Prof. Dr.

Budi Anna Keliat, MAppSc

Hp. 08128100821
E-mail. Budianna_keliat@yahoo.com
DOSEN KEPERAWATAN JIWA FIK UI
 TANPA AKIBAT
NO KESEHATAN JIWA BENCANA BENCANA
(RISKESDAS, (WHO, 2005)
2007)
1 GANGGUAN JIWA 0.46 % 3-4 %
BERAT
2. GANGGUAN MENTAL 11.6 % 15 – 20 %
EMOSIONAL
3 STRES RINGAN - - 20 – 50 %
BERAT
 TANPA BENCANA AKIBAT BENCANA
NO KESEHATAN JIWA (RISKESDAS, (WHO, 2005)
2007)

1 GANGGUAN JIWA BERAT 20.160

0.32% (9 juta penduduk)

2. GANGGUAN MENTAL 863.100

EMOSIONAL
13.7%
3 STRES RINGAN – BERAT 1.8 – 4.5 juta
20-50%

4 SEHAT JIWA
4/23/2019 4
Kejadian yang menyebabkan
kerusakan fungsi masyarakat :
◦ Hilangnya nyawa dan fungsi tubuh manusia
◦ Kerusakan sarana dan prasarana
◦ Terganggunya perekonomian masyarakat,
◦ Gangguan ekologi kehidupan
◦ Segala dampaknya

Masyarakat yang terkena tidak

sanggup mengatasinya sendiri.
1 •ALAM

2 •NON ALAM

3 •SOSIAL
  Gempa bumi
 Gunung meletus
 Tsunami
 Banjir
 Kekeringan
 Angin topan
 Tanah longsor
 Kegagalan teknologi
 Wabah penyakit
Kebakaran
Kecelakaan
  Teroris
 Konflik Sosial
 Pembunuhan massal
TSUNAMI: ACEH, MENTAWAI

BANJIR BANDANG: WASIOR

GUNUNG MELETUS: MERAPI

PETA SEBARAN GUNUNGAPI INDONESIA
Gempa bumi Letusan Gunung
Merapi
Tsunami Tanah longsor
Banjir
Topan

Warning System

Prakiraan badai

Awan Badai Tropical Cyclone

BIOLOGI
Epidemi,
penyakit
tanaman, hewan,
SARS, Flu Burung
dll.

Kandang kurang Bersih ?

Korban Flu Burung

Bahaya Teknologi

Kecelakaan
Pesawat

Semburan lumpur
Sidoarjo

Akibat Radiasi Nuklir /

Radioaktif
LINGKUNGAN :
Kebakaran hutan

Memadamkan kebakaran hutan

 Teror

Tragedi Bom Bali

 Konflik

Konflik Sosial di Pontianak

SEBELUM SAAT SETELAH
BENCANA BENCANA BENCANA

4/23/2019 22
 Pre-Incident  Preparadness

 Impact (0-48 hours)

 Rescue (0- 1 week)  Emergency
 Recovery (1-4 weeks)

 Return to Life ( 2 years)  Rehabilitation

Goals Preparation, improve coping
Behavior Preparation versus denial
Role of all Prepare, train, gain knowledge
helpers
Role of mental Prepare
health Train
professionals Gain knowledge
Collaborate with public officials
Inform and influence policy
Set structures for rapid assistance
Goals Survival, communication
Behavior Fight/flight, freeze, surrender, etc.
Role of all Rescue, protect
helpers
Role of mental Basic Needs*
health Establish safety/security/survival
professionals Ensure food and shelter
Provide orientation
Facilitate communication with family, friends and community
Assess the environment for ongoing threat/toxins

Psychological First Aid*

Maintain support and “presence” for those who are most
distressed
Keep families together and facilitate reunion with loved ones
Provide information, foster communication and education (ie,
services)
Protect survivors from further harm
Reduce physiological arousal
Monitoring the Impact Environment
Observe and listen to those most affected
Monitor the environment for stressors

