Anda di halaman 1dari 21

Keperawatan kesehatan komunitas terdiri dari tiga kata yaitu keperawatan,

kesehatan dan komunitas, dimana setiap kata memiliki arti yang cukup luas.
Azrul Azwar (2000) mendefinisikan ketiga kata tersebut sebagai berikut :
1. Keperawatan adalah ilmu yang mempelajari penyimpangan atau tidak
terpenuhinya kebutuhan dasar manusia yang dapat mempengaruhi perubahan,
penyimpangan atau tidak berfungsinya secara optimal setiap unit yang terdapat
dalam sistem hayati tubuh manusia, balk secara individu, keluarga, ataupun
masyarakat dan ekosistem.
2. Kesehatan adalah ilmu yang mempelajari masalah kesehatan manusia mulai
dari tingkat individu sampai tingkat ekosistem serta perbaikan fungsi setiap unit
dalam sistem hayati tubuh manusia mulai dari tingkat sub sampai dengan
tingkat sistem tubuh.
3. Komunitas adalah sekelompok manusia yang saling berhubungan lebih sering
dibandingkan dengan manusia lain yang berada diluarnya serta saling
ketergantungan untuk memenuhi keperluan barang dan jasa yang penting untuk
menunjang kehidupan sehari-hari.
Menurut WHO (1959), keperawatan adalah bidang perawatan khusus yang
merupakan gabungan ketrampilan ilmu keperawatan, ilmu kesehatan
masyarakat dan bantuan sosial, sebagai bagian dari program kesehatan
masyarakat secara keseluruhan guns meningkatkan kesehatan, penyempumaan
kondisi sosial, perbaikan lingkungan fisik, rehabilitasi, pence-gahan penyakit dan
bahaya yang lebih besar, ditujukan kepada individu, keluarga, yang mempunyai
masalah dimana hal itu mempengaruhi masyarakat secara keseluruhan.
Keperawatan kesehatan komunitas adalah pelayanan keperawatan profesional
yang ditujukan kepada masyarakat dengan pendekatan pads kelompok resiko
tinggi, dalam upaya pencapaian derajat kesehatan yang optimal melalui
pencegahan penyakit dan peningkatan kesehatan dengan menjamin
keterjangkauan pelayanan kesehatan yang dibutuhkan dan melibatkan klien
sebagai mitra dalam perencanaan, pelaksanaan dan evaluasi pelayanan
keperawatan (Spradley, 1985; Logan and Dawkin, 1987). Keperawatan kesehatan
komunitas menurut ANA (1973) adalah suatu sintesa dari praktik kesehatan
masyarakat yang dilakukan untuk meningkatkan dan memelihara kesehatan
masyarakat. Praktik keperawatan kesehatan komunitas ini bersifat menyeluruh
dengan tidak membatasi pelayanan yang diberikan kepada kelompok umur
tertentu, berkelanjutan dan melibatkan masyarakat. Dari beberapa pengertian
diatas dapat disimpulkan bahwa perawatan kesehatan komunitas adalah suatu
bidang dalam ilmu keperawatan yang merupakan keterpaduan antara
keperawatan dan kesehatan masyarakat dengan dukungan peran serta
masyarakat, serta mengutamakan pelayanan promotif dan preventif secara
berkesinambungan dengan tanpa mengabaikan pelayanan kuratif dan
rehabilitatif, secara menyeluruh dan terpadu ditujukan kesatuan yang utuh
melalui proses keperawatan untuk ikut meningkatkan fungsi kehidupan manusia
secara optimal.

Community health nursing consists of three words namely nursing, health and
community, where every word has a meaning that is wide enough. Azrul Anwar
(2000) defines three words are as follows:
1. Nursing is the study of irregularities or non-fulfillment of basic human needs
that can affect a change, diversion or not functioning optimally each unit
contained in the human body's biological system, Balk as individuals, families, or
communities and ecosystems.
2. Health is the study of human health problems ranging from the individual to
the ecosystem level and improving the function of each unit in the human body's
biological systems ranging from the sub up to the level of body systems.
3. Community is a group of people that are interconnected more frequently than
with other human beings who are welcome and mutual dependence to meet
needs for goods and services necessary to support daily life.
According to WHO (1959), special care nursing is a field which is a combination
of nursing skills, community health sciences and social assistance, as part of
overall public health programs improve the health of guns, penyempumaan
social conditions, physical environmental improvements, rehabilitation,
prevention disease and a greater danger, addressed to individuals, families, who
have the problem where it affects society as a whole. Community health nursing
is professional nursing services addressed to the society with the approach pads
high-risk groups, in efforts to achieve optimal health through disease prevention
and health promotion to ensure the affordability of health services needed and
involving clients as partners in planning, implementation and evaluation of
service nursing (Spradley, 1985; Logan and Dawkins, 1987). Community health
nursing according to the ANA (1973) is a synthesis of public health practice
committed to improving and maintaining public health. Community health
nursing practice is holistic by not limiting its service to specific age groups,
sustainable and involve the community. From some of the above understanding
can be concluded that the health care community is a field in the science of
nursing which is the integration of nursing and public health with the support of
community participation, and give priority to preventive and promotive services
on an ongoing basis without ignoring curative and rehabilitative services, a
comprehensive and integrated directed coherent whole through the nursing
process to improve the function of human life go optimally.

Public Health Nursing is a noble and humane work that


addressed to the client.
2. Community Health Care is based on humanitarian efforts
to enhance growth and development for human terwijudnya
particularly healthy and healthy society in general.
3. Community Health Care Services must be affordable and can be
acceptable to everyone.
4. Promotive and preventive efforts is an attempt to ignore the subject without
curative and rehabilitative.
5. Public Health Nurses as providers and society as a

consumer of health services, ensuring a relationship of mutual


support and influence change in policies and services
keearah improvements in public health
6. Development of public health personnel on an ongoing basis ..
7. Individuals within a society share responsibility for health.

