Teori Model

Keperawatan Keluarga

Desy Indra Yani
Bagian Keperawatan Komunitas
Fakultas Keperawatan
Universitas Padjadjaran
 Pendahuluan

The relationship between theory, practice, and
research is that through this knowledge nurses can
consider options and interventions to support
families.
By understanding theories and models, nurses are
prepared to think more creatively and critically
about how health events affect family clients.
Theories and models provide different ways of
comprehending issues that may be affecting families.
Simply put, theories offer choices for action
RELATIONSHIP BETWEEN THEORY,
PRACTICE, AND RESEARCH

 RELATIONSHIP BETWEEN THEORY,
PRACTICE, AND RESEARCH

Inductive reasoning is a process that moves from
specific pieces of information toward a general idea; it is
thinking about how the parts create the whole.
Deductive reasoning goes in the opposite direction of
inductive reasoning. Deductive reasoning is where
the general ideas of a given theory generate more
specific questions about what filters back into the
cycle, and helps refine understanding of the theory and
how to apply the theory to practice (White, 2005; White
& Klein, 2008).

Apa itu teori?
Untuk apa teori?
 Teori

Teori adalah cara sistematik dan terorganisir
untuk menjelaskan suatu fenomena terutama
hubungan antara fenomena, memperkirakan
dan mempengaruhi hasil.
Teori digunakan untuk make sense of the world
Menggambarkan
Menjelaskan
Membuat prediksi suatu fenomena (LoBiondo-
Wood & Haber, 2002; Polit & Hungler, 1998)
 Konsep

the building blocks of theory, are words that create mental
images or abstract representations of phenomena of study.
Concepts, or the major ideas expressed by a theory, may exist
on a continuum from empirical (concrete) to abstract (Powers &
Knapp, 2005).
The more concrete the concept, the easier it is to figure out
when it applies or does not apply (White & Klein, 2008, p. 8).
For example, one concept in Family Systems Theory is that
families have boundaries. A highly abstract aspect of this
concept is that the boundary reflects the energy between the
environment and the system. A more concrete understanding of
family boundaries is that families open and/or close their
boundaries in times of stress.
 Proportions

Propositions are statements about the relationship
between two or more concepts (Powers & Knapp, 2005).
A proposition might be a statement such as: Families as a
whole influence the health of individual family members.
The word influence links the two concepts of families as a
whole and health of individual family members.
Propositions denote a relationship between the subject
and the object. Propositions may lead to hypotheses.
Theories are generally made up of several propositions.
 Hypothesis

A hypothesis is a way of stating an expected
relationship between concepts or an expected
proposition (Powers & Knapp, 2005).
The concepts and propositions in the hypothesis are
derived and being driven by the original theory.
For example, using the concepts of family and
health, one could hypothesize that there is an
interactive relationship between how a family is
coping and the eventual health outcome of family
members.
 Model Konseptual

A conceptual model is a set of general propositions that integrate concepts
into meaningful con- figurations or patterns (Fawcett, 2005)
Conceptual models in nursing are based on the observations, insights, and
deductions that combine ideas from several fields of inquiry.
Conceptual models provide a frame of reference and a coherent way of
thinking about nursing phenomena.
A conceptual model is more abstract and more comprehensive than a
theory.
Like a conceptual model, a conceptual framework is a way of integrating
concepts into a meaningful pattern, but conceptual frameworks are often
less definitive than models.
They provide useful conceptual approaches or ways in which to look at a
problem or situation, rather than a definite set of propositions.
Praktek Keperawatan Keluarga
(Hanson & Kaakinen, 2001).