Technical Assistance, Consultation, and Training*

Improve capacity of organizations and caregivers to
provide what is needed to reestablish community
structure, foster family recovery/resilience, and safeguard
the community
Provided to:
- Relevant organizations
- Other caregivers and responders
- Leaders
Goals Adjustment
Behavior Resilience versus exhaustion
Role of all Orientation, provision, of needs
helpers
Role of mental Needs Assessment*
health Assess current status, how well needs addressed, recovery
professionals environment, what additional interventions are needed for:
- Group
- Population
- Individual

Triage*
Clinical assessment
Refer when indicated
Identify the vulnerable, high-risk individuals and groups
Emergency hospitalization or outpatient treatment
 Rescue (0-1 week)
Outreach and Information Dissemination
Make contact with and identify people who have not requested
services (ie, “Therapy by walking around”)
Inform people about different services, coping, recovery process,
etc. (ie, by using established community structures, flyers, Web
sites)

Fostering Resilience/Recovery*
Social interactions
Coping skills training
Education about: stress response, traumatic reminders, coping,
normal versus abnormal functioning, risk factors, services
Group and family support
Fostering natural social support
Looking after the bereaved
Repairing organizational fabric (eg, operational debriefings when
this is standing procedure in responder organizations)
Spiritual support
Goals Appraisal/planning
Behavior Grief, reappraisal, intrusive memories, narrative formation
Role of all Responsiveness, sensitivity
helpers
Role of mental Monitor the recovery environment*
health Observe and listen to those most affected
professionals Monitor the environment for toxins
Monitor past and ongoing threats
Monitor services that are being provided
Goals Re-Integration
Behavior Adjustment versus phobias, PTSD, avoidance, depression,
etc.
Role of all Continuity of assistance
helpers
Role of mental Treatment
health Reduce or ameliorate symptoms or improve functioning via:
professionals individual, family and group psychotherapy
Pharmacotherapy
Short-term or long-term hospitalization
 Spiritual
Biology Social

Psychology Cultural
 CEDERA/
SAKIT BIO PSIKO Tanda dan Gejala
Ansietas & Dpresi

Tanda dan gejala SOSIAL

Fisik
Fungsi Sosial
Terganggu
 BENCANA
PSIKO BIO Sakit Kepala,
Pernafasan,
Pencernaan,
Tidur

Tanda dan gejala SOSIAL

Ansietas/Depresi/
Fungsi Sosial
PTSD
Terganggu
 BENCANA

SOSIAL BIO Sakit Kepala,

Pernafasan,
Pencernaan,
Kehilangan : Tidur
Orang yg dicintai,
Pekerjaan, PSIKO
Tempat tinggal Ansietas,
Depresi,
PTSD
Trauma 2 wks. 1 mo. 6 mo.

Acute Stress Reaction

Grieving/Bereavement

Depression

Anxiety Disorders

PTSD

Psychosis, Schizophrenia

Adjustment Disorders

Exacerbation of previous mental disorders

Substance abuse, Eating, Sleep Disorders

• PERAWATAN • PERAWATAN
FISIK: JIWA:
• MB • PERAWAT JIWA
• MATERNITAS • PSIKIATER
• ANAK
• PSIKOLOG
BIO PSIKO

• PERAWATAN SPI: SPI SOS • PERAWATAN

SOSIAL:
•PEMUKA AGAMA
•TIM KES
• PEK SOS
• TIM KESWA
• SEKTOR TERKAIT
 JIWA

MAT KOM
MANUSIA

ANAK MB
 MASALAH KESWA:
◦ Ansietas
◦ Depressi
◦ PTSD
◦ Gangguan Jiwa
 DIAGNOSIS KEPERAWATAN
 Ansiets
 Risiko Bunuh Diri
 Keputusasaan
 Ketidakberdayaan
 Harga diri rendah (situasional)
 PTSD
 Diagnosis keperawatan terkait Psikosis
  SAKIT KEPALA
 SUSAH TIDUR
 TIDAK NAFSU MAKAN
 GEMETARAN
 GELISAH
 SUKAR KONSENTRASI
 SUKAR MEMUTUSKAN
 MERASA TIDAK AMAN
SEBELUM SAAT SETELAH
BENCANA BENCANA BENCANA

