case press on community

15

Nursing is a profession focused on assisting individuals, families, and communities in attaining, maintaining, and recovering

optimal health and functioning. Nursing can also be defined as a science and an art that focuses on promoting quality of life as

defined by persons and families, throughout their life experiences from birth to care at the end of life. Nonetheless, Community

Health Nursing is a synthesis of nursing practice, Public Health practice, Health Promotion and Primary Health Care.

The practice of community health nursing expands into the areas of disease prevention, health enhancement,

empowerment, advocacy, community development and research.

The nature of community health nursing is comprehensive directed towards the individual, families and the community at

large. The community health nurse fulfils a unique role in the community, promoting and protecting the health of the community,

whilst using a framework of sustainability.

Community health nursing acts to promote optimum health of individuals and the community by promoting the right to

informed choice, advocacy and self determination.

Community health nurses identify and challenge barriers to wellness and empower people to change the agents that affect

their health adversely. Community health nursing practice is built upon the foundation of nursing science. Community health

A FAMILY CASE STUDY ON: Mr. & Mrs. Leon Miro’s Family Gravador, Evelyn & Digal, Darrel

Introduction

http://en.wikipedia.org/wiki/Death

http://en.wikipedia.org/wiki/Childbirth

http://en.wikipedia.org/wiki/Quality_of_life

http://en.wikipedia.org/wiki/Art

http://en.wikipedia.org/wiki/Science

http://en.wikipedia.org/wiki/Health

http://en.wikipedia.org/wiki/Community

http://en.wikipedia.org/wiki/Family

http://en.wikipedia.org/wiki/Profession

15

nurses within Berwickwide Community Health Service (B.C.H.S), have all undertaken additional education to practice as

community health nurses within a Primary Health Care setting.

Primary health care as described by WHO (World Health Organization) recognizes that this setting can be the first level of

contact with a health system that is in close proximity to where people work and live.

When the Community Health Nurse works within a primary health care setting there are a number of core concepts that

are inherent and valued within this environment, they include promotion and understanding of health as a complete state of

physical, social and emotional well-being, not merely the absence of disease; contribution to identifying and meeting the main

health needs of the community; accessible, available and affordable services based on principles of social justice and equity;

comprehensive service delivery and program content that includes treatment, early identification and intervention and health

promotion; the participation and consultation of people and communities about health issues and their own health care;

multidisciplinary approaches; and promoting health through working in collaboration with other sectors in order to address the

social and environmental factors that inhibit health and well-being.

Nevertheless, Community Health Nursing basically focuses in individuals and family in the community.

Family is the basic unit of society. Families in every culture throughout history have engaged in same basic functions

which are essential for the maintenance and promotion of health: provision of affection, security, identity and satisfaction,

affiliation and companionship, socialization and establishes control. In different societies, these tasks have been performed in

different ways. Nonetheless, families always have produced children, physically maintained their members, protected their

health, given emotional support, and acceptance, and provided supportive and nurturing care during illness (Spradely, 2001).


15

Any alteration in any of one or more functions may perpetuate predicaments that disrupt normal family patterns, and can

eventually lead to the exhaustion of energy and resources that may impair coping and adaptive mechanisms.

This case presentation is a compilation of all our efforts, hard works, and endeavors together, of course, with our chosen

family. This presentation includes our assessment data, the family problems identified, the prioritization of health problems, our

nursing interventions and plan of care, health teachings, and lastly, the outcome results.

In addition, we would like to present how the family functions in the community, the roles of each member and what are

the factors that hinder or promote them from having a good access to the community resources.

Indeed, this paper will not only serve as an academic requirement, but as a medium of change for the development and

enhancement of our skills, knowledge, attitudes, and values toward the care of family and community as a whole.


15A FAMILY CASE STUDY ON: Mr. & Mrs. Leon Miro’s Family Gravador, Evelyn & Digal, Darrel

Family Nursing

Assessment

15

Family assessment has been undertaken by social scientists who examine various dimensions of family life since the last half of the twentieth

century there has been a growing interest in the empirical study of the family. Assessment may also be undertaken by health professionals

(e.g., public health nurses or student nurses) with the goal of obtaining information about the families who seek their assistance in order to

determine the necessary interventions and the methods of evaluating their outcomes.

Many of the objectives of family assessment are similar to assessment of individuals and their personalities. Issues about what is being

assessed may be primary but when, where, how, and why the assessment is taking place may all be relevant.

The whole family is not equivalent to the sum of its individual and dyadic parts. Adults in intimate relationships may consider each other as

their "whole" family. But with the birth of a child, a mother-father-child triad transforms the adult dyad into a larger family system with new

and multiple role demands. For even young children, being with both parents together means coping with the dynamics of the marital

relationship, and family (including marital) life after the birth of a second child may change even more profoundly. Further, family

cohesiveness, warmth, and flexibility may be essential for optimal child as well as adult development, and serve as resources and buffers

against stressful life events. Assessment of the many family subsystems may be necessary but each may be understood well only in the

context of the family as a whole.

Questionnaires, structured and unstructured interviews and tasks, descriptions of observations in naturalistic settings have been developed

to assess family life and describe the family along many different dimensions.


Family Nursing Assessment

15

Social scientists and mental health professionals often study the dimension of family structure. Family structure is characterized by the roles

and relationships among the individual members of the family. The family may include one or several male and/or female adults of various

ages, in varying biological relationships with one or several male and/or female children of various ages from infancy through adulthood.

Each child and adult has varying physical, cognitive, emotional, and social characteristics and possible problems in living that he or she

brings to daily family life. Assessment of family structure and its changes over time may be made to understand, for example, general and

specific effects of age, education, marital status, socioeconomic and other social conditions, developmental processes, roles, culture and the

acculturation process, and religious beliefs and practices.

Assessment may be made of the dimension family dynamics. Family dynamics consist of the sequence of interactions (parent-child

exchanges) and transactions (parentA-child-parentB-child-parentA exchanges); their synchrony, reciprocity, and patterns of mutual

influence. These patterns may affect individual child, marital, and family characteristics, and these, too, may change over time. These

analyses may provide information about family cohesion and intimacy, distribution of power in the family, decision making, family flexibility,

and family competence and adjustment.

A wide variety of chronic or acute stresses may affect family structure and dynamics including, for example, violence between the adults in

the home, separation and/or divorce of the parents, and the illness, injury, or death of a child, parent, grandparent, or animal companion.

The assessor decides whether the focus should be on the whole family or one or more of its subsystems: parental, marital, or sibling. One or

more family members' individual attitudes, values, and perceptions of family life and relationships may be the focus. Description and ratings

of family life may also be made after whole family interviews. Family behavior may also be observed, described, and scored in the home

(e.g., at dinner); or coded from videotapes made of the family dinner or in a laboratory (e.g., planning a menu); or by a mental health

professional after, for example, hearing an hour-long argument about the lack of manners or a child's refusal to eat at the dinner table. The

information obtained from different persons (inside or outside the family), from different methods (objective or subjective), and in different


15

social contexts may be similar, but each may be unique, and all may be relevant for more complete and useful understanding (Hayden et al.

1998; Snyder et al. 1995).

Caution is always needed in interpreting information from the use of any method of assessment when families are from different structures

(e.g., single parent, gay, lesbian, foster, or blended families) and cultures, especially applying norms derived from assessment of families in

majority cultures and from traditional families. Although questionnaires have been translated into languages other than English and

completed by persons of various cultures (Olson 1995), observation, description, and empirical scoring of family life across different cultures

has not received equal attention.

The diversity of family life across communities and nations and the importance of understanding culture and minority status has increasingly

affected judgments about family structure and dynamics, family psychopathology, and family therapy (Boyd-Franklin 1989; Flores and Carey

2000; McGoldrick, Giordano, and Pearce 1996; Pedersen 1997; Szapocznik and Kurtines 1993).

FAMILY NAME: MIRO

A. Family Demographics

Family demographics refer to such things as a family’s composition, socioeconomic status and the ages, education,

occupation, ethnicity, and religious affiliations of its members. The father is considered the head and the provider of the

family while the mother takes responsibility of the domestic needs and in charge of the emotional growth and values

formation of the children. They both perform different tasks and being remarked separately by the children. Children

see their mothers soft and calm, while they regard their fathers as strong and the most eminent figure in the family.


15

1. Family Composition & Relationship to the Head of the Family

The family is composed of 5 members: Mr. Leon Miro is the head of the family, and his wife, Mrs. Delfina Miro.

They had 9 children with their youngest child Mrs. Delia Miro and their 2 grandson, namely, Noel Miro and John Rey

Miro who lives with them.

2. Place of residence of each member

Everyone is residing in Purok 4 Brgy. Balugo, Valencia, Negros Oriental. According to Mr. Leon Miro, they own

numerous land with title, one of which is somewhere in Cebu, Philippines where one of the family members resides.

It’s been a long time that they were able to visit and stay to other places, thus, since their house was built

approximately 1 year ago, they stay in that house peacefully.

Mr. Rogelio which is the wife of Mrs. Delia Miro, although he does not reside in the said house, he visited his

family every other week and even stay overnight at the house, this statement was according to Mr. Leon Miro.

3. Socioeconomic Status and Occupation

The main income of the Family is farming, where in both Mr. Leon Miro and Mrs. Delfina owns a cow.

According to Mr. Leon Miro, their monthly income would range to four thousand pesos (P4,000) , although Ms. Delia

Miro will find a ways to somehow earn a money — like helping in catering a birthday party.

4. Demographic Data


15

Name Age Sex Marital Status Position Education

Attainment

Leon Miro 72 Male Married Grandfather Elementary Level

Delfina Miro 70 Female Married Grandmother Elementary Level

Delia Miro 33 Female Married Mother High School

Graduate

Noel Miro 7 Male Single 1st Son Grade 1

John Rey Miro 4 Male Single 2nd Son n/a


15

5. Genogram

6.


