The family is the nucleus of civilization.

”
–Ariel and Will Durant: Wisdomquotes.com

The family is the smallest unit of the society and the natural fundamental core of the
community and consequently, it is considered as the primordial recipient of the nursing effort,
which is contributory to the development, and progress of the community through active
involvement and self – responsibilities of each constituent. It is composed of persons, male and
female, being molded to be as one, working hand in hand to maintain a good atmosphere
among the family members.

A nucleus controls the functions of the entire cell and can be thought as the “command center”
of the cell. The nucleus as well has different components which are all needed in order for it and
the cell to function well, same as with the “commander” or the head of the family and the
members who has different functions within the family.

The impression or status of each family will always affect the status of the community as a
whole. Community health nursing is a response to the health needs of the people. It does not
focus on a particular class or family. It is comprehensive and general in approach. Community
health service is not episodic as it requires continuous observation and monitoring of the
community as a whole. Promotion and preservation of the health of its different clients
(individual, family, group or community) is the primary goal of community health nursing.

Conducting a family case study is a means by which we Nurses reaches and feels the community
through its basic structure – the family. It is a tool in determining the health status of a family
through assessment and critical inspection. Through this, health related problems are identified,
thus giving us Nurses a hint on where to act and how to intervene. It is also a means towards
improving the health of the community people, making them more productive. To come up with
a family case study gives a sense of fulfillment to share our skills, knowledge and time to
alleviate and uplift the living condition of a family.
 INITIAL DATABASE

A. Family Structure, Characteristics, and Dynamics

Position in the
Name Age Sex Civil Occupation Educational Attainment
Family
Mr. Z 30 Male Married Father Farmer Elem. Level
(Grade 3)
Mrs. Z 29 Female Married Mother Housewife Elem Grad
(Respondent) (Grade 6)
Child 11 Male Child Eldest Child Student Elem. Level
AZ (Grade 5)
Child 10 Female Child Second Child Student Elem. Level
BZ (Grade 4)
Child 7 Male Child Third Child Student Elem. Level
CZ (Grade 3)
Child 5 Female Child Fourth Child Student Elem. Level
DZ (Grade 1)

The Family Z is considered as a nuclear type of family. A nuclear type is a typical type of
family composed of a father, a mother and child/children. This type of family structure is found
in almost all societies, although the length of time in which the family remains in this form
varies even within the same society.

The nuclear family can be a nurturing environment in which to raise children as long as
there is love, time spent with children, emotional support, low stress, and a stable economic
environment. In nuclear families, both adults are the biological or adoptive parents of their
children (Jay C, 2004,).

The Z family resides in Purok Six (6), Cabungaan B, Laoag City. They have started living
there since May 2009.

Mr. Z and Mrs. Z go hand in hand in terms of decision-making. They consult each other in
terms of planning and budgeting for their family. They discuss matters concerning their
children’s schooling financially and also with regards to the emotional problems or aspects
within the family. When problem arises, they make sure that both of them will handle and solve
the problem. But then, in terms of matter concerning health Mrs. Z is more dominant. She
makes sure that she will comply with the appropriate regimen when certain health issues arise.
She has greater awareness concerning health matters compared to Mr. Z since of course
believing it is her duty as the mother. These health matters include immunization, feeding the
right food and caring for the sick member.
B. Socio-Economic and Cultural Characteristics

The Z family’s main source of income is coming from Mr. Z’s farming. Mr. Z earns about
Php 6,000.00 a month. Since Mrs. Z does not work, she is in charge of the house and in taking
care of the children. Mrs. Z budgets the money in terms of food, education and miscellaneous
where clothes, shoes and slippers comes in. Out of Mr. Z’s earnings, most of it goes to the
family’s budget for food. The education of the children is free and they can walk from their
house to the school so only some school supplies are being bought. Usually, there is nothing to
be left for the miscellaneous expense.

With Mr. Z’s monthly income, the family strives hard to accommodate everything they
need for them to live. According to NEDA, each individual should at least have Php 2768.60
when the total monthly income of the family is divided among the total family members. The
total monthly income of Mr. Z is about Php 6, 000.00 and when divided among the 6 members,
it is only Php 1, 000.00, thus, they can be considered poor. Mrs. Z also informed that they do not
have any financial assets at hand in case of emergency. They typically borrow money from their
relatives.

