PENGKAJIAN KELUARGA

1. PENGKAJIAN KELUARGA FERY MENDROFA, Mkep, Sp.Kom

2. THE INDICATIONS FOR A FAMILY ASSESSMENT (CLARKIN, FRANCES, MOODIE, 1979) • 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.

3. ASSESSMENT MODEL • THE FRIEDMAN FAMILY ASSESSMENT MODEL • THE CALGARY FAMILY ASSESSMENT MODEL

4. GUIDELINES FOR ASSESSMENT • ENGAGEMENT STATE • ASSESSMENT STAGE - Problem identification - Relationship between family interactions and health problem - Attempted solutions - Goal exploration • TERMINATION STAGE

5. THE THEORETICAL FOUNDATIONS SYSTEMS THEORY • A family system is part of a larger suprasystem and is also composed of many subsystem. • A family is a whole is greater than the sum of its parts. • A change in one family member affects all family members. • The family is able to create a balance between change and stability. • Family members’ behaviors are best understood from a view of circular communication rather than linear causality.

6. CYBERNETICS1. Familyposses self-regulating ability through the process of feedback.2. Feedback process can simultaneously occur at several different systems levels with families.COMMUNICATION THEORY1. 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.

7. CHANGE THEORY1. 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.

8. 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

9. 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)

10. 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

11. 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

12. 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

13. PENGKAJIAN MODEL CALGARY THREE MAJOR CATEGORIES • STRUCTURAL • DEVELOPMENTAL • FUNCTIONAL

14. STRUCTURAL ASSESSMENT INTERNAL STRUCTURE • Family composition • Gender • Rank order • Subsystem • Boundary Tools: genogram and ecomap

15. STRUCTURAL ASSESSMENT EXTERNAL STRUCTURE • Extended family • Larger system CONTEXT • Ethnicity • Race • Social class • Religion • Environment

16. DEVELOPMENTAL ASSESSMENT • STAGES • TASKS • ATTACHMENT

17. FUNCTIONAL ASSESSMENT INSTRUMENTAL FUNCTIONING Activities daily living EXPRESSIVE FUNCTIONING • Emotional communication • Verbal communication • Non verbal communication • Circular communication • Problem solving • Roles • Influence • Beliefs • Alliances/coalitions

18. OUTLINE PENGKAJIAN MODEL CALGARY Nama KK: Tgl: Anggota klg yg hadir: Pengkaji: Tempat pengkajian: • Masalah kesehatan dan rujukan • Komposisi keluarga • Keterikatan keluarga • Riwayat kesehatan dan tumbuh kembang • Kekuatan keluarga dan masalah • Hipotesis/kesimpulan • Tujuan dan rencana • Tanda tangan pengkaji:

19. 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.

20. 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.

21. MASALAH-MASALAH YANG SERING MENGHAMBAT PENGKAJIAN PADA TERMINATION STAGE • Perawat tidak menyimpulkan hasil pengkajiannya untuk keluarga. • Perawat tidak menginformasikan pada keluarga langkah berikutnya.

22. Thank you