Revisi Analisa Film Still - Alice

LAPORAN PRAKTIKUM ANALISIS FILM “STILL ALICE”
TUGAS MATA KULIAH KEPERAWATAN KELUARGA
Oleh:
Kelompok 6/ Kelas E
Siti Kholidah 162310101122
Widodo Hardianto 162310101259
Jenny Amalina A. R. 162310101262
Aldiana Septi Saputri 162310101268
Adhi Nur Satrio A. 162310101281
PROGRAM STUDI SARJANA KEPERAWATAN
FAKULTAS KEPERAWATAN
UNIVERSITAS JEMBER
2018
A. IDENTITAS KELUARGA
1. GAMBARAN SINGKAT TENTANG FILM (SEBUTKAN ANGGOTA KELUARGA

DALAM FILM DAN DESKRIPSIKAN KHUSUS ANGGOTA KELUARGA YANG
AKAN MENJADI PASIEN ANDA
Judul Film : Still Alice

Genre : Drama
Pemeran : Alice Howland (Julianne Moore) sebagai Ibu atau Tokoh Utama
John Howland (Alec Baldwin) sebagai Ayah
Anna Howland (Kate Bosworth) sebagai Putri pertama
Tom Howland (Hunter Parrish) sebagai Putra kedua
Lydia Howland (Kristen Stewart) sebagai Putri ketiga
Charlie Jones (Shane McRae) sebagai suami Anna
Dr. Benjamin (Stephen Kunken) sebagai Dokter Ahli Saraf
Nama keluarga : John Howland

Umur :-
Alamat : Amerika Serikat

Agama : Kristen
Pekerjaan : Dokter dan Ahli Biologi
No.Telepon :-
Komposisi Keluarga :
No Nama Jenis Umur Hubungan Pekerjaan Pendidikan

Kelamin
1 John Howland L - Ayah Dokter dan Ahli
Biologi
2 Alice Howland P 50 Ibu Professor
3 Anna Howland P - Anak Pengacara
4 Tom Howland L - Anak Mahasiswa
5 Lydia Howland P - Anak Aktris
6 Charlie Jones L - Menantu -
7 Dr. Benjamin L - Dokter Dokter Ahli Saraf
Alice Howland adalah seorang ibu dan juga mempunyai profesi sebagai dosen bahasa
di salah satu Universitas. Alice Howland merupakan istri dari John Howland yang berprofesi
sebagai ahli laboratorium dan memiliki 3 anak yakni, Anna Howland putri sulung yang
bekerja sebagai seorang pengacara, Tom Howland putra kedua yang masih berstatus sebagai
mahasiswa kedokteran dari salah satu universitas, dan yang terakhir Lydia putri bungsu yang
memiliki pemikiran yang berbeda dari kedua kakaknya, dia tidak ingin melanjutkan kuliah,
melainkan ingin menggapai mimpinya sebagai seorang artis. Dan melanjutkan hidupnya
sebagai pemain teater di California.
Semuanya berjalan dengan baik sampai suatu saat ketika Alice mengalami sedikit
masalah saat menyampaikan presentasi di Columbia University. Dan berlanjut ketika Alice
sedang pergi jogging, secara mendadak dia lupa jalan pulang menuju rumahnya dan tersesat
di dekat kampus. Dari keanehan yang terjadi pada dirinya, Alice memutuskan untuk pergi
menemui Dr. Benjamin seorang Dokter Ahli Saraf. Setelah melakukan serangkaian tes
tentang daya konsentrasi, Alice mengira dirinya sedang mengalami perubahan hormon
karena hendak memasuki menopause. Tetapi diagnosa Dr.Benjamin terhadap Alice adalah
Alzheimer dini, yakni penyakit yang menyerang sel-sel dibagian otak. Setelah sang suami
mengetahui tentang keadaan Alice, mereka berdua berniat untuk tidak memberitahukan
kepada anak-anak mereka. Tetapi, dikarenakan penyakit Alzheimer yang diderita Alice
menurut Dr.benjamin biasanya dapat diturunkan melalui gen. sehingga membuat Allice dan
john harus memberitahukan hal ini kepada anak mereka. Benar saja, saat menjalani test Anna
mendapatkan hasil yang positif.
Untuk mengantisipasi penyakit Alzheimer tersebut Alice menggunakan berbagai cara

untuk membantunya menjaga semua ingatan yang dia miliki. Seperti membuat pertanyaan
dan jawaban tentang dirinya di Handphone pribadinya. Membuat video kegiatan apa yang
harus dia lakukan di laptop. Tetapi segala hal yang dilakukan Alice untuk mengantisipasi
penyakit tersebut tidak menghentikan bagaimana penyakit Alzheimer tersebut menggerogoti
Alice dan juga ingatannya. Alice yang memiliki profesi sebagai dosen mulai lupa dengan
materi apa yang harus ia sampaikan waktu itu. Alice yang tidak bisa menemukan letak kamar
mandi sampai akhirnya suaminya menemukannya menangis karena hal itu.
2. Tipe Bentuk Keluarga : Dyad Family yang berarti keluarga yang terdiri dari sepasang
suami istri yang ditinggal dalam satu rumah tanpa anak.
3. Latar belakang budaya (etnis) : Dalam film Still Alice para pemeran yang ada di dalamnya
termasuk etnis kuliat putih. Dan juga Alice yang berprofesi
sebagai dosen juga mengajar terhadap mahasiswanya yang
mayoritas etnis kulit putih. Dan dalam Film tersebut
seluruh pemeran berbicara dalam bahasa inggris.
4. Penggunaan jasa perawatan : Untuk penggunaan jasa perawatan kesehatan keluarga

Holland sangat percaya terhadap dokter, dibuktikan dengan
Alice dan John melakukan tes dan periksa tentang
penyakitnya.
5. Status kelas sosial : status ekonomi dalam film Still Alice bisa di bilang menengah ke
atas, dikarenakan Allice yang berprofesi sebagai dosen bahasa di
salah satu universitas terkemuka dan John mempunyai pekerjaan
sebagai ahli laboratorium. Jadi penghasilan yang mereka peroleh
dari pekerjaan masing-masing sudah lebih dari cukup untuk
kehidupan sehari-hari. Dan keluarga tersebut tidak menerima
bantuan apa-apa dalam bentuk apapun.
6. Aktivitas rekreasi dan waktu luang :
a. Ketika Alice menyempatkan menonton acara teater Lydia , meskipun pada saat itu
Alice sempat lupa, akibat penyakitnya yakni alzheimer dini.
b. Saat Alice dan John jogging dan berhenti disalah satu restoran es krim kesukaan Alice.
B. Riwayat dan Tahap Perkembangan Keluarga :

1. Tahap perkembangan keluarga dalam film Still Alice memasuki dalam tahapan
“Keluarga dengan Tahapan Berdua Kembali (Keluarga usia pertengahan)”.
2. Di dalam film Still Alice keluarga telah melaksanakan tugas perkembangan keluarga:
a. Menyediakan lingkungan yang meningkatkan kesehatan, dibuktikan dengan disaat
Alice di diagnosa mengalami alzheimer dini, sang suami John selalu bersedia
mengantarnya untuk periksa dan tes kepada Dr. Benjamin, selaku dokter ahli saraf
yang menangani Alice saat itu.
b. Memperkokoh hubungan perkawinan, dibuktikan dengan dukungan yang diberikan
oleh John terhadap Alice. Dengan sebisa mungkin jika John tidak bekerja, maka dia
akan menemani Alice dirumah sepanjang waktu. Dan membantu Alice jika
mengalami kesulitan akibat penyakit alzheimer dini yang Alice alami.
C. Data Lingkungan
1. Karakteristik rumah:
Rumah keluarga Alice berada di perkotaan New York, USA. Seperti rumah di
perkotaan pada umumnya, tidak terdapat teras rumah. Bangaunan rumah didominasi oleh
tembok dan furnitur dari kayu. Interior rumah cukup luas dan tertata rapi, penyekatan
ruangan juga terkesan modern dan nyaman. Pencahayaan dan ventilasi rumah memadai.
Suplai air di dapur dan peralatan di dapur adekuat, kamar mandi besih, peralatan mandi
lengkap, sanitasi juga baik. Kamar tidur dilengkapi dengan ranjang besar, kamar mandi
dalam, lemari pakaian, meja,kursi, dll. Semua pengaturan ini sangat memadai bagi
mereka, walaupun saat semua anggota keluarga sedang berkumpul rumah tidak terlihat
penuh, sesak dan berantakan. Namun karena Alice mengidap penyakit alzeimers, meski
penataan rumah tetap, namun ia lupa letaknya. Model rumah seperti ini sangat bisa
menjamin privasi keluarga dari tetangga, dapat dilihat dari penyakit yang diidap Alice
hanya keluarga dan orang terdekat yang mengetahui. Keamanan rumah cukup menjamin,
dan keluarga tidak ada permasalahan tentang secara keseluruhan pengaturan rumah.
2. Karakteristik lingkungan dan komunitas tempat tinggal yang lebih luas:

Rumah Alice berada di tengah pusat keramaian kota, rumah hanya dijadikan tempat
hunian saja. Lingkungan rumah juga terlihat bersih dengan tata kota yang apik serta
dilengkapi sarana yang digunakan sebagai mana mestinya. Jalanan cukup ramai tapi tidak
ada kemacetan, banyak orang yang memilih untuk berjalan kaki juga. Transportasi umum
yang terdapat di dekat rumah adalah taksi, jika berpergian jauh keluarga lebih memilih
untuk menggunakan kendaraan pribadi. Fasilitas pemasaran seperti supermarket, toko
buku, restoran mudah dijangkau dari rumah. Lembaga kesehatan dan pelayan sosial juga
ada di kota tempat tinggalnya. Sekolah, universitas dapat didatangi dengan mudah hanya
dengan berjalan kaki. Fasilitas rekreasi seperti taman juga ditampilkan dalam film.
Keluarga merupakan orang kulit putih Amerika, dan berasal dari kelas sosial menengah
ke atas.
3. Mobilitas geografis keluarga:

