TEORI & MODEL KEPERAWATAN KELUARGA

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

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TUJUAN
Setelah membahas topik ini mahasiswa mampu: 1. Mendeskripsikan masing-masing konsepsual model & teori yg mendasari praktik keperawatan keluarga;

2. Mendiskusikan perbedaan diantara teoriteori kep, teori-teori sain sosial keluarga, dan teori terapi keluarga; dan
3. Mengidentifikasi teori dan model keperawatan keluarga yg dapat digunakan dalam praktik keperawatan keluarga.
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INTRODUCTION
By understanding theories and models, the nurse is better prepared to think creatively and critically about how the illness event is affecting the family client. Theories and models open doors to different ways of understanding issues that may be affecting families, and thereby offer options for action. No one theoretical perspective stood out as yielding the best family nursing care.
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Intro
However, nurses who understand multiple theories and models are able to offer multiple solutions for families to consider in their adaptation to the health issue of the family.
Nurses who draw from multiple theoretical lenses will integrate a variety of approaches into their care, thereby providing more holistic, family-centered nursing.

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

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

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Components/Elements of theory
1.Purpose Why is the theory formulated
2.Concepts are building blocks of theory ideas, mental images of a phenomenon, an event or object that is derived from an individuals experience and perception. Has a major concept like nursing, person, health or environment.

3. Definitions give meaning to concepts which can either be descriptive or procedural (stipulate-use of term within the theory)

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Components/Elements of theory
4. Propositions are expressions of relational statements between and among the concepts. It can be expressed as statements, paradigms or figures . 5. Assumptions- accepted truths that are basic and fundamental to the theory. Or value assumptions where what is good or right or ought to be.
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Characteristics of a Theory
1. Systematic, logical and coherent
(orderly reasoning, no contradictions) 2. Creative structuring of ideas mental images of ones experiences and create different ways of looking at a particular event or object.

3. Tentative in nature ( change over time or evolving but some remain valid despite passage of time)
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Hubungan teori, praktik dan penelitian

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

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Artinya teori kep mendasari praktik kep keluarga dan praktik kep keluarga memfasilitasi perkembangan teori kep keluarga

Teori, praktik & riset saling menentukan dan mempengaruhi satu sama lain
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 Klein & White (1996 dlm Friendman, 1998): Fungsi teori menyediakan pengetahuan utk meningkatkan pelayanan/praktik kep thd keluarga Tujuh cara teori secara langsung atau tidak berkontribusi thd peningkatan praktik kep: - Accumulation teori membantu dlm mengakumulasi * mengorganisir hasil riset - Precision teori lebih mempertajam atau memperjelas shg dimungkinkan utk dipahami dengan bhs sehari-hari

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- Guidance teori mengarahkan peneliti utk kembangkan atau uji hipotesis

- Connected mendemonstrasikan bagaimana ide-ide terkait satu sama lain

shg menjadi sistimatis

- Interpretationm membantu memberi arti atau makna ttg fenomena yg diamati

- Prediction memprediksi apa yg dpt atau mungkin terjadi dikemudian hari

- Explanation memberi jawaban thd pertanyaan kenapa dan bagaimana
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Konsepsual model
Konsep : jelaskan fenomena Proposisi: jelaskan hubungan antar konsep

Abstrak

Teori
Lebih konkrit daripada konsepsual Model.

Teori/model kep keluarga

Lebih konkrit

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CONCEPTUAL SOURCE OF FAMILY NURISING THEORY

Nursing models/ theory

Family nursing theories

Family social science theories

Family therapy theories

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Nursing Models and Theories

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

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NURSING THEORIES/ CONCEPTUAL MODELS

Orientasi pd sistem: Neumans system
conceptual model Orientasi perkembangan: Orems self-care model Orientasi pd sistem dan interaksi: - Roys adaptation model - Kings interacting systems model Orientasi pd sistem dan perkembangan: - Rogers life process model Model/teori lain yg mendukung: - Nightingale - Friedemann
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Nursing theories for understanding families

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

Roy's Adaptation Theory (1983):
The client is an individual, family, group, or community in constant interaction with a changing environment. The family system is continually changing and attempting to adapt. The goal of nursing is to promote adaptation and minimize ineffective responses.
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Florence Nightingale
Nightingale described the family as having both positive and negative inuences on the outcome of clients.
Nightingale noted that the family was a supportive institution throughout the lifespan for its individual family members. She rmly believed in home health nursing and maintaining ill persons in the home environment.
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Imogene King
Imogene Kings theory of goal attainment.
The individuals role in the family contributes to the socialization and development of each member.