Community nursing paradigm consists of four main components, namely


humans, nursing, health and the environment (Logan & Dawkins, 1987). As the
goal of nursing practice can be divided into individual clients, families and
communities.
1. Individuals as Clients
Individuals are members of a unique family as a unified whole from the aspect of
biology, psychology, social and spiritual. The role of nurses on the individual as a
client, basically meet their basic needs including the needs of biological, social,
psychological and spiritual because of the physical and mental weakness, lack of
knowledge, lack of will to independence of patients / clients.
2. Family As Client
The family is closely related group of individuals who continually and there is
interaction with each other either individually or jointly, within its own
environment or society as a whole. Families in their function and scope affect
basic human needs are physiological needs, feel safe and comfortable, loved and
loving, self-esteem and self-actualization.
Some of the reasons which led the family is one focus of nursing care that is:
a. The family is the primary unit in society and an institution that involves
people's lives.
b. The family as a group can cause, prevent, correct or ignore the health
problems within the group itself.
c. Health problems within the family are interrelated. The illness of a family
member will affect all members of the family.
3. Community As Client
Society has a characteristic of the interaction between people, governed by
customs, norms, laws and regulations are typical and have a strong identity
binding on all citizens.
Health in community health nursing is defined as the ability to carry out the roles
and functions effectively. Health is an ongoing process leads to creativity,
constructive and productive. According to Hendrik L. Blum there are four factors
that affect health, the environment, behavior, health care and offspring.
Environment consists of the physical environment and social environment. The
physical environment is related to the physical environment such as water, air,
waste, soil, climate, and housing. Example in a region experiencing outbreaks of
diarrhea and skin diseases caused by clean water shortages. Heredity is a factor
that has been present in the human innate, such as asthma. These four factors
are interrelated and mutually supporting one another in determining the health
status of individuals, families, groups and communities. Nursing in community
health nursing is seen as a form of essential services provided by nurses to

individuals, families, and groups and communities who have health problems
include promotive, preventive, curative and rehabilitative by using the nursing
process to achieve optimal health. Nursing is a form of professional services as
an integral part of health care services in the form of biological, psychological,
social and spiritual comprehensively addressed to individual families and
communities include both healthy and sick human life cycle.
Environment in nursing paradigm focuses on community environment, where the
environment can affect human health status. Environment here includes the
physical, psychological, social and cultural and spiritual environment.

The goal of nursing is the prevention and improved public health through efforts
to:
Direct nursing care (direct care) to individuals, families and groups within the
community context.
Direct attention to the health of the entire community (community general
health) and consider how the issue or issues of public health can affect families,
individuals and groups.
And then specifically expected to: individuals, families, groups and communities
have the ability to:
Identify the health problems experienced by
Establish and prioritize health problems such problems
Formulate and solve problems
Tackling the health problems they are experiencing
Evaluate the extent to which solving an issue that they face which ultimately can
improve their ability to independently maintain good health (self care)
Target community nursing
The whole of society including individuals, families and groups of both healthy
and sick, especially those at high risk in the community.
Individual
Individuals are members of the family as a unified whole from the aspect of
biology, psychology, and spiritual soaial. Then the nurse's role is to assist
individuals to meet their basic needs because of physical weakness and mental
experience, limited knowledge and lack of ability to self-reliance.
Family
The family is the smallest unit of society comprising heads of households, other
family members who gathered and lived in a household because of blood ties
and the bonds of marriage or adoption. Between family and the other one
interdependent and interacting, if one or several family members have health
problems then it will affect others and family members who are nearby. These
problems, the family is the focus of a strategic health care:
a. The family as an institution that needs to be taken into account
b. Families have a major role in the maintenance of health of all family members
c. Health problems in a family of related
d. The family as a place penggambilan decisions in health care
e. Family is an effective intermediary in a variety of businesses - public health
efforts.

Special groups
Namely a set of individuals who have in common gender, age, problem,
organized activities are particularly vulnerable to health problems include:
a. Special group with special health needs as a result of the development and
growth such as: pregnant women, newborns, toddlers, school age children and
the elderly age or older.
b. Groups with special health needs supervision and guidance as well as nursing
care, among others: the case of venereal disease, tuberculosis, AIDS, leprosy and
others - others.

Community nursing is a form of health care as part of efforts in prevention and


improved community health status through direct nursing care (direction) of the
individual, family and community context as well kelompokdidalam
lagsungterhadap health concern throughout the community and consider the
public health problems or issues that may affect the individual , families and
communities.

