TEORI & MODEL

KEPERAWATAN KELUARGA

Ns. Setyoadi, M.Kep., Sp.Kep.Kom.

TUJUAN
Setelah membahas topik ini mahasiswa
mampu:
1. Mendeskripsikan masing-masing
konsepsual model & teori yg mendasari
praktik keperawatan keluarga;
2. Mendiskusikan perbedaan diantara teoriteori kep, teori-teori sain sosial keluarga,
dan teori terapi keluarga; dan
3. Mengidentifikasi teori dan model
keperawatan keluarga yg dapat digunakan
dalam praktik keperawatan keluarga.

INTRODUCTION
By understanding theories and models, the
nurse is better prepared to think creatively
and critically about how the illness event is
affecting the family client.
Theories and models open doors to different
ways of understanding issues that may be
affecting families, and thereby offer options
for action.
No one theoretical perspective stood out as
yielding the best family nursing care.

Intro
However, nurses who understand multiple
theories and models are able to offer multiple
solutions for families to consider in their
adaptation to the health issue of the family.
Nurses who draw from multiple theoretical
lenses will integrate a variety of approaches
into their care, thereby providing more
holistic, family-centered nursing.

WHAT IS THEORY?
Internally consistent group of relational
statements (concepts, definitions and
propositions) that presents a systematic view
of phenomenon and which is useful for
description, explanation, prediction and
control (Walker and Avant,1983)
All theories serve the function of describing,
explaining, or making predictions about
phenomena (LoBiondo-Wood & Haber,
2002).

What is
Nursing theories ideally represent logical and
intelligible patterns that make sense of the
observations a nurse makes in practice and
enable the nurse to predict what is likely to
happen to clients (Fawcett, 1999).
The major function of theory in family nursing
is to provide knowledge and understanding
that improve nursing services to families.

Components/Elements of theory
1.Purpose Why is the theory formulated
2.Concepts are building blocks of theory ideas, mental images of a phenomenon,
an event or object that is derived from an
individuals experience and perception.
Has a major concept like nursing, person,
health or environment.
3. Definitions give meaning to concepts
which can either be descriptive or
procedural (stipulate-use of term within the

Components/Elements of theory
4. Propositions are expressions
of relational statements
between and among the
concepts. It can be
expressed as statements,
paradigms or figures .
5. Assumptions- accepted
truths that are basic and
fundamental to the theory. Or
value assumptions where

Characteristics of a Theory
1. Systematic, logical and coherent
(orderly reasoning, no contradictions)
2. Creative structuring of ideas
mental images of ones experiences and
create different ways of looking at a
particular event or object.
3. Tentative in nature ( change over time or
evolving but some remain valid despite
passage of time)

Hubungan teori, praktik dan

penelitian

Apa dan kenapa teori diperlukan ?

Teori beri ciri, penjelasan, atau
memprediksi fakta dari fenomena fenome di dalam keperawatan
Teori memberikan suatu hubungan
timbal balik dengan praktik atau
praktik perlu didasari teori dan
sebaliknya.

Artinya teori kep mendasari praktik kep

keluarga dan praktik kep keluarga
memfasilitasi perkembangan teori
kep keluarga
Teori, praktik & riset saling
menentukan dan mempengaruhi
satu sama lain

Klein & White (1996 dlm Friendman,

1998):
Fungsi teori menyediakan
pengetahuan utk meningkatkan
pelayanan/praktik kep thd keluarga
Tujuh cara teori secara langsung atau
tidak berkontribusi thd peningkatan
praktik kep:
- Accumulation teori membantu dlm
mengakumulasi * mengorganisir hasil
riset
- Precision teori lebih mempertajam

- Guidance teori mengarahkan peneliti utk

kembangkan atau uji hipotesis
- Connected mendemonstrasikan bagaimana
ide-ide terkait satu sama lain
shg menjadi sistimatis
- Interpretationm membantu memberi arti atau
makna ttg fenomena yg diamati
- Prediction memprediksi apa yg dpt atau
mungkin terjadi dikemudian hari
- Explanation memberi jawaban thd pertanyaan
kenapa dan bagaimana

Konsepsual model

Abstrak

Konsep : jelaskan fenomena

Proposisi: jelaskan hubungan antar konsep

Teori
Lebih konkrit daripada konsepsual
Model.