Teori/ model keperawatan

Teori terapi keluarga
Teori ilmu keluarga sosial





 Perbedaan antara Ketiga
Teori (Hanson, 2001)
Kriteria Family Social Family Therapy Nursing Theories

Tujuan teori
Theories
Deskriptif &
theories
Deksriptif & Deskriptif &
explanatori (model prescriptive (model prescriptive (model
akademik), praktek) menuntun praktek)
menjelaskan fungsi disfungsi dan mebimbing
dan dinamika menunjukkan tindakan pengkajian
keluarga terapeutik keperawatan dan
usaha2 intervensi
Fokus displin Interdispin (walau Perkawinan dan terapi Fokus keperawatan
utamanya soslogikal) keluarga dan kesehatan
mental keluarga
Target Utamanya keluarga Utamanya pada Utamanya pada
populasi normal (orientasi pada keluarga bermasalah keluarga yang sehat
normal) walau pendekatan baru dan masalah
fokus pada kekuatan penyakit
keluarga
 Pendekatan Teoritis
Teori Keperawatan/ Model
Konseptual
Orientasi Sistem
Sistem perilaku (Johson)
Konseptual sistem (Neuman)
Orientasi perkembangan
Perawatan diri (Orem)
Orientasi interaksi & sistem
Model adaptasi (Roy)
Model sistem terbuka (King)
Orientasi sistem &
perkembangan
Model proses kehidupan
(Roger)
Teori Ilmu Sosial keluarga
Perkembangan
Orientasi pd sosisoloogi
(Duvall)
Orientasi pd psikologi
(McGoldrick &Carter)
Sistem
Mainstream
ekologi
Struktur-fungsional interkaksi
Teori peran
Teori stress & koping klg
Institusional-histeris
Lain-lain
Teori konflik
Teori pertukaran sosial
Teori pembelajaran sosial
Teori Terapi Keluarga
Teori sistem keluarga
Teori sistem klg Bowerian
Teori keluarga struktural
(Minuchin)
Teori komunikasi/ interaksi
keluarga
Perilaku
Psikodinamik
Pengalaman-humanistik
Intervensi krisis keluarga
 The Family System
Theory

The Family Systems Theory is an approach that
allows nurses to understand and assess families as
an organized whole and/or as individuals within
family units who form an interactive and
interdependent system (Hanson & Kaakinen, 2005).
Family Systems Theory is constructed of concepts
and propositions that provide a framework for
thinking about the family as a system.
in family nursing, we look at a three-generation
family system (Goldenberg & Goldenberg, 2007).
 The Family System
Theory

One of the major assumptions of Family Systems
Theory is that family systems features are designed
to maintain stability, although these features may be
adaptive or maladaptive.
At the same time, families change constantly in
response to stresses and strains from both the
internal and external environments.
Family systems increase in complexity over time,
and as a system, families increase their ability to
adapt and to change (White & Klein, 2008).
 The Family System
Theory

All parts of the system are interconnected
The whole is more than the sum of its parts
One way of visualizing the family as a whole is to
think of how each family member acts during a family
ritual or routine.
 The Family System Theory

All systems have some form of boundaries or borders between the system
and its environment
Families control the in-flow of information and people coming into its family
system to protect individual family members or the family as a whole.
Boundaries are conceptualized as a continuum ranging from closed to open or
any variation in-between.
Boundaries are physical or abstract imaginary lines that families use as barriers
or filters to control the impact on the family system (White & Klein, 2008).
Family boundaries include levels of permeability in that they can be closed,
flexible, or too open to information, people, or other forms of resources.
Systems can be further organized into subsystems.
he subsystems of the family, which may in- clude parent to child, mother to
child, father to child, child to child, grandparents to parents, grandparents to
grandchildren, and so forth.
These subsystems take into account three dimensions of families: structure,
function (including roles), and processes (interconnection and dynamics).
By understanding these three dimensions, family nurses can streamline
interventions to achieve specific family outcomes.
 APPLICATION OF FAMILY SYSTEMS
THEORY

The focus of the nurses practice from this perspective is family as the
client.
Nurses work to help families maintain and regain stability.
Assessment questions of family members are focused on the family as a
whole.
Interventions by family nurses must address individuals, subsystems
within the family, and the whole family all at the same time.
One strategy would be to assess the family process and functioning, and
offer intervention strategies to assist families in their every- day
functioning.
The goal of using a family systems perspective is to help the family reach
stability by building on their strengths as a family, using knowledge of the
family as a social system, and understanding how the family is an
interconnected whole that is adapting to the changes brought about by the
health event of a given family member.
 The Family System Theory
Strengths
theory covers a large array of
phenomena, and views the family and
its subsystems within the context of its
suprasystems (the larger community
in which it is embedded)
this is an interactional and holistic
theory that looks at processes within
the family, rather than at the content
and relationships between the
members.
The family is viewed as a whole, not
as merely a sum of its parts.
it is an excellent data-gathering
method and assessment strategy.
Weaknesses
Because this theoretical
orientation is broad and
general, it may not be
specific enough for
beginners, to define family
nursing interventions.
It is important for family
nurses to be able to under-
stand conceptually how
important the family as a
whole is to the practice of
family nursing.
Developmental and Family Life
Cycle Theory