1. General Objectives Improving health status and ability of people to meyeluruh in


maintaining their health to achieve optimal health status mandiri.2. Specific objectives a.
Understanding of healthy and ill understood by masyarakat.b. Increasing the ability of
individuals, families, groups and communities to carry out basic maintenance efforts in order
to address the problem keperawatan.c. Tertanganinya vulnerable group of families who need
guidance and care keperawatan.d. Tertanganinya specific community groups / vulnerable who
need guidance and care keperawatandi home, in nursing and in masyarakat.e. Tertanganinya
cases that require follow-up treatment and nursing care dirumah.f. Ser-vice specific cases that
include high-risk groups who require treatment and nursing care at home and in Puskesmas.g.
Resolved and the controlled circumstances of physical and social environment for optimal
health to the state. COMMUNITY HEALTH NURSING TARGET Target nursing community
is the whole of society including individuals, families, and high risk groups such as families
resident in the slums, isolated areas and areas not covered include groups of infants, toddlers
and mothers hamil.Menurut Anderson (1988) target keperawatankomunitas consists of three
levels namely: 1. Individual level. Nurses provide nursing care to individuals who have
certain health problems (eg tuberculosis, pregnant women) are found in the clinic, health
center with the target and the center of attention on health problems and solving health
problems individu.2. Keluarga.Sasaran activity level is a family where family members who
have health problems were treated as part of family by measuring the extent of fulfillment of
the task that is familiar with family medical health problems, making decisions to solve
problems of health, providing care to family members, creating a healthy environment and
utilize resources in the community to improve family health. Community Health Care service
priority is focused on vulnerable families, namely: a. Families who have affordable health
care, family namely: pregnant women who have not the ANC, post-partum mothers who
labor and are helped olehdukun neonatusnya, some toddlers, chronic infectious disease that
can not be intervened by the program, endemic diseases, chronic diseases tidakmenular or
families with certain disabilities (mental or physical). b. Families with high risk, ie families
with pregnant women who have nutritional problems, such as arduous anemiagizi (HB less
than 8 g%) or Chronic Energy Deficiency (CED), families with pregnant women at high risk

such as bleeding, infection, hypertension, family with a toddler with BGM, families with low
birth weight neonates, families with elderly nursing home or a family with cases of suicide
attempts.

MINISTRY OF HEALTH
Health promotion (health promotion)
Levels of health care is a first degree in memberikanpelayanan through improved
health. The implementation aims to improve the health status of the target so
that the community or health problems do not occur. These could include level of
service, personal hygiene, environmental sanitation improvements, periodic
health examinations, penigkatan nutritional status, health habits, prenatal
services, elderly services, and all activities associated with improved health
status.

Specific protection (special protection)


Special protection is done in protecting the public from hazards
will cause a decline in health status, or other forms of protection against certain
diseases, health threats, which include the level of health care is the provision of
immunizations that are used for protection in certain diseases such as
immunization of BCG, DPT, hepatitis, measles and others. Safety protection
services where health services are provided to a person who works at a high risk
of accidents such as working in the production of chemicals, the form of special
protection service erupa use of personal protective equipment and so forth.

Early diagnosis and prompt treatment (early diagnosis and prompt treatment)
Level of health services has been entered into in the beginning or the onset of
symptoms of an illness. Level of service is implemented in preventing the further
spread of the disease and the impact of the onset of the disease so it does not
spread. Form level of health services may include surveying activities in order to
search for cases of both individuals and society, a survey of case screening and
prevention of the spread of cases.

Limitation Disability (barring disability)


Limitation of disability is done to prevent the patient or the public are not impacted due to
diseases caused disability. These levels are implemented in case of illness or disability that
has the potential. Form of activity that can be done can be a treatment to stop the disease,
prevent further complications, providing all the facilities to cope with disability and prevent
death.
Rehabilitation (rehab)

Level of service is implemented after the patient was diagnosed healed. Often at
this stage found in the recovery phase of the disability program as exercises that
are given to patients, and provide facilities so that patients have the confidence
back, or passion for life back into the community and the public would accept
gladly because they have consciousness.

Community
Community nurses work across diverse areas, providing primary health care throughout the
lifespan. They provide comprehensive nursing across the full range of health needs to clients
anywhere in the community from community health centres, primary health clinics, public
health units, schools and universities, local councils and clients homes. Community
nurses provide health care to people requiring health interventions and also consider the
social conditions that affect health status. Any person or carer can access community nurses.
Many Hospitals and GPs refer to community nurses and clients ask directly for help.
What is Community Nursing?
Most community nurses work in the government sector while some work as domiciliary
nurses for private organisations such as Bluecare, Ozcare and St Luke's Health Services (also
see Domiciliary Nursing).
Community nurses work with clients to match assessment results against current or evidence
based treatment options when implementing health care. Community nurses usually work in
multidisciplinary teams that ensures the client receives the full range of health care. Much of
the work is focused toward illness/disease prevention or early intervention to prevent
exacerbations of chronic illness and unnecessary hospital admission.
Community Nurses work across the full range of health care delivery
Community nurses assist clients and their carers/families in focusing on their health situation
in relation to their environment and coping skills to maximise their management of the
disorder. Community nurses use health promotion, prevention, early intervention, treatment
and referral as the mainframe for community nursing service delivery. They work with the
acute care sector, domiciliary and community mental health nurses, specialists, general
practitioners, allied health specialists, health advancement specialists and community based
care providers and organisations to provide a continuum of care in the following range of
interventions and case management:

clients at risk for complications of conditions/diseases such as diabetes, asthma,


chronic respiratory, cardiac and renal conditions, palliative care, depression, other
mental illness including risk of suicide, drug misuse or addiction, managing serious
drug withdrawal states and early intervention for first time convicted illicit drug users;
notifiable infections, sexual health/contraception including pap smear and breast
screening services and HIV/AIDS management;
risks associated with aging as in continence management, risk of falls, dementia,
arthritis, improving social networks;

improving access to adequate nutrition, shelter/housing and employment;

mens health, well woman clinics;

child health information and advice, parenting advice, injury prevention improving
immunisation rates throughout the lifespan;

advocating on behalf of people who are at risk for domestic violence, financial abuse,
marginalised by social bias or disadvantaged by gaps in aging government policies;

managing the transition from home-hospital-home continuum of care for acute


interventions, eg., wound management, in home IV services.