Mobilisasi keluarga paling sering dari kota New York ke Los Angeles (tempat tinggal
anak kedua) dan rumah masa kecil Alice di pinggir pantai New Hampshiers. Tapi sang
suami seringkali luar kota untuk pekerjaannya, salah satunya di Minessota.
4. Asosiasi dan transaksi keluarga dengan komunitas:

Setelah ia mengetahui ada yang salah dengan dirinya, ia sering mengunjungi ke
rumah sakit ahli saraf untuk melakukan terapi pengobatan dan bergabung di AACC
(Alzeimers Accociation Care Conference), disana ia diberi kesempatan berpidato untuk
menceritakan pengalamannya dan bagaimana ia menjali hidupnya dengan mengidap
Alzeiemers. Alice adalah seorang dosen di UCLA dan suaminya seorang dokter di klinik
Mayo. Rekan kerjanya juga mengetahui ada yang salah dalam diri Alice, karena saat
proses belajar mengajar, para siswa mengeluhkan metode pembelajaran Alice karena
pengaruh dari penyakitnya. Namun pihak Universitas dapat memahami keadaannya, dan
ia harus berhenti dari pekerjaannya.
5. Sistem pendukung atau jaringan sosial keluarga:
Dalam keluarga Howland, hubungan kekeluargaan sangat erat, terutama anak

pertamanya Anna. Ia yang paling mengerti terhadap kondisi keluarga. Semua anggota
keluarga terlibat dukungan emosional kepada Alice, terutama suaminya karena hanya
mereka yang tinggal serumah. Tom anak kedua adalah seorang dokter bedah, ia sangat
sibuk dengan pekerjaan jadi jarang pulang ke rumah dan Lydya, ia seorang pekerja seni
yang masih kurang mapan. Tom tidak dapat berbuat banyak pada Alice, dan Lidya sering
berdebat bila bertemu dengan Alice karena merasa bahwa ia mengekang dan
menyamakan dengan saudaranya. Anna yang paling sering mengunjungi rumah, ia tidak
tega jika meninggalkan Alice sendirian dirumah, namun keadaannya yang sedang hamil
anak kembar tidak memungkin untuk membantu menjaga Alice 24 jam. Mr. Howland
juga bersifat terbuka pada semua, jika ia sedih terhadap keadaan Alice ia menceritakan
kepada anaknya, seringkali kepada Anna. Mr. Howland dan Alice tidak sabar menanti
kelahiran cucu pertama, Alice langsung ingin menggendong cucunya dipelukan.
Hubungan dengan dokter ahli saraf cukup intens, ia satu-satunya dokter yang
berhubungan dengan Alice dan membantunya dalam terapi pengobatannya. Namun Mr.
Howland ingin Alice mendapatkan perawatan yang lebih dengan mengirimnya berobat di
klinik Mayo.
6. GENOGRAM DAN ECOMAP
Genogram
A J
C N T L
Keterangan : A : Alice
J : John
N : Anna
C : Charlie
T : Tom
L : Lydia
Gambaran Ecomap Keluarga Alice
LINGKUNGAN KELUARGA
BESAR REKREASI /
HIBURAN
PEKERJAAN FASILITAS
KESEHATAN
J A
C N
Keterangan : A : Alice
J : John
N : Anna
C : Charlie
T : Tom
L : Lydia
Keterangan : 1 garis menandakan hubungan yang lemah
2 garis menandakan hubungan yang normal
3 garis menandakan hubungan yang kuat
a. Analisis Ecomap Secara Spesifik Terkait Hubungan Keluarga dan Lingkungan Sekitar
Dalam film Stil Alice terdapat lima anggota keluarga dan juga satu menantu, dari
lima anggota tersebut hanya Alice dan John yakni suami Alice yang tinggal satu rumah,
sedangkan ketiga anaknya memilih hidup sendiri dengan pilihan mereka. Dimulai dengan
Anna yaitu putri pertama dari Alice dan John yang sudah menikah dengan Charlie dan
sekarang Anna dalam kondisi hamil, Tom putra kedua yang uga tidak memilih tinggal
bersama orang tuanya dikarenakan masih menempuh kuliah di salah satu Universitas
dengan mengambil Jurusan Kedokteran. Sedangkan putri yang terakhir Lidya yang
berikeras memilih jalan hidupnya sendiri dan tidak mau menggubris arahan dari orang
tuanya dan juga tinggal jauh dengan Alice dan John. Hubungan antara Anna dan Tom
dengan orang tuanya bisa dikatakan normal seperti layaknya hubungan antara anak dan
juga orang tua, tidak seperti Lidya yang mempunyai sifat yang keras kepala dan juga
susah diatur hubungan Lidya dengan orang tuanya bisa dibilang tidak terlalu erat bahkan
terkesan acuh. Akan tetapi hal tersebut berubah setelah Lidya mengetahui penyakit sang
ibu yang terdiagnosa mempunyai penyakit Alzheimer dini, sosok Lidya menjadi anak
yang dekat dengan ibunya dibandingkan dengan saudaranya yang lain, Anna dan Tom.
Hubungan keluarga ini dengan fasilitas kesehatan yang sangat baik, bisa dilihat dari
Alice yang langsung berinisiatif untuk memerikakan kondisi yang dialaminya saat itu
dengan pergi ke dokter Ahli Saraf. Kemudian sang suami John ketika mengetahui
penyakit apa yang dialami oleh sang istri turut mengantarkan Alice untuk melakukan
serangkaian test, dan anak-anak mereka juga kooperatif dalam menanggapi hal yang telah
terjadi kepada ibu mereka, Anna dan Tom juga mau untuk melakukan test dikarenakan
menurut dokter Ahli Saraf penyakit yang dialami oleh ibu mereka bisa diturunkan
melalui gen.
Hubungan keluarga Alice dengan lingkungan sekitar cukup baik, mereka semua
bekerja sesuai kemampuan dan keahliannya masing-masing. Meskipun saat Alice
mengetahui penyakitnya dia masih berusaha untuk aktif mengajar di salah satu
Universitas. Alice berusaha mengingat semua kebiasaannya, aktivitas yang dia lakukan
ketika berada dirumah. Bahkan Alice juga mengunjungi toko es krim favoritnya setelah
dia selesai jogging.
D. STRUKTUR KELUARGA
1. Pola Komunikasi:
Saat keluarga berkumpul bersama mereka (tanpa Lydya) dan berkomunikasi satu
sama lain, obrolan berjalan fungsional. Namun bila ada kehadiran Lydia, pasti ada selisih
paham entah antara Alice dengan Lydia atau Anna dengan Lydya. Pola komunikasi yang
digunakan keluarga Howland dominan komukasi terbuka, keluarga mengutarakan emosi
dan kebutuhannya secara verbal hal ini juga dikarenakan gaya bicara budaya Barat. Suatu
hari Mr. Howland membicarakan tentang penyakit Alice kepada anak-anaknya, mereka
semua sedih dan sejak saat itu mereka lebih memperhatikan dan mencoba mengerti
keadaan Alice. Mr. Howland menemani Alice datang ke dokter ahli saraf, untuk
mengetahui lebih jauh kondisi penyakit Alice. Karena penyakitnya ini, Alice depresi dan
seringkali meluapkan emosi kepada suami dengan kata-kata yang kasar namun Mr.
Howland tetap dapat menenangkannya. Terkadang dibelakang Alice terjadi percakapan
antar Mr. Howland dan anaknya. Mereka membahas bagaimana sebaiknya Alice ini
dirawat dan menyembunyikan kesedihan di hadapan Alice.
2. Struktur kekuasaan:
Mr. Howland menjadi pemegang keputusan dalam keluarga. Misalnya saat terapi
pengobatan Alice, ia yang mengarahkan istri dan anak-anak untuk membawanya ke
klinik Mayo dan bagaimana mereka menjalani perawatan intensif. Hal ini dipengaruhi
oleh latar belakang budaya, ketergantungan emosional suami/istri dan komitmen mereka
terhadap pernikahan, dan situasional kondisi Alice yang parah. Anna juga sesekali
memberikan masukan untuk keputusan-keputusan yang diambil, misal saat keluarga
mendiskusikan siapa yang dapat menjaga Alice jika di bawa ke pengobatan Klinik Mayo,
sementara Mr. Howland akan ke luar Minessota untuk dinas, Tom sedang dalam kondisi
tidak dapat menjaga dan Anna memiliki bayi dan ingin kembali bekerja. Tom
menyarankan Lydia, untuk menjaga Alice tapi Anna tidak menyetujui saran Tom karena
menganggap Lydia tidak akan bisa melakukannya. Namun pemegang kekuasaan dalam
keluarga tetap di dominasi oleh Mr. Howland.
3. Struktur Peran:
Mr. Howland berperan sebagai kepala keluarga ia menjalankan tugas dengan baik,
ia menjadi tulang punggung keluarga, pemegang keputusan, caregiver utama Alice, dan
sebagai ayah yang baik untuk anak-anaknya. Anna menjalankan perannya sebagai anak
sulung sekaligus peran sebagai seorang istri dan ibu baru. Ia mengerti bagaimana kondisi
orangtua dan kedua adiknya, serta bisa membagi waktu antara keluarga kecilnya dengan
orangtua. Ia tahu bagaimana harus berbuat. Peran Tom tidak terlalu berpengaruh tapi ia
adalah anak patuh yang dan tidak bermasalah dengan keluarga. Lydia memiliki sifat yang
berbeda sendiri, ia lebih suka hidup bebas dan tidak diatur. Wataknya keras sebagai anak
bungsu, apa yang orangtua nasehatkan kepadanya dianggap sebagai sebuah pengaturan
terhadap dirinya terutama pada Alice, tapi Anna selalu membela Alice atas tingkah
Lydia. Saat Alice sudah mulai sakit parah, Lydia mulai melunak dan lebih dekat pada
Alice dan mendengarkan ibunya dengan sabar.
Peran keluarga ini dipengaruhi oleh latar belakang budaya dan status kelas sosial.
Sebagai keluarga yang terdidik, dukungan, keeratan hubungan, dan kesadaran pelayanan
kesehatan terpenuhi dengan baik meski dalam keluarga juga merasa tertekan dan stress
menghadapi penyakit Alice. Keluarga mereka juga mempercayai adanya Tuhan, saat
didiagnosa Alzeimers Alice Mr. Howland berkata pada Alice Tuhan akan membimbing
kita selanjutnya saat kita pergi ke Rochester Minnesota untuk berobat di Klinik Mayo
sekaligus Mr. Howland dinas disana. Hilangnya pean Alice sebagai seorang Ibu, malah
membuat keluarganya semakin erat dan memperhatikan satu sama lain.
4. Nilai-nilai keluarga:
Keluarga Howland yang berasal dari etnis orang berkulit putih Amerika, memiliki
gaya hidup yang produktif, gila kerja, berorientasi pada masa depan, sadar akan
kesehatan, rasionalis dan demokratis. Hal ini terbukti dari kebiasaan yang mereka
lakukan, keinginan yang ingin mereka capai dan apa yang mereka rencanakan untuk
masa depan keluarganya. Nilai-nilai seperti ini mayoritas tertanam dalam keluarga
budaya Barat. Tentu nilai seperti diatas berdampak positif bagi keluarga, tetapi ada
kekurangannya juga. Tiap anggota keluarga memiliki rutinitas dan kesibukan masing-
masing yang tidak dapat ditinggalkan, sehingga waktu bersama keluarga menjadi kurang
intens. Kejadian seperti inilah yang menjadi bakal konflik keluarga tersebut dan secara
langsung maupun tidak langsung dapat mempengaruhi status kesehatan keluarga.
E. FUNGSI KELUARGA
1. Fungsi Afektif
Dalam film Still Alice dalam keluarga Howland ini setiap anggota keluarganya
mengerti tentang apa yang dibutuhkan oleh anggota keluarga yang lain, seperti ketiga
anak Alice yang selalu menyempatkan berkunjung untuk merawat dan menemui ibunya
(Alice), John Howland yang selalu ada saat Alice membutuhkannya karena Alzheimer
yang dialaminya, dan John Howland memperkerjakan seorang pengasuh untuk mengurus
Alice saat John bekerja.
2. Fungsi Sosialisasi
Dalam film Still Alice: keluarga Howland ini dalam membesarkan ketiga anaknya
memberikan kasih sayang dan perhatian dengan baik, dan didalam keluarga ini mereka
membesarkan anaknya bersama-sama sehingga keluarga ini harmonis. Serta mereka
sangat mengutamakan pendidikan untuk ketiga anaknya meskipun anak ketiga tidak
melanjutkan kuliah. Anak pertama sudah berkeluarga namun tetap selalu menyempatkan
untuk berkunjung menemui orang tuanya.
3. Fungsi Perawatan Kesehatan
Didalam film ini Alice sudah mengetahui mengenai penyakitnya, dan mulai
berkonsultasi dengan dokter untuk menangani penyakitnya. Namun Alice tidak langsung
memberi tahu kepada suami dan anak-anaknya mengenai penyakitnya. Saat penyakitnya
mulai memburuk Alice memberanikan diri untuk mengatakan kepada suami dan anak-
anaknya tentang penyakitnya. Setelah kejadian itu semua merasa kasihan dan
mengupayakan kesembuhan Alice.
Pengobatan yang dilakukan oleh Alice selain mendapatkan beberapa jenis obat juga
rutin melakukan konseling serta mengupayakan selalu melatih ingatannya dengan game.
Semenjak saat itu Alice tidak pernah lepas dari ponselnya. Anak-anaknya juga mulai
sering menghubungi dan mengunjungi Alice terutama anak ketiganya. Karena penyakit
yang dialami oleh Alice merupakan penyakit turunan jadi Alice sangat khawatir kepada
tiga anaknya. Dari ketiga anaknya, anak pertama positif Alzheimer dan anak kedua tidak.
Namun untuk anak ketiga (Lydia), dia tidak terlalu memikirkan hal tersebut sehingga
tidak memeriksakannya.
Walaupun Alice rutin menjalani pengobatan namun penyakitnya tetap makin
memburuk, sehingga makin lama kondisi Alice makin memprihatinkan. Semenjak saat
itu Alice sangat bergantung dengan John (suaminya). John yang khawatir dengan kondisi
Alice lalu memperkerjakan pengasuh untuk merawat Alice selagi John bekerja. Dengan
memperparahnya keadaan Alice, anak ketiganya kembali tinggal serumah untuk merawat
Alice. Jadi praktik di keluarga ini baik karena tidak membiarkan Alice namun
merawatnya dengan penuh perhatian.
F. KOPING KELUARGA
Stresor Jangka Pendek dan panjang :
1. Sejak didiagnosa penyakit Alzheimer, Ny.A menjadi sering cemas dan timbul stressor
yang membuatnya berfikir mengenai penyakit yang dialaminya dan factor resiko genetic
yang bias menular ke anak-anaknya, selain itu Ny.A juga merasa cemas akan penyakitnya
yang bias berpengaruh pada karier dan juga pekerjaannya. Sedangkan koping atau
dukungan yang diberikan oleh keluarga kepada Ny.A sudah sangat baik, terlihat dari
suami dan juga anakanaknya yang selalu ada untuk menemani, merawat dan selalu
memberikan perhatian lebih kepada Ny.A.
2. Kemampuan Keluarga Berespon Terhadap Stresor : Keluarga berharap agar Ny.A tidak
mengalami stress berlebih yang bisa berpengaruh pada kesehatannya. Keluarga juga
selalu meberikan pengertian dan tidak mau Ny.A merasa cemas akan efek dari penyakit
yang dideritanya.
3. Strategi Koping Yang Digunakan : Keluarga Ny.S dan suami selalu membicarakan dan
mendiskusikan masalah keluarga bersama sebelum bersama-sama mengambil keputusan.
4. Strategi Adaptasi Disfungsional : Apabila timbul perselisishan atau konflik dalam

