TEORI & MODEL

KEPERAWATAN KELUARGA

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

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)

Hubungan teori, praktik dan

penelitian

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.

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