Teori/model kep
keluarga
Dikembangkan dari berbagai
Teori yg mendukung

Lebih
konkrit

CONCEPTUAL SOURCE OF
FAMILY NURISING THEORY

Nursing models/
theory

Family
nursing
theories

Family therapy theories

Family social
science
theories

Table 3-1

DIFFERENCES AMONG FkNIILY SOCIAL THEORIES, FAMILY

THERAPY THEORIES, AND NURSING AIODELS AND THEORIES
Fa.M1ILY SOCIAL

FAMILY THERAPY

CRITERIA

SCIENCE THEORIES

THEORIES

Purpose of
theory

Descriptive and explanatory

(academic models); to explain
famil
y functioning and
dynamics

Discipline

Interdisciplinary (although

focus

primarily sociological)

Target
population

Primaril"normal" families
y
(normality-oriented)

NURSING THEORIES

Descriptive and
(practice models); to explain prescriptive (practice

Descriptive and prescriptive

family dysfunction and guide

therapeutic actions

models); to guide
nursing assessment
and intervention

efforts
Marriage and family therapy;
famil
y mental health; new
approaches focus on family
strengths
Primaril"troubled" families
y
(pathology-oriented)

Adapted from Jones, S.L., & Dimond, S.L. (1982). Fancily theory and fancily therapy models:
Comparative review with implications for nursing practice. Journal of Ayychiatric \ inning
and 11ental Health Services, 20(10), 12-19.

Nursing focus

Primarily families with

health and illness
problems
V

Box 3-2

THEORETICAL FAWNDATIONS USED IN FAMILY NU SING PRACTICE

Family Social Science Theories

Structural-functional theory
Systems theory
Family developmental theory
Family interactional theory
Family stress theory

Change theory
Others
Chaos theory
Social exchange theory
Conflict theory
Ecological theory
Anthropological/multicultural theory
Phenomenological theory

Narrative therapy theory

Solution-oriented therapy theory

Nursing Models and Theories

Systems theory
King
Roy

Neuman
Orem

Rogers
Friedemann
Parse

Denham
Others

Leininger
Family Therapy Theories
Structural family therap y theory
Family systems therapy theory
Interactional family therapy theor

yy
Others
Psychodynamic therapy theory
Experiential therap
y theory
Humanistic therapy theory
Strategic therapy theory
Behavioral/cognitive therapy theory

Watson

Peplau
Barnard

Newman

Integrated
Hanson & llischke
Friedman
Wright & Leahey

\1cCuhhin & McCuhhin

Nursing Models and Theories

The nursing models, in large part,
represent a deductive approach &
inductive approaches to the development
of nursing science.
It is imperative/more importen that family
nurses build a body of knowledge that
stems from theory and is based in
research. It is important to establish that
the family-as-client is fully accepted in
nursing

NURSING THEORIES/
CONCEPTUAL MODELS
Orientasi pd sistem: Neumans system
conceptual model
Orientasi perkembangan: Orems self-care model
Orientasi pd sistem dan interaksi:
- Roys adaptation model
- Kings interacting systems model
Orientasi pd sistem dan perkembangan:
- Rogers life process model
Model/teori lain yg mendukung:
- Nightingale
- Friedemann

Nursing theories for

understanding families
Neuman's System Theory (1983):
- The family is described as an appropriate
target for both assessment and nursing
interventions. The way each member
expresses self influences the whole and
creates the basic structure of the family.
- The major goal of the nurse is to help keep
the structure stable within its environment.

Nursing theories for

understanding families
Roy's Adaptation Theory (1983):
- The client is an individual, family, group, or
community in constant interaction with a
changing environment. The family system is
continually changing and attempting to adapt.
- The goal of nursing is to promote adaptation
and minimize ineffective responses.

Florence Nightingale
Nightingale described the family as having
both positive and negative influences on
the outcome of clients.
Nightingale noted that the family was a
supportive institution throughout the
lifespan for its individual family members.
She firmly believed in home health nursing
and maintaining ill persons in the home
environment.

Imogene King
Imogene Kings theory of goal attainment.
The individuals role in the family contributes
to the socialization and development of each
member.
The family was the vehicle (pembawa) for
transmitting values and norms of behavior
across the life span,
which includes the role of a sick family
member and transmitting the health care
function of the family.

Betty Neuman
She viewed the family as a system composed of family
member subsystems. The relationships between
individual family members or subsystems are the central
focus of her model.
The family system becomes threatened when it is
exposed to stressors that affect its stability (equilibrium)
and influence its state of wellness.
The family has the ability to open or close its
boundaries/ikatan to protect its members and
preserve/mmlihara the integrity of the family as a whole.