Legend:

- Female - Male

- with hypertension -

DELIA , 70 y/o LEON , 70 y/o

DELIA , 70 y/o

NOEL , 70 y/o JOHN REY , 70 y/o

A; died due to aging C; died due to hypertension

and its complications

B 1; Unknown reason

of death

2; unknown reason

of death

3; unknown reason

of death

a e g hb c d i

15

The genogram is a map of family process. It can be described as a graphic representation of families that charts the interactional

processes over three generations (McGoldrick, Gerson, and Shellenberger 1999). With its lines, boxes, circles, and symbols, the

genogram records important facts, life-changing events, and complex relationships of a family system. These deceptively simple

explanations capture the essence of a complex clinical and consulting instrument that depicts nuances of description and

relationship that may be lost in larger narratives or omitted in an overly intense focus upon self.

The construction of a genogram is an interpersonal event in which an individual, couple, or family collaborate with a

consulting professional in the gathering, recording, and interpreting of data about family relationships. Data are initially drawn

from clients' memories as they report and interpret events. These are recorded with standardized symbols that indicate dates,

descriptions of events, perceived relationships between family members, pertinent information about deaths, births, addictions,

and illnesses, and family secrets known to the client.

The meaning of events and relationships within the family is a function of individual memory and is of equal importance

with objective facts, because memory intrudes itself into one's interpretation of present events. The role of memory in present

events has long been debated in professional circles but, nevertheless, is still taken seriously by investigators from varied and

diverse fields of study including anthropology, psychology, sociology, and philosophy.

Many clinical observers relate the genogram to the theory of Murray Bowen (Becvar and Becvar 2000) because it easily

communicates the intergenerational transmission of anxiety that is focused around closeness/distance issues of relationships;

these dynamics are the centerpieces of his theory. The genogram's depiction of dates, sequences of nodal events, and

descriptions of relationships, together with the evolved context of family history, provides a picture where marital and family

problems can be readily identified (Guerin and Pendagast 1976; Titelman 1998).


15

Though similar to the ecomap, the genogram can also identify community and other systems that interact with the family

as well as beliefs, rituals, and customs of culture. This function is particularly important because the cultural diversity is a reality

for everyone. Family professionals must therefore be sensitive to the contours of cultural practice.

Culturally, the genogram is also used to chart the uniqueness of families. Using the genogram, culturally sensitive

professionals can recognize both the strengths and vulnerabilities of minority families—as represented by diverse family forms

and relationships—and therefore avoid harmful labeling. For example, African-American families often include blood and non-

blood members, informally adopted children, and varied support arrangements (Boyd-Franklin 1989). Asian and other immigrant

families may live in multigenerational households in which the opinions of senior members are revered and respected in ways

unfamiliar to western family practice (Tseng and Hsu 1991). While nontraditional by some standards, family professionals now

find evidence that varying cultural traditions of family life can and do provide the nurturance, care, and respect attributed to

healthy family relationships and a place where children can grow to responsible adulthood.

Thus, the genogram is widely used for assessing family dynamics, either in general or focused around specific issues. This

versatile instrument is used in both consultation and research. Its value resides in objective and subjective evaluation as well as

the collaborative development of a family narrative.


15

B. Physical Environment

Physical environment data describe geography, climate, housing, space, social and political structures, food availability

and dietary patterns, and any other elements in the internal or external physical environment that influence a family’s

health status.

1. Housing

The housing is well constructed, even though some areas are not finished. It is conducive as shelter especially

during the rainy season. It is made up of concrete hollow blocks. Nonetheless some parts are made up of wood or

bamboo.

a. Adequacy of living space

There is adequate space inside the house, with an estimated dimension of 100 sq. meters. It can

accommodate 10-15 persons and the family members are able to perform tasks within the house unlimitedly.

b. Sleeping arrangement

There is an adequate sleeping space for the whole family. Mr. Leon sleeps together with his wife. While

Mrs. Delia sleeps together with her two (2) sons in the other room.

c. Adequacy of furniture and appliances

Based on our observation, the family has its own sala set in a wood material (along with other wood

materials such as dining table). The family has no any appliances other than radio. They use dry woods and

colon most of the time, as a material in cooking their foods, although they have gas stove and gasul.

d. Presence of insects and rodents


15

There are no observed rodents during our homevisit. However, Mr. Leon claimed that at times, they

observed some at night. Nevertheless, there were no flies and mosquitoes within the family’s household

during the day. Mrs. Delfina claimed that there are some mosquitoes at night.

e. Presence of accident hazards

In the kitchen, the knives are not placed in the proper place. Since they have two grandchildren, it is can

serve as a hazard to the other members of the household, especially the children. Nevertheless, the house is

well arranged and other things are kept in proper places.

f. Food storage and cooking facilities

The family has a refrigerator to keep their bought foods for a long time, such as meat and fish. In

addition, they also have cabinets to store their other groceries. Their cooking facilities include metal

cauldrons and they cook it in the kitchen using firewood.

g. Water supply

The family gets their water supply from the waterline of the barangay. They said that the water is clean

and drinkable. They have enough water for their bathing and washing purposes.

h. Toilet facility

They have their own comfort room with a bowl that is flushed with water. Sanitary condition is fairly good

and indeed conducive for comforting their selves every time they want to urinate or poo.

i. Garbage/refuse disposal


15

The family has their own garbage can. Sometimes, they manage their waste by burning it. Hazardous

garbage like broken bottles and bulbs are buried few meters below the ground. In addition, they also have a

compost pit but it is almost full. Nevertheless, they are planning to make another one.

j. Drainage system

The family has their own septic tank. In addition, they have an open drainage leading from their sink to a

vegetable patch nearby.

2. Kind of neighborhood

Their house is approximately 7-8 meters away from other households. They have a lot of neighbor. One of their

neighbors is their daughter with her husband and children. Nevertheless, the area is not congested. They are

surrounded with fruit-bearing trees such as mango trees, coconut trees, etc. and vegetable patches.

3. Food availability

The family has their own vegetable garden. They plant a lot of vegetables so that they would not spend bigger

money in their groceries. They also have fruits, and occasionally harvest some of them.

4. Social health facilities available

Their barangay has a health center. However, it is located in Palinpinon, which us far from their house. The

municipality also has an adequately functioning RHU.

5. Communication and transportation facilities available


15

Their house is just located few meters from the highway. However, motor cabs or jeepneys are not always

available. They have to wait for few minutes before the motor cabs or jeepneys to pass by. In addition they have no

telephone connection but they have cellular phones to contact their relatives and loved one in other places, such as

Cebu and Manila


15

Catechism

Recreation

School

Delia’s Husband

Couples for Christ Health Care

Extended family

Friends

Neighbors

Church


Mrs. Delia

Mr. Leon

NoelJohn Rey

Mrs. Delfin

a

Strongly Attached

Moderately Attached

Slightly Attached

15

C. Psychological & Spiritual environment

Pscyhological and spiritual environment refers to information such as affectional relationships, mutual respect, support,

promotion of members’ self-esteem and spiritual development, and family member’s life satisfaction and goals.

In relationships, we have the opportunities to develop a deeper sense of ourselves through the mirror of our partner.

If you have a generous, loving partnership, then you are possibly learning lessons related to creating a generous and

loving relationship with your inner self as well. If you are in an abusive relationship, are you seeing the mirror of your

relationship with your self? We have the tendency to repeat certain patterns in our relationships. It seems we take the

best and the worst within ourselves and project it into the container that is our relationship. We use the relationship as

a testing ground.

However, when we go through changes or life transitions, it may put additional stress on the partnership by having

little time for each other, being agitated and upset, etc. One person in the relationship isn't experiencing change, they

both are. If one person in the mirror changes, then the other will reflect that change. These may be positive changes or

can be a stirring up of old issues that haven't yet been healed or released. In a partnership, we partner through change

as well as through stability. Life is constantly changing around us and our ability to remain flexible and grow together

make for a stronger spiritual relationship. Choosing to look in the mirror of our partner, you see aspects of yourself that

may be ready for transformation or release. Is there something that irritates you about your spouse? Is there a common

argument that you have? Do you share similar views on many things, but have a particular stuck point on one subject?

Instead of leaping first to blame or lash out at your partner, look into the mirror and see what is there for you to see. Is


15

there something attempting to get your attention? Are you faced with this same theme over and over again? Is there a

deeper issue regarding change that you're avoiding or overlooking?

Change itself can be a scary experience for some. In partnerships, change can feel threatening to the solid

foundation or nest that you have built together. When one partner is undergoing deep internal changes, the other may

feel left out, neglected, no longer connected and unappreciated. If that partner refuses to reflect upon the mirror that

he/she is presented with, and chooses not to undergo changes as well, the mirror becomes out of balance. There is no

longer a reflection of each other. One person has changed more than the other is willing to change. This is when

struggle appears in the relationship.

In a spiritual relationship, partners consciously work through these changes, each partner facing their inner feelings,

looking in the mirror to see that which is ready for transformation. A spiritual relationship as such requires tremendous

courage for both partners, trusting that the other will continue to transform and flow with the changes along with you.

Any relationship requires courage and trust. Communication is a necessary aspect of partnership and courage is most

valuable. Stepping up to the plate and facing yourself in the mirror everyday can be exciting, thrilling and challenging.

Allowing it to be something you face together every day is powerful and is the cornerstone of a spiritual partnership.

During our visits, there is a good interaction and relationships between members of the

household. Good values such as respect to each other manifest in the family with strong support


15

from one another to boost each members’ self-esteem. These good values they have really

manifest especially during our home visits where they warmly welcome us (student nurses).

Throughout our interaction with the family, we learn that they regularly go to church every

Sunday around 9:00am, attending the 2nd mass of the day at Perpetual, Balugo, Valencia,

Negros Oriental. They are also part of Couples for Christ and even a Charismatic leader.

According to Mr. Leon Miro, they are contended of the kind of life they have, they were even

thankful to GOD to have healthy body capable of doing activities of daily living.


15

D. Family structures or roles

Family structure and roles includes family organization, socialization process, division of labor, and allocation and use of

authority and power.

People throughout history depended on families and the kinship system for their survival. This dependence permitted

and required that they conform to expected family roles depending on their living circumstances. This gave a family strong

control over its members, a circumstance that is changing in the modern world because people no longer always need

families for economic survival.