Community Nurses work in general and speciality areas and the following are just some
examples of the diversity of community nursing.
Generalist Community Health Nursing
The Community Health Nurse works with other members of the Community Health Team
and the general public to plan and deliver services that promote and maintain the health,
safety, independence and well being of people living in the community. Their clients include
the frail aged and their carers, people with a disability and those with chronic illnesses as well
as those who need before and after hospital services. The Community Health Nurse visits
clients in their home to assess physical, functional, emotional, social, environmental and
safety factors. Nurses assist the client to identify their care goals and organise agreed care
activities and together with the client, monitor the care plan and makes changes where
necessary. They consult with, and refer to other care support services such as Meals on
Wheels, Domiciliary Nursing Services, Medical Aids Subsidy Scheme, Home care Service,
Taxi Subsidy Scheme, and many more.
Community Health Nurses work together with hospital staff to prevent unnecessary hospital
admissions by identifying support needs, providing education and organising appropriate care
for the people in our community. Where hospitalisation occurs, the Nurse can assist by
coordinating and supporting the client's care before and after a hospital stay. Orthopaedics
and Respiratory are two areas where the Nurse works in partnership with The Prince Charles
Hospital. Community Health Nurses undertake Health promotion activities and have
speciality roles in areas such as Diabetes, Continence, Dementia Care and Asthma Education.
Alcohol and Drug Nursing
Alcohol and Drug Nurses work across a range of health settings in clinics, health centres,
homes, community-based organisations and work with government sectors, ie Education,
Police and Corrective Services. Primarily they offer assessment, withdrawal management
from psychoactive drugs, brief and early intervention programs, opioid treatment services,
alcohol and drug counselling and relapse prevention. Consultation liaison services are
provided to General Hospital Services, Mental Health, Watchhouse, General Practitioners and
other community services on the management and treatment of people with alcohol and drug
services. Nurses work closely with Mental Health and general Community Health Services to
provide holistic services to clients who have more than one diagnosis. Health promotion and
education on alcohol and drug issues is undertaken within specific alcohol and drug
campaigns, clinician education programs and with the community, families and individuals.

Public Health Nursing


Public Health Nurses play a major role in the surveillance of all notifiable conditions and the
timely follow up of priority notifiable conditions that require public health action eg vaccine
preventable diseases and meningococcal infections. The nurses are also responsible for
implementing immunisation programs that will enable the Health Service District achieve the
immunisation targets set by the National Health and Medical Research Council (NHMRC)
and Queensland Health. Both these areas involve providing extensive education and advice to
health professionals, community organisations and the public.
Indigenous Health Nursing
Indigenous Health Services are targeted at addressing the health status inequities of the
Indigenous population. Nurses working in this area focus on providing culturally appropriate
services across the lifespan with particular emphasis on those health issues with higher
prevalence in the indigenous community. New mothers and babies who are considered at risk
are provided with an in-home nursing service to assist in lactation and care of the new babe.
The major burden of disease for indigenous people is cardiovascular disease, alcohol and
drug issues, cervical and breasts cancer and diabetes. Most of these conditions are treatable
and preventable, but the outcomes of these diseases result in higher morbidity and mortality
rates in indigenous populations than those in non-indigenous populations and significantly
shorter life spans. Nurses work with Indigenous Health Workers, community leaders and
elders to ensure services provided are culturally sensitive and appropriate to the specific
community and individual. Immunisation is also a significant part of the nurse's role.
Sexual Health and HIV/Aids Nursing
This Service provides a free and confidential service to the public by offering sexual health
tests, information, counselling, and pregnancy testing, emergency contraception and family
planning advice. The Service also has a specialist and community based HIV/AIDS service
that provides clinical care, ongoing chronic disease management and support for clients and
their carers/families. Services are provided to the public and those clients in institutions, ie
correctional facilities.
Sexual health nurses work as independent nurse practitioners in relation to the control and
prevention of sexually transmissible diseases including HIV and other blood borne viruses
such as Hepatitis B and C. Nurses fully assess, perform routine serology for pathological
examination and provide routine treatment and medication for clients. They provide topical
treatments, HIV testing with counselling and are responsible for contact tracing and follow up
for notifiable diseases. Clients are case managed with particular emphasis on clients with dual
diagnosis [mental health and alcohol and drug problems]. Nurses provide education to clients
and other professional groups and opportunities are available for ongoing research and
clinical trials.
Acute In-Home & Post Acute Nursing
Nurses working in post acute and acute in home services assist clients and their carers in
assuming self care for an acute health issue. The health issue may have necessitated a hospital
admission or the admission may have been prevented or have been reduced in duration
through the provision of services to the clients in their own home. Services frequently include
intravenous antibiotics and wound management. Nurses work closely with the acute care
sector, the clients General Practitioner and the multidisciplinary health care team to provide
optimal service delivery.

Child Health & School Based Youth Health Nursing


Child Health nurses assist parents in focusing on the health, development and wellbeing of
families and their children from birth to the age of 18. This is achieved by working in
partnership with parents, children GPs and carers to prevent and detect health problems in the
early stages and provide support for all aspects of the parenting role.
Hospital/Liaison Nursing
Liaison nurses assist in the smooth transition of clients from the acute setting to their homes.
Nurses arrange appropriate community based services to enable clients to receive care in their
own homes. Liaison Nurses provide key resources in regard to discharge planning and are a
central contact point with community based service providers. This service also assists in the
prevention of inappropriate hospital admissions or re admissions by ensuring adequate
community based support services.
How do I become a community Nurse?
Nurses considering a career in community nursing can choose from a variety of postgraduate
courses. These courses range from general community health, alcohol and drug , sexual
health, HIV/AIDS, public health, nurse immuniser, maternal and child health, indigenous
studies, mental health studies, aged care, health education, health promotion and
advancement, continence management, diabetes nurse educator and accreditation,
rehabilitation, womens health, mens health, cultural and indigenous awareness, management
and administration, teaching and health education, and leadership. For more information on
postgraduate course availability in this area, click here to go to the further education section.
What opportunities are available for community nurses?
There is a national shift in directing more health care into the community as the costs of
hospitalisation continue to increase. This will occur in conjunction with a more integrated
approach to delivering and managing health care services overall. Thus the future will see
people with chronic disease and those with the conditions of aging being case managed by
community health nurses. There will be a need for community nurses to liaise with hospitals,
GPs and community based organisations, to manage the transition from home-hospital-home
in the pre and post acute nursing care delivery. Community nursing in the speciality areas
such as sexual health, alcohol and drug, womens health, child health and diabetes will
continue to need community nurses. Nurses experienced in population health and/or
indigenous health will have scope in clinical delivery in primary health care centres, and
there will always be opportunities for experienced nurses in research and teaching positions
in the tertiary sector and at local, State and Federal health government levels.
Areas Available with Community Nursing.

