Transcript PENGKAJIAN KELUARGA

PENGKAJIAN KELUARGA
FERY MENDROFA, Mkep, Sp.Kom
THE INDICATIONS FOR A FAMILY
ASSESSMENT
(CLARKIN, FRANCES, MOODIE, 1979)
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A FAMILY IS EXPERIENCING EMOTIONAL DISRUPTION
CAUSED BY A FAMILY CRISIS.
A FAMILY IS EXPERIENCING EMOTIONAL DISRUPTION
CAUSED BY A DEVELOPMENTAL MILESTONE.
A FAMILY DEFINES A PROBLEM AS A FAMILY ISSUE, AND
THERE IS MOTIVATION FOR FAMILY ASSESSMENT.
A CHILD OR ADOLESCENT IS THE IDENTIFIED PATIENT.
THE FAMILY IS EXPERIENCING ISSUES THAT ARE SERIOUS
ENOUGH TO JEOPARDIZE FAMILY RELATIONSHIPS.
A FAMILY MEMBER IS ABOUT TO BE ADMITTED TO THE
HOSPITAL FOR PSYCHIATRIC TREATMENT.
ASSESSMENT MODEL
1. THE FRIEDMAN
FAMILY
ASSESSMENT
MODEL
2. THE CALGARY
FAMILY
ASSESSMENT
MODEL
GUIDELINES FOR ASSESSMENT
1. ENGAGEMENT STATE
2. ASSESSMENT STAGE
- Problem identification
- Relationship between family interactions and
health problem
- Attempted solutions
- Goal exploration
3. TERMINATION STAGE
THE THEORETICAL FOUNDATIONS
SYSTEMS THEORY
1. A family system is part of a larger suprasystem
and is also composed of many subsystem.
2. A family is a whole is greater than the sum of
its parts.
3. A change in one family member affects all
family members.
4. The family is able to create a balance between
change and stability.
5. Family members’ behaviors are best
understood from a view of circular
communication rather than linear causality.
CYBERNETICS
1. Family posses self-regulating ability through the
process of feedback.
2. Feedback process can simultaneously occur at
several different systems levels with families.
COMMUNICATION THEORY
1. All non verbal communication is meaningful.
2. All communication has 2 major channels for
transmission: digital and analogic.
3. A dyadic relationship has varying degree of symmetry
and complementary.
4. All communication consists of 2 levels: content and
relationship.
CHANGE THEORY
1. Change is dependent on the perception of the
problem.
2. Change is dependent on context.
3. Change is dependent on coevolving goals for
treatment.
4. Understanding alone does not lead to change.
5. Change does not necessarily occur equally in all
family members.
6. Facilitating change is the nurse’s responsibility.
7. Change can be due to a myriad of causes.
OUTLINE PENGKAJIAN MODEL FRIEDMAN
TAHAP I
I. DATA UMUM
1. NAMA KEPALA KELUARGA
2. ALAMAT
3. KOMPOSISI KELUARGA (DALAM TABEL)
LENGKAPI DENGAN GENOGRAM
4. TIPE KELUARGA
5. SUKU
6. AGAMA
7. STATUS SOSIAL EKONOMI KELUARGA
8. AKTIVITAS REKREASI KELUARGA
PENGKAJIAN – DATA UMUM…
II. RIWAYAT DAN TAHAP
PERKEMBANGAN KELUARGA
9. TAHAP PERKEMBANGAN KELUARGA SAAT
INI
10. TAHAP PERKEMBANGAN KELUARGA
YANG BELUM TERPENUHI
11. RIWAYAT KELUARGA INTI
12. RIWAYAT KELUARGA SEBELUMYA (PIHAK
SUAMI DAN ISTRI)