Gender roles, as they pertain to the family, are interactive. Being a daughter implies that there is a mother or father. It

suggests that being a daughter entails expectations about a female's behavior visà-vis a parent and a parent's behavior vis-

à-vis the daughter. A daughter or son reasonably expects physical care and emotional support to a certain age, and parents

might expect increasing domestic responsibility and self-direction with their child's physical maturation. Societies usually

codify these responsibilities in general terms.

Role compatibility is important in a society that permits multiple role sets for wives and husbands, as when a wife

expects her role to include employment outside the home and her husband does not. These kinds of incompatibilities

produce role conflict, in this case between the female's self-expectations and the male's role prescriptions. Therefore

gender roles become an important part of premarital assumptions and anticipations. Such incompatibilities require varied

forms of negotiation, and sometimes counseling, to reduce conflict. Various theories address these negotiations that may

include professional mediation and counseling. A study of Australian males, who became primary childcare givers while


15

their wives worked, indicated how difficult it was to shift one's behavior away from traditional role expectations. These

men were highly pressured by peers to return to traditional family roles (Grbich 1992).

Family power is important to those who want to understand how families function as a unit to make decisions about how

to manage money, about where to live, about occupational and educational choices, about parenting practices, about

where to go on a vacation, and so on. Family scientists define power in terms of who is able to influence others to get their

way in the family, and who is able to block others from getting their way. In most cases, family power is a property of the

family system, not of a single individual, because it is almost impossible for one individual to have their way all of the time.

Although the rules that govern power in a particular family may evolve as children are born, grow up, and move out, as the

marital relationship changes or dissolves, or as the circumstances of the family changes, power is deemed to be fairly

predictable within these stages. This predictability can be a comfort to those family members who are happy with the

power arrangements or a matter of disdain, perhaps even a matter of personal health and safety, for those who find

themselves dominated by others.

The resource theory of family power was influential because the idea suggested that men do not become heads of

households by divine right or natural biological processes, but because they have more and easier access to educational,

financial, and occupational resources in society. The idea suggested that opening up women's access to resources outside

the family could result in a more evenly balanced distribution of power within the family.

Most family scientists take a macrosystemic view, first articulated by Constantina Safilios-Rothschild (1967), that the

bases of family power are a reflection of culturally defined gender ideologies and gender-segregated resources in the wider

society in which a family is embedded. In practically all societies, this means that males have more power in families

because of patriarchal beliefs about male authority. For example, a 1996 Gallup Poll conducted in twenty-two countries


15

found that women are almost universally perceived as more emotional, talkative, and patient than men, whereas men are

perceived as more aggressive, ambitious, and courageous than women. Even though there may be little scientific

justification for these perceptions, they exert a strong influence in favor of male dominance in families that might be

diminished through women's resources, but not completely muted.

Building on the idea that family power should be subjected to the same ethical principles as other forms of social power,

Brian Jory and his colleagues have conducted a number of studies exploring how the abuse of power in families is rooted in

ethical beliefs about power ( Jory, Anderson, and Greer 1997; Jory and Anderson 1999; Jory and Anderson 2000). In studies

of abusive men (and their women partners) conducted in the United States, Jory concluded that interventions that change

the ethical beliefs of those who abuse power in their families can result in a positive transformation of their values and

behavior. The abuse of power in families is a challenge for those who shape all societies to transcend the bounds of culture

and custom and work towards balancing the scales of intimate justice in all societies by fostering ethical beliefs about

equality, freedom, respect, fairness, and caring in families, and by showing compassion for those who are suffering the

anguish of victimization, whatever their cultural heritage.

Miro family is a nuclear family, composed of a father, a mother, and 7 children.

Division of labor within the family is equally distributed. Daily, one of Mr. Leon’s responsibilities

is moving their domestic animals from one place to another; he is also responsible in cleaning

their surroundings. On the other hand, Mrs. Delfina is the one who prepares their food, washes


15

their dishes, and other household tasks. The two of them are also responsible in taking care of

their grandchildren if their daughter, Mrs. Delia is not around.

The use of authority and power is equally divided between Mr. Leon and his wife, Mrs. Delfina.

Nevertheless, legitimate power is present within the household – the husband is considered as the

head of the household, grandparents also have the right or power over raising the small children

of Mrs. Delia; and even sometimes the father, Mr. Leon, has control over what the other member

of the family wears.

E. Family functions

Family functions refer to a family’s ability to carry out appropriate developmental tasks and provide for its members’

needs.

Generally, there is no obvious signs of conflict between members, although Mrs. Delfina Miro claimed that problems

are irresistible and thus it will exist, they (Mrs. Delfina and Mr. Leon Miro) could easily find a solution to that problem and

eventually will be able to resolve it.

Every members of the family carry out appropriate developmental tasks. Mr. Leon Miro at the age of 72 with his wife

Mrs. Delfina Miro at the age of 70 years old has the central task of integrity vs. despair. Kozier, et. Al. (2000) specifies that


15

their role is to have acceptance of worth and uniqueness of one’s own life versus having sense of loss, contempt of others.

Accroding to them (Mr. Leon Miro and Mrs. Delfina Miro), they does the following:

1. Decide where and how to live out the remaining years.

2. Continue a supportive, close, warm relationship with a spouse or significant other.

3. Find a satisfactory home or living arrangement and establish a safe, comfortable household routine to fit health

and economic status.

4. Maintain maximum level of health; care for self physically and emotionally.

5. Maintain contact with children, grandchildren, and other living relatives.

6. Maintain interest in people outside the family and in social, civic, and political responsibility.

7. Find meaning in life and in facing inevitable illness and death of oneself, spouse, and other loved ones.

8. Work out a significant philosophy of life, finding comfort in that philosophy or religion.

Mrs. Delia Miro who is the mother of Noel and John Rey Miro, belongs to young adulthood with the central task of

generativity vs. stagnation. As a mother of 2 children, she does the following tasks:

1. Rearranging the home physically and reallocating the resources (space, material objects, etc.) to meet the needs of remaining members.

2. Meeting the expenses of releasing the offspring and redistributing the budget.

3. Redistributing the responsibilities among grown and growing children and between the husband and wife on the basis of interests, specialty, and availability.

4. Maintaining communication within the family to contribute to marital happiness while remaining available to young adult and other offspring.


15

5. Widening the family circle to include the close friends of spouses of the offspring as well as the entire family of in-laws.

F. Family values & beliefs

Family values and beliefs influence all aspects of family life. Values and beliefs might deal with raising children, making

and spending money, education, religion, work, health and community involvement.

The problem of value has been the speculations’ object for many philosophers and scholars representing various

schools and positions. Value is quite relative concept - it is always “somebody’s”, that is, value for concrete person, that

belongs to definite social group and culture.

Value is defined as the worth, importance, or usefulness of something to somebody (Microsoft Encarta, 2008). There

are many Filipino values that Filipinos should be proud of.

“Value” can be understood, as an object of a person’s needs, desires and aspirations, of his positive evaluations and

attitudes. A value may be a physical object, person, institution, idea, kind of activity, type of social relations, etc.

Values can differ by the degree of their generality and abstractness. There are concrete values of everyday life, and

abstract ones, which reveal deeper meaning of human existence. Concrete values can be seen in two ways: as “every day”

values, that means various spheres of human life and activities, like work, family life, further education, leisure time

activities, housing, etc., and separate elements of every day life sphere, like character of activities, their distribution in

time, physical environment, relations with other people, future perspectives, so on. Abstract values can be personal, that

are related to person’s individual desires and aims, for example, realization of his possibilities, prestige, fame, power,


15

influence, and general social values, related to social groups and their ideas, that person adopts (social wealth, progress,

peace or war, social equality, privileged position in the group, etc.)

Values and needs are inseparable from human actions. Actions are conscious behaviour that is oriented to concrete

aims, and this behaviour is influenced by person’s needs, values, social norms, and the like. The orientation of action to

concrete aim or task consists of two layers: one is closer to needs and drives, and the other to values. The later, also called

“value orientation”, is the source of action’s direction, rise of new norms and obedience to old ones.

Individual values are not independent; they all together formulate value system, characteristic for individual or

society. Value system means values, recognized by the individual, that together form entire whole. Various value systems

are possible, and together they make more or less continuous person’s value system.

Values are embedded deeply in the social environment. They influence all spheres of life. Work is one of them. As

value, work can be understood in three aspects mentioned above: the place of work among other “everyday life” values,

value of different aspects of work, and abstract values, expressed by professional activity.

“Everyday” values are different spheres of human life, his activities (family life, work, social and political activities,

social life, etc.) and their results (individual’s financial situation, for example). Work as “everyday life” value means

activities, performed by individual, and his general working situation, composed from external conditions of work, social

environment, payment, social guarantees, promotion possibilities, etc. In that way, work can be compared with other

spheres of people's life, like family life, further education, social and political activities, recreation.

Value of Raising children


15

According to Mrs. Delfina, it is important to keep in mind that each day offers many teaching

opportunities from their life. In raising their children, they learn to value the time spent in

conversation and they savor the moments together with their children. They raised their children

with character, children who will do the right thing, and make the right choices in the journey of

life.

Value of Money

According to them, money is simply pieces of paper. However, money is very important for them.

In the absence of money, a great variety of things would never have happened, and their

satisfaction would have been at the lowest level.

Value of Education

According to them, more education means more money, greater employment options and better

job security. That is one of the reasons they have been encouraging their children to focus on

their studies. Unfortunately, some of their children were not able to have a good education.

Value of Religion

According to Mrs. Delfina, religion is part of their human life; it is a necessary part or element of

their life.

Value of Work

For them, the work itself is the highest value; it becomes their “way of living”. Even the time and

way of their leisure are adapted to they work.


15

Value of Health

They considered health as their “everything”. They believe that the greatest asset of their life is

their ability to be able to wake up everyday and go to work. Good health also enables them to

enjoy life.

Value of Community involvement

According to them community involvement is important because everyone should have a voice in

making decisions that will affect their lives. They said, when they get involved in their community

they could help make important decisions that can be vital to the community’s future.

