INTRODUCTION

A family is a group of individuals who needs improvement, enhancement or help with

regards to their health and their environment whether it is stated by the family or
observed by the health worker. The family is a very important social institution, they
have two very important function namely, reproduction and socialization. It is generally
considered as the basic unit of care in community health nursing for many reasons. It
may contribute knowingly or unknowingly to the development of health problems of its
members. It also performs health-promoting, health maintaining and disease preventing
activities. Maglaya (1997). In many cases the family is the locus of decision making on
health matters. It is the source of the most solid support to its members particularly to
the young, the elderly, the disabled and the chronically ill.

A family health care plan is a blueprint of the care that the nurse designs to
systematically minimize or eliminate the identified health and family nursing problems
through explicitly formulated outcomes of care and deliberately chosen set of
interventions, resources and evaluation criteria, standards, methods and tools.

Primary health worker or the nurse formulates a family health care plan for his or her
family client to individualize and focus the care since every family differs from one
another. One may have a problem that is the same with the other but the intervention
may vary due to the different levels of resources available in the family client. The
nursing model for family is that of the individualized care that is focused on the
physical, social and psychological needs of the total family unit. Nursing care
emphasizes delivery of safe , quality care that optimizes family unity. Therefore, family
centered care includes all the family members namely; the spouses, parents, children,
siblings in as many aspects of care and decisions about care as possible. Family
members are an excellent source of patient history and are essential for effective
discharge planning. Information gained from family members is valuable to the care of
the hospitalized patient. The role of the nurse includes listening, advising, advocating,
teaching, encouraging and supporting.

Patient and family centered care is an approach to the planning, delivery and evaluation
of health care that is grounded in mutually beneficial partnerships among health care
providers, patients and families. It redefines the relationships between and among
consumers and health providers. Patient and family centered practitioners recognize the
vital roles families play in ensuring the health and wellbeing of infants, children,
adolescents and family members of all ages. They acknowledge the emotional, social
and developmental aspects which are integral components of health care. They
promote the health and wellbeing of individuals and families and restore dignity and
control to them. Patient and family centered care is an approach to health care that
shapes policies, programs and facility design and staff day to day interactions. It leads
to better health outcomes and wiser allocation of resources, and greater patient and
family interactions.
A nurse needs to formulate a family health care plan for his/her clients to determine
how to prevent, reduce, or resolve the identified problems of the family; to support the
strengths of the family; to implement nursing interventions in an organized,
individualized and goal directed manner.

Formulating a health care plan is not simply a means of working for the family; it is
more on working with the family. In participatory planning, the nurse promotes the
individualization of care to the clients.

We should formulate a participatory family health care plan establishing these following
standards:

1. Involve patients and families in all aspects of the planning delivery and evaluation
of health care services.
2. Recognize families as important members of the health care team. Encourage and
support families in planning of care and decision-making.
3. Support patients in involving their families in their health care experiences in
ways they choose.
4. Welcome family members at all times regardless of rounds, change of shifts or
other events on the units.
5. Encourage and support family members to be present during procedures and
treatment, if this is the preference of the patient.
6. Provide information, in ways that patients and families would find helpful
empowering and supportive in nurturing care giving and decision making.
7. Provide easy and accessible opportunities for patients and families to ask questions
of doctor and nurses.
8. Provide care that respects clients’ values, preferences and expressed needs.
9. Coordinate and integrate the care for the patient-coordinate services (i.e. tests,
consultation and procedures).
At the end of our health worker-family client relationship, we expect the following to
happen: to be able to establish a friendly and trusting relationship with the BANA
family, to be able to establish a friendly and trusting relationship with the BANA
family , to be able to help or at least partially solve the health problems of the BANA
family and to be able to make a correct and comprehensive family healthcare plan
for the BANA family.

