Family Health Assessment Guide

Names of Members Present: Emanuel, Ana, Christian, and Cristina

1. Identifying Data
a. Family surname: Emanuel Burabuza and Ana Sengoli

b. Household Members (relationship, gender, age, occupation, education):

i. Emanuel: father, male, 33 years old, occupation: driver, education: form 4 and driving
course.
ii. Ana: mother, female, 28 years old, occupation: pastor at church, education: diploma and
wanting to work on degree
iii. Christian: son, male, 4 years old, occupation: n/a, education: preschool
iv. Cristina: daughter, female, 2 years old, occupation: n/a, education: n/a

c. Financial data (sources of income, financial assistance, medical care; expenditures):

i. Sources of income include Emanuel’s driving and Ana’s preaching at the church.
ii. Expenditures include: paying for home improvements, buying food for the home, and car
savings.
iii. Medical care: the children receive free care for being under 5 years old, 10,000 shillings
for health insurance for the entire year. Fees for rapid malaria tests (500 shillings). They
must pay out of pocket for anything that isn’t covered by the community health fund
(CHF).

d. Ethnicity: Emanuel: Nyamwezi tribe and Ana: Nzigua tribe from the Tanga Region.

e. Religion: Christian, part of the Anglican church

f. Identified client(s): the entire family.

2. Family Characteristics
a. Extended family
i. Relatives living outside household:
1. Emanuel
a. Parents: Tori (father) & Rehmi (mother)
b. Siblings: Emanuel (first born), then girl, girl, boy
2. Anna
a. Parents: Nuhu (deceased father) & Grena (mother)
b. Siblings: Anna (first born) then one brother younger

ii. Location of relatives:

1. Emanuel: Kigurunyembe
2. Anna: Kihonda

iii. Frequency & duration of contact:

1. The extended family members live within the Morogoro region so they are able to
visit on the weekends and Anna mentioned she gets to see them when she has the
chance and is not working.

iv. Means of communication:

 1. Main communication is by cell phone.

b. Family mobility
i. Length of time living in residence:
1. They have been living in their current residence for one year now as a family.

ii. Location of previous residence:

1. Kigurunyembre is where they previously lived and they rented in that location.

iii. Frequency of geographic moves:

1. They moved to Morogoro about one year ago and began building their current
home.

iv. Country/area of origin:

1. Tabora (Emanuel) and Tango (Anna) are the couples region of origin.

c. Family structure
i. Employment history:
1. Emanuel said he is self-employed and that driving has been his only employment.
He started off driving with a motorcycle and now drives his van.
2. Anna said her preaching has been her only employment history.

ii. Leisure time interests:

1. Anna said that when she is not working away preaching and doing her job, she
first works in the house to clean, care for the needs of the children, does cooking
(especially for her husband) and on Sunday’s she goes to church.
2. Emanuel mainly does a lot of driving and working and outside of that he said
there was not a whole lot that he does. He does get the foods & goods he
mentioned in the assessment.

iii. Division of labor:

1. Anna does a majority of the cooking, cleaning and caring of the children.
However, they did mention that if Anna is sick, Emanuel is capable and willing to
let Anna rest and he is able to do the caring, cooking and cleaning that she
normally would be doing.

iv. Allocation of roles:

1. Emanuel stated that he was the one who makes the decisions in their household
for the most part. Later on in the discussion they did mention that they often work
together for their decision-making but in the end, Emanuel usually has the final
say. Anna did mention that Emanuel often listens to her side or opinion.
2. Emanuel also did mention that he makes most of the decisions when it comes to
the money.

v. Distribution of authority & power:

1. For the most part, Emanuel and Anna seemed as if they really worked together as
a couple to make most of their decisions but Emanuel does have the authority and
power with the family.
d. Family cohesion
i. Emotional bonding of family members:
1. There was definitely evidence of emotional bonding between family members .
Christian and Christina were very warm towards both parents i.e. Hugging and
clinging to their mother.
ii. Degree of individual autonomy:
1. There was a small amount of individual autonomy among the family. Christian
and Christina are too young to make choices for themselves in regards to their
daily life. Ana said that if she needed to make a choice she would consult and talk
to Emanuel then decide from there what to do.

