Typology 42

8/2/2019 Typology 42

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CHAPTER IV

Family Coping Index

This chapter presents the Family Coping Index. Family Coping Index provides a

foundation for estimating the nursing needs of the family and includes 9 cues that can help us

rate the familys ability to cope according to the different criteria set forth in the said index.

Table 2. Family Coping Index of Family Duque

CRITERIA IDEAL ACTUAL RATING JUSTIFICATION

Physical

Independene

This category is

concerned with

the ability to

move about, to

get out of bed, to

take care of daily

grooming,

walking, etc.

The causes ofdependence may

vary; lack of

physical

independence in

the family may

be due to actual

physical

incapacity.

The children in the

family are

physically

dependent in terms

of personal

grooming and

hygiene. While it

is true that the

mother tends forthem, the personal

hygiene and

grooming is not

given much

attention. The

children were left

to fix their hair and

change their

clothes and left to

study on their own.

3 The rating for this

criterion is 3

because all of them

are capable of

delivering their

assigned chores

except for some

grooming needs of

the children like thecutting of nails, the

cleaning of ears and

the brushing of teeth

where the kids are

unable to efficiently

put into practice yet

given their young

age. These are some

of the areas where

the children still

need assistance

from their parents.


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Therapeutic

Competence

This category is

concerned with

the knowledge

of the

procedures or

treatment

prescribed for

the care of

illness, such as

giving

medications,

dressings,

exercise and

relaxation,

special diets, etc.

The mother in the

absence of

medication at the

health station

would always

prefer to seek the

services of the

hilot for simple

fevers, cough and

colds of the

children. For Mr.

Duques diagnosed

TB, they utilized

the free

medications given

by the barangay

health stations and

finished the course

for 6 months.However, they

failed to have a

follow-up x-ray

taken due to lack

of financial

resources. They

religiously take

their afternoon

siesta after their

favorite noontime

show in TV. The

household chores


criterion is 3

because even if the

parents are looking

for ways to address

the illness in the

family, they seek

instead the service

of an untrained hilot

or utilized herbal

medication other

than bringing their

concerns directly to

the barangay health

station in their area.

The fathers vices

(drinking, smoking

and cockpit derby)

are viewed as meansof relaxation or

diversion from the

daily grinds of

living. The ill-

effects of drinking

and smoking were

known but they do

not realize the

seriousness of the

longtime effects of

these vices in their

body. The family


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and the walks

taken in the fields

were considered as

their form of

exercise.

never practiced

isolation of sleeping

area or separating

eating wares of Jun

who has an active

PTB before

treatment and the

weeks following

treatment where he

was still highly

infectious. Mrs.

Duque was more

concerned on the

ostracized feelings

of Jun than the

potential danger it

poses to her and

their children.


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Knowledge of

Health

Condition

This category is

concerned with

the knowledge

of the disease or

the inability to

understand

communicability

of the disease

and modes of

transmission,

understanding of

general patterns

of development

of newborn baby

and the basic

needs of the

infant for

physical care.

The mother claims

that whenever the

children are sick,

she would resort

first to a hilot if

they do not have

money to buy the

medicines. They

self-medicate for

simple fever,

cough and colds.

She utilizes banaba

leaf for hampol

(usually placed on

the forehead and

believed to absorb

the heat from the

body). She would

also preparecalamansi nectar

for cough (directly

squeezing a mature

calamansi juice

around a

teaspoonful) and

administers it for

cough. They did

not isolate Jun for

fear that he will

feel ostracized

inside their house.


criterion is 1

because regardless

of the health

teachings they got

from the barangay

nurse regarding the

infectiousness of

Jun, they were

unable to apply it in

the household

because of lack of

knowledge about

the nature of the

disease and how it

can be transmitted

from one person to

another and the

gravity the diseasecan bring to others

especially to his

household

members.


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Application of

Principles of

General

Hygiene

This category is

concerned with

family action in

relation to

maintaining

family nutrition,

securing

adequate rest

and relaxation

for family

members. Also,

the familys

ability to

maintain

cleanliness with

their bodies and

the

surroundings.

Meals are well-selected. Habits

of sleep and rest

are adequate.