Community Health Nurse


Alcohol and Drug Nurse

Sexual Health Nurse

Child Health Nurse

School-based Nurse

Womens Health Nurse

Family Health Nurse

Acute In-Home Nurse

Post-Acute Nurse

Immunisation Nurse

Public Health Nurse

Council Nurse

Aged Care Nurse

Dementia Nurse

Continence Nurse

Hosp/Community Liaison Nurse

Indigenous Health Nurse

Community Nurse Educator

Sexual Health Nurse Educator

Alcohol & Drug Nurse Educator

Diabetes Nurse Educator

Continence Nurse Adviser

Community Nurse Manager

Community Nursing Director

Director of Nursing, Community

Community Mental Health Nurse see Mental Health nursing

Latar Belakang
Keperawatan adalah salah satu profesi yang ada di masyarakat yang bergerak di bidang
kesehatan. Perawat dikenal sebagai salah satu tenaga kesehatan yang bekerja di rumah sakit
bersama dokter, bidan, fisioterapi, dan lain-lain. Area yang dimiliki oleh keperawatan
bermacam-macam. Diantaranya adalah keperawatan medikal bedah, maternitas, gerontik,
gawat darurat, dan komunitas. Pembagian area keperawatan itu bertujuan untuk
mengelompokkan bagian-bagian serta tanggung jawab setiap area keperawatan supaya ruang
lingkupnya lebih spesifik dan pengatasan masalahnya dapat lebih detail. Contohnya area
keperawatan gerontik hanya menangani orang lanjut usia, keperawatan maternitas menangani
ibu dan anak, dan lain sebagainya. Dengan adanya pengelompokan berdasarkan area tersebut,
maka layanan yang diberikan juga semakin menyeluruh dan spesifik.
Keperawatan komunitas merupakan salah satu area keperawatan yang mempunyai ruang
lingkup yang luas dan melebihi runag lingkup area keperawatan lain. Luasnya ruang lingkup
tersebut juga disertai dengan bertambahnya peran serta tanggung jawab yang dimiliki
perawat komunitas. Namun, apabila semua peran itu dapat dilaksanakan dengan optimal,
maka pencapaian tujuan dan program yang telah disusun untuk sebuah komunitas akan
tercapai secara maksimal. Kurang maksimalnya peran perawat komunitas di suatu tempat
disebabkan karena berbagai faktor. Seperti halnya yang terjadi di negara kita. Peran perawat
komunitas belum berjalan sesuai harapan. Berbeda dengan yang terjadi di luar negeri
terutama negara yang sudah maju. Pemberdayaan perawat komunitas sangat maksimal.
Mereka benar-benar memantau wilayah yang menjadi binaannya.

Konsep Dasar Keperawatan Komunitas


Pengertian
Kelompok sosial yang ditentukan oleh batas-batas wilayah, nilai-nilai keyakinan dan minat
yang sama serta adanya saling mengenal berinteraksi antara anggota masyarakat yang satu
dengan yang lain (WHO, 1995).
Komunitas adalah suatu kesatuan hidup manusia, yang menempati suatu wilayah nyata dan
berinteraksi menurut suatu sistem adat istiadat serta terikat oleh suatu rasa indentitas suatu
komunitas (Koenjaranigrat, 1990).
Sedangkan keperawatan komunitas adalah suatu sintesa dari praktek keperawatan dan praktek
kesehatan masyarakat yang diterapkan untuk meningkatkan dan memelihara kesehatan
penduduk (Ana, 1978).
Kesatuan yang unik dari praktek keperawatan dan kesejahteraan masyarakat yang ditujukan
kepada pengembangan dan peningkatan kemampuan kesehatan baik diri sebagai perorangan
maupun secara kolektif, sebagai keluarga, kelompok khusus/masyarakat dan pelayanan
tersebut mencakup spektrum pelayanan kesehatan untuk masyarakat (Ruth dan Freeman,
1981).
Tujuan
Tujuan keperawatan komunitas untuk mencegah dan peningkatan kesehatan masyarakat
melalui upaya :
1. Yankep secara langsung (direct care) terhadap individu, keluarga dan kelompok dalam
konteks komunitas.
2. Perhatian langsung terhadap kesehatan seluruh masyarakat (healt general community) dan
mempertimbangkan bagaimana masalah issue kesehatan masyarakat dapat mempengaruhi
keluarga, individu dan kelompok.
Secara spesifik diharapkan individu, kelompok, keluarga dan masyarakat mempunyai
kemampuan untuk :
a. Mengidentifikasi masalah kesehatan yang dialami.
b. Menetapkan masalah kesehatan dan memprioritaskan masalah tersebut.
c. Merumuskan serta memutuskan.
d. Menanggulangi kesehatan yang mereka hadapi.
e. Mengevaluasi sejauh mana pemecahan massalah yang mereka hadapi yang akhirnya dapat
meningkatkan kemampuan dalam memelihara kesehatan secara mandiri (self care).
Sasaran
1. Individu
Anggota keluarga sebagai kesatuan yang utuh dari aspek biologi, psikologi, sosial dan
spiritual. Individu dibantu agar dapat memenuhi kebutuhan dasarnya karena adanya
kelemahan fisik dan mental yang dialami, keterbatasan pengetahuan dan kurangnya
pengetahuan atau kemauan untuk menuju mandiri.
2. Keluarga
Merupakan fokus pelayanan kesehatan yang strategi, antara lain sebagai berikut :
a. Keluarga sebagai lembaga yang diperlukan diperhitungkan.
b. Keluarga mempunyai peran utama dalam pemeliharaan kesehatan seluruh anggota
keluarga.

