CHN Case Study

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A Community Diagnosis of Sitio Asana 1,
Brgy.Santisima Cruz, Sta. Cruz, Laguna
Community Health Nursing
Related Learning Experiences

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Presented to the Faculty of the College of Nursing and Allied Health
In partial Fulfillment of the Requirements in Community Health Nursing Related
Learning Experiences
GROUP I
BSN II-A
Ambrosio, Maui
Barnobal. Rhea
Birador, Rozelle Mae
Lazaro, Marie Kris
Lorico, Jena Marie
Natoza, Rhoniel
Molina, Paul Joseph
Ortiz, Daira Lee
Sarmiento, Randell Mar
Diploma in Midwifery - II
Jara, Baby Dina
Leonardo, Liezel
Ramos, Nirv Mae
San Esteban, Nicole
Taiño, Maydirence
October 1st 2014
Class Instructors:
Mrs. Ma. Janice M. Bernardo, R.N, MAN
Mrs.Myranie L. Sy, R.N, MAN
Mrs.Laarni A. Bundalian, R.N, MSN
Mrs.Conchita E. Villamin, Ed. D, RN

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DEDICATION
We would like to dedicate this simple work to the whole faculty of College of Nursing
and Allied Health and to our class instructors in the Community Health Nursing who
taught us everything and gave us worthwhile advises to improve and achieve the
success of this study; to our beloved parents, who are always there and for guiding us
as we conduct the study; to our classmates, BSN II-A and Diploma in Midwifery II-A ,for
always making us smile as an encouragement; to our Alma Mater, Laguna State
Polytechnic University for homing our potentials and for serving as a tract in order to
achieve our dreams; to the Municipal Health Office and to the whole people of Brgy.
Santisimaespecially the Sitio Asana I, for allowing us to experience and learn from their
lives; and most importantly to our Almighty God for being our inspiration on doing the
study, for giving us strength, overflowing blessings, and broad knowledge while
conducting this study.

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Acknowledgement
With the sense of appreciation and pleasure, the student midwives and nursing
researchers aspire to express their overwhelming and sincere thanks to the following
persons that prolonged their never-ending support, advices, assistance and
encouragement to the success of this study. This section is for all of them.
To our cherished University President, Hon. Nestor M. de Vera, for raising
academic excellence in Laguna State Polytechnic University.
To the faculty members of the College of Nursing and Allied Health especially
Dean May M. Veridiano, Ph.D. RN, for the help and assistance on the community
activities and also for elevating the student’s competencies.
To our beloved research instructors, Mrs. Janice M. Bernardo, Mrs.Laarni A.
Bundalian, Mrs.Myranie L. Sy and Mrs.Conchita E. Villamin for being compassionate on
sharing their knowledge and for sacrificing their time and effort just to help the
researchers on conducting this study. Rain or shine, you’re with us, Ma’am. Thank you!
To the Municipal Health Office headed by Dra. Delia A. Becina for allowing us to
conduct the community service inSitio Asana I, Brgy.Santisima, Sta. Cruz, Laguna.
To the Brgy.Santisima Officials headed by Hon. Jessie M. Alejandrino and to the
Health Center Staff headed by the Rural Health Midwife --- for the continuous support
until we finished this study.

To our classmates, BSN II-A and Diploma in Midwifery II-A, for their positive
support even when things seems impossible to finish during the accomplishment of this
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case study.
To our supportive parents, for the moral and financial support especially for
understanding their situation during the accomplishment of the study.
And of course, to our Omniscient God, for giving us the opportunity to see and
touch the lives of community people; and for the strength and courage on facing the
trials, hardships and sacrifices while conducting this study; and for the wisdom,
provision and unending assistance for the student midwives and nursing researchers.

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Chapter 1
INTRODUCTION
Community Health Nursing is the synthesis of nursing and public health practice
applied to promote and protect the health of population. It combines all the basic
elements of clinical nursing with public health and community practice. It is essential
particularly at this point in time because it maximizes the health status of individuals,
families, groups and the community through direct approach with them.
There are so many factors that can affect the health of a family in a community.
Chronic illnesses, accidents, vices like tobacco smoking, alcoholism and drug addiction,
and environmental changes that affect health are steadily becoming the major concerns
influencing human health in our country.
And as nurses of the 20th century, we have our duties and responsibilities to
keep a self-motivated balance with the ever changing needs of the health of our society.
To help the community with these societal needs, nurses must understand
concepts and models of the community health nursing, the importance of health
promotion, disease prevention, health care planning, implementation and evaluation of
health care efforts for the advantage of the community.