keluarga Tn.J maka akan selalu ada salah satu dari anggota keluarga yang memahami dan
meredam emosinya sehingga mampu membicarakan masalah dnegan baik sehingga
ditemukan solusi serta jalan keluar.
G. IDENTIFIKASI PERMASALAHAN KELUARGA
DATA DIAGNOSA RENCANA TINDAKAN JURNAL

MALADAPTIF KEPERAWATAN KEPERAWATAN KEPERAWATAN / RUJUKAN
TERAPI KELUARGA
1. Kurang terbuka 1. Kesiapan Setelah dilakukan 1. Yakinkan keluarga a psycho educational
antara meningkatkan proses perawatan selama 3 x bahwa pasien intervention focused
hubungan keluarga berhubungan 24 jam , diharapkan diberikan perawatan on communication
Lidya (anak dengan keluarga mulai keluarga mampu terbaik for caregivers of
ketiga) dengan meningkatkan k melakukan kesiapan 2. Identifikasi sifat family member in the
orang tua kepedulian terhadap keluarga yang lebih dukungan spiritual early stage of
ditunjukkan Allice yang mengalami baik dengan kriteria bagi keluarga alzheimer's disease :
saat lydya tidak Alzheimer dengan hasil: 3. Hargai dan dukung results of an
mau mengikuti menemani dan 1. Anggota mekanisme koping experimental study
arahan orang memberkan dukungan keluarga bisa adaptif yang
tua dan juga kepada Allice di melakukan digunakan keluarga
lidya marah berbagai kegiatan peran yang
saat Allice ditandai dengan diharapkan
membahas mengungkapkan ditingkatkan ke
tentang buku keinginan skala 5(secara
Diary. meningkatkan respek konsisten
2. Saat dimeja pada anggota keluarga menunjukan)
makan Lidya 2. Anggota
berdebat keluarga bisa
dengan Anna, saling
karena Anna mendukung
tidak ditingkatkan
memperbolehk skala 5(secara
an Allice konsisten
mencatat menunjukan)
alamat 3. Anggota
pertujukkan keluarga bisa
Lidya untuk menghabiskan
membantu agar waktu satu
Allice bisa sama lain
mengingat ditingkan
3. Anna berdebat menjadi skala 4
dengan John (sering
(suami Allice) menunjukan)
karena Anna
kurang setuju
apabila Allice
dirawat oleh
Lidya
H. TERAPI KELUARGA
Judul film : Still Alice (2014)
Masalah keluarga : Seorang wanita bernama Alice yang merupakan

seorang istri sekaligus ibu dari 3 anak yang
mendapat serangan dini penyakit Alzheimer.
Sehingga semenjak dia dipastikan menderita
penyakit Alzheimer ingatan yang dimiliki mulai
hilang dan sulit mengingat.
Terapi keluarga : A psycho-educational intervention focused on

communication for caregivers of a family member
in the early stage of Alzheimer’s disease: Result of
an experimental study
Pengertian terapi keluarga: Terapi keluarga adalah model terapi yang

bertujuan mengubah pola interaksi keluarga
sehingga bisa membenahi masalah-masalah dalam
keluarga. Pada kasus ini kami mengambil terapi A
psycho-educational intervention focused on
communication for caregivers of a family member
in the early stage of Alzheimer’s disease: Result of
an experimental study yang dikutip dari jurnal
keperawatan keluarga. Sebuah intervensi psiko
edukasi difokuskan pada komunikasi untuk
pengasuh anggota keluarga dalam tahap awal
penyakit Alzheimer dan diuji pada lima variable
hasil proksimal: pengetahuan pengasuh, persepsi
kesulitan komunikasi dan tingkat gangguan yang
dirasakan terkait dengan kesulitan-kesulitan, self
efficacy dan keterampilan.
Indikasi terapi keluarga : Didalam jurnal tidak disebutkan secara spesifik