The family was the vehicle (pembawa) for transmitting values and norms of behavior across the life span,
which includes the role of a sick family member and transmitting the health care function of the family.
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Betty Neuman
She viewed the family as a system composed of family member subsystems. The relationships between individual family members or subsystems are the central focus of her model. The family system becomes threatened when it is exposed to stressors that affect its stability (equilibrium) and inuence its state of wellness.
The family has the ability to open or close its boundaries/ikatan to protect its members and preserve/mmlihara the integrity of the family as a whole.
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Martha Rogers
Fawcett (2000) elucidated/menguraikan Rogers theory by explaining that the family is a constant open-system energy eld that is ever-changing in its interactions with the environment. Aplication model The family unit is a whole The family is an open system in constant interaction with the environment Families are continuously inuenced by information The family system is subject to change along a spacetime axis. The family has the capacity for feeling, knowing, and comprehending and for using these processes to determine patterns, make choices, and recognize its environment.
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Dorothea Orem
Dorothea Orems self-care decit theory (1985) depicts/mgambarkan the family as the basic conditioning unit, in which the individual learns culture, roles, and responsibilities. Ways families addresses self-care for their members Self-care of families can be evaluated in a variety of situations Self-care reects the personal values and health beliefs of the family Self-care can be administered to families by individual self-care agents The concept of self-care can be used to promote health in families
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Marie-Louise Friedemann
Marie-Louise Friedemanns (1995) framework of systemic organization is built on the view of the family-as-client.
The family is described as a social system that has the expressed goal of transmitting culture to its members. The elements that are central to Friedemanns theory are family stability, family growth, family control, and family spirituality.
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Integrated Approaches to the Nursing of Families

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

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

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Social Sciences Theories for understanding families

Structural-Functional Theory:
The family is viewed as part of the social system, with individuals being parts of the family system.

The family, as a social system, performs functions that serve both the individual and society.
Individuals act in accordance with a set of internalized norms and values that are learned primarily in the family through socialization.

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Five functions of the family important to understand:

Affective
Socialization and social placement Reproductive Economic Health care

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Social Sciences Theories for understanding families

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

Beginning family
Childbearing family Families with preschool children

Families with school-aged children

Families with teenagers Families launching young adults

Middle-aged parents
Families in later years
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Culturally Sensitive Care

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

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IMPLICATIONS FOR NURSING

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

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FAMILY THERAPY THEORIES

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

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Family Therapy Theories

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

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

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

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2. Interactional Family Therapy

This approach views the family as a system of interactive or interlocking behaviors or communication processing.
The approach assumes that emotional problems result from the way people interact with each other in the context of the family. Primary goals of family therapy include understanding the communication rules and processes that troubled families use and teaching the family to use more functional communication.
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Interactional
Key interventions using this theoretical orientation focus on establishing clear, congruent communication, and clarifying and changing family rules (Jackson, 1965; Satir, 1982).
This approach is very useful for family nurses because it stresses the interactions between family members.

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3. Family Systems Therapy Theory

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

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BOWENS FAMILY SYSTEMS THEORY: EIGHT INTERLOCKING CONCEPTS

Differentiation of self
Nuclear family emotional system Multigenerational transmission process

Family projection process

Triangles Sibling position

Emotional cutoff
Societal regression
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Eight concepts
Healthy function differentiation of self is ability of persons to distinguish themselves from their family of origin, both emotionally and intellectually.
The nuclear family is viewed as a family emotional system. In this system, the coping strategies and patterns that are used tend to be passed on from generation to generation, a phenomenon that Bowen called the multigenerational transmission process.
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Eight concepts
family projection process, Parents who are anxious and have poor differentiation of self tend to transfer their anxiety and low level of differentiation to a susceptible child.
triangulation is a way that families use to deal with anxiety. In certain stressful situations, anxiety may spread from a triangle within the family to triangles that include persons outside the family.

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

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Bowens family systems

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

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

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Tanya jawab?

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