College of Nursing

A Family Case Study

In Community Health Nursing

Submitted by:
Jeanette Leigh S. Bravo
AU-FC1-BSN3-MAIN3

Submitted to:
Eduard Adrian C. Manuel
Clinical Instructor
 INTRODUCTION

Community Health Nursing is the synthesis of nursing and public health practice applied

to promote and protect the health, prevent diseases and disability, as well as rehabilitation of four

levels of clientele: the individual, family, population group, and the community as a whole.

It combines all the basic elements of professional, clinical nursing with public health and

community practice to maintain the social well-being of the community.

In accordance to the criteria of the Primary Health Care System in selecting the family,

priority was given to the importance of delivering health care services, as well as the location

and accessibility of health care services, particularly to underprivileged and deprived families.

These criteria are as follows: health condition of all or one member of the family, location of the

household, accessibility of the family to the barangay health clinic or any available health care

facilities, and, lastly, a monthly family income of less than five thousand pesos (P5, 000).

According to local officials, the B family required support and assistance, and was eager

to cooperate and participate throughout the activities and medical services provided. With the

conditions mentioned above in mind, the student nurse chose the B family as the subject for my

community health nursing practice. The B family live in Zone III, Barangay Dizol, San Jose

City, Nueva Ecija which consists of four (4) family members. Throughout the community

nursing process, I have developed the following goals:

For the community:

 The community work in collaboration with the community health nursing student to

protect and preserve the health of its members, and to promote self-care among

individuals and their families.

For the family:

 In response to our nursing actions, the family will be able to identify both existing and

potential problems along with wellness needs, allowing them to improve their health and

be self-sufficient in sustaining their health.

For the students:

 To put nursing skills and knowledge to use, as well as to put health teachings into action

and to enhance social skills in the community to improve their health status.
 II. FAMILY PROFILE

The family B resides at Zone III, Dizol, San Jose City, Nueva Ecija. The head of the

family is Mr. F. B. he is 51 years old, born on May 2, 1971 and he was born in San Jose City,

Nueva Ecija. His highest educational attainment is high school. He is a farmer and a Roman

Catholic. He inherited the lot of their house to his late Father Mr. C. B. His wife is Mrs. C. B.

who is 50 years old and born on October 3, 1971 at San Jose City, Nueva Ecija. They have a

monthly income of about 4,000 pesos depending on the harvest of their crops. Mr. and Mrs. F. B.

has two children, a 20 year-old daughter and a 28 year-old son. Their daughter is currently

attending college in her third year, and their oldest child has graduated from college.
 III. INITIAL DATA BASE

A. Family Structure, Characteristics and Dynamics

It is a nuclear family. Mr. F. B. is the head of the family and they both work together to

make decisions in their home. Some activities, such as modest home chores, are handled by their

daughter, while the son assists with more intensive labor. Their son also works in the farm for

their income. Miscommunication arises between them from time to time, but they always

provide a solution. They are generally simple and humble and also have a positive relationship

with their neighbors.

B. Socio-economics and Cultural Background

Mr. F. B. works as a farmer who plants “palay” and occasionally vegetables in their own

yard. They also make money by raising livestock such as chicken, fishing and selling some

vegetable crops. Aside from that, Mr. F. B. also work to other landowner to grow their crops and

help them in farming. With their livestock animals and vegetable crops, they can meet the family

needs, mainly food. Their palay's family income ranges from $1,000 to $4,000. If no additional

expenses, such as loans or debts, are incurred, the family income is sufficient for their own

expenses.

The family is a member of the Roman Catholic Church, however they do not always attend

mass on Sundays due to tight schedules and busy work on the farm. As part of their tradition as a

family, they visit Our Lady of Manaoag Church whenever possible to give thanks and offer a

prayer. They are involved in community programs, and they are aware of the schedules for their

community services and activities. Their social life consists of attending weddings, funerals, and

birthdays within their family, relatives, and the community as well.

C. Home and Environment

Zone III, Barangay Dizol, San Jose City is approximately 365 meters from the barangay hall

by walking. It is surrounded by rice fields and a system of irrigation. The barangay is

agriculturally rich, with rice fields, and public transportation and private vehicles are the only

modes of transportation to town.

