INTRODUCTION A family client is a group of individuals who needs improvement, enhancement or help with regards to their health and

their environment whether it is stated by the family or observed by the health worker. The family is a very important social institution, they have two very important function namely, 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 problems of its members. It also performs healthpromoting, health-maintaining and disease preventing activities. Maglaya(1997). In many cases, the family is the locus of decision making on health matters. It is the source of the most solid support and to its members, particularly to the young, the elderly, the disabled and the chronically ill. A family health care plan is a blueprint of the care that the nurse designs to systematically minimize or eliminate the identified health and family nursing problems through explicitly formulated outcomes of care and deliberately chosen set of interventions, resources and evaluation criteria, standards, methods and tools. Primary health worker or the nurse formulates a family health care plan for his or her family client to individualize and focus the care since every family differs from one another. One may have a problem that is the same with the other but the intervention may vary due to the different levels of resources available in the family client. The Nursing model for family is that of the individualized care that is focused on the physical, social and psychological needs of the total family unit. Nursing care emphasizes delivery of safe, quality care that optimizes family unity. Therefore, family centered care includes all the family members namely the spouses, parents, children, siblings in as many aspects of care and decisions about care as possible. Family members are an excellent source of patient history and are essential for effective discharge planning. Information gained from family members is valuable to the care of the hospitalized patient. The role of the nurse includes listening, advising, advocating, teaching, encouraging and supporting. Patient and family-centered care is an approach to the planning, delivery and evaluation of health care that is grounded in mutually beneficial partnerships among health care providers, patients and families. It redefines the relationships between and among consumers and health providers. Patient and family-centered practitioners recognize the vital role families play in ensuring the health and well-being of infants, children, adolescents and family members of all ages. They acknowledge the emotional, social and developmental aspects which are integral components of health care. They promote the health and well-being of individuals and families and restore dignity and control to them. Patient and family-centered care is an approach to health care that shapes policies, programs and facility design and staff day- to- day interactions. It leads to better health outcomes and wiser allocation of resources, and greater patient and family satisfaction. A nurse needs to formulate a family health care plan for his/her client to determine how to prevent, reduce, or resolve the identified problems of the family: to support the strengths of the family: to implement nursing interventions in an organized, individualized and goal-directed manner. Formulating a health care plan is not simply a means of working for the family; it is more on working with the family. In participatory planning, the nurse promotes the individualization of care to clients. In order to be appropriate, nursing care should suit and be unique to a particular client. Planning facilitates the delivery of the most appropriate care by considering the uniqueness of each client. By doing so, the nurse falls on an error implementing an approach to one family same as with the other. The nurse must involve the family in determining health needs and problems, in establishing priorities, in selecting appropriate courses of action, implementing them, and

evaluating outcomes. By doing this, the nurse promotes participatory planning and makes the family feel that the health of its members is a family responsibility and commitment. We should formulate a participatory family health care plan establishing these following standards: 1. Involve patients and families in all aspects of the planning, delivery and evaluation of health care services. 2. Recognize families as important members of the health care team. Encourage and support families in planning of care and decision-making. 3. Support patients in involving their families in their health care experiences in ways they choose. 4. Welcome family members at all times regardless of rounds, change of shift or other events on the unit. 5. Encourage and support family members to be present during procedures and treatments, if this is the preference of the patient. 6. Provide information, in ways that patients and families would find helpful, empowering and supportive in nurturing, care-giving and decision making. 7. Provide easy and accessible opportunities for patients and families to ask questions of doctors and nurses. 8. Provide care that respects clients values, preferences and expressed needs. 9. Coordinate and integrate the care for the patient- coordinate services (i.e. tests, consultation and procedures). At the end of our health worker family client relationship, we expect the following to happen: to be able to establish a friendly and trusting relationship with the Ringor family, to be able to help or at least partially solve the health problems of the Ringor family, and to be able to make a correct and comprehensive family health care plan for the Ringor family. INITIAL DATA BASE A. Family structure, Characteristics and Dynamics The Ringor family has a nuclear type of family composed of the father, Mr. Marolito Ringor(32 y/o), the mother, Mrs. Luzviminda Ringor(30 y/o) and their children, Mr. Chester James Ringor(10 y/o), Mr Brian Jasper Ringor(9 y/o), Ms. Desiree Mikaela Ringor( 7 y/o) and Mr. Adriane Kert Ringor(1 y/o) respectively. They are currently residing at # 122, Purok 2, Sunny Side Fairview, Baguio City. The type of family according to family head, decision making and bread-earning is patriarchal. The dominant decision maker for health are both the parents but for money and expenses, its the father since he is the bread winner of the family. The family have harmonious relationship towards each other and there is no presence of or readily observed conflict between the members. The children respect their parents and they also help one another when one of them is in need. B. Socio-Economic and Cultural Characteristics The family has an income of P2100.00 a week. One thousand is allotted for food and the actual expense is 700, 200 is allotted for health, and the actual expense is 150 and 150 is allotted for education and the actual expense is also 150 . The excess is used by the father at work and is saved for future use. According to the mother, the income of his husband is adequate to meet their basic needs. As for the educational attainment of the family, the father finished his elementary education only, the mother finished her high school education, the first child is currently a grade 4 student, the second and third child are grade 1 students. The youngest is only 1 y/o so he stays at home. The mother was baptized in Las Pinas and the rest of them are baptized in St. Vincent Church. The do not go to mass regularly. They are Roman Catholic. The father is from Pangasinan and the mother came from Manila. When they got married, they had already stayed in Baguio, the father as a painter in BIP company and the mother as a housewife.

