KONSEP COMMUNITY

SETTING

CITRA WINDANI MAMBANG SARI

OUTLINE
• Menjelaskan asuhan keperawatan pada setting yang berbeda
• Mengidentifikasi comumunity setting
• Mengidentifikasi peran perawat dalam berbagai setting
Perlunya Community Setting, why?
• AKB dan AKABA menurun
• Communicable diseases terkontrol
• The aging of baby boomers  lansia meningkat
• Life span meningkat
• Pembiayaan kesehatan meningkat
Asuhan keperawatan pada
setting khusus
• Home setting
• Official and voluntary health agencies
• Residential care for elderly
• School setting
• Work setting
• Urban and rural setiing
• Correctional setting
• Disaster setting
Home setting
• Asuhan keperawatan dilakukan di rumah
• Biasanya yang sudah pulang dari RS dan butuh tindak lanjut
perawatan
• Cenderung pada penyakit kronis
Official and voluntary health agencies
• Biasanya LSM / NGO / di bawah kegiatan kegamaan
Residential care for the elderly
• Beberapa lansia yang khususnya dengan penyakit kronis  isolasi
di rumah
• Retirement community
• Panti
School setting
• Fokus kepada kesehatan siswa/mahasiswa, pertumbuhan individu,
dan beberapa masalah spesial seperti mentally or physically
disabled.
• Asuhan keperawatan yang dilakukan :
• Perawatan cedera
• Perawatan kesehatan
• Imunisasi
• Rujukan
• Pengkajian fisik
• Health edu
Oocupational Health
• Pekerja kurang pengetahuan tentang status kesehatan
• Fokus :
• Menjaga kesehatan pekerja
• Mencegah terjadinya penyakit dan cedera akibat pekerjaan
• Pendampingan setelah perawatan
• Safe environment
Program :
• Weight reduction
• Job-related safety
• Exercise
• Smoking cessation
• Family planning
• Addiction free lifestyles
Urban and rural setting
• US Census,
• Rural = area kurang dari 2500 orang
• Urban = punya inti populasi lebih dari 50000
• Punya permasalahan yang berbeda
• Punya karakteristik masing-masing
• Cultural competence
Correctional setting
• Lembaga Permasyarakatan  tahanan, pidana
• Lembaga sosial rehabilitasi  anak dan remaja
• Deteksi dan pengkajian
• Perawatan
• Pencegahan
• Health edu
• Care provider
Disaster setting
• BUKAN HANYA ALAM, tapi waspadi disaster yang lai seperti :
KIMIA, BIOLOGIS, TERORISM
• Mulai dari rumah masing – masing  home disaster plan
• Peta disaster masing-masing wilayah
• tahap-tahap disaster non disater - predisaster - impact-
emergency- recovery
• URGENT :
• Jalur evakuasi
• Tahap recovery
Peran perawat
• Komunikator
• Teachers
• Manajer
• Care provider
• Health edu
• Case manager
• Discharge planner
• Continuity of care nurse
Kompetensi yang dibutuhkan
• Health promotion and protection
• Diseases prevention
• Teaching and coaching
• Critical thinking
• Role modeling
• Improving health outcomes
• Team collaboration
• Monitoring and ensuring quality care
• Cultural competence
• Interpersonal communication skill
• Assessment of all aspects of patient’s health status
• Diagnosis of health states
• Planning care
• Implementing care safely and efficiently
• Evaluating care
• Consultation
KEPERAWATAN KOMUNITAS
• INDIVIDU
• KELUARGA
• KELOMPOK
• MASYARAKAT

SEKOLAH
SCHOOL HEALTH NURSING
DASAR HUKUM

• UU No 20/2003 : Sistem Pendidikan nasional

• UU No 36 /2009 : Kesehatan
• SK bersama Mendiknas, Menkes, Menag dan Mendagri :
Pembinaan dan pengembangan UKS
KESEHATAN DAN SEKOLAH

SEKOLAH KESEHATAN

CERDAS &
SEHAT

SDM TANGGUH
 HYSTORICAL MODEL

TRIAS PROGRAM UKS

PENDIDIKAN YAN-KES

LINGKUNGAN
 Healthy School
CDC (2011); Murray et al (2007);
Davis dan Allensworth (2007)
Integrated Healthy School
• Health Services
• Nutrition Services (layanan nutrisi, kantin sehat)
• Counseling, Physicological and Social Services (konseling,
pelayanan social dan psikologis)
• Healthy and safe school environment (lingkungan yang sehat dan
nyaman untuk sekolah)
• Health Promotion for staff (promosi kesehatan untuk staf)
• Family and community involvement (keterlibatan keluarga dan
masyarakat)
• Health Education (Pendidikan kesehatan)
• Physical Education (pendidikan fisik)
Health Promoting School
Leger (2010), WHO (1996)
• Kebijakan sekolah yang sehat
• Lingkungan fisik sekolah
• Lingkungan social sekolah
• Hubungan komunikasi
• Keterampilan kesehatan personal
• Pelayanan kesehatan
OCCUPATIONAL
HEALTH NURSING
Occupational Health Nursing Knowledge Domain
• Nursing science
• Medical science
• Occupational health science
• Epidemiology
• Business and economics
• Social and behavioral sciences
• Environmental health
• Legal and ethical
HEALTHY AGING
Latar Belakang
Kondisi Lansia di Indonesia
LATAR BELAKANG
Jumlah Penduduk Lansia

•Tahun 2000 = 400

Dunia Juta
•Tahun 2025 = 1.5 M

•Tahun 2000 = 7.28 %

Indonesia •Tahun 2020 = 11.34 %
Hasil Penelitian Demografi UI (2008)

The Young •60 – 69 tahun

Old •11.13 juta

The middle •70 -79 tahun

Old •5.8 juta

The Grand •> 80 tahun

Old •1.96 juta
 DATA UMUM PENDUDUK LANJUT USIA (dalam %)
(DATA OF ELDERLY POPULATION BY %)

No STATUS MALE FEMALE TOTAL

A PERKOTAAN / URBAN 100 100 100
1 Tidak terlantar (not neglected) 63.85 50.70 56.85
2 Rawan terlantar (neglect prone) 25.05 33.84 29.73
3 Terlantar (neglected) 11.10 15.46 13.42
B PEDESAAN / RURAL 100 100 100
1 Tidak terlantar (not neglected) 41.40 32.18 36.61
2 Rawan terlantar (neglect prone) 34.06 38.72 36.48
3 Terlantar (neglected) 24.54 29.10 26.91
C PERKOTAAN + PEDESAAN (U + R) 100 100 100
1 Tidak terlantar (not neglected) 49.85 39.38 44.36
2 Rawan terlantar (neglect prone) 30.67 36.82 33.89
3 Terlantar (neglected) 19.49 23.80 21.75
CBS Indonesia, 2000
 Konsep “Menua sehat”
(The “Healthy Aging” Concept)
Endogenic Aging

Cellular Tissue Organ

Anatomical

Healthy Aging
(menua sehat)

Environment Life Style

Exogenic Factors

Gambar . Model Healthy aging dengan faktor-faktornya

(Boedhi-Darmojo, 1994, 2001)
 RISK FACTORS “ SPIDER MODEL” DEGENERATIVE DISEASES
Blood Pressure  Heart disease

Tobacco Stroke

Dyslipidemia Hypertension

Improper food Dementia

Glucose  CORE Diabetes M

Personality/ Stress  Cancer

Physical inactivity Osteoporosis

Alcohol Liver disease

Environment  Renal failure

Oral hygiene  Respiratory disease

Gambar 1. Faktor risiko dan penyakit degeneratif (FR harus dihindari/dihilangkan sedini mungkin
supaya lebih berhasil) - Boedhi-Darmojo, Retirement Speech 6 Januari 2001,
Sidang Konsorsium Ilmu Kesehatan (KDK) 2000.
 The 13 i
- Immobility - Impaction ( constipation )
- Instability - Iatrogenesis
- Intelectual impairment - Insomnia
( dementia )
- Isolation ( depression )- Impairment of
- Incontinence - Vision
- Impotence - Hearing
- Immuno - deficiency - Smell
- Infection - Communication
- Inanition ( malnutrition ) - Convalescence
- Skin integrity

(Each of these complaints / symptoms are subjects of research / studies)

Source : Solomon et al ( UCLA Conference 1988 )

 GENDER

Health & Behavior

Social-serves determinants

Economic ACTIVE AGEING Personal

determinants determinants

Social Physical
determinants environment
CULTURE
Figure 8 The determinants of Active Ageing
WHO, 2002
 ACTIVE AGEING AS PREVENTION
OF DISEASE IN THE ELDERLY
HEALTHY AGEING  ACTIVE AGEING APPEAR TO
PREVENT DEGENERATIVE & CHRONIC DISEASE
USUALLY SUFFERED BY THE ELDERLY POPULATION

SEE THE SPIDER MODEL OF

RISK FACTORS & DEGENERATIVE DISEASE

START PREVENTION AS EARLY AS POSSIBLE !!!

HEALTHY AGEING ACTIVE AGEING SUCCESSFUL AGEING