It provides a framework for nurses to understand
normal family changes and experiences over the
members lifetimes
the theory assesses and evaluates both individuals
and families as a whole.
Concepts:
Families develop and change over time
Families experience transitions from one stage to
another
 Developmental and Family
Life Cycle Theory
STrengths
it provides a systematic
framework for predicting
what a family may be
experiencing at any stage in
the family life cycle.
Family strengths and
available resources are
easier to identify because
they are based on assisting
families to achieve
developmental milestones.
Weakness
As family structures
continue to change in
response to the culture
and ecologic system,
trajectories of families
likely will not fit within
the traditional
developmental
framework (White &
Klein, 2008).
Bioecological Systems Theory

 Bioecological Systems Theory
This theory seems to combine both
Weaknesses:
Developmental Theory and Systems Theory to
understanding individual and family growth.
Strengths:
it represents a comprehensive and holistic
view of human/family developmenta
bio/psycho/socio/ cultural/spiritual approach
to the understanding of how humans and
families develop and adapt to the larger society.
It includes both the nature (biological) and
nurture (environmental contexts) aspects of
growth and development for both individuals
and families.
The bioecological perspective provides a
valuable com- plement to other theories that may
offer greater in- sight into how each aspect of the
holistic approach affects individuals and families
over time.
The bio/
psycho/socio/cultural/religious
aspects of human/ family growth
and development are not detailed
enough to define how
individuals/families can
accomplish or adapt to these
contextual changes over time,
given their biological imperative.
Aspects to the theory require
further delineation and testing,
that is, influence of biological and
cognitive processes, and how
they interact with the
environment.
The Family Cycle of Health
and Illness Model

 Family Assessment
and Intervention Model

 Teori Orem

Theory of self care
Self-care requisites
Self-care consists of universal
Self-care consists of developmental,
Health care (health deviation) needs
Therapeutic self-care demands
Deliberate actions
estimative and transitional operations
production and evaluation operations
 Teori Orem

The theory of self care deficit self-care agency
Self-care agency:
A set of power components enabling performance of
self-care operations
Five sets of foundational capabilities and dispositions
The self-care operational capabilities
investigative-estimative
judgment and decision-making
Productive operations of self care agency
 Teori Orem

Helping methods
Acting or doing for others
Guiding others
Supporting another
Providing an evironment
Teaching another

The theory of nursing system.

Wholly compensatory system
Partially compensatory system
supportive educative program
 Teori Orem

Keluarga
Suatu sistem/ unit interaksi orang-orang yang berkaitan
dengan pernikahan, kelahiran, atau ikatan sosial kuat
lainnya dengan komitmen dan attachment antara
anggota yang meliputi kewajiban dan tujuan utuk
menciptakan, mempertahankan dan meningkatkan
perkembangan sosial, mental, fisik dan emosional
adalah setiap anggotanya
Interaksinya adalah interdependent
Kemandirian dan ketergantungan tergantung pada tahap
perkembangan dan status kesehatan anggota keluarga
 Teori Orem

Keluarga sebagai basic conditioning factors
Faktor yang mengkondisikan self-care system, the therapeutic self-
care demand, & self-care agency
Keluarga sebagai tempat/ struktur untuk dependent care
unit
Mengkondisikan the dependent care system dan dalam dependent
care system diciptakan
Keluarga sebagai unit pelayanan
Keluarga memiliki fungsi-fungsi tertentu berkaitan dengan
self-care dan dependent care semua anggota yang melebihi
atau berbeda dari memenuhi kebutuhan self-care secara
indivifu
 Teori Stres Keluarga

