A Family Case Study

Presented to the
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In Partial Fulfilment of the Requirements

In
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FAMILY CASE STUDY

Submitted by:
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 DECLARATION

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 CERTIFICATION

The study has been read, supervised and certified as meeting the requirement in scope and
quantity as stipulated by Community Health Practitioners Registration Board of Nigeria in
partial fulfilment of the requirement for the award of bachelors in Community Health
Science.

USEN JOEL SILAS Date

FSS, CHEW, ASHM, CHO, PHCT,
BSC. (Com. Health) MSC, PH, PH.S ST.
 DEDICATION

In the name of Allah, the merciful, the most beneficent, I dedicate the case study to
Almighty Allah and my family mostly my children and my mother who stood by me and my
co-workers at Imala Model PHC, Imala in Abeokuta North Local Authority. I say thank you
and God bless you all.
 ACKNOWLEDGEMENT

The study has provided the healthcare practitioner with opportunities to know the
different problems and needs of a family in order for them to develop more in terms of their
environment and especially with their health status. But all of these could not be done without
the help of those significant people who helped the practitioner throughout the study.

I would like to thank the following:

First of all, to Almighty Allah, I am thankful for giving me a chance to live and
experience this opportunity. Thank you for making all things possible, for giving me all I
needed, and for making me earn insights in this way knowing the worth of my life. For His
guidance and safety which He provides every day, for all the blessings that He has showered
upon me, and for giving me the strength to pursue everything.

Next, to my beloved family, friends and supporters, thank you so much for helping
me with your prayers, allowing me to be exposed to the community, and helping me with my
needs, especially financial matters.

To our dear Clinical Instructors (mention the names of your instructors) who were
always there to help and support me especially in my activities and programs, and in making
our case presentation successful. I am grateful for the encouragement you gave me every time
I felt discouraged especially for the outcome of my activities, for your patience, for
understanding our differences, for your concern, and for the guidance you gave me. I
appreciate it and it inspires me more to continue and pursue it I am happy and blessed to have
you as my clinical instructor.

I would also like to extend our gratitude to the family of Mrs G for accommodating,
welcoming, and trusting me to share their basic and personal information that made my case
study successful.
II. TABLE OF CONTENTS

Title Page……………………………………………………………………………………..1
Declaration……………………………………………………………………………………2
Certification…………………………………………………………………………………..3
Dedication…………………………………………………………………………………….4
Acknowledgement……………………………………………………………………………5
Table of Contents……………………………………………………………………………..6
Introduction……………………………………………………………………………………
Objectives of the Study………………………………………………………………………
Initial Database………………….............................................................................................
Family Structure, Characteristics, and Dynamics……………………………………….
Socio-Economic and Cultural Characteristics…………………………………………….
Home and Environment……………………………………………………………
Health Assessment of Each Family Member……………………………………………
Identification of the Case…………………………………………………………………….
Family Background…………………………………………………………………………..
Socio-economic Background………………………………………………………………..
Family Medical & Health History……………………………………………………………
Family Apgar………………………………………………………………………………....
Family Coping Index…………………………………………………………………………
Family Nursing Assessment Tool…………………………………………………………….
Nursing Theory………………………………………………………………………………
Management…………………………………………………………………………………
Medical…………………………………………………………………………………….
Problem identification……………………………………………………………………..
Levels of prevention……………………………………………………………………
Summary/ Evaluation……………………………………………………………………….
References……………………………………………………………………………………
 Chapter I
INTRODUCTION

Many people around the globe, especially middle-aged individuals, treasure their
families and find it difficult to be replaced. A family could be a group of two or more people
who are related by birth, marriage, or adoption and live together thereby sharing a common
emotional bond by offering support, comfort, warmth, nurturing, and performing certain
interrelated social tasks such as protecting their lineage and maintaining their safety. There
are many types of families; including nuclear, extended, blended, patriarchal, matriarchal,
and democratic.

A nuclear family consists of a married couple and their children. It is composed of a

male and a female being moulded to be one, working hand in hand to have a good
atmosphere among the family members. They work hand in hand with other types of family
especially the extended family which includes blood relatives beyond the immediate family,
such as grandparents, aunts, uncles, and cousins. Almost all families, regardless of type,
share common activities (Cherlin, 2008). They provide many functions for their members and
society at large including teaching their children their societal norms, morals and cultures.
They care for their young ones by providing basic needs such as clothing, food, shelter, safety
and medical care. They make sure their lineage continues by engaging in sexual relationships
for reproduction and mutual satisfaction. Family members work to earn an income to support
their basic needs.

