Ateneo de Davao University

Jacinto St., Davao City

In partial fulfillment of the requirements in

NCM 2141: COMMUNITY HEALTH NURSING 1 RLE (INDIVIDUAL AND FAMILY AS

CLIENTS)

Submitted to

Ms.Dinna Rose D. Bayog, R.N., M.N.

Submitted by

Donceras, Nikko
Espinosa, Patrick
Lamoste, Elizabert
Lagua, Aira
Malano, Angela
Mamale, Rhea
Millamena, Judy Ann
Ninonuevo, Juan Nicus
Ocop, Floremie

October 05, 2019

COMMUNITY HEALTH NURSING

 CASE PRESENTATION FORMAT

Level 2

ledgment

First, we thank God for giving us strength and perseverance in facing our struggles. His
ever warm embrace that comforted us in facing challenges. Without Him this would have not
been possible

Second, we would like to give appreciation to our clinical instructors that guided us not
only during the duty but also during the making of the case presentation.

Third, we highly appreciate the barangay captain, barangay officials and barangay
kagawads that gave support in conducting our duty, through them our stay in the community
was safe and worry free

Fourth, the give ledgement to the midwives and public health nurses that gave us
additional knowledge about our community exposure.

Fifth, we want to express our gratitude towards the barangay health workers that
assisted us in our community health nursing clinical exposures for helping us navigate the area
and looking for pregnant patients.

SIxth, we would like to thank our chosen families that welcomed us with open arms.
Without their kind consideration and cooperation this study would not be possible.

Seventh, we give appreciation to our respective parents that supported us emotionally

and financially to complete this case presentation.

Finally, we commend each and every group member that contributed to this research.
Through teamwork we have achieved a common goal that will further lead us to the path of
nursing.

AMDG!
I. INTRODUCTION

A. Background of the Study

Community is defined as a group of people living in a defined geographic area sharing

common goals and traits. Community Health is a branch of medical and paramedical approach
concerned in the promotion of health, prevention of diseases, and management of factors
affecting the health of the total population.

Community health nursing is nursing practice in the community, with the primary focus
on the health care of individuals, families, and groups in a community. The goal is to preserve,
protect, promote, or maintain health (Stanhope and Lancaster, 2013). Furthermore, according to
Northeastern State University (2019), community health nursing has 6 basic elements, namely,
promotion of health, prevention of health problems, treatment of disorders, rehabilitation,
evaluation, and research. Community health nursing is the synthesis of nursing and public
health practice applied to promote and protect the health of the population. It combines all the
basic elements of clinical nursing with public health and community practice. It is essential,
particularly at this point in time because it maximizes the health status of individuals, families,
groups and the community through direct approach with them.

` zzxz. As a follow-up to the 2011 World Health Assembly resolution (WHA64.7)

on strengthening nursing and midwifery, WHO was compelled: “…to provide technical support
and evidence for the development and implementation of policies, strategies and programmes
on interprofessional education and collaborative practice, and on community health nursing
services” (WHO, 2017).

Moreover, according to the Department of Health (2019), the department has several
deployment programs including the Registered Nurses for Health Enhancement and Local
Service or the RN HEALS. In this program, deployed nurses are assigned for 6 months in the
community (Rural Health Units) and then another 6 months for hospital service.

Locally, the barangay is the nearest government unit that deals with the community. As
such, the well-being of the barangay is dependent upon the people who runs it. Furthermore, it
was stated by Alama (2019), within are countless stories of barangay government workers who,
with selflessness and zeal for public service are impacting the lives of people in their
community.
 The barangay is headed by the barangay officials wherein the organizational structure is
attached in the appendices. Bankas Heights was named after a Datu from the Bagobo
Tagabawa tribe named Bankas who owned the entire community way back years ago. In
relation to this,most of the community members are remnants of the Bagobo Tagabawa Tribe.
Given this, our patient’s family started to live in Purok 7, Bangkas Heights, Toril, Davao City for
four years now after the demolition of their previous residence in Maa, Davao City.

To help the community with these societal needs, nurses must understand the concepts
and models in the community health nursing, the importance of health promotion, disease
prevention, health care planning implementation and evaluation of health care efforts for the
advantage of the community.

B. Objectives

General Objective

After 2 weeks of community exposure at Purok 7 Bankas Heights, Toril, Davao City the
group will be able to apply the nursing process to the four levels of clientele and be able to
synthesize and create an output regarding their learnings and evaluation.

Specific Objective

Within 2 weeks of exposure at Purok 7, Bankas Heights, Toril, Davao City the group will be
able to:

A. Cognitive
 1. Assess clients physically, mentally, emotionally and spiritually through a thorough
interview.
2. Assess the children, who are below six (6) years of age, of their growth and
development through the Metro Manila Developmental Screening Test.
3. Classify prescribed medications and/or supplements.
4. Formulate a Family Nursing Care Plan according to the result of the prioritization.
5. Educate the clients on the advantages of immunization and the disadvantages of
lack of immunization.
6. Explain to clients about the importance of proper sanitary waste disposal.
7. Inform clients about the healthcare services provided by Bankas Health Center.
8. Identify to the clients the dangers of personal smoking habits and how it will
affect the family’s health.
9. Classify ways on how to efficiently use their living space.
10. Educate the clients about Natural Family Planning.

B. Psychomotor

1. Perform the Metro Manila Developmental Screening Test on the client.

2. Execute proper bag technique in doing urine test for albumin and sugar.
3. Evaluate the clients’ application on proper sanitary waste disposal.
4. Assess clients’ employment of strategies in using living space efficiently.

C. Affective

1. Develop a sense of respect regarding the clients’ beliefs and decision-making.

2. Recognize personal and group challenges and overcoming them.
3. Develop sense of friendship, trust and teamwork between members of the group.

C. Theoretical Framework – Salmon White's construct for public health nursing

Salmon White: Construct for public health nursing

 Mark Salmon White (1982) describes a public health as an organized societal effort to
protect, promote and restore the health of people and public health nursing as focused on
achieving and maintaining public health.

Construct for public health nursing

Mark Salmon White’s Construct for Public Health Nursing gave 3 practice priorities i.e.;
prevention of disease and poor health, protection against disease and external agents and
promotion of health. For these 3 general categories of nursing intervention have also been put
forward, they are: education directed toward voluntary change in the attitude and behaviour of
the subjects, engineering directed at managing risk-related variable, enforcement directed at
mandatory regulation to achieve better health.

Application

The theory is readily and constantly applied to the field of community health nursing as
this is part of public health service. As stated in the theory, it has three practice priorities,
namely the prevention of disease and poor health, and protection against disease and external
agents. This is seen when the student nurses perform the bag technique and when they give
health teachings to their respective families. Also the promotion of health is also mentioned, as
student nurses, we are advocates of health.

II. INITIAL DATA BASE

A. Family Structure, Characteristics and Dynamics

1. Demographic Data
NAME OF AGE SEX RELATIONSHI CIVIL EDUCATION ETHNIC RELIGION
FAMILY P TO HEAD STATUS AL BACKGRO
MEMBER OF FAMILY ATTAINMEN UND
T

X 23 Femal Mother Common Elementary Davaoeño Roman

e Law Graduate Catholic

Y 24 Male Father Common High School Davaoeño Roman

Law graduate Catholic

2. Place of Residence

The family resides at Purok 6, Saypon, Crossing Bayabas, Toril, Davao City for 1 month.
They have just transferred from Capalong for the reason of____. The house was from their
patient X’s mother but has been given to the couple. Patient X’s house is in front of her mother’s
house. Hence, they are in a matrilocal set-up. Their house is situated in a congested area and
is few meters away from the dike.