mengenai indikasi terapi keluarga yang diberikan,
namun terapi keluarga imi sangat penting untuk
pengasuh orang dengan gangguan demensia atau
tahap awal penyakit Alzheimer.
Kontraindikasi terapi keluarga: (tidak disebutkan didalam jurnal)
Persiapan terapi keluarga: Peserta diidentifikasi pengasuh utama dari anggota

keluarga atau teman, dengan masalah kognitif yang
terkait tahap awal kemungkinan penyakit
Alzheimer, berusia 55 atau lebih tua dan mampu
berkomunikasi dalam bahasa Prancis atau dalam
bahasa Inggris. Pengasuh yang berpartisipasi atau
yang baru-baru telah mengambil bagian dalam
kelompok pendukung pendidikan atau forum
serupa, atau yang tidak mampu berperan
dikeluarkan.
Prosedur terapi keluarga :
1. Prainteraksi
Menurut model keperawatan McGill dan self efficacy, diberikan
pendekatan belajar mengajar bagi peserta yang lebih tua, dipertahankan
sebagai pendekatan keseluruhan pedagogis untuk penelitian. Pendidik
lainnya menarik dari konsepsi ini untuk menginformasikan teori
pendidikan bagi peserta didik yang lebih tua, dengan alasan untuk
kebutuhan pengembangan ilmu dan seni pendidikan untuk orang tua.
Serta untuk memperoleh keterampilan yang tepat untuk mengurangi
tingkat ketergantungan.
2. Orientasi
Sesuai dengan teori self efficacy (Bandura,1986, 1997), empat strategi
penguatan self efficacy dimasukkan kedalam program yaitu, pelajar
diberi kesempatan untuk menguasai keterampilan komunikasi, model
yang efektif dibagikan dengan pelajar, pembelajar “dibujuk” untuk
melakukan keterampilan (melalui pendekatan persuasi terkait self
efficacy tertentu) dan beragam tindakan pendekatan digunakan untuk
mengurangi ketakutan dan kecemasan pelajar. Keempat strategi ini telah
terbukti meningkatkan kemungkinan keberhasilan untuk melaksanakan
tugas keterampilan yang baru dipelajari.
3. Kerja
Pendekatan pembelajaran yang difasilitasi oleh strategi yang berasal dari
teori sosial kognitif seperti yang digambarkan sebagai pendekatan psiko
edukasi. Pada program ini dilakukan pra dan post intervensi. Program ini
dikembangkan dalam bahasa Inggris dan Perancis. Hal ini terdiri dari
lima modul, setiap modul mengandung terkait komunikasi dibidang studi
tertentu yang membahas kesulitan komunikasi dengan keterbatasan
kognitif yang berkaitan dengan konsentrasi dan perhatian, memori,
orientasi, penilaian, penalaran, variabilitas suasana hati, emosi dan
visual-spasial dan eksekutif fungsi. Pra pengujian program dilakukan
dengan dua pengasuh. Program intervensi dilakukan selama lima sesi
mingguan individual dari sekitar 90 sampai 120 menit. Hasil lima
variabel, yaitu pengetahuan pengasuh, persepsi kesulitan komunikasi dan
tingkat gangguan yang dirasakan kesulitan dalam hal mengatakan, self
efficacy dan kemampuan komunikasi, instrumen diukur dengan baik
atau disesuaikan dengan alat validasi.
4. Terminasi
Perbaikan signifikan dalam self efficacy di post intervensi satu minggu
dan signifikan lebih meningkat di post intervensi enam minggu.
Mengingat peran utama dari self efficacy sebagai precursor untuk
pemikiran dan perubahan perilaku, hasil ini memberi dukungan terhadap
prinsip-prinsip model self efficacy. Empat bukti berbasis self efficacy
memperkuat strategi yang digunakan dalam penelitian ini kemungkinan
besar memberikan kontribusi terhadap hasil ini. Mengingat bahwa
peserta memiliki kesempatan untuk berlatih keterampilan komunikasi
dan bahwa strategi pemodelan disampaikan oleh kedua perilaku
intervensi peneliti dan melalui model simbolik digambarkan dalm
program ini. Peneliti juga melakukan umpan balik dan strategi yang
diimplementasikan untuk mengurangi perasaan permusuhan dalam
rangka untuk menempatkan peserta nyaman disesi pembelajaran.
Evaluasi terapi keluarga : Peneliti menyadari bahwa instrument

penelitiannya membutuhkan metodologis kerja
lebih lanjut.
Sumber referensi :
http://dem.sagepub.com/content/early/2011/06/22/1471301211408124
I. CRITICAL APPRAISAL
Penulis Jurnal Krystyna Klodnicka Kouri, Francine C.

Ducharme, Francine Giroux.
Judul Jurnal A psyco-educational intervention focused on
communication for caregivers of a family
member in the early stage of Alzheimer’s disease:
Results of an Experimental study.
Nama Jurnal,Edisi dan Tahun Dementia, 2011
Tujuan Penelitian Untukmengembangkanintervensipsiko-
pendidikan individual yang berfokus pada
komunikasi untuk pengasuh seseorang dengan
masalah kognitif yang terkait dengan tahap awal
penyakit alzheimer.
Metode Penelitian Desain eksperimental dengan pra dan pasca tes
digunakan untuk menguji efek dari intervensi
psikoedukasi. Peserta dalam kelompok kontrol
menerima brosur informasi tercetak pada memori
dan masalah komunikasi, diadaptasi dari
publikasi Memory Loss with Aging (College of
Family Physicians of Canada, 1996).
Hasil dan Pembahasan Intervensi psiko-pendidikan individual
komunikasi untuk keluarga dengan penderita
dementhia dapat meningkatkan pengetahuan
tentang kognitif dan keterampilan komunikasi.
Intervensi yang efektif melibatkan partisipasi
aktif oleh pengasuh dan umumnya keterampilan
berbasis (termasuk keterampilan berlatih dan
diskusi).
Implikasi Keperawatan Sebagai perawat kita harus memfasilitasi keluarga
dengan anggota keluarga yang berfokus pada
komunikasi
Dementia
http://dem.sagepub.com/
A psycho-educational intervention focused on communication for caregivers of a

family member in the early stage of Alzheimer's disease: Results of an experimental
study
Krystyna Klodnicka Kouri, Francine C. Ducharme and Francine Giroux
Dementia published online 23 June 2011
DOI: 10.1177/1471301211408124
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dem.sagepub.com
caregivers of a family
member in the early stage of
Alzheimer’s disease: Results
of an experimental study
Krystyna Klodnicka Kouri
Maimonides Geriatric Centre, Quebec, Canada
Francine C. Ducharme
Université de Montréal, Canada
Francine Giroux
Institut universitaire de gériatrie de Montréal, Canada
Abstract
A psycho-educational intervention focused on communication was conceived for caregivers of
family members in the early stage of Alzheimer’s disease (i.e., persons with dementia), and tested
on five proximal outcome variables: caregiver knowledge, perceptions of communication
difficulties and degree of perceived disturbance related to these difficulties, self-efficacy and
skills. Guided by a theoretical framework that encompassed geragogy, the McGill model of
nursing and self-efficacy theory, the intervention was evaluated via an experimental design with
pre-post tests. Fifty family caregivers were randomly assigned to an experimental group
(intervention program), or to a control group (information flier on communication and
memory). Statistically significant effects were found on four dependent variables: caregiver
knowledge, degree of disturbance related to communication difficulties, self-efficacy and skills.
No significant effects were observed in regard to the perceived presence of communication
difficulties. This communication program serves as a useful tool to prepare caregivers for their
new role.
Corresponding author:
Krystyna Klodnicka Kouri, Maimonides Geriatric Centre, 5795 Caldwell Ave, Montreal, QC, Canada, H4W 1W3
Email:kkouri@crc-lennox.qc.ca
2 Dementia 0(0)
Keywords
Alzheimer’s type dementia, caregiving, geragogy, psycho-educational intervention, self-efficacy
Introduction and context of study