C. Home and Environment The family generally has a clean environment but has presence of breeding sites for vectors, specifically, mosquitoes and the house is located just one foot away from a cliff hence the children are at risk for falls especially that they play outside the house near the cliff . The house of the family has one bed room which has a double-deck bed inside where all the six family members sleep. The approximate size of the sleeping room is 6 sq m. The type of materials used for the house are wood(for the walls) and galvanized iron(for the roof). Their food is stored in an open cabinet. A medicine cabinet is absent. They keep poisons in a cabinet under the sink. They are using a gas range with a safety device. They have a dirty kitchen but have a clean surrounding. Burning of food is seldom done. There are no stairs present in the house. They do not have a habit of leaving sockets with plugs still connected. They always make sure that when they leave, the gas stove is closed and all the electric wirings are checked. The family members always wear slippers when going outside the house and when entering the comfort room. There is no presence of slippery floor. They have a dog present. The highway has a near proximity to the house. Their water supply is from a deep well but the water source for drinking is from the water delivery. Their water supply is family-owned. Their water is stored in a water dispenser and the water used for cooking is stored in a gallon with cover. Potability of water is tested but the mother do not know when the last test for the water was done. Their toilet facility is flush and is shared with four families. Their toilet has a foul smell but has no presence of flies. Garbage disposal is collected every Saturday; classification of garbage collection is practiced by the family. Their drainage system is open and continuously flowing. Rurban is the kind of neighborhood that the family has and the houses has a distance of approximately one foot apart. The area is generally congested. Social and government facilities that are available are the daycare center, elementary, DSWD and DENR. Health facilities and manpower that are available are the barangay health station which composes of the barangay health workers. The barangay health station is approximately 150 meters away from the house. There are no hospitals available near the place. The communication facilities that are available are mobile phone, television, radio and by word of mouth. The transportation facilities that are available on a 24-hour basis are the public utility jeeps and taxis. D. Health Status Mrs. Luzviminda Ringor had pre natal check-ups done every month of all her pregnancies before and even for her current pregnancy now. She gave birth to all her children at Baguio General Hospital. All were normal birth. The youngest child of the family is currently having a productive cough and is treated at home by rest, sleep and Carbocysteine as an OTC drug. The pregnant mother weighs 52.3 kg and her food preference is vegetables. The sick childs mid-upper arm circumference is 12 cm for both left and right arm. His food preference is also vegetables but eats less than the required. The usual content of their food during breakfast are noodles and eggs with 2 cups of rice each, during lunch, varied viands with two to three cups of rice, during dinner, also varied viands with two to three cups of rice. The father of the family is an alcohol drinker and a chronic smoker. He also has elevated blood pressure sometimes. E. Values and practices on Health Promotion/Maintenance and Disease Prevention The children in the family did not have complete immunizations. The first child only received 1st, 2nd, 3rd HEP B, 1st OPV, 1st DPT and measles vaccine. The second, third and last child received BCG, 1st, 2nd, 3rd HEP B, 1st OPV, 1st DPT and measles vaccine. Mrs. Luzvimandas reason for submitting her child for immunization is for protection of her children to diseases. She also had a complete immunization for TT. Both parents do not know if they had a complete immunization during their childhood. Mrs. Luzviminda Ringor is not currently using a family planning method but is willing to try injectables after her delivery for the sake of trying. She had a misconception about tubal ligation that when she does so, she will lose her hair. Mrs. Luzviminda Ringor has only 5 hours of sleep which is interrupted due to her sick child.