3. Type of Family Structure

In the house, only the couple, patient X and Y lives. The mother had an ex-partner, who
is her live in partner, and bear a child but the child, upon 2 years of age died because of
pneumonia and the couple decided to separate. She is currently living in with patient Y for 7
months and is currently pregnant with their child.

4. Dominant family members in terms of decision (health care)

In terms of budget, It is Patient X who manages the income given by her partner for
household expenses, food and for savings. In terms of making decisions, it is observed that the
Patient Y makes the decision based on also Patient X’s suggestions. But in terms of health
care, it is Patient X who prompts her partner to seek medical help, take medications and do
follow up visits because her partner is quite passive in terms of health care and would just
ignore felt symptoms until it is still bearable. Generally, the family is in an egalitarian set up as
they make shared decision.

5. General Family Relationship / Dynamics

It is seen that the members have a harmonious and close relationship as they are able
to fulfill their own roles. Patient X would always make sure to fulfill her roles in maintaining the
house tidy and Patient Y always makes sure to provide their basic needs by working
industriously. Despite being tired from work, Patient Y would always make time to help his
partner in chores and in doing the laundry. Also, patient Y has a jolly and bubbly personality
which makes their living day to day lighter. According to patient X, that they would only fight in
small things like her partner going to computer shops and play but it gets resolved after they do
not talk and separate for a while to let the anger subside. Currently, they are both making
preparations together and is excitedly waiting for their baby.
6. Family History

a. Genogram (INSERT GENOHRAM NIKKI)

 b. Narrative of Family History

Patient X is 23 years old, G2P1 is the focus of the study. She is currently
cohabiting with Patient Y and is pregnant. She previously had live in partner and they
had a child but has separated after the child died from pneumonia and soon after, her
ex-live in partner also died from pneumonia. Patient X verbalized that she was
underweight and had low hemoglobin too, on her first pregnancy but has not
experienced any complication during delivery. According to her, her mother also has
anemia because of sudden onset of fatigue and dizziness.

B. Socio-economic and Cultural Characteristics

1. Income and expenses

FAMILY OCCUPATIO PLACE OF WORK MONTHLY INCOME

MEMBER N

A. Patient Helper at IWHA IWHA, toril, Davao City Php. 12,276 /month
Y Bread box
company

B. Patient On call laundry Crossing Bayabas, Toril Php.600/month

X service
provider

TOTAL 12,876/month
(Gross Income)

MONTHLY EXPENSES AMOUNT

Electricity (shared) 300 pesos/month

Water 200 pesos/month

Food 1000 pesos/ month

Transportation 1550 per/month

Miscellaneous

Soap 100 pesos/month

 Shampoo 80 pesos/month

Toothpaste 80 pesos/month

Detergent 100 pesos/month

Dishwashing soap 30 pesos/month

Total 3,440 pesos/ month

2. Adequacy to meet basic necessities (food, clothing, shelter)

The family is able to eat three full meals a day and is able to eat snacks when wanted.
Upon observation, the members of the family are dressed appropriately. They have adequate
living space and is in their ownership. They verbalized that they will put floor mat, ensure ceiling
and place plaster holes in their roof as soon as possible before the birth of their baby to ensure
the safety of their child.

3. Who makes decisions about money and how it is spent

It is the mother who makes decisions about how the money is being budgeted for their
daily necessities and household expenses. However, she also allows her partner to enjoy his
income by giving him allowances for his food, transportation and data load. The money left from
all the expenses will be saved for their future house renovation and their future child needs.

4. Significant others-role (s) they play in family’s life

Patient X stays often in her mother's house during her free time because she is left at
their house when her partner goes to work. According to Patient X, her mother and siblings
gives her snacks at times, bonds with her when she goes to their house. However, she clarifies
that her mother does not interfere with her own family life nor does it give money to them. She
teaches her on infant care. She is her person to go to in times of emergency, and during crisis.
She also serves as a resource person to them in treatments for certain diseases.
5. Relationship of the family to larger community-nature and extent of participation of the family
in community activities

The family is just new to the current environment they live in and is currently adapting to
city life. According patient X, she is not active in the activities in the community but avails on
health services provided by the health center. She has not transferred her voter’s information in
Davao from Capalong and therefore, still can not vote. However, she finds her neighbors very
accommodating and kind. We have observed that she also had made friends whom she chats
and strolls with in vacant time. She spends most of her time at home do household chores or
sometimes she strolls around the neighborhood and bonds with her mother. The husband, on
the other hand, is close to his neighbors because of her friendly and bubbly personality. Also, he
makes friends with people he plays with in the internet shop that is also his neighbor. Generally,
the family is not active in the community. They at least know the leaders in their barangay.

C. Home Environment

1. Housing

a. Adequacy of living space

They have a quite big living space for a family size of 2, at the moment. They have 2
bedrooms, a kitchen, and a living room. It can be seen that the living space is more than
adequate for the couple and even when they will have their child.

b. Sleeping arrangement

The couple sleeps together in their room that has walls to separate the other living room
and the living room. They can freely move in their bed.

c. Presence of breeding or resting sites of vector of diseases

The family’s home environment have no stagnant water that may serve as breeding sites
for mosquitoes. However, Patient X verbalized that there are cockroach and rats that sometimes
roam below, as they can see it through the spaces between their bamboo floor. That is why they
make sure to sweep the trash out from the ground beneath the floor.

d. Presence of accident hazards

 Upon entering their house, it can be observed that their floors are made with kawayan
with huge gaps between them. This is an accident hazard as someone can slide their foot
through the spaces and could cause injuries. Also, protruding heads of nails could cause
injuries if not seen. Moreover, the presence of street dogs in the area can be a threat to the
safety of people.

e. Food storage and cooking facilities

The family does not have a refrigerator that is why they do not buy much meat and
consume as soon as they buy it. Patient X verbalized that when they buy vegetables, they put it
in plastic containers and closes it properly to maintain its freshness. The proper way of food
storage eliminates the risk of food contamination, because some insects such as flies can
transmit microorganisms. The family cooks food using firewood outside their house using their
pots and cauldron.

f. Water supply-source, ownership, potability

National Waterworks and Sewerage System (NAWASA) is the primary water supply in
the community. The family has a shared water line with patient X’s mother which is located
outside the house because the water is not able to reach their house due to its elevated.
However, the water is potable that can be used for their daily needs.

g. Toilet facilities-type, ownership, sanitary condition

The family has their shared with patient X’s mother toilet facility behind their house. They
take a bath in structure was made of kawayan with a cemented floor. But for toileting, they have
a cemented wall with cloth draping structure for their privacy and their toilets are ceramic where
you have to manually flush it with water. It is said that the wastes will go in a big drum below,
under the soil and when it is full, they will find another place to build their toilets again. The
comfort room has a foul odor and unsanitary.

h. Garbage/refuse disposal-type, sanitary condition

The family collects the garbage without following segregation and would put them all in
the sack which is collected about 2x a month only. Sometimes, they would collaborate with their
neighbors to pay a motorcycle sidecar to take their trash to the highway trash bins so that they
can be disposed.
i. Drainage System-type, sanitary condition

The purok has an open drainage system that collects wastewater and also solid wastes. In
times of excess water during raining, water would flow which results to flooding. It is unhygienic
and unsafe as it can breed disease carrying pathogens when stagnated.