G. Communication patterns

Family communication patterns include the frequency and quality of communication within a family and between the

family and its environment.

Much of the literature in popular culture leads one to believe that men and women are truly quite different in terms

of their emotional experiences and their communication of those experiences. According to John Gray (1992), author of

Men are from Mars; Women are from Venus, men and women differ in their experience of emotions and their

communication of them. Gray, however, is not an academic, and his work is not based on empirical research.

Indeed, much of the empirical scholarship on sex and gender differences indicates quite the Empirical studies on sex

and gender differences indicate that men and women are more similar than they are different in terms of communicating in


15

their close, personal relationships. PAUL BARTON/CORBIS opposite. Specifically, it shows that men and women are more

similar than they are different in terms of communicating in their close, personal relationships (Canary and Emmers-

Sommer 1997). Although some differences do exist, they are not substantial enough to declare that the sexes or genders

are significantly different. Many of the socalled differences in the sex and gender literature are related more to flaws in the

studies themselves, such as errors in recollection in self-report studies, or individuals' reports that are affected by social

desirability. Specifically, social desirability refers to an individual reporting what he or she thinks others would find

acceptable, rather than what actually may be the truth. Within the context of gender differences, this would account for

men and women reporting what they stereotypically believe men and women should do from a social expectation

standpoint versus what they actually do.

Research on communication in close, personal relationships suggests that men and women are more similar than

they are different. Nevertheless, some differences do exist between men and women. Many of the differences surface

within the contexts of conflict or household chores. For example, in their extensive examination of the sex and gender

literature, Dan Canary and Tara Emmers-Sommer (1997) offered the following conclusions regarding sex and gender

differences. First, women, compared to men, express a greater range of emotions, such as sadness, fear, love, happiness,

and anger. Women are also more inclined than men to disclose personal information, such as their personal opinion or

details of their personal history. Compared to men, women are more likely to use touch to convey feelings of closeness;

these feelings could be sexual in nature, but not necessarily. Interestingly, women are more likely to exercise power

strategies than men. Compared to men, women are more likely to engage in manipulative behaviors and to exercise

negative and confrontational conflict behaviors. Finally, women are more likely than men to enact self-disclosure

behaviors, engage in loyalty toward their partner and relationship, and enact task-sharing in an effort to maintain their

relationship. The authors also found that women, even in dual-career couples, tend to do the lion's share of the household


15

chores and childrearing duties. Thus, some differences do exist between men and women; however, the extensive literature

on sex and gender differences indicates that the differences are far outweighed by the similarities.

Interestingly, however, some of the subtle differences that do exist contribute in a noteworthy fashion to how men

and women manage their relationships, particularly issues of contention and conflict. According to John Gottman (1994),

both sex (physiological) and gender (sociological) differences are exhibited in couple conflict. Similarly, men's and women's

adherence to particular gender role and relational ideologies relates to their responses during conflict.

Gottman and colleagues (Gottman 1994; Gottman and Levenson 1988) have offered specific couple communication

patterns that contribute to both satisfactory and dissatisfactory couple relationships, with a specific focus on the close,

personal relationship of marriage. (It is important to note that most or all of this research has been conducted in the

United States.) In fact, Gottman is able to predict divorce accurately 94 percent of the time. Gottman has found that the

behaviors of criticism, defensiveness, contempt, and withdrawal hold the most impact in influencing a close relationship

negatively. Although men and women can exercise all of these behaviors, it is of particular harm when the man in the

relationship withdraws from conversation about important issues of contention. This particular behavioral pattern is

indicative, for example, of a mixed couple-type in which the husband is a separate and the wife is a traditional.

Within the family, we observed that there is frequent communication between members using

necessary elements in communication such as direct eye contact and appropriate gestures. The

medium of verbal communication used by family members is the Visayan/Cebuano dialect.

Nevertheless, Mrs. Delfina Miro claimed that communication between members of the family is


15

not a problem and rarely experience feelings of isolation since whenever she is alone inside the

house, she spends her leisure time visiting her neighbors or attending to other household chores.

Moreover, all family members are present in the evening, and during weekends. Mr. Leon Miro

also stressed out that they eat together during dinner and even discuss a lot of things.

Family boundaries are semi-permeable; they constantly allow communication and linkages with

the outside world. In the case of our family, Mrs. Delfina claimed that she frequently

communicates to her neighbors.

H. Family decision making patterns

Family decision-making patterns refer to how decisions are made in a family, by who are they made and how are they

implemented.

Decision making is a term used to describe the process by which families make choices, determine judgments, and

come to conclusions that guide behaviors. That the process is called family decision-making implies that it requires more

than one member's input and agreement (Scanzoni and Polonko 1980). The family decision-making process is a

communication activity—it rests on the making and expression of meaning. The communication may be explicit (as when

families sit down and discuss a prospective decision) or implicit (as when families choose an option based on their past

decisions or some other unspoken rationale). Families are confronted with a myriad of decisions, including the purchase of


15

products, the selection of educational practices, the choice of recreational activities, the use of disciplinary practices, and

the deployment of limited resources. Decision making is an unavoidable, daily process.

Family decision making is a process that can be filled with tension, extremely pleasant and rewarding, both, or

somewhere in between. In the decision-making process, families can address the differences among members (Galvin and

Brommel 2000) and negotiate their needs for closeness and independence (Baxter and Montgomery 1996). Further, as

James Atkinson and Timothy Stephen (1990) observed, decision making is inextricably bound to values. In decision making

"values are communicated within the family group and [they] will become part of a family's assumptive foundation as its

members coordinate future action" (Atkinson and Stephen, p. 5). Thus, family decision-making spans many family goals

and practices.

Furthermore, decisions within families may be classified into several types: instrumental, affective, social, economic,

and technical. Instrumental decisions are those which rest on functional issues such as providing money, shelter, and food

for the family members (Epstein, Bishop, and Baldwin 1982). Affective decisions deal with choices related to feelings and

emotions. Decisions such as whether to get married are affective. Social decisions (Noller and Fitzpatrick 1993) are those

related to the values, roles, and goals of the family, such as decisions about whether one parent will stay at home while the

children are preschool age. Economic decisions focus on choices about using and gathering family resources. Whether an

eighteen-yearold child should get a job and contribute to the family income is an economic decision. Technical decisions

relate to all the subdecisions that have to be made to carry out a main decision. For instance, if a family decides that one

member will quit work and go to college, then a variety of technical decisions must be made to enact that decision (Noller

and Fitzpatrick 1993).


15

Families use a variety of processes for actually reaching a decision. Many families have a habitual process that they

use regularly whenever they need to make a decision. Other families vary in the way they approach decision making

depending on the type of decision, their mood, and their stage of development. Researchers often discuss five possible

processes that families use in reaching decisions. These include appeals to authority and status, rules, values, use of

discussion and consensus, and de facto decisions.

Some families discuss their processes and have an overt, preferred mode for decision making. Other families simply

fall into one or another process without thinking about it much. Additionally, many families may say they prefer to reach a

decision through a discussion of all the members, yet the power relations in the family are such that discussion only

confirms what the father, for example, wants as the decision. In this manner, the family may preserve an illusion of

openness while actually using an authoritarian process for coming to a decision. Barbara J. Risman and Danette Johnson-

Summerford (2001) talk about manifest power and latent power. Manifest power is present in decision making by authority

because it involves enforcing one's will against others. Latent power, sometimes called unobtrusive power, exists when the

"needs and wishes of the more powerful are anticipated and met" (p. 230). When families profess a democratic style of

decision making, but really acquiesce to the will of an authority figure, latent power is being exercised. Families make

countless decisions using power relations and these various processes: authority, rules, values, discussion, and de facto.

Often the process engaged in by the family reveals more about them and affects them more profoundly than the outcome.

According to them, Mr. Leon he is usually the one who decides with regards to a certain

matter. Mrs. Delfina prefers to reach a decision through a discussion of all the members.


15

Occasionally, husband and wife sit down and discuss a prospective decision. Nevertheless, every

decision of each member of the family is to avoid family conflicts.

I. Family problem solving patterns

Family problem-solving patterns describe how a family handles its problems, who dealt with them, the flexibility of a

family’s approach to problem solving and the nature of its solutions.

Family problems come in many sizes and shapes. They range from minor annoyances, such as spats between

children, to life-threatening situations such as physical abuse by a parent. They may be brief events that disappear in

minutes or recurring disputes that last a lifetime. Whatever their form and duration, problems are distinguished by the

presence of negative experiences for some family members. Such experiences provide natural motivation to eliminate the

problem. Solving a family problem means finding a way to remove the negative experiences without creating new

difficulties.

Humans have a variety of innate capabilities that are used for solving problems (Pinker 1997; Ellis and Seigler 1994).

These include the abilities to recognize patterns in human situations, to recall relevant events from the past, to visualize

events that may occur in the future, and to weigh the likely consequences of alternate future actions. One particular

combination of abilities, rational problem solving, is especially important. It was initially identified in studies of the human

thought process (Dewey [1910] 1982) and has been widely applied in work with couples and families (Forgatch and

Patterson 1989; Vuchinich 1999). This form of problem solving occurs in a sequence of stages: (1) the problem is clearly


15

defined; (2) several alternative possible solutions are generated; (3) each alternative is evaluated in terms of potential

costs and benefits; (4) one alternative is selected as having the best potential to solve the problem; and (5) the solution is

applied and adjusted as necessary.

These stages are generally recognized as being logical and based on elements of common sense. Indeed, they may be

seen as essential to adaptation in the process of evolution (Pinker 1997; Vuchinich 1999). Using some variation of them

provides a way to make changes that are likely to help eliminate the problem. However, individuals do not always use a

rational approach to dealing with the difficulties in their lives. Other approaches to problem solving are prevalent and are

often linked to couple and family dysfunctions.

