CENTRAL PHILIPPINE

UNIVERSITY COLLEGE OF
NURSING
Jaro, Iloilo City, Philippines

A Family Case Study

in Partial Fulfillment of Requirements in

Related Learning Experience

Presented to:

Lilia T.

Hilasque Clinical

Instructor

Presented by:

Hautea, Rya Kelly M.

Heria, Annekha L.

Hulleza, Grazella C.

Ikalina, Terrence Albert

P. Jagna-an, Ray Angelo

C.

BSN-2D
I. Initial Data Base

A. Family Structure Characteristics and Dynamics

The B. family from the 11 Islands of Zamboanga, consists of Mr. Y a father and
comprises his eight children. S, 14 years of age his eldest and N, 3 years of age the youngest of
his family. Mr. Y is the breadwinner of his family. His children cannot move without their
father’s support and decisions, mainly with the involvement of money matters. The eldest child S
takes good care of the family whenever their father is out for work.

B. Socio-economic and Cultural Characteristics

Mr. Y, a fisherman, is the head and the main provider of his family. Upon arrival at the
shop, his children will wait for him to be able to have their baon. Instead of giving his children
their allowance, Mr. Y will give them fish that he caught from the sea and his children will sell
them and the money they’ve gathered will be for their school. An average of one hundred fifty
pesos per day is the income of Mr. Y’s family and they’ve also sold shells and cultivate sea
weeds. They’re a part and dependent on the government's 4P’s program or the Pantawid
Pamilyang Pilipino Program as their family’s background.

C. Home Environment

Their home condition is definitely poor, the house is too small for the family and it is
made of light materials such as weak and thin wood. The surroundings are shabby and it's quite
positive because of the words of wisdom from the eldest child. Living on an island is a challenge
they need to face, there will be inevitable problems and dangers likely to occur for example, fire
when they’re cooking in their small kitchen. There is no electricity in their place so the children
are forced to gather in the dim of a gas lamp in order for them to study. Their source of water is
from a water hose connected to a spring located in Sitio, Parang-Parang. The hose is so old and
dirty, the water itself contains moss and it’s not potable. The 11 Islands is a very far place, mishap
and thunder storm from the shore and many others are expected. There Are no healthcare centers
on their island and the transportation is hard for the children. They still need to ride their own little
boats to manage to go to school or to go somewhere.
 D. Health Status of Each Family Member

Eight of the siblings are all underweight, especially the youngest child who is
undiagnosed. The youngest child called N doesn’t drink milk but coffee or sugar with hot water as
an alternative for milk which may have adverse effects on the child’s teeth and bones. The risk of
malnutrition is serious because the inadequate food intake for these children both in quantity and
quality will not suppress unwanted illnesses. The family cannot afford to buy their own food,
even a small amount of rice due to poverty. They’re forced to eat what’s available in their
environment such as root crops. Client Y is a smoker so there is a chance or a probability of
contributing risk factors of acquiring lifestyle diseases.

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

On weekdays before getting to school the children are waiting for their father to return
so that they can get their allowances. It takes an hour for the children to row their boat to reach
the shore and walk for kilometers to go to school. After finishing school in order to get home
they’ll walk and ride their boat again and will arrive late. They wake up early in the morning on
weekends so they could cross an island in Sitio Parangparang gathering 11 empty gallons. These
gallons are utilized for washing and to quench their thirst consumed for only a week. Whenever
they take a shower or bath only two-dippers per sibling is allowed to be used which causes poor
hygiene and a variety of illnesses. Mr. Y their father together with his children works all day
continuously even on weekends for their livelihood. Still, their income won’t suffice their daily
needs and they barely eat. And this leads to deficient health and nourishment, they do not have
enough rest and they’re relentless which means they are vulnerable to the risk of illnesses and
diseases.