The family is used

to walking

barefooted

anywhere along

their neighborhood

except Mrs.

Duque. They are

not particular of

how they look and

how they smell.

They can cut nails

if they can borrow

a nail cutter from

their neighbor. The

children love to

swim in the pond

where the carabao

takes its bath not

far from wherethey are. Their

meals usually

consist of rice or

cassava if rice is

no longer available

and affordable,

tilapia fish from

the pond, and

vegetables from

their backyard.

Dried fish whet

their appetite and


criterion is 1

because the family

members has

problem regarding

general hygiene;

from personal

hygiene to

environmental

hygiene. Food

intake can be

adequate at times

but lacked the

quality of proper

and good nutritional

value. Personal

hygiene in general

is not among their

concerns. Infact, asyou enter their

house, a pack of

clutters in

assortment will

shock you from

farming gears,

school items, soiled

clothes and linens

interlacing with

newly laundried

ones and cobwebs

of all sizes


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satiates them

especially at lunch

time where they

eat more. They

have no proper

place for storage of

left over foods

because they

seldom have

leftover foods,

Mrs. Duque

claimed. They

sleep soundly at

night inside a

mosquito net.

Their sleep is

disturbed only on

rainy seasons

because someportions of the roof

leaks and they

would open an

umbrella atop the

net according to

Mrs. Duque and

place some

collecting pails to

areas with bigger

leaks.

decorates their

ceilings. The family

is not also keen in

observing personal

hygiene. They let

the children bath on

their own. They

allow them to roam

around the

neighborhood

barefooted. They

are not really so

meticulous with the

way they discard

their wastes. They

simply sweep the

area directly around

them but they dont

mind heaping themup nearby. As air

and some dogs

scatter the contents

of the heaps of

garbage, sharp

litters are being

carried out to where

the children usually

play. Mosquitoes

were all over too in

some of the clothing

idly set aside.


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Health

Attitudes

This category is

concerned with

the way the

family feels

about health care

in general;

including

preventive

services, care of

illness and

public health

measures.

Herbal and other

natural products

available in the

farm are utilized to

treat fever, cough

and colds. Mrs.

Duque has high

regard on hilot

and would claim

90% of diseases

and complaints are

addressed faster by

the hilot than a

prescription can,

which usually

takes longer to

take effect. The

health station and

health centers werereserved for more

serious illness like

TB and health

centers are viewed

mainly as birthing

centers and areas

where special

procedures are

done like the

removal of her

IUD.


criterion is 3

because even

though the family is

aware of the

possible cross

infection in their

family of a highly

infectious disease,

they intentionally

did not take initial

actions to separate

and isolate Mr.

Duque during his

most infective stage.


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Emotional

Competence

This category

has something to

do with the

maturity and the

integrity of the

family members.

Their ability to

cope with the

usual stresses

and problems in

life; and to plan

for happy and

fruitful living.

The degree by

which

individuals

accept the

necessary

disciplinesimposed by

ones family and

culture; the

development and

maintenance of

individuals

responsibility

and decision;

willingness to

meet reasonable

obligation, to

accept diversity

When an issue

arises, the couple

would exchange

heated verbal

arguments; but as

soon as it was

vented over, the

husband usually

leaves the house,

while Mrs. Duque

continues to nag

until the anger and

resentment

subsides. They will

then go through

long periods of

silence, carrying

out their usual

tasks withouttalking to each

other for weeks.

The children got

affected in a way

because a little

mistake would cost

endless reprimand

and yelling. The

issues were usually

resolved by

allowing time to

pass to calm down


criterion is 5

because the family

is able to cope

positively with the

problems that arise

in the family. They

solve their problems

by arguing on it but

do not result to any

violent reactions.

Hurts and bitter

feelings are not

further aggravated

because they would

talk about their

issues after they

were both

emotionallyprepared to face

each other. In the

height of anger, Mr.