The 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 a comprehensive and general approach.

The community is a group of people sharing geographic boundaries and/or values

and interests. (Maglaya, 2004) No two communities are alike. The family is a major

influence on the health behaviours of an individual. With this, families in a community

must be aware of the things and practices pertaining to their health.

Community health service is not episodic as it requires continuous observation and

monitoring of the community as a whole. The primary goal of community health nursing is
the promotion and preservation of different clients (individuals, families, population groups
and communities).

Every family is unique. Community health workers who are exposed to the
community learn how to interact and adapt to the different kinds of people living in a
community. It is in the family that develops health values, beliefs and practices. Family
influences the health and activities of their member (Chen, Shiao, & Gau, 2007). With this, it
is important that families in the community are aware of the things and practices pertaining to
their health.

Conducting a case study is a way where community health workers to improve and
apply all the concepts. It is a tool for determining the health status of a family through
assessment and critical inspection because of this, health-related problems are identified
which gives an indication to the health practitioner on how to intervene just to give holistic
care and improve the deficiency.

The family that was chosen by the researcher is one of the important concerns of
Nigerians especially with the current status of the nation – Depression. Mental depression
nowadays in Nigeria is rampant and it is one of the problems identified in the community. A
family living in a poor environmental condition without enough resources and lack of
knowledge on vital health information and also experiencing socio-economic related
problems is detrimental to their psychological well-being. Tiring as it is, reaching out to this
family and mingling with them makes the researcher feel a sense of fulfilment as they share
knowledge, skills and time to support to uplift the condition of the family.
 Chapter II

OBJECTIVES OF THE STUDY

This chapter presents the general and specific objectives of this family case study.
Setting objectives provides direction for planning a family case intervention. It facilitates
motivation for the client and the health practitioner by providing a sense of achievement.
(Kozier, Erb et. al., 2004).

GENERAL OBJECTIVES
At the end of the practitioner–family relationship, the adopted family will be able to
improve their mental health status and become self–reliant in maintaining their health through
appropriate interventions in a given time frame.

SPECIFIC OBJECTIVES
After 1 month of home visits and community health practitioner-family interaction, the health
practitioner will be able to:
1. Establish rapport and trust with the family
2. Trace the family medical and health history
3. Illustrate the genogram of Mrs G that will help visualise the hereditary pattern
4. Explain the family Apgar score that shows the relationship of family function
5. Determine the different nursing theories that are related to Mrs. G's condition,
concerns, and problems
6. Give health teachings about possible risk factors
7. Identify actual and potential problems which may be a hindrance in attaining optimum
health
8. Categorize the identified health problems as a health threat, health deficit or
foreseeable crisis
9. Plan possible solutions or nursing actions to prioritise health problems
 Chapter III

INITIAL DATABASE

A. Family Structure, Characteristics, and Dynamics

Position in Educational
Name Age Sex Civil Occupation
the Family Attainment

Mr. Late Male Late Husband Farmer SSCE

Mrs. 52 Female Widow Mother Trader SSCE

G (Respondent)

Child 27 Male Child Eldest Child Student HND

AG

Child 25 Female Child Second Child Seamstress SSCE

BG

Child 20 Male Child Third Child Student Senior

Secondary
CG

Child 18 Male Child Fourth Child Student Senior

Secondary
DG

Child 14 Female Child Fifth Child Student Junior

Secondary
EG

The Family G 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 G family resides Oke Odo-Imala, Abeokuta North LGA, Ogun State. They have
started living their family since February of 2005. They reside there since their joined
together.
Mr. G and Mrs. G went hand in hand in terms of decision-making until the departure
of Mr G. They used to consult each other in terms of planning and budgeting for their family.
They discussed matters concerning their children’s schooling financially and also with
regards to the emotional problems or aspects within their family. When problem arose, they
made sure that both of them would handle and solve the problem. But then, in terms of matter
concerning health Mrs. G 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 the then Mr. G 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

