Download - 1. Dasar Teori Kep Keluarga
TUJUAN
Setelah membahas topik ini mahasiswa mampu:
1. Mendeskripsikan masing-masing konsepsual model & teori yg mendasari praktik keperawatan keluarga;
2. Mendiskusikan perbedaan diantara teori-teori 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.
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.
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.
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 (LoBiondo-Wood & Haber, 2002).
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.
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
individual’s 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)
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.
Characteristics of a Theory
1. Systematic, logical and coherent
(orderly reasoning, no contradictions)
2. Creative structuring of ideas
mental images of one’s 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)
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.
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
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
- 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
Konsepsual model
Teori
Teori/model kep
keluarga
Abstrak
Lebih
konkrit
Konsep : jelaskan fenomena
Proposisi: jelaskan hubungan antar konsep
Lebih konkrit daripada konsepsual
Model.
Dikembangkan dari berbagai
Teori yg mendukung
CONCEPTUAL SOURCE OF
FAMILY NURISING THEORY
Nursing models/
theory
Family social
science
theories
Family therapy theories
Family
nursing
theories
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
NURSING THEORIES/
CONCEPTUAL MODELS
Orientasi pd sistem: Neuman’s system
conceptual model
Orientasi perkembangan: Orem’s self-care model
Orientasi pd sistem dan interaksi:
- Roy’s adaptation model
- King’s interacting systems model
Orientasi pd sistem dan perkembangan:
- Roger’s life process model
Model/teori lain yg mendukung:
- Nightingale
- Friedemann
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.
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.
Florence Nightingale
• Nightingale described the family as having
both positive and negative influences on
the outcome of clients.
• Nightingale noted that the family was a
supportive institution throughout the
lifespan for its individual family members.
• She firmly believed in home health nursing
and maintaining ill persons in the home
environment.
Imogene King
• Imogene King’s theory of goal attainment.
• The individual’s 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.
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 influence 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.
Martha Rogers
• Fawcett (2000) elucidated/menguraikan Rogers’ theory by
explaining that the family is a constant open-system energy
field 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 influenced by information
– The family system is subject to change along a space-
time 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.
Dorothea Orem
• Dorothea Orem’s self-care deficit theory (1985) depicts/m’gambarkan 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 reflects 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
Marie-Louise Friedemann
• Marie-Louise Friedemann’s (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 Friedemann’s theory are family stability, family growth, family control, and family spirituality.
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 ―fit‖ the structure, processes, and style of functioning for that family.
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
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.
Five functions of the family
important to understand: • Affective
• Socialization and social placement
• Reproductive
• Economic
• Health care
Social Sciences Theories for
understanding families
• Duvall’s 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.
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
Culturally Sensitive Care
• Is care provided with awareness of child's and family’s
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.
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.
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
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).
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.
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.
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.
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.
3. Family Systems Therapy
Theory • Murray Bowen’s 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.
BOWEN’S 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
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.
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.
Eight concepts …
• Sibling position is another important concept in family
systems therapy. From this perspective, people are seen
as developing fixed 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 influences the emotional process in families—like
a background influence affecting all families.
Bowen’s family systems …
• Bowen’s family systems therapy focuses on promoting differentiation of self from family and promoting differentiation of intellect from emotion.
• Using Bowen’s 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 people’s 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.
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.