II. First Level Assessment

Blue water, white sand, swaying red and theatrical orange sky. The “Eleven Islands”, a group of
islands in the southern Zamboanga Peninsula, are rich in the wonderful colors of nature. These incredible
islands would attract many people, but behind these perfect islands tells a sad story. It was once called the
“No Man’s Land” because before the pirates and terrorists stayed in the islands of Zamboanga. This island
has no water supply, no electricity, no health centers, no school, and has an insufficient food source which
concerns the families living in the area.
1. Presence of Wellness Condition

A. The family’s small house that is made of light materials became a strong foundation for the
children where there are colorful posters hanging by the walls with inspirational words written
by the eldest daughter of the family which serves as their light and motivation to keep pursuing
their dreams. In spite of having many obligations that await them on the island, they never
complain about a single thing. They are full of hope. Their eagerness to study keeps them on
track because for them, having a proper education will help them overcome extreme poverty.

B. The children, at such a young age, have learned so much from dealing with the difficulties in
fife. They showed persistence to be in school despite their struggles to sell their father’s catch so
they have an allowance in school. They, themselves, want to be able to finish their education
despite their financial situation and the distance of the school and hardships before reaching the
school; so, do the parents of the children. And because of their situation, the children have
become independent.

2. Presence of Health Threats

A. Presence of risk factors of specific diseases.

• The island does not have a clean water source in the community. The children would go to a
cave called “Sitio Parang-Parang”, the only place where they can get clean water from the
spring. Young children are already carrying heavy gallons full of water, which even some
fully grown adults would have difficulties

in carrying. If they continue to always do physically taxing activities, it would strain their
underdeveloped bodies and hinder their growth and might affect their backbone.

• Presence of moss in spring water that is both used for drinking and bathing presents risk
factors of acquiring microorganisms which can result in loss of bowel movement (LBM),
diarrhea, amoeba or any related gastro-intestinal complications.

• Presence of contributing risk factors for acquiring lifestyle diseases since the father of the
family has a habit of smoking cigarettes.
B. Family size beyond what family resources can adequately provide

• The family earns from fishing and catching shellfish. They sold the fish for only 25 pesos
per piece, definitely a price so low for the fish as big as our arms. The total money earned
is approximately 170 pesos per day which is too small to meet the basic and daily
necessities of a family of 11. The eldest daughter would still go and buy sugar, coffee, and
rice for their meals for the day, leaving no spare money for their needs.
• The family’s source of income is greatly dependent on the climate. Their only primary
source of livelihood is from seaweed cultivation to fishing unfortunately, Sometimes, due
to the harsh weather conditions, the father of the family would not be able to harvest the
seaweed that he has cultivated; and it is during these times when it’s difficult for them to
earn a livelihood.

C. Accident hazards. Specify:

• Hazard brought about by calamities.
• Fire hazard. The island doesn’t have electricity so they are just using fire lamps during
night and if not used safely, it can cause fire accidents. In addition, because their house is
made of light materials, it could easily get burned.
• The means of transportation going to school poses a great threat to the children. They can
fall off the boat and drown any time. It is also dangerous for the children to go home late
because the tides would be rising.

D. Faulty/unhealthful nutritional/eating habits or feeding techniques. Specify:

• Inadequate food intake both in quantity and quality.
• The youngest sibling is only drinking coffee or sugar dissolved in hot water as a substitute
for milk, because coffee and sugar are cheaper than milk and they've already used to it.
Drinking coffee or sugar dissolved in hot water is not appropriate for children and this
unhealthy habit could cause serious nutritional deficiencies.
• Lack of food resources. Water is not just the problem on the island but also regular food
resources. The family would be lucky if they get to eat rice as their meal. The family eat
root crops almost every meal every day because they can barely afford to buy rice and
meat.
E. Stress-provoking factors
• Parent's educational attainment. The parents did not finish their education providing them
little opportunities for a much higher paying job.
 • Financial status and family size. Their income couldn’t sustain or is very insufficient for
their family’s needs, especially that they have a big family to feed.
• Location. Confronting the difficulties of everyday living on the island, where there is no
water, no electricity, not a school for children or a health center for the infirmed.
• Care-giving burden. The Eldest daughter has already assumed the role of taking care of
her younger siblings in order to alleviate some of her parents' burdens.

F. Poor home/environmental condition/sanitation. Specify:

• Inadequate living space
• Lack of food storage facilities
• Polluted water supply (-There is a presence of moss and smells unpleasantly)
• Poor lighting and ventilation
G. Unhealthful lifestyle and personal habits/practices. Specily:

• Poor personal hygiene. The family rations it when taking a bath, only allowing 2 scoops
of water per child. They also needed to share soap and a sachet of shampoo, which will
not be enough to clean themselves properly. If the children would not be able to wash
their bodies properly, this may result in problems with their hygiene like body odor or
greasy skin or infections.
• Inadequate rest or sleep
• Lack of/inadequate relaxation activities

3. Presence of Health Deficit

A. The father is still quite young, but his front teeth are already gone. This is a sign of failure to
maintain dental health.
B. All family members show signs of malnutrition.

4. Presence of Stress Points/Foreseeable Crisis Situations

A. Entrance at school. Before they get to reach the nearest school, they need to trek hills and
paddle in the ocean for an hour. Then the children need to sell fish for their allowances even
though they are already tired and late for school.
 B. Exit at school. The sea is dangerous to cross, especially when the sun is about to set and the
tides would start rising. Due to this, the children are worried about going home when it’s
already late. The whole situation poses a great threat to their lives.
C. It is difficult for the father to see his children working, but he is unable to do anything because
he knows that his income alone is not enough to support the whole family. As soon as their
father arrived, they would not be given the money for their school needs, instead he handed all
the fishes to his children and then paddled their way onto the sea going to school to sell the
fishes on their way. As a result, sometimes the children became late in school.
D. Every weekend instead of having firn and enjoying themselves, the children still need to fetch
water for the whole weekdays and look for seashells to sell and earn money.

III. Second Level Assessment

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

a. lack of or inadequate knowledge, economic implications, Social-stigma, physical
and emotional consequences. Also, concerns regarding their rational or
psychological way of thinking.

2. Inability to make decisions with respect to taking appropriate health action due to:
a. failure to comprehend the nature of the condition, lack of/ inadequate community
resources for care.

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

personal development due to:
a. Family resources are limited, particularly financial and physical resources. Lack of
understanding of the need of cleanliness, hygiene, and preventative actions.

4. Faulty/unhealthful eating habits, inability to recognize the presence of a problem due to:
a. Lack of knowledge and financial constraints.
b. Physical inaccessibility

5. Malnutrition, Inability to recognize the presence of a health problem due to:

a. inadequate knowledge
b. Unhealthy diets and regimen
c. financial constraints.
IV. FAMILY COPING INDEX
Criteria
Physical Independence
Therapeutic Competence
Knowledge of Health Condition
Application of principles of
General Hygiene
Health Attitude
Emotional Competence
Family Living
Physical Environment
Use of Community Facilities
Scale Justification
They are able to get in and out of bed and walk
independently, therefore there are no abnormalities
5 in terms of their physical independence.
The parents are somewhat aware of what to do if a
family member becomes ill, but due to financial
constraints and a lack of transportation, they are
1
unable to visit a health center that can potentially
help them.
They are aware of their health situation, but owing to
1 financial constraints and a lack of mobility, their
health concerns are overlooked.
The family does not get enough sleep, and they do
3 not have access to basic diet or safe drinking water.
The family seems unconcerned about their approach
1
to health promotion and prevention.
The family is emotionally capable; they deal with
5 stress and challenges with greater maturity.
The family has mutual regard for one another, and
5
they make decisions that benefit each function.
The family's home was designed to accommodate
2 each member of the family perfectly, despite the fact
that their water was not sterile.
The family is aware of alternative facilities, but due
1 to distance, they are unable to access or use them.
V. PROBLEM PRIORITIZATION

A. Presence of risk factors of specific disease.

Criteria Score Justification
Nature of the condition or (2/3) x l = 0.67 The presence of risk factors for a
problem presented specific disease is a health risk
that could lead to the development
of a disease that could progress to
a serious health condition.

Modifiability of the condition (l/2) x 2 = 1 The problem is partially

or problem modifiable since they don’t have
proper water supplies that could
serve as the intervention measure.
Preventive Potential (2/3) x l = 0.67 If the right precautions are taken
Salience (2/2) x l = 1 The situation appears to necessitate
rapid action.
Total Score 3.34

B. Accident hazards.
Criteria Score Justification
Nature of the condition or (2/3) x l = 0.67 The problem is seen as a form of.
problem presented Health threat.
Modifiability of the condition (l/2) x 2 = 1 The issue is somewhat solvable.
or problem The only solution is to renovate
the house.
Preventive Potential (2/3) x l = 0.67 The difficulty could be mitigated
to some extent. If the family is
aware of weather changes, it
might be
possible.
 Salience (l/2) x l = 0.5 In comparison to other coexisting
issues, the issue does not require
immediate treatment.
Total Score 2.84

C. Faulty/unhealthful nutritional/eating habits or feeding techniques.

Criteria Score Justification
Nature of the condition or (3/3) x l = 1 The problem is a health deficit.
problem presented
Modifiability of the condition (l/2) x 2 = 1 The problem is partially
or problem modifiable. The only way to
tackle the situation is to give
more
nutritional options for children.
Preventive Potential (2/3) x l = 0.67 The problem could be moderately
prevented. It could be done if the
family will be able to give source
of nutrients to their children.
Salience (2/2) x l = 1 The issue requires prompt
attention because it may result in
an incorrect development of their
growth.
Total Score 3.67

D. Family size beyond what family resources can adequately provide as a health threat.
Criteria Score Justification
Nature of the condition or (2/3) x l = 0.67 The problem is seen as a health
problem presented threat.
Modifiability of the condition (0/2) x 2 = 0 The problem could not be modified
or problem at all.
 Preventive Potential (1/3) x l = 0.33 The problem may be prevented but
family size could not be trimmed
down
Salience (0/2) x l = 0 It is not perceived as a problem at
all.
Total Score 1

E. Poor home/environmental condition/sanitation.

Criteria Score Justification
Nature of the condition or (2/3) x l = 0.67 The problem is seen as a health
problem presented threat.
Modifiability of the condition (l/2) x 2 = 1 The problem is partially
or problem modifiable because there are no
alternative water sources for the
family.
Preventive Potential (1/3) x l = 0.33 Due to a lack of sufficient
resources, the problem has a low
potential for prevention.
Salience (2/2) x l = 1 The problem is seen as urgent and
requires rapid response.
Total Score 3

F. Unhealthful lifestyle and personal habits/practices.

Criteria Score Justification
Nature of the condition or (3/3) x l = 1 The problem is seen as a health
problem presented deficit.
Modifiability of the condition (l/2) x 2 = 1 The problem is partially
or problem modifiable, the only way to
remedy this problem is to provide
 more nutritional options for
children.
Preventive Potential (2/3) x l = 0.67 The problem could be moderately
prevented. If the family can obtain
a better supply of nutrients, this
could be done.
Salience (2/2) x l = 1 The problem is in need of
immediate attention since this
could result in the children's
development being stunted.
Total Score 3.67

G. Presence of stress points/foreseeable crisis situation.

Criteria Score Justification
Nature of the condition or (1/3) x l = 0.33 This problem is seen as a
problem presented foreseeable crisis.
Modifiability of the condition (l/2) x 2 = 1 The problem is perceived as
or problem partially modifiable if the family
members engaged in health
promoting activities.
Preventive Potential (2/3) x l = 0.67 The problem may be moderately
preventive if members of the
family were to look after their
overall health.
Salience (l/2) x l = 0.5 In comparison to other issues, the
situation does not require
immediate attention because it is a
predicted crisis.
Total Score 2.5

Problem Score
Faulty/unhealthful nutritional/eating habits 3.67
or feeding techniques.
Unhealthful lifestyle and personal 3.67
habits/practices.
Presence of risk factors of specific disease. 3.34
Poor home/environmental condition / 3
sanitation.
Accident hazards. 2.84
Presence of stress points/foreseeable crisis 2.5
situation.
Family size beyond what family resources can 1
adequately provide as a health threat.