ACKNOWLEDGEMENT

First and foremost, we would like to thank God, above all for showing us the wisdom,
confidence and courage that we were able to finish this project and use it with a purpose that
could not profit only us but as well as our fellowmen, to whom our service is for.

Secondly, to our parents for it not for their unending support both financially and morally, it
certainly would not be possible for us to go this far.

To the Abellanosa family, for without your support and full cooperation, we won’t be able to
make this project possible.

To our friends, thanks for all the help you’ve shared for this project.

Lastly, to our instructor, Ms. Elma M. Ygot, RN, M.Ed., for giving us this kind of
responsibility that test our patience, determination and versatility and for giving us enough
knowledge to finish this project and for teaching us to know the essence of family. Through this
project, we were able to rediscover a better person in ourselves. It molds us to be responsible
students and to be more efficient and good nurses in the near future.

Thank you.
 TABLE OF CONTENTS

I. Acknowledgement
II. Introduction
III. Objectives, Scope and Calendar of activities
IV. Initial Database for Nursing Care Practice
V. First level Assessment
VI. Second Level Assessment
VII.Prioritizing of Problems
VIII. Family Nursing Care Plans
IX. Bibliography
X. Appendices
• Pictures
• Charts & Tables
 INTRODUCTION

“The Family is one of nature’s masterpieces” – George Santayana

We are all born the product of a union between a man and a woman, and we are all very
much shaped by those who raised us, our parents and/or caregivers. We are the product of
human relationships, and most of us spend our days within the context of relationships with
other people. We need other people to be close to us in our lives, or we tend to get sick. Who
we are is very much a function of where we have come from, and who we surround ourselves
with. Despite their vital importance in our lives, relationships can be very difficult to manage. We
expect our intimate partners to provide for many of our needs, but often find that differing
expectations, frustration, and a need to be right create conditions for conflict and erosion of
intimacy. Angels though they may be, our children test us for weaknesses and we don't always
pass. Our adult parents grow older and require care, placing a burden on our other
responsibilities. A diverse set of communication and relationship skills is required if one is to
successfully meet the challenges of family life.
An accurate physical assessment requires an organized and systematic approach using
the techniques of inspection, palpation, percussion, and auscultation. It also requires a trusting
relationship and rapport between the nurse and the patient to decrease the stress the patient
may have from being physically exposed and vulnerable. The patient will be much more relaxed
and cooperative if you explain what will be done and the reason for doing it. While the findings
of a nursing assessment do sometimes contribute to the identification of a medical diagnosis,
the unique focus of a nursing assessment is on the patient's responses to actual or potential
problems.

Home visiting is a major strategy for delivering health, social support, and educational
services directly to individuals in their homes.

A nursing care plan outlines the nursing care to be provided to a patient. It is a set of
actions the nurse will implement to resolve nursing problems identified by assessment. The
creation of the plan is an intermediate stage of the nursing process. It guides in the ongoing
provision of nursing care and assists in the evaluation of that care.
 OBJECTIVES, SCOPE AND CALENDAR OF ACTIVITIES

Objectives

• To establish a good working relationship.

• Efficiently conduct family health assessment.
• Accurately identify family health problems.
• Prepare family health care plans for the top three priority problem.
• Work out details of the family health care plan with the family.
• Assist families in implementing family nursing care plan.
• Evaluate health care conducted on the client family.
• Develop family's ability and confidence in providing health care to its members.

Scope

This study is confined to the family of Mr. And Mrs. Chandie Abellanosa #06 Ufeba,
Bulacao, Cebu City. It is included in this study the observation and interview of the family
members.

Calendar of Activities

• June 25, 2010 - 1st Home Visit and ocular inspection of the area.
– Initial Interview and physical assessment of the family members.
– Meeting for the First and second level assessment.
• June 26, 2010 – 2nd Home visit for health teachings and Nursing interventions.
• June 27, 2010 - Documentation of gathered data.
 INITIAL DATE BASE FOR NURSING CARE PRACTICE

A. Family Structure, Characteristics and Dynamics

• Members of the household and relationship to the head of the family

1. Chandie Abellanosa - Head of the family

2. Iris Abellanosa - Wife
3. Jhon Abellanosa - Son

1. Demographic Data
Family Member Age Sex Civil Position in the Family
Status
1. Chandie Abellanosa 22 M married Head of the family
2. Iris Abellanosa 21 F married Wife
3. Jhon Abellanosa 4 M single Son
mos

2. Place of residence of each member

• All members of the family are residing at #06 Ufeba, Bulacao, Cebu City.