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TABLE OF CONTENTS
ACKNOWLEDGEMENTS………………………………………………………………………..4
INTRODUCTION………………………………………………………………………………….6
TABLE OF CONTENTS
COMMUNITY PROFILE………………………………………………………………………….9
VICINITY MAP……………………………………………………………………………………15
SPOT MAP……………………………………………………………………………………….16
BARANGAY ORGANIZATION CHART………………………………………………………..17
HEALTH CENTER ORGANIZATION CHART
I. FAMILY STRUCTURE
A. Total Population
B. Sex
C. Civil Status
D. Type of Family
E. Family Size
II. Socioeconomic and Cultural
A. Employment
B. Monthly income
C. Education
D. Religion
III. Home and Envionment
a. Residency (lengthof stay)
b. Home ownership
c. Land Ownership
d. Type of Houses
e. Type of Structure
f. Electricity Availability

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g. Means of Cooking
h. Food Storage
i. Water Source
j. Storage of Drinking Water
k. Garbage Disposal system
l. Type of toilet
III. HEALTH CARE
a. Birth attendant
b. Place of delivery
c. Infant feeding
d. Weight of the children
e. Height of the children
f. Immunization of the children
IV. DATA ON COMMUNITY DEVELOPMENT
a. Health problem on the community
b. Cause and possible solution
c. Other needs of the community
d. Solution to the needs of the community
V. COMMUNITY PROBLEMS RECOMMENDATION
a. Problem prioritization
b. Community health care plan
IX. APPENDICES

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COMMUNITY PROFILE
PHYSICAL FEATURES
Location and Land Area
Barangay Santisima Cruz is one of twenty-six Barangays of Santa Cruz with the
largest population. It is located at:
1) North-Laguna de Bay.
2) South Barangay- City of Santa Cruz, Public market.
3) East Bay, Laguna de San Pablo.
4) West- Santa Cruz River.
The entire terrain of the Barangay is a valley on the shore of the lake of Laguna and
Santa Cruz River approximately 80% of which are residential with a small portion of
commercial businesses. The remaining is approximately 20% coastal. Coast being
more than 35% of the land is sinking in the water during the rainy season. Nevertheless,
people are used to live there and preserve the lake of Laguna and trade in the public
market.
Barangay Santisima Cruz has a population of 11800, 6238 are women and 5562 are
men who, in 2444 families and 2145 as the total number of homes. And 66.39% of
houses were made up of wood and cement. Then 16% of houses were made in cement,
13% were wooden and 4.61% were made in nipa materials.

Barangay Santisima Cruz is composed of Barangay Hall, two Health Centers,
Barangay Outpost, three Day Care Centers, and a Sport Complex. There is a public
school, the Santisima Cruz Elementary. There are also establishments and big
commercial stores namely, UNITOP Super Market, TIP-TOP Grocery, HIGH GLORY’S
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GRACE, AMYRC PUBLIC MARKET DRUG STORE, and PUBLIC MARKET Phase II.
With respect to Health Care, there are 2 midwives, 3 day-care workers, 3 BNS, 9
BHW. They also have several officials of SNO per Sitio. GMAC, Dengue Brigade,
BERT, BDCC and CAPIN had been established, too.
Currently, there are projects being implemented in the village, such as the annual
weighing of 0-7 months, Feeding Programs, PABASA saNutrisyon with the help of the
Municipal Nutrition Office, Regular Medical Consultation and vaccination every
Wednesday. Pre-natal check-up every Tuesday and Thursday are also scheduled.
Clean and Green Credit Assistance provided by the NGO’S, Special Feeding Program,
sponsored by the NGO’s and Private School, and also Special Program for the
employment of Students (SPES) SCHOLAR/ FINANCIAL AID ASSISTANCE,
Communal Faith Garden and First Steps in Education (Grade I) are established.

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Resources
The main occupation of Barangay Santisima Cruz is ‘Self Employment’. And on
the shore of the river and the lake, the main source of income is fishing. There are some
professional people and some are overseas contract workers residing. There are
residents who take care for domesticated animals like pigs, chickens, ducks and buffalo.
And there are some people who have their own businesses and some unemployed.
DEMOGRAPHIC FEATURES
I. Population
The barangay Asana I, has a latest population of 2,050 people and 520
household, according to their group age as below the table:
II. Population Density
The barangay Asana 1, Santisima Cruz, Sta. Cruz, Laguna and near in the
Laguna Bay and Sta.Cruz river side and the public market as a population density of
approximately 50 hectares with 1 church, 1 barangay health center and accompanied
by their own barangay health workers, 1 basketball court and 1 bridge, 1 barangay hall
and 40 artesian wells.