e. Family adaptation
i. Flexibility in role change:
1. As stated above, Emanuel stated that if Ana was unable to care for the children or
something of that nature he would most definitely take over her role. There seems
to be a very good sense of team work.
ii. Flexibility in power structure:
1. Overall there was some flexibility of power structure but it was very minimal, and
as stated above, Emanuel has the final say on pretty much every decision.

f. Family processes
i. How members communicate:
1. Members of the family talk in person, the have cell phones and they also have
email.
ii. How decisions are made:
1. The decisions are made together. They stated that they are a team. Ana did say
that if Emanuel disagreed with her she would back down and what he thought or
said would go.
iii. How problems are solved:
1. They talk about the problems as a couple and then decide where to go from there.
iv. How conflict is handled:
1. Conflict is handled together. If there is an issue the couple had stated they would
work together to figure it out. But once again Emanuel got the final say.

g. Family social integration

i. Language and/or dialect spoken:
1. Both parents speak Swahili, English, and their native language of Seguri and
Kargu. The children know Swahili but the parents are not teaching English to the
children.
ii. Literacy; ability to read or write in language:
1. Emanuel has completed Form Four and Ana has her Diploma and wants to
continue her Degree in Theology. Christian is in preschool.
iii. Degree of racial or cultural identity:
1. Even though they are from different native tribes, Emanuel and Ana’s parents had
no issue with them getting married. Also Emanuel was able to chose his own
wife.
2. Network with religious organizations:
3. They are Christian and part of the Anglican Church.
iv. Network with social organizations:
 1. The family is not part of any other clubs or social organizations other than the
church.

h. Degrees of stress experienced by the family

i. Combination of stressors:
1. They are stressed about their parents and other family members asking for money.
2. They are also stressed about if they were to need things they do not want to
burden other family members or people in the community.
3. They are also stressed about paying for school fees and and getting Christian to go
to school even though he doesn't want to.

i. Family health behavior

i. Activities of daily living (how family spends typical day):
1. Emanuel wakes up in the morning, checks on his family, eats and gets ready to
head out for work, but he keeps in contact with his family throughout the day.
Ana wakes up, prays, takes care of her morning hygiene like brushing teeth and
washing up, then she cleans up the house, cooks breakfast, reads the Bible,
prepares the kids for school, and then prepares lunch and dinner when the timing
is appropriate later on.
ii. Health history:
1. Emanuel’s mother and father both had the “pressure”/hypertension. Ana’s parents
also had hypertension.
iii. Health status (problems and priorities):
1. For Emanuel, he stated his main health problems right now include malaria and
intestinal parasites. For Ana, she stated her main health problems right now
include malaria, headaches, and toothaches.
iv. Risk behaviors:
1. Emanuel and Ana both stated that they do not drink alcohol and they do not
smoke cigarettes.
v. Family planning used:
1. Emanuel and Ana stated that they use the calendar method to prevent pregnancies.
vi. Self-care (health promotion and prevention):
1. Emanuel and Ana both stated that they received immunizations as a kid when
they were younger. They said they go to the doctor to get medicine when they
need it, and they get blood tests when needed. All children born nowadays get
immunizations when they are born and they continue to receive the appropriate
immunizations as they grow up, so Christian and Christina have received
immunizations as well.
vii. Health care resources (Professionals, lay healers, and agencies working with family):
1. Emanuel and Ana said that they go to Morogoro Regional Hospital when they
need healthcare services. They said there is a dispensary that they could use but it
is far away from where they live.
viii. Family strengths (health):
1. Ana stated their family health strengths right now are that they try to prevent
malaria and vector-borne diseases by using mosquito nets when they sleep in their
home, and they clean their hands before they eat their meals.
ix. Family priorities (health):
1. Ana stated their family health priorities right now are to keep staying strong and
healthy so that they can work harder and be better off in their daily lives. She also
 said she wants Christian to stop sucking his thumb because it can cause diseases
that are preventable.

