INTRODUCTION

Family is the central social faction, a small community, basically in any federation,
composed of a man and a woman, or any two individuals bound together through the bonds of
marriage, blood or adoption. This is the main foundation to form an integral community in which
its members may or may benefit from one another. A family plays a vital role in fostering
healthy activities towards the quorum of the family members itself. It is involved in upbringing
virtuous entities.
It is the basis for the personalities of every individual in a given community. Family is
where we all learn to love, care, interact and heed with any beings from all walks of life. These
fundamental skills, and family values are necessary to live an honorable and prospers life in
harmony and in community. Thus, family and community go hand in hand.
The community is a group of people sharing common geographic boundaries and/or
common values and interests. It functions within a particular socio cultural context, which means
that no two communities are alike (Maglaya, 2004).

Purpose of the Study

Family as an essential unit of the community requires exceptional attention from health
practitioners. The study aims to determine the level of family functioning and as well as clarify
the interaction pattern between members of the chosen family. It also intends to identify family
strength and weaknesses.
Moreover, the study endeavours to create an awareness of the family’s present health
condition and so as to construct plans in solving or at least minimizing existing problems. By
exploiting the baseline data obtained, proper health practices can be promoted and implement
plans that may help establish interventions that may improve the family’s health status.

Initial Database for Family Nursing Practice

A. Family Structure characteristic and Dynamics

1. Members of the Household and relationship to the head of the family

Member Number Family Member Position

01 FR Father / Head
02 CR Mother
03 JR Son

2. Demographics
Member Number Age Sex Civil Status
01 33 Male Married
02 23 Female Married
03 15 Male Single

3. Place of Residency
Member Number Place of Residency
01 Living with the Family
02 Living with the Family
 03 Living with the Family

4. Type of Family Structure

Their family is a typical family, nuclear in structure. It is composed of Mr.FR, a
33 years old man who was the head of the family. He is the one who decides and plans
for the family. Then we have Mrs.CR, she is 23 years old who is the mother of the
family. She supports her husband’s decisions and helps him in every action her husband
made. They have a son, Jeffrey is a 3rd year highschool student.

5. Dominant Family Member in Terms of Decision Making Especially in Matter of Health

Care

The Father, is considered the head of the family who decides especially in the
matter of health care. Mrs. Rivera on the other hand, also does the decision making when
it comes to budgeting.

6. General Family Relationship

The family has some misunderstandings. The son and the mother have a little
dispute which may have been resulted from lack of communication. She even said on an
interview. “Pasaway naman kasi minsan eh. Lalo na kapag pinapatawa ako sa iskwelahan
nila dahil may gulong nangyari. Minsan lang kasi kami mag usap nyan at iniintindi ko na
lang kasi sa age nya.” Their age gap could have been one factor of why their conflict
arises.

B. Socio Economic and Cultural Characteristics

1. Income and Expenses

Budget Food LPG House Allowance Electricity

Allowance Rental
Expenses Market LPG used for 4 JR= 40
expenses months
TOTAL: PhP. 100 for PhP 4 Gas PhP. 100 PhP. 40 baon PhP. 20
PhP. 264 per day food rent Electricity
PhP. 7,392 per
month

Daily Expenses of Rosales Family

Mr. FR, though he was not able to pursue his college life does not let education to hinder
the family’s future. The first few years were rough for the family. When they migrated in
Pugadlawin, the father was able to find a job as a family driver. According to Mr.FR, their
income is not constant. For rough seasons, he can earn for at least PhP. 7,000 per month. The
mother knows how to budget money well but this will not usually suffice the needs of the family
specially when they have to spend on miscellaneous fees like when someone gets sick.
 2. Educational Attainment of Each Member

Family Member Educational Graduate

FR 2nd year High school
CR 3rd year Highschool
JR 2nd year High school

3. Ethnic Background and Religious Affiliation

The family originates at Batangas before they migrated at Pugadlawin.

The family uses Tagalog as their medium of communication. The religion of the
family is Roman Catholic. They are not able to attend mass every Sunday because
according to them, they have more important things to attend to like looking after
their sick family member, job-searching, and maintaining their house. But
whenever they have problems, they still ask help and guidance from Almighty
God.