Mr. Ringor has 7 hours of sleep which is continuous. Their children have 8 hours of sleep which are also continuous. Naps are present for all except for the father because of his work. Their nature of exercise is walking which is done 30 minutes to one hour every day. Mrs. Luzviminda Ringors relaxation activity is sleeping and watching TV. Their children also relax through watching TV and playing. Mr. Manolito Ringor smokes 5 sticks of cigarette/day and started smoking at the age of 17. He also drinks 1-2 bottles of alcohol or beer twice a week. According to his wife, his reason for smoking and drinking is stress and work. FIRST LEVEL ASSESSMENT IDENTIFIED HEALTH STRENGHTS/POTENTIALS AND NEEDS 1. Regular exercises S: Clients claim that they exercise everyday by means of walking for an hour O: Slender in built Absence of muscle wasting 2. Good personal hygiene O: Clean nails No presence of body odor Clean clothes IDENTIFIED HEALTH PROBLEMS 1. Risk for fall O: Presence of uneven stairs without any railings House is located 1 foot away from cliff Children playing near their house Youngest child with productive cough S: Two weeks na yung ubo ng anak ko Nawala na yung fever niya O: Productive cough noted Childs RR : 50 bpm Child uses accessory muscles when breathing Presence of breeding and resting sites of Mosquitoes. S: Client states that Madami kaming lamok dito O: Presence of empty plastic bottles piled up on one side of the house. Water storages are left open

2.

3. Appropriate role assumption of individual family members S: Client states that Mr. Ringor is the head of the family and is the bread winner of the family. Client states that three of her children are going to school and the youngest stays at home since he is not yet qualified for school O: Mother is the one managing the family owned house Mother is the one doing the house hold chores

3.

4.

Cigarette smoking S: Client stated that her husband is smoking two sticks a day Inadequate sleep S:

5.

6.

Client states that 5 hours lang ang tulog ko Space is inadequate for the family O: Approximately 50 sq.meters One double deck bed for 6 family members One room for the whole family

PRIORITIZATION OF IDENTIFIED HEALTH PROBLEMS Health Problem: Risk for fall CRITERIA SCORE JUSTIFICATION GIVEN Nature of the 2 The problem is a health condition or problem threat and it does not present require immediate attention. Modifiability of the condition or problem a. Current knowledge, technology & interventions .5 COMPUTATION 2/3 x 1= 0.67 ACTUAL SCORE 0.67

There is adequate 1.8/2 x 2= 1.8 knowledge and technology on how to fix an uneven stairs and adding railings to the stairs There is enough resources in the community such as bamboo sticks that could be used for the railing and rocks to even the stairs The family has enough financial support to fund this situation and even man power to fix the stairs and railings The nurse could help in terms of man power

1.8

b. Resources of the community where the family lives

.5

c. Resources of the family

.5

d. Resources of the health worker Preventive Potential a. Gravity/severity of the problem b. Duration of the problem c. Presence &

0.3

0 .75

The family havent experienced any fall All of the family members are at risk of falling Family havent done

1.25/3 x 1= 0.56

.42

appropriateness of current management initiated by the family d. Exposure of any vulnerable/high risk group Salience TOTAL .50

anything to improve the problem The mother is pregnant and all their children are under 10 years old The family havent recognized the problem 0/2 x 1= 0 0 2.89

Health Problem: Youngest child with productive cough CRITERIA SCORE JUSTIFICATION GIVEN Nature of the 3 The problem is a health condition or problem deficit and it requires present immediate attention. Modifiability of the condition or problem a. Current knowledge, technology & interventions 0.5 There are a lot of researches and information regarding the disease condition which is readily available for both the parents of the child The family lives near the town so they can easily seek help from the clinics and hospital. There is also a barangay health center in their place. The family has enough financial support and good discipline to improve their lifestyle The nurse could help in terms of knowledge, skills, positive outlook and time to work with the family.