3. Interpersonal Needs
a. Identified subsystems and dyads: Anna primarily takes care of the children, so that is one
subsystem, Anna and Emanuel are a strong parental dyed

b. Parent-child interactions: Anna takes full care of the children during the week. This includes
playing with, feeding, bathing etc. On Sunday when Anna works, there is a house girl that cares
for the children. Emanuel plays with the children when he is home, but only performs care when
Anna is sick.

c. Spousal relationships: Anna and Emanuel have a very strong, happy, and healthy spousal
relationship. It appears they have strong communication as well.

d. Sibling relationships: Christian and Christina play and dance together well, but also fight like
normal siblings over toys, cell phone, etc. A kind of “monkey-see-monkey-do” relationship was
observed where Christina followed everything Christian did.

e. Concerns about elders: Anna and Emanuel are both first born, so the responsibility of their
parents is on them. However, they explained that if their parents are to get ill, they would go to
their homes to care for them and it would be no problem. If necessary, their parents would also
be welcomed to their home to be looked after. Even though it would seem like a burden in
America, they explained that this was not so here and it would be no problem at all.

f. Caring for other dependent members: Anna and Emanuel are always the first family members to
call when in need for money from parents or siblings. Sometimes this is hard for them because
they only have money for their own family, but they are very willing to care for their family
members when in need.

4. Family Needs
a. Developmental
i. Children and ages
1. Christian - 4
2. Christina - 2

ii. Responsibilities for other members:

1. Ana, as the mother, was considered the main caretaker for the children. She
identified herself as the family member responsible for keeping them clean and
fed, as well as engaging in play with them during the day. She also expressed
difficulties with getting Christian to school in the morning, showing that as
another responsibility she carries. When they are both unable or unavailable to
watch the children, their house girl will take over responsibility for this. An
example identified was on Sundays, when Emanuel and Ana are both out of the
working.

iii. Recent additions or loss of members:

1. Christina is the most recent member of the family. Emanuel stated that his sister’s
children were around Christian’s age.
 2. Ana’s father passed recently from a motorcycle accident. Emanuel stated that he
has lost multiple family members in the past, including one of his sister’s firstborn
and siblings of his parents.
iv. Family stage:Using Duvall’s Developmental Stages and Tasks of the Family, they are in
the “Families with Preschool Children” stage. The major tasks with this stage are:
socialization of the children, integrating new children while still caring for older children,
and maintaining healthy relationships both within and outside of the family.

v. Tasks that need to be accomplished:

1. Continued supportive and healthy relationships between family members.
2. Christian is still sucking his thumb; this is discouraged for his age.

b. Loss or Illness
i. Non-normative events or illnesses: Anna and Emanuel have dealt with loss in their
family. On Emanuel’s side he lost his sisters first born child and grandfather. On Anna’s
side she lost her father and uncle.
ii. Reactions or perceptions of ability to cope: When asked about the families ability to cope
with these situations they mentioned their faith and prayer. Anna told us there isn't much
time to mourn, she said you have to be strong, being the first born there is a lot of
responsibility and things to take care of.

iii. Coping behaviors used by individuals and family unit: Faith was a major coping behavior
for the family. Siblings/clan didn't help however, Emanuel and Anna were supportive of
each other.
iv. Adjustments family has made: Some adjustments made included Emanuel helping more,
Anna stated it made their faith stronger, and at one point during the assessment she stated
“life goes on”.

v. Roles and tasks being assumed by members: After Anna lost her father Emanuel began
helping more to support her during the stress of that event.

vi. Any one individual bearing most of responsibility: Anna was bearing the most
responsibility during this event. Being the oldest sibling she was responsible for making
sure her mother was okay.

vii. Family idea of alternative coping behaviors available: They put emphasis on the stress of
their first born responsibilities. They did not mention other coping behaviors. Faith and
support from one another were the coping behaviors.

