Republic of the Philippines UNIVERSITY OF NORTHERN PHILIPPINES Tamag, Vigan City COLLEGE OF NURSING FAMILY NURSING CARE PLAN In Partial Fulfillment of the Requirements of the Subject H.C. 102 (Primary Health Care II – R.L.E.) Presented by: Vanessa Raquepo Jesabel Remular Jonas Jaco P. Talamo BSN II – B Presented to: Ms. Aiza Ramos, R.N. (Clinical Instructor) Date of Submission: February 8, 2009 INTRODUCTION Community Health Nursing (CHN) is one of the two major nursing fields in the Philippines. Nursing practice in the community means different things to different nurses. Many, if not most of us, emphasize the setting of practice; that is, community health nursing is nursing practice outside the hospital. Not a few nurses choose community health nursing because they do not want to go on afternoon and night shifts. They simply prefer the pace of work in the community. The practice of community health nursing is enhanced by the bodies of knowledge of other academic disciplines such as the social sciences. Concepts like, the sociology, psychology, anthropology, economics and political science help nurses understand the health care delivery system and their clients, and thus perform their roles and functions better. Before going further, we must also know that the family is a very important institution that performs two major functions – reproduction and socialization. It is generally considered as the basic unit of care in community health nursing for many reasons. It may contribute knowingly or unknowingly to the development of health and nursing problems of its members. Ideally, the family provides its members with protection, companionship, security, and socialization. The structure of the family and the needs that the family fulfills vary from society to society. The nuclear family – two adults and their children – is the main unit in some societies. In others, it is a subordinate part of an extended family, which also consists of grandparents and other relatives. A third family unit is the single-parent family, in which children live with an unmarried, divorced, or widowed mother or father. However, it also performs health-promoting, health-maintaining and disease-preventing activities. In many cases, it is the family that provides unfailing nursing care particularly to the chronic-ill members. It is the source of the most solid support to its members, above all to the young, the elderly and disabled. Historical studies have shown that family structure has been less changed by urbanization and industrialization than was once supposed. The nuclear family was the most prevalent preindustrial unit and is still the basic unit of social organization. The modern family differs from earlier traditional forms, however, in its functions, composition, and life cycle and in the roles of husbands and wives. The only function of the family that continues to survive all change is the provision of affection and emotional support by and to all its members, particularly infants and young children. Specialized institutions now perform many of the other functions that were once performed by the agrarian family: economic production, education, religion, and recreation. Jobs are usually separate from the family group; family members often work in different occupations and in locations away from the home. Education is provided by the state or by private groups. Religious training and recreational activities are available outside the home, although both still have a place in family life. The family is still responsible for the socialization of children. Even in this capacity, however, the influence of peers and of the mass media has assumed a larger role. INITIAL DATA BASE A. Family Structure, Characteristics and Dynamics The Corpuz Family is an extended type of family and is a permanent settler in Barangay Ayusan Sur, Vigan City. The family is composed of nine members: three girls, four boys and a mother. Mrs. Manuela Corpuz, sixty-nine years old, is the matriarch and the head of the family; she is a widow and she lives with her children and her grandchildren. Mrs. Rosanna C. Quodala, thirty-five years old, is the ninth daughter of Mrs. Corpuz and she has two children namely Renz Joseph, ten years old, and Mica Desiree Quodala, eight years old; both are elementary pupils. Mrs. Quodala, a midwifery graduate, is a plain housekeeper and his husband works at Candon City, Ilocos Sur. Mr. Edwin Corpuz, forty-two years old, is the fifth son of Mrs. Manuela Corpuz and the older brother of Mrs. Rosanna C. Quodala. He is self-employed, single and lives with the family. Another member of the family is Mr. Teddy Boy Corpuz, thirty-one years old, the eleventh son of Mrs. Manuela Corpuz. He is a college graduate and is a government employee. Mr. Marlon Corpuz, twenty-nine years old, is the youngest son of Mrs. Manuela Corpuz and is married to Aileen Rapanut, 26 years old. He is a tricycle driver and the couple lives together with the family. The family is part of the predominant religion in the locality, the Roman Catholic. In the matters of health care and finance, both the members of the