Mr. F. B. inherited the land on which their house was built from his father. The family’s

home is composed of concrete with a yard. They have a water pump in front of the house for

irrigation and a potable water near the dirty kitchen. They have fruits on their yard like pomelo,

guyabano, mango, avocado, and they also have eggplant, string beans, horseradish, chili and

calamansi. The floor of their house is tiled, and their yard is rocky. They have appliances such as

television, electric fan, and refrigerator.

They have a filthy kitchen attached to the house that has unorganized kitchen stuffs. They

make use of firewoods and stove in cooking. The family practices waste segregation and they

dispose their waste at the garbage disposal. The bathroom is tiled located inside the house along

with a small toilet bowl.

D. Family Health

The family eats three times a day, plus extra snacks from their harvest. Mrs. C. B. together

with her family enjoys eating variety of root crops and fruits from their yard, including sweet

potato, mango, pomelo, avocado and some other fruits. Upon assessment, Mr. and Mrs. F. B.

blood pressure is within normal range, and they mentioned that sometimes they experienced joint
pain, and muscle pain due to intensive works in the farm and aging. The family eats rice,

vegetables and sometimes meat and fish.

The student nurse delivered health-related information on the necessity of water sanitation,

and environmental hygiene, as well as information about some herbal medicine they can find in

their yard and use as home remedy.

E. Values Placed on Health

For any ailments that develop within the family, the family member consults at the health

center and health clinic.

PHYSICAL ASSESSMENT

Physical Examination of the Daughter J. B:

A head to toe assessment was done to Daughter J.B, a 20 year old. She weighing 47 kg

with a height of 63 inches (160 cm) on September 1, 2022 at around 10:25 am. Daughter J.B

vital signs were taken with results as follows: Temperature 36.3 C, Pulse Rate 84 beats per

minute, Respiratory Rate 16 breaths per minute.

I observed that Daughter J.B have a fair complexion of skin, her hair is black in color and

she has a short curly hair with no dandruff and lice. The color of the eyes are brown. The nails

are not dirty and trimmed on both foot and hands. There is a presence of scar or local reaction at

the vaccination site and some scars on her legs from healed wounds that she had back then.

There is also presence of insect bites on her arms and legs. During the assessment cold and

cough are noted.

 IV. LEVEL OF ASSESSMENT

The process of determining existing and potential health conditions or problems of the

family. Second level assessment identifies the nature or type of nursing problems the family

experiences in the performance of their health tasks with respect to a certain health condition or

health problem.

A. First Level of Assessment

1. Presence of Health Deficit

 Common colds that can progress and can lead to flu if not monitored or treated.

2. Presence of Health Threats: Poor Home/Environmental Condition/Sanitation.

 Improper drainage system

 Poor waste management

 Water is from water pump, and water system of the barangay

 Presence of breeding or resting sights of vectors of diseases

3. Foreseeable Crisis: Difficulty of reaching the health center/hospital in case of

emergency

 House located far from the health center/hospital

 Unavailability of the ambulance in the Barangay

 Bumpy, rough and slippery road

B. Second Level of Assessment

 The results of the student nurses' detailed second level assessment of the highlighted

health conditions/problems are shown below. These issues are classified as family nursing

issues.

Poor environment sanitation Incapability to offer a health-promoting home

environment due to lack of health-related

information and knowledge about existing

and potential problems.

Difficulty of reaching the health Inability to provide community resources due

center/hospital in case of emergency to unavailability of the Barangay ambulance

and the location and distance of the house

from the health center/hospital in case of

emergency.

Presence of breeding or resting sights of Inability to identify it as a health threat to the

vectors of diseases family because there is a lack of knowledge

and information about what can insects and

rodents do to affect health, also there is a lack

of knowledge and skills on what preventive

measures they can do to make their

environment better.

Direct contact of pets to the family members Inability to identify the present condition

because there is an inadequate knowledge

about the importance of sanitation and

hygiene, and about possible skin disease and

 illness.

V. FAMILY HEALTH PROBLEMS AND JUSTIFICATION

CUES AND DATA HEALTH PROBLEMS

 Poor environment sanitation  Health Threats

 Stagnation of water because of  Risk for dengue and malaria cause

improper drainage system and poor by the presence of mosquito.

waste management that can lead to

environmental pollution and the

presence of mosquito.
 Possibility of water contamination
 Water source is from water system
resulting to gastrointestinal health
and water pump
problems. Transmission of diseases

such as cholera, and diarrhea.

 Presence of breeding or resting sites of  Health Threats

vectors of diseases  Presence of rodents in drainage

canals, irrigation canals and in the

rice fields in the surrounding.

