SAN PEDRO COLLEGE

12 C Guzman St., Davao City

FAMILY CASE STUDY

IN PARTIAL FULFILLMENT OF THE

REQUIREMENTS IN NCM 209 - RLE
IMCI ROTATION

SUBMITTED TO:
LUKE AVILA, RN
CLINICAL INSTRUCTOR

SUBMITTED BY:
Lorenzo Miguel B. Bautista
Hans G. Bregundot
Arquen Jacob B. Cabigas
Mikael Joshua D. Trabucon
Mary Justin N. Africa
Charles Trisha N. Aliniabon

FEBRUARY 4, 2021
CRITERIA (ONLINE CLINICAL EXPERIENCE)

INTRO/OBJECTIVES 10%

FAMILY DEVELOPMENTAL TASK 15%

FAMILY COPING INDEX 15%

PRIORITIZATION 20%

FNCP 30%

IMPLICATIONS 10%

TOTAL 100%

CRITERIA (WRITTEN)
CONTENT 80%

PROMPTNESS 5%

REFERENCES 5%

NEATNESS 5%

FORMAT 5%

TOTAL 100%

CRITERIA (ORAL)
PRESENTATION 20%

CONTENT 40%

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 DELIVERY 20%

PERSONAL ATTRIBUTES 10%

VISUAL AID 10%

TOTAL 100%

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TABLE OF CONTENTS

Criteria 1

Table of Contents 3

Introduction 4

Objectives 6

Family Developmental Task

Families with preschool children 7

(2 1/2 - 6 yrs)

Family Coping Index 9

Prioritization

Case 1: Pneumonia 11

Case 2: Dysentery 12

Case 3: Unsanitary Waste Disposal 13

Case 4: Inadequate living space 15

Case 5: Breastfeeding 16

Case 6: Family Size beyond what 17

family resources can adequately
provide

Implications 19

References 21

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INTRODUCTION

IMCI or Integrated Management of Childhood Illness is an integrated

approach to child health that focuses on the well-being of the whole child. It is also
a strategy for reducing death and morbidity associated with major causes of
childhood illness. Furthermore, this is to contribute to the healthy growth and
development of children aged less than 5 years.

In this case analysis, different activities are collated together to further

understand the concept of IMCI such as the Family Developmental Tasks (FDT),
Family Coping Index (FCI), Prioritization, and Family Nursing Care Plan (FNCP).
The Family Developmental Task is a way to explain how the family as a unit
interacts with larger units outside the family and with smaller units inside the family.
The group was assigned to further explain Duvall’s developmental third stage
which is “Families with Preschool Children”. A family that consists of children in the
age bracket from two and a half (2 ½) to six (6) years old with 6 tasks that should
be accomplished. Family Coping Index, its purpose is to provide a basis for
estimating the nursing needs of a particular family. It is also the ability of the family
to cope with the nine areas of family nursing which are: Physical independence,
Therapeutic competence, Knowledge of Health condition, Application of the
Principles of General Hygiene, Health Attitudes, Emotional Competence, Family
Living, Physical Environment, and Use of Community Facilities. When there are
multiple cases of health problems, prioritizing them will provide a huge help as you
will be able to determine which of these should be given the most and least
attention. The four (4) criteria: nature of the problem, modifiability of the problem,
preventive potential, and salience will help you further in prioritizing by having a
more accurate scoring. Lastly, the family nursing care plan is the 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.
These are also chosen sets of interventions, resources and evaluation criteria,
standards, methods, and tools.

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 In this case study the student nurses were presented with a family of 4 living
near a dumpsite in Tugbok, Davao City. The student nurses identified 6 problems
within the family and prioritized these problems according to a set of criteria. After
prioritization of the problems identified, the student nurses selected the top 3
problems with the highest score and individual family nursing care plans were
made to provide a potential solution to these problems. The problems with highest
prioritization identified were as follows: Unsanitary waste disposal, family size
beyond what the family can provide, pneumonia.

Poverty was seen to be one of the main causes of the problems identified
as only the mother is earning for the family. Another potential cause of the problem
is the living environment, in this case, the living environment is very poor and is
not conducive to living. Poor environmental conditions along with the low income
that the family earns resulted in the problems identified and the student nurses
were tasked to make a care plan suited for the family.

Around 9.2% of the global population live in poverty, this is equivalent to

689 million individuals who live significantly below their needs. In the Philippines
the rate of poverty is around 20% of the total population, which is around 20 million
individuals. In Davao City, 4.6% of the population are considered poor, which
consists of roughly around 46,000 individuals.

In line with our IMCI rotation, the case tackles several problems which are
more common in the community setting than in the clinical area. Thus, the student
nurses were able to utilize the concepts that were taught beforehand and use them
to identify, diagnose, and intervene with the problems. As members of the nursing
community the data that were gathered can be used in future studies that can be
related to a community setting.