PENGKAJIAN – DATA UMUM…
III. LINGKUNGAN
13. KARAKTERISTIK RUMAH
14. KARAKTERISTIK TETANGGA DAN
KOMUNITAS RW
15. MOBILITAS GEOGRAFIS KELUARGA
16. PERKUMPULAN KELUARGA DAN
INTERAKSI DENGAN MASYARAKAT
17. SISTEM PENDUKUNG KELUARGA
PENGKAJIAN – DATA UMUM…
IV. STRUKTUR KELUARGA
18. POLA KOMUNIKASI KELUARGA
19. STRUKTUR KEKUATAN KELUARGA
20. STRUKTUR PERAN (FORMAL DAN
INFORMAL)
21. NILAI ATAU NORMA KELUARGA
V. FUNGSI KELUARGA
22. FUNGSI AFEKTIF
23. FUNGSI SOSIALISASI
24. FUNGSI PERAWATAN KELUARGA
PENGKAJIAN – DATA UMUM…
VI. STRES DAN KOPING KELUARGA
25. STRESOR JANGKA PENDEK DAN PANJANG SERTA
KEKUATAN KELUARGA
26. KEMAMPUAN KELUARGA BERESPONS TERHADAP
SITUASI/STRESOR
27. STRATEGI KOPING YANG DIGUNAKAN
28. STRATEGI ADAPTASI DISFUNGSIONAL
VII. PEMERIKSAAN FISIK
VIII. HARAPAN KELUARGA
PENGKAJIAN MODEL CALGARY
THREE MAJOR CATEGORIES
1. STRUCTURAL
2. DEVELOPMENTAL
3. FUNCTIONAL
STRUCTURAL ASSESSMENT
INTERNAL STRUCTURE
1. Family composition
2. Gender
3. Rank order
4. Subsystem
5. Boundary
Tools: genogram and ecomap
STRUCTURAL ASSESSMENT
EXTERNAL STRUCTURE
• Extended family
• Larger system
CONTEXT
1.
2.
3.
4.
5.
Ethnicity
Race
Social class
Religion
Environment
DEVELOPMENTAL ASSESSMENT
1. STAGES
2. TASKS
3. ATTACHMENT
FUNCTIONAL ASSESSMENT
INSTRUMENTAL FUNCTIONING
Activities daily living
EXPRESSIVE FUNCTIONING
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2.
3.
4.
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Emotional communication
Verbal communication
Non verbal communication
Circular communication
Problem solving
Roles
Influence
Beliefs
Alliances/coalitions
OUTLINE PENGKAJIAN MODEL CALGARY
Nama KK:
Tgl:
Anggota klg yg hadir:
Pengkaji:
Tempat pengkajian:
I.
Masalah kesehatan dan rujukan
II.
Komposisi keluarga
III.
Keterikatan keluarga
IV. Riwayat kesehatan dan tumbuh kembang
V.
Kekuatan keluarga dan masalah
VI. Hipotesis/kesimpulan
VII. Tujuan dan rencana
VIII. Tanda tangan pengkaji:
MASALAH-MASALAH YANG SERING
MENGHAMBAT PENGKAJIAN
PADA ENGAGEMENT STAGE
• Persiapan perawat untuk menghadapi
keluarga belum optimal, seperti
penguasaan form pengkajian; gambaran
kebutuhan keluarga tidak diketahui.
• Perawat cenderung menempatkan diri
sebagai expert.
• Tidak bertemu dengan seluruh anggota
keluarga.
MASALAH-MASALAH YANG SERING
MENGHAMBAT PENGKAJIAN
PADA ASSESSMENT STAGE
• Perawat belum melakukan komunikasi
efektif untuk menggali data.
• Perawat belum mendapat kepercayaan
penuh dari keluarga sehingga keluarga
belum menceritakan masalahnya secara
terbuka.
• Kemampuan perawat dalam merangkai
informasi belum terlatih.
MASALAH-MASALAH YANG SERING
MENGHAMBAT PENGKAJIAN
PADA TERMINATION STAGE
• Perawat tidak menyimpulkan hasil
pengkajiannya untuk keluarga.
• Perawat tidak menginformasikan pada
keluarga langkah berikutnya.
Thank you