Makati Medical Center – College of Nursing

SY 2015 – 2016

A Case History of a Family with a One Month Old Infant Living Within Inadequate Living Space

In Partial Fulfillment of the Course

Requirement of NCM101 – Related Learning Experience

Submitted To:

Ma’am Shangri-La Juan I

(College of Nursing)

Submitted By:

Kristoffer Villa

BSN II-A

Group I

July 29, 2015

Table of Contents

Chapter I

I) Introduction…………………………………………………………………………. P.3

II) Purpose……………………………………………………………………………… P.4

III) Objectives…………………………………………………………………………… P.5

IV) Significance of the Study……………………………………………………….. P.6

V) Scope and Limitations……………………………………………………………. P.7

VI) Background of the Study……………………………………………………….. P.8

Chapter II

VII) Review of Related Literature……………………………………………… P.9 - 11

Chapter III

VIII) Client Presentation…………………………………………………………… P.12

Chapter IV

IX) Bibliography……………………………………………………………………… P.13

Introduction

Community Health Nursing (CHN) is one of the two major fields of nursing in the Philippines. It’s a synthesis of nursing knowledge and practice and the science and practice of public health, implemented via a systematic use of the nursing process and other processes to promote health and prevent illness in population group. Also, CHN is the totality of its philosophy and beliefs, principles, processes and standards. As one of the subsystems, its influences and is influenced by the health care delivery system. (Maglaya, 2009)

Also Community Health Nursing is a type of nursing field that combines the primary health care and nursing practice with public health nursing. The community nurse conducts a continuing and comprehensive practice that is supposed to prevent the problem of the individual, cure the problem/condition of the patient that is too poor to afford a proper hospital setting, and lastly to rehabilitate the injuries the individual has acquired. Its Philosophy of care is based on the belief that care is directed to the individual, the family, and the whole community contributes to the health care as a whole.

What is a community? A community is a group of people sharing common geographic boundaries and/or common values and interest within a specific social system. This social system includes health system, family system, economic system, educational system, religious system, welfare system, political system, recreational system, legal system and communication system. (Maglaya, 2009)

What is a family? From a systems perspective, a family is defined as a collection of people who are integrated, interacting and interdependent (Maglaya, 2009). Just like other systems, the parts (family members) interact with each other and the action of one affects the other members. The family has a boundary which means that other people can recognize its members and those who are not. (Maglaya, 2009)

The family that I have used for this Case History is a nuclear family living with an extended family arrangement. They reside in a barangay named Pio Del Pilar. The Acuña family lives in a two story house that has an unconducive environment in regards to ventilation, space, and cleanliness. The inhabitants are the following: the grandmother, the mother, two children, a one month old infant, and two uncles. While the father on the other hand is working overseas in China. In addition to this, they have some borders that rent out rooms. They also have a variety of pets such as dogs, parrots, and cats. Furthermore, it was seen that there were some vectors identified. Some of which were lice on the dogs and cockroaches in the home.

Purpose

The researcher’s motivation or intention for overseeing and managing this type of study is to primarily determine the well-being of the 1 month old female infant. This would also include the two siblings residing in the home. One is an eight year old male and the other is a 10 year old female. The determination of the well-being of the infant and children is significant to be able to pinpoint some problems that may identified that can affect their health, growth, and development. In effect, these problems can first be identified by the student nurse, then improved or resolved by the cooperation of the family.

Some of the problems that was seen to be of importance was the issue of an unconducive environment and living space of the family’s home. Their house is a two story floor with two bedrooms, one bathroom, a kitchen, and a living room. However, there are ten people living in this cramped area.

Aside from the cramped living space, they also have an issue with vectors running rampant. These would include dog lice and cockroaches. This would be important because this could be a source of bacteria and sickness to the inhabitants. For example, the family had mentioned an unrecalled skin disease that they had all acquired including the infant. The cause of the spread of the skin disease was not identified. This is a prime example why this type of environment will be high risk in acquiring different diseases. It makes the infant and children extremely susceptible. Furthermore, hampering their well-being.