INITIAL DATA BASE

A. Family structure, characteristics and dynamics.
The Bana family has a nuclear type of family composed of the father, Mr
RAYAN bana (31y/o), the mother, Mrs vilma Bana (31y/0) and their children,
MR Treba bana(9y0) , Mr Christian Bana (1y/o). They are currently residing at
10 teachers camp, Baguio city. The type of family according to family head,
decision making and bread –earning is patriarchal. The family have
harmonious relationship towards each other and there is no presence of
readily observed conflict between the members. The children respect their
parents and they also help one another when one of them is in need.
B. SOCIO- ECONOMIC AND CULTURAL CHARACTERISTICS:
The family has an income of P15000 a month. One thousand is allotted for
food and the actual expense per month is 5000, 1000 allocated for health,
3000 for education ,1000 for feeding, the excess is saved for future use.
According to the mother, the income of her husband is adequate to meet
their basic needs. As for the educational attainment of the family, the father
finished his college education and the mother also finish her college
education, the first child is currently in elementary school, the second child is
one year old and stays at home. The mother was baptized in Ilocos and the
rest of them are baptized at st.--------------- They do not go to mass regularly.
They are roman catholic. The father is from ILOCOS, and the mother is from
baguio. When they got married, they had already stayed in Baguio, the father
is a office worker and the mother as a house wife.
C. HOME AND ENVIRONMENT
The family generally has a clean environment but has presence of breeding
site for vectors, specifically mosquitoes and the house is located close to the
cliff hence the children are at risk for falls especially that they play outside
the house near the cliff. The house of the family has 2 bedroom single bed,
size of the sleeping bed 6 sq m. The type of materials used for the house is
concrete walls and galvanized roof. The food is stored in a refrigerator, a
medicine cabinet is absent, the keep poisons under the cabinets under the
sink. They are using a gas range with a safety device. There is no stairs
present in the house, they do not have a habit of leaving sockets with plugs
still connected. They always make sure that when they leave, the gas stove is
turned off and all the electric wirings are checked. The family members
always wear shoes when going outside the house and when using the
comfort room. There is no presence of slippery floor. They have a dog
present. The water supply is from Baguio water district, but the source for
drinking is from the purified water delivery. The water is stored in a water
dispenser and the water used for cooking is readily from the faucet. Water
used in the house is boiled. The toilet facility is water system toilet owned.
The toilet has no foul odor, no presence of flies. Garbage disposal is collected
every Tuesday; classification of garbage collection is practiced by the family.
Their drainage system is open and stagnant. Urban is the type of
neighborhood that the family has and the houses has a distance of
approximately 3ft apart, there is presence of broken pipes in the
environment. The area is generally congested. Social and government
facilities that are available are the convention centers.

D. HEALTH STATUS
Mrs. Vilma Bana had pre-natal check-ups done every month of all
pregnancies before on her 1st and 2nd child. She gave birth to all her children
at Baguio General Hospital. All were normal delivery. Presently there is no
sick member of the family. The usual content of their food during breakfast is
noodles and lunch is rice with viands or rice with chicken, during dinner, also
varied viands with two to three cups of rice. They are not smokers but they
consume alcohol occasionally.
E. VALUES AND PRACTICES ON HEALTH PROMOTION/ MAINTENANCE AND
DISEASE PREVENTION.
The children in the family have completed all the immunizations. The
first child received BCG, 1ST, 2ND, 3RD Hep B, OPV, DPT, PCV, PENTA, 1st
and 2nd MMR. The second child received BCG, 1st, 2nd and 3rd Hep B,
OPV, DPT, MMR. Mrs. Vilma reason for submitting her child for
immunization is for protection of her children against disease. She had
a complete immunization for Tetanus Toxoid. Most parent do not know
if they had a complete immunization during their childhood. Mrs. Vilma
is currently using a family planning method IUD. Mrs. Vilma has a 6
hours of sleep a day. Mr. Bana has 7 hours of sleep which is
continuous. The children has a 8 hours of sleep which is only
continuous. Naps are present for all except for the father because of
his work. Mrs. Vilma’s relaxation activity is sleeping and watching TV,
the children also relaxed through watching TV and playing games.
They exercise by walking once a week every Sunday.

IDENTIFIED HEALTH STRENGTHS/ IDENTIFIED HEALTH

PTENTIALS AND NEEDS PROBLEMS
1. Regular exercise Risk for accidental
Subjective: hazards.
 Clients claimed that Objective
they exercise once a  Presence of
week by means of broken pipes
walking. around the house.
 House is located 3
Objective: ft close to a cliff.
 Family looks fit  Children playing
 Absence of obesity in a cliff.
2. Good personal hygiene Presence of breeding
O: and resting sites for
 Clean nails vectors.
 No body odor Subjective:
 Clean clothes  “We have a lot of
mosquitoes and
flies around.
Objectives:
 Open drainage
and stagnant
water.
 Mosquitoes seen
flying around
doors a nd
windows.
PRIORITIZATION OF IDENTIFIED HEALTH PROBLEMS

Health Problem: Threat of cross infection from a community disease r/t

open drainage system.

CRITERIA SCORE JUSTIFICATI COMPUTATI ACTUAL SCORE

GIVEN ON ON
Nature of the condition or 2 The problem 2/3x1= 0.66 0.66
the problem present is a health
threat and
requires
immediate
attention.

Modifiability of the
condition or problem

a. Current knowledge, 3 3/2x2= 3 3

technology and There is no
intervention. adequate
knowledge
about
harboring
infectious
diseases
from their
environment
b. Resources of the 2 . 2/2x2= 2 2
community where the
family lives. There is no
enough
resources in
the
community
such as
steel bars,
cement and
etc. to be
c. Resources of the 3 used to fix 3/2x2= 3 3
family the drainage
system.

