Special Populations in Psychiatry Adolescent Psychiatric Nursing

By : Tri Anjaswarni, S.Kp. M.Kep. Disampaikan dalam Kuliah Mata Ajar Mental Health Nursing pada Program Studi Ilmu Keperawatan Fakultas Kedokteran Universitas Brawijaya Malang Learning Objectives After studying this chapter the student should be able to : 1. List the developmental tasks of adolescence. 2. Compare the various theiretical views of adolescence 3. Identify the major areas that should be included when assessing adolescents 4. Describe maladaptive responses evident in adolescence 5. Analyze nursing intervenstions useful in working with adolescents 6. Evaluate nursing care provided for adolescents A. Introduction Adolescence is a time of transition an age when the person is not yet an adult but is no longer a child. Difficult periode for adolescence Terjadi berbagai perubahan perilaku terkait dengan perkembangan yang terjadi pada diri remaja Penekanan bidang garap pada masa remaja adalah berfokus pada perkembangan personal (person development).

Nurse Specialist of psychiatric

menangani anak remaja dengan berfokus pada proses menjadi dewasa berhubungan dengan aspek social, emotional, dan physical dalam penyesuaiannya di keluarga, sekolah dan kelompok umur sebaya. membantu anak remaja untuk memperoleh kesuksesan

B. Developmental Stage
Havighurst identified the following tasks that should be accomplished during adolescence : 1. Achieving new and more mature relations with age mates of both sexes 2. Achieving masculine or feminine social roles 3. Accepting physical build and using the body effectively 4. Achieving emotional independence from parents and other adults 5. Preparing for marriage and family life 6. Praparing for career 7. Acquiring a set of values and an ethical system as a guide to behavior and developing an ideology

C. Theoretical Views of Adolescence

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1.

Theory
Biological Theory

Description

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Emphasis is on physical growth, behavior, and the environment which influence feeling, thoughts and action. Transform the young person physically from a child into a reproductively mature adult. The changes fall into two categories : hormonal & somatic Psychoanalytical Puberty is called the genital stage, in which sexual interest is awakened Theory (Freud) The genitalia mature(sexual exploration and maturation) The release of sex hormones increases. Upset the balance between the ego and id New solutions must be negotiated Psychosocial Theory Adolescents attempt to establish an identity within the social (Modified by : environment Erickson, Sullivan and Emphasize the effect of social factors on developmental processes others) Ego identity or relationship between a persons self perception and how a person appears to athers The stage of Identity V.S Identity diffusion To coordinate self security, self esteem, intimacy, general activity and sexual satisfaction in relationships. Attachment Theory Focuses on the quality of attachments Insecure attachments as risk factor that can result in maladaptive responses to loss or trauma. Cognitive Theory Adolescence is an advanced stage of cognition (cognitive functioning) Formal thought : The ability to reason goes beyond the concrete to more abstract thinking ( concrete objects to symbols or abstractions) This develops continuously from the concrete thinking of childhood to abaout age 2. Cultural Theory View adolescence as a time when a person believe that adult privileges are deserved but are withheld. This stage end when society gives full power and status of an adult. Multidimensional Th Adolescence is seen as adaptation on continuum of development. Less emphasis on age and more on the development level and timing of biological, psychological, & environmental influences.

D. Assessing the Adolescent

The data collection should include the following information :
1. Appearance 2. Growth and development 3. Biophysical status (illness, accidents, disabilities) 4. Emotional status (relatedness, affect, and mental status : mood and thought disorder, and suicidal). 5. Cultural, religious and socioeconomic background 6. Performance of activities of activity of daily living (home, school, work) 7. Patterns of coping (ego defenses such as denial, acting out, withdrawal) 8. Interaction patterns (family, peers, society) 9. Sexual behaviors (nature, frequency, preference, sexuality transmitted diseases) 10. Use of drugs, alcohol and others addictive substances (tobacco, caffein) 11. Adolescents perception and satsfaction with health. 12. Adolescents health goals 13. Environment (physical, emotional, ecological) 14. Available human and material resources (friends and school and community involvement) Dikumpulkan dari anak remaja & orang lain yang signifikan interview, (examinations), (observations), (reports).

outcome identifikasi anak remaja (usia belasan tahun) yang berresiko tinggi mempunyai masalah.

Gambar 1 Profile of the high-risk adolescent

Home Peers
Lack of Frience Antisocial friends Acting out Secretiveness

School
Truancy Undeachiem ent, Disruptive behavior

Substanc

e Abuse
Regular use Large amounts

Antisocial Behaviors

High-Risk Adolescent

Delinquency ,Trouble with law

Sexual
Promiscuit y Pregnancy Sexual Abuse Appearanc e Poor hygiene Disregard for dress

Medical
Chronic illness Handicap

Mood Functional
Sleep problems Eating Problems Psychosomati c Depression Anxiety Hostility

tipe perilaku anak remaja yang harus diperhatikan: 1. Body Image 2. Identity 3. Independence 4. Social Role 5. Sexual Behavior

E.Maladaptive Responses
1. Inappropriate Sexual Activity 2. Unwed Motherhood 3. Suicide 4. Runaways 5. Conduct Disorders 6. Violence 7. Drug Use 8. Hypochondriasis 9. Weight Problems 10. Occult Involvement 11. Parental Divorce

F.Nursing Diagnoses
Diagnosis berdasarkan DSM-IV psychiatric illness

G.Nursing Intervention useful in Working With Adolescents

Using Modality Therapy 1. Health Education 2. Family Therapy 3. Group Therapy 4. Individual Therapy 5. Medication Management 6. Talking with Adolescents 7. Parents of the Adolescent

H. Evaluate Nursing Care