Mr. Z works as a farmer, he works from 3 am until 8 pm everyday. He seldom goes home
but rather stays in the farm, which is situated far away from the family’s house. Mrs. Z doesn’t
work and stays in their house. She is the typical housewife where in you can see her wash
clothes, prepare food, sweep the yard and make the house clean.

All of them are affiliates of Protestantism. Mrs. Z mentioned that they do not go to
church anymore since they have lived in Purok Six (6) for the reason that of the distance they
have to travel from their place to the church.

Significant others are called such due to their own role in one’s life. They are the ones
very close to a person or group of persons. For family Z, the significant others in their lives are
their relatives and some neighbors. They usually run to their relatives if they face hardships and
problems. Mrs. Z also confirmed how helpful and welcoming her neighbors are with them.

The Z Family barely enjoys the community resources since the community itself lacks
resources. The children, though, go to Cabesa Elementary School. The father is usually in their
farm while the mother is in the house doing household chores. The family uses the irrigation
nearby as their means of water source in washing their clothes. There is also a shallow well built
within the irrigation where the family gets their water source for drinking if they get lazy in
getting water from the faucet, meters away from their house.

C. Home and Environment

The house is made of wood, mostly bamboo. Mrs. Z did not know the exact
measurement of their house. Her husband knows it yet he was not there during the interview.
In order for the house to be considered as adequate, the total floor area should be divided
among the total members of the family and each should at least have 3.5 m 2.

The house only has 2 windows and can sustain the adequate ventilation needed by the
family. Mrs. Z told us that their house is usually “presko” since it is beside the irrigation and the
air goes to and fro freely inside the house.

The house has 2 rooms. The one is the sala/dining room and the other is the bedroom,
with no bed at all. Mr. and Mrs Z, together with the children, sleep in one room. They use
“banig” in sleeping.

The Z Family has only one appliance which is the radio powered by batteries since the
place has no electrical supply yet. In terms of garbage disposal, they either bury or burn their
garbage.

Mrs. Z uses wood and charcoal in cooking. She is the one who prepares the food. She
cooks inside the house at the back portion. The foods that they usually eat are fish and
vegetables. The family uses plastic plates and stainless spoons in eating. When it comes to
storing their food, they just cover it with a plate. In terms of cooking facilities the family is equip
with pots, “sandok”, and knives.

The irrigation is the family’s main source of water and sometimes they will go through to
their neighborhood deep well. They wash their clothes and get their drinking water supply
there. They put their water in a big container with cover. They usually don’t sterilize their
drinking water supply.

Z Family has no comfort room. They usually urinate and remove bowels anywhere near
their house. They have not yet built their own comfort room since, according to Mrs. Z, because
they don’t have enough budget for it.

The drainage system of the family is an open type where in the drainage flows anywhere
and is continuous. It is dirty and has a stinky smell. There is some rice grains noted. There is no
obstruction present at the drainage system since it is open and flows anywhere.

The family does not own any transportation facilities. They ride on a jeepney or truck in
going to the city proper.

The family has one chicken and a dog. There are vegetables planted near the house.
D. Health Assessment of Each Family Member

D1. PAST AND PRESENT ILLNESS

1. Health Assessment on Each Member
A. Mr. Z – According to Mrs. Z her husband has never undergone immunizations at all since
it was not that important before. A 5’4 tall and weighs about 55 kilograms. His BMI reveals
normal weight with a value of 20.8. In addition, her husband has no genetic or hereditary
illness known. He is not a smoker. He drinks alcohol rarely since they have no budget for that.

B. Mrs. Z – She has no degenerative, chronic, or infectious diseases as of the present time.
She has also not completed immunizations. When she was still 4 years old, she experienced
chicken pox. She is 5 feet and 3 inches and weighs 60 kilograms. Her BMI reveals normal
weight with a value of 23.4. She has no complaints as of the present time and has not taken
any medications as of the moment. At times of illness, she would just drink Paracetamol for
fever and Mefenamic acid for pain or treat wounds with crushed plants coming from their
backyard. The family is not using family planning anymore.

C. Child AZ – has no any degenerative, chronic, or infectious diseases as of the present

time. He has not completed immunizations. He is 4 feet and 10 inches and weighs 38
kilograms. He likes to eat vegetables and fish.

D. Child BZ –has no any degenerative, chronic, or infectious diseases as of the present time.
She has not completed immunizations. She is 4 feet and 7 inch tall and weighs 36.5
kilograms.