The family
has no
enough
financial
support to 1/2x2= 1
1 fund the
d. Resources of the situation to
Health worker improve the
drainage
system.
The nurse
could help in 1/3x1= 0.33 0.33
Preventive Potential 1 terms of
a. Gravity/Severity of man power.
the problem

The family
haven’t 2/3x1= 0.66 0.66
2 experienced
b. Duration of the any diseases
Problem related to
the problem.

All of the
family
members
are risk in
acquiring 2/3x1= 0.66 0.66
2 diseases
such as
c. Presence & dengue,
Appropriateness of malaria, and
current management etc.
initiated by the family 2/3x1= 0.66 0.66
2 The family
observed
d. Exposure of any cleanliness
vulnerable/ high risk of the
group. drainage.

1/2x1= 0.5 0.5

1 Some
members of
Salience the family is
school aged,
infant and
adult.

The family
thinks the
situation
doesn’t
need
immediate
action.
TOTAL 12.47

Health Problem: Accidental hazards related to broken pipes and broken

stairs.

CRITERIA SCORE JUSTIFICATI COMPUTATI ACTUAL SCORE

GIVEN ON ON
Nature of the condition or 2 The 2/3x1= 0.66 0.66
the problem present problem is
a health
threat it
doesn’t
require
immediate
attention.
Modifiability of the condition
or problem

a. Current knowledge, 2 2/2x2= 2 2

technology and There’s an
intervention. adequate
knowledge
and
technology
on how to
fix broken
stairs and
remove
b. Resources of the 2 broken 2/2x2= 2 2
community where the pipes.
family lives.
There is
enough
resources
in the
community
such as
rocks that
can be used
for the
stairs and
only
sacrificing
c. Resources of the family 1 time to 1/2x2= 1 1
remove the
broken
pipes.

The family
can able to
financially
support to
fund this
situation
but with
assistance
coming
from the
community
d. Resources of the 1 especially 1/2x2= 1 1
Health worker man power.

The nurse
could help
in terms of
Preventive Potential man power.
a. Gravity/Severity of the 2 2/3x1= 0.66 0.66
problem

The
children are
b. Duration of the 3 playing 3/3x1= 1
Problem outside the
house.

All of the
family
member are
prone to
0 accident. 0/3x1= 0 0
c. Presence &
Appropriateness of
current management
initiated by the family

3 The family 3/3x1= 1 1

d. Exposure of any haven’t
vulnerable/ high risk done
group. anything to
solve the
1 problem. 1/2x1= 0.5 0.5

The family
Salience members
are school
aged, and
infant.

The family
thinks that
the
situation
doesn’t
need
immediate
action.

TOTAL 9.82

Health Problem: Risk for infection related to presence of breeding site for
vectors

Criteria Score Justificatio Computatio Actual

Given n n Score
Nature of the condition or 3 The 3/3x1= 1 1
the problem present problem is
health
deficit it
requires
immediate
attention.

Modifiability of the
condition or problem

a. Current knowledge, 1 1/2x2= 1 1

technology and They are
intervention. aware on
some of the
programs
and
practices of
DOH such
as
“operation
taob” and
“Sabayang
4 o’clock
b. Resources of the 1 habit”. 1/2x2= 1 1
community where the
family lives. There are
NDP’s that
are going
to the
community
to inspect
every
household
and to
educate
the family.

1/2x2= 1 1
c. Resources of the 1
family
They have
knowledge
needed to
improve 1/2x2= 1 1
1 the
d. Resources of the situation.
Health worker
The nurse
could help
in terms of
knowledge
to educate
the family.
Preventive Potential 1 1/3x1= 0.33
a. Gravity/Severity of
the problem

The family
members
haven’t
experience
d diseased
caused by
2 vectors 2/3x1 2
b. Duration of the such as
Problem dengue,
malaria.

The family
are at risk
1 for diseases 1/3x1= 0.33 0.33
c. Presence & caused by
Appropriateness of infections
current related to
management vectors.
initiated by the They haven’t
family 3 done 3/ 3x1= 1 1
anything to
improve the
d. Exposure of any problem.
vulnerable/ high
risk group. The family
1 members are 1/3x1= 0.33
school aged,
infant and
Salience adults.

The mother
recognized
the problem.

TOTAL 8.99

Complete list of prioritized family problems

Family Problems Score

1. Threat of cross infection from a community disease r/t 12.47
open drainage system.

2. Accidental hazards related to broken pipes and broken 9.82

stairs.

3. Risk for infection related to presence of breeding site for 8.99

vectors