Martha Rogers
Fawcett (2000) elucidated/menguraikan Rogers theory by
explaining that the family is a constant open-system energy
field that is ever-changing in its interactions with the
environment.
Aplication model
- The family unit is a whole
- The family is an open system in constant interaction with
the environment
- Families are continuously influenced by information
- The family system is subject to change along a spacetime axis.
- The family has the capacity for feeling, knowing, and
comprehending and for using these processes to
determine patterns, make choices, and recognize its
environment.

Dorothea Orem
Dorothea Orems self-care deficit theory (1985)
depicts/mgambarkan the family as the basic
conditioning unit, in which the individual learns culture,
roles, and responsibilities.
Ways families addresses self-care for their members
- Self-care of families can be evaluated in a variety of
situations
- Self-care reflects the personal values and health beliefs of
the family
- Self-care can be administered to families by individual selfcare agents
- The concept of self-care can be used to promote health in
families

Marie-Louise Friedemann
Marie-Louise Friedemanns (1995)
framework of systemic organization is built
on the view of the family-as-client.
The family is described as a social system
that has the expressed goal of transmitting
culture to its members.
The elements that are central to
Friedemanns theory are family stability,
family growth, family control, and family
spirituality.

Integrated Approaches
to the Nursing of Families
No single theory or conceptual framework
from family social science, family therapy,
or nursing fully describes the dynamics of
family life.
Integrating theories allows nurses to view
the family from a variety of perspectives,
which increases the probability that the
interventions selected will be implemented
by the family, because they fit the
structure, processes, and style of
functioning for that family.

FAMILY SOCIAL SCIENCE

THEORIES
Developmental theory
System theory
Structural-functional theory
Interactional/Communications theory
Family stress theory
Others:
- Conflict theory
- Social exchange theory
- Multicultural theory

Table 3-2

SL"\L'SIARY OF SOCLILL SCIENCE THEORIES

Structural

The focus is on families as an institution and how they function to

maintain family and social needs.

Interactional

"Theory

it

Family
Interactional

go

The focus is on the interactions 0within families and the symbolic

Theory

communication.

The focus is on the life cycle of

Developmental

Theory

.40

families and representing norma-

tive stages of family development.

ti

Family

Systems
"Theory
Family
Stress

Theory

Change
Theory

0-

go

The focus is on the circular interactions among members of family

systems, which result in functional or
dysfunctional outcomes.
The focus is on the anal-sis of how
families experience and cope with
stressful life events.
The focus is on how families remain
stable or change when there is change
within the family structure or from
outside influences.

Adapted from Ingoldsbv, C., Smith, S., & Miller, J. (2004). Exploring faamily
theories.

Los Angeles: Roxbury.

Social Sciences Theories for

understanding families
Structural-Functional Theory:
- The family is viewed as part of the social system, with
individuals being parts of the family system.
- The family, as a social system, performs functions
that serve both the individual and society.
- Individuals act in accordance with a set of internalized
norms and values that are learned primarily in the
family through socialization.

Five functions of the family

important to understand:

Affective
Socialization and social placement
Reproductive
Economic
Health care

Social Sciences Theories for

understanding families
Duvalls developmental or life-cycle theory (1977):
- Families experience growth and development in much
the same way as individuals.
- Critical role transitions of individual members, such as
birth, retirement, and death of a spouse, are viewed
as resulting in a distinct change in the family life
patterns.
- Families develop and change over time in predictable
ways.
- Families and their members perform certain
timespecific tasks that are decided upon by
themselves, within their cultural and societal context.
- Family behavior is the sum of the previous
experiences of its members as incorporated in the
present and in their expectations for the future.

8 Duvall's Developmental
Stages

Beginning family
Childbearing family
Families with preschool children
Families with school-aged children
Families with teenagers
Families launching young adults
Middle-aged parents
Families in later years

Culturally Sensitive Care

Is care provided with awareness of child's and familys
own values and beliefs and recognize how they influence
their attitudes and actions.
Cultural sensitivity means having an awareness and
appreciation of cultural influences in health care and
being respectful of differences in cultural belief systems
and values.
A multicultural perspective means using appropriate
aspects of the family's cultural orientation to develop
health care interventions.

IMPLICATIONS FOR
NURSING
Nurses can play a vital role in supporting
parenting as they work with families. This
work must be done in collaboration with
parents if positive results are to be
achieved.