 Uncovered pail with stored water

 Pets in the house of the family  Health Threat

(Dogs, Chickens and Cat)  Direct contact of the pets to the

  Fur and feather that can cause family members

allergies.

 House located far from the health  Foreseeable Crisis

center/hospital  Difficulty of reaching the health

 Bumpy and rough road center/hospital in case of

 Inaccessibility of required emergency

care/services

VI. FAMILY NURSING DIAGNOSIS

Problem Family Nursing Diagnosis

1. Possibility of water contamination Inability to identify the presence of problem

due to inadequate knowledge about the

possible transmission of diseases such as

cholera and diarrhea, and gastrointestinal

health problems.

2. Presence of breeding or resting sites of Inability to recognize the presence of rodents

vectors of diseases in drainage canals and irrigation canals, and

in uncovered storage of water.

3. Difficulty of reaching the health Inability to provide community resources due

center/hospital in case of emergency to the location and distance of the house from

the health center/hospital in case of

 emergency.

VII. PRIORITIZATIONS OF PROBLEMS

1. Possibility of water contamination

CRITERIA COMPUTATION ACTUAL JUSTIFICATION

SCORE

a. Nature of the 2/3 X 1 0.67 It is consider as health threat

problem because the water is from a

water pump or water system

may be contaminated which

can cause a disease to the

family.

b. Magnitude of 1/4 X 3 0.75 Less than 25% of the

the problem proportion of the population is

affected by the problem which

is not severe.

c. Modifiability of 3/3 X 4 4 It is highly modifiable because

the problem we can help them to gain

knowledge about the proper

ways of preparing water for

drinking.

d. Preventive 3/3 X 1 1 It is highly preventive because

 potential we can teach the family about

the proper ways of preparing

the water such as boiling, and

filtering to have water that is

safe to drink.

e. Social concern 1/2 X 1 0.5 The family recognized the

situation as a problem but not

needing an urgent action.

TOTAL 6.92

2. Presence of breeding or resting sights of vectors of diseases

CRITERIA COMPUTATION ACTUAL JUSTIFICATION

SCORE

a. Nature of the 2/3 X 1 0.67 It is consider as health threat

problem because the family is at risk

from vectors of diseases.

b. Magnitude of 2/4 X 3 1.5 Approximately 25% - 49% of

the problem the proportion of the

population is affected by the

problem.

c. Modifiability of 3/3 X 4 4 It is highly modifiable because

the problem we can help them to gain

knowledge about the proper

 ways of maintaining their

environment clean, and the

resources and actions needed to

solve the problem.

d. Preventive 3/3 X 1 1 It is highly preventive because

potential we can teach the family about

the proper ways of maintaining

the cleanliness of the

environment that can prevent

the incidence of dengue,

malaria and other infectious

diseases.

e. Social concern 2/2 X 1 1 The family recognized the

situation as a problem because

of its possible effect to health

but there is a lack of action to

respond to this problem.

TOTAL 8.17

3. Direct contact of pets to the family members

CRITERIA COMPUTATION ACTUAL JUSTIFICATION

SCORE

a. Nature of the 2/3 X 1 0.67 It is consider as health threat

 problem because the family is at risk

from zoonotic diseases.

b. Magnitude of 1/4 X 3 0.75 Approximately less than 25%

the problem of the proportion of the

population is affected by the

problem.

c. Modifiability of 3/3 X 4 4 It is highly modifiable because

the problem this problem can be manage

easily and they can just put the

animals in the cage.

d. Preventive 3/3 X 1 1 It is highly preventive because

potential animals move around

anywhere and excrete their

waste, this can also be manage

through sanitation.

e. Social concern 0/2 X 1 0 The family does not recognized

the situation as a problem.

TOTAL 6.42

4. Difficulty of reaching the health center/hospital in case of emergency

CRITERIA COMPUTATION ACTUAL JUSTIFICATION

SCORE

a. Nature of the 1/3 X 1 0.33 It is consider as foreseeable

 problem crisis because there need will

not be entertain immediately in

emergency situations.

b. Magnitude of 2/4 X 3 1.5 Approximately less than 25% -

the problem 49% of the proportion of the

population is affected by the

problem.

c. Modifiability of 3/3 X 4 4 It is partially modifiable

the problem because they can easily reach

for help through the use of

phones and land transportation.

d. Preventive 2/3 X 1 1 It is partially preventive

potential because due unavailability of

the barangay ambulance

because it’s under

maintenance, and the location

of the house is far from the

health center.

e. Social concern 1/2 X 1 0.5 The family recognized the

situation as a problem but does

not need instant action.