family take part in decisionmaking, in which its success is a product of open communication for all the members of the family. For the family dynamics, one good observed instance is their communication dynamics. If quarrel arises, pride has no space because they talk to each other with full sincerity. Interaction patterns among family members are usual and typical. B. Socio-Economic and Cultural Characteristics Since the family’s estimated income is only P5, 000 a month which they obtain from tricycle driving, selling and contributions of other members, it is only enough for the family to meet their basic needs. Food production activities such as vegetable gardening, poultry, and fruit trees are being practice for family consumption in addition to their resources. When it comes to financial matters, education of children, participation on barangay activities and other matters, Mrs. Rosanna Quodala and her mother take part in the decision-making. They are also the one responsible in disciplining and imparting good values to their children which is manifested by their hospitality and since their religion is Roman Catholic, their children shows love and respect for the elderly. When it comes to political factors, Mrs. Rosanna Qoudala is very active in participating on different barangay activities and in fact, she is a member of the BALIKATAN organization and a volunteer midwife at the Barangay Health Station. C. Home and Environment The family is living in their own house. The construction of the house is composed of materials like concrete, wooden walls and galvanized iron roofing. The house contains four rooms: a living room, a kitchen, only one bedroom and a bathroom. The type of toilet facility the whole family uses is the water-sealed and it is located outside their house, specifically at their backyard near the open dumping which makes it inappropriate and unhygienic. Their house has the open draining system; water wastes flow to the open canal beside their house. Breeding sites for mosquitoes, flies, cockroaches, and rodents are to be anticipated due to open drainage and poor environmental sanitation as evidenced by the location of the house just along the national road that makes them exposed to air and noise pollution. When it comes to garbage disposal and management, it is not that pretty good because the family does not practice the proper and correct way to segregate their garbage and wastes, they put their garbage on an open receptacle and they usually burn those disposed; their other way to dispose their garbage is open dumping at their backyard. When it comes to their supply of electricity, the house is connected to ISECO. Appliances like television, electric fan, radio, and the like play a very important role for the family’s leisure time and relaxation in the community. The family owns a pet dog. The brothers of Mrs. Quodala own the chickens and roosters for selling. On water supply, they are drinking water taken through a water pump. They usually place it on covered water jugs. No other treatments such as chlorination and boiling are prepared or done on the water they drink; they just drink it straight from the source. Their food, on the other hand, is stored in basket cases. Communication facilities are so apparent due to the fast evolution of technology; wireless communication is so rampant. Each of the members of the family owns a cell phone because it is more economy in nature, as stated by Mrs. Rosanna Quodala. On the other hand, the family owns a tricycle and a motorcycle for income and transportation matters. D. Health Status of Each Family Member The family has no history of any hereditary diseases or conditions. The student nurses have observed that Mrs. Manuela Corpuz and the other members of the family are all healthy and physically fit as of now while the two children of Mrs. Rosanna Quodala have cough and fever sometimes in a year when rainy season or cold weather approaches. E. Values and Practices on Health Promotion / Maintenance and Disease Prevention The children, Renz Joseph and Mica Desiree, have completed all the vaccines required by the Department of Health. Since Mrs. Rosanna is a volunteer midwife at the Barangay Health Station, she and her family are aware with the availability of preventive health services in the community since they have the fear of acquiring new illnesses that contributes to financial burden. On the other hand, the family members have enough rest and sleep. Work in the home serves as their exercise. Going to the church every Sunday is already a big retreat and relaxation activity for them. The student nurses have observed a smooth and close parent-sibling relationship as evidenced by strong family bonds; for instance, when the student nurses conducted the interview with the said family, they immediately participated and showed oneness through the participation of each member of the family. Sometimes, occasional conflicts occur in the family but are immediately resolved through small talks and explanations. Habitually, the men in the family drink 2-6 bottles of liquor before they will eat their meals; they can also consume a minimum of one pack of cigarette per day. FIRST LEVEL ASSESSMENT Health Strengths HEALTH POTENTIALS 1. No family history of hereditary disease or condition. Cues: The members of the family are healthy and physically fit as of now. Health Problems HEALTH THREATS 1. Family size beyond what family resources can adequately provide. Cues: Inadequate living space as evidenced by only two sleeping rooms for the nine members of the family. The head of the family is unemployed. The family only depends on the amount of money they get from selling and tricycle driving. 