The researcher will be teaching the family the proper ways to have an acceptable living environment to raise the children. This would be to prevent any rise of disease or vectors that will be source of contamination or infection.

In addition, this study would also allow the community know the importance of having an adequate living space and environment for their family to thrive in.

Objectives

The following objectives are listed below:

1) Problems that led to the development of the Health problem

Inadequate living space for 1 month old infant Risk for sickness due to unsanitary living space Vectors running rampant around the family’s living space Pets have foreign contaminants The lighting in the household is dim

Lately they have been healthy in the family household but in their past history the mom said they all acquired a disease that has left marks on their skin when it went away.

2) Interrelationship of the variables that led to the development of the Health problems and Family Nursing problems:

The interrelationship of the inadequate living space is where the beginning of the problems will start to manifest along with the house not being able to have proper airway circulation. Because of this the household has been inadequate to live due to a lot of the family’s things are just being put onto anywhere and or is stacked together in one spot of the house until it starts to grow. Thus the vectors has made this there home due to the family just leaving the things they own unattended. And also for the fact that they own animals that are also unclean since they are harboring foreign contaminants such as lice’s, and ticks.

3) For the family’s problem the appropriate nursing interventions would be to help them have the proper health environment for the children to thrive in. Such as

House management and cleanliness ( to rid of the unnecessary objects in the household)

Proper airway ventilation (Windows must be open so air from the outside will be able to get inside the house and replace the stale air)

Pet management (To inform them about the health care of having pets and also the benefits of taking the pet to a veterinarian)

4) The family’s response was positive. They have quite an understanding of the problem and will respond to it as soon as they can. As well as too take care of the unnecessary objects in the household.

Significance of the Study

The conduct of this study can contribute to the following individuals and community:

First and foremost would be the inhabitants of the home. They would benefit from this study because it will shed light to the problems that were seen in their home. Through this, they may all be more aware of what is conducive and unconducive for them to live in. In addition, the family may initiate problem solving and implementation to resolve the identified problems. And they may also be encouraged in partaking in an initiative in improving their lifestyles, health conditions, and well-being.

In the case of the Acuña family’s problem is important because with poor house conditions predisposes them to a large variety of health conditions. These may include respiratory infections, difficulty of breathing or asthma, lead poisoning, injuries, and even an impairment of one’s mental health status.

Next, the infant and children may benefit from this study by allowing their caretakers to recognize and expand their knowledge on the infant’s and children’s necessities such as health issues. Since they are at a stage where many aspects are crucial for them to grow up, it can provide significance to their health status, growth, and development.

Another entity that can contribute to this study could be the community. They may further improve and develop their programs and laws that help and focus the families’ necessities to thrive in a healthy environment.

Scope and Limitations

In this section states the scope or boundaries of the study. The scope of this study is the family with a one month old infant living within inadequate living space. It will be limited to the nuclear family living with an extended family household arrangement.

The researcher will conduct this study in the Barangay named Pio Del Pilar which is located in Makati City. The data was obtained on the following dates: July 6-8, 13-15, 20-22, and the 27th. The time frame of this study was from the start of CHN duty (July 6th) at the Barangay to the 27th of July.

The data sources that were used originated from the family members. Also the interview done had open and closed ended questions to further give knowledge about their living situation to the researcher.

The limitations that were beyond the researcher’s control was the family’s lack of memory on some particular information. For some of the questions in the interview, they were not all answered thoroughly because they were unable to recall it. Another thing that was out of the researcher’s control was the family’s educational standing. In consequent, sometimes they would not know the rationale or may be confused or even have a different perception on some aspects. Due to the mentioned limitations, restrictions must be placed on the study.

Some weakness or shortcomings that were noted in the study were the following:

It involved the researcher’s lack of proper time management. This was due to the fact that he must accomplish prior responsibilities of the other patients at the health clinic before he may visit his given family. The lack of time management could be a result of an influx of demands at the barangay’s health clinic which could be many patients needing attention to the paper works that must be accomplished.