To understand family efforts at problem solving it is first necessary to address the basic nature of problems and how

they arise in family life. Since John Dewey's early formulations (1938) it has been acknowledged that the essence of

problems is blocked goal attainment (Tallman 1988). Goals are physical or psychological states that individuals or groups

seek. These include such things as sexual gratification, a sense of self-esteem, a full stomach, parental approval, or

religious salvation. When attainment of such goals is blocked, individuals sense some form of frustration. At a certain level,

such frustration creates a negative experience for the individual. Those experiences can be transformed into a perceived

problem. When that happens, the individual feels dissatisfied and attempts to remove the blockage and reach the goal. If

the individual finds a way to reach the goal, the problem is solved. Because of the negative affect in this process, emotional

regulation is a key element in how couples and families try to solve their problems. Certain types of emotional regulation

can short-circuit problem solving.


15

One of these types of emotional regulation is denial. Denial is a normal defense mechanism that allows the individual

to avoid the pain of facing negative experiences. The negative emotion is regulated by denying its existence. With denial,

an individual or family has negative affective experiences but tries to ignore them and takes no action to eliminate them.

For example, a wife who is physically abused by her husband may think and act as though nothing is really wrong with her

marriage.

The family basically utilizes deliberation and compromise within the household as their

primary means of restoring order and addressing certain issues. During our conversation with

Mrs. Delfina Miro, she claimed that family member may freely express their views on certain

issues of sensitive nature for as long as the manner of expression is acceptable in the context of

respect and utmost courtesy towards each other especially towards her, her husband, who are the

core hierarch of the family. Confrontation and argumentative altercation would be the last resort.

In terms of financial issues, the family usually sets aside resources for more important

expenditures and needs such as food, electricity, and the education of their children as well as

that of her niece, setting aside health needs among minor priorities. According to Mr. Leon Miro,

conflicts among their environment (neighbors) are seldom and if ever it will exist, they will do

their best to settle the issue diplomatically and as much as possible evade from oral arguments

and confrontation.


15

J. Family Coping Patterns

Family coping patterns encompass how a family handles conflict and life changes, the nature and quality of family support

systems, perceptions and responses to stress.

Stress research includes attention to events or conditions that may cause harm and to the responses aroused by

those stressful events or conditions. These outcomes include felt distress, disrupted interaction, and poorer health. The

overall stress process includes both stressful agents and stress outcomes (see Pearlin et al. 1981). This process also

includes two other major sets of variables: social factors that influence exposure to stressful conditions, and individual and

group resources that shape efforts to cope with stressors.

Although early stress research focused on unpleasant physical stressors (Selye 1982), social scientists studying

families have been particularly interested in social stressors—events or conditions that are linked to individuals' and

families' social characteristics, positions, and roles.

The concept of social stress calls attention to both environmental/social demands and individual/family capacities or

resources; stress occurs when there is a discrepancy between these capacities and demands. Such stressors can come

from external demands on families and family members, or they can arise within family roles themselves. Theoretically, a

discrepancy can be in either direction: demands could be greater than a person's capacities, or demands could be far

below individual capacities. Thus, restricted opportunities can be at least as stressful as high demands: Carol Aneshensel

(1999; see also Wheaton 1999) calls attention to stressors that occur when aspects of the social environment obstruct an

individual's ability to attain sought-after ends.


15

One early and influential approach to studying social stressors focused on change per se as stressful. Thomas A.

Holmes and Richard H. Rahe (1967) developed a checklist of stressful life events aimed at capturing the set of events that

had happened to an individual. These checklist approaches to the measurement of social stress were based on two key

assumptions. First, they assumed that one could calculate a standard estimate of the amount of change demanded by a

specific event, such as divorce or the birth of a child, and that this amount would be generally the same for all who

experienced that event. Second, they assumed that one could capture the effects of the accumulation of several events in a

short period of time by summing the amount of change implied by each, and that this total amount of change was the

critical dimension linked to stress outcomes.

Subsequent research, however, has cast doubt on each of these assumptions. Change per se does not seem to be the

key dimension producing negative outcomes: changes that are undesired, involuntary, unexpected, and involve role losses

generally have more negative effects than other changes. Nor is it the case that the same event has uniform effects on

different people. Consistent with the concept of stress as a discrepancy between demands and capacities, much depends

on the resources and coping repertoires that individuals and families possess.

In addition, the impact of transitions and eventful changes depends in part on the circumstances prevailing prior to a

specific life event. A notable example is marital termination: although the end of a marriage is generally viewed as a

stressful event, termination of a conflict-filled or unsatisfying relationship may actually improve well-being. And because

spouses may differ in how satisfied they are, this example also suggests that the same family event will not necessarily

affect all members of a family in the same way. In an influential analysis, Blair Wheaton (1990) has shown that in the case

of role exits, including retirement, widowhood, divorce, and a child's move away from home, the more stressful prior


15

conditions in that role, the less the impact on mental health. Similarly, Susan Jekielek (1998) finds that children's response

to parental divorce is less adverse when there has been more marital conflict.

Effects of specific life events also depend in part on the subsequent level of chronic problems. It is largely because

major life events typically result in an enduring alteration in social circumstances, thereby increasing chronic problems,

that they affect individual and family outcomes.

Chronic problems in any given role can also lead to other stressors, in a process that Leonard Pearlin and his

colleagues describe as stress proliferation—the tendency of stressors to beget other stressors (Pearlin, Aneshensel, and

LeBlanc 1997). They illustrate this process in a study of informal caregivers to people with acquired immunodeficiency

syndrome (AIDS). As the illness progresses, the difficulties faced in the role of caregiver expand, straining one's capacities

to manage those demands. Moreover, these strains affect the caregiver's ability to enjoy the opportunities, and manage the

stressors, embedded in other roles such as work roles and social and leisure activities. Once these are affected, the altered

conditions in these other roles can have an additional, independent effect on the caregiver's health and well-being.

Thus, the concept of social stressors reaches beyond the notion of discrete life events to include chronic or persisting

circumstances, such as low income, unpleasant working conditions, role strains, and conflicts among multiple social roles,

as well as the resources that individuals and families are able to bring to bear in their efforts to deal with their

circumstances. Because both those circumstances and resources are likely to be linked to social position—as indicated by

one's race, gender, marital status, and economic position—this broad definition of social stress brings stress research

closer to traditional sociological topics such as social stratification and race and gender discrimination. It offers a more

comprehensive way of thinking about the way that social circumstances, including normatively structured family and

occupational social roles, shape individual opportunities, individual distress, and family well-being.


15

How a family handles conflict and life changes

When conflict arises, they talk with each other and agree on a solution and as much as

possible, they discuss on how to implement it.

The nature and quality of family support systems

Mr. & Mrs. Miro has an excellent support system. Some of their sons and daughters are

just few meters away from the house. They are always willing to listen and help solving

their problems and any disturbed feelings.

Perceptions and responses to stress

They consider stress as part of everyday life. Every time they encounter a stressful

situation, they give their selves a break even for a few moments. They try to be respond a

stressful situation in a positive way by giving their selves messages as to how well they can

cope rather than how horrible everything is going to be.


15

K. Family health behavior

Family health behavior refers to familial health history, current physical health status of family members, family use of

health resources and family health beliefs.

A growing body of research has shown that family plays an important role, if not the most important role (Doherty

1993), in shaping our health attitudes and behaviors. This is important because positive health behaviors have been shown

to significantly affect physical and mental health (Grzywacz and Marks 1999).

Prior to understanding the role the family plays in the adoption of health attitudes and beliefs, it is important to

identify what health is. The World Health Organization (1986) defines health as. . . the extent to which an individual or

group is able, on the one hand, to realise aspirations and satisfy needs; and, on the other hand, to change or cope with the

environment. Health is, therefore, seen as a resource for everyday life, not the objective of living; it is a positive concept

emphasizing social and personal resources, as well as physical capacities. (p. 73)

The family is the basic social context in which health behaviors are learned and performed (Ford-Gilboe 1997).

Research in several different countries has found that families directly or indirectly influence one's mental health, physical

health, drug use (including cigarettes and alcohol), diet, exercise (including participation in sports), dental hygiene habits,

and sexual risk-taking behavior. This influence lasts a lifetime.

Each older individual and later life family is unique. Throughout the elderly population, there are significant

variations in the amount of dependency experienced as well as in the amount of care received (Uhlenberg 1996). In a study

of 18,136 older adults, it was found that various factors influenced the utilization of formal resources, including marital


15

status, race, age, and education (Ozawa and Tseng 1999). Younger, well educated, single, or widowed adults were more

likely to utilize out of home services. White, as opposed to nonwhite, older adults were more likely to subscribe to in-home

services. Married adults were less likely to receive formal services than nonmarried, due to the informal supports more

available to married adults (Ozawa and Tseng 1999).

An individual's geographic location is also a factor in relation to use of formal services. In some countries, formal

services are not as readily available as in the United States, or family members are expected to meet the service needs of

their older relatives. Misa Izuhara (2000), for example, notes that in Japan although family relationships may have become

less dependent, the government has not developed necessary services to meet the needs of the older population. In the

United Kingdom, surveys have found that older individuals are supported by their families when needed, but that informal

social supports often provide for the older A geriatric social worker kneels beside a patient at an adult daycare facility for

Alzheimer's patients. Although families provide the majority of care to their older members, formal services such as this

program exist to support both the individual and the family.

Several studies have found that having adult children is not a predictor of use of formal services. Spouses are a more

likely resource than are children (Cicirelli 1981; Ozawa and Tseng 1999). Consequently, older, divorced, or widowed

individuals with children may use formal resources to a greater extent than older, married persons without children.

1. Immunization status

All children in their house are complete with regards to immunization. Mrs. Delia had them immunized at the BHS.

2. Use of other preventive services


15

Mr. Delfina has a maintenance dose for her hypertension.

3. Medical & nursing history indicating past significant illnesses, beliefs and practices conducive to illness

Mr. Leon claimed that his parents have history of hypertension, as well as Mrs. Delfina’s mother.


15

4. Nutritional assessment

a. Anthropometric data

Name Leon Delfina Delia Noel John Rey

Height 160 cm 162 cm 157 cm 125 120 cm

Weight 42 kg 40 kg 45 kg 22 kg 20 kg

b. Dietary history

The following data shows their regular dietary intake:

Breakfast: Rice, egg, sardines, coffee,

Lunch: Rice, vegetables, fish, meat

Supper: Rice, vegetables, fish

c. Eating/Feeding Habits/Practices

According to Mr. Delfina, vegetable is always present in every meal. Sometimes, they eat fatty foods. But usually, they mix fish

on their vegetable to make their viand more delicious.