Since Mr G is deceased, the G family’s main source of income is coming from Mrs.
G’s trading. She earns about N60,000 a month. She is in charge of the entire family. She
budgets the money in terms of food, education and miscellaneous where clothes, shoes and
slippers comes in. The education of the children is not free and not too costly and they can
walk from their house to the school except the one doing his HND. Usually, there is nothing
to be left for the miscellaneous expense.
With Mrs. G’s monthly income, the family strives hard to accommodate everything
they need for them to live. Though the first female child is assisting as well. According to
National Bureau of Statistics Nigeria, Dollar per day sets poverty at US$2 a day or less and
extreme poverty at US$1.25. Mrs. G’s monthly income is N60,000. 1USD equals N1620.
Meaning N60,000 is equivalent to 35.2USD. In this case, Mrs. G’s daily income is 1.43 USD.
Thus, they can be considered almost extremely poor. Mrs. G also informed the health
practitioner that they do not have any financial assets at hand in case of emergency. They
typically borrow money from their relatives.
 Mrs. G also engages in farming to support her trading business which adds more
economic value to her family’s status.
Mrs. G and her family members are affiliates of Protestantism. And worship mainly
on Sundays.
They usually run to their relatives if they face hardships and problems. Mrs. G also
confirmed how helpful and welcoming her neighbours are with them.
The family has less likely to participate in community activities since Mr. G
demise. Though the children occasionally, partake in few community activities such as fiesta,
parties and carnivals.
The G Family barely enjoys the community resources since the community itself
lacks resources. All her children have attended Imala Community Primary School before
various colleges outside the community. The family uses Oke Odo River as their means of
water source in washing their clothes. There is also boreholes within the community where
the family gets water for cooking and drinking purposes.

C. Home and Environment

Mr G had built a permanent house for the family before his demise. The house only
has 2 windows and can sustain the adequate ventilation needed by the family. Mrs G told the
community health practitioner that their house is usually “presto” since it is beside the river
and the air goes to and fro freely inside the house.
The house has 2 rooms. One is the dining room and the other is bedroom, with a
family bed in each. Mrs. G, together with her two daughters, sleep in one room and the boys
do sleep in the other room used as dining room.
The G Family has access to electricity. Though its availability is epileptic in supply.
In terms of garbage disposal, they either bury or burn their garbage.
Mrs. G uses 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 ceramic 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 and knives and various dishes.
The river is the family’s main source of water. They wash their clothes there and gets
their drinking water supply from boreholes. They put their water in a big container with
cover. They usually don’t sterilize their drinking water supply.
 G Family has no comfort room. They usually urinate in containers in the night and
pour outside the waste the following day and remove bowels anywhere near their house.
They have not yet built their comfort room since, according to Mrs G, they are still planning
for such and do not have enough budget for it yet.
The drainage system of the family is an open type where the drainage flows anywhere
and is continuous. It is dirty and has a stinky smell. There are some rice grains noted. There is
no obstruction present in the drainage system since it is open and flows anywhere.
The family does not own any transportation facilities. They patronise motorcyclists to
distant places. When they go to their farm, they usually walk kilometres.

The family has a few chickens and 4 goats. There are vegetables planted near the
house.

D. Health Assessment of Each Family Member

i. PAST AND PRESENT ILLNESS

1. Health Assessment on Each Member
a. Mr. G – The community health practitioner has never met Mr. G since he is late. Mrs.
G, however, told us that she thinks her husband when he was alive never undergone
immunizations at all since it was not that important before. Mrs. G said that her husband
was about 1.72m tall and weighs about 68 kilograms. Mrs. G said that her husband did not
have any known genetic or hereditary illness. He was not a smoker. But he used to drink
alcohol.
b. Mrs. G – She has hypertension as of the present time. She has also not completed
immunizations. She has malaria occasionally. She is 1.60m height and and weighs 63
kilograms. Her BMI reveals normal weight with a value of 24.6. Her presenting complaint
are palpitation and mood change and she is currently using amlodipine and Lisinopril to
control her BP. When she falls sick, she would just take paracetamol for fever and
ibuprofen for pain or treat wounds with crushed plants coming from their backyard.
c. Child AG to EG – None of children has degenerative or chronic disease. They are
apparently looking healthy. None is malnourished. They mostly depend on family daily
meals. The elderly children take the height pattern of the mother. No sign of underweight.

ii. Family assessment based on functional health pattern

1. Health Perception-health management patterns

- With no known vices like smoking and drinking except for Mr. G who did drink
alcohol when he was alive.
- Was able to recognize the importance of having a healthy well-being.
- Uses herbal plants from their backyard and at times from herbalists.