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III. Power Supply
The MERALCO agency is one of the main power source of the barangay Asana
I, it supplies almost 90% of the barangay households. And the other power supplies are
man-made like kerosene lamp, candle and other light sources, according to the people
of the barangay.
IV. Communication Services
In the status of the barangay, the common means of communications are the
cell phones and televisions. Few have their own internet services, radios and
telephones. And rarely nowadays, others are using the postal mail for their
communication.
PHYSICAL INFRASTRUCTURES
I. Transportation
Travelling from one place to another inside or outside the vicinity of the barangay
has been made easy and convenient. Tricycle is the primary mode of transportation that
takes the passengers to the other sitios and municipalities. There are also some
families who have their own motorcycles and few have their pedicabs and bikes. But
still, there are some residents who prefer walking than riding.

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II. Water Supply
Artesian well is the primary water supply in the community and others get their
sources of water from NAWASA. Only few residents are using deep well as their water
supply for their household chores. Most of the family in the community are purchasing
mineral water as their drinking supply.
SOCIAL FEATURES
I. HEALTH FACILITIES AND SERVICES
Health Center is the primary health care provider for the people of Sitio Asana I.
Almost all of the families are going to the health center for health consultation,
morbidity, pre-natal and post natal visit and immunization for their children.
II. LIVELIHOOD
Sitio Asana I in SantisimaCruz has many income generating, like rugs making,
tinapaand tulinganmanufacturing, also cooking some kakanin like banana cue, kalamay,
kinabog, majablanca and etc. Mostly, their livelihood is from the bay site that’s why
many are fishermen and fish vendors at the market. Others are construction workers at
the nearby river that was under renovation.

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III. EDUCATIONAL FACILITIES
Based on the researcher’s months of stay within the community, poverty is not a
hindrance for the fulfilment of their education. There are no colleges and high schools at
Sitio Asana I. But the rest of the barangays have many schools and institutions. And
they have two Day Care Centers that helps children at their young age to be educated
on the right attitude, skills and knowledge.
IV. GARBAGE DISPOSAL
Majority of the garbage disposal of waste are picked-up and collected only once
or twice a week. Only few of the barangay households are using open burning, hog
feeding and burial in pit.

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I. FAMILY STRUCTURE
Total Population
Number of Surveyed Households
64%
Figure 1.1
22%
total number of surveyed
households
total number of
households who refused
total number of
households who are out of
house
total number of
unsurveyed households
Number of Surveyed Households
Frequency Percentage
10%
4%
total number of surveyed households 332 64%
total number of households who refused 23 4%
total number of households who are out of house 52 10%
total number of unsurveyed households 113 22%
total number of households 520 100%

Community Health Survey is one method that the researchers used in
conducting this Community Diagnosis. Aside from doing a house-to-house
visitation and observation, the Community Health Survey form helped a lot on
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collecting data from the community.
And based on the figure 1.1 above, 64% of the whole population was the
total number of households that the researchers had surveyed; 4% of the
population refused to our community survey and 10% of it were out of their
houses while 22% of the whole population were not surveyed.
There are some households on Sitio Asana I who refused to be surveyed.
This is because of some excuses like they are busy on doing their household
chores or they will go to some other place during the visit. Another reason why
some houses were not surveyed was because their homes are closed. But
fortunately, the researchers were able to get the attention and cooperation of the
332 families (64%) out of 520 households.

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Sex distribution
47%
53%
female male
Figure 1.3
Female 834
Male 931
Gender, defined as the socially prescribed and experienced dimensions of
femininity and masculinity in society, is evident in the diverse ways individuals
engage in health behaviours.

Health is affected by macro-level influences including social structures and
institutions which shape the expectations of women and men, and the way their
lives are organized. To understand health practices and illness experiences it is
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increasingly recognized that accounting for gender is vital.
Based on the figure 1.3 above, it is stated that there are 53 % male
and 47% female at the Sitio Asana I.
The number of male is slightly greater than the female. Men at their
sitio have more vigorous works than female like on what their commonly work
there, being a fisherman and a construction worker. This means that more male
muscles are being stretched, although females have their works too. Nowadays,
some vices like smoking and drinking alcohol, which is more frequently done by
males before, females there are now doing it too. This can be a risk factor and
dangerous to the health.

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CIVIL STATUS
Single Married Common Law Widowed Separated
Figure 1.4
450
400
350
300
250
200
150
100
50
0
A person's marital status indicates whether the person if they are married ,
single , common law , widowed or even separated. Base on the research , the
community has the highest population of single . Some unmarried people object to
describing themselves by a simplistic term "single", and often other options are given,
such as "divorced", "widowed", widow or widower.
In some cases, knowing that people are divorced, widowed, or in a relationship is
more useful than simply knowing that they are unmarried.

