I. INTRODUCTION A family is a very important social institution that performs reproduction and socialization.

They are considered the basic unit of care in the community health nursing for many reasons. The family is also the locus of decision-making on health matters which are health promoting, health maintaining and disease preventing activities. It consists of those individuals, male or female, young or adult, legally or not legally related, genetically or not genetically related, who are considered by others to represent their significant persons. The economic resources of the family are secured by adult members. The family protects the physical healthcare services. Nutritional and lifestyle practices of the family also directly affect the developing health attitudes and lifestyle practices of the children. The family creates an atmosphere that influences the cognitive and psychosocial growth of its members. It may contribute knowingly or unknowingly to the development of health. On health matters, it is the source of most solid support and care to its member particularly to the young, the elderly, the disabled and the chronically ill. Health care process is a series of interactive activities done by both health worker and client geared toward the attainment of the clients request for health care such as health promotion, disease prevention and rehabilitation of an existing disease. A primary health worker or nurse formulates a family health care plan for his or her client to minimize, control, prevent or eliminate the identified problem experienced by the family. To choose interventions, resources, and evaluation methods and tools based on the formulated goals and objectives, method of health care provider-family contact and method of delivering interventions required to effectively implement interventions. It will also help deliver the most appropriate care to the client by eliminating barriers to family health development. A family health care plan is also important in the prioritization of problems identified. In formulating a participatory health care plan, we should encourage the full participation of the family and the community if possible for this plan to take in effect. By considering the community as a whole, a health care provider should first gather information needed such as family structure, characteristics and dynamics, socio economic characteristics, home and environment, health status of each family member, belief, values and practices on health potentials and disease prevention, then analyze the data gathered, list all possible health potentials, health threats, health deficits and foreseeable crisis situations, prioritize family health problems, formulate goals and objectives and develop the intervention plan. At the end of a health care worker-family client relationship, I expect that the health care worker is able to let the family recognize the presence of a wellness state, health condition, make their own decisions about taking appropriate health actions to maintain wellness or manage health problems, maintain and improve a home environment conducive to health maintenance

and personal development and utilize community resources for health care. That the family, as a whole becomes independent and cautious of the well-being and health of each member regarding all aspects such as physical, emotional, social, and behaviors towards self, others and the community. I also expect that in the long run, both are having a trusting relationship that even if the time of terminating the home visit has arrived, there is still the understanding, respect and rapport that were built is present.

III. FIRST AND SECOND LEVEL ASSESSMENT A. Health Strengths HEALTH STRENGTHS (FIRST LEVEL ASSESSMENT) 1. Appropriate role assumption SUPPORTING CUES SECOND LEVEL ASSESSMENT The parents are responsible for Ability to provide a home and the financial security of the family. Charlice, when goes home from school works at her aunts place to meet some of her basic needs as well. The younger children stay in their house to do household chores, go to school and sometimes go to the garden to help in 2. Good family relationship farming. There were no verbalized conflict in the family upon moments of assessment or visit. Ability to provide a home and environment which is conducive to health maintenance and personal development because of solidarity of the family. environment which is conducive to personal development

B. Health Problems HEALTH PROBLEM (FIRST LEVEL ASSESMENT) 1. Presence of health deficit: Illness state (Hypertension) > Mother was diagnosed of hypertension > She experiences nape and back pain 3. Unhealthful lifestyle and personal habits/practices Cigarette smoking SUPPORTING CUES FAMILY NURSING DIAGNOSIS (SECOND LEVEL ASSESSMENT) Inability to provide adequate nursing care to the member of the family due to lack of knowledge about the disease

> BP taken was 150/90 mmHg or health condition. > Sir Timpac smokes 1 pack Inability to make decisions of cigarette at most per day with respect to taking appropriate health action due to presence of environmental influence Inability to make decisions

4. Unhealthful lifestyle and

> Both the mother was

personal habits/practices Poor personal hygiene

observed to have dirty untrimmed nails > The children walk barefoot outside the house

with respect to taking appropriate health action due to interruptive prioritized activities: occupation/work related Inability to make decisions with respect to taking appropriate health action due to inadequate knowledge as to alternative courses of actions open to them. Inability to provide a home and environment which is conducive to health maintenance due to inadequate knowledge on effects of dirty environment and effects of mosquitoes, rodents and roaches on health. Inability to provide a home and environment which is conducive to health maintenance due to inadequate knowledge on effects of unsanitary waste disposal and the diseases it may cause.