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OBJECTIVES

General:

To assess the knowledge of the student nurses about the Integrated

Management of Childhood Illness (IMCI) concept and apply the skills and
knowledge learned in real-life situations.

Specific:

At the end of the time allotted for conducting research and reporting, the students
will be able to:

- Have a better understanding of how these different activities will help in

acquiring or gathering data;
- Apply the correct practices for every situation that arises after each
assessment;
- Determine which information to use whether or not they are necessary to
record;
- Identify which problem or situation needs more attention and intervention;
and
- Create an FNCP that will provide courses of action that will best address
the situations.

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 FAMILY DEVELOPMENTAL TASK

● Families with preschool children (2 1/2 - 6 yrs)

FDT and Task Remarks Justification

Socialize the children Achieved Socialization with

children promotes good
communication within
the family and
establishes the social
skill of the members of
the family.

Integrate new children while Achieved Introduce or expose your

still meeting the needs with child to an environment
other children that is surrounded by
children of his age so as
to let him mingle,
experience, and
understand that he is not
alone and should never
be alone since this is the
basic nature of man.

Maintain healthy Achieved The Family continues to

relationships within the interact with each other
family and stay positive even in
their current situation.
Father and Mother are
now working harder
together to raise their
children; the father takes
better care of himself
and his kids while his
wife is away.

Adjusting to the cost of Achieved Families with

family life. preschoolers need to
adjust their financial
costs since the child is at
the age where they can
enter in primary school/
kindergarten, and the
child will slowly self-
wean from the mother

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Adapting to the needs of
pre-school child to stimulate
growth and development
learning materials or things
that stimulate growth
Coping with parental loss of
energy and privacy(for
parent)
and will switch to solid
foods.
Achieved A family with preschool
children makes sure that
the children are engaged
in active play. They
provide them with
opportunities to
meaningfully interact in a
physical activity and
connect with each other.
Keeping children’s gross
and fine motor skills in
mind, while also
considering the benefits
of physical activity on
children’s overall
development.
Achieved A family with preschool
children is a busy family
because children at this
age demand a great
amount of time. At some
point of time, the parents
energy will not match
the/their child/children
,could not keep up with
the demand of time, and
there will be less privacy
for the spouse. But
adapting just right to the
critical needs and
interests of a preschool-
age child in a
stimulating, growth-
promoting way, the
spouse could surely
cope with the demand of
time, energy depletion,
and lesser privacy.
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 FAMILY COPING INDEX

Situation:
A family of 4 living near the landfill in Tugbok Davao city. The father is a 55-
year-old who is hypertensive and bedridden because of a stroke last January 2020.
The mother is a 45-year-old who is also hypertensive and works as a garbage
collector in the landfill near their house. They have 2 kids aged 1 and 4
respectively. Both their children are malnourished mainly because the mother is
the only one working and her income is insufficient to provide for the whole family.
The mother regularly visits the health center to avail of the free anti-hypertensive
medications given by the health center.

Coping Index Rating Justification

Physical Independence 3 The father cannot take care of

his own activities of daily living as
he is bedridden and relies on his
wife to assist him in doing those.
His wife is sometimes busy with
working and sometimes she
neglects to take care of her
family, especially her husband.

Therapeutic Competence 3 The father was advised to

undergo physical therapy to
prevent atrophy, but the family
cannot afford a physical therapist
because of financial restraints.
The mother however complies
with the anti hypertensive
medication for her and her
husband.

Knowledge of Health Condition 3 The mother who was diagnosed

with hypertension complies with
her daily maintenance
medication and gives importance
to taking them. She however
does not control her diet as she
often eats bulad and salt as
viand.

Application of the Principles of 1 The family is incapable of

General Hygiene maintaining proper nutrition due
to the mother’s low income and

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 not able to provide food that is
enough to suffice the nutrition
needed. Thus, resulting in both of
their children’s malnutrition.The
children were not able to
complete their immunization.

Health Attitudes 3 The family goes to the hospital

only when there is an
emergency. The wife takes care
of her husband but isn’t able to
do so at all times as she is
working and her children are too
young to do anything
themselves.

Emotional Competence 5 The family members are able to

cope up with the stress despite
their current situation. They are
dealing with the problems one by
one each day and are living a
fruitful life.

Family Living 5 Even if their living conditions are

poor, the family values one
another and tries their best to get
along with each other.
Misunderstandings are
immediately fixed through
communication.

Physical Environment 1 The family lives in a slum area

near a landfill and thus there are
poor environmental conditions.
Their house is made of plywood
and tarpaulin. The mother also
works in the landfill as Garbage
collector.

