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CHN Case Study

  1. 1 A Community Diagnosis of Sitio Asana 1, Brgy.Santisima Cruz, Sta. Cruz, Laguna Community Health Nursing Related Learning Experiences
  2. 2 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
  3. 3 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.
  4. 4 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.
  5. 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 5 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.
  6. 6 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.
  7. 7 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
  8. 8 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
  9. 9 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.
  10. 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 10 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.
  11. 11 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.
  12. 12 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.
  13. 13 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.
  14. 14 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.
  15. 15 Map of Santisima Cruz
  16. 16 Spot Map
  17. 17
  18. 18 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%
  19. 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 19 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.
  20. 20 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.
  21. 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 21 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.
  22. 22 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.
  23. 23 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
  24. 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 24 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.
  25. 25 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.
  26. College Graduate College undergraduate College Student High School Graduate High School Undegraduate High Scool Student Elementary Graduate Elementary Undergraduate Elementary Student Kinder No schooling 26 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%
  27. 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 27 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
  28. 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. 28 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.
  29. 29 Chapter III HOME ENVIRONMENT
  30. 30 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
  31. 31 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.
  32. 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 32 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.
  33. 33 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.
  34. 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 34 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.
  35. 35 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.
  36. 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 36 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
  37. 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 37 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
  38. Information on the type of fuel used for cooking is another measure of 38 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
  39. 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 39 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
  40. 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 40 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.
  41. 41 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
  42. 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, 42 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
  43. 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; 43 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. 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.
  45. 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.
  46. 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
  47. 47 Chapter IV Health Care
  48. 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. 49 Chapter IV DATA ON COMMUNITY DEVELOPMENT
  50. 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.
  51.  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. 52 Chapter V Community Nursing Care Plan
  53. 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. 54 2. Poor Personal Hygiene Assessment Diagnosis Planning Intervention Rationale Evaluation 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. 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. 56 4. Imbalance Nutrition Assessment Diagnosis Planning Intervention Rationale Evaluation 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. 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
  58. 58
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