Stres keluarga penyakit
ABCX model (Hills 1949)
BagaimMencari stresor dan kesulitasn
B. Menyediakan sumber-sumber kekuatan dalam
penyelesaian masalah (koping, dukungan sosial,
dll)
C. Mendefinisikan keseriusan kejadian stresor
X. Kemampuan keluarga beradaptasi dengan stres
A. keluarga dengan kejadian stresful
 Teori Stres Keluarga
Pengkajian

Stresor
Persepsi terhadap stresor
Sumber kekuatan keluarga
Koping keluarga
Gangguan fungsi keluarga
Pengalaman sebelumnya
Persiapan/antisipasi
Intervensi
Membantu keluarga dalam peningkatan sumber-sumber
& support system
Modifikasi persepsi
 Teori Struktural
Fungsional

Keluarga sebagai sistem terbuka
Hubungan antar keluarga dan sistem sosial lain
Pendekatan pada struktur keluarga & fungsi keluarga
Melihat keluarga sebagai institusi sosial yang bersifat
fungsional
 Teori Struktural
Fungsional

Asumsi :
Keluarga sebagai sistem sosial dengan syarat
fungsional
Keluarga sebagai kelompok kecil memiliki sifat
generik yang lazim
Sesbagai sistem sosial menyelenggarakan fungsi
fungsi
Keluarga memiliki norma dan nilai-nilai
 Teori Perkembangan

Menguraikan perkembangan keluarga dari waktu ke
waktu
Tahap-tahap perkembangan keluarga berbeda satu
dengan lainnya
Terdapat saling ketergantungan yang tinggi
Dituntut adanya porubahan
 Teori Perkembangan

Asumsi Dasar
Keluarga berkembang dan berubah dari waktu ke
waktu
Adanya peningkatan kematangan dan interaksi -->
tindakan dan reaksi terhadap tuntutan lingkungan
Adanya pembagian tugas sesuai konteks budaya dan
masyarakat
Kecenderungan untuk memulai secara jelas
 Teori Perkembangan
Keluarga pemula

Child bearing
Keluarga dengan anak pra sekolah
Keluarga dengan anak sekolah
Keluarga dengan anak remaja
Keluarga dengan anak dewasa muda (launching)
Orangtua usia pertengahan
Keluarga dalam masa pensiun dan lansia
 Teori Sistem

Keluarga sebagai suatu sistem
Sebuah kombinasi elemen-elemen dalam interaksi
yang seimbang
Keluarga sebagai unit fokus pada mengobservasi
interkasi antara anggota keluarga dan antara
keluarga dengan penyakit/ masalah bukan
mempelajari anggota keluarga secara individual
 Teori Sistem

Konsep Teori Sistem diaplikasikan pada keperawatan
keluarga:
1. Sebuah sistem keluarga adalah bagian dari supra sistem
yang lebih besar dan terdiri dari banyak sub sistem
supra sistem: tetangga, organisasi, komunitas
sub sistem: orangtua-anak, perkawinan, sub sistem
persaudaraan
Boundary: apa yang ada di dalam & diluar sistem
Terlalu terbuka: sistem kehilangan identitas & integritas
Terlalu tertutup: kebutuhan berinteraksi dengan dunia luar
ditiadakan
 Teori Sistem

2. Keluarga sebagai suatu kesatuan lebih besar dari
jumlah dari bagian-bagian keluarga
Mempelajari keutuhan keluarga memungkinkan
utk mengobservasi interaksi antar keluarga dapat
lebih menjelaskan secara keseluruhan fungsi anggota
keluarga
3. Sebuah perubahan pada seorang anggota keluarga
memngaruhi seluruh anggota keluarga
Pengaruh penyakit pada anggota keluarga mempengaruhi
semua anggota keluarga & berbagai hubungan keluarga
 Teori Sistem

4. Keluarga dapat membuat keseimbangan
perubahan dan stabilitas
5. Perilaku anggota keluarga adalah terbaik
dimengerti dari sebuah gambaran melingkar dari
pada hubungan linier
Mempengaruhi gaya bertanya perawat pada saat
interview
Linier menggali karakteristik deskriptif
Sirkuler menggali karateristik inteasksional
Family Nursing Roles





Variables that influence family health care