The communication domain has been identified as a major concern by informal caregivers in
the dementia context (Barnes, 2006; Martin-Cook, Davis, Hynan & Weiner, 2005); a subject
also targeted as highly problematic by these care providers in the early phase of dementia
disorders (Kinney & Stephens, 1989; Kuhn, 1998). In a recent randomized controlled trial,
caregivers reported that communication was one of the most important subjects for
knowledge acquisition (Martin-Cook et al., 2005). Moreover, caregivers who received
communication skills training at a later time in their ‘career’ reported that it would have
been more useful to have learned these skills earlier, underlining that these abilities would
have helped them to resolve communication problems with the person with dementia from
the outset of the illness (Done & Thomas, 2001). However, caregiver interventions focused
on the early stage of a dementia disorder in conjunction with communication difficulties have
received little attention in the research literature (Hendryx-Bedalov, 1999; Kuhn & Fulton,
2004).
It is also noteworthy that, in general, outcomes of caregiving interventions in the
dementia context have not been encouraging (see meta-analyses: Acton & Kang, 2001;
Sörensen, Pinquart, Habil, & Duberstein, 2002; Yin, Zhou & Bashford, 2002; Zarit &
Leitsch, 2001). Similarly, few significant outcomes were found in several reviews that
examined interventions for dementia caregivers (see reviews Acton & Winter, 2002, and
Livingston, Johnston, Katona, Paton, et al., 2005; see systematic review Peacock &
Forbes, 2003; Thompson, Spilsbury, Hall, Birks, et al., 2007).
This overall paucity of favourable outcomes might be due to several reasons. First, it
is possible that interventions are not meeting the major concerns of these care providers.
Along with the expressed need for communication-related interventions (Done &
Thomas, 2001; Martin-Cook et al., 2005), early evidence suggests that dementia
caregivers may also be lacking in self-efficacy in regard to their caregiving abilities. In
a grounded theory study with primarily older caregivers, Szabo & Strang (1999) reported
that a prevailing theme of caregivers was that they did ‘not believe in their own abilities
to manage as caregivers’ (p.73), this being indicative of low levels of self-efficacy. Also, in
their meta-analysis, Pinquart and Sörenson (2003) reported that caregivers displayed
lower levels of self-efficacy than non-caregivers. Despite these findings, Self-efficacy
theory does not appear to have been retained in any early-stage dementia-related
caregiver intervention studies.
A second explanation for poor outcomes may be related to an inappropriate selection of
outcome variables for interventions. More particularly, outcome variables that are sensitive
to change in the long term, such as psychological distress or burden, often are used
inappropriately as proximal outcome measures for interventions unlikely to lead to
change on these variables in the short term (Bourgeois, Schulz & Burgio, 1996; Zarit &
Femia, 2008; Zarit & Leitsch, 2001). Another reason for poor outcomes may be related to
the nature of the delivery mode of programs. Whereas most caregiving interventions are
conducted in a group format, the benefits of the individualized approach are well
substantiated in the caregiving intervention literature (see meta-analyses: Knight, Lutzky,
Kouri et al. 3
& Makofsky-Urban, 1993; Livingston et al., 2005 and Clark, Chaston, & Grant, 2003;
Gerdner, Buckwalter, & Reed, 2002; Yin, Zhou & Bashford, 2002).
Concomitantly, there are indications that interventions that target the earlier stage of
dementia lead to certain benefits for the caregiver. Noteworthy outcomes of several studies
include significant increases in Alzheimer’s disease (AD) knowledge (Kuhn & Fulton, 2004),
improved communication and interaction with care receiver (Quayhagen et al., 2000),
increased caregiver knowledge about memory loss and services (Whitlatch, Judge, Zarit, &
Femia, 2006) and increased caregiver knowledge in regard to AD, along with improvements in
caregiver reactions to patients’ impairments (Kuhn and Mendes de Leon, 2001).
Purpose of study
The purpose of this study was two-fold: 1) to develop an individualized psycho-educational
intervention focused on communication for the caregiver of a person with cognitive
problems associated with the early stage of Alzheimer’s disease; and 2) to test the effects
of the intervention on selected proximal dependent variables related to communication.
Theoretical framework
The theoretical framework encompassed geragogy, the McGill model of nursing and self-
efficacy theory. Geragogy (John, 1988; Lebel, 1978), a teaching-learning approach for the
older learner, was retained as the overall pedagogical approach for the study. Geragogy
is rooted in a long history (see review, Zych, 1992), and was brought to the forefront in
recent decades by Hans Mieskes (1970, 1971), a pedagogue and gerontologist, who
coined the expression geragogik (i.e., geragogics) in reference to pedagogy of older
aged persons. Other pedagogues drew from this conception to inform educational
theory for older learners, arguing for the need to develop the science and art of
education for older persons; termed ‘geragogy’ (as distinct from ‘andragogy’ as related
to the adult learner and ‘pedagogy’ – in reference to the younger-aged learner)
(Battersby, 1987; Lebel, 1978; Zych, 1992). More particularly, it was put forth that a
geragogical orientation is relevant to those activities that enable older individuals to gain
control over their lives (Glendenning, 1992; Peterson, 1983), as well as to acquire
appropriate skills to reduce their level of dependency (Moody, 1987). This theoretical
orientation had a direct application to this study, which was concerned with the
acquisition of communication-related knowledge and skills by learners in the later
stage of life.
Another component of the conceptual framework was a nursing care model, i.e., the
McGill model (Allen, 1977), a conception having roots in social learning theory and
focused on the family context of a health-related ‘life event’. In this study, the family
context was that of the caregiver and person with dementia and the life event was early
stage AD. Key variables in the model include learning and health promotion. The learner
in the model is endowed with the capacity and the desire to learn (Kravitz & Frey, 1989),
a premise that underscored the caregiver as a learner in the study. Health promotion in
the model is concerned with the development of the person’s autonomy and self-efficacy
with the goal of augmenting the person’s capabilities to manage problems (Allen, 1986;
Gottlieb & Feeley, 2006). Given the key role of learning and self-efficacy in the McGill
model, Self-efficacy theory (underpinned by Social Cognitive Theory), was retained to
4 Dementia 0(0)
guide the particular teaching-learning strategies in this study. Self-efficacy is concerned

with the belief that one can perform a specific behavior or task or modify one’s thinking,
rather than with the actual capacity to carry out the task (Bandura, 1986; 1997).
Furthermore, the stronger the individual’s efficacy beliefs in regard to a particular
learning task, the more likely it is that learning will take place. Self-efficacy has been
found to be a fundamental variable in predicting health behaviors (see review, Hevey,
Smith, & McGee, 1998), older adults’ adherence to exercise activity (see review, Martin &
Sinden, 2001) and more recently, successful outcomes in conjunction with self-perceived
health in older caregiver husbands (Ducharme, Lévesque, Zarit, Lachance, & Giroux,
2007).
Description of psycho-educational intervention

A learning approach that is facilitated by strategies emanating from social cognitive theory
as illustrated herein is denoted as a psycho-educational approach. The content of the
intervention program was drawn from the empirical literature related to the early AD
context, and was complemented by data from the clinical practice of the researchers. The
program was developed in English and in French, and was formulated at a grade five to six
scholastic level. It is comprised of five thematic modules, each module conceived around
specific communication-related subject areas that address communication difficulties
associated with cognitive limitations related to concentration and attention, memory,
orientation, judgment, reasoning, mood variability, emotions and visual-spatial and
executive functions. The program was validated by experts in the dementia field, namely a
geriatrician, neuropsychologist, speech language therapist and geriatric nurse, and by a
former recent caregiver of an AD parent. Pre-testing of the program was conducted with
two caregivers.
In accordance with self-efficacy theory (Bandura, 1986, 1997), the four self-efficacy
strengthening strategies were incorporated into the program, i.e., the learner was given
opportunities to master communication skills, effective models were shared with the
learner, the learner was ‘persuaded’ to perform skills (via the particular self-efficacy
related persuasion approaches), and diverse actions-approaches were used to reduce the
learner’s fears and anxieties. These four strategies have been shown to increase the
likelihood of success for implementing newly learned skills-tasks (Bandura, 1997).
Methods
Design
An experimental design with pre- and post-tests was used to test the effects of the psycho-
educational intervention. Participants in the control group received a printed information
flier on memory and communication problems, adapted from the publication Memory Loss
with Aging (College of Family Physicians of Canada, 1996).
Hypotheses
Based on the empirical and theoretical literature, we hypothesized that participants in the
experimental group would: 1) have a significant increase in communication-related
Kouri et al. 5
knowledge; 2) perceive significantly fewer communication-related difficulties; 3) perceive a

lower degree of disturbance (related to communication difficulties); 4) experience a higher
level of communication self-efficacy; and 5) report a greater use of communication skills,
than participants in the control group.
Setting and sampling

The investigation took place in an urban-rural region in southeastern Québec, Canada.
The sample was recruited via memory clinics, a geriatric assessment unit and the
community. Participants were self-identified principal caregivers of a family member or
friend diagnosed with cognitive problems associated with the early stage of probable
Alzheimer’s disease (MMSE score: 20 to 28) (Folstein, Folstein, & McHugh, 1975),
aged 55 or older and able to communicate in French or in English. Caregivers who
were currently participating, or who recently had taken part in an educational/support
group or similar forum, or who were unable to assume the role of learner (i.e., had
cognitive or other limitations), were excluded.
Seventy caregivers met the eligibility criteria, 57 of whom accepted the invitation to
participate. Of this group, seven persons either did not take part, or did not complete the
study, principally due to the death or illness of the caregiver or care receiver. In the final
sample (n ¼ 50), caregivers were randomly assigned to the psycho-educational intervention
group (n ¼ 25), or to the control group (n ¼ 25) where they received a printed information
flier on memory and communication.
Description of the sample

All participants were Caucasian, predominantly female (n ¼ 41), and for the most part were
homemakers or were retired (n ¼ 31). The majority were aged over 55 (n ¼ 41), and were
primarily family members of the person with dementia (n ¼ 44), i.e., 26 children and 18
spouses. The others were close friends (n ¼ 9). A larger proportion (n ¼ 29) lived apart
from the person with dementia. In terms of the duration of caregiving, the majority
(n ¼ 33) of participants had fulfilled this role for more than two years. Fifteen had been
caregivers between one and two years, while only two had been in this role for less than one
year (see Table 1).
The two groups were equivalent with the exception of age. The control group (mean age:
64; SD: 10.50) was significantly older than the experimental group (mean age: 59; SD:
8.56) (p<0.05). In terms of education, all participants had attended high school with the
exception of two individuals who had not attended post primary educational institutions
(see Table 1).
Procedure
Ethical considerations
Approval for the research project was obtained from the Research and Ethics Committee of
a University Institute of Geriatrics. Given that all participants had access to potentially
helpful ‘tools’ (i.e., program or information flier), from an ethical perspective it was
deemed that all participants would derive a potential benefit.
6 Dementia 0(0)
Table 1. Sociodemographic characteristics of the sample (n ¼ 50)
Sample Experimental Group Control Group

(n ¼ 50) (n ¼ 25) (n ¼ 25)
Age
Range 39-81 40-77 39-81
Mean 61,96 59,12* 64,8*
SD 9,91 8,56 10,5
*(p < 0.05) (two-tailed t-test)
Frequency (%) Frequency (%) Frequency (%)
Sex
Female 41 (82%) 20 (80%) 21 (84%)
Male 9 (18%) 5 (20%) 4 (16%)
Ethnicity
Caucasian 50 (100%) 25 (50%) 25 (50%)
Duration of caregiving
2 years 33 (64%) 16 (64%) 17 (68%)
1 - 2 years 15 (30%) 7 (28%) 8 (32%)
<1 year 2 (4%) 2 (8%) 0 (0%)
Education
Primary 2 (4%) 0 (0%) 2 (8%)
Secondary 48 (96%) 25 (100%) 23 (92%)
Occupation
Employed (FT) 9 (18%) 6 (24%) 3 (12%)
Employed (PT) 10 (20%) 5 (20%) 5 (20%)
Homemaker 5 (10%) 3 (12%) 2 (8%)
Retired 26 (52%) 11 (44%) 15 (60%)
Relationship caregiver to person with dementia
Married/civil 18 (36%) 7 (28%) 11 (44%)
Son-daughter 26 (52%) 15 (60%) 11 (44%)
Other relation 3 (6%) 0 (0%) 3 (12%)
Friend 3 (6%) 3 (12%) 0 (0%)
Living arrangements
Co-habits 21 (42%) 10 (40%) 11 (44%)
Lives apart 29 (58%) 15 (60%) 14 (56%)
FT: Full time; PT: Part time
Delivery of the intervention