Use of Community Facilities 5 The family lives in a community

where there are available
barangay health centers near
them and they visit the barangay
regularly for their
antihypertensive medication.

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 PRIORITIZATION

Case 1 Pneumonia

CRITERIA COMPUTATION SCORE JUSTIFICATION

1. Nature of the Problem 3/3 x 1 1 Pneumonia as a

(Health Deficit) health deficit requires
immediate attention
and adequate
management to
minimize or lessen the
effect of diseases.

2. Modifiability of the 2/2 x 2 2 There is current

Problem knowledge,
Scale: Easily interventions and
Modifiable resources available to
solve the problem.

The problem has been

long present and the
3. Preventive Potential 1/3 x 1 0.33 family has no
Scale: low knowledge in
managing the disease.

The family recognizes

Pneumonia as a
problem and has
4. Salience 2/2 x 1 1 access to health
Scale: problem centers. They view it
needing immediate as a serious problem
attention and that it needs
immediate action

Total Score: 4.33

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Case 2 Dysentery

CRITERIA COMPUTATION SCORE JUSTIFICATION

1. Nature of the Problem 3/3x1 = 1 1 Dysentery is a health

(Health Deficit) deficit that needs
immediate attention.

2. Modifiability of the 1/2x2 = 1 1 Partially modifiable based

Problem on how modifiable the
Scale: Partially patient’s current
Modifiable environment and lifestyle
is.

3/3x1 = 1 1 Can be easily prevented

3. Preventive Potential so long as the patient’s
Scale: High lifestyle and environment
(sanitation) improves.
There are also treatment
options in the health
centers.
4. Salience
Scale: problem not 1/2x1 = 0.5 0.5
needing immediate
attention The family perceives
dysentery as not needing
immediate attention as
there are no life
threatening effects that
are physically manifested.

Total Score: 3.5

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Case 3: Unsanitary waste disposal

CRITERIA COMPUTATION SCORE JUSTIFICATION

1. Nature of the Problem Unsanitary waste

(Health Threat) 2/3 x 1 = 0.67 0.67 disposal can be
identified as poor
home/environmental
condition/sanitation
which is classified as a
health threat in the
typology of nursing
problems.

2. Modifiability of the 2/2 x 2 = 2 2 Unsanitary waste

Problem disposal is easily
(easily modifiable) modifiable as it requires
a simple intervention to
fix and the intervention
can be done by the
family members
themselves

3. Preventive Potential 3/3 x 1 = 1 1 As the problem is easily

(high) modifiable or fixed, the
preventive potential is
also high as the problem
can be prevented by
simple interventions by
the members
themselves.

The salience is low as

4. Salience 0/2 x 1 = 0 0 they are used to this
(not perceived as a environmental condition
problem or condition and it has become part
needing change) of their daily routine and
they have managed to

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 live with it. Thus, their
perception is that if they
can live with it then it
does not need
immediate attention.

Total Score: 3.67

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Case 4: Inadequate living space

CRITERIA COMPUTATION SCORE JUSTIFICATION

1. Nature of the Problem 2/3x1 0.67 Inability to provide a

(Health Threat) home environment
conducive to health
maintenance and
personal development
due to Inadequate family
resources specifically
financial constraints and
Limited physical
resources.

2. Modifiability of the 0/2x2 0 The problem can be

Problem lowly modified because
Scale: Not Modifiable the family has limited
resources that could
provide themselves a
bigger place to live.

3. Preventive Potential 2/3x1 0.67 By increasing the living

Scale: Moderate space, the transferability
of communicable
diseases might be
lowered and it could
also provide more
privacy for the
members.

The family doesn’t see

4. Salience 0/2x1 0 the inadequate living
Scale: not perceived space as a problem as
as a problem or long as they have a
condition needing place to stay and rest.
change

Total Score: 1.34

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Case 5 Breastfeeding

CRITERIA COMPUTATION SCORE JUSTIFICATION

1. Nature of the Problem 3/3x1 1 Readiness for

(wellness state) Enhanced
Capability for
Breastfeeding.

2. Modifiability of the The problem can

Problem 2/2x2 2 be easily
Scale: easily modifiable
Modifiable because the
mother can visit
the near
healthcare centers
for interventions to
learn at home.

The infant in the

3. Preventive Potential 3/3x1 1 family is directly
Scale: high affected thus the
score is high

The family does

not perceive this
4. Salience 0/2x1 0 as a problem
Scale: not perceived since they don’t
as a problem or recognize it as a
condition needing problem in the first
change place.

Total Score: 4

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Case 6 Family size beyond what family resources can adequately provide

CRITERIA COMPUTATION SCORE JUSTIFICATION

1. Nature of the Problem 2/3x1 0.67 The family’s

(health threat) condition is not
conductive to
maintain wellness
or realize health
potential.

