ASUHAN KEPERAWATAN KELUARGA

ULFAH NK
Goal for Learning Are : Need To Know :
1. Know back ground 1. Definisi
2. Identify legal and Keperawatan
ethic issues in keluarga
family nursing
3. Recognize the
health problem
issues
4. Know trends in
family nursing
5. Identify roles of
nursing in family
nursing
 Changing
Global

Changing
Population
Asia : EKSPULSI
Eropa : Zero Population Growth
Amerika Utara : o Urbanisasi
Australia :
New Zailand :
o Peningkatan kwalitas hidup
 PENINGKATAN KWALITAS HIDUP
DIPENGARUHI OLEH

ACCELERATION EFFECT
RICH POOR

o Menguasai Perubahan dg mengontrol dan membimbing diri sendiri

o Mencegah future shock
MULTIKULTURAL
o Keragaman budaya & etnis
o Kekuatan sumber dan identitas nasional
LINGKUNGAN
o Perubahan paradigma
o Hanya ingin memiliki yang dibutuhkan
o Pengembangan technology : medic, food supplay
1. ABORSI
2. BIRTH CONTROLE
3. ADOPSI
4. MBA ( MARRIGE BY ACCIDENCE )
5. SUBTANCE ABUSE
6. CHRONICAL MENTAL ILNESS
7. KDRT ( FAMILY VIOLENCE)
Penyakit degeratif
Penyakit Infeksi
Perilaku Sehat ( Mis : Obesitas, Kes. Jiwa,
Jantung, DM, Osteoporosis)
Penyakit Kronis
HOME HEALTH CARE
Swasta/ Praktek mandiri
Government
Hospital Base
Sosial
HOSPICE
Meninggal dg tenang dan bermartabat

NURSING HOME
Kesejahteraan lansia
Direct care
Basic Need
Follow up care
Infection Control
Advocacy
Family Health Educator
Case Management ( Cost, Time and
Length of Time)
Documentation
 KEPERAWATAN

JENJANG AKADEMIK JENJANG PROFESI

o DIPLOMA DI berbagai tatanan :

o SARJANA o RUMAH SAKIT
o SPECIALIS o PUSKESMAS
o DOKTORAL o PANTI
o MASYARAKAT

Perawatan di Rumah /
HOME CARE
HOME CARE
 Pelayanan kesehatan
masyarakat (Keperawatan)
yang dilakukan di rumah
pasien

Habbs & Perrin, 1985

Nursing Home Characteristics and Services

1.7 Million
Most Nursing Medicare
Homes (67%) and/or
are for-profit Medicaid
16,000+ certified beds
Nursing
Homes

1.5 million+
people (6%+ Average
of people >65 Nursing
years old) are Home Size:
in Nursing 104 beds
Homes
 Resident Characteristics

Most residents are white Age range: 75-84: 30%,

(86%), female (62%), married >85 y/o: 45%,
(17%) and live alone <65 y/o: 12%

Assistance Incontinent of
needed with 3-4 bladder or
ADLs: 95% bowel: 50%

Dementia of Depressed (at

some kind: 65% least one clinical
symptom): 20%

Physical restraint use: Receiving psychotropic

6% (some NHs: 0%) medication: 63%

46% of residents are admitted from

acute care
 Resident Length of Stay

50%+ 50% + Short-Term (typically Medicare

covered)
2.5 years 14-32 days Long-Term (typically Medicaid
(mean) (mean) covered)
 Between 25%-50% of
residents are hospitalized
during any one year
Some residents can be
hospitalized as many as 4
times in one year (e.g.
with diagnosis of COPD,
CHF)
 Reasons for hospitalization
include:

Physician practice pattern

and hospital vacancy rate
Residents Medicare
eligibility
Nursing Home resources
(staffing; IV administration;
diagnostic services)
Family pressure
 Before WWII, 40% of patient-physician
encounters occurred in the home
1990: 0.88% (<1%) of Medicare patients
receive home visits from physicians
1994: 66/123 medical schools offered
home visit specific instruction; only
3/123 required > 5 home visits
General practitioners 12% of PCP work
force but make 26% of house calls
 Low frequency of home
visits is due to:
1. Deficits in physician
compensation for visits
2. Time constraints
3. Perceived limitations of
technologic support
4. Concerns about risk of litigation
5. Lack of physician training and
exposure
6. Corporate and individual
attitudinal biases
 $22.3 billion dollar industry
44% of patients discharged from the
hospital require post-hospital care;
either nursing home or home health
care
43 referrals/year per physician
among internists and family
physicians J Am Geriatr Soc 1992;40:1241-9
 5-10%of patients in a primary care practice
receive home health care.
National homecare and Hospice Survey 1992
30%+ of patients age 85 or older require at
least one home health care visit per year.
Medical Management of the Home Care patient: Guidelines for Physicians
1998 by AMA
2%
of home care patients received physician
home visits.
National Homecare and hospice Survey 1992
 Improved medical care through the
revealing of unknown health care needs
Ability to assess the environment which can
lead to design and implementation of
home-based interventions that prevent falls
and other self-injury
Insight into psychosocial issues
Enhancement of physician-patient
relationship
 Home-based assessments increase the prospect of
elderly patients remaining at home. Cleveland Clinic
Journal of Medicine May 2001
Assessments are done in familiar surroundings
Physicians report a higher
level of practice satisfaction
than those who do not
offer this service
 Time intensive
Less technological
support
Financial issues
Provider safety
Izin Praktik ;
Pasal 19 ; Perawat yang menjalankan Praktik
Keperawatan wajib memiliki izin.
2. Perawat harus melampirkan:
a. Salinan STR yang masih berlaku
b. Rekomendasi dari Organisasi Profesi Perawat/
Surat pernyataan memiliki tempat praktik atau
surat keterangan dari pimpinan Fasilitas
Pelayanan Kesehatan
Pasal 20 : SIP hanya berlaku untuk 1 (satu) tempat
praktik
Pasal 21 : Perawat yang menjalankan praktik mandiri
harus memasang papan nama Praktik Keperawatan
BAGI KLIEN DAN KELUARGA
Meringankan biaya
Kenyamanan
Ikatan emosional
BAGI PERAWAT
Pengkajian comprehensive klien dan
lingkungannya
Variasi lingkungan kerja
 PEMERINTAH : PUSKESMAS

SOSIAL : KEAGAMAAN, LSM

Hospital based : dg alasan tambahan Yan :

ambulasi dini, infeksi nasokomial,
kesinambungan, peny. Kronis

PRAKTEK MANDIRI : Imbalan jasa langsung dari pihak ke tiga

Populasi :
Wanita
Lansia
Jenis Layanan : keperawatan & kesehatan
masayarakat
Kasus terbanyak di AS : Jantung,
muskuloskleletal, DM, Disfungsi pernafasan,
Luka, Keracunan, Kanker, palliative care
Kasus terbanyak di Indonesia : Pasca stroke,
pasca bedah, DM, TERMINAL ill.
 Usethe INHOMES mnemonic to help
recall the areas of focus for the home visit
I Immobility
N Nutrition
H Home Environment
O Other People
M Medications
E Examination
S Safety, Spiritual health, Services
Pengkajian dan observasi TTV
HE dan pelatihan
Pemberian obat Rice R, 2001
Tube feeding
Nasopharyngeal & tracheostomy respiration
Gangguan Mental
Pemasangan /pemeliharaan catheter
Perawatan luka
Perawatan Colostomy
Kebutuhan cairan dan nutrisi
Perawatan rehabilitasi
Pengelolaan dan evaluasi askep
1. Mandi
2. Berhias dan berpakaian
3. Menyediakan makanan
4. Membantu makan
5. Kebersihan mulut
6. Perawatan kulit dan kuku
7. Eliminasi / toiletting
8. Ambulasi
9. Olah raga
 ALLENDER SPRADLEY 2001
PEMBERI LAYANAN

Tenaga Informal Tenaga formal

SESUAI STANDAR

HOME CARE AIDE : ANA, 1999

6 STANDAR ASUHAN KEPERAWATAN

8 STANDAR PRAKTEK PROFESIONAL
BASIC RENCANA KEBUTUHAN PASAR
Analisa Eksternal (Kebutuhan
pasar & pesaing)
Analisa Internal (Kemampuan &
Komitemen)
DOKUMENTASI
Komponen Yan Kes
Komponen Fungsional
Komponen Fisiologis
Komponen Psikologis
 WE ARE THE
FIRST

WE ARE WE ARE
DIFFERENT THE BEST
1. Isue dan etik legal FN
2. Masalah kesehatan FN
3. Trends in FN
4. Peran Perawat in FN
5. Home care
6. Jenis Organisasi Pemberi Yan Kes
7. Home Care Aide