The intervention program was carried out over five weekly individualized sessions of
approximately 90 to 120 minutes. To ensure consistent delivery of the intervention,
learning sessions followed a pre-determined format for each module and also for each of
the ten subject areas in the module. A checklist-record monitoring form was completed at
each session by a trained nurse practitioner and allowed the researchers to verify that all
Kouri et al. 7
intervention components were covered in a systematic manner. All 25 participants in the

intervention group completed the five modules with the majority (n ¼ 21) doing so within a
five-week period. For the remaining four individuals, unplanned events (e.g., illness,
physician appointments) required the deferral of a session to a subsequent week.
Data collection instruments

The five outcome variables, i.e., caregiver knowledge, perceptions of communication
difficulties and the degree of perceived disturbance in regard to said difficulties, self-
efficacy and communication skills, were measured with either existing validated
instruments or adapted versions of validated tools, or with newly conceived instruments.
In this study, the internal consistency reliability coefficient Cronbach’s a was greater than
0.90 for all measures, with the exception of the ‘degree of disturbance’ questionnaire –
wherein an inadequate number of relevant responses did not permit analysis. However, in
a preceding study, a Cronbach a of 0.90 had been reported for this measure (Teri et al.,
1992). The validated measures included a self-efficacy scale (Bandura, 2001) and a two-part
questionnaire, ‘Communication difficulties with the person with cognitive problems as
perceived by the caregiver’ and ‘Degree of perceived caregiver disturbance in regard to
these difficulties’ (Teri et al., 1992). The Caregiver Self-efficacy Scale (Bandura, 1997,
2001), which assesses the person’s level of self-efficacy in relation to communication skills
with the person diagnosed with early AD, was used to measure Self-efficacy (SE). Self-
efficacy items are worded in terms of judgements of capability, phrased as ‘I am confident
that I can do. . . ’, in accordance with Bandura’s (2001) measurement guidelines. In the most
common measurement format, judgements of both capability and strength are integrated
into a single item (Bandura, 1997; Lee & Bobko, 1994 Maibach & Murphy, 1995), this being
retained in the present study. A horizontal analogue scale was used wherein participants
indicated their response by placing a vertical mark through the line. The value is obtained by
measuring the distance between the left (‘0’) end of the line and the mark made by the
participant (maximum distance or score is (‘100’), and then adding all scores for a total
score. Mean scores (range: 0 to 100) were then calculated for the overall measure. An
internal consistency reliability coefficient (Cronbach’s a) of 0.96 was reported for this scale.
An expanded version of the Revised Memory and Behaviour Problems Checklist
(RMBPC) developed by Teri et al. (1992) was used to measure the communication-related
behavioural problems perceived by the caregiver. The first part evaluates the frequency with
which the caregiver perceives problematic behaviours in the person with dementia via a 5-
point Likert scale format ranging from (0) Never occurred to (4) Occurs daily or more often.
The second part evaluates caregiver reactions to these behaviours via five graded alternative
responses ranging from (0) not at all to (4) extremely. Teri (1992) reported a Cronbach’s a
of.84 for the first part of the measure and a Cronbach’s a of.90 for the second part.
Concurrent and discriminant validity were confirmed by Teri and colleagues (19920
through comparison of RMBPC scores with well-established indexes of cognitive
impairment, caregiver burden and depression. In the present study, all items in Teri’s tool
were retained, and additional communication-related cognitive problems, drawn from the
scientific literature, were added. The means of relevant item scores were calculated for each
part of the measure. In this study, the internal consistency reliability coefficient Cronbach’s a
was 0.92 for the first part of the tool; although as mentioned it was not possible to determine
this value for the second part of the tool due to an inadequate number of responses.
8 Dementia 0(0)
However, given that the original tool had already been validated by Terri et al. (1992), the
results in this study were retained for analysis.
The last two measures, communication knowledge and skills, were conceived for the study
due to the unavailability of such tools. The Knowledge measure is a closed question, three-
response format (‘true’, ‘false’ or ‘don’t know’), appropriate for gathering factual data when
a respondent may be undecided or has minimal knowledge about a subject (Polit & Beck,
2004). The correct responses are added for a potential maximum score of 50 (range: 0 to 50)
and mean scores are then calculated for the total measure. In this study the Cronbach’s a
was 0.91. The Communication Skills Questionnaire is conceived as a Likert scale with a
multiple choice, graded alternative format and provides information in regard to both the
intensity and direction of opinion of the respondent (Polit and Beck, 2004). In the response
format, first the person determines the relevance of the item for the caregiver’s current
context. Then for relevant items, the person chooses one of five alternatives that best
describes the current use of communication skills (ranging from (1) on occasion, to (5) all
of the time). The means of valid item scores were calculated for the overall measure. Scores of
‘0’ (does not apply) were considered valid if a response other than ‘0’ had been indicated on at
least one of the measurement times. If the respondent answered ‘0’ at all three measurement
times, this was not included in the calculations. A Cronbach’s a of 0.94 was reported for this
measure.
The measures were reviewed by four experts in the dementia field. They judged the items
in all measures to be representative of the domain of cognitive problems associated with
early stage AD, comprehensive (i.e., covered the complete spectrum of the domain) and easy
to understand for older-aged persons. The measures were initially formulated in English, and
then translated into French. Verification of the English-to-French translation was conducted
using Brislin’s (1970) forward–backward method. All measures were pre-tested with two
family members of individuals who had cognitive problems associated with the early to
moderate stages of Alzheimer’s disease.
Procedure for data collection

The timeline for administration of measures is as follows: Time 1 measures were
administered one week pre intervention; Time 2 and Time 3 measures were administered
one week and six weeks post intervention respectively. All measures were administered
through an interview self-report format for both experimental and control groups in the
presence of a research assistant. Data were collected over twenty months. The research
assistants (two nurses and one social worker) received a six-hour structured training
program and were blind to group assignment.
Data analysis
Sociodemographic data were analyzed using the Student t-test for continuous variables and
Chi-Square statistics for categorical variables. Assumptions of homogeneity of variance-
covariance matrices and sphericity were examined, and the normality of distribution
assumption was verified for all dependent variables. No deviations were identified at the
alpha level of 0.05. In addition to the assumption of normal distribution, the assumption of
homogeneity of regression curve was verified. This assumption was respected for all Total
scores, with the exception of self-efficacy. Thus, analyses of covariance (ANCOVA Group X
Kouri et al. 9
Time) using pre-test scores as covariates were carried out to test four of the research
hypotheses (in regard to knowledge, communication difficulties, perceived degree of
disturbance and skills). Since there was no evidence to indicate that the age difference
between the groups within this age cohort would have an impact on the outcomes, age
was not considered as a covariate in the analyses. For self-efficacy data, an analysis of
variance (ANOVA) was performed.
Results
Four out of five hypotheses were supported in the study. Results are reported in Tables 2
and 3. In Hypothesis I, it was postulated that participants in the experimental group
(psycho-educational program) would have a significant increase in knowledge about
communication associated with the cognitive limitations of a person diagnosed with the
early stage of AD, as compared with those in the control group. This hypothesis was
supported. After controlling for the effect of pre-test scores, the total scores of the two
groups were significantly different (F(1,47) ¼ 13.84, p<0.001). Moreover, 23 percent of the
variance was explained by the Group effect. There was also a significant Time effect between
Post-test (Time 2) and Follow-up (Time 3) (F(1,47) ¼ 6.40, p<0.05). In sum, the
experimental group exhibited overall significant differences in knowledge scores at Post-
test (Time 2) and at six weeks Follow-up (Time 3), and a significant Time effect between
Post-test (Time 2) and Follow-up (Time 3).
In Hypothesis II, it was hypothesized that participants in the experimental group would
perceive significantly fewer communication difficulties associated with the family member’s
cognitive limitations than participants in the control group. This hypothesis was not
supported. Neither the Group X Time interaction, nor Time or Group effects reached a
significant level. However, participants in the experimental group did perceive a reduced
occurrence of communication difficulties at Time 2, and a further decrease at Time 3, in
comparison with the control group. It is posited that with a larger sample size, the differences
between the groups might have attained significance.
In Hypothesis III, it was postulated that participants in the experimental group would
perceive a significantly lower degree of disturbance in regard to communication-related
difficulties associated with the cognitive limitations than participants in the control group.
This hypothesis was supported. The total scores of the two groups were significantly different
(F(1,47) ¼ 14.87, p<0.001). Significant differences were found between the two groups at
Post-test (Time 2) and at six weeks Follow-up (Time 3). Moreover, in regard to the total
score, the group effect explained 24 percent of the total group variance.
In Hypothesis IV, it was postulated that individuals participating in the experimental
group would perceive a significantly higher degree of self-efficacy in relation to
communication skills associated with the family member’s cognitive limitations, than
individuals participating in a control group. As mentioned, the assumption of
homogeneity of regression curve was not upheld for the Self-efficacy total score, thus a
Group X Time analysis of variance (2 X 3 ANOVA) was carried out. A statistically
significant Group X Time interaction was detected (F(2,94) ¼ 15.45, p<0.001) and the
decomposition of this interaction showed that the total group mean scores were not
significantly different at Pre-test. However, they were significantly different at Post-test
(Time 2) (F(1,47) ¼ 4.88, p<0.05), and at Follow-up (Time 3) (F(1,47) ¼ 12.71, p<0.001).
Simple effects for time showed that this effect was present only for the experimental group
10
Table 2. Results of analyses of covariance (N ¼ 50)
Partial eta
Experimental Group (n ¼ 25) Control Group (n ¼ 25) F squared
(group)
Group
Pre-test Post-test Follow-up Pre-test Post-test Follow-up Covariable X Time Time Group atT2 atT3
Knowledge
M 29.12 38.96 39.96 33.44 35.88 34.24 33.98 *** 0.546 6.409 * 13.845 *** 0.23
SD 9.42 7.65 7.48 9.95 9.86 10.17
Adjusted M - 40.43 40.83 - 34.41 33.37
Communication difficulties
M 1.65 1.74 1.86 1.65 1.70 1.68 69.057*** 2.208 0.039 1.152 0.024
SD 0.57 0.55 0.54 0.61 0.59 0.57
Adjusted M - 1.74 1.86 - 1.70 1.68
Degree of disturbance
M 1.04 0.60 0.51 1,10 0,97 1,05 60.360*** 2.563 0.019 14.868*** 0.244
SD 0.73 0.70 0.76 0.57 0.44 0.42
Adjusted M - 0.63 0.53 - 0.95 1.03
Communication skills
M 3.05 3.43 3.70 2.97 3.25 3.02 18.135*** 4.757* 3.374 5.453* 0.104 0.43 10.94**
SD 0.89 0.75 0.48 0.94 1.03 0.93
Adjusted M - 3.41 3.69 - 3.27 3.03
*p<0.05, **p<0.01, ***p<0.001
Dementia 0(0)
Table 3. Results of analysis of variance for self-efficacy (N ¼ 50)
Partial eta TIME