FAMILY THERAPY THEORIES

Sructural family therapy theory
Family systems therapy theory
Interactional/Communications theory
Others:
- Psychodynamic theory
- Experiental therapy theory
- Strategic therapy theory
- Behavioral therapy theory
- Solution-oriented therapy theory
- Narrative therapy theory

Family Therapy Theories

Family therapy have been developed to work with troubled
families, and, therefore, most focus primarily on family
pathology
Family therapy models are concerned with what can be done
to facilitate change in dysfunctional families, they are both
descriptive and prescriptive (suggest treatment or intervention
strategies).
Three prominent family therapy models are summarized in the
following sections: (1) structural family therapy, (2) family
systems therapy, and (3) family interactional and
communications therapy (Goldenberg & Goldenberg, 2004).

1. Structural Family Therapy

Theory
From this perspective, the family is viewed as an open
sociocultural system that is continually faced with
demands for change, both from within and from
outside the family.
Transactional patterns help the family to be stable or
homeostatic. The family structure comprises a covert
set of functional demands that organize family
interactions.
The ability to mobilize these alternative transactional
patterns to meet external and internal demands for
change determines the adaptability of the family.
Dysfunctional transactional patterns lead to poor
adaptation and to family dysfunction.

Structure
The goal of structural family therapy is to
facilitate restructuring of the family.
The family nurse who is working from this
theoretical perspective assesses families
by asking questions, observing family
transactions, and asking family members
to interact with each other about a
particular situation.

2. Interactional Family Therapy

This approach views the family as a system of interactive
or interlocking behaviors or communication processing.
The approach assumes that emotional problems result
from the way people interact with each other in the
context of the family.
Primary goals of family therapy include understanding
the communication rules and processes that troubled
families use and teaching the family to use more
functional communication.

Interactional
Key interventions using this theoretical
orientation focus on establishing clear,
congruent communication, and clarifying
and changing family rules (Jackson, 1965;
Satir, 1982).
This approach is very useful for family
nurses because it stresses the interactions
between family members.

3. Family Systems Therapy

Theory
Murray Bowens particular version of
family systems theory begins with the
assumption that anxiety is an inevitable
(tidak bisa dihindarkan), omnipresent
(muncul dimana-mana) part of life
(Gladding, 2001; Goldenberg &
Goldenberg, 2004).
Chronic anxiety is the basic cause of
dysfunction in individuals and in families.

BOWENS FAMILY SYSTEMS

THEORY: EIGHT INTERLOCKING CONCEPTS

Differentiation of self
Nuclear family emotional system
Multigenerational transmission process
Family projection process
Triangles
Sibling position
Emotional cutoff
Societal regression

Eight concepts
Healthy function differentiation of self is
ability
of persons to distinguish themselves from
their family of origin, both emotionally and
intellectually.
The nuclear family is viewed as a family
emotional system.
In this system, the coping strategies and
patterns that are used tend to be passed on
from generation to generation, a
phenomenon that Bowen called the
multigenerational transmission process.

Eight concepts
family projection process, Parents who
are
anxious and have poor differentiation of
self tend to transfer their anxiety and low
level of differentiation to a susceptible
child.
triangulation is a way that families use to
deal with anxiety. In certain stressful
situations, anxiety may spread from a
triangle within the family to triangles that
include persons outside the family.

Eight concepts
Sibling position is another important concept in family
systems therapy. From this perspective, people are seen
as developing fixed personality characteristics based on
their birth order in their family of origin (Toman, 1961).
Emotional cutoff occurs when children have unresolved
attachments to parents. Children who are emotionally
fused to their parents and family of origin may live near
or far from them.
Societal regression is where the emotional process in
society influences the emotional process in familieslike
a background influence affecting all families.

Bowens family systems

Bowens family systems therapy focuses on promoting

differentiation of self from family and promoting
differentiation of intellect from emotion.
Using Bowens approach, a family nurse or therapist
would have individuals or couples investigate their
family tree. The nurse would serve as coach and
teacher, asking questions about peoples history while
helping the clients to construct a family tree, called a
multigenerational genogram.
The goal is to help family members reduce
triangulation, develop relationships with individual
family members, and end emotional withdrawal.

SUMMARY
The theoretical/conceptual frameworks
and approaches that provide the
foundations for nursing of families have
evolved from three major traditions and
disciplines: family social science, family
therapy, and nursing.
By integrating several theories, nurses
acquire different ways to conceptualize
problems, thus enhancing the possibilities
of successful interventions.

Tanya jawab?