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Type of Family
Figure 1.5
Nuclear 216
Extended 113
Others 3
Total 332
In a family, both mothers and fathers play important roles in the growth
and development of their children. The number and the structure of family in the
household, as well as the relationship between the parents, are strongly linked to
their child’s well-being.
65%
34%
1%
nuclear extended others

Based on the figure above, the family type which is nuclear in structure
has 65% which the largest count, while the extended family has 34%, and the
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least is of 1% consisting of the other family structure like homosexual.
In this case, you can see that more families in the whole community still
have a nuclear structure. But at the same time, extended family is also
increased. This is because some couples who doesn’t have their own home, they
prefer living with their in-laws.

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I. SOCIO-ECONOMIC INDICATORS
Employment
Socioeconomics also known as socio-economics or social economics is
the social science that studies how economic activity affects and is shaped by
social processes. In general it analyzes how societies progress, stagnate,
or regress because of their local or regional economy, or the global economy.
Based on our research, most of the people within the community are self-employed
. They have their own viceps such as tricycle , that has been use to
have a source of income. The Brgy. Santisima is located near the beside the
Sta. Cruz River, and by that they use to catch some fish and sell it in the public
market, and they were called vendor. Also, some of them use to have some
sources of income in their sari – sari store business. But other families are
employed and are working in the government.
These may affect patterns of consumption, the distribution of incomes
and wealth, the way in which people behave (both in terms of purchase decisions
and the way in which they choose to spend their time), and the overall quality of
life.

College Graduate
College undergraduate
College Student
High School Graduate
High School Undegraduate
High Scool Student
Elementary Graduate
Elementary Undergraduate
Elementary Student
Kinder
No schooling
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Educational Attainment
9%
8%
7%
Figure 2.1
3%
20%
5%
10%
3%
Category Frequency Percentage
17%
11%
7%
College Graduate 87 9%
College undergraduate 75 8%
College Student 24 3%
High School Graduate 189 20%
High School Undergraduate 65 7%
High School Student 93 10%
Elementary Graduate 99 11%
Elementary Undergraduate 69 7%
Elementary Student 154 17%
Kinder 31 3%
Not yet schooling 45 5%

Based on the figure above, 9% of the population are college graduates.
8% are college undergraduate, those are the persons who stopped on their
studies. Right now, 3% are college students. And 20% of the community are
high school graduates; 7% are high school undergraduates; and currently, 10%
are high school students. Another 11% are elementary graduates, 7% for
elementary undergraduates. Currently, 17% are elementary students. 3% are
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kinder and 5% not yet schooling due to their age.
We can see here that the high school graduates have the highest
percentage. Most of their reason why they didn’t continue it to college is due to
lack of finance. That’s the reason why not all families can afford having a good
education. And this factor can affect their health and their future employment.
Studies show that education is one of the major socioeconomic factors
that influence a person’s behavior and attitudes. In general, better-educated
person is more knowledgeable about the use of health facilities, family planning
methods, and the health of their family, according to Philippine National
Demographic and Health Survey (2008). They also added that education is
highly valued by Filipino families. This is reflected in the country’s constitution,
which states that education up to high school level is a basic right of all Filipino
children. http://dhsprogram.com/pubs/pdf/FR224/FR224.pdf
And according to Child Trends’ Data Bank (2002-2012), educational
attainment is a powerful predictor of well-being. Young adults who have
completed higher levels of education are more likely to achieve economic

success than those who have not. In addition to qualifying one for a broader
range of jobs, completing more years of education also protects against
unemployment. In the past few decades, earning differentials by education level
have been increasing, especially among men. Adults with higher levels of
education also report being in better health and having higher levels of socio-emotional
well-being. They are also less likely to divorce, or be incarcerated.
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http://www.census.gov/population/www/socdemo/educ-attn.html
The studies prove that having a good educational attainment in life has a
huge impact on the health, behavior, and also to the socioeconomic level of a
person and his family.