4/23/2019 42
 Pre-Incident  Preparadness

 Impact (0-48 hours)

 Rescue (0- 1 week)  Emergency
 Recovery (1-4 weeks)

 Return to Life ( 2 years)  Rehabilitation

Goals Preparation, improve coping
Behavior Preparation versus denial
Role of all Prepare, train, gain knowledge
helpers
Role of mental Prepare
health Train
professionals Gain knowledge
Collaborate with public officials
Inform and influence policy
Set structures for rapid assistance
Goals Survival, communication
Behavior Fight/flight, freeze, surrender, etc.
Role of all Rescue, protect
helpers
Role of mental Basic Needs*
health Establish safety/security/survival
professionals Ensure food and shelter
Provide orientation
Facilitate communication with family, friends and community
Assess the environment for ongoing threat/toxins

Psychological First Aid*

Maintain support and “presence” for those who are most
distressed
Keep families together and facilitate reunion with loved ones
Provide information, foster communication and education (ie,
services)
Protect survivors from further harm
Reduce physiological arousal
Monitoring the Impact Environment
Observe and listen to those most affected
Monitor the environment for stressors

Technical Assistance, Consultation, and Training*

Improve capacity of organizations and caregivers to
provide what is needed to reestablish community
structure, foster family recovery/resilience, and safeguard
the community
Provided to:
- Relevant organizations
- Other caregivers and responders
- Leaders
Goals Adjustment
Behavior Resilience versus exhaustion
Role of all Orientation, provision, of needs
helpers
Role of mental Needs Assessment*
health Assess current status, how well needs addressed, recovery
professionals environment, what additional interventions are needed for:
- Group
- Population
- Individual

Triage*
Clinical assessment
Refer when indicated
Identify the vulnerable, high-risk individuals and groups
Emergency hospitalization or outpatient treatment
 Rescue (0-1 week)
Outreach and Information Dissemination
Make contact with and identify people who have not requested
services (ie, “Therapy by walking around”)
Inform people about different services, coping, recovery process,
etc. (ie, by using established community structures, flyers, Web
sites)

Fostering Resilience/Recovery*
Social interactions
Coping skills training
Education about: stress response, traumatic reminders, coping,
normal versus abnormal functioning, risk factors, services
Group and family support
Fostering natural social support
Looking after the bereaved
Repairing organizational fabric (eg, operational debriefings when
this is standing procedure in responder organizations)
Spiritual support
Goals Appraisal/planning
Behavior Grief, reappraisal, intrusive memories, narrative formation
Role of all Responsiveness, sensitivity
helpers
Role of mental Monitor the recovery environment*
health Observe and listen to those most affected
professionals Monitor the environment for toxins
Monitor past and ongoing threats
Monitor services that are being provided
Goals Re-Integration
Behavior Adjustment versus phobias, PTSD, avoidance, depression,
etc.
Role of all Continuity of assistance
helpers
Role of mental Treatment
health Reduce or ameliorate symptoms or improve functioning via:
professionals individual, family and group psychotherapy
Pharmacotherapy
Short-term or long-term hospitalization
 Gangguan kecemasan yang dapat terjadi dari sebuah
peristiwa atau pengalaman yang
menakutkan/mengerikan, sulit dan tidak
menyenangkan dan terdapat penganiayaan fisik atau
perasaan terancam (APA ,2000)

 Gangguan kecemasan yang terjadi pasca trauma atau

terkena semacam kejadian traumatik. (National Institute
of Mental Health ,2008)