Duque usually

leaves the house to

work in the field

while Mrs. Duque

tries to pacify her

emotions. The

couple is aware of

their economic

capacities too and


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with fortitude, to

consider the

needs of others

as well as ones

own.

emotions. On the

kids part, the

usual cause of

trouble is fighting

over a toy or a

candy. The parents

due to their meager

resources could

not afford to give

quality food,

clothing, shelter,

and education to

the children. If

times are good,

they eat 3 times a

day. During worse

times, they try to

eat at least two

times a day andmake use of root

crops to supply

their carbohydrate

needs. The

children fear the

discipline of their

father which is

spanking, so they

were more

behaved whenever

their father is

around.

would only resort to

borrowing money in

emergency cases

like when there is

an emergent need

for consultation to a

private clinic.


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Family Living This category is

concerned with

the interpersonal

or group aspects

of family life.

The ways by

which they make

decisions

affecting the

family, the

degree with

which they

support one

another or do

things as a

family, the

degree of respect

and affection

and the ways inwhich they

manage family

budget.

The couple gets

along well with

each other. The

spats and bouts of

arguments were

considered normal

and unavoidable.

The husband and

wife help each

other in chores at

home and

caretaking

responsibilities in

the field. The wife

holds the money if

they have and she

allocates it by

setting aside

important expenseslike lot payment,

essential needs of

the children and

their food. They

cannot afford to go

malling though, if

they have extra

money from a sale

of pork meat, they

would bring the

kids to Tacurong, a

city nearby and


criterion is 5

because the decision

making involves

both. There is an

exchange of

opinions and

choices; and whose

ever idea is feasible,

it is being carried

out for the good of

the family. Their

children were well-

behaved and it gave

us an impression

that they discipline

their children fairly

well. Respect and

gestures of affectionwere evident too as

they exchange

stories with us and

each other.


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shop for shoes and

clothes. They have

incurred debts

because of Juns

illness, hence

budgeting for their

needs had trimmed

down.

Physical

Environment

This category is

concerned with

the home, the

community, and

the working

environment as

it affects the

familys health.

The condition of

the house such

as the presenceof accident

hazards,

screening,

plumbing

system, facilities

for cooking and

privacy.

The house needs

repair in order to

have adequate

space for the

whole family in

which they can

have privacy. They

sleep altogether in

one room under

one mosquito net

that is very seldomwashed, so the

likelihood of

transmitting

communicable

diseases is very

suitable. The walls

and the roof are

dilapidated. The

rain can profusely

leak through it and

they can be peeped

inside their house


criterion is 1

because their

environment has

accident hazards

like the presence of

sharp objects such

as nails and broken

bamboo sticks with

rough and

protruding strandsthat might

accidentally be

stepped on. The

possibility of the

children to fall in

the irrigation canal

which has no cover

and the bridge was

made with 3 thin

old rounded

bamboos. The

mosquitoes that


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through the holes

in the walls.

Threats for

accident are

everywhere. The

wares inside the

house were topsy-

turvy and sharp

objects like a piece

of wood with nails

or a bamboo stick

that is not sand can

cause accidental

puncture that could

jeopardize their

health. The waste

and other

containers contain

water that can beideal breeding sites

for vectors of

diseases.

became a prominent

dweller of their

house comfortably

breeding on

unattended soiled

linens piled for long

at a corner of their

house. The heaps of

garbage openly

piled in front of

their gate, where

cats, dogs, and rats

dwell and play.


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Use of

Community

Facilities

This category

has to do with

the degree of the

familys use and

awareness of the

available public

facilities for

health education

and welfare.

This includes the

ways in which

they would use

the services of

private

physicians

clinic, hospital,

welfare

organizations,

churches andother facilities

offered by the

community.

The family utilizes

the barangay

health stations and

centers as needed

only for what they

considered as

major illnesses like

Juns TB infection.

Before that, they

had made

consultation in a

private hospital in

Tacurong City

after a neighbor

had lent them

money for the said

consult. They

sought the help of

the center after hewas positively

diagnosed. They

got Mr. Duques

TB medication

regimen at the

center. Mrs. Duque

had her IUD

removed too in

that center after

consulting a

private doctor

regarding her


criterion is 3

because even if

there are resources

available in the

barangay, they fail

to utilize it to meet

their health needs.

They reason that

physical distance

most of the time

hinder them from

seeking the help of

the barangay center

in Tacurong City.