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Chapter III
HOME ENVIRONMENT

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A. Residency (length of stay)
The researchers conducted their research at Sitio Asana, Brgy.
Santisima. They found out that most of the community people were born
on the said place. They say that it was one of the factors why they can’t
leave the place although Santisima is one of the places that everyone
know that is common to have floods. The other factor they can’t leave the
place is because most of them are working at the Public Market as a
vendor or ass a fisherman at the Sta. cruz river. Although, not all of them
were born at Santisima, some of them say that they started to live the
place when they got married since their partner in life lives the places.
Some of them were just renting a place because the houses that is for rent
is in a very cheap amount.
B. Home ownership
Home Ownership
75%
20%
5%
owned
rented

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Owned 250
Rented 66
others (borrowed) 16
Total 332
All families need a home that is comfortable for each and every member.
But there are various ways in the production, rehabilitation, or other provision of
affordable housing that may affect health outcomes of the children and families.
And as you can see, on figure above, 79% of the community houses that
were surveyed are personally owned by the family who are living there. On the
other half, 21% of the community households are being rented.
The reason for that 21% is because not all families can afford having their
own houses, so some families decided to rent houses where they can have
enough space to live in and in a sufficient rental fee.
Cohen (2011) explained about her research on what’s the connection
between housing and health. She stated that individuals who choose to become
homeowners may share a common set of characteristics that, regardless of
tenure, influence parenting and health and at least partially explain different
outcomes among renters and owners. She emphasized that by providing families
with greater residential stability, affordable housing can reduce stress and related
adverse health outcomes. Also, affordable housing may improve health
outcomes by freeing up family resources for nutritious food and health care
expenditures.

According to Am J Public Health (2002), lack of affordable housing has
been linked to inadequate nutrition, especially among children. Relatively
expensive housing may force low-income tenants to use more of their resources
to obtain shelter, leaving less for other necessities such as food. Children from
low-income families receiving housing subsidies showed increased growth
compared with children whose families were on a subsidy waiting list, an
observation consistent with the idea that subsidies provide a protective effect
against childhood under nutrition. Temporary housing for homeless children often
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lacks cooking facilities, leading to poor nutrition.
C. Land ownership
As we conduct the study as Sitio Asana, Brgy. Santisima we found out
that most of the community people built a house in a land that is not personally
owned by them. They either says that the land was personally owned by the
government or they just ask permission to the land owner if they can build a
house permanently in their land. Although some family builds their house at a
land that is personally owned by them or either say that it was inherited from their
parents or grandparents.

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D. Type of House
Construction Material Used
17%
51%
32%
wood mixed concrete
Wood 56 17%
Mixed 169 51%
Concrete 107 32%
The physical characteristics of households are important indicators of
health and of the general socioeconomic condition of the population.

On figure above, it’s all about the construction material that is used to
build the community houses. 17% are made up of wood; 51% is made up of
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mixed materials and 32% of houses are fully furnished with concrete materials.
People in the community thought that having a fully concrete house is
so much expensive so they chose building with a mixed construction materials.
Cohen (2011) also stated that well-constructed and managed affordable
housing developments can reduce health problems associated with poor quality
housing by limiting exposure to allergens, neurotoxins, and other dangers. And
by alleviating crowding, affordable housing can reduce exposure to stressors and
infectious disease, leading to improvements in physical and mental health. She
even added that the efforts to minimize children’s exposure to lead paint in the
home have greatly reduced the incidence of lead poisoning and associated
physical and cognitive health problems.
This means that, housing materials can really affect multiple dimensions of
health in a family. Poor housing conditions contribute to increasing exposure to
biological, chemical and physical hazards, which directly affect physiological and
biochemical processes.
In addition, concerns about poor housing facility and fear of homelessness
are psychosocial stressors that can lead to mental health problems.

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E. Type of structure
Type of Family
65%
34%
1%
nuclear extended others
Nuclear 216
Extended 113
Others 3
Total 332
In a family, both mothers and fathers play important roles in the growth
and development of their children. The number and the structure of family in the
household, as well as the relationship between the parents, are strongly linked to
their child’s well-being.
Based on the figure above, the family type which is nuclear in structure
has 65% which the largest count, while the extended family has 34%, and the
least is of 1% consisting of the other family structure like homosexual.

In this case, you can see that more families in the whole community still
have a nuclear structure. But at the same time, extended family is also
increased. This is because some couples who doesn’t have their own home, they
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prefer living with their in-laws.
F. Electricity availability
Lighting Facility
90%
8% 2%
Electricity 299
Kerosene 26
Others 7
Total 332
electricity
kerosene
others

The researchers found out that 90% of the households at Sitio Asana 1
have their electricity and MERALCO is their source. Only 8% of the community
households are using Kerosene as the Light source because they are lack of
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financial support. And 2% pertains to the so-called ‘jumper’.
Having an electric source is a good thing for a family. But using kerosene
as their light source can be a health threat to them because it can lead to a fire.
And also, using a so-called ‘jumper’ is prohibited but still few families are doing it
illegally.
G. Means of cooking
Cooking Facility
3%
27%
70%
Electric stove 9
Gas stove 90
Firewood 233
Total 332
Electric Stove
Gas Stove
Firewood