5. Current health status indicating presence of illness states


15

Mr. Leon and Mrs. Delfina Miro have an existing high blood pressure levels. In addition, Mrs.Delfina was also

recently diagnosed to have mild cardiomegaly caused by her hypertension. She usually feels dizziness, headache, vertigo,

vomiting, and palpitations. Nevertheless, They have no allergies, as claimed by Mrs. Delfina.

L. Family social & cultural problems

Family social and cultural patterns comprise family discipline and limit-setting practices; promotion of members’ initiative,

creativity and leadership, family goal setting; family culture; and development of meaningful relationships within and

without the family.

Cultural Patterns are not the same as social habits. On the other hand, a social habit is of a "grassroot" nature which

means, it is deeply rooted in a society's lifestyle. Moreover, a cultural pattern is often enforced by a government or a

religious leadership body, and often the people would only be too glad to get rid of it. Cultural patterns, like social habits,

have a life cycle. They are born, live for a while and then die, or in more technical words: they phase in and they phase out.

And like social habits, there are good cultural patterns (constructive) and bad cultural patterns (destructive).

Cultural patterns, as massive as they may look, are really only as massive as the active support of the hundreds, or

thousands, or millions of individuals who carry them into the future - plus the passive support of every single individual

who allows their existence to continue.


http://www.recastreality.org/DrillsSH/SocialHabitsSH.htm

15

Even the most overwhelming cultural pattern - like the public humiliation and abuse of Jews in Nazi Germany - can be

terminated if the individuals who carry it into the future stop carrying it into the future. This works pretty much like a

certain concept in software programming. Enforcing it with violent methods works, although for the building of awareness

it does not accomplish a lot: Such patterns tend to form again a few years or decades later, because an actual learning

process has not occurred. Often the counter-reaction against the violence makes the situation even worse than it was.

The slower but better way - because it really lasts - is the way through the human mind. The drills on our website teach you

the mental skills you need to really do something about cultural patterns that you don't like - not only think about it, which

you probably have done for a longe time. Go to the drill section if you want to learn more.

Family Rules are to be obeyed at all times by all DO members, with exceptions only in a rare situation when warranted, or

in an unavoidable circumstance. Those who repeatedly or persistently disobey them will be disciplined in an appropriate

and proportionate manner according to the severity and frequency of the offense, up to and including the loss of their DO

Family membership.

Family discipline and limit-setting practices;

Mr. Leon provides a loving, happy, secure environment for their children and grandchildre,

making sure that their physical, spiritual and emotional needs are being met. With regards to

disciplining their children (when they were still small) and their grandchildren, at first, they give

correctional punishment or a sort of a corporal punishment – they give verbal instruction; letting

the child know clearly what they expect. However, they believe that Corporal punishment should

be a last resort and should only be used when the child has put himself or others at serious risk or

harm or has been seriously disobedient


http://www.recastreality.org/DrillsSH/SHDrillsIndex.htm

http://www.recastreality.org/DrillsSH/MindSoftwareSH.htm#com

15

Family goal setting

Mrs. Delfina sometime makes a list of everything she think she think you wants... all the goals she

think you want to achieve. Sometimes, they may involve money, or material things, or better

relationships, or a special vacation, or a change in your personal attitudes or habits. Then she

plans for it and then to achieve her goal, she follows what she has planned.

Development of meaningful relationships within and without the family

They believe that in any relationship, there is going to be give-and-take as situations and

circumstances change. Each members of the family are trying to Find the courage and creativity

to promote and protect each members’ self-esteem. By using the value of self-esteem, they provide

a much more nurturing atmosphere, one each member will not want to abandon. Also, they have

trust, respect, and love with one another.


Data Analysis

15

Family Name: Miro

Family Constellation: Multigenerational / Extended Family

Family Member Age Sex Marital Status Education Occupation Community

Involvement

Leon Miro 72 Male Married Elementary Level Farmer Couples for

Christ

Delfina Miro 70 Female Married Elementary Level Housewife Couples for

Christ

Delia Miro 33 Female Married High School Graduate Housewife - -

Noel Miro 7 Male Single Elementary Student - -

John Rey Miro 4 Male Single n/a n/a - -

Financial Status:

Using the following scale, the family was scored based on our professional observations and judgment:

0 = Never 3 = Frequently


Data Analysis

15

1 = Seldom 4 = Most of the time

2 = Occasionally N = Not observed

Facilitative Interaction among Members

a. Is there frequent communication among all members?

b. Do conflicts get resolved?

c. Are relationships supportive?

d. Are love and caring shown among members?

e. Do members works collaborate?

Total


Scor

eDate

Scor

eDate

Scor

eDate

3 9-25-08 4 9-26-08 3 10-2-08

4 9-25-08 4 9-26-08 4 10-2-08

4 9-25-08 4 9-26-08 4 10-2-08

4 9-25-08 4 9-26-08 4 10-2-08

4 9-25-08 4 9-26-08 4 10-2-08

19 9-25-08 20 9-26-08 19 10-2-08

15

Comments: The family is very responsive of one another and they maintain a stimulating flow of conversation

throughout the time we were there. During our visits, there was no tension among members which led

us to believe they resolved conflicts instantly. Support, love and care manifest in the family especially

to their youngest member of the family — John Rey Miro. Hand-in-hand, they work collaboratively to

meet the needs in life, as verbalized by Mr. Leon Miro.


15

Enhancement of Individual Development

a. Does family respond appropriately to members’

developmental needs?

b. Does it tolerate disagreement?

c. Does it accept members as they are?

d. Does it promote member autonomy?

Total

Comments: The family does tolerate disagreement in moderation, as expressed by Mrs. Delfina Miro. Family

members often disagreed on some things but no matter if they had a misunderstanding they still

cared and respected one another. They were also aware that each of them had different personalities.

As such, they tried their best to respect and accept each member as they were without imposing their

own values.


Scor

eDate

Scor

eDate

Scor

eDate

4 9-25-08 4 9-26-08 4 10-2-08

4 9-25-08 4 9-26-08 4 10-2-08

4 9-25-08 4 9-26-08 4 10-2-08

4 9-25-08 4 9-26-08 4 10-2-08

16 9-25-08 16 9-26-08 16 10-2-08

15

Effective Structuring of Relationships

a. Is decision making allocated to appropriate members?

b. Do member’s roles meet family needs?

c. Is there flexible distribution of tasks?

d. Are controls appropriate for family stage of development?

TOTAL

Comments: The family’s flexibility with regards to the distribution of tasks was well showcased during the

length of our stay with them. During our interaction with the family members, it was evident that

there is flexible distribution of tasks where in one assume the responsibility of the other when /she is


Scor

eDate

Scor

eDate

Scor

eDate

4 9-25-08 4 9-26-08 4 10-2-08

4 9-25-08 4 9-26-08 4 10-2-08

4 9-25-08 4 9-26-08 4 10-2-08

4 9-25-08 4 9-26-08 4 10-2-08

16 9-25-08 16 9-26-08 16 10-2-08

15

incapable of doing such role. Mr. Leon Miro shared that decision making was a joint process for

members of the family to work with.


15

Active Coping Effort

a. Is family aware when there is a need for change?

b. Is it receptive to new ideas?

c. Does it actively seek resources?

d. Does it make good use of resources?

e. Does it creatively solve problems?

TOTAL

Comments: During our interaction with the family members, it was evident that the family is very open about

new ideas especially with regard to the improvement of their health. Indeed, they even raise

questions with regard to their conditions and ways to improve health. According to them, they make

use of their resources wisely since they are able to sustain family basic needs.


Scor

eDate Score Date

Scor

eDate

4 9-25-08 4 9-26-08 4 10-2-08

4 9-25-08 4 9-26-08 4 10-2-08

4 9-25-08 4 9-26-08 4 10-2-08

4 9-25-08 4 9-26-08 4 10-2-08

4 9-25-08 4 9-26-08 4 10-2-08

20 9-25-08 20 9-26-08 20 10-2-08

15

Healthy Environment and Life-style

a. Is family lifestyle health promoting?

b. Are living conditions safe and hygienic?

c. Is emotional climate conducive to good health?

d. Do members practice good health measures?

TOTAL

Comments: Most of the family members’ lifestyle is health promoting. The members follow a fiber and mineral diet

from vegetables due to lack of other resources, although, they occasionally eat pork, poultry and fish

when they have enough budget for such product. Since the problems of the family are easily resolved,


Score Date Score Date Score Date

3 9-25-08 3 9-26-08 3 10-2-08

2 9-25-08 2 9-26-08 2 10-2-08

3 9-25-08 3 9-26-08 3 10-2-08

3 9-25-08 3 9-26-08 3 10-2-08

11 9-25-08 11 9-26-08 11 10-2-08

15

we assume that the family has good emotional climate that is truly conducive to good health. However,

the living condition of the family (especially to children) is not that safe since sharp objects (such as

bolo) are readily accessible by the children.

Regular Links with Broader Community

a. Is family involved regularly in the community?

b. Does it select and use external resources?

c. Is it aware of external affairs?

d. Does it attempt to understand external issues?

TOTAL


Score Date Score Date Score Date

3 9-25-08 3 9-26-08 4 10-2-08

3 9-25-08 3 9-26-08 3 10-2-08

3 9-25-08 4 9-26-08 4 10-2-08

4 9-25-08 4 9-26-08 4 10-2-08

13 9-25-08 14 9-26-08 15 10-2-08

15

Comments: The family is aware of the external issues (community) and even make use of the external resources

—– such as health services. As verbalized by Mr. Leon Miro, they attend community activities that will take

place in their baranggay if they are available. This was proven during our Structured Health Teaching and

Nursing Clinic held at Balugo, Valencia Brgy. Hall, both Mr. Leon Miro and Mrs. Delfina Miro are present

during the said activity.

