manila is sending them money intended for Ritchelle’s maintenance.

The family is a Roman Catholic. Mrs. Carmelita is active both in their church and in community. In fact, she is currently the Business Manager of their Purok Organization. They are able to acquire information through their Barangay Captain and Barangay Kagawads.

C. Environmental Factors The family’s house is partially concrete. They have two rooms and a sala. They have their electricity wherein they can use their television, lamps, electric fan, DVD player and karaoke player. Mrs. Carmelita, Nathan and Mia are sleeping in one room while on the other room, the one who sleeps are Ritchelle and Manilyn. Albert and Ji-ar sleep in the sala. They have six chairs, one table and one cabinet. Other storage for their clothes is a box “karton”. The client’s environmental sanitation is poor. Both frontyard and backyard is not clean and the house itself is not neat and well arranged. The mother said she has no time for cleaning the front and backyard because she has lots of odd jobs to do. The kitchen is untidy. They get their drinking water from the artesian well just beside the road, in front of their house and store it in the water jar. They use their own drinking glasses when they drink water. The client has their own toilet and it is water sealed. The toilet is separated from the house wherein you have to go outside the house and walk for 10 steps to reach it. The municipal garbage truck collects the community garbage twice a week but sometimes the family disposes their trash by burning. They have their domestic animals such as the chicken and dogs. The household pests are plentiful in their house which are mosquitoes, flies, cockroaches, and rats wherein they don’t do anything to these pests. They just let them live and roam around in their house. They have poor drainage system. They are riding in a tricycle as a means of transportation in taking or going to the nearest health center, school and in going to town. They are also using cellphones when communicating to their loved ones and significant others. The family members have a good relationship with their neighbors. They are treating each other like brothers and sisters. It appears that each and every one of them knows each other well. They helped one another in times of need.

D. Health Assessment of Each Member Mrs. Carmelita is complaining of her arthritis. She has been experiencing pain on her left ankle for 7 years. She said she has already gone to a doctor and every year, she goes to the Rural Health Center for check-up and to update herself with regards to health information. According to the client, when she’s in pain, what she is doing is that she is putting a warm compress on the affected area and also applying liniments and oils. She said that her arthritis is due to her work before. She works before in a farm. She is exposed into sun all day long, lifts heavy stuffs and is doing repetitive movements. She stands without rest for almost 8 hours and when she came home, she washes her feet right away with cold water without taking a rest for 15 or 30 minutes.

Albert and Ji-ar has no complains or any illness aside from they are having flu twice in a year. Manilyn and Mia don’t have any illness too. Nathan Rod, the grandson of Mrs. Carmelita has not experienced flu or fever since he came from Manila. He had only diarrhea during the first moth of his stay but it was managed by the family. Ritchelle, went home from Manila last May because it was found out that she has Rheumatic Heart Disease. Ritchelle only found out that she has this kind of heart ailment last year when she went on a check up because she always faints and has difficulty of breathing. According to her, her doctor said that she has to undergo for an operation. Her papers, requirements and other documents needed for the operation is already prepared but she became hesitant because her mother wont let her to go in an operation. Her mother thinks that it may not be the best option in treating the illness of her daughter. They are both scared of what will happen because the mother thinks the consequences if the operation is unsuccessful. She is scared of what will happen and of course going in an operation is very expensive. Aside from they don’t have enough money; they are not well prepared psychologically and emotionally. For now, Ritchelle is having her maintenance. Mrs. Carmelita doesn’t allow her to lift heavy objects or go into strenuous activity that might trigger or worsen her illness. Instead, she’s the one responsible for taking care of Nathan, their new and additional member of the family. The family has no history of Hypertension, Diabetes or Cancer. Albert and Ji-ar admitted they are smoking and the rest, they don’t. All of Mrs. Carmelita had their complete immunization when they were small. Common illness they got is flu, fever, and diarrhea. Her children have not yet experienced being hospitalized due to a severe or complicated disease or ailment.

IV. • •

RECORDS AND REPORTS Home visit records Health teaching

V.

PROBLEMS IDENTIFIED ACCORDING TO PRIORITY 3 2/3 3 1/3 2

1. PRESENCE OF ARTHRITIS 2. PRESENCE OF BREEDING PLACES OF INSECTS AND RODENTS 3. ADDITIONAL MEMBER OF THE FAMILY

PROBLEMS IDENTIFIED ACCORDING TO PRIORITY: Presence of Breeding Places of insects and rodents 1. CRITERIA NATURE OF HEALTH PROBLEM HEALTH THREAT 2. MODIFIABILITY OF PROBLEM EASILY MODIFIABLE 3. PREVENTIVE POTENTIAL MODERATE 4. SALIENCE A SERIOUS PROBLEM , IMMEDIATE ATTENTION 2/2 X 1 1 2/3 X 1 2/3 2/2 X 2 1 2/3 X 1 2/3

3 1/3 TOTAL

Presence of Arthritis 1. CRITERIA NATURE OF HEALTH PROBLEM HEALTH DEFICIT 2. MODIFIABILITY OF PROBLEM EASILY MODIFIABLE 3. PREVENTIVE POTENTIAL MODERATE 4. SALIENCE A SERIOUS PROBLEM , IMMEDIATE ATTENTION 2/2 X 1 1 2/3 X 1 2/3 2/2 X 2 1 3/3 X 1 1

3 2/3 TOTAL

Additional Member of the Family

1.

