PROGRAM STUDI ILMU KEPERAWATAN

FAKULTAS KEPERAWATAN
UNIVERSITAS AIRLANGGA

By : Setho Hadisuyatmana, S.Kep.Ns.

} Responses and
reactions may
vary during the
family process
In providing care to family,
it is prefer to have it for
families whose at risk by
any cause that could lead to
health problems; such as
inability and less informed
in helping their possible
problems
} Keluarga miskin belum kontak dengan sarana pelayanan
kesehatan dan belum mempunyai kartu sehat/BPJS
} Keluarga miskin sudah memanfaatkan sarana pelayanan
kesehatan mempunyai masalah kesehatan terkait dengan
pertumbuhan dan perkembangan balita, kesehatan
reproduksi, penyakit menular.
} Keluarga tidak termasuk miskin yang mempunyai masalah
kesehatan prioritas serta belum memanfaatkan sarana
pelayanan kesehatan
} Who lived in low social-economic or poor
} Who were unable to solve health problem
} Who lived with hereditary and disabilities
} Pregnants under16 y.o. or more than 35 y.o.
} Mal-nourished
} Primipara or multipara
} Labor complication history
} Premature
} Born with disabilities
} Weigh development problems
} Insufficiently breastfed
} Mother who suffer from tropical disease
} Attempted
abortion/unwanted child
} History with
abuse/domestic violence
} Frequent illness
} Divorce, decedent member
Family Stressors Family Stress Adaptation
Strategies

•FM experience, •Responses •Defends

envy, economy, Mechanism
socio-culture •Coping
Strategies
•Mastery/Control
} Stress : Response or stern condition which may
triggered by stressors and/or undone demands
(Antonovsky, 1979; Burr, 1973)
} Stressors : Trigger agents that activate stress
(Chrisman and Fowler, 1980) :
serious occasions which produce changes in
family system (Hill,1949).
} Adaptation : Conformation process towards
changes.
} Defends mechanism:
§ Habits, instinctive to respond
§ Tactics in avoiding troubles/problems of
stressors and usually as a way of unclear
solution nor accessible settlings.
§ Avoiding behavior : disfunctional to
problems
§ Exp.: denial to an important family issue
} Coping Strategy:
§ Positive strategy of an adaptation process
§ Efforts to solve individual problem faced to
his/her wellbeing demand, but really
suppress his/her sources (Lazarus et al,
1974).
} Mastery:
§ An outcome of an effective coping strategy
§ Coping is solved as a result of en effective
means and well-practiced
} Family group analysis, positive response, problem
based, affective, responding behavior used by
family and its subsystem to solve problems or
lessen stress which caused by some phenomenon.
} More complicated than individual coping
} Strategy source:
1. Internal : united family capability to be cohesive
and integrated; role flexibility.
2. External : social support system used by family.
} As an impact of ineffective resources and
adaptive strategies taken to solve stressors
threat.
} Disorganized period of a family, stressful
} Stipulates family resources, with unclear
completion.
} Usually the family was so receptive to advices
and information (Wallace, 1978)
} Process of family and social relationship
(Friedman, 1998)
} As the concept of social support as family
coping, either internal or external support are
beneficially proven.
} Instrumental : family as a practical an
concrete help
} Informational : family as a collector and
disseminator
} Appraisal : Family as guidance, feedback,
mediator, validator of family identity
} Emotional support
} Hill’s Family Stress Theory
Way of a family conformation after crisis
involve (1) disorganizing process, (2)
Reversion view, and (3) re-organizing and
new level in family function.

} ABCX McCubbin and Patterson’s Theory

Improved Hill’s ABCX theory
 Coping
Source

Family Crisis
Stressors Non
Crisis

Perception
on stressors

The existence of crisis depends on way of perceiving stressors

and the use of coping resources.
 Adaptation
b. B
New
Resources
b.
resources

a. a. A
stressors x. cumulative coping x. X
crisis

c.
‘a’ perception
c. C
Perception
of X-aA-bB Mal-
adaptation

ABCX McCubbin and Patterson’s

Every ABCX variable was re-tested
and its definition was modified
} aA : } bB :
five type of stressors which ability in fulfilling the
trigger the cumulative: requirements
1. Base stressor } cC :
2. Normative transition the definition and family
3. Previous stern meaning
4. Consequence of family } xX :
coping family adaptation
5. ambiguity
Another model:
Boss’ Contextual Family
Stress
} Stressful contact of a family member
with an external family forces
eg.: law, on job, school

} Stressful contact of whole family

members with an external family
forces
eg.: Poverty, discrimination

} Traditional Stressors
eg.: delivery, fm’s growth, marriage, additional
elder as member, moving, grieving

} Situational Stressors
unique, non-normative, idiosincratic
eg.: hospitalized member Child exposure to violence
} Antestress
before confronting the actual stressors,
anticipation is needed.
} Actual period
The most helping response usually internal and
efforts of spiritual support.
} Post stress
strategy is taken to reform family into new
homeostasis.
Stress phase period and Coping tasks
When nurses work with families, we (nurse) have to notice the precise time of
stress and coping goal of which family may take during every of three periods
(Friedman)
} Internal Strategies •External Strategies
1. Family group reckoning 1. Look for information
2. The use humors 2. Maintaining active
3. Problem meaning relationship with
control community
4. Gather to solve 3. Looking for social
problems: passive support :
appraisement, informal social support
cognitive reforming system
5. Role flexibility formal social support
6. Normalization system
independent group
system
4. Look for spiritual support
I. Denial of problems and family member
exploitation
II. Denial of family problems
III. Separated and grieving
IV. Otoritarianism :Rely on clear domination of
one family member

“All of which are prone to Violence”

} Non-physical exploitation
(emotional) :
scapegoat, use of impedance

} Passive emotional non-physical

exploitation :
child-elder neglect

} Physical-emotional exploitation :
Sexual harassment, family
violence, child abuse, parental
abuse
 } Actions that may not-
necessarily be classified
as criminal acts, but to
include abuses (one or
more) of:
◦ Physical and sexual
◦ Economic
◦ Coercion
◦ Acts to fear
◦ Child exposure to domestic
violence

Sexual Abuse of a child Family abuse/Domestic

Violence
} Visible denial in family conviction :
Family myths (problems considered to be
offensive or unimportant mater to discuss because
of its only worsen effect. ), the use impedance
(Denying the problems),

} Vindicated refusal trough emotional

space, habits, special traditions,
triangling, and pseudo-mutuality
(Ignoring the problems)
Denial of family problems
Adaptive mechanism in breaking the
ability to fulfill an affective function
} Triangling :
Having third person into conflict as alliance or
distraction

} Pseudomutuality
looks good in the outside but not inside,
formal, rigid, normative intimacy

Denial of family problems

Adaptive mechanism in breaking the
ability to fulfill an affective function
Detection Management Prevention
 Challenging the Taboo

Vague signs and symptoms

Complex social implications

 causes
screening questions
symptoms of abuse
resources in the community
} Problem } Bandura's Self-Efficacy
Identification Theory,
} Early case finding } Lazarus' Stress Theory,
} Health Education } Froma Walsh's Family
} Home Visit Resilience Framework, and
} Direct & Indirect McCubbin and Patterson’s
Care
Family Stress and Resilience
} Care Planning
Model.
} Counselling
Questions?