4. Significant others

Family Member Role

FR Independent/ head /Decision-making
CR Independent/ mother / Decision-making
JR Dependent/ Son

5. Relationship of the Family to Larger Community

The family does not actively participate when there is activity/programs held in
the community. They do not belong to any social group and only goes to health
center when a family member gets sick. However, they are able to relate with
their neighbours efficiently.

C. Home and Environment

a. Housing
The Rivera family resides at Molave, Pugadlawin Las Pinas City. Their house is
made up of wood. It has only one multifunctional room that has an area of 12.89
square meters, which measures 3.47 m in width and 4.29 m in length. A door which
is 1.80 m by 0.66 cm serves as an entrance of the house. The height of the ceiling
from the floor is 2.72 m. It has one open window.
1. Adequacy of Living Space
Mrs. CR said: “Ay talagang masikip dito, isang hakbang mo lang ay nasa
lutuan ka na, mga dalawang hakbang naman ay nasa pinto ka na. Mahirap
nga din pag kami ay nagkakasama dito sa loob ng bahay kaya marami sa
amin ay nariyan lang sa may labas at si Jeffrey ay nakikihiga sa silong ng
kaitbahay.” From the statement and measurements of the house, it can be
 evident that the Sta. Maria family has no adequate living space. The area
of the house which is 12.89 square meters when divided to three to assume
their share of space, gives each member of the household with 3.05 square
meters each.

2. Sleeping Arrangement
The Family uses only one room for sleeping and resting. They don’t have
enough space for them to be able to do activities a normal family is doing.
They don’t have their bed, instead, they use weaved-mat in sleeping which
is 2.11 m by 1.43 m. They lie side-by-side on the mat. When it comes to
ventilation, they only have one desk electric fan which according to them
is not enough to supply air especially in hot, humid days.

3. Presence of breeding or Resting Sites of Vectors of Diseases

The drainage at the side of their house serves as a breeding site of the
vectors of diseases since the drainage is stagnant and seems to be polluted.
There are lots of uncovered garbage containers around their house which
is a perfect breeding ground for flies, roaches and rodents.

4. Food Storage and Cooking Facilities

The family doesn’t have their own refrigerator so they just cover their left-
over with a plastic tray with openings. They cook food using a “super
kalan” Most of the time, instead of storing, they rather consume all the
food to avoid spoilage.

5. Toilet Facility
When it comes to toilet facility, they have their own toilet.they don’t
share it with other families. It is 1.34 m by 1.13 m in size and has a height
of 2.08 m. Moreover, it is made of rough concrete which is hard to clean
especially when dirt seep into the pores of the concrete. The toilet bowl is
uncovered and kept unclean. Water is contained in a plastic drum which is
also uncovered.

6. Garbage/ Refuse Disposal

They dispose their garbage to a plastic bag but are sometimes left near the
toilet facility. Waste segregation is not exercised. Garbage is being
collected every Thursday.

7. Drainage System
The drainage system in the left side of the house and the neighborhood is a
small canal. It is often filled with small garbage which causes it to be
stagnant. It has a ghastly garbage odor which can be smelled around the
house. All of the fluid waste from the neighbourhood.

b. Kind of Neighborhood
 Their neighborhood is amicable. The community shows no harm when it comes to
their neighbors because many of their neighbors are their relatives and they are
the ones who helps the family when they need them.

c. Communication and Transportation Facilities Available

There is a landline connection in the community but the family is not able to avail
it. For them to communicate with their other relatives, they sometimes borrow cell
phone from their neighbors. The only available means of transportation accessible
for them is pedicabs or sidecars which is not that far from that house.

D. Health Status of Each Family Members

(PE not done.)

E. Values, Habits, Practices on health promotion, maintenance and disease prevention

1. Immunization status of family members:

Mrs. CR noted that their son is fully immunized although date was not recalled.

2. Healthy lifestyle practices:

Mrs. CR made clear that the only way that the family could be healthy is eating the
right food and not getting stressed with problems. Although they admitted to have
problems financially, and thus, not having to eat nutritious food most of the time, they
are aware that these are essential for health.

3. Adequacy of:

a. Rest and sleep:

The family is generally well rested after sleep and can perform everyday
errands and tasks, which are demanded of them. They usually sleep at around
9:00 p.m. and wake up at 6:00 a.m. Although this is not regular because
sometimes the son has to do school projects and assignments for which they
have to stay up late. The parents’ sleep pattern is also not that regular because
sometimes they have to finish business orders from their customers. Although
they don’t have enough sleeping space, they are able to rest because their
environment is conducive to sleep and it is quite.

b. Exercise/activities:
They seldom do exercise. For them, doing household chores acts as
replacement.