CUES AND EVIDENCES HEALTH PROBLEM FAMILY NURSING PROBLEM

Subjective

Mrs. Delfina claimed that she

experienced vomiting, vertigo,

headach, dizziness and palpitations

last 2006.

The precipitating factors according

to Mrs. Delfina is due to excessive

exercise.

Mrs. Delfina verbalized “Maglisod

Health Deficit::

Hypertension

1. Inability to recognize the presence of

Hypertension problem due to lack or

inadequate knowledge

2. Inability to make decisions with respect

to taking appropriate health action due

to failure to comprehend the nature,

magnitude and scope of the problem.

3. Inability to provide adequate nursing

care to the sick member of the family


Statement of

15

ko og katulog magabii kay maglisod

man ko og ginhawa”

Objective

Diagnosed with mild cardiomegaly

X-ray result: Chest PA: Clear lung

mild cardiomegaly

Medication: Losartan (Bespar)

50mg 1 tab 2x a day 7am – 5pm

Laboratory results:

Urinalysis: (9/18/08)

Color- Light Yellow

Transparency – clear

Specific gravity – 1.010

Complete Blood Count

Hematocrit 36

Hemoglobin 12.2

WBC 4.2

Fasting Blood Sugar 100.3

Kidney Function 0.9

Liver Function (SGPT) 34

Lipid Profile

due to

a. Lack of knowledge about the health

condition

b. Lack of knowledge on the nature

and extent of nursing care needed

c. Inadequate family resources for

care, specifically financial

constraints inadequate knowledge

about disease condition


15

HDL 41.7

Triglyceride 166

Total Cholesterol 148.1

HDL ration 3.6

Potassium 3.94


15


Subjective

Mrs. Delfina verbalized “Parehas

mi’ng duha (Pointing to Mr. Leon

Miro), mga high blood-on”

Mr. Leon Miro claimed “Magsakit

usaha’y ning akong tangkugo…

dayon, usahay gyud, manghalap

unya mawala ako’ng panglantaw

dayon malipong ko Mahadlok ko na

matumba ko nya ako ra usa”

Mrs. Delfina claimed that they were

advised by the physician to have

their blood pressure be taken

regularly.

Couples claimed that both family

have history of the heredofamilial

disease which is hypertension

Objective

Mr. Leon Miro’s blood pressure =

Health Deficit::

Cardiomegaly


Cardiomegaly problem due to lack or

inadequate knowledge

2. Inability to make decisions with respect

to taking appropriate health action due

to failure to comprehend the nature,

magnitude and scope of the problem.



due to


condition



c. Inadequate family resources for

care, specifically financial

constraints inadequate knowledge

about disease condition


15

140/90 mmHg

Mrs. Delfina Miro’s blood pressure

=140/80 mmHg


15


Subjective

Mr. Leon verbalized “Gidala man

namu na siya (John Rey) sa hospital

niaging semana (First week of

October) kay dili naman mawala

iyang ubo og sip-on”

Mrs. Delfina verbalized “Hasta to’ng

iyahang igsoon (Noel Miro), gisip-on

man pud to…”

John Rey claimed “Sipon ko!”

Objective

Upon physical assessment:

Using penlight, presence of

mucoid secretions in nasal

cavity observed

Frequent sniffing noted

Presence of secretions on arm noted

whenever John Rey wipe his nose using

his arm

Health Threat:

Cough and Colds


cough and colds problem due to lack

or inadequate knowledge

2. Inability to decide about taking

appropriate action due to failure to

comprehend the nature, magnitude

and scope of the problem.

3. Inability to provide a home

environment conducive to health

maintenance due to lack of inadequate

family resources.



due to


condition



15


Hypertension


WEIGHT COMPUTATION

1. Nature of the condition or problem presented

Scale: Wellness state

Health deficit

Health threat

Foreseeable crisis

3

3

2

1

3

3/3 x 1 = 1

2. Modifiability of the condition or problem

Scale: Easily modifiable

Partially modifiable

Not modifiable

2

1

0

1

1/2 x 2 = 1

3. Preventive potentialsScale: High

Moderate

Low

3

2

1

2

2/3 x 1 = 0.667

4. Salience

Scale: A condition or problem needing immediate attention

A condition or problem not needing immediate attention

Not perceived as a

2

1

0

2

2/2 x 1 = 1

Priority Setting


15

Cardiomegaly


WEIGHT COMPUTATION



Health deficit

Health threat

Foreseeable crisis

3

3

2

1

3

3/3 x 1 = 1




Not modifiable

2

1

0

1

1/2 x 2 = 1


Moderate

Low

3

2

1

2

2/3 x 1 = 0.667

4. Salience



Not perceived as a

2

1

0

2

2/2 x 1 = 1

15

Cough and Colds

WEIGHT COMPUTATION



Health deficit

Health threat

Foreseeable crisis

3

3

2

1

2

2/3 x 1= 0.667




Not modifiable

2

1

0

2

2/2 x 2 = 2


Moderate

Low

3

2

1

1

1/3 x 1 = 0.333


15

4. Salience



Not perceived as a problem or condition needing change

2

1

0

0

0/2 x 1 = 0

TOTAL 3



Family Nursing

Care Plan

15

HEALTH PROBLEM

FAMILY NURSING PROBLEMS

GOAL OF CARE

OBJECTIVES OF CARE

INTERVENTION PLAN

OUTCOME CRITERIANursing

Interventions

Method of Nurse-Family Contact

Resources Required

Hypertension 1. Inability to recognize the presence of Hypertension problem due to lack or inadequate knowledge

2. Inability to make decisions with respect to taking appropriate health action due to failure to comprehend the nature, magnitude and scope of the problem.

3. Inability to provide adequate nursing care to

After the nursing intervention, Mr. and Mrs. Miro’s blood pressure level will be in normal range within one (1) week

After the nursing intervention, the family will:

a. Express understanding with regards to the factors that contributed to the occurrence of hypertension

b. Recognize the early signs and

1. Observe the family’s lifestyle and daily activity patterns

2. Inquire about their daily dietary intake

3. Obtain their blood pressure level during home visit

4. Discuss with the family (especially to Mr. Leon and Mrs. Delfina):a. The nature,

magnitude, and scope of the problem

b. The common signs and

Home visit

and

Clinic Visit

1. Material sources:

a. Blood pressure apparatus

b. Visual aids showing examples of foods high in sodium concentration or pictures of people having healthy lifestyle.

The family was able to achieve and maintain normal blood pressure level.

a. Verbalize at least three (3) factors that can contribute to the occurrence of increased blood pressure

b. List down at least two (2)


Family Nursing

15

the sick member of the family due to

a.Lack of knowledge about the health condition

b.Lack of knowledge on the nature and extent of nursing care needed

c.Inadequate family resources for care, specifically financial constraints inadequate knowledge about disease condition

symptoms of elevated blood pressure

c. Plan a healthy activity and dietary patterns

d. Remind each other, from time to time, to avoid things that can cause increased blood pressure

e. Express the importance of cooperation with treatment regimen

f. Verbalize the significance of having regular check up

symptoms of hypertension

c. The probable reasons of acquiring such condition

d. The implications of having Hypertension and the need to follow rigidly the taking of appropriate medications

e. Consequences of Hypertension

5. Explore with the family ways of implementing measures to maintain normal blood pressure.

6. Promote the selection of proper foods to eat and the avoidance of foods rich in sodium

7. Reinforce the importance of cooperation with treatment regimen

8. Encourage them to have a regular check up to monitor their blood pressure

2. Time and effort of the nurse and family members.

3. Expenses for teaching aids and transportation of the student nurse.

examples of foods high in salt

c. Verbalize a healthy plan of activities for the day

d. Express the importance of taking medications

e. Identify at least two (2) signs and symptoms of hypertension

f. Verbalize to have a regular check up in the hospital or any health center


15

level 9. Guide the family in

using “contracting” as motivation strategy

10. Make proper referral to existing agencies on hypertension so that the family can avail the programs

HEALTH PROBLEM


GOAL OF CARE

OBJECTIVES OF CARE

INTERVENTION PLAN


Interventions


Resources Required

Cardiomegaly 1. Inability to recognize the

After the nursing

After the nursing

1. Assess the family’s lifestyle and daily

Home visit 1. Material sources:

The family was able to maintain


Family Nursing

15

presence of Cardiomegaly problem due to lack or inadequate knowledge

2. Inability to make decisions with respect to taking appropriate health action due to failure to comprehend the nature, magnitude and scope of the problem.

3. Inability to provide adequate nursing care to the sick member of the family due to a. Lack of

knowledge about the health condition

b. Lack of knowledge on the nature and extent of nursing care needed

c. Inadequate family resources for care,

intervention, the family member (Mrs. Delia) will maintain a normal and healthy cardiac functioning

intervention, the family will:

a. Express understanding with regards to the factors that contributed to the occurrence of cardiomegaly

b. Recognize the early signs and symptoms of cardiomegaly

c. Plan a healthy activity and dietary patterns

d. Remind each other, from time to time, to avoid things that can worsen cardiomegaly

e. Emphasize the importance of cooperation

activity patterns2. Discuss with the

family (especially to Mrs. Delfina):a. The nature,


b. The common signs and symptoms of Cardiomegaly

c. The probable reasons of acquiring such condition

d. The implications of having Cardiomegaly and the need to follow rigidly the taking of appropriate medications

e. Consequences of Cardiomegaly

3. Explore with the family ways of implementing measures to maintain normal heart size and preventing it to worsen.

and

Clinic Visit

a Visual aids showing examples of ways on how to have healthy heart


3. Expenses for teaching aids and transportation of the student nurse.

a normal and healthy cardiac functioning of Mrs. Delfina

a. Enumerate at least three (3) examples of a factors that can worsen the condition of cardiomegaly

b. Verbalize at least three (3) ways on preserving and maintaining the integrity of the heart

c. Express the importance of taking medications

d. Identify at least two (2) signs of progress and deterioration cardiomegaly

e. Observe family having a


15

specifically financial constraints inadequate knowledge about disease condition

with treatment regimen

f. Verbalize the significance of having regular check up with regards to her heart enlargement

4. Promote the selection of lifestyle that preserve the integrity of the heart

5. Emphasize the importance of cooperation with treatment regimen

6. Encourage them to have a regular check up to monitor the wellness of the heart

7. Guide the family in using “contracting” as motivation strategy

8. Make proper referral to existing agencies with regards to cardiomegaly so that the family can avail the programs

healthy lifestyle

f. Allocate resources to meet the needs of Mrs. Delfina


15

HEALTH PROBLEM


GOAL OF CARE

OBJECTIVES OF CARE

INTERVENTION PLAN


Interventions


Resources Required

Cough and colds

1. Inability to recognize the presence of cough and colds problem due to lack or inadequate knowledge

2. Inability to decide about taking appropriate action due to failure to comprehend the nature, magnitude and scope of the

After the nursing intervention, the family members will take the necessary measures to properly manage cough and colds

After the nursing intervention, the family will:

a. Able to recognize the signs and symptoms of Cough and colds

b. Express understanding regarding factors that contributed

1. Monitor the family members’ respiratory health status

2. Ask and assess the duration and severity of the family member’s condition

3. Perform physical assessment focusing the respiratory system of the affected family member (specifically

Home visit 1. Material sources:

a. Visual aids of the ingredients for demonstrating preparation of herbal medications (SLK syrup & Calachuchi

The family was able to take the necessary measures to properly manage cough and colds

a. Verbalize at least three (3) factors that can badly affect the member’s health and wellbeing.

b. Express


Family Nursing

15

problem.