2. Kind of Neighborhood

The client's house is situated in a congested urbanized area. Though they are far away
from the main highway, there are from 200-400 people that lives in the Purok. Despite the fact
that they are just new in the place, she verbalized that she is in good terms and close to the
people in their neighborhood. She talks with them frequently and strolls with some of her friends
from the neighborhood.

3. Social and Health facilities available

There is a Barangay Health Center for crossing bayabas which is the primary health
care provider for the people in different purok.Moreover, each of the barangay has a barangay
health worker that coordinates the programs and services offered by the barangay to the
residents. Almost all of the families are going to the health center for health consultation,
immunization, prenatal and postnatal visits and many more services.

4. Communication and transportation facilities available

In the purok, the common means of communication are cellphones, televisions and
radio. Both patients has their own phone that they use in communicating and for entertainment.
Tricycles are the primary mode of transportation to the main highway. However, the family do
not own one so, they need to commute and pay 10 pesos for them to be able to go in the main
highway where the market and malls are found. But still, the common preference of some
residents is walking just in near distance destination.

D. Health Status of Each Family Member

1. Patient’s Data

Vital Signs

Patient Temperature Respiratory Rate Pulse Rate Blood Pressure

 Patient Y 36 ℃ 19 85 100/60

patient X 35.9℃ 21 107 110/70

The mother of the family is patient X, who stands 5 feet and weighs 42 kilograms. Her
first menstrual period or menarche was at 12 years old. She regularly has her monthly
menstrual period at 28 days cycle. Her obstetrical data is Gravida 2, Para 1, her first pregnancy
was when she was 21 years old. Her Last Menstrual Period (LMP) was July 30, 2019. Her
expected date of confinement (EDC) is on May 7, 2020. Upon assessment, her fundal height is
at 24 cm and age of gestation (AOG) at 25 weeks and 3 days. Upon auscultation, FHT is
audible with 130 bpm heard at the Left lower quadrant. Quickening are regularly felt by the
mother and braxton hicks are felt twice a week by the patient, as verbalized.

2. Patient’s History- indicating current or past significant illnesses or beliefs and practices
conducive to health and illness

a. Past Health History

Patient X is G2P1A0L0. The mother was not diagnosed with any complications
during her previous pregnancy, she had only underweight and low hemoglobin. The
baby was delivered in a normal spontaneous vaginal delivery (NSVD) at TJ lying on
2018

Patient Y was previously diagnosed with UTI on 2018 and was admitted to the
hospital due to painful urination. He had series of antibiotic treatment in a hospital in
Capalong which treated his UTI.

b. Present Health History

The mother is now 6 months pregnant and had already undergone her first
prenatal check up in the barangay health center and will do follow up prenatal checkup.
It is a planned pregnancy as the couple wants to have a child of theirs as partners.
Patient X only found out about her pregnancy when it was already 2 months through a
pregnancy test and had been smoking and drinking alcoholic drinks before discovering
 about her pregnancy. She currently has low hemoglobin (108g/L) and underweight (BMI:
18.1). She is planning to give birth at a lying-in in Toril.

Patient Y was diagnosed with Arthritis and Ulcer in 2018 and until today, he
experiences the onset of symptoms of arthritis when he eats pork and feels pain in the
abdomen when he does not eat on time. He treats his arthritis by putting his foot on a
warm rock and treats his ulcer by taking mefenamic acid. He has undiagnosed hernia
where the bulging was seen when he was still 15 and is currently present. He also has 1
month of cough as of the moment and is currently treated with amoxiclav and
carbocisteine.

3. Nutritional assessment (especially for vulnerable or at risk members)

a. Anthropometric Data Measurements

NAME A S NUTRITIONAL STATUS REMA

OF G E RKS
FAMILY E X
MEMBER
W HEIGHT BMI NORM
EI AL
G
HT

Patient X 23 F 5 ft 18.1 underwei

e 42 kg/m² ght
m kg
a
l
e

Patient Y 24 51 5ft 22
M kg kg/m² Normal
a
l
e

b. Dietary history specifying quality and quantity of food or nutrient per day
 The family is able to eat 3 times a day. However, sometimes Patient X do not have the
appetite to eat due to the odor or the way he food was prepared, and so she would not
sometimes eat breakfast. She is picky in terms of finding food for her meal. They consume food
that are balanced and nutritious. However, for protein, they opt to fish meat or chicken because
pork is contraindicated for Patient Y's arthritis. Patient X would cook at times but sometimes,
they would only buy from neighbors selling ready to eat meals. On a 24 hours dietary recall, she
verbalized that she ate rice and bihon for breakfast, rice and egg for lunch and rice and fish for
dinner.

c. Eating/ feeding habits/ practices

The mother is a picky eater. She verbalized that she only eats food that is appealing to
her smell and the way it was prepared. She verbalized that at times, she wants to eat and other
times, she does not. At times she forces herself to eat, she would just vomit what she has
eaten.

Patient Y eats balanced healthy food and is prohibited to eat pork. So, he opts to
chicken and fish for sources of protein. At times, he eats pork and instantly, he would feel the
symptoms of arthritis.

4. Developmental Data

a. Patient

Sigmund Freud’s Psychosexual Development

Sigmund (later changed to Sigmund) Freud

was born on 6 May 1856 in Freiberg, Moravia (now
Pribor in the Czech Republic). His father was a
merchant. The family moved to Leipzig and then
settled in Vienna, where Freud was educated.
Freud's family were Jewish but he was himself
non-practicing. Freud was an Austrian neurologist
and the founder of psychoanalysis, who created an
entirely new approach to the understanding of the
 human personality. He is regarded as one of the most influential - and controversial -
minds of the 20th century.

Freud proposed that psychological development in childhood takes place during five
psychosexual stages: oral, anal, phallic, latency, and genital. These are called psychosexual
stages because each stage represents the fixation of libido (roughly translated as sexual drives
or instincts) on a different area of the body. As a person grows physically certain areas of their
body become important as sources of potential frustration (erogenous zones), pleasure or both.

Stage Description Result Justification

Genital This is the last stage of Freud's psychosexual Achieved The client
Stage theory of personality development and begins in was able to
puberty. It is a time of adolescent sexual experience
(Puberty to
experimentation, the successful resolution of which heterosexual
Adulthood)
is settling down in a loving one-to-one relationship intercourse
with another person in our 20's. with her
husband and
Sexual instinct is directed to heterosexual pleasure,
was able to
rather than self-pleasure like during the phallic
experience
stage.
sexual
gratification.
b. Child (additional for 0-6 years old)--assessment of infant, toddlers and preschoolers- e.g.
Metro Manila Developmental Screening Test (MMDST).