E. Child BZ –has no any degenerative, chronic, or infectious diseases as of the present time.
He has not completed immunizations. He is 4 feet and weighs 33 kilograms.

F. Child DZ – has no any degenerative, chronic, or infectious diseases as of the present

time. She has complete immunizations. She is 3 feet and 11 inches tall and weighs 17
kilograms. She appears thin. This child has many allergies and there are rashes still seen on
her legs.

FAMILY ASSESSMENT BASED ON FUNCTIONAL HEALTH PATTERN

1. Health Perception-health management patterns

 With no known vices like smoking and drinking except for Mr. Z who drinks alcohol
rarely.
 Was able to recognize the importance of having a healthy well-being.
 Uses herbal plants, though not approved by the DOH, from their backyard

2. Nutritional-metabolic pattern
  Do not take any food supplements or vitamins
 Daily food intake is mainly rice, fish and vegetables
 Children eat junk foods whenever they were given money
 Children have poor appetite according to Mrs. Z

3. Elimination pattern
 Eliminates everyday with an average frequency of urine: 5 times
 According to Mrs. Z, all of the family members have no difficulty in voiding.
 The family members defecate every day and with no difficulty in defecating noted.

4. Activity-exercise pattern
 Family preferred to stay at home and take a nap if they have free time while their
children play with other children in the community after class.

5. Sleep-rest pattern
 Family usually has 7-8 hours of uninterrupted sleep according to the mother.
 They usually sleep at around 9 in the evening and wake up at around 4 to 5 in the
morning.
 They also take a nap at free time.

6. Cognitive-perceptual pattern
 Was oriented to time, place and is able to identify people and significant others by their
first names.
 Was able to respond accordingly and correctly to questions. Retaliates as soon as he can
and was able to rationalize. Verbal pattern and spontaneity normal
 Memory intact
 No sensory defects

7. Self-perception/self-concept
 Showed apprehension and worry towards unspecific consequences.
 Perceived situations (health deficits) to be very stressful but remain passive about things
and condition.

8. Roles and relationship

 Family members have an open communication and able to discuss their problems
according to the mother.

9. Coping Stress
 Gains strength in the “assurance and guarantee” provided by family members.

10. Values/ Beliefs Pattern

  The family is Protestant in faith. Expressed great belief and faith in God. Is certain that
the Divine providence would protect them from any unidentified and possibilities of
harm.
 Does not go anymore to church since they are situated far away from the place of
worship they attend.

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

The children in the family has not all completed their immunization. All the children in
the family were dewormed last March 2008.
The family has adequate rest and sleep. They sleep early and wake up early, the usual
time of sleeping is 9pm and they wake up at around 4 to 5am. Mrs. Z stated that farming, doing
the household chores, and walking are their ways of exercise. The father is in the farm. The
mother usually does the household works and talks with the neighbors during free time. The
children are either in school or are playing with other children in the community.
The mother recognizes the importance of health in the family, however, because of
financial constraints made them ignores any major health problems that may arise.
Furthermore, they were not able to sustain sufficient supplies of medication or articles which
they would need related to their health care needs. They often use alternative medicines or
herbal medicines for treating their illness and habitually self-medicate if OTC medications are
available. The family believes in the power of herbal plants. They occasionally use herbal plants
lodged near the house in treating diseases or symptoms in the family since their transfer from
Nurallah. Mrs. Z said that she had no choice but to use these plants for the reason that the
barangay health center is far away from their home. But if the symptoms manifested by the
family member become severe, they immediately go to the health center or to the hospital.

FAMILY COPING INDEX

Rating

CRITERIA IDEAL ACTUAL JUSTIFICATION

The members are all

1. Physical Is concerned with ability to able to move without 5 There are no abnormalities
Independence move about, to get out of assistance and in the physical
bed, to take care of daily difficulty. They do independence of the family
grooming, walking, etc. their activities of daily members. Every member
living without aid. has no noted disabilities or
They are independent disparities in moving and/or
in moving about and doing their ADL.
using their
musculoskeletal
system.
2. Therapeutic Includes all of the The parents are aware 3 The parents are aware of
Competence procedures or treatments on what to do if a their lapses in therapeutic
prescribed for the care of member fells ill. competence. They are
illness such as giving However, due to sentient of their financial
medications, using financial problems difficulties, which is the
appliances, dressing, and distance of the primary reason for not
exercise, relaxation, special health center, they having or following the
diets, etc. cannot provide appropriate procedure or
enough and/or treatment, having
appropriate appliances and even enough
interventions. clothes for the children.
Although, they use
herbal plants, those
plants are not
approved by the DOH.

