Family Asessment Guide • Family Structure • •
Konsep Keluarga Efy Afifah,M.Kes
• Family roles and functions • • • • •
• Physical health status • •
current physical health status of each member perceptions of own health and other family members health
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preventive health practices
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routine health care, when and why physician last seen
• Interaction patterns • • •
ways of expressing affection, love, sorrow, anger and so on most significant family member in person’s life openness of communication with all family members
• Family values • • • •
cultural and religious orientations use of leisure time and whether leisure time is share with total family unit family’s view of education, teachers and the school system health values, how mush emphasis is put on exercise, diet, preventive health care
Definisi keluarga • Definition of family vary by discipline, the professional and distinct groups of family • Family is an aggregate made up of a body of units, the individuals that represent the whole or the family • The concepts of family has 5 critical attributes (Stuart,1991): 1. the family is a system or unit • 2. family members may or may not be relates and may or may not live together • 3. the unit may or may not contain children • 4. commitment and attachment exist among unit members and include future obligation • 5. the unit care giving functions consist of protection, nourishment and socialization of unit members •
size and type; nuclear, extended or other alternative family age and sex of family members
family members working outside the home; type of work and satisfaction with it household roles and responsibilities and how tasks are distributed ways childearing responsibilities are shared major decision maker and methods of decision making family members’satisfaction with roles, the way tasks are divided and the way decisions are made
Pendahuluan • Keluarga bagian dari community diterjemahkan sbg masyarakat setempat, menunjuk pada warga sebuah desa, kota, suku atau bangsa. • Tujuan dasar adalah memenuhi kebutuhan kesehatan termasuk memenuhi kebutuhan individu didalamnya
• Alasan penting perawat bekerja dengan keluarga: • • • • •
klg sumber yg ptg u/ pemberian pely kesehatan klg mjd titik masuk pencarian kasus dalam keluarga klg mrpkan sistem pendukung utama bagi klien status kesehatan klien sgt dipengaruhi o/ klg pemahaman yg lebih dalam ttg klien dapat diperoleh dari klg
• Keluarga adalah unit dasar dari masyarakat • Keluarga didefinsikan sbg: dua orang atau lebih yg dihubungkan melalui: perkawinan, darah, kelahiran atau adopsi (Duvall,1977) • Keluarga: dua orang atau lebih terlibat sec. emosional satu sama lain dan tinggal pada geografi yg berdekatan (Friedman, 1981) • Peran dan fungsi keluarga: • • • • •
melindungi dan mensosialisasikan anggota m’berikan dukungan emosi dan keamanan menciptakan rasa memiliki pemenuhan kebutuhan dasar menyediakan lingk fisik yg aman
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Varied Family forms 1.Nuclear family/klg inti/ parent working 2.Nuclear family/dual earner 3.Nuclear dyad/blm py anak 4.Single parent family 5.Single adult living alone 6.Three generation extended family 7.Middle aged/ elderly couple 8.Extended kin network/jaringan kekelgsuku
• Non Traditional • • • • • •
• Coping Resources • •
• Traditional
1. Unmarried parent and child family 2. Unmarried couple and child family 3. Cohabiting couple/psgn hidup bersama 4. Guy/lesbian family 5. augmented family/divorce-tdk py anak 6. commune family/ hidup berklmpk-gipsi
degree of emotional support offered to ane another availability of support persons and affiliations outside the family/ teman2, anggota pengajian,mesjid methods of handling stressful situations and conflicting goals of family members financial ability to meet current and future needs
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• Family communication patterns •
Intrafamily communication
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defining communication is the process of exchanging feelings, desies, needs information and opinions (MC Cubbin & Dahl, 1985)
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Family communication: a symbolic, transacttional process of creating and
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Elements of communication:
• • • •
a sender of a messages a form/channel of the messages a receiver some interaction between the sender and the receiver
sharing meanings in the family.
The family health care function
Family life cycle (Duvall, 1985) 1. 2. 3. 4. 5. 6. 7. 8.