CRITERIA NATURE OF HEALTH PROBLEM FORESEEABLE CRISIS 1/3 X 1 1/3

2.

MODIFIABILITY OF PROBLEM PARTIALLY MODIFIABLE 1/2 X 2 1/2

3.

PREVENTIVE POTENTIAL MODERATE 2/3 X 1 2/3

4.

SALIENCE A PROBLEM BUT NOT NEEDING IMMEDIATE ATTENTION TOTAL 1/2 X 1 1/2

2

PRIORITIZED PROBLEM: Presence of Arthritis
CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION

1. NATURE OF HEALTH PROBLEM HEALTH DEFICIT 3/3 X 1 1

IT IS HEALTH DEFICIT FOR IT REQUIRES IMMEDIATE ATTENTION AND ADEQUATE MANAGEMENT TO IMPROVE THE CONDITION IT IS EASILY MODIFIABLE: THERE IS A CHANCE OF SUCCESS IN ERADICATING THE PROBLEM.

2. MODIFIABILITY OF PROBLEM EASILY MODIFIABLE ½X2 1

3. PREVENTIVE POTENTIAL MODERATE 2/3 X 1 2/3

IT IS MODERATE BECAUSE IT IS A CHRONIC ILLNES AND IT ONLY REQUIRES MAINTENANACE TO REDUCED OR ALLEVIARE THE ILLNESS IT IS A SERIOUS PROBLEM THAT NEEDS IMMEDIATE ATTENTION BECAUSE IT MAY CAUSE OTHER COMPLICATION

4.

SALIENCE A SERIOUS PROBLEM, IMMEDIATE A

2/2 X 1

1 TOTAL=3 2/3

VI.

RECOMMENDATIONS AND CONCLUSION

In order to gather correct and sufficient information from the client, you must re establish rapport, gain their trust and show them the sincerity to help them overcome their problems. Because of this, the client was able to actively participate to the interviews and activities prepared for. As a result of this, I was able to obtain cues and significant information that helped me identify and prioritize health problems and help find ways to solve them. As to the family involved in the study, family members should further take note of the following:
• The importance of hygiene and cleanliness

• Balanced diet must be observed. • Have a regular exercise. • Keep their toilet clean to prevent spread of microorganism or diseases such as typhoid fever, malaria that comes from feces.
• The family must realize that smoking can greatly affect their family, especially Albert

and Ji-ar, who may develop lung illnesses due to constant exposure to cigarette smoke.
• Maintain a good environmental sanitation by cleaning the front and backyard

everyday; be aware of the stagnant waters in the kitchen. • Also, because of unsecured water facilities, they must always remember to sterilize their water through boiling or chemical use. • Avoid burning garbage because it can affect and destroy the ozone layer.

VII.

FAMILY CARE PLAN

DATA/ CUES

HEALTH PROBLEM

FAMILY NURSING PROBLEM Inability to meet the adequate needs of the dependent member of the family due to difficulty managing homemaker/ maintenance tasks as caused by swelling and pain of the left ankle of the mother as the head of the family.

GOALS OF CARE

OBJECTIVES OF CARE

NURSING INTERVENTION

EVALUATION

Pain on the left ankle Swelling of the left ankle Difficulty walking in

ARTHRITIS

HEALTH DEFICIT

Client said, “Dugay na ni akon arthritis, mga 7 years na.”

After 3 days of nursing intervention, the client will be able to incorporate relaxation skills and diversional activities into pain control program.

After one day of nursing intervention , the client will be able to : 1. Alleviate pain

Suggest the client to assume position of comfort while in bed or sitting in chair. Promote bedrest as indicated. Encourage frequent changes of positions. Avoid jerky movements. Involve diversional activities appropriate for individual situation Apply warm or cold packs when indicated. Provide information about the disease process.

After 1 day of nursing intervention, the client was able to: 1. Report pain is lessen 2. Increase her mobility by performing self-care activities with dependence 3. Appear relaxed and able to manage the activities of daily living without assistance 4. Acquire the adequate and correct information about arthritis.

2. Increase mobility 3. Appear relaxed, able to manage activities of daily living by self/ with assistance as appropriate. 4. Acquire information about the disease process/ prognosis and treatment needs.

VIII. BIBLIOGRAPHY AND REFERENCES

http://www.allnursingschools.com/faqs/community-health-nurse.php http://www.dhss.mo.gov/LPHA/PHNursing/PHNPreceptorHandbook.pdf www. nursingcrib.com Geissler, Alice C., 1997. Nursing Care Plans 4th Edition.

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