PENGKAJIAN KELUARGA

FERY MENDROFA, Mkep, Sp.Kom

THE INDICATIONS FOR A FAMILY ASSESSMENT

(CLARKIN, FRANCES, MOODIE, 1979)

1. A FAMILY IS EXPERIENCING EMOTIONAL DISRUPTION CAUSED BY A FAMILY CRISIS.

2. A FAMILY IS EXPERIENCING EMOTIONAL DISRUPTION CAUSED BY A DEVELOPMENTAL MILESTONE.

3. A FAMILY DEFINES A PROBLEM AS A FAMILY ISSUE, AND THERE IS MOTIVATION FOR FAMILY ASSESSMENT.

4. A CHILD OR ADOLESCENT IS THE IDENTIFIED PATIENT.5. THE FAMILY IS EXPERIENCING ISSUES THAT ARE SERIOUS

ENOUGH TO JEOPARDIZE FAMILY RELATIONSHIPS.6. 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 FOUNDATIONSSYSTEMS THEORY1. 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.

CYBERNETICS1. Family posses 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.

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 KELUARGA25. 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 STRUCTURE1. Family composition

2. Gender

3. Rank order

4. Subsystem

5. Boundary

Tools: genogram and ecomap

STRUCTURAL ASSESSMENTEXTERNAL STRUCTURE

• Extended family

• Larger system

CONTEXT1. Ethnicity

2. Race

3. Social class

4. Religion

5. Environment

DEVELOPMENTAL ASSESSMENT

1. STAGES

2. TASKS

3. ATTACHMENT

FUNCTIONAL ASSESSMENTINSTRUMENTAL FUNCTIONINGActivities daily living

EXPRESSIVE FUNCTIONING1. Emotional communication

2. Verbal communication

3. Non verbal communication

4. Circular communication

5. Problem solving

6. Roles

7. Influence

8. Beliefs

9. Alliances/coalitions

OUTLINE PENGKAJIAN MODEL CALGARYNama KK: Tgl:Anggota klg yg hadir:Pengkaji:Tempat pengkajian:I. Masalah kesehatan dan rujukanII. Komposisi keluargaIII. Keterikatan keluargaIV. Riwayat kesehatan dan tumbuh kembangV. Kekuatan keluarga dan masalahVI. Hipotesis/kesimpulanVII. Tujuan dan rencanaVIII. 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