They claimed that

the stations nearby

always run out of

medical supplieswhen they need it so

they would rather

access the service of

an untrained hilot

(no formal training,

just known to have

skills in treating

ailments, usually

from superstition

like gihiwitan or

gibuyagan) who is

just few houses


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complaints of

lower abdominal

pain and spotting

and yellowish

discharges. On

what they consider

as minor and

common illness

like fever, cough

and colds; they just

seek help from

hilot and do some

herbal

interventions if

paracetamol and

antibiotics are not

available or if their

resources are

depleted.

away from them and

can deliver relief as

well. They seldom

go to church

claiming it is far

and it is too hot to

walk toward it

sometimes. Mrs.

Duque claimed that

her children had

been recipients of

some health

services by the

government and

private

organizations like

the Ligtas Tigdas

and feeding

programs in school.


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CHAPTER V

Typology of Nursing Problem

This chapter presents the different health problems manifested by the family such as

wellness state, health deficits, health threats, foreseeable crisis and stress points as well as their

computations to determine their highest to lowest priority.

Cues or Data Family Nursing Problems

Subjective Data:

Mrs. Duque stated Nag sige man balik balik

ang TB ni Jun. Kaliwat man abi ini nila. Tatay

kag nanay nya amo ini ang kinamatyan amo

nga ginahambalan ko gid si Jun magpabulong

tong nagdupla sya sang dugo. She further

added magsige lang baya na sya inom kag

sigarilyo mam. Mga napulo ka stick gid angmaubos nya sa is aka adlaw lay maluo-ran daw

sya.

Objectve Data:

X-ray readings read active PTB both lung

fields. Pads of rifampicin and isoniazid were

shown to us and a positive sputum exam result.

Jun assumes a kyphotic posture very typical for

TB patients.

I. Tuberculosis as a health deficit.

Inability to make decisions with respect to

taking appropriate health actions due to:

a. Failure to comprehend the nature, scope,

magnitude and extent of infectiousness of the

disease.

b. Inaccessibility of appropriate resources for

care due to cost constraints or

economic/financial inaccessibility.


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Subjective Data:

When asked as to why Mr. Duque was not

separated from them (area of sleeping and

eating utensils) during its infectious state? Mrs.

Duque answered Ginhambalan ko man sya

kag ginhambalan man sya didto sa sentro pero

nahiubos man sya sa akon pag abot diri sa

balay. Magtalikod lang kuno sya sa amon kag

hugasan lang gali ang mga plato kag kutsara

sang maayo, ngaa lainon pa gid sya? Naakig

sya sa akon mam, ti wala na lang ehbahala

na lang.

Objective Data:

The entire family sleeps together in one room

under one mosquito net that had beendiscolored since it has not undergone laundry

for quite a period of time. Their plates and

utensils were seen one on top of the other

unattended.

II. Tuberculosis as a health threat to family

members.

Inability to provide a home environment

conducive to health maintenance and personal

development due to:

a. Ignorance of the importance of observing

preventive measures like isolation and

separation of eating utensils during the first

two weeks of treatment to prevent cross-

infection.

b. Lack of or inadequate knowledge in carrying

out measures to improve home environment

like thorough cleaning and proper waste

disposal, washing of linens and mosquito nets

regularly, separating soiled clothes from newlylaundried ones and washing of the dishes and

not allowing it to stand unwashed for long

period of time where flies and cockroaches can

leave their wastes and other contaminants.

c. Unsanitary environmental conditions like

allowing garbage to pile up and rot directly in

front of their household emitting foul odor that

can aggravate respiratory ailments.


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Subjective Data:

Mrs. Duque exasperatedly verbalized kulang

man abi ang kita sa harvest.di gid makaya

paabuton na naman apat ka bulan bag-o na

naman makakwarta ti indi nabudlayan gid kami

subong nga nagadalagko na ang mga bata

buntis na naman ako subong, kunsabagay apat

na ka tuig si toto (Kris Mark) puede na sundan

pero abaw dugang na naman ini na gastusan.

Objective Data:

After the removal of Jennifers IUD last June

2011, the couple did not immediately decide to

take alternative family planning methods,

hence the unplanned pregnancy

III. Family size beyond what family

resources can adequately provide.


taking appropriate health actions due to:

a. Lack of knowledge as to what alternative

courses of action open to the family like sexual

abstinence or pills during the time after her

IUD was removed.

b. Lack of personal will to make necessary

interventions to avoid getting pregnant at a

time when the couple is not ready for an

additional member in the family.