2. Nutritional-metabolic pattern

- Mrs G do take food supplements or vitamins

- Daily food intake is mainly rice, sweet potatoes, amalar, fish, vegetables, etc.
- Children eat junk foods whenever they are given money
- Children have poor appetite according to Mrs G

3. Elimination pattern

- Eliminates every day with an average frequency of urine: 5 times

- According to Mrs. G, all of the family members have no difficulty in voiding.
- The family members defecate every day and some, every other day with no difficulty
in defecating noted.

4. Activity-exercise pattern

- The boys do involve themselves in football practices.

- 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.
- But Mrs G rarely finds sleep in the night.
- They also take a nap in free time.

6. Cognitive-perceptual pattern
- Was oriented to time, and place and can 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 can rationalize. Verbal patterns 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 conditions.

8. Roles and relationship

- Family members communicate openly and can discuss their problems according to the
mother.

9. Sexual reproductive

- Mrs G is in her menopausal age

- The parents have been separated since the demise of the father.

10. Coping Stress

- Mrs G has been depressed on several occasions with overburdened demands of the
family.
- Gains strength in the “assurance and guarantee” provided by family members.

11. 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 go to church every Sunday.
 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 2016.

The family has adequate rest and sleep. They sleep early and wake up early, the usual
time of sleeping is 9 pm and they wake up at around 4 to 5 am. But that is not the case for
Mrs G as she rarely finds sleep in the night. Mrs G stated that farming, doing household
chores, and walking are their ways of exercise. The father is late. The mother usually does the
household work and talks with the neighbours during her free time. She also farms when it’s
season. 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 ignore 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 healthcare needs. They often use alternative medicines or
herbal medicines to treat 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 to treat diseases or symptoms in the family. However, if
symptoms manifested by the family member become severe, they immediately go to the
health centre or the hospital.
 Chapter IV
IDENTIFICATION OF THE CASE

Patient’s Code Name: Mrs. G

Age: 52 years old
Nationality: Nigerian
Civil Status: Widow
Occupation: Trader
Date of Last Admission: Year 2023 due to hypertensive crisis
Sources of Information: Mrs. G

FAMILY BACKGROUND

Mrs. G lives together with her 5 children. She was married but lost her husband to
death in the course of the marriage. She did not benefit much from her marriage as her
husband died and left her young children to nurture. The 5 children (3 girls and 2 boys) are
all alive, 4 are studying and 1 is a seamstress. They are currently living at Oke Odo, Imala,
Abeokuta North LGA. They are Yoruba by tribe. Mrs. G is a High School graduate. She
trades to feed her family.
She most often faces financial problems due to her children's school expenses. They are only
dependent on her small income and, at times, support from family relatives.
Mrs. G suffered severe malaria complicated by anaemia a few years ago. She hardly
went for health check-ups until she was diagnosed with HTN.

SOCIO – ECONOMIC BACKGROUND

Mrs G as a trader has monthly income of about N60,000. She is at times assisted
financially by her daughter who is a seamstress.
Her family relatives, sometimes, support her budget with finances which could helped
her sponsor her children who are in school.
 They lived in the family house. The house is a 2-room bungalow. They are using a
charcoal for cooking in their common kitchen. The house is more than 30 years old. There is
a high possibility that their house might demand some refurnishes and repairs.

FAMILY MEDICAL & HEALTH HISTORY

According to Mrs G, her 5 children have not all completed their vaccinations. The
third (3rd) child of the family, Ms CG sometime in 2012, experienced hospitalisation for 1
week at Ayetoro General Hospital due to Pneumonia. Also, the cause of her husband’s death
remains unknown.
In 2006, Mrs. G stated that she experienced intense headaches and she was 34 years
old back then. The doctor who treated her told her that it was tension headaches. In
September 2017 she had the same form of headaches and did not seek a health care provider
or having because according to her, she purchased the same drugs used during the first
occurrence from an over-the-counter pharmacy.
Furthermore, Mrs G also stated that during her second to last childbirth, she
experienced preeclampsia and severe bleeding after delivery. The birth attendant told her that
it was because she did not go to antenatal clinics. This occurrence repeated itself during the
last childbirth.