Information on the type of fuel used for cooking is another measure of
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the socioeconomic status of the household.
On figure above, it is all about the kitchen’s cooking facility. 3% of the
community households uses electric stove to cook their food. 27% uses gas
stove and 70% uses firewood or charcoal as their way to cook food.
Using a firewood or charcoal has been their most preferred method. This is
maybe because it is more affordable, no need for gas or electricity. Everyone can
easily get woods and dry it beside their houses.
The use of some cooking fuels causes pollution and can have adverse conseq
uences on health and the environment. Smoke from solid fuels is a serious
health hazard, particularly for persons with respiratory ailments.
H. Food storage
Food Storage
80%
10%
10%
covered
uncovered
refrigerated

Based on the graph for food storage, 80% of surveyed households say
that they covered their foods, 10% for the uncovered and also 10% for those who
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use refrigerator as a way of food storage.
For the food storage, the people in the community of Asana 1, preferred to
cover their foods with 80% and 10% use to keep their foods refrigerated, this
10% are the families that have good and stable income. The proper way of food
storage eliminates the risk of food contamination, because some insects such as
flies can transmit microorganisms that can cause food poisoning to the families.
I. Water source
Water supply
31%
2% 67%
artesian well
deep well
NAWASA
Covered 265
Uncovered 35
Refrigerated 32

It’s all about the sources of their water supply. 67% of the household that
are not surveyed uses artesian well as their water source. 2% gain their water
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supply at deep well and 31% over NAWASA as their source of water.
Most of the people in the community use artesian well because it is more
affordable and available than the other sources. But not all artesian well are safe.
That’s why some families experienced digestive disorders.
A study by the World Health Organization in 2010 reported the
improvement of water, sanitation and hygiene can prevent 9.1% of the WASH-related
disease burden or 6.3% of deaths. A very large share of the disease
burden falls on children under the age of five.
J. Source of drinking water
As we conduct the study, we found out that most of the family buys a
Purified drinking water to a dealer. And some of them are just using water from a
artesian well and use it as their drinking water without boiling. Although, we know
that the Municipal Health Office is conducting a few test to know if an artesian
well used for drinking is safe. It will be better if the community people will
undergo boiling preparation before drinking water.

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K. Garbage disposal
Garbage Disposal
47%
52%
1%
Based on the graph, 52% of garbage disposal were open, 48% were
covered and 0% of garbage disposal were none.
The garbage disposal in Asana 1 was open with 52%, the usual thing that they
do, they are placing their garbage on a sack and just place it on the front of their
house. In this way of garbage disposal, it’s easy for the flies to soar with it and for
the dogs and cats to scatter the garbage. And this condition is a health threat
because it can affect the health of the community
covered
open
none
covered 158
open 172
none 2

Majority of the garbage disposal of waste are picked-up and collected only once
or twice a week. Only few of the barangay households are using open burning,
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hog feeding and burial in pit.
0 50 100 150 200 250 300
burial in pit
garbage collection
open dumping
open burning
hog feeding
Method of Disposal
hog feeding 6
open burning 52
open dumping 36
garbage collection 262
burial in pit 16
Composting 0

There are 262 families who are using garbage collection as their method
of disposal; 52 uses open burning; 36 uses open dumping; 16 uses burial in pit;
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and 6 families uses hog feeding.
Almost all of the residents are just waiting for the expected day that the garbage
collectors are going to visit them. For them, this is the easiest way of disposing
their garbage. But few prefer open burning as their method of disposal which is a
health threat for our mother earth. Some are just open dumping which also leads
to unsanitary environment. And few houses use burial in pit and hog feeding as
their method of disposal.
L. Type of Toilet
Toilet Facility
16, 5% 6, 2%
311, 93%
1, 0%
flush type
pit privy/communal
with septic
ballot system

44
flush type 16
pit privy/communal 6
with septic 311
ballot system 1
Total 332
Having access to sanitation is a basic human right. Without toilets,
untreated human waste can impact a whole community, affecting many aspects
of daily life and ultimately posing a serious risk to health.
Based on figure 3.4, 93% of households in Asana 1 have their own toilet
with septic tank. 5% of households were flush type. There are also 2% or 6
communal/pit privy type. Nevertheless, there is only 1 family that uses ballot
system as their way of disposing human waste.
The importance of having a septic tank is, their human waste will just stack
on it and there will be no contamination of microorganisms in the water near to it.
The 5% families who has flush type toilet are those that have good and stable
income. There are also 6 communal/pit privy that build by the community health
center for the houses that doesn’t have their own toilet. The only family that uses
ballot system as their way of disposing their human waste is a health threat
because there is a possibility that their waste can affect the food that they will
eat.