c. Masalah kesehatan dalam keluarga saling berkaitan.


d. Keluarga sebagai tempat pengambilan keputusan (dicision making) dalam perawatan
kesehatan.
e. Keluarga merupakan perantara yang efektif dalam bimbingan usaha kemasyarakatan.
3. Kelompok Khusus
Sekumpulan individu yang mempunyai kesamaan jenis jelamin, umur, permasalahan
(problem) keluarga yang berorganisasi yang sangat rawan terhadap masalah kesehatan antara
lain :
a. Kelompok khusus yang butuh kesehatan sebagai akibat pengembangan dan pertumbuhan
(growth dan development) seperti: ibu hamil, BBL, anak balita, anak usia sekolah dan usia
lansia/lanjut usia.
b. Kelompok dengan kesehatan khusus yang memerlukan pengawasan dan bimbingan, antara
lain khusus penyakit kelamin, TBC, kusta, dll.
Prinsip
1. Kemanfaatan
Intervensi/pelaksanaan yang dilakukan harus memberikan manfaat sebesar-besarnya bagi
komunitas, artinya: ada keseimbangan antara manfaat dan kerugian.
2. Autonomi
Bebas untuk melakukan/memilih alternatif yang terbaik yang tersediakan untuk komunitas.
3. Keadilan
Melakukan upaya/tindakan sesuai dengan kemampuan atau kapasitas komunitas.
Tingkat Pencegahan
A. Intervensi keperawatan mencakup :
1. Penkes/keperawatan komunitas.
2. Mendemonstrasikan keterampilan dasar yang dapat dilakukan di komunitas.
3. Intervensi keperawatan yang memerlukan keahlian perawat, seperti: melakukan konseling
pada remaja, balita, usila, pasangan yang akan menikah, dll.
4. Kerjasama lintas program dan linta ssektoral dalam mengatasi masalah kesehatan di
komunitas.
5. Rujukan keperawatan dan non keperawatan apabila diperlukan.
B. Leavgil dan Clark
1. Prepathogenesis phase (tahap sebelum terjadinya penyakit) keluarga primary prevention.
a. Healt promotion/peningkatan kesehatan
- Penkes
- Penyuluhan kesehatan masyarakat (PKM)
- Pengamatan tumbang anak
- Pengadaan rumah sehat
- Konsultasi perkawinan
- Sek education
- Pengendalian lingkungan
- Program P2M melalui kegiatan keluarga imunisasi dan pemberantasan vektor
- Stimulasi/bimbingan dini/awal dalam kesehatan keluarga askep pada anak/balita dan
penyuluhan tentang kecelakaan
- Askep pre natal
- Pelayanan KB
- Perlindungan gizi

b. General and specifik protection (perlindungan umum dan khusus)


- Imunisasi
- Hygiene perorangan
- Perlindungan diri dari kecelakaan
- Perlindungan diri dari lingkungan
- Pengendalian sumber pencemaran
c. Phatogenesis phese
1. Secondary prevention (pencegahan sekunder) melalui 2 kegiatan :
a. Early diagnosa dan promp treatment (diagnosis diri dan pengobatan segera/adekuat) antara
lain :
- Penemuan kasus secara dini
- Pemeriksaan umum lengkap
- Pemeriksaan missal (mass screning)
- Survey terhadap kontak, sekolah dan rumah
- Penanganan kasus
- Pengobatan adekuat.
b. Disability limtation (pembatasan kecacatan)
- Penyempurnaan dan interaksi terapi lanjutan
- Pencegahan komplikasi
- Perbaikan fasilitas kesehatan
- Penurunan beban sosial penderita
- dll
2. Tertiary prevention (pencegahan tersier)
Usaha pencegahan terhadap masyarakat yang telah sembuh dari sakit serta mengalami
kecacatan, antara lain :
a. Pendidikan kesehatan lanjutan
b. Terapi kerja
c. Perkampungan rehabilitasi sosial
d. Penyadaran masyarakat
e. Lembaga rehabilitas dan partisipasi masyarakat
Peran dan Fungsi Perawat Komunitas
A. Definisi Peran
Seperangkat tingkah laku yang diharapkan oleh orang lain terhadap seseorang sesuai
kedudukannya dalam suatu sistem.
Dipengaruhi oleh keadaan sosial baik dari dalam maupun dari luar dan bersifat stabil.
Bentuk dari prilaku yang diharapkan dari seseorang pada situasi sosial tertentu.
(Kozler Barbara, 1995)
B. Peran Perawat Element Role (Dolteny, 1987)
1. Care Giver
Perawat mampu :
a. Memberikan Yankep pada individu, keluarga, kelompok/ masyarakat sesuai diagnosa
sifat sederhana sampai dengan kompleks.
b. Memperhatikan klien berdasarkan kebutuhan signifikan.
c. Menggunakan proses keperawatan untuk mengidentifikasi DP fisik, psikologis.