Jean Piaget: Cognitive Development

Jean Piaget was born on August 9, 1896 in

Neuchâtel, Switzerland and died September 16, 1980 in
Geneva. Jean Piaget was a Swiss psychologist who was
the first to make a systematic study of the acquisition of

understanding in children. He is thought by many to have been

a major figure in 20th-century developmental

Jean Piaget was a Swiss psychologist and genetic

epistemologist. He is most famously known for his theory of
cognitive development that looked at how children develop
intellectually throughout the course of childhood. Prior to
Piaget's theory, children were often thought of simply as mini-adults. Instead, Piaget suggested
that the way children think is fundamentally different from the way that adults think.
 Jean Piaget's theory of cognitive development suggests that children move through four
different stages of mental development. His theory focuses not only on understanding how
children acquire knowledge, but also on understanding the nature of intelligence.1 Piaget's
stages are:

● Sensorimotor stage: birth to 2 years

● Preoperational stage: ages 2 to 7
● Concrete operational stage: ages 7 to 11
● Formal operational stage: ages 12 and up

Stage Description Result Justification

 Preoperational ● Children begin to think symbolically and Achieved The client was
stage: ages 2 learn to use words and pictures to able to use
to 7 represent objects. words and
● Children at this stage tend to be pictures to
egocentric and struggle to see things represent
from the perspective of others. objects.
● While they are getting better with Furthermore,
language and thinking, they still tend to the child
think about things in very concrete passed the
terms. Language
sector of the
MMDST.

5. Risk factor assessment

The mother, CJA, stated that her father, JAS, is hypertensive. Also, she stated that her
partner, JJA, is a smoker since then even before they met; he has been a smoker even before
they met and is not aware of at what age he started. Furthermore, she stated that the father can
consume a pack of cigarette per day.She tolerates the habit despite the presence of the
children at home. He drinks alcohol but only occasionally. In terms of physical activities, the
mother seldom does physical exercise but says that she takes a walk when having to go to
places that is bearable for her. She considers it her way of exercising.
6. Physical Assessment

Patient: PATIENT Y

Address: Purok 6, Saypon, Barangay Crossing Bayabas, Toril, Davao City

Body Structure

Mobility
Behavior
.

Head

Skin, Hair, Nails

Eyes

Ears

Nose
.

Mouth
.

Neck

Neurologic
 Patient's level of consciousness is alert. She is oriented to time and place and she is
able to concentrate at the time of interview. Patient’s sensation is present.

Cardiovascular

Chest and Thorax

Abdomen

Genitourinary

7. Results of laboratory/diagnostic and other screening procedures supportive of assessment

findings

The patient’s urine was tested for albumin and sugar. For the urine test for albumin, no
cloudiness appeared upon heating the upper portion of the test tube. This indicates a negative
result for pregnancy-induced hypertension. For the urine test for sugar, there was blue-green
color change occurred upon heating the mixture of benedict’s solution and 8 drops of urine; this
is an indication for traces of sugar in the urine. Based on her hematology results,she has a low
hemoglobin (108 g/L) and Hematocrit (0.32) . In her urinalysis, there are epithelial cells and
mucous threads, pus cells and RBC but in normal levels.

8. Pharmacology

The patient is taking ferrous sulfate which was prescribed to her during her first prenatal
check up. She verbalized her understanding that its purpose is to prevent anemia and that she
takes it regularly. The client recalls that it was also prescribed to her on her first pregnancy.

E. Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention

1. Immunization status of family members

 NAME AGE VACCINE 1st 2nd 3rd REMARKS
dose dose dose

PATIE 24 BCG ✓ COMPLETE

NT Y Y.O.
DPT ✓ ✓ ✓
COMPLETE

OPV ✓ ✓ ✓
COMPLETE

Hepa B ✓ ✓ ✓
COMPLETE

Measles ✓ ✓ COMPLETE
Vaccine

PATIE 23 BCG ✓
NT X Y.O. COMPLETE

DPT ✓ ✓ ✓
COMPLETE

OPV ✓ ✓ ✓
COMPLETE

Hepa B ✓ ✓ ✓
COMPLETE

Measles ✓ ✓ COMPLETE
Vaccine

TT ✓ INCOMPLE
TE (in
progress)

2. Healthy lifestyle practices

 The family makes sure to eat balanced food with protein,carbohydrates and vegetable.
The mother cooks the food at times but sometimes would buy food from their neighbors selling
ready to eat meals. The family does hygiene everyday and would make sure that their house is
clean and tidy. The mother is compliant in taking ferrous sulfate for iron supplementation.

3. Adequacy of:

a. Rest and sleep

The client regularly has 10-13 hours of sleep everyday, they usually sleep at
approximately 7pm-10pm and wakes up at exactly 7-8am to prepare for the day and she wakes
up earlier to prepare for her husband. They do not take naps anymore during the day.

b. Exercise/activities

Clients verbalize that she does the household chores everyday like sweeping,
doing the laundry and washing the plates. Also, they would sometimes walk with her neighbor
around the purok. She verbalized that she does not like to be always in bed so she finds things
she can do. Her partner, patient Y is a helper at IWHA and his daily work there is for him his
exercise.

c. Use of protective measure: e.g. adequate footwear; use of bed nets and protective
clothing

For most of our home visit, we have observed that the couple has its own protective
gears such as footwear and clothing that provide comfort to them. When the client allowed us to
go inside their house, we have observed that their room has bed nets.

4. Relaxation and other stress management activities

According to Patient X her relaxation activities is to sleep and talk with her friends in the
neighborhood. Also, she visits her mother' s house often and watch television. When she is
stressed, she likes to walk around with her friends around the Purok.

On the other hand, for patient Y, he likes to take a day off for his relaxation and play mobile
legends and other mobile games in his cellular phone and at times, play online with other
people in the computer shop. He also likes to take a walk or stroll when stressed.
5. Use of promotive-preventive health services

Mother is aware and avails health services provided by the health center such as
prenatal check-ups, immunizations and free iron supplementations to promote health and
prevent complications in pregnancy. During the urine testing for sugar, we found out that there
are traces of sugar and we advised her to limit sugar intake, and she was compliant to this and
understood that by doing so, would prevent her from having complications. She takes her
supplements and receives immunization as needed. On the other hand, her partner only seeks
medical help in the health center and takes medication when the symptoms felt are unbearable
or when his partner urges her to do so. The family puts effort keep their surroundings clean and
free from breeding sites of insects and rodents. According to patient X, they use mosquito nets
when they sleep to prevent acquiring the dengue virus.

III. TYPOLOGY OF NURSING PROBLEMS

A. First Level of Assessment

1) PRESENCE OF WELLNESS CONDITION- the client has good health seeking behaviors and
gives importance to immunization though her eldest has not had measles vaccination. The
family has an emergency health plan and the mother avails of the prenatal check up available in
the community. She ensures healthy food is served in the table and adequate sleep.

2) PRESENCE OF HEALTH THREAT - The eldest daughter lacks measles vaccination making
her at risk of having measles. The father is currently smoking which can lead to health
complications. In their environment, unsanitary waste disposal and drainage systems are seen
and practiced which poses a great risk on their health. Also, the presence of dogs and snakes in
their vicinity can potentially harm the people in the household. Lastly, their house is made of
light materials, as they cook using firewood, it is a fire hazard that will potentially leave them
with nothing.

3) PRESENCE OF HEALTH DEFICIT – no health problems and deficit as of the moment.

4) PRESENCE OF FORESEEABLE CRISIS - The mother is currently 4 months pregnant with a

score of G3T2L2. The child would be illegitimate because the mother and the father are not
married.
B. Second Level of Assessment
1) Inability to make decisions with respect to taking appropriate health action due to
ignorance of community resources for care.
- The family will be knowledgeable on the importance of immunization and refer the family to the
health center. The mother stated that her eldest has not had her measles vaccination due to
lack of information on the immunization services offered in the barangay health center and she
was quite alarmed because of the prevalence of measles and her daughter not having the
vaccine.