.


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Subjective Data:

When asked about why they do not do

something about the mound of garbage in front

of their gate, Mrs. Duque replied hindi lang

man ina amon basura, tanan dira man gahaboy,

ti ngaa kami lang abi manglimpyo sina? Kung

kis-a kung pisanan kami ti ginasunog namon

ang sa babaw na mga papel kag kahoy pero

ang sa dalom ti bulok naman ina ah. We

pointed out that the garbage is emitting a foul

odor which can bring about some respiratory

problems, she answered naanad na man lang

kami ah, daw wala naman bahokung

maghulaw lang ang ulan ti ga usbong eh.

Objective Data:

Presence of mounds of garbage in front of their

bamboo gate and at the back of their house. Itcontained all sorts of debris from animal

manure to spare woods with nails, plastic

materials, dried leaves, bamboo stems, candy

and biscuit wrappers.

IV. Improper waste disposal

Inability to utilize the available community

resources to address the garbage disposal

problem due to:

A Lack of knowledge about the possibility of

acquiring diseases since garbage is suitable

breeding places of vectors such as insects and

rats.

b. Lack of initiative to perform clean-up

drives actions to terminate the potential

source of health threats.

c. Failure to seek the assistance of the garbage

collection facility in the community due to lack

of initiative to organize or report and summon

the help of the barangay response team toaddress garbage problems in their vicinity and

community as a whole.


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Subjective Data:

Okay man lang ang mga kabataan. Gakaon

man bisan ano lang ah, bisan hilaw na kamatis

sawsaw sa toyo ayos na ina na sud-an nila.

When asked how often do the children drink

milk or whats their protein source? She

answered malaka lang kami ka kaon karne ka

baboy o di gani baka. Panagsa kung may

magpautang karne diri ti maka kuha man kami

sang pila ka kilo o di gani kung may birthday ti

paihaw kami manok. Kung kis-a gapanarap

lang kami da sa pond ka tag iya ka lupa sang

tilapia, kung kis-a may haloan man nga

madakop ti maka isda kami. She added gatas

lang bear brand kung may kuarta di gani

mangutang sa tyangge sang liberty condensada

kay gina sagol sang mga bata sa kan-on, pero

lagsik man sila, natural lang man na sa ila nganiwang kay palahampang

Objective Data: Tonette 7 years old weighs 15

kilos when she is ideally 17 to 23 kilos. Kris

Mark 4 years old is only 10 kilos when he is

supposedly between 12 to 18 kilos for his age.

The children are skinny and pale looking. They

have poor performances in school when we

scanned their workbooks.

V. Malnutrition as a heath deficit

Inability to provide nursing care to the

dependent members of the family due to:

a. Lack of adequate resources to provide the

necessary food for a well-balanced nutrition.

b. Lack of knowledge about the nature,

magnitude and scope of malnutrition.

c. Lack of knowledge and means to monitor

the progress of weight and growth of the

children since they fail to view malnutrition as

a problem.


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Subjective Data:

Mrs. Duque viewed home improvement as

the least of their concerns for now. Much as

they want to, other more important concerns

like their daily sustenance, clothing,

medication and meeting up payments for the

lot and personal debts come first. She

verbalized Gusto man unta namon

magdugang extension pero ti kay pigado man,

sakto lang ibayad utang ang kita. She

furthered that di man kabalo mamanday si

Jun, tani kung kabalo sya puede man

mahinayhinayan unta biskan sako lang anay

ang dingding.

Objective Data: Scarcity is visible and

palpable in their home. They only have one

room and sleep together under one mosquitonet.

VI. Inadequate living space


taking appropriate health actions in home

improvement due to:

a. Inadequate financial resources to provide

additional living space.

b. Inadequate knowledge as to take initiative to

promote privacy among family members like

utilizing blankets to make partitions of one

area from the other.

c. Low salience of the problem attributing

home improvement as unnecessary expense for

the family.