Kouri et al.
Experimental Group (n ¼ 25) Control Group (n ¼ 24) F GROUP simple effects squared Simple effects
(group)
Group Control
Pre-test Post-test Follow-up Pre-test Post-test Follow-up X Time Pre-test Post-test Follow-up Group Experimental Group
M 87.79 93.48 94.44 89.68 90.33 88.93 15.454*** 0.81 4.88* 12.71*** 0.045 1.04 28.55***a
SD 8,99 5,00 5,00 5,12 5,00 5,82
*p < 0.05, **p < 0.01, ***p < 0.001

a
Tukey post-hoc comparisons showed significant differences (alpha ¼ 0.01) for T1 vs T2 and T1 vs T3 for average score
11
12 Dementia 0(0)
(F(1,47) ¼ 28.55, p<0.001). Tukey post hoc comparisons showed significant differences at an
alpha level of 0.01 between T1 and T2 and between T1 and T3 for this group. Moreover, 22
percent of the variance was explained by the time effect (see Table 3). In conclusion,
Hypothesis IV was supported. The mean scores were significantly different between the
experimental and control groups at one week Post-test and at six weeks Follow-up.
Finally, in Hypothesis V, it was hypothesized that individuals participating in the
experimental group would report a significantly higher use of effective communication
skills with their family member than individuals participating in a control group. A
significant Group X Time interaction was identified (F(1,47) ¼ 4.76, p<.05), revealing a
significant group effect at six weeks post intervention (Time 3) (F(1,47) ¼ 10.94, p<.001).
In sum, this hypothesis was partially supported in that significant differences between the
two groups were identified only at six weeks post intervention (Time 3).
Discussion
This experimental study resulted in significant positive results on four proximal variables. In
particular, the intervention had the greatest immediate impact on caregiver communication-
related knowledge, degree of disturbance in regard to communication difficulties and
communication-related self-efficacy. As well, delayed effects (six weeks post intervention –
Time 3) were identified in communication skills.
With respect to the first hypothesis, one week after completing the program, caregivers
were significantly more knowledgeable about communication than those in the control
group, and moreover they continued to learn in the post intervention period (between
Time 2 and 3). Indeed, at the conclusion of the study (at follow-up – Time 3),
participants reported that they had reviewed the program document frequently post
intervention, this being a possible reason for the further significant increase in knowledge
at Time 3. The importance of these findings is reflected in the central role of knowledge in
conjunction with the modalities of knowledge transmission in the self-efficacy model
(Bandura, 1986, 1997). Whereas knowledge alone won’t necessarily lead to behaviour
change, the initial acquisition of the requisite knowledge domain is a fundamental
component of the self-efficacy model, that is, knowledge is an antecedent to efficacy
expectations.
The second hypothesis, concerned with the effects of the intervention on the presence of
communication difficulties, was not supported in this study. However, as reported,
participants in the experimental group did perceive a reduced frequency of occurrence of
communication difficulties at Time 2, and a further decrease at Time 3, in comparison with
the control group. While these results were not significant, they were coherent with the initial
rationale for the second hypothesis. This hypothesis put forth that participants would
become less sensitive or more oblivious to the communication difficulties of the person
with dementia and perceive their occurrence to a lesser degree as the result of becoming
more knowledgeable and more self-efficacious post intervention. Given that the results
reflected the trend of decreased caregiver perceptions of communication difficulties, it is
posited that with a larger sample size these results might have attained a significant level.
While this is offered as the more likely reason for the reduced (albeit not significant)
caregiver perceptions of communication difficulties at Times 1 and 2 by the experimental
group, another possible explanation for these results is related to the timeline of the study.
The overall timeframe for each participant was only twelve weeks (from T1 to T3). Given
Kouri et al. 13
that the overall cognitive status of the person with dementia would not be expected to
change in such a short time period, the communication-related problems experienced by
these persons within this time period might also have remained unchanged, as reflected in the
findings of this study.
The third hypothesis, which addressed the effects of the intervention on the degree to
which participants were disturbed by the presenting communication difficulties, was
supported. Whereas there were no significant differences in the nature and frequency of
communication-related difficulties identified by the two groups over the three
measurement times, caregiver perceptions of the degree of disturbance related to these
communication difficulties did differ significantly between the groups over time.
Participants who completed the program were significantly less disturbed one week post
intervention and maintained these improved perceptions six weeks after end of program.
One probable reason for these favourable outcomes is a function of the significant increases
in knowledge that were identified at Time 2 (with further significant increases at Time 3). It is
likely that once caregivers were more knowledgeable, they had a better understanding of
their family members’ cognitive difficulties. Thus, knowing that their family members were
not able to control the behaviours that led to communication difficulties, it is highly plausible
that caregivers were able to ‘accept’ these difficulties and so be less disturbed by them. In
fact, participant comments such as ‘I know that he/she can’t help it, so I don’t make a big
deal of the problem’, or ‘He/she just can’t control his/her actions, so I don’t say much’, were
heard frequently in the course of program sessions; most especially after caregivers had
learned communication strategies that conveyed an emotively ‘nonreactive’ response to
the family member. It is also possible that caregivers, having acquired a repertoire of
communication-related skills in the course of the program, were able to intervene more
effectively at an earlier moment in caregiver to care receiver communication interactions,
thus reducing the likelihood of communication difficulties from escalating into more
disturbing situations.
Another reason for the reduced perceptions of disturbance may have been related to
increases in participants’ personal self-efficacy. Efficacy beliefs affect both thought
patterns and behaviours, which then can enhance or undermine performance (Bandura,
1986, 1997). Having been exposed to a learning process wherein self-efficacy strengthening
strategies had been used, and wherein self-efficacy levels increased significantly six weeks
post intervention, it is highly possible that these participants also strengthened their self-
efficacy beliefs in regard to their perceived degree of disturbance and in turn changed their
‘thought patterns’ or ways of thinking.
In support of this proposition, we refer to two caregiving studies. First, Gottlieb and
Rooney (2003) reported that the amount of caregiver upset in response to memory and
behavioural problems (problem areas directly linked to potential communication
difficulties), was highly and inversely associated with communication linked ‘relational
self-efficacy’; that is, the higher the level of caregiver relational self-efficacy, the lower was
the degree of upset in regard to memory and behavioural problems of care receivers.
Similarly, Steffen and her colleagues (2002) found that caregivers of cognitively impaired
older adults reported increased levels of self-efficacy in relation to ‘replying calmly’ to
interruptions of their family members, and simultaneously reported being less angry in
response to disruptive behaviours of their family members (Steffen et al., 2002).
The fourth hypothesis was also supported, with significant improvements in self-efficacy
at one-week post intervention (Time 1) and further significant increases at six weeks post
14 Dementia 0(0)
intervention (Time 2). Given the major role of self-efficacy as a precursor to thought and
behaviour change, these outcomes lend support to the key tenets of the self-efficacy model.
The four evidence-based self-efficacy strengthening strategies (Bandura, 1986, 1997) used in
this investigation most likely contributed to these results. We are reminded that participants
had opportunities to practice communication skills (i.e., enactive mastery experiences) and
that modeling strategies were conveyed by both the modeling behaviours of the researcher-
interventionist and via the symbolic models depicted in the program. As well, the researcher
carried out persuasory feedback and implemented strategies to reduce aversive feelings in
order to put the participant at ease at the learning sessions.
The fifth hypothesis, concerned with the use of communication skills, was partially
supported, given that it was only at six weeks post intervention (Time 3) that caregivers
reported a significantly higher use of skills. This delay was likely related to the way in which
self-efficacy influences thought and behaviour change, in that a time lag can occur
subsequent to increased self-efficacy perceptions and prior to actual changes in behaviour
or thought (Bandura, 1986, 1997). These results can be further explicated in terms of how
mastery experiences and modeling influence self-efficacy perceptions and behaviour change.
Mastery experiences are the strongest source of self-efficacy; however they do not necessarily
lead to immediate significant changes in behaviour. As a skill is practiced, one’s mastery of
the skill increases; each success in turn augmenting self-efficacy perceptions. These stronger
beliefs support one’s attempts to continue to try to master the skill, a process depicted by
reciprocal influences between mastery and self-efficacy perceptions. In the course of the
program, participants were encouraged to continue to use their skills and at six weeks
post intervention (Time 3) a number of participants reported on their successes in the use
of skills; this being likely related – in part – to these mastery experiences.
Modeling, the second most important influence on self-efficacy, also does not necessarily
lead to immediate changes in behaviour. The evidence supports the postulate that being
exposed to models that exhibit useful skills and strategies raises one’s self-efficacy beliefs and
in turn augments the actualization of the related skills (Bandura, 1997; Schunk, 1987). At the
six-week post-intervention meeting, participants noted that they had continued to review the
stories in the program post intervention and had found them to be especially helpful. They
also reported on the utility of certain communication strategies (skills) that had been
demonstrated by the researcher during intervention sessions. It is likely that as
participants continued to refer to the program models over time, and as they recalled the
modeling behaviours of the clinical researcher ‘model’ at the learning sessions, their self-
efficacy perceptions increased, and in turn they used their new skills with increasing
frequency and effectiveness, such that significant outcomes were eventually identified at
six weeks post intervention (Time 3). In sum, it is possible and even likely that these two
influences on self-efficacy, i.e., mastery experiences and modeling, were two key influencing
factors that resulted in increased self-efficacy perceptions, which in turn led to the increases –
albeit delayed – in overall communication skills.
Strengths and limits of the study