3. Type of Family Structure

• Patriarchal
• Nuclear

4. Dominant family members in terms of decision making (in terms of Health Care)
• Chandie and Iris Abellanosa.

5. General family relationship/dynamics

• NO presence of any obvious and observable conflict between family members.

B. Socio-economic and Cultural Characteristics

1. Income and Expenses

a. Occupation, place of work and income of each working member:
• Chandie Abellanosa – Tricycle Driver – P50.00/ day

b. Adequacy to meet basic necessities

• The family spends at least P100/day for their needs. Income of the family is
not adequate to meet the necessities of every member. The following are the
priority expenditure of the family ranked from the most prioritized to the least:
- Food
- Water
- Electricity
- Health care
- Clothing
 c. Who makes decisions about money and how it is spent?
• Chandie and Iris Abellanosa are the ones making the decisions about the
finances of the whole family.

2. Educational Attainment of each member

• Chandie Abellanosa – 2nd year high school

• Iris Abellanosa – 1st year high school

3. Ethnic Background and religious affiliation

• The family speaks Cebuano and Tagalog. They are both Roman Catholic.

4. Significant others
• The lot where the family currently resides is owned by another private citizen.

5. Relationship of the family to the larger community

• The family is aware of existing organizations in the community but not a
member of any of these organizations.

C. Home and Environment

1. Housing

a. Adequacy of living space

• Not crowded

b. Sleeping arrangement
• Mr. and Mrs. Abellanosa sleep with their newborn baby in one room.

c. Presence of breeding or resting sites of vectors of disease

• Open and unsanitary drainage system.
• Improper and open garbage disposal pit.

d. Presence of accident hazards

• Sharp objects
• Poor lighted place.

e. Food storage and cooking facilities

• The family sees to it that the food and water containers are always covered.
They also use wood and charcoal to cook food.

f. Water supply
• Water supply of the family comes from the water works system.

g. Toilet facility
 • The toilet facility is owned but sanitation is quite poor.

h. Garbage disposal
• Garbage is usually collected on Fridays but they also burn their garbage from
time to time and sometimes just throw it in the garbage pit near their house.

i. Drainage system
The house has its own septic tank and toilet. The drainage system is open and
sanitation is poor.

2. Kind of Neighborhood

• slum

Social and Health Facilities available

• The family mentioned that they avail the following services from the
community: Immunizations, check up for both children and adults.

• The Bulacao Health Center, is the primary source of health care of the family.

Communication and Transportation Facilities available

• The family's means of communication includes a cellphone and newspaper.

• Their means of transportation is by the public utility vehicles.

D. Health Status of each family member

1. Medical and nursing history indicating current or past significant illnesses.

▪ Chandie Abellanosa

- Family History

*Father side: hypertension

*Mother side: Diabetes

-Past History

*Childhood illnesses: fever, cough and colds, chicken pox,

mumps

*Injuries: none

*Hospitalization: Diarrhea

-Present Health Status

*cough and colds for 2 weeks

• Iris Abellanosa
 - Family History

*Father side: Diabetes, hypertension

*Mother side: hypertension

*Childhood sickness: fever, cough and colds

2. Beliefs and practices conducive to one's illness

- Chandie and Iris Abellanosa agreed to the following statements:

• Food rich protein such as meat, fish & eggs are needed.

• Headache, nausea, and vomiting are common signs of pregnancy.

• Breastfed infants are healthier than bottle fed infants.

• Illness such as measles, polio, diphtheria and tetanus can be avoided through
immunization.

• Oresol are given to babies who have diarrhea.

• Family planning is good for maternal health.

• Herbal meds are safe and causes no side-effects when taken in excessive amounts.

• Small cuts and contusions may be cleansed using soap and tap water.

• Not taking a bath during menstruation.

• Don't cut fingernails during Tuesday & Wednesday.

• Do not sleep when hair is wet.

• Do not wash hands after ironing.

• Do not eat too much at night before sleeping.

• Do not eat sour foods during menstruation

• Consults faith healers.

• Do not allow family members to take a bath when they are sick.

• Believes in “paglilihi”

3. Nutritional assessment

- Eating/feeding habits/practices

• The family's food preferences are: poultry, fish, vegetables and instant food.
 • The family usually eats three times a day but there are instances that they eat two times
a day only.