X.GENOGRAM

FAMILY APGAR
Component Score Definition Justification
Adaptation Use of intra and extra No enough resources.
1 familial resources for Initially, needs assistance
problem solving when came from both parents if
family equilibrium is under occurrence of unexpected
stress. financial matters. But lately,
family relatives could
support.
Sharing of decision making She always insists that her
and nurturing idea is right as the mother
 Partnership 1 responsibilities by family and provider.
members.
Physical and emotional She wishes to do something
1 maturation and self- for herself like opening a
Growth fulfilment are achieved by bigger boutique for her
family members through business.
natural support and
guidance.
Caring or loving Caring and loving in the
Affection 2 relationship among family family can be witnessed.
members.
Commitment to devote time She is preoccupied with
to family members for ways to earn for the family's
physical and emotional progress.
Resolve 1 nurturing; usually involves a
decision to share wealth and
space.
Total Score 5
Moderately -Inadequate coping or decision-making skills
Interpretation Dysfunctional -Emotional Immaturity

Legend: Total Score:

0- Hardly Even 0-3 Severely dysfunctional family
1- Sometimes 4-6 Moderately dysfunctional family
2- Almost Always 7-10 Highly functional family
Analysis and Interpretation

A healthy family unit is considered by Smilkstein to be a nurturing unit that

demonstrates integrity in five components. Adaptation, Partnership, Growth, Affection and
Resolve. This tool is useful in suggesting areas to be assessed relative to family functioning
and potential areas of family strengths and resources. Various types of family strengths which
are scored as follows: “Almost always” (2 points), “Sometimes of the time” (1 point’0, or
“Hardly even” (0 point). The scores for each of the components are totalled; a score 7-10
suggests a highly functional family. 4-6 points a moderately dysfunctional family; and 0-3
points a severely dysfunctional family. This helps determine the family’s ability to acquire
resources and productive use of money or social support, the ability to communicate in depth
with each other with openness and support and consensual decision making; the presence of
encouragement, support, prairie recognition, respect for individuality and flexibility of family
functions and roles.(David, E.et.al,2007)
Regarding my client’s family, in terms of adaptation, the score is 1, this means that
the family don’t have intra- and extra-familial resources for problem-solving when family
equilibrium is under stress. Mrs. G mentioned that whenever they have financial problems,
her daughter or family relatives sometimes help them if there is a need to. Coming to
partnership, the family scored 1 because the sharing of decision-making and nurturing
responsibilities by family members are merely observed. After all, Mrs. G is the sole
caretaker of the family and considers her ideas to be always right. The third component is
Growth, the family scored 1 because physical and emotional maturation and self-fulfilment
achieved by family members through mutual support and guidance are occasionally observed.
The fourth component is Affection; the family is scored 2 because caring among family
members can be witnessed. The last component is resolve the family scored 1 maybe, there is
no commitment to devote time to other members because they are preoccupied with ways to
earn a living. The total score is 6, which means their family is moderately dysfunctional; this
implies that the family needs to improve their sense of adaptation, partnership, growth, and
commitment to devote time to other members of the family.
 Chapter V
FAMILY COPING INDEX

Family Coping Areas Point Scale Assessed Problems Justification System

No Problem “Mo n se ise mi o de n
Physical Independence 5 ranmi lowo gan-an.”
Lack of Financial “Ohun ti mo n ri nidi oja mi
Therapeutic 2 resources to seek ni mo fi n gbo bukata idile
Component medication mi. Mi o kin lo se ayewo afi
ti oba je pajawiri nikan ni
mo ma nse bee.”
Able to identify “Ti ori ba n fomi lera lera,
Knowledge of Health 2 health status but mo ma nra oogun ni ilé
Condition don’t have any action oogun titi di igba ti ayewo
so pe mo ni High Blood
Pressure”
Taken improper “A ma n sun idoti wa tabi ka
Application of Principle 2 garbage disposal & daanu sinu igbo lagbegbe
of General Hygiene segregation wa”
Failure to visit the “Mo pinnu lati ma lo sibe
Health Centre for nitori owo e ma n po ti mo
Health Attitudes 3 antenatal and ba lo si ilé iwosan”
unwillingness.
Good relationship “Awon imoran mi ma ndaa
between the family gege bi eni to n da nikan
Emotional Competence 3 members; but the toju idile lowo bayi”
client always insists
that what she thinks
is right
Client is sometimes “Awon imoran mi ma ndaa
Family Living moody because she gege bi eni to n da nikan
 3 misses a partner. toju idile lowo bayi”
1 Inadequate space Based on our observation, a
Physical Environment family of 6 with 2 room is
not adequate for them to live
together. And they cook
behind the house and have
no comfort room.
They are aware of Based on our observation,
Use of Community availability of they house is near in the
Response 3 community method Health Centre but they don’t
of mosquito’s bite utilize the resources that
prevention but they health centre offered
are not utilizing it
Comments:

They are friendly, cooperative, and willing to open up or share information regarding their
family status and health.