TOTAL 7.33
5. Lack of financial control

CRITERIA COMPUTATION ACTUAL JUSTIFICATION

SCORE

a. Nature of the 2/3 X 1 0.67 It is consider as health threat

problem because it limits the family

from spending and investing on

their needs, especially in their

health needs.

b. Magnitude of 2/4 X 3 1.5 Approximately less than 25% -

the problem 49% of the proportion of the

population is affected by the

problem.

c. Modifiability of 3/3 X 4 4 It is easily modifiable because

the problem the family can thrive in

improving their harvest and

livelihood for good income.

d. Preventive 2/3 X 1 0.67 It has a moderate preventive

potential probability because family is

residing far from the city

where there’s plenty of

opportunity

e. Social concern 2/2 X 1 1 The family recognized the

situation as a problem but does

 not have the resources for

immediate action.

TOTAL 7.84

VIII. SUMMARY OF HOME VISITS AND DOCUMENTATION

The BSN Level III student of PHINMA-Araullo University, Jeanette Leigh Bravo started

to conduct a case study to the community setting in Barangay Dizol, San Jose City, Nueva Ecija

on August 29, 2022. She asked permission and approval from the Barangay Captain, Mr.

Maximo Padua and the barangay officials before doing any action in the barangay. Since the

infection of Covid virus is still spreading, we are encourage to interview our family for this case

study. Observing community guidelines and protocols, the following activities were done:

August 29, 2022

 First home visit in Barangay Dizol to a family which the head of the family was suffering

from joint pain.

August 30, 2022

 Home visit in Cabatuan and the following activities were done:

 Taking vital signs

 Health teaching to the family were the student nurse talks about importance of visiting

health care facilities for check-ups

 Feeding program

September 1, 2022
  I continued to conduct home visit and interview, and chose the right family who is

qualified based on the standard of the case study.

September 2, 2022

 I started to compose the paper works of my family case study.

September 3, 2022

 Visit the family to gather information about my chosen family for the case study.

September 8, 2022

 Finalization of the family case study.

IX. EVALUATION

The family case study was done for 2 weeks that result to the pursuit of the desire

outcome. This is an adequate time for the student nurse to utilize plan and interventions on the B

family. The student nurse assessed the family systematically to gather and interpret the

information provided by the chosen family, this is to identify the health problems and needs of

the family. Upon gathering data, it is essential to establish rapport and good relationship with the

family to promote participation, and provide comfort to gain their trust.

The B family showed their participation throughout the course of activity by providing

the information needed for health history and to evaluate the family health need which resulted

in attaining the desired outcomes. The information and assessment gathered by the student nurse

are used to formulate plan of action and activities to be done that will benefit the family in

improving their health. The main purpose of the home visit of the student nurse is to help
encouraged the family to allow some time to visit the health center/clinic for check-ups and

when there is an illness occur in the family.

The student nurse provided health teaching to the family, with this the family was able to

gain adequate information and important knowledge on the health threats present in their

surroundings. This includes the family’s risk of acquiring disease from their pets and from the

presence of breeding or resting sites of vectors. The family was able to improve their

environment and improve water consumption and storage, and also promoted sanitation and

proper waste disposal.

The expected outcomes of improving their surroundings was met, and the B family was

able to perform the health teaching being discussed to them. The family is being encourage to

maintain the cleanliness and good hygiene in their surroundings, and the importance of house

renovating their environment for their safety.

The student nurse have enjoyed the whole process of the case study wherein she

successfully practiced and applied the principles of the nursing health for the home visit and the

skills needed. Through the planned activities the family were able to achieve community health

goals and objectives. The student nurse would like to express her warm gratitude to the B family

for their collaboration and participation during the home visit.