viii. Level of anxiety now and usually: When asking Anna and Emanuel if they had any
worry, they told us “not much”.

c. Resources and Support

i. General level of resources and economic exchange with community: Ana and Emanuel
expressed that they didn’t feel they had enough money because they are unable to finish
their house and they did not have the money to purchase flooring or electricity at this
time. They did feel they had adequate access and resources for food and water. They have
a nearby market they can get groceries and water from as well as building materials for
the house.
 ii. External sources of instrumental support (money, home aides, transportation, medicines,
etc.): Taking into considerations cultural differences, this family does not have external
support or money because traditionally that support comes from within the family. This
family employs a house girl for assistance with cooking, cleaning, and caring for the
children when both parents are away from the home. The family stated that they do have
access to, and utilize the public transportation system. Medications they use are free from
the Morogoro Regional Hospital. The family does have health insurance (the community
health fund), and they also have car insurance.

iii. Internal sources of instrumental support (available from family members): Family
members in traditional African culture provide all monetary support to its members. The
family has their own car.

iv. External sources of affective support (emotional and social support, help with problem
solving): The family’s main source of external support is from the health care facility
when they are ill. The family expressed that there are not any social programs that are
available to them.

v. Internal sources of affective support (who in family is most helpful to whom?): Both Ana
and Emanuel are first born children which in traditional African culture means that they
have the most responsibility as internal support to the family. They each have to rely
majorly on each other for support.

vi. Family more open or closed to outside assistance? The family expressed willingness to
accept outside assistance. The culture in this community involves help from Good
Samaritans. If the family needed help with various types of expenses, the community
would come together to meet those needs for money, transportation, health care
treatment, etc.

vii. Family willing to use external sources of support? The family conveyed a strong
willingness to accept external support, especially with healthcare. They had many
questions about health promotion and ways to meet specific health status goals.

d. Environment
i. Type of dwelling: Anna, Emanuel, Christian, and Christina live in a single family home
that is made of brick and stone with a mental roof and concrete floors. The windows had
screens but the rooms are not closed in.

ii. Number of rooms, bathrooms, stairs; refrigeration, cooking: The home had a sitting room,
kitchen, two bathrooms, and three bedrooms. There were no stairs inside of the home and
all of the rooms were located on a single level. There was no refrigeration in the home
and cooking was done over charcoal and with gas. There is no electricity in the home but
solar energy is used by the family.

iii. Water & sewage: There is one communal water source (a pipe) that is used by everyone
in the community, there is no running water inside of the home. There is a cement sewer
system inside the home that is connected to the toilets, but they are in need of another
one.
 iv. Sleeping arrangements: Emanuel, Anna, and Christina all sleep together in the master
bedroom while Christian sleeps in his own bedroom. Christina will move into her own
room once she is finished breastfeeding.

v. Types of jobs held by members: Anna works as a minister at an angelic church and
Emanuel drives a van to transport people. He previously worked driving a motorcycle
taxi.

vi. Exposure to hazardous conditions at job: Anna reported that she is not exposed to any
hazardous conditions at her job in the church while Emanuel reported hazards in regards
to traffic accidents and poor road conditions that can lead to injury.

vii. Level of safety in the neighborhood: Both Anna and Emanuel reported a high level of
safety in the neighborhood and denied any feelings of danger. There was no community
watch program or security measures seen in the neighborhood

viii. Level of safety in household: Emanuel and Anna both reported high levels of safety in
the household and denied any feelings of danger during both the day and at night. Anna
reported that when Emanuel is away from the home for work she feels safe during the
day but feels a decreased level of safety during the night.

e. Internal Dynamics
i. Roles of family members clearly defined?: Emanuel’s family role is to work as a driver
and provide the majority of the money for the family, he also does the grocery shopping/
food buying for the family as well. Anna does the cooking, cleaning, and all of the child
care needs, such as bathing, dressing, feeding, and entertaining the children. Christian
goes to school but doesn’t have a specific role in the family and neither dose Christina,
since they are just children.