C. Use of protective measures

All the family members does not wear slippers at home. They do not use
bednets when sleeping.

c. Relaxation and other stress

 Their main form of relaxation and release of tension and stress is through
sleeping and a little tête-à-tête with neighbors and other family members.
When the father goes home from work, the only way for him to relieve
stress is by sleeping.

TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PROBLEMS

First Level Assessment
I. Presence of Wellness Condition
A. Potential for enhanced capability
1. Healthy lifestyle

The family eats three times a day. Their breakfast is usually between 6am to 7am
and consists of pandesal and coffee. On the other hand, the lunch is done between
11am to 1pm while dinner is done between 6pm-8pm. They usually eat the
cheapest kind of fishes, “tinapa” and “tuyo” for lunch and dinner due to the
limited supply of funds. In order to compensate for the lack of food, they drink
lots of water coming from a pump which streams water form NAWASA. Their
fluid intake ranges from 6-10 glasses of water per person a day. Whenever they
don’t have enough money to buy food, they usually ask food from their
neighbors. The parents don’t perform any form of physical exercises. They
consider household chores as their exercise instead.

2. Health Maintenance
The family members had no illnesses experienced from the past and present.
Colds were said to be occasional and the longest term would be 2 weeks. They
can manage colds by drinking juices and taking neozeps as medicine. They
implement self- management first if symptoms are not that serious as to their
perception. The family takes Vitamin supplements like Vit E which they get from
the health center.

3. Parenting

Mrs. CR shared with us that she’s having conflicts with her son. She said that she
often reprimands her son specially when she is being called by the school just
because his son just did something. She and her son cannot go along quite well.
“Hindi nga kami magkasundo eh. Lalo na pag sumasagot siya sakin umiinit ulo
ko.” Whenever she tries to open it up with her son, she was often misinterpreted.
But now, she’s trying to be patient and instead understands her son to avoid any
gap between her and her son.

4. Spiritual Well-being

The family is not active in church activities. They seldom went to church. Their
son attends Sunday masses only twice a month. However, when they experience
hard times in dealing with problems they gain strength from God. Even though
 poverty come their way, they still believe that God has a better plan for their
family.

B. Readiness for enhanced capability

1. Healthy Lifestyle

In general, the family has an unhealthy lifestyle, not being able to consider
eating nutritious foods, drinking purified water, maintaining proper hygiene
both in themselves and to their environment and performing any kind of
exercise.

2. Health Maintenance / Health Management

The whole family preferred to go to Health center for consultations. The

family prioritize their health and thus, they take vitamin supplements
everyday to manage it and prevent illness.

3. Spiritual Well- being

The family keeps their faith intact even though they are not capable to put it
into practice. They put God first whenever they faced with different
challenges in their lives.

II. Presence of Health Threats

In their family there is a present of health threats. One of this is the poor
environmental sanitation. Moreover, their place is conducive to diseases and
accidents.

A. Accident Hazards
1. Fire Hazard

The family’s house is composed of mixed materials but mostly it is made up

of woods wherein it could be burned easily. The house wiring was improperly
installed; it hangs freely around the house and may cause accidents.

B. Faulty/ unhealthy nutritional/ eating habits or feeding techniques/ practices.

The family’s diet which is mainly composed of dried fish and processed
foods makes them more prone to malnutrition. It is mainly high in salt and
carbohydrates and is insufficient in fiber, vitamins, minerals, calcium and
other essential nutrients needed by our body. However, the family eats on
time three times a day. They have enough water intake.

C. Poor home/environmental condition/ sanitation

The family has an evidently inadequate living space. They live in a one all
purpose room of 14.89 square meters in size. The environmental sanitation is poor
 because of the kind of drainage system they have and their way of waste disposal.
These aspects attract pathogens and vectors. They don’t practice proper waste
segregation. The presence of roaches, rodents, mosquitoes, and flies inside and
out of the house reflects the sanitation of the family. Within their vicinity, there’s
a lot dog manure. They don’t have enough ventilation inside the house and
mounds of dust are seldom cleaned. However, they do have enough lighting.

D. Unhealthy lifestyle and personal habits/ practices

The family has an unhealthy lifestyle due to the fact that they don’t concern that
much about their surroundings. They don’t practice proper sanitation. All of the
family members walk barefooted. They don’t have exercise and other physical
activities. Nutritious food is not always included in their daily diet.

III.Presence of Health deficits

The family currently does not experience any instances of failure in health
maintenance since they have and had no illnesses experienced and they were able
to manage the usual coughs and colds.

IV. Presence of Stress points/ foreseeable crisis situations

A. Relationship with one another
Adolescence-the mother is having a difficult time communicating with son, Jeffrey who
is in the adolescent stage of maturity.

Second Level of Assessment

I. Inability to recognize the presence of the condition or problem due to:

A. Lack or inadequate knowledge

The family has inadequate knowledge about health care since they are not able to
attend neither health seminars nor being oriented by means of proper education. Some
of the problems observed in the family were not being solved though it is possible for
them to do something about it.

B. Attitude/Philosophy in life which hinders recognition/acceptance of a problem

The family’s attitude/philosophy towards the problem inhibit the family’s capability to
mend their living space. “Ayos lang naman kahit nakapaa at ganito ang bahay. Mas
mahalaga yung di naman kami nagkakasakit. Nakakakain naman kami. At hindi naman
kami mamamatay sa ganito. Unahin muna ang mga kailangan katulad ng pagkain.”
Although they are aware that it could be problem, they chose not to do anything about it
because they think they have more important things to think and attend to. But in general,
financial constraints inhibit them from making an action to modify this situation.

II. Inability to make decisions with respect to taking appropriate health action
 A. Feeling of confusion/ helplessness and/or resignation brought about by perceived
magnitude/severity of the situation or problem
Since they find it difficult to solve problems such as health problems and matters
regarding their environment, there’s a feeling of helplessness because their concern is
mostly on finances.

B. Inaccessibility of appropriate resources for care

Their resources are not enough for them to maintain their health and environmental status
only the health center is available which the whole family cannot utilize. They really cannot
decide on what action to make regarding their inadequate working space because of their
economic and financial constraints.

III.Inability to provide adequate nursing care to the sick, disabled, dependent or

vulnerable/ at-risk member of the family due to:

A. Lack of/ inadequate knowledge about the disease/ health condition

The family is unable to make solutions with regards to the problems in the house
since they are unaware of some complications and they lack the ability of
managing it.

B. Lack of/ inadequate knowledge of the nature and extent of nursing care needed.
They are not well oriented on some actions needed for them to achieve a
sustainable status with regards to health and even the nature of the concerns.

C. Lack of/ inadequate knowledge and skill in carrying out the necessary
interventions/treatment/procedure care
The family has no point of reference with regards to healthy lifestyle program
which may help them in the interventions they need for the health care. They are
not active and do not attend health programs held by their vicinity.

IV. Inability to provide a home environment conducive to health maintenance and

personal development due to:

A. Inadequate family resources specifically, financial constraints and limited physical

resources
Although the family has a monthly income of PhP 7, 000, this amount is barely enough
for a family. Although they facilities for cooking, bathing and sleeping needs, they do not
have enough money for developing or renovation of the said facilities to avoid accidents
that can happen due to slippery floor in the bathroom and poor lighting in the cooking
area. Moreoever, there is a lack of space to construct facility which if put into action
properly may lead to a better living.

B. Lack of/ or inadequate knowledge of importance of hygiene and sanitation

 They are not well informed about proper sanitation and hygiene which causes
them some health problems. They are not oriented on what are the possible effects
they might experience due to these conditions.

V. Failure to utilize community resources for health care due to:

A. Inaccessibility of required care and services.

Because of inadequate knowledge about the condition they are experiencing now,
they are not able to avail the required care and services needed for them to able to
improve their lifestyle.
B. Negative attitude/philosophy in life which is not conducive to health maintenance and
personal development.
The family’s attitude/philosophy towards the problem inhibit the family’s capability
to mend their living space. “Ayos lang naman kahit nakapaa at ganito ang bahay. Mas
mahalaga yung di naman kami nagkakasakit. Nakakakain naman kami. At hindi
naman kami mamamatay sa ganito. Unahin muna ang mga kailangan katulad ng
pagkain.” Although they are aware that it could be problem, they chose not to do
anything about it because they think they have more important things to think and
attend to. But in general, financial constraints inhibit them from making an action to
modify this situation.

Cues Data
Cues/Data Family Nursing Problems
VI. Inability to recognize the presence
Mr and Mrs. Rivera, both are highschool of the condition or problem due to:
undergraduate. The family has inadequate C. Lack of/ or inadequate knowledge.
knowledge about health care since they
are not able to attend neither health
seminars nor being oriented by means of D. Attitude/Philosophy in life which
proper education. Some of the problems hinders recognition/acceptance of a
observed in the family were not being problem
solved though it is possible for them to do
something about it.

The family’s attitude/philosophy towards

the problem inhibit the family’s
capability to mend their living space.
“Ayos lang naman kahit nakapaa at
ganito ang bahay. Mas mahalaga yung di
naman kami nagkakasakit. Nakakakain
naman kami. At hindi naman kami
mamamatay sa ganito. Unahin muna ang
mga kailangan katulad ng pagkain.”
Although they are aware that it could be
problem, they chose not to do anything
about it because they think they have
more important things to think and attend
to like finding ways to get money.
Since they find it difficult to solve
problems in health and matters regarding
their environment, there’s a feeling of
helplessness because their concern is
mostly on finances.
Their resources are not enough for them
to maintain their health and
environmental status. A Health Center is
available at Pugalawin where the family
goes for a check-up every time they get
sick.
The family is unable to make solutions
with regards to the problems in their
house since they are unaware of some
complications and they lack the ability of
managing it.
They are not well oriented on some
actions needed for them to achieve a
sustainable status with regards to health
and even the nature of the concerns.
The family has no point of reference with
regards to healthy lifestyle program
which may help them in the interventions
they need for the health care.
VII. Inability to make decisions with
respect to taking appropriate health action
C. Feeling of confusion/ helplessness
and/or resignation brought about by
perceived magnitude/severity of the
situation or problem
D. Inaccessibility of appropriate resources
for care
III. Inability to provide adequate nursing care
to the sick, disabled, dependent or
vulnerable/ at-risk member of the family
due to:
D. Lack of/ inadequate knowledge about
the disease/ health condition
E. Lack of/ inadequate knowledge of the
nature and extent of nursing care
needed.
F. Lack of/ inadequate knowledge and
skill in carrying out the
necessaryinterventions/treatment/proce
dure care
IV. Inability to provide a home environment
conducive to health maintenance and personal
development due to:
C. Inadequate family resources
The family has financial constraint or has D. Lack of/ or inadequate knowledge of
limited financial resources. There is a importance of hygiene and sanitation
lack of space to construct facility which if
put into action properly may lead to a
better living.

They are not well informed about proper

sanitation and hygiene which may cause
them some health problems. They are not
oriented on what are the possible effects
they might experience due to these
conditions.
V. Failure to utilize community resources for
health care due to:
C. Inaccessibility of required care and
services.

Due to inadequate knowledge about the

condition they are experiencing now, they
are not able to avail the required care and
services needed for them to able to
improve their lifestyle.

Family Coping Index

Instructions: Rate the following areas (5) being highest and (1) is the lowest.
Areas
Physical independence
Therapeutic competence
Knowledge of health
Knowledge of health 5
condition
Health attitude
Emotional competence
Family living
Physical environment
Scaling Justification
4 The family members are independent and are capable
of doing and carrying out their appointed tasks.
Although the youngest member of the family may
need supervision now and then regarding few
household tasks.
4 The family members are able to follow instructions
regarding their health and taking medication as
needed. They have a complete check-up every two
years.
4 The family has knowledge regarding their health.
The family is able to give full attention on a certain
health condition and its management.
4 They are willing to adapt and change their lifestyle.
3 The family is in good terms at the moment although
the mother and son sometimes have conflict.
4 The family has great respect for each other. The
family also plans to save money through budgeting.
2 The environment of the family being assessed is not
conducive nor properly sanitized for a healthy living.
Lots of hazards surrounding the house are really
threatening like stagnant waters and not working
drainage. The wastes of animals were disposed
 anywhere and woods which may cause accidents are
also observable. When it comes to the house itself,
the space is not sufficient for them having only a
multipurpose room and ventilation is inadequate.

Use of community facility 2 The family is aware that there are services available
in their community health center, but they do not
usually utilize it because they think that have more
important things to attend to and to think about like
having a means to make money.