Physical Assessment indicating Presence of Illness State

(Undiagnosed by a Medical Practitioner)

• Chandie Abellanosa - cough and colds for 2 weeks

• Irish Abellanosa - colds for 2 days

• Jhon Abellanosa - fever for 2 days

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

Disease Prevention

1. Immunization Status of the Family Members

▪ All members of the family have a complete immunization

2. Health Lifestyle Practices

• Trimming of fingernails

• Hand washing

• Bathing

• Use of slippers

3. Adequacy of:

a. Rest & sleep

-The family sleeps at night and usually have an average of 7-8hrs of sleep.

b. Exercise / Activities

- Mr. Abellanosa has a regular exercise of walking every morning.

c. Use of Protective Measures

- The family uses mosquito nets when sleeping at night.

d. Relaxation and Stress management activities

- The family usually watches television for relaxation.

 PRIORITATION OF HEALTH PROBLEMS

LOW INCOME

Actual
Criteria Computation Justification
Score

Nature of the 3/3 x 1= 1 S: “Ang akong bana ra man ang nangita

Problem sa amoa. Sikad driver lang tawon iyang
trabaho. Kulang ra gyud tawon sa amoa
iyang suweldo. Sayo sa buntag mulakaw
nana siya, unya pagka ala-sais sa gabii
na muuli. Usahay, magabi-an nana
siya..” as verbalized by Mrs. Iris
Abellanosa.

O: The family as we observed has many

expenses and need to be met, they are
the one who pays the electric bill
consumption of their parents as their
neighborhood.

I: It is health deficit having a low income

and having a lot of expenses to spend. It
can affect the ability of the family to meet
the needs of individual members of the
family.

Modifiability of the O: The problem is partially modifiable

Problem 2/2 x 2= 2 since the family had limited resources by
alternatives. But though some new
health teachings and instructing the
family to utilize is resources that is
available and suggesting to establish a
small livelihood or ways that could
augment their monetary aspect. Such as
advising to plant vegetable and sell it to
their neighbors and to their supermarket

O: If the resources and suggested

 alternatives is applied somehow it can
help and reduce the occurrence of
Preventive 2/3 x 1= 0.6 health problems such as malnutrition.
Potential

O: The family is aware of their problem,

that it needs an immediate intervention
and they are willing to acquire solution to
2/2x 1= 1 solve it.
Salience
4.6
 IMPROPER GARBAGE DISPOSAL

Actual
Criteria Computation Justification
Score

Nature of the 2/3 x 1= 0.6 S: “Ginasunog ra man namo among

Problem basura. Kapoyan naman gud mi mag
kalot ug yuta ug maglubong ug basura.
Ginatapok ra namo sa kilid among
basura dayon ginasunog na namo.” As
verbalized by Mrs. Iris Abellanosa.

O: The family throws their garbage to

where they are about to burn it. They do
not segregate the biodegradable from
non-biodegradable wastes. They burn all
garbage they throw.

I: The problem is a health threat.

Improper disposing of wastes and
garbage can lead to the increased
occurrence of communicable diseases.

Modifiability of the O: The problem can be easily modified

Problem 2/2 x 2= 2
through the utilization and proper use of
resources available in their place and
backed up by stressing of the
importance of proper waste disposal by
teaching and facilitating them to
segregate biodegradable from non-
biodegradable garbage; emphasize to
the family not to do burning because it
might cause harm to their health & the
environment

O: If the problem can be controlled, the

occurrence of communicable diseases
Preventive
such as gastroenteritis or diarrhea and
Potential 3/3 x 1= 1 parasitism can somehow be prevented
by putting proper waste disposal into
practice

O: The family perceives the problem as

a non-threatening situation and they are
Salience ½x1 0 not aware of the consequences of
3.6 having improper waste disposal
 PRESENCE OF INSECTS AND RODENTS

Actual
Criteria Computation Justification
Score

Nature of the 2/3 x 1= 0.6 S: Nah! Daghan gyud diria ng mga

Problem langaw, ok-ok, ug ilaga. Naa ganiy
pukyutan nagpuyo sa among atop,
daghan kaayo. Pero naanad naman pud
mi. pasagdan nalang namo.” As
verbalized by Mrs. L.

O: Their house is very open and the

insects and rodents can easily get into
the house

I: The problem is a health threat in which

the presence of rodents and insect
increase the rate of possible onset of
disease with in the family because
insects and rodents are known vectors
of disease.

Modifiability of the
Problem 1/2 x 2= 1 O: The problem is partially modifiable
since rodents and insects cannot be
easily controlled and it freely moves in
and out on their house. Through health
teachings such as always clean their
house and provide cover to keep the
cleanliness of the food.