2) Inability to provide a home environment conducive to health maintenance and

personal development due to lack of knowledge on the importance of hygiene and
sanitation
- The family will properly segregate and dispose their trash and maintain the cleanliness of their
surroundings. The whole barangay reports that the biodegradable wastes are buried into pits
and the non biodegradable wastes are being burned and this practice has been used for over
years. The lack of sanitary officials to collect their trash has been a problem and potentially can
cause harm to their health due to burning. The mother also reports that their trash are compiled
in a sack and is situated behind their house which could attract flies to swarm in the place.

3) Inability to recognize the presence of the condition or problem due to: lack of
knowledge and denial about existence or severity as a result of fear of physical
consequences of diagnosis of problem
-The family will be able to recognize the threat brought by using firewood as means of cooking
to their light material made house and be able to apply interventions to prevent accidents. Upon
observation, we saw that their houses were made of plywood and light coconut product
materials and she reported that firewood is used in cooking their everyday meals. If the firewood
is irresponsibly handled, it may cause an accident.

4) Inability to provide a home environment conducive to health maintenance and

personal development due to inadequate family resources specifically financial
constraints and inadequate knowledge on preventive measures
-The family will be able to ledge the potential harm of having inadequate living space and be
able to decide upon how to cope with this problem. Upon the report of the mother, it can be
observed that they have a small house for their growing family. Therefore, the family must make
and decide on plans on their intervention to this problem

5) Inability to recognize the presence of the problem due to knowledge deficit on the
effects of 2nd hand smoking
The father will gradually cease to smoke and hence, allocate time and budget on matters that
are more important. The father has been reported to be smoking for years but the mother was
not minding it because she was not knowledgeable that although she is not smoking, she could
have diseases due to inhalation of 2nd hand smoke.

6) Inability to recognize the presence of a problem due to future increase of demands

secondary to additional family member
The family will be able to mention their plan on how they are going to cope with the demands
brought by the increase in family size. The mother is now in its 4 th gestational month and as the
family grows, the demand also increases and matters on responsible parenthood must be
discussed to ensure that each member attains support in growth and development.

IV. FAMILY COPING INDEX

Definition:

The objective of this indicator is to present bench mark for approximating the nursing
needs of a particular family, thus the family coping index. It is the coping capacity and not the
underlying problem that is being rated, and it is designed to record the family rather than
individual coping capacity. In public health nursing, the family cannot be seen only as a factor
that affects health; rather, the family is the patient.
 Scaling Cues:

1- Poor competence 3- Moderate competence 5- High Competence

CRITERIA RATING JUSTIFICATION NURSING

INTERVENTION

-Encourage by
Physical 3 The family is able to cope easily with their
educating the mother in
Independence daily living activities. Ms. Aballe wakes up
taking up her role as a
at 6 AM to prepare food for her husband
This category parent and the
and children for work and school. Ms.
is concerned importance of her
Aballe stated that she occasionally walks
with the ability support for their
around the neighbourhood with her
to move about motivation to go to
youngest child as a form of exercise. On
to get out of school
the other hand, Mr. Armillo goes to work at
bed, to take
7 AM to start his work and gets home by 4
care of daily
PM. The children are already able to -Initiate the mother in
grooming,
groom themselves and the eldest child is creating a routine of
walking and
able to go home by herself. However, there household chores that
other things
was a day during the home visit when the the mother prefers to
which involves
children were not able to go to school follow.
the daily
because she feels tired of sending them.
activities.
She also verbalized that she sometimes
don’t clean up their yard out of laziness.
 - Commend the family
Therapeutic 5 The mother who is now 4 months pregnant
for the good knowledge
Competence already had her first prenatal check up and
and follow through on
already planned on going back for the
This category procedures and
second trimester. She is able to apply
includes all treatment.
nursing care in treating her children when
the
they are ill. She is compliant in her prenatal -Conduct health
procedures or
supplements and careful on what she eats teaching regarding
treatment
to prevent complications during pregnancy. prenatal to reiterate its
prescribed for
Ms. Aballe was also advised to limit importance and
the care of ill,
activities that is tiring for her body and was benefits.
such as giving
cautioned in handling hair products that -Instruct client to
medication,
contain harmful chemicals and that she continuously have
dressings,
should rest as often as possible during her prenatal check up not
exercise and
first prenatal check-up and she was below 4 times in the
relaxation,
compliant to this advice.The family course of pregnancy
special diets.
ensures adequate and healthy intake of
food and period of rests.
Knowledge of 3 The mother is aware of what has to be -Determine client's
Health avoided during pregnancy, such as previous knowledge of
Condition smoking and drinking alcohol; and is also or skills related to
knowledgeable about the need of exercise. pregnancy
This system is
She is cautious and careful on what she
concerned -Commend the client
eat and follow a diet best for her and for
with the for her healthy
the baby. She knew that her work in the
particular practices to keep the
parlour will put her and the baby in danger
health baby healthy
since she will be exposed to chemicals so
condition that
she decided to quit her job. However, she -Conduct health
is the
verbalized that her partner has smoking teaching regarding the
occasion of
habits that she just tolerates. Second hand effects of secondhand
care.
smoking may put the mother and child at and thirdhand smoking
risk. not only to the pregnant
mother but as well as
to the children residing
in their home.

Applications 3 The family is able to eat full meals 3 times -Reinforce mother on
of Principles a day. They secure periods of rest and the importance of
Hygiene relaxation as well as quality time with the nutrition and sleep
family. Ms. Aballe always makes sure to for growth and
This is
feed her children with vegetables because development.
concerned
she knows the benefits or the nutrition that
with the family -Conduct health
her children would get in eating it.
action in teaching regarding
However, in terms of carrying out
relation to immunization and its
preventive measures, the mother is aware
maintaining importance
that her child does not have immunization
family
and still did not get her immunized despite -Encourage the
nutrition,
verbalization of the desire. Her first child mother to have her
securing
 child get vaccinated
adequate rest was completely immunized except for her
and relaxation 1st child since the child is not with her
-Inform the mother
for family during infant days.
about the
members,
immunization
carrying out
services in the health
accepted
center
preventive
measures,
such as
immunization.

Health 3 The family seeks medical attention from -Appreciate the

Attitudes professionals and comply with the given family’s health
medications of the doctor. Ms. Aballe seeking behavior
This category
herself believes in the competence of the
is concerned -Discuss to the
doctors. No matter how far their house is to
with the way mother, the causes
the hospital every time she or her children
the family of recurrent
are sick, she always brings herself or her
feels about pneumonia and the
children to the doctor for a check up to
health care in importance of
know what medications she can give to
general, addressing it
treat whatever disease they are
including
experiencing. Also, the family has a doctor -Offer different
preventive
who is their first choice to visit for options on sources
services, care
consultation of symptoms.However, her of services that are
of illness and
daughter, JC, had a recurring pneumonia less costly but has
public health
that is probably due to improper nursing the same quality.
measures.
care and follow up given to the child.

Emotional 5 The family members take part of their -Use active listening
Competence respective roles, helping each other to to help client
surpass difficulties. Ms. Aballe makes sure express emotions
This category
to take care of the children while the father such as crying,
has to do with
the maturity is away to work to provide the family. She guilt, and anger
and integrity makes sure that when he gets back, he is (within appropriate
with which the able to rest well for the next day. The limits).
members of father also goes straight to their home. For
-Talk to the client
the family are Mrs. Aballe, communication is important
therapeutically and
able to meet for her and her husband to avoid
ask open ended
the usual misunderstandings and arguments
questions
stresses and between them. Although, it cannot be
problems of avoided they will always talk about the -Encourage the
life, and to problem to solve it because it is for the family to continue
plan for a children. strengthening their
happy and relationship through
fruitful living. love, care, and
support to each
other.
Family Living 5 The family members get along with each -Use therapeutic
other very well. It is both Mr. Armillo and communication, and
This category
Ms. Aballe who makes the decision for encourage
is concerned
their family since the children are client/family to
largely with
dependent on them. Although both of the verbalize fears,
the
parents have a child from their previous express emotions,
interpersonal
partners, both of them did not have a hard and set goals.
with the
time in gaining the trust of each other’s
interpersonal -Convey feelings of
child. The children were able to bond well
or group acceptance and
with their parents as if they really are their
aspects of understanding.
parents. They, too, as siblings get along
family life – Avoid false
very well. They play together and help
how well the reassurances.
each other in grooming themselves. There
members of
was one day during our home visits that -Encourage the
the family get
we witnessed the bond between the two family to continue
along with one
siblings where they put makeup and their bonding
another, the
lipstick to each other. routine and open up
ways in which
on the idea of
they take
planning for more
decisions
bonding activities
affecting the
that are attainable
family.
at home.

Physical 3 The family lives in a compound-like house -Emphasize the

Environment separately together with Mrs. Aballe’s importance of
parents. The home environment is big for 2 healthy and clean
This is
families living in it and the environment of environment and
concerned
the family’s house has trees around it; cleaning
with the hence, there’s shade. However, they have -Conduct
home, the a lot of dogs that are freely walking around discussion on what
community which can be threatening to the neighbours the family can do
and the work who are passing and is even risky for the on the dogs that
environment children despite the dog’s immunization. are freely walking
as it affects The mother also worries that there are around in their
family health. snakes around their environment which yard
she had already encountered. Also, their
-Encourage the
house is situated near the cliff and their
family to observe
non-biodegradable trash are just burnt
precautionary
because their community lack solid waste
measures with the
disposal systems.
threat present in
their environment

-Educate the client

on proper disposal
of non-
biodegradable
trash and
consequences of
burning it.

Uses of 3 She is knowledgeable and avails services -Educate the client

Community in the barangay health center, infact, she about the
Facilities sometimes has her prenatal check-up community
conducted. However, she is uninformed on resources for
Generally,
the immunization services offered in the continuing
keeps
health center which her eldest daughter information and
appointments.
could avail to. support.
Follows
through -Educate the
referrals. Tells family on the
others about immunization
Health services in the
health center and
Department
the importance of
services.
immunization.

-Conduct teaching
regarding the
services offered by
the government to
allow the family to
save time and
effort in seeking
medical help.
V. PRIORITIZATION AND SALIENCE OF THE PROBLEM

A. Illegitimacy of the child as foreseeable crisis

Criteria Computation Score Justification

Nature of 1/ 3 x 1 0.33 It is a foreseeable crisis

the Problem

Modifiability 1 / 2 x 2 1 It is partially modifiable because the

of the problem that will arise will depends on the
Problem uncertain circumstances that will arise in
the future.

Preventive 1/3 x 1 0.33 Illegitimacy of the child cannot be

Potential prevented instantly. Based on the current
financial status of the family, annulment is
not their priority.

Salience 1/2 x 1 1 This is a problem but not needing

immediate attention.

Total 2.99

B. Recurrence of Pneumonia as a health threat

Criteria Computation Score Justification

Nature of the 2/ 3 x 1 0.67 It is a health threat

Problem

Modifiability 1/ 2 x 2 1 It is partially modifiable because

of the pneumonia can be detected and treated
Problem through medical interventions

Preventive 3 /3 x 1 1 Pneumonia can be easily prevented.

Potential

Salience 2/2 x 1 1 This needs immediate attention before

complications occur.

Total 3.67

C. Personal habit of smoking by the Father

Criteria Computation Sco Justification

re

Nature of 2/3x1 0.67 It is a health threat

the Problem

Modifiability 1/2x2 1 It is partially modifiable because smoking, being a habit,

of the cannot be stopped instantly most especially if it’s been
Problem practiced for a very long time despite all the knowledge
of its negative effects.

Preventive 2 /3 x 1 0.67 Smoking can be prevented with by making the client

Potential understand the disadvantages of smoking not only to
him but also to the family. This needs client’s
cooperation.

Salience 2/2 x 1 1 This needs immediate attention before complications

occur.
 Total 3.34

D. Poor environmental sanitation: Inadequate living space

Criteria Computation Score Justification

 Nature of 2/3x1 0.67 It is health threat.
the problem

Modifiability of
1/2x2 1 Increasing the living space will require quite a
the problem
financial expenditure.

Preventive
potential 3/3x1
Increasing the living space will allow more facilities
1
to be utilized.

Salience 0/2x1 0
It is not a felt problem.

Total : 2.67
score:

E. Accident Hazard specifically Fire hazard due to light materials used to built house and
firewood use

Criteria Computation Score Justification

Nature of 2/3x1 0.67 It is health threat.
the problem

Modifiability
0/2x2 0 Basing in their current socio-economic
of the
condition, having a house of bricks is not
problem
their priority and they are already settled
with what they have

Preventive 3/3x1 1 Having a house made of wood and using

potential wood in cooking is a great threat and can
burn the house easily.

Salience
0/2x1 0 It is not a felt problem.

Total score: 1.67

F. Lack of Immunization of the Child

Criteria Computation Score Justification

Nature of the 2/3 x 1 0.67 It is a health threat.

Problem

Modifiability 2/2 x 2 2 It is easily modifiable because the child can still

of the have her vaccination. They can avail the health
Problem services on immunization offered by the
government.

Preventive 3/3 x 1 1 It has a high preventive potential such that children

Potential who are not completely immunized may have their
immunization. As of now, the child has not yet
acquired measles virus, hence, she has to get
immunized as soon as possible.

Salience 2/2 x 1 1 It is a problem recognized by the family that needs

immediate attention such that there is an increase
of cases of measles.

Total 4.67

G. . Poor Environmental Sanitation on unsanitary waste disposal

Criteria Computation Score Justification

Nature of It is a foreseeable crisis.
2/3x1 0.67
the Problem

Modifiability 1 Pregnancy cannot be modified. The mother is

1/2x2
of the expected to give birth and this demands costs and
Problem a lot of preparation.

Preventive 1 Difficulty in coping from the expenses of giving birth

3/3x1
Potential can be prevented if the family is able to prepare as
early as possible. Constant monitoring also helps in
preventing progress of complications.

Salience 1 This needs partial attention. The mother is gravida

2/2x1
2 and 4 months pregnant. She has to undergo
prenatal check ups per trimester to monitor her
condition.

Total
3.67

X. FAMILY NURSING CARE PLAN

IX.