ii. Where do authority and decision-making rest? At first Emanuel stated that he makes the
decisions in the family, but immediately Anna turned her head to him and sort of laughed
and gave him a look and then Emanuel laughed as well. They talked it through and both
agreed that they talk through the decisions with each other and make a joint decision on
most things. They said that they make joint decisions with the main focus being on their
children and what is best for their family.

iii. Typical patterns of interaction: They interacted well together, they laughed and smiled at
each other when answering all of our questions. Their interactions were positive and
happy between each other and with their children.

iv. Communication, including verbal and nonverbal: They communicated very well with
each other, and did a lot of talking back and forth especially when they were having
trouble understanding our questions. Their verbal communication was difficult to
understand at time because when they talked amongst each other they spoke in Swahili,
but it was encouraging to see them help each other understand. Their nonverbal
communication was seen through eye-contact, smiling, and laughing with one another.

v. Expression of affection, anger, anxiety, support, etc.: In Tanzania they don’t express their
affection with one another like they do in the United States, through hand holding and
 kissing. Their expression of affection was a playful tap on the shoulder or leg along with
a laugh and smile. They didn’t show any expression of anger or anxiety. They were very
supportive of one another and talked through struggles with the communication barrier
and supported each other with difficult times/ family deaths.

vi. Problem-solving style: The said that when they come across a problem they talk amongst
one another calmly and decide on a solution together that will best benefit the family.

vii. Degree of cohesiveness and loyalty to family members: Emanuel and Anna are very loyal
to each other and you can clearly see how much they love and care about each other and
their family through their interactions. Emanuel mentioned that if Anna were to get sick
he would take over her roles of cooking, cleaning, and taking care of the children so
Anna can rest. Emanuel was also Anna’s support system when her father passed away.
These statements showed how loyal he was to his family. Anna is also very loyal to her
family by caring for the children and cooking for Emanuel and being the head of the
house while Emanuel is gone for work many days. Emanuel is also supportive of Anna’s
career as a minister, because many African men aren’t supportive of women who pursue
preaching as a career.

viii. Conflict management: When they came across a problem they said that they would talk
through their problems and eventually come to a conclusion together. When they can’t
agree on a decision then it usually comes down to what Emanuel wants, because he is the
man of the house and in African tradition the man has the final say. Anna said she is very
blessed though, because Emanuel is nice and listens to her and her thoughts on decisions.
5. Analysis
a. Identification of family strengths:
i. Level and amount of communication, teamwork, bonding, health promotion activities,
well aware of health history, health literacy, wash their hands before meals
b. What are needs identified by family?
i. More money, better ways to prevent malaria and HTN, stop thumb sucking
c. What are needs identified by community health nurse?
i. Financial security, better closure for shelter, be aware of stagnant water sources, and
other risk reduction efforts to prevent mosquitos from entering the home, HTN screening
and risk factor modification, and stop thumb sucking
6. Two complete nursing diagnoses for the family, including interventions directed at meeting those
needs, and desired outcomes.
a. Diagnosis 1:
i. Risk for vector-born diseases related to high prevalence of mosquitos and open roof at
home.
ii. Interventions:
1. Choosing one room to have completely closed off from the outdoors, remove any
stagnant water, toilet seat covers, putting insecticide coils near doors outside,
continuing to use insect nets and frequent Malaria checks
iii. Desired Outcomes:
1. Family will remain free of vector-born diseases

b. Diagnosis 2:
i. Readiness for enhanced knowledge related to positive health outcomes as evidenced by
verbalizing questions on how to improve their health status.
ii. Interventions:
 1. Provide education on preventing HTN (foods to avoid and foods to consume,
exercise) HTN screenings; provide methods on how to stop thumb sucking
iii. Desired Outcomes:
1. The parents will get their blood pressure screened once every three months,
verbalize understanding of lifestyle changes related to prevention of HTN,
Christian will remain free of thumb sucking behaviors within 3 months

Genogram
Include household members, extended family, and significant others; ages or date of birth, occupation,
geographic location, illnesses, health problems, major events, triangles, and characteristics of relationships.