The major strength of this study is the theory-driven evidence-based program that addressed
a major preoccupation of caregivers in the early stage of a dementia disorder, i.e.,
communication difficulties between the caregiver and the person with Alzheimer’s disease.
More particularly, the content of the program was drawn from an expansive review of the
Kouri et al. 15
literature and was validated by experts. The program was then delivered using theory-guided
strategies (i.e., drawn from geragogy, the McGill Model of Nursing and self-efficacy theory).
The favourable outcomes on four proximal variables attest to the utility of this intervention
tool, even at this early stage of testing.
However, this investigation has certain limitations, more particularly with respect to the
size of the sample and the two new measures that were conceived for the study to assess
communication knowledge and skills. In regard to the sample, while our calculations
indicated that a sample size of 50 (25 per group) should allow us to capture medium to
large effects (Cohen, 1988), it was recognized that this size of sample would be highly
unlikely to detect small effect sizes. The size of the sample was probably a key reason that
significant outcomes for communication skills were identified only at six weeks post
intervention (Time 3). A larger sample size may have led to a significant outcome on this
variable at an earlier point in time.
With respect to the knowledge and skills related measures, while the conception of the
subject domains of these instruments was conducted with great care to ensure that they had
face validity and encompassed all of the relevant cognition-related content areas and the full
range of key communication-related situations, and despite the high internal consistencies of
these measures, further psychometric work on these tools will better inform researchers on
the utility of these measures for future research initiatives.
Future directions and conclusion

This experimental study was conceived in response to a particular and important void
highlighted by caregivers of persons with dementia disorders, i.e., the inability of
caregivers to deal effectively with the communication difficulties that arise with the family
member affected by such an illness; affirmed as problematic even in the initial stage of the
disorder. While this program is still at an early stage of testing, the favourable outcomes in
this study are encouraging. Given the apparent utility of this intervention tool, and
considering that its format is appropriate as a self-learning instrument, it serves as a
useful reference for knowledge and skills acquisition not only for informal caregivers, but
also for care providers in the formal health care services network.
In terms of research potential, this program can be used as an intervention tool for
testing – with adaptation as required, in similar or related contexts, e.g., in more
advanced stages of AD or for other types of dementia disorders. Additionally,
considering the importance of the communication domain for caregivers and given the
present-day focus on the conception of multi-component interventions for these persons,
it would not be unreasonable to suggest that a communication dimension in these
programs would be a useful addition. Once again, the content of this program
represents such a resource.
This study also brings to the forefront alternate theoretical orientations for consideration in
the conception of intervention studies for caregivers. More particularly, the use of geragogical
principles to provide direction to educational programs for older learners and the applicability
of self-efficacy theory to guide intervention strategies, are two such examples. With a few
exceptions, e.g., the work carried out by Ducharme and her colleagues (Ducharme,
Levesque, Zarit, Lachance, & Giroux, 2007), these conceptual frameworks have not been
privileged in caregiving research, and most especially not in the early stages of a dementia
16 Dementia 0(0)
disorder. As mentioned, self-efficacy measures have been retained in a number of dementia-

related caregiving intervention studies; for example, in Gottlieb and Rooney’s (2003) and
Steffen and colleagues’ (2002) investigations. Several other studies have included both a
communication-related skills training component and self-efficacy measures to evaluate
communication-behavioural outcomes (Gitlin, Winter, Dennis, Corcoran, Schinfeld, &
Hauck, 2002; Huang, Shyu, Chen, Chen, & Lin, 2003; Lovett & Gallagher, 1998). However
there is no indication in these latter investigations that self-efficacy theory had been retained to
guide the intervention strategies of the relevant programs. This may explain – in part – the
limited findings in the majority of these investigations.
The two new measures developed for this study also offer potential for future research. In
particular, the communication related skills instrument is highlighted as an especially useful
tool for the caregiving domain. An exhaustive assessment of what a participant ‘does’ or
carries out subsequent to an intervention is generally not incorporated into caregiving
intervention studies, as confirmed by a review of the literature. Such a post intervention
evaluation of caregiver actions can help to identify what ‘worked’ in the intervention, thus
providing valuable data and informing further initiatives, e.g., inspiring refinements to
interventions. The skills evaluation model in this study is a self-report prototype with a
high degree of specificity in regard to post intervention assessment modalities for
participant communication actions or skills. Even though a Cronbach’s a of 0.94 was
reported for this measure in our study, we are cognizant that this instrument requires
further methodological work.
In conclusion, given the current orientation of health care services delivery toward the
home-based care model, and considering the increasing numbers of persons affected by
dementia disorders such as AD – wherein caregiver responsibilities are of long-duration; it
is imperative that interventions be responsive to caregiver needs, such as the communication-
focused program in this study.
Acknowledgements
This study was funded by the Québec Interuniversity Nursing Intervention Research Group; The
Desjardins Research Chair in Nursing Care for Seniors and their Families; the Fondation de
recherche en sciences infirmières du Québec; the Canadian Nurses Foundation and the Research
Centre on Aging of the University Institute of Geriatrics of Sherbrooke, Canada.
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gériatrie de Montréal. Address: Centre de recherche, Institut universitaire de gériatrie de
Montréal (Qc), Canada, H3W 1W5. [email: francine.giroux@criugm.qc.ca]

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LAPORAN PRAKTIKUM ANALISIS FILM “STILL ALICE”

TUGAS MATA KULIAH KEPERAWATAN KELUARGA

Siti Kholidah 162310101122

Widodo Hardianto 162310101259

Jenny Amalina A. R. 162310101262

Aldiana Septi Saputri 162310101268

Adhi Nur Satrio A. 162310101281

PROGRAM STUDI SARJANA KEPERAWATAN

1. GAMBARAN SINGKAT TENTANG FILM (SEBUTKAN ANGGOTA KELUARGA

Judul Film : Still Alice

Nama keluarga : John Howland

Alamat : Amerika Serikat

No Nama Jenis Umur Hubungan Pekerjaan Pendidikan

Untuk mengantisipasi penyakit Alzheimer tersebut Alice menggunakan berbagai cara

4. Penggunaan jasa perawatan : Untuk penggunaan jasa perawatan kesehatan keluarga

6. Aktivitas rekreasi dan waktu luang :

B. Riwayat dan Tahap Perkembangan Keluarga :

2. Karakteristik lingkungan dan komunitas tempat tinggal yang lebih luas:

3. Mobilitas geografis keluarga:

4. Asosiasi dan transaksi keluarga dengan komunitas:

5. Sistem pendukung atau jaringan sosial keluarga:

Dalam keluarga Howland, hubungan kekeluargaan sangat erat, terutama anak

6. GENOGRAM DAN ECOMAP

4. Strategi Adaptasi Disfungsional : Apabila timbul perselisishan atau konflik dalam

DATA DIAGNOSA RENCANA TINDAKAN JURNAL

Judul film : Still Alice (2014)

Masalah keluarga : Seorang wanita bernama Alice yang merupakan

Terapi keluarga : A psycho-educational intervention focused on

Pengertian terapi keluarga: Terapi keluarga adalah model terapi yang

Indikasi terapi keluarga : Didalam jurnal tidak disebutkan secara spesifik

Kontraindikasi terapi keluarga: (tidak disebutkan didalam jurnal)

Persiapan terapi keluarga: Peserta diidentifikasi pengasuh utama dari anggota

Prosedur terapi keluarga :

Evaluasi terapi keluarga : Peneliti menyadari bahwa instrument

Penulis Jurnal Krystyna Klodnicka Kouri, Francine C.

A psycho-educational intervention focused on communication for caregivers of a

The online version of this article can be found at:

Additional services and information for Dementia can be found at:

Email Alerts: http://dem.sagepub.com/cgi/alerts

Version of Record - Jul 22, 2011

communication for DOI: 10.1177/1471301211408124

Introduction and context of study

guide the particular teaching-learning strategies in this study. Self-eﬃcacy is concerned

Description of psycho-educational intervention

knowledge; 2) perceive signiﬁcantly fewer communication-related diﬃculties; 3) perceive a

Setting and sampling

Description of the sample

Table 1. Sociodemographic characteristics of the sample (n ¼ 50)

Sample Experimental Group Control Group

FT: Full time; PT: Part time

Delivery of the intervention

intervention components were covered in a systematic manner. All 25 participants in the

Data collection instruments

Procedure for data collection

*p<0.05, **p<0.01, ***p<0.001

Partial eta TIME

*p < 0.05, **p < 0.01, ***p < 0.001

Strengths and limits of the study

Future directions and conclusion

disorder. As mentioned, self-eﬃcacy measures have been retained in a number of dementia-

Francine Giroux, MSc, is a statistician at the Centre de recherche de l’Institut universitaire de

Anda mungkin juga menyukai

p<0.05, p<0.01, p<0.001

p < 0.05, p < 0.01, p < 0.001