COMMUNITY HEALTH ASSESSMENT FORM

Respondent: Felix Age: 51 Sex: Male

Relation to Head (If not the Head of the Family)
I. Family Data
A. Head of the family: Felix Bravo Age: 51
B. Name of Spouse: Carmelita Bravo Age: 50
C. Address: Brgy. Dizol San Jose City, Nueva Ecija Tel No.:
D. Educational Attainment

i. Husband: High School Graduate

ii. Wife: High School Graduate
E.Length of Residency: Since birth
F.Ethnic Origin : N/A
G.Family: Nuclear Nuclear (√) Extended ( )
H.Religion: Roman Catholic
I.No. of Children: 2
J.Members of the Household: 4
Name Age Sex Status Education Occupation

Felix Bravo 51 Male Married Farmer

Carmelita Bravo 50 Female Married Housewife
Julius Bravo 28 Male Single N/A
Jeanette Bravo 20 Female Single Student

II. Socio Economic Data

A. Source of Income
Occupation: Farming
Husband: Farming
Wife: Housewife
Employed () Unemployed () Self–employed (√)

Monthly Income
Below ₱ 2,000 () ₱ 2,000 - ₱ 5,000 (√)
₱ 5,001 - ₱ 8,000 () more than ₱ 8,000 ()
B. Family Expenditures

1. Food
Below ₱ 50 () ₱ 50 – 75 ()
More than ₱ 70 (√)

2. Clothing number of times of buying

Once a year (√) Twice ()
Thrice a year ()

3. Housing
Water (√) Electricity (√) Telephone ()

4. Schooling
 Public (√) Private () Others

C. Housing and Environmental Condition

A. Home Type

Concrete (√) Wood ()

Mixed () Makeshift () Others

Ventilation:

Poor () Good (√)

Lighting:
Adequate (√) Inadequate ()

Surroundings:
Clean (√) Dirty ()

B. Source of Water Supply

Artesian well () Deep well (√)
NAWASA () Others: POWAS

C. Storage of Drinking Water

Refrigerated (√) Covered (√)
Uncovered ()
Containers used:
Plastic () Clay jars ()
Bottles (√) Others: Water jug

D. Toilet Facilities
Sanitary
:
Flush (√) Pit privy () Others
Owned (√) Shared ()
Unsanitary:
“Ballot” system () Others

E. Garbage Disposal
Collection () Burning (√)
Burying () Open dumping (√)
Garbage cans () Others

F. Food Storage
Covered (√) Uncovered ()
Refrigerated (√)

G. Presence of Animals
Dogs (√) Cats (√)
Pigs () Others: Chicken
H. Backyard Gardening
Vegetables (√) Herbal (√)
Fruit-bearing (√) Others

D. Community Resources
A. Health and Other Facilities
Health center (√) Barangay hall (√)
School (√) Church (√)
Park () Market (√)
Health center (√) Private clinic (√)
Public hospital (√) Private hospital (√)

B. Indigenous health workers

Trained “hilot ” () BHW (√)
“Herbularyo” (√) Untrained “hilot” (√) Others:

C. Sources of health funds:

Government (√) Private () NGOs/POs () Others:

E. Nutrition
A. Food preference
Fish () Fruits/ vegetables ()
Meat () Mixed (√)

B. Common
Rice and egg () Rice and sardines (√)
Rice and noodles (√) Others:

C. Presence of Nutritional Disorder

1. Goiter
Enlargement of the neck () Dysphagia ()
Hoarseness () Others:

2. Anemia
Pallor () Easy fatigability ()
Body weakness ()
3. Vitamin A deficiency
“Pilak sa mata” () Night blindness () Others

4. Others:________

F. Knowledge, Attitude and Practice

A. Do you utilize the health center: Yes (√) No ()

If no, why?
B. Reason:
Illness (√) Prenatal ()
Family planning () Postnatal ()
Dental (√) Nutrition ()
C. First Person consulted in times of illness:
M.D. ( √) Nurse ()
Midwife () “Hilot” ()
“Herbularyo” () BHW ()
Others
D. Usual Illness in the Family
Fever, cough and cold________________________________________________________
_________________________________________________________________________

What do you do for this condition?

Self- medication (√) Consultation (√)

Hospital () Private clinics ()

Nursing () Others:
E. Other’s diseases
TB () Leprosy ()
Skin disease () Hepatitis () Others:

F. Do you submit your children (0-12 months) for immunization? YES

Name of Child Birthday Immunization

BCG DPT OPV AM
Julius Bravo July 25, 1994 √ √ √ √
Jeanette Bravo November 6, 2001 √ √ √ √

G. Do you practice family planning? Yes () No ( √)

Method: NONE If no, why?

H. Method of infant feeding:

Breast ( √) bottle () Mixed ()

I. Subjects you want to learn in health education:

Drug abuse () Nutrition ()
Family planning () Herbal plants (√)
First aid measure (√) Others: