COMMUNITY HEALTH NURSING RLE

5 in 1 Family Case Study

Submitted to: Leah E. VIrtudazo, BSPT, RN

CHN Lecturer

Submitted by:
Domingo, Blessing S.
Delon Santos, Kurt Christensen
Donato, Micah
Dumlao, Nicolette
Hernaez, Chezca Evhan

BSN 2E

Date of Submission: 10/31/2024

 I. INTRODUCTION
Health

Health is a state of complete physical, mental and social well-being and not merely the absence of
disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental
rights of every human being without distinction of race, religion, political belief, economic or social
condition.

Family
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.

Primary Health Care

According to the declaration of Alma Ata, primary health care constitutes, Primary health care is
essential health care based on practical, scientifically sound, and socially acceptable methods and
technology made universally accessible to individuals and families in the community through their full
participation and at a cost that the community and country can afford to maintain at every stage of their
development in the spirit of self-reliance and self-determination. It forms an integral part both of the
country's health system, of which it is the central function and main focus, and of the overall social and
economic development of the community. It is the first level of contact of individuals, the family, and
community with the national health system bringing health care as close as possible to where people live
and work, and constitutes the first elements of a continuing health care process.

Community Health Nursing

Community health nursing is the utilisation of the nursing process in the different levels of client-
individuals, families, population groups and communities, concerned with the promotion of health,
prevention of disease and disability and rehabilitation. 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 health in the community. Which is
vital to nurses to improve their experiences in providing optimum care for individuals and their families.

As Researcher

Being exposed in the community did not only provide us an avenue to apply what we have acquired
in the classroom but it also gave us an opportunity to serve our fellow citizens. A day spent in the
community is always a learning experience for us because we are able to socialise and interact with
different people in the community and that we are able to see the real world. Every exposure gives us
realisations that make us become better versions of ourselves. Though tiring as community health nursing
can get, reaching out to the families gives us the sense of fulfilment as we share our knowledge, skill, and
time to aid in uplifting the conditions of each family.

As community health nurses, we strive to promote prevention over treatment. Our role as educators
is to provide clients with information that allows them to make healthier choices and practices. In order to
improve individual, family, and community health, correct knowledge, attitude and skill should be taught and
subsequently practised. By correcting poor health practices and maintaining a safe home or work
environment, patient’s lower risks to their health and require fewer visits to health care facilities.

Through the family case study, we are able to have a better understanding of the multidimensional
nature of health which can enable us to plan and implement health promoting interventions for our clients.
In this way we are able to give the utmost family-centred care to our clients making us even more effective
community health nurses.
 II. DEMOGRAPHIC

Maddiangat is the gateway to the Municipality of Quezon, Nueva Vizcaya. It is located five
kilometers from the gateway to the Municipality of Solano, Nueva Vizcaya and Eastern part of Magat.Early
settlers from Ilocos Region named the area San Antonio after Patron St. Anthony due to its geographical
location. Maddiangat, a barangay surrounded by creeks, was named after the Maddiangat creek in 1961.
The area was popular for fishing due to its abundant fish. The barangay is composed of Ilocanos, Tagalog,
Pangasinense, Bicolanos, Igorots, and Ifugaos, with Ilocano being the dominant dialect. The creek is
currently used to irrigate rice fields, providing 90% of the barangay's leading rice producers.
According to the Barangay Census, the total population of Barangay Maddiangat is 2,797 as of
February 2024, with 686 families. Barangay Maddiangat covers 1,340 hectares, with 334.07 of it being
agricultural. Farming, fishing, and business are the main economic activities in this area. The majority of the
religions in the barangay are Roman Catholic, INC, Protestant, Baptist, and Jehovah's Witnesses.
According to their history, there were several settlers in their barangay, resulting in diverse ethnolinguistics
such as Ilocano, Kalanguya, Ifugao, kan - kana - i, Ibaloi, Bisaya, Kapampangan and Pangasinense. They
travel primarily by bicycle, motorcycle, and car.

III. HOUSEHOLD

Member of Position in Relationshi Civil Age Date of

the House the Family p to the status Birth
head of the
fam

Mr. S Grandfather Grandfather Married 64 y/o October 05,

1960

Mrs. F Grandmother Wife Married 59 July 6, 1966

Mr. CJ Grandchild Grandchild Single 19 y/o April 17,

2005

Ms. KM Grandchild Grandchild Single 11 y/o January 20,

2013

Mr. K Grandchild Grandchild Single 9 y/o January 13,

2015

IV. FAMILY SITUATION

This family is located in Purok 1, Maddiangat, Quezon, Nueva Vizcaya. They are a family of 5 that
falls just a little above the poverty threshold with a monthly income of ₱14,000/mo. The grandfather used to
be a construction worker but found a new job recently as a security guard. He earns ₱12,000/mo on paper
but only takes home about ₱10,200 after government benefits. The grandmother only relies on inconsistent
on-call household tasks by the neighbours and earns 500/sunday from that on average. She was just
recently chosen to partake in a community-based program that provides temporary employment to workers
known as TUPAD, but this only happens once a year and with low chances of being chosen. Along with
these and with some random side-hustles such as seasonal harvest of crops for ₱100/day keep the family
afloat.

The husband and wife had 2 sons and 1 daughter who are all living away from them and are seldom
in touch. The grandchildren stay with the grandparents as their parents had remarried and are tending to
families of their own. Aside from the struggles in supporting 3 grandchildren, tending to the eldest
grandchild’s needs is also putting a strain on their finances. The eldest was a result of an unsuccessful
abortion and had been bedridden all his 19 years of life. The other two have to attend school with little to no
child-support from the parents.

The family faces numerous challenges, these include lack of finances to support health
maintenance, scarcity of employment opportunities, and absence of emotional and financial support from
the other family members. Despite these, the grandmother who makes the majority of decisions and who is
also under the threat of her compromised health does her best to keep the family’s health and education
sustained for the hope of a better quality of life. This case study will examine the impact of these challenges
on the family’s health and overall well-being.

INITIAL DATA BASE

A. Family structure, characteristics and dynamics
1. Family Structure
The Ila family appears to be an extended family with grandparents and grandchildren who
are first degree cousins. The parents of the 3 grandchildren are living away and do not play a part in
any of the childrens’ life aspects besides being biological parents.
The grandmother does almost all of the decision making and is the primary care-giver to the
grandchildren. The grandfather remains the head of the household as the bringer of greater
financial value and to whom the 3 grandchildren are dependent on.

2. Family Characteristics

Family Member Age Gender Marital Status

1. Mr. S 64 y/o Male Married

2. Mrs. F 59 y/o Female Married

3. Mr. CJ 19 y/o Male Single

4. Ms. KM 11 y/o Female Single

5. Mr. K 9 y/o Male Single

3. Family Dynamics
The relationship between the family members is that of a normal grandparents to
grandchildren dynamic since the children have lived with them since they were infants. The children
still look for their parent’s love and care but they have all moved on from their unsuccessful first
marriages and have built families of their own. Communication with them is also scarce but mostly
non-existent.
The grandparents in the family rarely do have conflicts that would escalate into a huge
misunderstanding because they are too focused on working to meet the needs of 3 grandchildren.
The grandmother may have her hands full but she never skips a day from taking care of the
grandchildren’s needs at home and at school. They have more concern on the children’s physical
needs as it is the most needed and more salient one and so there is very little to no attention given
to the emotional side of things. The children as observed are quiet and reserved, it is highly
noticeable that they are not used to expressing themselves as it probably has not been practised
within the family. The grandmother, despite the multiple struggles, keeps her emotions in check so
as not to burden the children.
 The grandmother makes the most decisions within the family, whether it’d be a decision for
the benefit of the family or of each member.

B. SOCIOECONOMIC STATUS AND SOCIOCULTURAL HEALTH

Socio Economic Status

This pie graph shows the estimated illustration of the Ila Family’s monthly expenses. There is a total
of Php9100 of expenses ideally without emergencies and additional unexpected expenditures. Her
husband’s monthly salary is Php10,200. This illustrates that the Ila family is one step away from poverty.

Socio Cultural Health

The Ila family continues to support their basic needs along with healthcare expenditures and
functional limitations by depending on the grandfather’s current employment and some help from his wife.
The neighbourhood would usually help Mrs. Ila by looking out for her bedridden grandchild while
they both go to work.The other two children are relatively more independent and attend school. Both are
experiencing their own struggles and privileges of being able to go to school but according to them, they
aren’t too vocal in discussing their studying struggles at home because grandma already has a lot of bigger
problems to deal with.

The family is also very interested to partake to the incoming immunisation program to be conducted
by the Maddiangat Community of Health. Mr. S possesses a health card issued by Philhealth but the rest of
the family do not.

C. HOME ENVIRONMENT

The Ila Family lives in a two-story house that is not finished yet. There are five members in the
family: Solomon (the grandfather), Florida (the grandmother), and their three grandchildren—Charles
Joshua, who is 19 years old; Kheanne Mae, who is 11; and Kheldwyn, who is 9. Even though the house is
not complete, it is a warm and loving home for everyone.

Downstairs is a living room, a kitchen, and a yard where Kheldwyn and Kheanne Mae like to play.
The living room has a bed for their grandson who is bedridden, so he can be comfortable. A cabinet in the
living room acts as a divider, giving some privacy while keeping the family close.

Upstairs, there is a rooftop but no bedrooms because the house is still unfinished. Despite this, the
family remains strong and supportive of each other. They help one another through tough times, making
their home a place full of love and happiness.

D. HEALTH STATUS OF EACH FAMILY MEMBER

Family Member Age Gender Health Age-related risk

Conditions

1. Mr. S 64 y/o Male

2. Mrs. F 59 y/o Female Hypertension/

Asthma

3. Mr. CJ 19 y/o Male Premature/ Seizures

Paretic

4. Ms. KM 11 y/o Female

5. Mr. K 9 y/o Male

E. PRACTICE ON HEALTH PROMOTION AND DISEASE PREVENTION

The grandmother is hypertensive and is actively taking medication for it. She takes 50mg of
Losartan once a day. The same goes for one of the grandchildren who was premature at birth. He has 2
medications for health maintenance namely Phenobarbital 90mg, 1 tab in the morning and 1.2 tab in the
evening; Clonazepam 10mg 1 tablet every night.

In the instance of a health emergency, the family always opt for Dr. Fonacier, a pediatric neurologist
at Salubris since she had been their doctor for Mr. CJ’s case and Mrs. Ila used to work for her as a helper
for a short period of time in the past years. There was also a time when they wanted to adopt her bedridden
grandchild given that he is “an interesting case” but because of Mrs. Ila’s personal worries for the safety of
her grandchild, she had to refuse.

Besides immunization programs being held in the barangay, the Ila family do not participate in
certain personal illness prevention precautions such as going for regular screening for blood pressure,
cholesterol level, or blood glucose testing. According to Mrs. Ila, they only get the chance to talk to health
care providers when they are already in the middle of experiencing health issues.

VI. 1ST LEVEL ASSESSMENT

CUES/DATA HEALTH PROBLEM JUSTIFICATION

1. Subjective:
“Dito rin kami Unsterilized drinking Drinking contaminated or
umiinom sa galing water unclean water makes you
sa poso” sick with diarrhoea,
Objective: Water vomiting and stomach
directly comes pain. You can get sick if
from the faucet you use contaminated
straight to drinking. water for cooking,
washing food, preparing
 drinks, making ice or
brushing teeth.
2. Subjective:
“Pag may Care-giving burden Caregiving can cause
kailangang tapusin, financial strain with family
hindi ko na caregivers often
nagagawa tulad ng contributing
paglilinis at financially/physically to
paglalaba kasi yung the person in their care.
bata na lang ang Your health and wellness
binabantayan ko. are oftentimes placed
Iniwan sakin ang second. Caregiver stress
obligasyon ng and burnout can affect
kanyang mga your own overall health
magulang. and well-being.
Objective:
Caregiving burden,
child is bedridden,
need assistance to
carry for toilet
activities.
3. Subjective:
“Ayan o, nakasako. Improper solid waste Open bins are ideal
Di na naming storage and disposal breeding grounds for
sinesegregate, bacteria, insects and
sinusunog nalang vermin. This increases the
naming. Simula risk of you contacting
nung binakurang salmonella which causes
itong likod, dito na typhoid fever,
kami nagsusunog.” gastroenteritis, food
Objective: Presence poisoning. Failing to
of sacks as garbage segregate waste properly
bins with no lids, can release solid harmful
situated at the back gas into the atmosphere.
of their house near Burning of plastic wastes
the fence. With flies increase risk of heart
and pungent odor, disease aggravates
mix of respiratory ailments, such
biodegradable and as asthma, emphysema
plastics. Presence that cause rashes, nausea
of ashes and or headache and
partially burnt solid endanger the nervous
wastes. system.
4. Subjective: “
Nagkukulang din Poor Poor sanitation is linked
kasi ako sa oras sa home/environmental to transmission of
paglilinis kasi sanitation diarrhoeal diseases such
kailangan ko ring as cholera and dysentery,
pumasok sa as well as typhoid,
trabaho” intestinal worm infections
Objective: Presence and polio. It exacerbates
of clutter around the stunting and contributes
house and layer of to the spread of
dust on the stairs, antimicrobial resistance.
furniture and rough
flooring.
5. Subjective:
“Matagal na yon, di Increase accident/injury Falls and injury causing
 ko na pinapaayos
kasi walang pamalit hazard hazard and allows 87% of
at wala ring a fractured among people
magkukumpuni , at age 65 and are the
wala ring pambili. second leading cause of
Objective: The huge spinal cord injuries and
cabinet that serves brain injury symptoms.
as a divider for the
kitchen and living
area is on the brink
of crumbling down
and poses a great
risk of accident.

IX. DOCUMENTATION

•A dirty sink filled with unwashed dishes, reflecting poor hygiene practices. Below the sink, there is
a trash bin that is not covered and indicating a lack of proper waste management.
•Messy rooms with unmade beds and disorganised belongings everywhere. This kind of
environment can lead to health issues like allergies, stress, and infections.
•A large wooden cabinet used as a room divider. The child's bed is next to the cabinet which poses
a great risk of severe injury in case of an earthquake.

•The bathroom with a dirty floor and lot of dust on top of the durabox. It’s important to keep the
bathroom clean to prevent the spread of germs and illness
 The Ila Family