2. Client Advocate
a. Bertujuan membantu klien dan keluarga dalam menginterprestasikan informasi dari
berbagai pemberi pelayanan kesehatan yang diperlukan untuk informasi cancent atas tindakan
keperawatan yang diberikan kepadanya.
b. Mempertahankan dan melindugi hak-hak klien.
Hak-hak klien (Disparty, 1998: 140)
- Hak atas pelayanan sebaik-baiknya
- Hak atas informasi tentang penyakitnya
- Hak atas privacy
- Hak untuk menentukan nasibnya sendiri, hak untuk menerima ganti rugi akibat kelalaian
tindakan.
Hak-hak tenaga kesehatan :
- Hak atas info yang benar
- Hak untuk bekerja sesuai dengan standar
- Hak untuk mengakhiri hubungan dengan klien
- Hak untuk menolak tindakan yang kurang cocok
- Hak atas rahasia pribadi
- Hak atas balas jasa
3. Concelor
Proses membantu klien untuk menyadari dan mengatasi tekanan psikologis/masalah sosial
untuk membangun hubungan interpesonal yang baik dan untuk meningkatkan perkembangan
seseorang dukungan emosional dan intelektual.
Peran Perawat :
a. Mengidentifikasi perubahan pola interaksi klien terhadap keadaan sehat sakitnya.
b. Perubahan pola interaksi merupakan dasar dalam merencanakan metode untuk
meningkatkan adaptasinya.
c. Memberi bimbingan penyuluhan kepada individu, keluarga, dalam mengintegrasikan
pengalaman kesehatan dengan pengalamannya.
d. Pemecahan masalah difokuskan pada masalah keperawatan.
e. Mengubah prilaku hidup sehat (perubahan pola interaksi).
4. Educator
Peran Perawat :
a. Dilakukan kepada klien/keluarga tim kesehatan lain baik secara spontan pada saat
berinteraksi maupun formal (sudah disiapkan terlebih dahulu).
b. Membantu klien mempertinggi pengetahuan dalam upaya meningkatkan kesehatan, gejala
penyakitnya sesuai kondisi dan tindakan spesifik.
c. Dasar pelaksanaan adalah intervensi dalam proses-proses keperawatan.
5. Collaborator
Bekerjasama dengan tim kesehatan (dokter, ahli gizi, radiologi, dll) dalam kaitannya
membantu mempercepat proses penyembuhan klien.
6. Koordinator
Peran Perawat :
a. Mengarahkan.
b. Merencanakan.
c. Mengorganisasikan.

7. Change Agent
Pembawa perubahan adalah seseorang/kelompok yang berinisiatif merubah/membantu orang
lain membuat perubahan pada dirinya atau pada sistem (Kemp, 1986). Mengidentifikasi
masalah, mengkaji motivasi dan kemampuan klien untuk berubah, menunjukkan alternatif,
menggali kemungkinan hasil dari alternatif, mengkaji sumber daya, menunjukkan peran
membantu, membina dan mempertahankan hubungan membantu, membantu selama fase dari
proses perubahan dan membimbing klien melalui fase ini (martiener Tarney).
8. Consultan
9. Interpersonal Program
C. Peran Perawat Menurut Konsarsium Ilmu Kesehatan Tahun 1989
1. Pemberi Asuhan Keperawatan.
2. Advocat.
3. Educator.
4. Koordinator.
5. Kolaborator.
6. Konsultan.
7. Pembaharu.
D. Peran Perawat Hasil Lokakarya Keperawatan Tahun 1983
1. Pelaksana pelayanan keperawatan.
2. Pengelolah pelayanan dan institusi keperawatan.
3. Pendidik dalam keperawatan.
4. Peneliti dan pengembang pelayanan keperawatan.
E. Fungsi Perawat
Adalah suatu pekerjaan yang harus dilaksanakan sesuai dengan perannya. Dapat berubah dari
suatu keadaan ke keadaan lain.
Fungsi perawat dalam melaksanakan perannya :
1. Fungsi Independent
- Dimana perawat melaksanakan perannya secara mandiri, tidak tergantung pada orang
lain/tim kesehatan lainnya.
- Memberikan bantuan terhadap adanya penyimpangan/tidak terpenuhinya KDM baik bipsiko-sosial/kultural maupun spiritual, mulai dari tingkat individu-tingkat masyarakat.
- Kegiatan dilakukan dengan diprakarsai oleh perawat yang bertujuan serta bertanggung
gugat atas rencana dan keputusan tindakannya.
2. Fungsi Dependent
Kegiatan dilakukan dan dilaksanakan oleh perawat atas instruksi dari tim kesehatan lainnya
(dokter, ahli gizi, radiologi, dll).
3. Fungsi Interdependent
Ini berupa kerja tim yang sifatnya saling ketergantungan baik dalam keperawatan maupun
kesehatan.
F. Perawat Komunitas Dapat Bekerja Diberbagai Tatanan
1. Klinik Rawat Jalan.
2. Kantor Kesehatan.