Another issue that posed to be a potential barrier was the researcher’s insufficient Tagalog. This may lead to some misinterpretations and difficulty in communicating and understanding on both parties.

Lastly, another weakness could be the time constraint again, but on the part of the researcher’s assigned partner. For him to fulfill his duties, he must wait upon his partner to finish her responsibilities first.

Background of the Study

In the community that the Acuña family resides is a Barangay called Pio Del Pilar. In this area there are services that are being provided for its residents. These services would include the following: Health, Education, Transportation, Communication, Leadership, Peace and Order, and Economy. Within the aforementioned services there are allotted budgets for each sector. This is important so the projects, events, and other necessities / resources for the services can be carried out and be given to the people living in Pio Del Pilar.

As for the health purposes, in the barangay they have a health clinic that is accessible to the residents. At the health clinic the people may go there for routine checkups, obstetric checkups, consultations, administration of immunizations and/or other medications.

Next, for educational purposes, the Barangay shows an importance in the schooling of the children. There is an elementary and high school that the students can attend.

In addition, the transportation that they use on a day to day basis can range from jeepneys, tricycles, bicycles, motorcycle, or a vehicle.

Then for communication and gathering information, they use cell phones, television for the news, and also the newspaper.

Also Pio Del Pilar has outstanding leaders that range from Budget and Finance to Bids and Awards committee. These leaders are essential in guiding and motivating its people to a certain goal of the Barangay. While the Public Order and Safety is responsible for maintaining peace and harmony within the streets and homes. This area is patrolled and monitored for the better good of its residents. Ever since Pio Del Pilar is recognized to be a place with a lesser extent of crime in the residence of the people.

As for the economy, they have been doing well with the circulation of monetary. There are many shops, stalls, and restaurants that are available.

Barangay Pio Del Pilar is also known with another name which would be “Culi-Culi.” This particular name was coined because there was once an enormous rice field where fruits and vegetables were planted and sown. Although Culi-Culi was not classified as a horse ranch, it had more than 100 horses that were used to service “Calesa” or “Karitelas”. This is what the travelers or visitors would use for transportation.

Culi-Culi was later renamed after the hero named General Pio Del Pilar, who lived in a placed located at J. Victor Street corner, Jacinto Street.

My reasons as to why I chose the Acuña family was because I was interested in the one month old baby that I was assigned to. Another reason was because I also wanted to discover the type of environment that the one month infant was exposed to. By implementing the nursing interventions may be able to help the family with the identified problems.

Review of Related Literature

Health Promotion

In defining the term, health promotion, there are three terms that are closely related which is primary prevention, health protection, and illness prevention. Prevention is defined as a means of avoiding a development of a disease. Now the levels of prevention occurs at different stages. These is were primary, secondary, and tertiary prevent come in. There are five steps that describe these levels: Primary prevention emphasizes on (a) health promotion, (b) health problem protection. While secondary prevention is targeted on (a) early health problem identification and (b) timely interventions carried out. On the other hand, tertiary prevention is focused on the restoration and rehabilitation of an individual’s level of function.

There exist many health promotion programs that facilitate its offering such as health promotion, definite protection, and screenings for diseases. In the community, the local department specifically for health may also offer immunizations and other safety measures. (Berman and Snyder, 2012)

Home Care

Within home care may include a diverse population that encompasses a range of ages, health issues, family structures, and cultural backgrounds. Some important dimensions would be safety and infection control.

Firstly, safety is a key component in preventing injuries. The most commonly encountered cases would be falls, fire, poisoning, and other accidents. Although the home health nurse cannot be expected to alter a family’s living space and lifestyle, they can encourage their concern and provide an intervention that can help improve the living conditions of the family. Some areas to assess is the environment of the home. This could include the following:

- The walkways and stairways (inside and outside) whether they are uneven, broken, of an absence of handrails.