2. Modifiability of the 2/2x2 2 The family can

Problem seek help from
Scale: easily nearby health
Modifiable centers to analyze
the advantages
and
disadvantages of
each alternative
method to
encourage better
decision making
on the best option
given the family’s
situated
possibilities.

3. Preventive Potential 3/3x1 1 The problem

Scale: high directly affects the
vulnerable
members of the
family such as the
child and the sick,
thus the score is
high.

The family
recognizes their
4. Salience 2/2x1 1 situation as an
Scale: perceived as a immediate
problem or condition problem which

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needing immediate needs to be
attention solved promptly.

Total Score: 4.67

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IMPLICATIONS:

Nursing is a calling and an obligation to perform care to your clients. It is also a

duty of contributing to the total recovery of our clients instead of pushing them towards
their deterioration. Furthermore, as stated in the Philippine nurse’s code of ethics article
1 section 1, “Health is a fundamental right of every individual”. Hence, as aspiring nurses
in order to provide them with the best assistance in maintaining their health, honing our
skills and enhancing our knowledge through studies would be essential. Integrated
Management of Childhood Illness (IMCI) is one of the necessary courses that a student
nurse should take to be able to perform good care in the near future especially in the field
of child-caring.

In nursing practice, IMCI is very vital as it reduces morbidity and mortality in

children. This case study is also significant in nursing practice as we, the student nurses,
were able to hone our skills and use our knowledge in building a case and studying it. In
nursing education, this case study became an avenue for further learnings as we were
exposed to real-life scenarios and as we made our case study our instructors were there
to instruct and guide us. In nursing research, the data gathered in this study could be
used to add to the pre-existing body of knowledge, which in turn would pave the way to
the development of new discoveries in nursing itself.

The process and interaction performed during IMCI has proven time and time
again in aiding children from getting sick and dying. Being able to prevent a child from
getting sick or, in some cases, getting worse from illnesses they already have, is the
primary goal of Integrated Management of Childhood Illness. IMCI booklets help guide us
nurses to correctly and swiftly classify diseases and urgent cases of referral in order to
protect the lives of children. Not only does this aid families as a most cost-effective care
for the low-income places, it also promotes prevention as it emphasizes the importance
of interventions, cure, and immunizations. IMCI has been nothing less than a total benefit
for both Primary Care and Public Health Care as a whole and we as nurses have our

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obligation to use all the resources possible to continue and practice effective and positive
healthcare.

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Breastfedbabies. (2018). Attachment and positioning. Retrieved from:

https://www.breastfedbabies.org/attachment-and-positioning

Gita-Carlos, R. A. (2019, October 17). PH poverty projected to be at 18.7% in 2021: WB.

Retrieved from https://www.pna.gov.ph/articles/1083509

Hope, I. (2018). Family Nursing Care Plan. Retrieved January 30, 2021 from
https://rnspeak.com/family-nursing-care-
plan/#:~:text=Family%20Nursing%20Care%20Plan%20is,the%20family%20as%20a%20
whole.&text=It%20is%20important%20to%20take,it%20is%20continuous%20in%20natur
e.

Peer, A. (2020, October 16). Global poverty: Facts, FAQs, and how to help. Retrieved from
https://www.worldvision.org/sponsorship-news-stories/global-poverty-facts

Philippine Statistics Authority Region XI (4 Feb. 2020). 2018 poverty estimates of Davao
region. Retrieved from: rsso11.psa.gov.ph/article/2018-poverty-estimates-davao-region.

RNpedia. (2018). A Typology of Nursing Problems in Family Nursing Practice. Retrieved

February 02, 2021 from https://www.rnpedia.com/nursing-notes/community-health-
nursing-notes/typology-nursing-problems-family-nursing-practice/

Stephanie. (2016). Nursing Prioritization: How do I know what to Do first? Retrieved January 31,
2021 from https://magoosh.com/nclexrn/nursing-prioritization/

Sta. Ana, C. (2021). Prioritization Rank Problem Score Justification. Retrieved January 30, 2021
from
https://www.academia.edu/27386854/PRIORITIZATION_RANK_PROBLEM_SCORE_JU
STIFICATION

RNpedia. (2021). Family Coping Index. Retrieved January 31, 2021 from
https://www.rnpedia.com/nursing-notes/community-health-nursing-notes/family-coping-

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 index/#:~:text=Justification%2D%20a%20brief%20statement%20that,the%20given%20pe
riod%20of%20time.

WHO. (2021). What is Integrated Management of Childhood Illness

(IMCI) Retrieved February 1, 2021 from (IMCI)? Retrieved February 1, 2021 from
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