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CHAPTER VI

Prioritization

This chapter shows the prioritization scoring for each health deficits and health threats

identified afflicting the Duque family.

Tuberculosis as a health deficit

Criteria Computation Actual Score Justification

1. Nature Of the

problem

3/3 x 1 1 The problem is a health deficit that

requires immediate action,

intervention and evaluation after 6

months of treatment to ensure that

pulmonary tuberculosis had been

completely treated and controlled.

2. Modifiability of the

problem

2/2 x 2 2 The community resources and

interventions necessary are

available to the family.

3. Preventive Potential 3/3 x 1 1 The possibility of cross infection of

tuberculosis to the other members of

the family is preventable if the

disease is completely treated.

4. Salience of the

problem

2/2 x 1 1 The family recognizes the existence

of the problem and the importance

of its immediate treatment.

Total Score 5


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Tuberculosis as health threat to family members


1. Nature Of the

problem

2/3 x 1 2/3 It is a health threat that does not

demand an immediate action for the

family.


problem

2/2 x 2 2 Current knowledge and interventions

are available to resolve the problem.

3. Preventive Potential 3/3 x 1 1 The possibility of preventing cross

infection to family members by

acting on the intervention like

isolating the infected person andseparating its personal belongings

can reduce or stop the spread of

infection.

4. Salience of the

problem

2/2 x 1 1 The family perceives it can lead to

serious problems and that it needed

attention to ensure that cross

infection of tuberculosis can be

arrested.

Total Score 4 2/3


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Family size beyond what family resources can adequately provide


1. Nature Of the

problem

2/3 x 1 2/3 It is a health threat.


problem

2/2 x 2 2 Resourcefulness and willingness of

the family can be tapped to solve

the problem.

3. Preventive Potential 3/3 x 1 1 The available family resources canbe utilized to bring about growth

promoting experiences for each

family member.

4. Salience of the

problem

x 1 1/2 The family recognizes it as a

problem but it does not view the

problem as needing an immediate

action.

Total Score 4.2


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Improper waste disposal


1. Nature Of the

problem

2/3 x 1 2/3 It is a health threat that does not

demand immediate action.


problem

2/2 x 2 2 With initiative and industriousness,

the family can easily modify the

problem by utilizing the communityresources available to address the

garbage problem.

3. Preventive Potential 3/3 x 1 1 Communicable diseases that can be

transferred by mosquitoes,

cockroaches, rodents and other

insects can be prevented.

4. Salience of the

problem

x 1 0.5 The family perceives it as a health

threat but does not consider it as

something to be given an immediate

action.

Total Score 4.2


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Malnutrition


1. Nature Of the

problem

3/3 x 1 1 It is a health deficit that requires

intervention to promote normal

growth and development of the

children.


problem

2/2 x 2 2 The problem is easily modifiable

since it only requires for the mother

to be oriented with food substitutesavailable in the community and to

promote proper sleep and rest as

well as hygiene practices that caneradicate parasitic infestation to the

young members of the family.

3. Preventive Potential 3/3 x 1 1 Susceptibility to other diseases and

infection can be prevented if

malnutrition is addressed, thereby

promoting normal growth and

development.

4. Salience of theproblem

0/2 x 1 0 It is not felt as a problem.

Total Score 4


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Inadequate living space


1. Nature Of the

problem

3/3 x 1 1 It is a health threat.


problem

x 2 1 Increasing the living space will

entail financial expenditure and the

family is not ready for any homeimprovement given their current

economic status.

3. Preventive Potential 3/3 x 1 1 Increasing the living space would

mean reducing the chance of cross

infection of communicable disease

like tuberculosis among familymembers. It will also give the

couple some privacy.

4. Salience of the

problem

x 1 0.5 A one-room affair is perceived to be

a health threat however, financial

demands and constraints stop them

from taking any immediate action.

Total Score 3.5


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The Prioritized Health Problems

The list of health condition or problems ranked according to priorities is presented:

1. Tuberculosis as a health deficit 5

2. Tuberculosis as health threat to family members 4 2/3

3. Family size beyond what family resources can adequately provide 4.2

4. Improper waste disposal 4.2

5. Malnutrition 4

6. Inadequate living space 3.5

Typology 42

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Transcript of Typology 42