Analysis & Justification

This table presents the Family Coping Index of “G”. The coping capacity of the
family corresponds to a point scale according to the family level of competence. 1 No
Competence, 3 Moderate Competence and 5 Complete Competence. As a result, the family
coping area which is Physical Independence is scaled to 3. This means not all the family
members can do their activities of daily living independently, on the other hand, physical
environment scaled 1 means that the family has no competence with the work environment
because they have inadequate living space, knowledge of health conditions, application of
principles of general hygiene and therapeutic competence scale 2, this means that in this area
the family coping is poorly competent in terms of their health condition. Emotional
competence, Family Living is scaled 4 which implies that the family is close-knit to each
other. They support each other in terms of decision making but sometimes they do not
understand each other. On the other hand, Health Attitudes are scaled 3 this means that in
this area of family coping capacity, they are moderately competent because when she was
pregnant, she did not care to go to the health centre for antenatal check-ups. Use of
Community Facilities- is scaled 3, this means that the coping capacity of the family is
moderately competent because the family is not utilising the community facilities.

NURSING THEORY

The following nursing theories are applicable in their client family:

The Nightingale’s Environment model where in, Nightingale viewed the manipulation
of the physical environment as a major component of nursing care. She identified ventilation
and warmth light, noise, variety, bed and beddings, cleanliness of rooms and walls, and
nutrition as major areas of the environment the client could control. When one or more
aspects of the environment are out of balance, the client must are use increased energy to
counter the environmental stress. In Nightingale notes in nursing, she discussed the
importance of the health of homes as being closely related to the presence of pure air, pure
water, efficient drainage, and cleanliness that it’s an adequate space for their family,
sufficient lighting, and pure clean air are what they are experiencing now.
Dorothea Orem’s combination of three theories, the theory of self-care, the theory of
self-care deficit and the nursing system theory also apply. In the self-care theory, it explains
the activities carried out by the individual to maintain their health. Whilst, self-care deficit is
the inadequacy of the self-care requisites.
According to Orem’s Theory, these areas are important for prioritising nursing
diagnosis:
- Air
- Water
- Food
- Elimination
- Solitude/Interaction
- Prevention of hazards
- Promotion of normality
- Maintain a developmental environment
- Prevent or manage the developmental threats
- Maintenance of health status
- Awareness and management of the disease process
- Adherence to the medical regimen
- Awareness of potential problem
- Modify self-image
- Adjust life style to accommodate health status changes
 Chapter VI

MANAGEMENT

A. Medical

Specific: Depression
Depressive disorder (also known as depression) is a common mental disorder. It
involves a depressed mood or loss of pleasure or interest in activities for long periods.
Depression is different from regular mood changes and feelings about everyday life. It
can affect all aspects of life, including relationships with family, friends and community. It
can result from or lead to problems at school and work.
Depression can happen to anyone. People who have lived through abuse, severe losses
or other stressful events are more likely to develop depression. Women are more likely to
have depression than men.
An estimated 3.8% of the population experience depression, including 5% of adults
(4% among men and 6% among women), and 5.7% of adults older than 60 years. More than
700,000 people die due to suicide every year. Suicide is the fourth leading cause of death in
15–29-year-olds.
Although there are known, effective treatments for mental disorders, more than 75%
of people in low- and middle-income countries receive no treatment. Barriers to effective care
include a lack of investment in mental health care, lack of trained health-care providers and
social stigma associated with mental disorders.

Symptoms and patterns

During a depressive episode, a person experiences a depressed mood (feeling sad,

irritable, and empty). They may feel a loss of pleasure or interest in activities.

Other symptoms are also present, which may include:

- poor concentration
- feelings of excessive guilt or low self-worth
- hopelessness about the future
 - thoughts about dying or suicide
- disrupted sleep
- changes in appetite or weight
- feeling very tired or low in energy.

Depression can cause difficulties in all aspects of life, including in the community and at
home, work and school. A depressive episode can be categorized as mild, moderate, or severe
depending on the number and severity of symptoms, as well as the impact on the individual’s
functioning.