A. NURSING THEORIES (3) RELATED TO THE CLIENT CARE

NURSING THEORIES

Florence Nightingale: Environmental Theory

 Florence Nightingale (12 May 1820 – 13 August 1910) was a nurse who contributed in
developing and shaping the modern nursing practice and has set examples for nurses which are
standards for today’s profession. Nightingale is the first nurse theorist well-known for developing
the Environmental Theory that revolutionized nursing practices to create sanitary conditions for
patients to get care. She is recognized as the founder of modern nursing. During the Crimean
War, she tended to wounded soldiers at night and was known as “The Lady with the Lamp.”
(source)

Environmental Theory

Florence Nightingale’s Environmental Theory defined Nursing as “the act of utilizing the
environment of the patient to assist him in his recovery.” It involves the nurse’s initiative to
configure environmental settings appropriate for the gradual restoration of the patient’s health,
and that external factors associated with the patient’s surroundings affect life or biologic and
physiologic processes, and his development.

She identified 5 environmental factors: fresh air, pure water, efficient drainage,
cleanliness or sanitation and light or direct sunlight. Given this, the focus of nursing in this model
is to alter the patient’s environment in order to affect change in his or her health. If any of these
areas is lacking, the patient may experience diminished health. A nurse’s role in a patient’s
recovery is to alter the environment in order to gradually create the optimal conditions for the
patient’s body to heal itself. In some cases, this would mean minimal noise and in other cases
could mean a specific diet. All of these areas can be manipulated to help the patient meet his or
her health goals and get healthy.

According to Nightingale, nursing is separate from medicine. The goal of nursing is to

put the patient in the best possible condition in order for nature to act. Nursing is “the activities
that promote health which occur in any caregiving situation.” Health is “not only to be well, but to
be able to use every power we have.” Nightingale’s theory addresses disease on a literal level,
explaining it as the absence of comfort.

The environment paradigm in Nightingale’s model is understandably the most important

aspect. Her observations taught her that unsanitary environments contribute greatly to ill health,
and that the environment can be altered in order to improve conditions for a patient and allow
healing to occur.
 Nightingale’s Modern Nursing Theory also impacted nursing education. She was the first
to suggest that nurses be specifically educated and trained for their positions in healthcare. This
allowed there to be standards of care in the field of nursing, which helped improve overall care
of patients.

Application

In relation to the family of Patient X, one of the problems is the poor environmental
sanitation especially in inadequate living space and unsanitary waste disposal. The role of the
nurse is to utilize the environment of the family to recover and avoid the family for possible
health risks. First, there is inadequate living space for the family wherein there enabling them to
sleep close to each other. With this, it increases risk for spread of microorganisms and
communicable diseases within family members. Another issue that was observed is the
unsanitary waste disposal. The family did not have proper waste disposal for their garbage.
Although they have garbage bin, they do not practice waste segregation as well as proper
disposal of it. Given this, it may lead to breeding of pathogens that might cause diseases to the
family. In addition to this, the group recognize accident hazard specifically fire hazard due to
light materials used in house and usage of firewood. The area of the house was at risk, thus by
using Nightingale's principles and observations about the environment, the group developed a
plan to improve the situation.

Ida Jean Orlando-Pelletier: Deliberative Nursing Process Theory

She was an internationally known psychiatric health nurse, theorist and researcher who
developed the “Deliberative Nursing Process Theory.” Her theory allows nurses to create an
effective nursing care plan that can also be easily adapted when and if any complications arise
with the patient.

As for being a respectable and credible role-model, Orlando was well educated with
many advanced degrees in nursing.

In 1947, she received a diploma in nursing from the Flower Fifth Avenue Hospital School
of Nursing in New York. In 1951, she received a Bachelor of Science degree in public health
nursing from St. John’s University in Brooklyn, New York. And in 1954, Orlando received her
Master of Arts degree in mental health consultation from Teachers College, Columbia
University.

Deliberative Nursing Process Theory

Ida Jean Orlando developed her theory from a study conducted at the Yale University
School of Nursing, integrating mental health concepts into a basic nursing curriculum. She
proposed that “patients have their own meanings and interpretations of situations and therefore
nurses must validate their inferences and analyses with patients before drawing conclusions.”

The theory was published in The Dynamic Nurse-Patient Relationship: Function,

Process, and Principles (NLN Classics in Nursing Theory) in 1961. Her book proposed a
contribution to concern about the nurse-patient relationship, the nurse’s professional role and
identity, and the knowledge development distinct to nursing.

Orlando’s nursing theory stresses the reciprocal relationship between patient and nurse.
What the nurse and the patient say and do affects them both. She views the professional
function of nursing as finding out and meeting the patient’s immediate need for help.

Application

It is the nurse’s responsibility to meet the patient’s immediate needs for help either by
supplying it directly or by calling in the services of others. The central core of the nurse’s
practice is to understand what is happening between the patient and the nurse, which provides
the framework for the help the nurse gives the patient. In relating this theory to the family of
Patient X, does not recognize the effect of anemia while pregnant. Nurses’ responsibility is to
build a rapport with the patient to gather essential data to help the family’s problem. Orlando
specifies that both the patient and the nurse participate in the exploratory process to identify the
problem as well as the solution. Therefore, the nurse-patient situation is a dynamic process;
each is affected by the behavior of the other. The interaction is unique for each situation. The
patient’s behavior stimulates the nurse’s immediate reaction and becomes the starting point of
the assessment. With this, in achieving deliberative nursing process, the nurse will be able to
formulate necessary family nursing care plan to recover.

In understanding and using the elements of the nurse’s immediate reaction in a

deliberative exploratory process, the nurse discovers, from the patient, information about the
present situation. The nurse involves the patient in exploring alternative possibilities about the
help the patient needs and exercises judgment while ascertaining with the patient whether the
patient is capable of doing each intervention alone. The intervention is done in a gradual and
systematic manner because convincing for smoking cessation cannot be achieved instantly.

Imogene King: Theory of Goal Attainment

Imogene Martina King (January 30, 1923 – December 24, 2007) was one of the pioneers
and most sought nursing theorists for her Theory of Goal Attainment which was developed in
the early 1960s. Her work is being taught to thousands of nursing students from all over the
world and is implemented in a variety of service settings as well.

As a recognized global leader, King truly made a positive difference for the nursing
profession with her significant impact on nursing’s scientific base. She made an enduring impact
on nursing education, practice, and research while serving as a consummate, active leader in
professional nursing.

Theory of Goal Attainment

The Theory of Goal Attainment states that “Nursing is a process of action, reaction, and
interaction whereby nurse and client share information about their perception in the nursing
situation.”

Imogene King’s Theory of Goal Attainment was first introduced in the 1960s. From the
title itself, the model focuses on the attainment of certain life goals. It explains that the nurse
and patient go hand-in-hand in communicating information, set goals together, and then take
action to achieve those goals. The factors that affect the attainment of goals are roles, stress,
space, and time. On the other hand, the goal of the nurse is to help patients maintain health so
they can function in their individual roles. The nurse’s function is to interpret information in the
nursing process to plan, implement, and evaluate nursing care.

To help nurses understand her work, she defined several terms which include the
patient, defined as a social being who has three fundamental needs: the need for health
information, the need for care that seeks to prevent illness, and the need for care when the
patient is unable to help him or herself.