beginning family (marriage) early childbearing family (eldest child is in infancy through 30 months of ages) pre school children (eldest child is 2.5 to 5 years of ages) school ages chlidren (eldest child is 6 to 12 years of age) teenage children (eldest child is 13 to 20 years of age) launching family (oldest to youngest child leaves home) middle age family (remaining marital dyad to retirement) aging family (retirement to death of both spouses)
• Families health practices • • • • • • • • •
• 5 tugas kesehatan keluarga • • • • •
Family functions • • • • • •
5 Family Functions: 1. Reproductive function 2. Economic function 3. Affective function 4. Socialization function 5. Health care function
Life style practices family dietary practices family sleep and rest practices family exercise and recreation family drug habits family self care practices environmental and hygienen practices medically based preventive practices dental health care practices
1 mengenal masalah 2. mengambil keputusan 3. melakukan perawatan di rumah 4. memodifikasi lingkungan 5. using fasilitas pelayanan kesehatan
The family power structure
• Variabel yg mempengaruhi family power structure: • • • • • • • • • •
family power hierarchy type of family form formation of coalition family communication network social class family developmental stage situational contigencies ethnic and religious influences person variables spouses emotional interdependency and commitment to marriage
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Power-Area pengkajian • Power kapasitas utk mempengaruhi, mengontrol, mendominasi dan membuat keputusan
• Power kemampuan potensial dan aktual dari individu utk mengontrol, mempengaruhi atau merubah perilaku seseorang
• Power selalu melibatkan hubungan interpersonal yg asimetrical
• Family power karakteristik dari sistem klg yg potensial dan aktual dari individu utk merubah perilaku anggota klg yg lain (Olson & Cronwell,1975)
• Komponen mayor dari power klg adalah: • - mempengaruhi • - membuat keputusan • Power, dominan, mempengaruhi dpt digunakan secara interchangeably • Melalui pembuatan keputusan, power dapat dimanifestasikan. • Resources disini termasuk informasi, ketrampilan, tehnik, bahan-bahan yg diakses ke individu/kelompok (hal-hal yg dipunyai/dimiliki individu/kelompok).
Legitimate power
Family Power Bases • • • • • • • • • •
Legitimate Power/authority/primary authority Helpless/ Powerless power Referent Power Resource Power Expert Power Reward Power Coercive Power Informational Power Affective Power Tension Management Power
Helpless/Powerless Power • mrpkan btk yg berlawanan dari legitimate power • secara tertutup mampu utk mendapatkan pengaruh atau kekuatan dari yg lain • ketergantungan anak-anaknya dan ketidakberdayaan menempatkan perasaan tg jawab pd ortu dan membuat mereka rentan thd usaha mengontrol anak dan menggunakan helpless power • Pada klg dgn penyakit kronik, cacat, usila • Pasanagan atau anggota klg yg cacat akan mengontrol klg bdskan kelemahan atau ketidak berdayaan
• refer thd kepercayaan dan persepsi ang klg seseorang py hak utk mengontrol perilaku anggt. klg • bdskan atas peran dan posisi kedudukan seseorang dlm klg • • • •
co: kontrol ortu atau dominasi thd anak mrpkan autoritas dasar yg bersft tradisional dimana suami mengontrol seluruh klg (pola patriakat) baik suami maupun istri menerima peran dominan suami sbg kebenaran dan terbaik (menunjukkan penerimaan peran. • Agar autoritas bisa efektif seluruh klg hrs menerima dan mensupport
• Referent Power • Anggota klg mengidentifikasi secara positif ORTU • anak-anak meniru perilaku anggota klg • biasanya ortu yg memberikan mereka sbg model peran
• Resource and Expert Power • Memiliki sejumlah besar resource yg berharga • powerkemampuan utk mempengaruhi/menekan yg lain • Contoh: suami dominan krn ia mengontrol keuangan atau istri dominan krn ia lebih praktis dan punya tujuan yg lebih terarah dp suaminya • Expert Power mempunyai pengetahuan khusus, ketrampilan, keahlian atau pengalaman
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• Reward Power
• Affective Power
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• Melalui manipulasi dari anggota klg dgn melimpahkan kasih sayang dan kehangatan. • co: suami memenuhi kebutuhan ekonomi klg, sdgkan istri memberikan limpahan kasih sayang dan pengasuhan anak yg bernilai tinggi bagi suami • affective power mrpkan sumber kekuatan bagi wanita
Anak sering menggunakan perilaku yg baik utk mendapatkan keuntungan yg diinginkan
• Coercive/Dominance Power •
•
Seseorang dengan power ini akan menghukum melalui: mengancam, memaksa atau berbuat kekerasan thd yg lain jika tidak menurut digunakan dgn pembuat keputusan
• Informational Power • •
persuasive message direct informational power and indirect dlm hubungan peran sex sec. tradisional prp sering menggunakan kekuatan informational indirect (isyarat, saran/anjuran, memperngaruhi individu utk berperilaku tanpa indikasi dibujuk) utk mendapatkan pengaruh dan tdk merusak image laki-laki di masyarakat
• Tension Management Power • mengatur ketegangan yg ada dan konflik dalam klg • terjadi bisa pd anak dan klg • menggunakan airmata, mengambek utk mendapatkan sesuatu
Examples of NANDA Nursing Diagnosis for a Family with adult members • Altered family processess r/t • •
-change in roles r/t sudden, unexpected illness -financial concerns -inability to problem solve - inadequate communication
• •
- hospitalization
Fear (individual family members) r/t - knowledge deficit
• Powerlessness (individual family members) r/t • - unplanned hospitalization - knowledge deficit • Ineffective family coping: compromised or disabled r/t •
- effects of chronic illness
• • • •
Impaires home maintenance management r/t: -alteration in communication skills -dysfunctional grieving Care giver role strain r/t: -physical/ emotional demands of role - perceived isolation of care
- family disorganization
giver
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