There are different patterns of depressive episodes including:

- single episode depressive disorder, meaning the person’s first and only episode;
- recurrent depressive disorder, meaning the person has a history of at least two
depressive episodes; and
- bipolar disorder, meaning that depressive episodes alternate with periods of manic
symptoms, which include euphoria or irritability, increased activity or energy, and
other symptoms such as increased talkativeness, racing thoughts, increased self-
esteem, decreased need for sleep, distractibility, and impulsive reckless behaviour.

Contributing factors and prevention

Depression results from a complex interaction of social, psychological, and biological factors.
People who have gone through adverse life events (unemployment, bereavement, traumatic
events) are more likely to develop depression. Depression can, in turn, lead to more stress and
dysfunction and worsen the affected person’s life situation and the depression itself.

Depression is closely related to and affected by physical health. Many of the factors that
influence depression (such as physical inactivity or harmful use of alcohol) are also known
risk factors for diseases such as cardiovascular disease, cancer, diabetes and respiratory
diseases. In turn, people with these diseases may also find themselves experiencing
depression due to the difficulties associated with managing their condition.

Prevention programmes have been shown to reduce depression. Effective community

approaches to prevent depression include school-based programmes to enhance a pattern of
positive coping in children and adolescents. Interventions for parents of children with
behavioural problems may reduce parental depressive symptoms and improve outcomes for
their children. Exercise programmes for older persons can also be effective in depression
prevention.

Diagnosis and treatment

There are effective treatments for depression. These include psychological treatment and
medications. Seek care if you have symptoms of depression.

 Psychological treatments are the first treatments for depression. They can be
combined with antidepressant medications in moderate and severe depression.
Antidepressant medications are not needed for mild depression.

Psychological treatments can teach new ways of thinking, coping or relating to others.
They may include talk therapy with professionals and supervised lay therapists. Talk
therapy can happen in person or online. Psychological treatments may be accessed
through self-help manuals, websites and apps.

Effective psychological treatments for depression include:

- behavioural activation
- cognitive behavioural therapy
- interpersonal psychotherapy
- problem-solving therapy.

 Antidepressant medications

Health-care providers should keep in mind the possible adverse effects associated
with antidepressant medication, the ability to deliver either intervention (in terms of
expertise, and/or treatment availability), and individual preferences.

Antidepressants should not be used for treating depression in children and are not the
first line of treatment in adolescents, among whom they should be used with extra
caution.

Different medications and treatments are used for bipolar disorder.

 Self-care
Self-care can play an important role in managing symptoms of depression and
promoting overall well-being.
What you can do:

- try to keep doing activities you used to enjoy

- stay connected to friends and family
- exercise regularly, even if it’s just a short walk
- stick to regular eating and sleeping habits as much as possible
- avoid or cut down on alcohol and don’t use illicit drugs, which can make
depression worse
- talk to someone you trust about your feelings
- seek help from a healthcare provider.

If you have thoughts of suicide:

- remember you are not alone, and that many people have gone through what you’re
experiencing and found help
- talk to someone you trust about how you feel
- talk to a health worker, such as a doctor or counsellor
- join a support group.
 B. PROBLEM IDENTIFICATION
General
i. Health Threat
 Lack of Food Storage- Lack of Food Storage
- They do not have a refrigerator to keep their food safe from microorganisms.
 Inadequate Living Space
- One living room for a family of six is a substandard space for the family, making
some of them to be sleeping in the dining room
 Prone to Fire
- Their house is made of light materials like wood and bamboo.
 Possible Pregnant Complication
- Because Mrs G never sought medical help even when she was having varicella virus
during her 3 months gestation.

ii. Health Deficit

 Malnutrition
- Food prepared is lack of nutrients
 Mental stress
- Depression

iii. Foreseeable Crisis

 Unwillingness to go to the health centre
- Possible complications may occur as a result

C. LEVELS OF PREVENTION
Primary Prevention
1. Health Promotion
- Health education to mothers about good nutrition and food hygiene health workers
- Distribution of supplements (iron, folic acid and vitamin A).
- Promotion of breastfeeding
- Development of low-cost weaning foods
 - Measures to improve family diet
- Nutritional education
- Home economics
- Family planning and birth spacing
- Family environment

2. Specific Protection
- Specific protein diet, eggs, milk, fresh fruit, etc.
- Immunization
- Fortification of food

Secondary prevention; early diagnosis and adequate treatment

1. Periodic nutrition surveillance.
2. Early diagnosis of any lag of growth.
3. Early diagnosis and treatment of infection including diarrhoea.
4. Developing the program for early dehydration of children with diarrhoea.
5. Developing supplementary feeding program during epidemics.
6. Regular deworming of school and preschool children.