3. Inability to provide a home environment conducive to health maintenance due to lack of inadequate family resources.

4. Inability to provide adequate nursing care to the sick member of the family due to

a. Lack of knowledge about the health condition

b. Lack of knowledge on the nature and extent of nursing care needed

to the occurrence of Cough and colds

c. Provide environment conducive to health preservation

d. Prepare SLK syrup with little or no supervision with the student nurses

e. Provide proper nursing care to members who are sick

johnrey)4. Discuss wit the

family: a. The nature,


b. The common signs and symptoms of Cough and colds

c. The possible reasons of acquiring such condition

d. The implications of having Cough and colds and the risk of transmitting it to other family members

5. Explore with the family ways of implementing measures to prevent the occurrence of cough and colds.

6. Discuss with the family the courses of action open to them specifically: a. The need to

increase fluid

ointment)

b. Supplies and equipment for cooking demonstrations.


3. Expenses for teaching aids, ingredients for the preparation

understanding with regards to condition of one of the members of the family.

c. Provide a good physical and social environment that promotes the family members’ health and integrity.

d. Satisfactorily takes care of the family member having cough and colds

e. Perform SLK-syrup-making satisfactorily

f. Use appropriate protective clothing and measures in


15

intakeb. Avoiding foods

and activities that can aggravate the condition (e.g., cold foods and drinks, and exposing self to cold wind and taking a cold shower)

c. Maintaining healthy and balanced diet (e.g., eating vegetable, fruits, drinking milk, etc.)

d. Avoid going to crowded places

e. Avoid going near to people who smokes

f. Taking SLK syrup to treat cough and colds

g. Bringing of umbrella or raincoat during rainy seasons

h. Taking enough rest or sleep

i. If someone is having cough and colds in the

s, and transportation of the student nurse.

preventing cough and colds

g. Wash hands regularly to prevent transmission of the disease

h. Avoid sharing personal items or utensils

i. Utilize as much as possible available resources within and outside the community to address such problem.


15

family, avoid sharing of utensils. Allocate specific utensil for the sick member



Family Nursing Care Plan

Implementation results

15

The family was able to achieve and maintain normal blood pressure level.

Verbalize at least three (3) factors that can contribute to the occurrence of increased blood

pressure

List down at least two (2) examples of foods high in salt

Verbalize a healthy plan of activities for the day

Express the importance of taking medications

Identify at least two (2) signs and symptoms of hypertension

Verbalize to have a regular check up in the hospital or any health center

The family was able to maintain a normal and healthy cardiac functioning of Mrs. Delfina. They were

able to:

Enumerate at least three (3) examples of a factors that can worsen the condition of

cardiomegaly

Verbalize at least three (3) ways on preserving and maintaining the integrity of the heart

Express the importance of taking medications

Identify at least two (2) signs of progress and deterioration cardiomegaly

Observe family having a healthy lifestyle


15

Allocate resources to meet the needs of Mrs. Delfina


15

The family was able to take the necessary measures to properly manage cough and colds. They were

able to:

Verbalize at least three (3) factors that can badly affect the member’s health and wellbeing.

Express understanding with regards to condition of one of the members of the family.

Provide a good physical and social environment that promotes the family members’ health

and integrity.

Satisfactorily takes care of the family member having cough and colds

Perform SLK-syrup-making satisfactorily

Use appropriate protective clothing and measures in preventing cough and colds

Wash hands regularly to prevent transmission of the disease

Avoid sharing personal items or utensils

Utilize as much as possible available resources within and outside the community to address

such problem.



Health Teachings

15

Encourage patient to have regular check up for his blood pressure level and also consult a cardiologist

Encourage patient to have a well balanced-diet with low-sodium low-fat diet.

Encourage patient to have regular exercise

Instruct patient to take a rest in between work and not to work excessively

Encourage patient to take his medication regimen religiously and emphasize its importance

Educate the family about the importance of appropriate diet, rationale of weight loss and regular exercise, seeking of

medical intervention

Encourage the patient to avail the community resources with regard to existing health problem (Hypertension): such

as blood pressure taking.

Teach the client on how to prevent dizziness when he/she ambulates from one position to standing position.

Teach patient on the factors that predisposes increase in blood pressure, the pathophysiology of hypertension, what

are the possible complication of hypertension and how hypertension is managed in order to prevent its complication.


Health Teachings: Hypertension

15

Encourage increase fluid intake (2-3 liters) for easy expectoration o f phlegm and teach its rationale and action of such

action.

Encourage religious intake of the drug for cough and colds, as prescribed by the physician.

Teach proper deep breathing and coughing exercises.

Teach family members regarding proper chest physiotherapy, which includes: postural drainage, percussion and

vibration. Its rationale which is to loosen the mucus and facilitate easy removal must be specify to the family.

Encourage the family members to let the patient takes citrus fruits and drinks rich in vitamin C (such as calamansi

juice).

Encourage the family members to provide vitamins for the child (Vitamin C).

Specify the importance of using appropriate gear against rain and cold weather, which is to use jacket and umbrella (if

it is raining)

Encourage the family members to keep an eye on the child not to let him play outside the house when it is raining.

Encourage the family members to avail the government services with regard to the existing health problem (cough and

colds)


Health Teachings: Cough and Colds


Learning & Insights

15

To put into comparison, our experience in this COPAR rotation has been like a pendulum. With the hurried lecture classes

requirements to be submitted and long exams, has been a roller coaster ride that is full of varying emotions. But when it comes

to our COPAR experience was a pleasant and enjoyable one. Our knowledge on nursing has yet again reached another level after

completing our COPAR rotation- one of the most tiring and challenging rotation because of the fact that we have to walk half of a

kilometer and even cross a river just to reach out every houses on our purok.

In our case presentation, we are able to identify the health problems of our priority family and were able to prioritize

nursing diagnosis regarding their present conditions.

We have improved our skills, increased our knowledge and developed positive attitudes regarding this particular nursing

rotation. To Ma’am Oliva for imparting her knowledge to us, guiding us always in every activity that we will conduct.

The community was very supportive in every activity that we will organize like the structured health teaching and the mass

U/A, Shiatsu, Ventusa & Accupressure. Working with them contributed to our learning. Not only did they help us learn but they

also made us appreciate the job of a CHN nurse and the weight of their responsibilities.

What we really appreciated about her during the duties was her uncanny ability to hold the team together. She was far

enough to let us do our work, yet close enough to pull us out of harms way. She inspired us to study harder and work faster yet


15

flexible not only on the duty area but also in the classroom. Her fast-pace attitude and friendly demeanor helped us to be

confident in what we do and very open to her about our problems in the rotation. She encouraged us greatly and has contributed

much to our learning in the COPAR with her practical questions during our ward classes.

We have no big problems with regards to our classmates. They have been what they have always been: good people, and

very helping teammates! We really appreciate our comrades in our team. They were very good to work with.

After weeks of community exposure, we believe that our vision of becoming a responsible nurse is now within a close

distance. This rotation has a certainly created a big impact as regarding to our studies and responsibilities as a future nurse.

Book Sources:

Beers, M.H. (2003). The merck manual of medical information. 2nd ed. USA: Simon & Schuster, Inc.

Cahill, M. (1995). Professional health guide: Infectious disorders. USA: Springhouse Corporation.

Kozier, B. (2004). Fundamentals of nursing: concepts, process, and practice. 7th Ed. Singapore: Pearson Education South Asia

Pte Ltd.

Leahy, J.M. & Kizilay, P.E. (1998). Foundations of Nursing Practice: A nursing process approach. Philadelphia, Pennsylvania

19106, W.B. Saunders.

Maglaya, A. S. (2004). Nursing practice in the community. 4th ed. Philippines.


Bibliography

15

Potter, P. & Perry, A. (2001). Fundamentals of nursing.5th ed. St. Louis: Mosby Co.

Reyala, J.P. et al. (2000). Community health nursing services in the Philippines. 9th ed. Philippines: National League of

Philippine Government Nurses, Inc.

Internet Sources:

http://www.crvp.org/book/Series03/III-7/...

http://www.crvp.org/book/Series03/III-7/chapter_v.htm

http://www.hawcc.hawaii.edu/nursing/filip1.htm

http://www.livinginthephilippines.com/philculture/early_childhood_and_death.html

http://www.recastreality.org/DrillsSH/CulturalPatternsSH.htm


http://www.livinginthephilippines.com/philculture/early_childhood_and_death.html

http://www.hawcc.hawaii.edu/nursing/filip1.htm

http://www.crvp.org/book/Series03/III-7/chapter_v.htm

Date post:	18-Nov-2014
Category:	Documents
Upload:	lexzaf
View:	108 times
Download:	0 times

case press on community

Documents