3. Knowledge Concerned with the The mother is 2 Though the mother

of Health particular health condition knowledgeable on recognizes pertinent health
Condition that is the occasion for care salient health issues issues, she does not regard
such as knowledge of the and responsibilities. it as important at all. This
disease or inability to Yet due to financial could be detrimental to the
understand problems, health lives of the members
communicability of diseases issues are overlooked. especially the children.
and mode of transmission.
Understanding the general
pattern of development of
newborn baby and basic
needs of infants for physical
care.

4. Application Concerned with family The family sleeps well 2 Even though aware of
of Principles of action in relation to and eats nutritious hygiene’s importance, the
General maintaining family food everyday. But family does not practice
Hygiene nutrition, securing their source of water good hygienic skills. Yes they
adequate rest and is not healthy at all. take a bath everyday but
relaxation for family They do not practice their source of water, eating
members, carrying out sterilization nor habits and maintenance of
accepted preventive healthy habits in food healthy lifestyle are not
measures (immunizations, storage and taken into consideration that
medical appraisal, safe preparation. much.
home-making in relation to
storing and preparing of
food).
5. Health Concerned with the way
Attitudes the family feels about
health care in general,
including preventive
services, care of illness, and
public health measures.
6. Emotional Has to do with the maturity
Competence and integrity with which the
members of the family are
able to meet the usual
stresses and problems of
life, and to plan for happy
and fruitful living. The
degree to which individuals
accept the necessary
disciplines imposed by
one’s family and culture.
The development of the
individual’s responsibilities
and decision. Willingness to
meet reasonable
obligations, to accept
adversity with fortitude, to
consider the needs of
others as well as one’s own.
7. Family Living Concerned with the
interpersonal or group
aspect of family life. The
family members get along
with one another, the ways
in which they make
decisions affecting the
family, the degree to which
they support one another
The parents are 1 Parents, as much as
concerned about the possible, want to protect
health of the their children from any harm
members of the family but then, they lack money
yet they do not and information for them to
participate actively in carry out the right health
maintaining optimum care for the family
health due to financial
constraints. Also, the
family lacks
information regarding
healthy lifestyle and
healthful ways toward
improvement of life.
The family are 5 The family lives
competent enough harmoniously at home. Even
emotionally. They see though conflicts arise, they
stress just like any really see to it that they
other family does. The would discuss each concern
parents take in a calm manner.
responsibility for the
children. They
discipline them and
teach them the morals
of life.
There is high concern 3 Others respect individual
within the family, relationships of each
especially with member of the family.
regards to their Decision-making is shared
interrelationship with among its members except
others. The parents on young member. Each has
discuss decision- his or her own part or role in
making. the family, which is well
respected.
 and do things as family, the The children are not
degree of respect and yet open for
affection, and the ways in suggestion to
which they manage the decision-making since
family budget. they are still young
and difficult to
comprehend their
current situations.

8. Physical Concerned with home, the The family’s house 2 The house environment is
Environment community and work space is not good not fitted for them
environment as its affect enough for the family. especially for the children,
family health. The condition There are presence of because of the presence of
of the house such as insects, rodents and pests and accident hazards
pressure of accident other vectors. Their in their community. Also
hazards, screening, house is also located their house is in poor
plumbing, system, facilities near a creek. They condition, that they can
of cooking, privacy, level of cook their food possibly acquire serious
community (deteriorated outside their house diseases. Their food storage
neighborhood, presence of wherein they just use is unsanitary. Though it is
social hazards, pests), earthly pot and used covered with cloth,
transportation of schools wood as fuel. Also a sometimes insects and other
and availability. nail attached on the small animals could crawl
wood on inverted inside the dish organizer.
position was noted. Also, the cloth that they
Bottles of liquor and used was dirty. The storage
decomposing woods of water has a cover, but it is
were noted as well. still unsanitary due to the
They live in a place presence of dirt on the
wherein it’s not outside of the container.
congested but then Having a early pot near the
the distances between house is really a fire hazard
their neighbors are because some of the coal
not that so far from fire might come in contact
each other with their bamboo wall and
the nails attached to wood
gives the possibility that
some of their family
members might stepped
into it.