Toilets and sanitation systems cater for one of the most basic human
functions. Inadequate facilities, poor access and poor knowledge of urinary or
bowel health can have wide ranging implications for physical, emotional and
psychological health. This is true for adults and children, but it is children who are
often powerless to bring improvements to this aspect of their life. While
inadequate access to clean, pleasant toilets will affect all children badly, it can
have a particularly negative impact for children with disabilities and/or additional
support needs, for children with bladder or bowel conditions, or for children
experiencing bullying.http://www.sccyp.org.uk/ufiles/Toilets-Literature-Review.pdf
The issue runs deeper into societal impacts, such as teenage girls often
leaving school at the onset of menstruation due to lack of privacy and the risk of
attack or rape associated with being forced to defecate in the open during
nightfall. Furthermore, it is reported that every year more children die from
diarrhea related disease than from HIV, malaria and tuberculosis combined. This
situation could be solved simply by providing improved water, sanitation and
45
hygiene facilities.
A safe toilet accompanied by hand washing with soap, provides an
effective barrier to transmission of diseases.

Toilet Ownership
87%
13%
Having your own toilet facility is needed by every family. Sharing toilet to
other families is an unsanitary thing. Not just for not contaminating each other,
but also for the sake of privacy. We can see here that there are 87% of the toilets
46
are owned while 13% of the toilets are shared.
Lack of access to sanitation facilities affects women more than men.
Studies have demonstrated that women who have to travel to use the toilet or to
defecate in the open are more susceptible to sexual harassment and violence.
Often, in densely populated areas, it is challenging for women to find privacy.
This can lead them to refrain from urinating and defecating for many hours, which
it has been suggested may cause urinary tract infections.
owned
shared
Owned 288
Shared 44
332

48
Birth Attendant
People in the barangay, especially pregnant women, they prefer to go to the midwife.
Midwife serves as the birth attendant in the barangay. Since they have enough skills and
knowledge pregnant women have trust in the midwife to handle their delivery
Birthing Place
The place of giving birth in the barangay or the delivery room is big enough, clean
enough and organize. Big enough for them to move, clean enough so that it cant cause
infection both to the mother and the baby. There is proper ventilation and light.
Infant Feeding
Those people who have their babies, they prefer breast milk to their babies aside from
they can save and conserve money, it has a lot of nutrients that you cannot find in
formula milk. It has a lot of benefits to the mother and also to the baby.

49
Chapter IV
DATA ON COMMUNITY
DEVELOPMENT

50
Health problems of community:
Based on our survey in Santisima Cruz ASANA II located at West- Santa Cruz
River, the most common health problems of community are:
- Poor environmental sanitation
- Poor family hygiene
- Inadequate living space
- Family size beyond
- Family resources beyond what family can adequately provide
- Congested area
- Unemployment
- Improper waste disposal
- Presence of resting sites of vectors of diseases
Causes and possible solutions:
 Poor disposal of human and household waste encourages vermin and insects to
thrive, and water and food become contaminated, covering food storage may
help to prevent contamination.
 Poor family hygiene may lead to cause transferring of infection, it may easily
absorb by the body, health teaching include hand hygiene help to prevent
transferring of microorganism.

 Encouraging the people in community to arrange things in their proper place
51
help to provide space in congested area.
Other needs of the community:
- materials use in referral for information dissimilation
Solution to the needs of the community:
Educating the resident of the risk advantages and disadvantages of a healthier
self and environment, dissimilation of information to the people in community to
provide knowledge to their health problems can help solving the community needs.

52
Chapter V
Community Nursing
Care Plan

53
1. Poor Environmental Sanitation
Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective:
“Pasensyana kayo at hindi
pa ako nakakapaglinis.” As
verbalized by the mother.
Objectives:
 Garbage can be
seen in different
places in the
house, not directly
disposed to its
proper place
especially plastics,
cans and bottles.
 Improper drainage
system
Inability to
provide home
environmental
conducive to
health
maintenance
and personal
development
due to lack of
knowledge of
importance of
sanitation.
After the whole
community
nursing
interventions,
the family will
be able to
recognize their
environmental
problem.
 Discuss about the
consequences of most
common diseases that may
acquire.
 Advise the techniques and
methodsthat can be used
on cleaning their house.
a. Wear a mask while
cleaning the home.
b. Use appropriate
equipment.
c. Having a body mechanics
while cleaning.
 Emphasize the importance
of having a sanitary
environment.
 Monitor for places that are
prone to soiling and dirt.
 To know the level
of awareness of the
family about the
problem.
 To help them have
an idea on proper
way of cleaning
their house and for
safety.
 To help them
recognize the
benefits that a
sanitary
environment can
give.
 To determine which
part of the house
must be prioritized.
Client is now
able to utilize
their own
garbage without
the help of
other.