3. Kesehatan Kerja.
4. Sekolah.
5. Rumah.
6. Perkemahan.
7. Institusi Pemeliharaan Kesehatan.
8. Tempat Pengungsian.
G. Perawat Dikomunitas Dapat Bekerja Sebagai
1. Perawat Keluarga
- Keperawatan kesehatan keluarga adalah tingkat keperawatan kesehatan masyarakat yang
dipusatkan pada keluarga sebagai satu kesatuan yang dirawat dengan sehat sebagai tujuan
pelayanan dan perawatan sebagai upaya (Bailon dan Maglaya, 1978).
- Peran perawat keluarga adalah melaksanakan asuhan keperawatan keluarga, berpartisipasi
dan menggunakan hasil riset, mengembangkan dan melaksanakan kebijakan di bidang
kesehatan, kepemimpinan, pendidikan, case management, dan konsultasi.
2. Perawat Kesehatan Sekolah
- Keperawatan sekolah adalah keperawatan yang difokuskan pada anak di tatanan pendidikan
guna memenuhi kebutuhan anak dengan mengikutsertakan keluarga maupun masyarakat
sekolah dalam perencanaan pelayanan (Logan, BB, 1986).
- Keperawatan kesehatan sekolah merupakan salah satu jenis pelayanan kesehatan yang
ditunjukkan untuk mewujudkan kemandirian siswa untuk hidup sehat, menciptakan
lingkungan dan suasana sekolah yang sehat.
- Fokus utamanya adalah siswa dan lingkungannya dan sasaran penunjang adalah guru dan
kader.
3. Perawat Kesehatan Kerja
- Perawat kesehatan kerja adalah penerapan prinsip-prinsip keperawatan dalam memelihara
kelestarian kesehatan tenaga kerja dalam segala bidang pekerjaan.
- Aplikasi prakteknya untuk memenuhi kebutuhan unit individu, kelompok dan masyarakat di
tatanan industri, pabrik, tempat kerja, tempat konstruksi, universitas, dll.
- Lingkup praktek mencakup pengkajian riwayat keseahtan, pengamatan, pelayanan
kesehatan primer, konseling, promkes, administrasi management quality asurance, peneliti
dan kolaborasi dengan komunikasi.
4. Perawat Gronologi/Gerontile
- Memberikan pelayanan pada orang lanjut usia dalam berbagai tatanan dan membantunya
mencapai untuk mempertahankan fungsi yang optimal.
- Lingkup praktek, memberi asuhan keperawatan, advokasi, melaksanakan kemandirian lanjut
usia, meningkatkan dan mempertahankan kesehatan, mencegah dan meminimalkan kecacatan
dan menunjang proses kematian dan bermartabat.

Dari uraian mengenai tugas keperawatan komunitas di atas, dapat diketahui bahwa
ruang lingkup yang dikerjakan oleh keperawatan komunitas memang cukup luas. Luasnya
bidang yang menjadi tugas keperawatan komunitas menuntut para pelaksanannya memiliki
kemampuan serta keterampilan yang memadai. Saat ini, mungkin di negara kita tugas serta
peran perawat komunitas belum dapat terlaksana sesuai harapan. Hal ini antara lain
dikarenakan oleh minimnya pengetahuan yang dimiliki oleh perawat kita serta kurang
maksimalnya pemberdayaan perawat di masyarakat, khusunya perawat komunitas.
Keperawatan komunitas pada prinsipnya tidak berbeda dengan area keperawatan yang
lain. Hal yang membedakan keperawatan komunitas dengan area keperawatan yang lain
adalah ruang lingkupnya. Keperawatan komunitas memiliki ruang lingkup yang lebih luas
dibandingkan dengan area yang lain. Keperawatan komunitas menangani individu, keluarga,
dan komunitas yang sehat dan yang sakit. Lain halnya dengan keperawatan medikal bedah
dan keperawatan klinik yang hanya menangani orang yang sakit saja. Selain itu, upaya yang
dikembangkan dalam keperawatan komunitas difokuskan pada upaya promotif dan preventif.
Meskipun bukan berarti upaya kuratif dan rehabilitatif diabaikan. Semua upaya tetap
dilakukan hanya saja fokusnya yang sedikit berbeda.
Pelaksanaan peran perawat komunitas tidak akan berhasil apabila tidak ada partisipasi
berbagai pihak. Keberhasilan kerja perawat komunitas juga ditentukan oleh peran masyarakat
sebagai objek utama yang menerima layanan. Peran masyarakat sangat dibutuhkan dimana
individu, keluarga maupun masyarakat yang menjadi sebagai pelaku kegiatan peningkatan
kesehatan serta bertanggung jawab atas kesehatannya sendiri. Kemandirian yang diharapkan
muncul dari masyarakat sebagai hasil kerja perawat komunitas tidak akan terwujud apabila
masyarakat tidak mau bekerja sama dengan perawat komunitas dalam mencapai tujuan
tersebut. Untuk itu, perlu adanya kesadaran dari masyarakat untuk turut serta dalam upaya
pelaksanaan program yang telah direncanakan oleh perawat komunitas sehingga tujuan yang
telah ditetapkan dapat dicapai secara maksimal.

From the description of community nursing tasks above, it is known that the
scope of which is done by the nursing community is quite extensive. The extent
of the areas of community nursing task demands that its implementation has the
ability and skills are adequate. Currently, the task may be in our country and the
role of community nurses can not be implemented as expected. This is partly
due to the lack of knowledge possessed by our nurses and lack of empowerment
of nurses maximal in the community, especially community nurses.
Community nursing in principle no different from other nursing areas. Thing that
distinguishes nursing nursing community with the other areas is its scope.
Nursing community has a broader scope than other areas. Nursing community to
handle individuals, families, and communities healthy and the sick. As with the
medical-surgical nursing and nursing clinic that deals solely with those who are
sick. In addition, efforts are being developed within the nursing community is
focused on promotive and preventive efforts. Although not curative and
rehabilitative means negligible. All the effort is just a slightly different focus.
Implementation of the role of community nurses will not be successful if there is
no participation of various parties. The success of community nurses work is also
determined by the community's role as the main object that receives the service.
The role of society is needed in which individuals, families and communities who
become perpetrators of health promotion activities and is responsible for their
own health. Independence is expected to emerge from the community as a result
of community nurses will not be achieved if people do not want to work together
with community nurses in reaching those goals. To that end, the need for
awareness of the community to participate in program implementation efforts
that have been planned by community nurses so that the intended purpose can
be achieved to the fullest.