- Floors can be noted if they are uneven or slippery.- Bathrooms can be noted if there is an adequate night lighting or ease of

accessibility and cleanliness.- Kitchen can be noted if there are any repairs needed to be done.- Bedrooms if there is an adequacy of lighting, ease of access to the commode- Electrical if there are any frayed electrical cords and outlets that are

overloaded.- Communication devices are noted if they have an access in case of

emergency.- Medications if some are beyond their expiration date and method of disposal.

Secondly, for infection control can present to be a challenge especially if the home care facilities are not conducive to basic aseptic requirements such as basic

running water. Hygiene poses an importance in preventing the spread of microorganisms. These would include hand cleansing, wound cleaning, etc.

Lastly, in the home some health issues must be established. These could be inadequacy living space, lack of cleanliness, or inadequate air circulation. One of the most commonly experience issues however would be the family’s lack of knowledge in regards to health control and self-care. (Berman and Snyder, 2012)

Family Health

In a society, a family is a basic unit that consists of indiviuals who may or may not be genetically related. Family health is centered on the consideration of the entire family’s health status as a whole along with each family members. The functions of the family is to secure economic resources, defending the health by giving food and shelter.

There are different types of families in today’s society. They are comprised of the following:

- Traditional family- Two-career family- Single-parent family- Adolescence family- Foster family- Blended family- Intragenerational family- Cohabiting family- Gay and Lesbian family- Single Adults Living Alone

On to another note, by applying a theoretical framework, helps promote the health of the individuals and families. This will also aid in determining the family’s level of function, interaction / communication patterns, pinpoint their strengths and weaknesses, and describe their health statuses. (Berman and Snyder, 2012)

Pest / Infection Control

There are four major categories of microorganisms that cause contamination in humans: bacteria, viruses, fundi, and parasites. All of which could be carried by several hundreds of species that can create problems. They can live and be transported via the air, water, food, soil, body tissues and fluids, and inanimate objects. They could also live on living organisms that can cause malaria, worms, and arthropods such as mites, fleas, or ticks.

For microorganisms to be spread there are many different types of methods of transmission:

- Direct- Indirect (e.g. vehicle-borne, vector-borne)

- Airborne

Furthermore, there are also factors that increase the susceptibility of infection these would include age. The reason being because newborns and older adults have a lowered immune system to defend against infections. The major cause of infant mortality would be credited to infection because they still have an immature immune system and is only protected by their mother’s immunoglobulins for the first two to three months. However, immunizations can be given to help boost their immunity by preventing different ailments. (Berman and Snyder, 2012)

Client Presentation

In this section will be the description of the selected family client who is the one month old female infant. MORE

Discussion of the significant individual findings of the family members currently living the

same household:

The father Jerry Yu is currently overseas at work

The mother FlorDeliza Acuña is an accountant and a college graduate, but is

currently a stay at home mom.

The grandmother was a 6th grade graduate and her line of work would be a tailor

making dresses

The brother Constantino Acuña owns and sells birds as a living as well as

owning a shop and also a college graduate

The other brother Benji Acuña works with the brother and a college graduate

The 8 year old brother along with the 10 year sister are both going to elementary

school within the Barangay Pio Del Pilar.

Discussion that includes the prioritized Health Problems:

Inadequate living space for 1 month old infant

Risk for sickness due to unsanitary living space

Vectors running rampant around living space

Pets in household are carrying foreign contaminants

The lighting in the household is dim, may cause injuries.

The Nursing interventions given to the patient’s family has been met. The family have

understood the dangers of the health problems that were listed and are working to rid of

the problem as to not cause any Health issues later on.

Bibliography

Berman, A., Snyder, S. (2012) Kozier and Erb’s Fundamental of Nursing Concepts, Process and Practice. Ninth edition.

Pearson Education, Inc. New Jersey. United States.

Maglaya, Araceli S. (2009) Nursing Practice in the Community. 5th Ed.

Argonauta Corporation. Marikina City. Philippines.