2. Presence of accident hazards. Cues: Unkept pointed or sharp materials like knives, bolo, chainsaw, etc. Vehicular accident hazards as evidenced by the location of the house just along the national road that makes the members of the family, most especially the children, more prone to accident. 3. Poor environmental sanitation Cues: Inadequate living space as evidenced by only one bedroom for the nine members of the family. Lack of food storage facility; they just place their food on basket cases that will bring about to unsanitary food handling and preparation. Presence of breeding or resting sites of insects, rodents, and other vectors as evidenced by improper waste disposal and open drainage system just beside their house that turns out to be a favorable reservoir for certain vectors. Cans, bottles, wastes and so on are not kept in proper garbage receptacles. Garbage is not segregated for biodegradable and nonbiodegradable as evidenced by open dumping at their backyard. 2. Correct or healthful nutritional or eating habits. Cues: Adequate food intake of all family members both in quality and quantity. The family’s diet is more on vegetables and poultry rather than red meat. 3. Good marital relationship. Cues: Smooth and close parent-sibling relationship as evidenced by strong family bonds; they go out together. Smooth interpersonal relationship between and among family members; occasional conflicts occur but are immediately resolved. 4. Proper role assumption. Cues: The members of the family participate and assume their part when it comes to financial matters and others. Children go to school and help in the household chores. 4. Unhealthful lifestyles and personal habits or practices. Cues: Frequent drinking of alcohol; habitually, the men in the family drink 2-6 bottles of liquor before eating their meals. Family members smoke; they can consume a minimum of one pack of cigarette per day. One or more family members walk barefoot outside the house. SECOND LEVEL ASSESSMENT Problems and Cues HEALTH THREATS 1. Family size beyond what family Inability to recognize the presence of a resources can adequately provide. problem due to: Cues: a. Lack of knowledge. b. Fear of consequence of diagnosis of Inadequate living space as problem, specifically: evidenced by only two sleeping rooms for the nine members of Economic / cost implications the family. The head of the family is unemployed. The family only depends on the amount of money they get from selling and tricycle driving. 2. Presence of accident hazards. Inability to provide a home environment which Cues: is conducive to health maintenance and Unkept pointed or sharp personality development due to: a. Lack of knowledge of preventive materials like knives, bolo, measures. chainsaw, etc. Vehicular accident hazards as evidenced by the location of the house just along the national road that makes the members of the family, most especially the children, more prone to accident. 3. Poor environmental sanitation Inability to provide a home environment which Cues: is conducive to health maintenance and Inadequate living space as personality development due to: a. Inadequate family resources, evidenced by only one bedroom specifically: for the nine members of the family. Financial constraints / limited financial resources Lack of food storage facility; b. Lack of knowledge of importance of they just place their food on hygiene and sanitation. basket cases that will bring about c. Lack of skill in carrying out measures to unsanitary food handling and to improve home environment. preparation. Presence of breeding or resting sites of insects, rodents, and other vectors as evidenced by improper waste disposal and open drainage system just beside their house that turns out to be a favorable reservoir for certain vectors. Cans, bottles, wastes and so on are not kept in proper garbage receptacles. Second Level Assessment Garbage is not segregated for biodegradable and nonbiodegradable as evidenced by open dumping at their backyard. 4. Unhealthful lifestyles and personal Inability to make decisions with respect to habits or practices. taking appropriate health action due to: Cues: a. Low salience of the problem. b. Inability to decide which action to take Frequent drinking of alcohol; from among a list of alternatives. habitually, the men in the family drink 2-6 bottles of liquor before eating their meals. Family members smoke; they can consume a minimum of one pack of cigarette per day. One or more family members walk barefoot outside the house.