5. Lack of immunization/ inadequate immunization status especially of children

>Gladys claims that she remembered having vaccines before but did not complete it according to her mother.

6. Poor home/environmental sanitation: presence of breeding sites for vectors of diseases (e.g. rodents, mosquitoes, flies, etc.)

> Insects were seen at the toilet and presence of stagnant water outside the house.

7. Poor home/environmental sanitation: Presence of unsanitary waste disposal.

> The type of toilet is closed pit privy, with foul smell and presence of some flies located at the back of the house and somehow lacks privacy because it uses only sacks as covers.

III. PRIORITIZATION OF HEALTH PROBLEMS A. Computations HEALTH PROBLEM: HYPERTENSION Nature of the problem: Health deficit Modifiability of the problem: Easily modifiable Preventive Potential: Highly Preventable 3/3x1 1 Hypertension if not controlled can lead to cardiac problems like stroke which could be 2/2x2 2 3/3 x1 1 It is a health deficit and requires more immediate intervention or management to eliminate unpleasant consequences The other has her maintaining drugs

fatal. It is highly preventable in such a way that the mother can modify her lifestyle to Salience 1/2x1 0.5 reduce complications. 1/2x1 The mother knows and recognizes it as a problem. She goes for check-up but of irregular pattern. She verbalizes need for immediate attention. Total Score 4.5

HEALTH PROBLEM: Poor Personal Hygiene Nature of the Problem: Health deficit 2/3 .67 The problem is a health threat in which the family can possibly acquire diseases which could be transmitted by unwashed hands and contact with dirt, which could alter and hinder their performance of the activities of daily living. Modifiability problem: > Easily modifiable of the 2/2x2 2 It is easily modifiable in which the student can teach and instruct the family to perform hygienic practices such as hand washing before consumption of meals and bathing at least once a day. Preventive Potential > Highly Preventable 3/3x1 1 It is highly preventable by the implementation of preventive measures which are easy to perform, thereby minimizing the occurrence of the disease and spread of infection. Salience 0/2 x 1 0 The family is not aware of the problem existing in their home. That is why they do not carry out the practices and knowledge about hygiene measures and they are not aware of what danger it brings them due to having poor

hygiene practices. Total Score 3.67

HEALTH PROBLEM: Presence of Breeding Sites of Vectors CRITERIA Nature of the Problem: Health threat COMPUTATION SCORE 2/3 x 1 .67 JUSTIFICATION The problem is a health threat in which the presence of breeding places of rodents and insects increase the rate of possible onset of disease within the family such as malaria, dengue, etc. Modifiability problem: a. Easily modifiable Preventive Potential 3/3x1 1 of the 2/2X2 2 The family is aware that presence of such insects is not good to health. The family the is insects pit capable by privy of and

eliminating covering

always

throwing the stagnant water in the containers outside their house. Salience 1/2x1 0.5 The family recognizes it as a problem but has not yet done any control measure. Total Score 4.17

HEALTH PROBLEM: Unsanitary Waste Disposal Nature of the Problem: Health deficit 2/3x1 .67 It is a health threat because it can lead to possible spread of infection to the rest of the members of the family. Modifiability problem: of the 1/2x2 1 Although materials they they were still given havent

> Partially Modifiable

started making the toilet that is sanitary to reduce the spread of diseases.

Preventive Potential > Moderate Preventive

2/3x1

.67

It is highly preventable by the implementation of preventive measures which are easy to perform, thereby minimizing the occurrence of the disease and spread of infection.

Potential

Salience

1/2 x 1

.5

The family is aware of the problem but is not doing anything about it.

Total Score

2.84

HEALTH PROBLEM: Lack Of Immunization Nature of the Problem: Health deficit 2/3x1 .67 It is a health threat since not all the immunizations were taken they are susceptible to diseases, they have low immune system. Modifiability problem: > Partially Modifiable of the 1/2x2 1 Gladys cannot find her

immunization card and so she is not sure of the vaccines already given to her and her older siblings.