COMPUTATION 3/3 x 1= 1

ACTUAL SCORE 1

2/2 x 2= 2

b. Resources of the community where the family lives

0.5

c. Resources of the family

0.5

d. Resources of the health worker

0.5

Preventive Potential a. Gravity/severity of .75 The child is already 2.75/3 x 1= 0.92 .92

the problem

experiencing cough and colds hence the score of .75 is given .75 All of the family members are at risk of having problems in the future The mother is giving medicine but she havent brought her child for check-up yet The mother is pregnant and the child has three other siblings The family thinks that the problem needs immediate attention 2/2 x 1= 1 1 4.92

b. Duration of the problem

c. Presence & appropriateness of current management initiated by the family d. Exposure of any vulnerable/high risk group Salience TOTAL Health Problem: CRITERIA Nature of the condition or problem present Modifiability of the condition or problem a. Current knowledge, technology & interventions

.50

.75

SCORE JUSTIFICATION GIVEN 2 The problem is a health threat and it does not require immediate attention.

COMPUTATION 2/3 x 1= 0.67

ACTUAL SCORE 0.67

0.5

There are a lot of researches about the possible outcome when breeding sites for mosquitoes are present There are groceries and stores where they could buy materials that could help them eradicate the mosquitoes. They have the money, skill, knowledge and attitude needed for the improvement of the breeding place.

2/2 x 2= 2

b. Resources of the community where the family lives

0.5

c. Resources of the family

0.5

d. Resources of the health worker

0.5

The nurse could help in terms of knowledge, positive outlook and time to work with the family.

Preventive Potential a. Gravity/severity of the problem 0 The family havent experienced any diseases related mosquito bite All of the family members are at risk of mosquito bites Family havent done anything to improve the problem Some members are middle aged people and one family member is a young adult The family thinks that the situation doesnt need immediate attention 1/2 x 1= 0.5 0.5 1.25/3 x 1= 0.42 .42

b. Duration of the problem c. Presence & appropriateness of current management initiated by the family d. Exposure of any vulnerable/high risk group Salience

.75

.50

TOTAL Health Problem: Cigarette Smoking CRITERIA SCORE JUSTIFICATION GIVEN Nature of the 2 The problem is a health condition or problem threat and it does not present require immediate attention. Modifiability of the condition or problem a. Current knowledge, technology & interventions 0.5 There are a lot of researches and information about the effects of smoking to a persons health and even other people around them. Health centers are available for health teachings on

3.59

COMPUTATION 2/3 x 1= 0.67

ACTUAL SCORE 0.67

2/2 x 2= 2

b. Resources of the community where the family lives

0.5

alternatives for smoking. c. Resources of the family d. Resources of the health worker 0.5 They have the knowledge needed to improve the situation The nurse could help in terms of knowledge, positive outlook and time to work with the family.

0.5

Preventive Potential a. Gravity/severity of the problem b. Duration of the problem c. Presence & appropriateness of current management initiated by the family d. Exposure of any vulnerable/high risk group Salience TOTAL Health Problem: Inadequate sleep CRITERIA SCORE JUSTIFICATION GIVEN Nature of the 2 The problem is a health condition or problem threat and it does not present require immediate attention. Modifiability of the condition or problem a. Current knowledge, technology & interventions 0.50 There are a lot of researches and information about the importance of sleep especially for pregnant 0.50 The father is having low stamina and he is easily tired The family is at risk for diseases related to smoking Family havent done anything to improve the problem Some members are middle aged people and one family member is a young adult The family thinks that the situation needs immediate attention

1.75/3 x 1= 0.58

.58

.75

.50

2/2 x 1= 1

1 4.25

COMPUTATION 2/3 x 1= 0.67

ACTUAL SCORE 0.67

2/2 x 2= 2

women b. Resources of the community where the family lives c. Resources of the family d. Resources of the health worker Health centers are available for health teachings about importance of sleep They have the knowledge needed to improve the situation The nurse could help in terms of knowledge, positive outlook and time to work with the family.