54
2. Poor Personal Hygiene
Subjective:
“Di pa kami
nakakaligo ang
dami ko
kasinggingawa
at ako’y naglaba”
as verbalized by
the mother.
Objective:
-Dirty and uncut
nails
- Uncombed hair
- Not properly
groomed
-with soiled
clothes
-Dirty appearance
-Poor oral hygiene
-Dirty ears
-Untidy
Inability to take
appropriate
actions to solve
the health
problem due to
lack of
intervention and
cooperation of
members of the
family.
After the nursing
intervention the
family will be
able to:
-Recognized
Poor Personal
Hygiene
-Provide time
and effort and
will cooperate.
-Verbalized the
importance of
personal hygiene
Educating and
encouraging the family
regarding the proper
Personal Hygiene like:
a. Brushing teeth every
after meal
b. Washing hands
before and after meal
c. Keeping their nails
clean.
d. Taking a bath
everyday
e. Changing their untidy
clothes always
-Discuss with
importance of hygiene
-Discuss about the
consequences of most
common disease that
may acquired
To learn on
how to
practice
proper
personal
hygiene and
to improve it
-To prevent
infection
-To know the
level of
awareness of
the family
The family
will be able
to improve
their physical
appearance
and proper
personal
hygiene.|

55
3. Unemployment
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective:
“Nahihirapan akong
makahanap ng magandang
trabaho.” As verbalized by the
client.
Objective:
- Low family income
- Most are
undergraduate
- Low self-esteem
Unemployment At the end of
the whole
community
health
service, the
family will
have the
knowledge
about a
simple
livelihood.
 Establish rapport.
 Provide information
about other livelihood
programs in the
barangay.
 Motivate the family to
attend seminars.
 Encourage to have a
time management.
 Emphasize the
importance of
financial
management.
 Impart the progress
of this livelihood
programs.
 Encourage to lessen
vices.
To build trust and to keep the
family comfortable.
To help them gain knowledge
about having a small
business.
To help them practice the
business want and to give
them more knowledge about
it.
To make them organize on
the things that they are doing.
For them to recognize
prioritization on their family
income.
To encourage them on doing
the project/business.
To save money and time.
Goal partially met.
The family verbalizes
the understanding
about the teachings.

56
4. Imbalance Nutrition
Subjective:
“Lugawangkalimitangpagkai n
namindito. Minsan,
galunggongangulamkapagna
kakapangisdaangasawako.”
as verbalized by the mother.
Objectives:
 BMI: 7 underweight;
3 normal
 2 or 3 meals a days
 Poor skin turgor
 Improper food
storage
 Kids are fond of
eating junk foods
Imbalance nutrition
related to lack of
nutritional
resources as
manifested by 7
underweight family
member
After the nursing
interventions, the
family will have the
knowledge on the
possible solutions
that can improve
their nutritional
status.
 Determine the family
eating habits.
 Identify the BMI of each
family member.
 Educate the family on
what nutritious foods our
body needs.
 Encourage the family to
plant vegetables or fruits
that can easily grow on
their backyard.
 Educate that they can
add some nutritious
vegetables on a simple
foods (e.g. noodles with
malunggay)
 To identify the
nutritional pattern of
the family.
 To know their
baseline nutritional
status.
 To help them
identify nutritious
food that can
improve their
nutritional status.
 This can help them
lessen their
expenses.
 This can add
nutrients to the food
that they will
prepare.
Goal partially
met. Family
members
verbalize
understanding
on the possible
solutions that
can improve
their nutritional
status.

57
5. Breeding Places of insects
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective:
“Maraming
insektosaloob at
labas ng bahay
namin” as verbalized
by the head of the
family”
Objectives:
 Stagnant
water
drainage
 Unclean
House
 Dirty
Surroundings
Breeding Places of
insects
At the time of home
visit, the family will
now have the
knowledge on how
to:
1. Clean their
environment;
2. Replace the
stagnant water; and
3. Remove
congested drainage
 clean
environment
 render
environment
al sanitation
 Emphasized
the
significant of
cleanliness
 To have a
clean and
free from
insects and
other
illnesses
Partially Met
On the time of visit
as evidence by:
1.Clean
Environment
2.No stagnant water
3.Continues flow of
water drainage

CHN Case Study

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