Application
 According to King, a human being refers to a social being who is rational and sentient.
He or she has the ability to perceive, think, feel, choose, set goals, select means to achieve
goals, and make decisions. He or she has three fundamental needs: the need for health
information when it is needed and can be used; the need for care that seeks to prevent illness;
and the need for care when he or she is unable to help him or herself. In relating this to Ms.
Aballe’s family’s problem regarding to the inability to recognize the presence of problem due to
future increase of demands secondary to additional family members, the nurses’ role is to
encourage the patient to share knowledge of him or her self, as well as the perception of
problems of concern to the interaction. From that, the nurse will help the patient recognize
his/her goal then formulate effective care plan as well as guiding the patient in achieving it.
B. CONCEPTUAL FRAMEWORK OF NURSING CARE – Concept map of nursing care

XI. HEALTH TEACHINGS

 Concerning the health problem of the family in terms of lack of immunization, the family
needs proper education and must know the importance of immunization to the child. Inform the
parents that the vaccine prevents diseases such as measles, mumps, and cough. Also,
encourage the parents to attend and avail services that are available in their barangay or
community. Lastly, convince the parents to have immunization of their child in the health center
or private hospitals. In terms of the environmental sanitation, the family needs to know the
importance of proper waste disposal and demonstrate proper segregation of non-biodegradable,
biodegradable, and residual. Advice the family not to burn plastics since it is not good for the
environment and to their health. Also, instruct the patient to maintain cleanliness in the
surroundings especially in their canals in order to prevent the breeding sites of the mosquitoes
and inform the family about the consequences of not practicing proper waste disposal. The
personal habit of smoking of the father is another problem of the family. Thus, the healthcare
provider must educate the patient about the complications and problems of engaging in smoking
such as lung cancer, heart disease, stroke, esophageal cancer, cataracts, etc. Advice the
patient to gradually stop smoking and encourage his or her to engage in physical activities that
would help his or her self busy from engaging this kind of vices. Another problem with the family
is their inadequate living space. To address it, the family should be knowledgeable that
inadequate living space may cause the spreading of diseases easy. With this, educate the
patient to wear personal protective equipment such as masks and observe proper cough
etiquette to avoid the spreading of diseases to each family member. The family is prone to
hazard due to light materials used in the house, the family needs enough knowledge on disaster
risk reduction management in order for them to know what action should they take. Also, advise
the family to be more careful in using firewood to avoid the cause of the fire which may lead to
the burning of their own house. Lastly, pregnancy is one of the problems of the family proper
education about exclusive breastfeeding must be taught to the patient and explain the benefits
of breastfeeding such as nutrients, emotional bonding with the mother, immunoglobulin which
helps to prevent diseases and to build for the immune system of the child. Also, advise the
patient to take vitamins to avoid acquiring diseases that lead to complications during pregnancy.
Lastly, discuss the importance of family planning methods to advise birth spacing. Given this,
the group formulated family nursing care plans to address the health threats, and foreseeable
crisis present in the nursing problems present in the family.

. XII. CONCLUSION AND RECOMMENDATIONS

A. Conclusion

In conclusion, After the two-week clinical exposure, the necessary screening tests, such
as the Metro Manila Developmental Screening Test (MMDST) and urine test, and have
interviewed, the group’s respective family. The student nurses have identified problems and
risks that pose a threat to the family. By doing so the proponents have devised methods of
health teachings to help the said family.

The family is healthy generally speaking but is lacking in some departments that are
necessary for the promotion of health. Preventive measures and health practices are some of
the said factors that lack in said family. For example, the mother is aware that her second child
is not immunized, this is a prime example for lacking in preventive measures in terms of health
promotion. Another example is that the father is a smoker, the family should be aware that
second-hand smoke is still a serious threat to health. Other problems such as improper waste
disposal and the risk of fire due to the house being made of light materials are also observed.
Although the following problems do not pose a real threat as of the moment these can surely
develop into bigger problems if lead unattended.

As student nurses, the group encouraged and taught the family ways of mitigating these
risks to help the family avoid a bigger crisis in the future. Health teachings were conducted and
screening tests were performed for further evaluation of the family to assist in the promotion of
health.

B. Recommendations

To the Client/Family

The group would recommend the family to comply in keeping their environment clean
specifically having sanitary waste disposal. The family should avoid burning non-biodegradable
waste as to also help our environment by lessening the production of carbon dioxide in the air
and promote fresh air. Therefore, the constant cleaning of their house and the surroundings
must be observed. They should also be aware and avail of the immunization services offered by
the health centers and get some shots for the family members. The group would also educate
the mother and the father about natural family planning.

Nursing Education
 The group would recommend the nursing students formulate and give proper health
teachings and interventions to the clients to improve the current health status of the clients.
Nursing students must also be diligent in enhancing their knowledge and skills that may later be
used in the nursing practice. They should broaden their minds and be open-minded in exploring
different strategies and approaches in dealing with different situations during their practice.

Nursing Practice

The group would like to recommend for future nursing students who will have their
community exposure to stock and apply appropriate knowledge and skills during the practice.
Given this, it will help them conduct interviews and tests accurately and effectively. Also, they
should ensure that they have a healthy mind and a healthy body to continue giving the quality
care the clients must accomplish. During the practice, nursing students must take the exposure
seriously since they will also gain learning from this experience.

Nursing Research

The group would recommend future researchers to conduct further studies about
maternal and child health nursing and community health nursing. Given this, it will help the
nursing research community as well as the nursing students in their future case presentations.
Moreover, this will enable nurses and student nurses to employ continuous, innovative and
quality care to the clients during their practice. Furthermore, future researchers should provide
more accurate and up to date information in their works. Thus, this will enable nursing students
to enhance their knowledge of maternal and child and community health nursing.

Nursing Practice

The group would like to recommend to have more practice or further studies about
maternal and child care about how to improve nursing health teachings and nursing
interventions or responsibilities towards the actual and potential problems that the client or
family would be going to experience. This research may serve as a guide to implement effective
and efficient nursing care not only to a child and pregnant women but as well as other
individuals and other families in the community.
XIII. REFERENCES

Gonzago, A. (2019). Florence Nightingale: Environmental Theory. Retrieved from

https://nurseslabs.com/florence-nightingales-environmental-theory/#Early-Life on October
04, 2019
Gonzago, A. (2019). Ida Jean Orlando: Deliberative Nursing Process Theory. Retrieved from
https://nurseslabs.com/ida-jean-orlandos-deliberative-nursing-process-theory/ on October
04, 2019

Petiprin, A. (2016). KING'S THEORY OF GOAL ATTAINMENT. Retrieved from

https://nursing-theory.org/theories-and-models/king-theory-of-goal-attainment.php on
October 04, 2019

Northeastern State University. (2019). The nurse’s role in community health. Retrieved from
https://nursingonline.nsuok.edu/articles/rnbsn/nurses-role-in-community-health.aspx on
October 05, 2019.

Department of Health. (2019). What are the deployment programs. Retrieved October 3, 2019
https://www.doh.gov.ph/node/1169 on October 05, 2019.
World Health Organization. (2019). Enhancing the role of community health nursing for
universal health coverage. Retrieved October 05, 2019 from
https://www.who.int/hrh/resources/health-observer18/en/.

Alama, R. (2019). A nurse's quest for a healthy barangay. Retrieved October 3, 2019 from
https://pia.gov.ph/features/articles/1022881.amp.

XIV. APPENDIX – documentation photos

A. INITIAL DATA BASE

B. MMDST
C.URINE TEST