Tertiary prevention; nutritional rehabilitation

1. Nutritional rehabilitation services.
2. Hospital treatment
3. Follow up of cases
 Chapter VII.
SUMMARY / EVALUATION

The Family G case study consists of different characteristics and health conditions of

its members. The study presents the family structure, socio-economic and cultural factors,

home and environmental factors, and health assessment of each member. It also contains data

about identified problems of the living conditions of the family.

Summary and Evaluation

The Family G 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. The V family resides in

Oke Odo of Imala, Abeokuta North LGA. They have been living here for more than 2

decades.

The house is a permanent old 2-room’s bungalow. Her husband is dead for more than

a decade ago. 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.

The G family’s main source of income is coming from Mrs G’s sales. She earns about
NGN60,000.00 monthly. With her monthly income, the family strives hard to accommodate
everything they need for them to live. According to National Bureau of Statistics Nigeria,
Dollar per day sets poverty at US$2 a day or less and extreme poverty at US$1.25. Mrs. G’s
monthly income is NGN60,000.00. 1USD equals NGN1,620.00. Meaning NGN60,000 is
equivalent to 35.2USD. In this case, Mrs. G’s daily income is 1.43 USD. Thus, they can be
considered almost extremely poor. Mrs. G also informed the health practitioner that they do
not have any financial assets at hand in case of emergency. They typically borrow money
from their relatives.
 All of them are affiliates of Protestantism. The family participates in their community

activities.

The G Family barely enjoys the community resources since the community itself

lacks resources. The children all attend school. The river is the family’s main source of water.

They wash their clothes there. They get their drinking water from the community borehole.

They put their water in a big container with a cover. They usually don’t sterilize their

drinking water supply.

G-Family has no comfort room. They usually urinate and remove their bowels

anywhere near their house. The drainage system of the family is an open type where the

drainage flows anywhere and is continuous.

The G family is identified to have plenty of environmental problems in which it is

evident that they practice poor environmental sanitation. With this situation and family

condition, many problems were identified such as health threats which include poor home

and environmental sanitation, and improper drainage system as well as health threats which

are improper personal practice as improper hygiene. A nursing care plan then is formulated to

address the different problems identified.

Nevertheless, the family has the chance to improve their health condition. They can

still meet the desired characteristics in their structure and maximise their health potential of

optimum wellness. They are cooperative and participative to the different issues and

interventions they are confronted with. Hence, they are willing to submit themselves for the

impartation of information and basic knowledge regarding family health.

The objectives of identifying family nursing problems were only partially achieved

due to security reasons on the part of the community health practitioner. Together with the

family, the community health practitioner as an agent has helped the family through
motivation and support to change their lifestyle and improve their health status. The family is

now equipped with fair knowledge which they could use anytime as the need arises.

Recommendations

 The G family should maintain a healthy and clean environment. They must clean their

surroundings to avoid the presence of vectors of diseases.

 The family should also maintain proper hygiene such as taking a bath regularly, trimming

their nails, frequent changing of clean clothes especially when come in contact with filthy

objects or experienced wetness of the back, refraining from walking barefooted, brushing

of teeth frequently, and proper and regular hand washing.

 They must also reorganise their cooking practices in terms of food preparation and

handling as well as keeping their kitchen utensils in a covered storage to avoid getting it

contaminated by insects or pests. In addition to that, they should also cover their food

storage.

 The family should also be advised to not wait for the ailment to become severe before

seeking medical help.

 The family must also be educated and follow the proper preparation of herbal medicines

as it was presented during the mother’s class.

 The family should persevere to perform proper waste segregation and disposal of their

garbage as was presented during the mother’s class.

 They should be encouraged to verbalise their concerns about the community so that

resolutions can be made.

REFERENCES:

https://nigerianstat.gov.ng/elibrary/read/544
https://www.who.int/news-room/fact-sheets/detail/depression

http://www.nhs.uk/Conditions/Malnutrition/Pages/Causes.aspx

http://www.nhs.uk/Conditions/Malnutrition/Pages/Symptoms.aspx
Untalan, A. Concepts and Guidelines in COPAR. 1st ed. Manila: Educational Publishing
House, 2005.

http://psychology.about.com/od/theoriesofpersonality/ss/psychosexualdev.htm