O: If the planned intervention are

Preventive 2/3 x 1= 0.6
carefully implemented and practice
Potential somehow the problem can be reduced to
controllable situation and prevent further
 development of communicable disease

Salience

½x1 0.5 O: The family is aware of the existing

problem. But they do not give attention
2.7 to it because they think its normal to
have it in their surroundings.
Prioritization of Nursing Problem

SCALE FOR RANKING HEALTH CONDITIONS AND PROBLEMS ACCORDING TO

PRIORITIES

SCALE FOR RANKING HEALTH CONDITIONS AND PROBLEMS ACCORDING TO

PRIORITIES
CRITERIA WEIGHT
2. NATURE OF THE CONDITION OR PROBLEM
PRESENTED 3
• WELLNESS STATE 3 1
• HEALTH DEFICIT 2
• HEALTH THREAT 1
• FORSEEABLE CRISIS
3. MODIFIABILITY OF THE CONDITION OR
PROBLEM 2
EASILY MODIFIABLE 1 2
PARTIALLY MODIFIABLE 0
NOT MODIFIABLE
4. PREVENTIVE POTENTIAL
4. HIGH 3
5. MODERATE 2 1
6. LOW 1
5. SALIENCE
• A CONDITION OF THE PROBLEM 2 1
NEEDING IMMEDIATE ATTENTION. 1
• A CONDITION OF THE PROBLEM NOT 0
NEEDING IMMEDIATE ATTENTION.
• NOT PERCEIVED AS A PROBLEM OR
CONDITION NEEDING CHANGE.
SCORING
• DECIDE ON A SCORE FOR EACH OF THE CRITERIA.
• DIVIDE THE SCORE BY THE HIGHEST POSSIBLE SCORE AND
MULTIPLY BY THE WEIGHT. (SCORE/HIGHEST SCORED WEIGHT)
SUM UP THE SCORE FOR ALL THE CRITERIA. THE HIGHEST SCORE IS 5 EQUIVALENT
TO THE TOTAL WEIGHT.
MAGLAYA, A.S 2003. NURSING PRACTICE IN THE COMMUNITY. ARGONAUTA CORP.
PHILIPPINES
IV. SUMMARY OF LAST DAY OF HOME VISIT
The first home visit done last June 22, 2010 was also the last home visit to the
Abellanosa family due to time constraints. On that day, the initial home and family
assessments were done, including which is the MMDST for the child assessment. To
assess the condition of the family, we performed an interview and did some observations
as well. We have assessed that the space of the home, especially that of the rooms
they use for sleeping is quite inadequate to accommodate all seven members of the
family. Although they use two rooms for sleeping, the other room is quite dark and a bit
crowded, because it is where they store their fresh clothes, some other equipments, the
books and other school supplies of their children, some other old things, mats used as
beddings, blankets, and many others, whereas the other room they use is the living
room. During the day, they entertain their guests in the living room and this is where
their children play around, relax, watch television shows, and study. At nighttime, they
use the space for sleeping. We have also observed that they have a poor sanitation,
evidenced by the soiled floors and ceilings, among others. Only two of the children and
the mother were at home, but on examination and interview, the results were fine.
According to the mother, nobody in the family has an illness at present and in the past
few months. It was also observed that even the family members leave their footwear
outside the house, besides from the guests, thus, they are barefooted inside the house.
The floors are lined with linoleum, but underneath reveals a soil. The lighting is good,
they use a natural source and if it becomes dim, they switch on their electric bulb. The
ventilation is good too, since they have an electric fan aside from the natural wind. The
bathroom and the artesian well are shared by the entire neighborhood. In terms of
waste disposal, the family keeps them in a sack before it is collected by the garbage
collectors who come usually twice a week. The neighborhood is surrounded by an open
drainage system where their wastes go directly. In terms of finances, three of them are
working, which, the mother said, is sufficient for their basic needs. Food consumption is
at three to four times a day, which usually consists of rice, vegetables, fish, or bread,
and seldom includes meat and chicken. The kitchen is located outside the house, since
the mother thinks that it is safer since she uses charcoal to cook the meals. The source
of drinking water is that of the artesian well, but for the youngest child, they purchase a
mineral water. Each family member takes a bath at least once a day and brushes their
teeth when at home. Each family member walks in the morning and in the afternoon
when going to their workplace or at school and then back at home. However, they do
not have a regular physical exercise like jogging, etc.