Preventive Potential > Moderate Preventive

2/3x1

.67

If the immunization is corrected, other diseases and infections maybe avoided.

Potential Salience 1/2 x 1 .5

The family is aware of the problem but is not doing anything about it.

Total Score

2.84

B. LIST OF PRIORITIZED HEALTH PROBLEM HEALTH PROBLEM RANK TOTAL SCORE

Presence of health deficit: illness state (hypertension) Poor home/environmental presence diseases of (e.g.

4.5

4.17

sanitation: vectors of

breeding or resting sites of mosquitoes, roaches, flies, rodents, etc.) Unhealthful personal lifestyle practices: and poor 3 3.67

personal hygiene Unhealthful personal lifestyle and 4 3.17

habits/

practices:

alcohol drinking Unhealthful personal lifestyle and 4 3.17

habits/

practices:

cigarette smoking Poor disposal Inadequate immunization 5 2.84 home/environmental 5 2.84

sanitation: unsanitary waste

status specially of children

A. HEALTH PROBLEM: HYPERTENSION a. Subjective Data : High Blood ak kano, ngem awan ti tumtumarek nga agas as verbalized by the mother. b. Objective Data BP: 150/90 mmHg Capillary Refill: 1-2 seconds INTERVENTIONS HEALTH DEFICIT: HYPERTENSION 1. Inability to recognize the presence of elevated blood pressure related to: a. lack of or inadequate knowledge about elevated blood pressure b. failure to comprehend the nature/magnitude of problem GOALS AND OBJECTIVES GOAL: Patient will maintain optimal tissue perfusion to different organs LTO: Given a 3-week (3 days per week) of nurse-family partnership, the family will be able to provide adequate nursing care to the member with elevated blood pressure STO: After 1 home visit, the family member with hypertension will: a. agree to listen to the discussions about the nature, effects, other accompanying symptoms of an elevated blood pressure and what the family can do about the problem b. set the date, time frame and venue for the discussion INTERVETION PLAN Method of contact, Resources proposedactions/methods needed of teaching Home Visit NURSE: a. time and effort of student nurse b. knowledge of student nurse about the disease c. facilitating skills FAMILY: a. time (1 hour) b. venue for the conference EVALUATION PLAN Outcome Criteria Methods of Evaluation 1. Instant Oral Feedback 2. Observation of an honest behavior of acceptance

After an hour of health education, the responsible family members will a. be able to explain what and how an elevated blood pressure happens
b. be able to enumerate the 6 Common Contributing/Risk Factors for Hypertension c. able to enumerate the 7 Ways on How to Manage Hypertension.

2. Failure to maximize community resources for health care related to: a. failure to comprehend the nature of the problem requiring professional help b. preoccupation with economic priorities 3. Inability to make decisions with respect to taking appropriate health action related to: a. economic priorities 4. Inability to provide adequate nursing care to the sick family member related to lack of knowledge about elevated blood pressure

d. Agree to go for check-up at the Health center or go for checkup at the hospital e. Allot time for going to health center for check-up

Formulate a contract with the family member and let them sign, together with another family member as a witness.

V. LEARNING INSIGHTS First thing Ive learned is that I should be contented and thankful with the things that I have because it cannot be denied that I am more blessed financially than the people in the community. I also learned to value my family since Ive seen the people in the community really value their family. And I have learned to value a simple life. I also have learned that we really went there for a purpose, to help them in our own way and to help them become independent. I learned that it is important to gain their trust and to establish rapport because it makes them more cooperative and it makes the interaction easier. Ive learned that communication is also very important and that you really should know their language because they can express themselves more using their own language. I also learned that they really need our help and that they are very thankful to have us in their community. I learned how to adapt to the ways of the community. I was very motivated to help the community in every way I could. I learned that time should be budgeted and should be used to do something productive I also learned to value my group mates. Ive learned to be sensitive about their needs and to wake up early to cook for them. Lastly, Ive learned to be myself. I learned that you need to show them who you really are because by that way you are earning their trust and you get to know the people of the community better.