0.50 0.50

0.50

Preventive Potential a. Gravity/severity of the problem \ b. Duration of the problem c. Presence & appropriateness of current management initiated by the family d. Exposure of any vulnerable/high risk group Salience TOTAL Complete list of prioritized family problems Family Problems 1. Youngest child with productive cough 2. Cigarette smoking .75 0.50 The mother havent experience any disorders or disease caused by inadequate sleep The mother is at risk for diseases related to inadequate sleep The mother havent done anything to improve the problem The mother is currently pregnant The mother havent recognized the problem 0/2 x 1= 0 0 3.45

1.75/3 x 1= 0.58

.78

.50

Score 4.92 4.25

3. Presence of breeding and resting site for 3.59 mosquitoes 4. Inadequate sleep 3.45 5. Risk for fall 2.89

SECOND LEVEL ASSESSMENT Health Problems According to Priority and Relevant Cues 1. Youngest having productive cough Cues: Two weeks na yung ubo ng anak ko Nawala na yung fever niya Productive cough noted Childs RR : 50 bpm Child uses accessory muscles when breathing 2. Cigarette smoking Client stated that her husband is smoking two sticks a day Patient is a chronic smoker 3. Presence of breeding and resting sites for mosquitoes Patient states that there is presence of mosquitoes but no appropriate actions to remove the breeding site 4. Inadequate sleep The mother doesnt recognize the importance of enough hours for sleep Ako lang naman ang maasahan kasi mga bata pa anak ko tapos may trabaho pa asawa ko kaya ako nagaalaga sa bata. 5. Risk for fall The family doesnt recognize the risk of falling if the problem isnt addressed or fixed Formulated Family Diagnoses Failure to utilize community resources for health care due to failure to perceive the benefits of health care or services

Inability to make decisions with respect to taking appropriate health action related to the failure to comprehend the magnitude of the condition Inability to maintain home environment conducive for health maintenance related to inadequate actions done by the family to eradicate the breeding place. Inability to provide a home environment conducive to health maintenance and personal development due to lack of supportive relationship among family members

Inability to recognize the presence of the problem due to lack of knowledge related to the risk for falling in the presence of uneven stairs without railings

SUMMARY OF INDIVIDUAL MEMBER LEARNING INSIGHTS FOR THE WHOLE PERIOD In the course of this community duty, I learned a lot. I learned about different alternatives for smoking and even the risks of smoking, uneven stairs and other simple things like empty plastic bottles could be a resting and breeding site for mosquitoes. I learned the importance of rapport with your patients. If rapport wasnt established in the beginning, it would be difficult to gather the needed data and information for your family nursing care plant and case files. My skills in physical assessment were enhanced and even my skill in blood pressure taking was enhanced because most of the community folks were asking us to take their blood pressure. Asides from the skills Ive learned, I also learned a lot about disease such as hypertension and diabetes since those are the common diseases of the community folks. I was also reminded of the importance of diet since our life style particularly our eating habits could be a contributing factor for future diseases. BIBLIOGRAPHY Salvacion G. BAilon-Reyes, Araceli S. Maglaya: Family Health Nursing The Process. Printing 4.Manila.Brainchilio Managers and consultants, 1990; reviewed and updated in 1994, 1997, 2003, by A.S. Magaya Frances Prescilla L. Cuevas, RN, MAN, et al.: Public Health Nursing in the Philippines 10th Edition.Publications Committee, National League of Philippine Government Nurses, Incorporated 2007. APPENDICES NAME DEANNE ROSE SEMON TASK BP taking Documentation of information Taking of pictures for documentation purposes Interview Conduct case findings House to house visitation Checked for immunizations Conduct physical assessment BP taking Documentation of information Interview Conduct case findings House to house visitation Checked for immunizations Conduct physical assessment BP taking Documentation of information Taking of pictures for documentation purposes Interview Conduct case findings House to house visitation Checked for immunizations Conduct physical assessment ACTIVITY Assembly time

CHASTEDY MIRANDA

ABBYGAIL BOBIAS

TIME 7:30-7:45

7:45-8:00 8:00-9:00 9:00-12:00 12:00-1:00

1:00-3:00 3:00-4:00 4:00-onwards

Travel time Pre-conference Home visitation/house to house Lunch break, Evaluation of morning activities Clarification is there is (working break) Home visitation/house to house Post-conference ARAS Travel time back to SLU dismissed