 Sindrom yang dialami oleh seseorang yang mengalami

kejadian traumatis dan individu tersebut tidak mampu
menghilangkan ingatan akan kejadian tersebut dari
pikirannya (Stuart & Laraia, 2005).
 Masalah/gangguan pada fisik dan psikologis
sebagai akibat dari kejadian yang menekan
atau mengancam kehidupan, yaitu:
◦ bencana alam
◦ perang
◦ kekerasan fisik, seksual dan emosional,
◦ kecelakaan
◦ semua kejadian yang membuat seseorang merasa
tertekan, putus asa dan merasa dirinya dalam bahaya

(National Institute for Clinical Excellence,2005)

 Mengalami bencana
 Melihat orang lain terluka atau
meninggal,
 Perasaan tertekan, tidak berdaya dan
ketakutan yang amat sangat,
 Menghadapi banyak kejadian traumatis,
seperti kehilangan anggota keluarga,
kehilangan rumah atau pekerjaan
 Memiliki masalah kesehatan
 Mencari dukungan dari orang lain
 Memiliki support group setelah
kejadian traumatis
 Memiliki strategi koping yang
efektif
 Bertindak dan berespon secara
efektif
 Keyakinan / agama
 •Re-Experiencing Symptoms
1

•Avoidance Symptoms
3

•Hyperarousal Symptoms
2
1. Merasakan kembali peristiwa traumatik
tersebut (Re-Experiencing Symptoms)
◦ Secara berkelanjutan memiliki pikiran atau ingatan yang tidak
menyenangkan mengenai peristiwa traumatik tersebut
(Frequently having upsetting thoughts or memories about a
traumatic event).
◦ Mengalami mimpi buruk yang terus menerus berulang (Having
recurrent nightmares).
◦ Bertindak atau merasakan seakan-akan peristiwa traumatik
tersebut akan terulang kembali, terkadang ini disebut sebagai
"flashback" (Acting or feeling as though the traumatic event
were happening again, sometimes called a "flashback").
◦ Memiliki perasaan menderita yang kuat ketika teringat
kembali peristiwa traumatik tersebut (Having very strong
feelings of distress when reminded of the traumatic event).
◦ Terjadi respon fisikal, seperti jantung berdetak kencang atau
berkeringat ketika teringat akan peristiwa traumatik tersebut
(Being physically responsive, such as experiencing a surge in
your heart rate or sweating, to reminders of the traumatic
event).
2. Menghindar (Avoidance Symptoms)
◦ Berusaha keras untuk menghindari pikiran, perasaan atau pembicaraan
mengenai peristiwa traumatik tersebut (Making an effort to avoid thoughts,
feelings, or conversations about the traumatic event).
◦ Berusaha keras untuk menghindari tempat atau orang-orang yang dapat
mengingatkan kembali akan peristiwa traumatik tersebut (Making an effort to
avoid places or people that remind you of the traumatic event).
◦ Sulit untuk mengingat kembali bagian penting dari peristiwa traumatik
tersebut (Having a difficult time remembering important parts of the traumatic
event).
◦ Kehilangan ketertarikan atas aktifitas positif yang penting (A loss of interest in
important, once positive, activities).
◦ Merasa "jauh" atau seperti ada jarak dengan orang lain (Feeling distant from
others).
◦ Mengalami kesulitan untuk merasakan perasaan-perasaan positif, seperti
kesenangan / kebahagiaan atau cinta / kasih sayang ( Experiencing difficulties
having positive feelings, such as happiness or love).
◦ Merasakan seakan-akan hidup anda seperti terputus ditengah-tengah - anda
tidak berharap untuk dapat kembali menjalani hidup dengan normal, menikah
dan memiliki karir (Feeling as though your life may be cut short - you don’t
expect to live a normal life span, get married, have a career).
3. Waspada (Hyperarousal Symptoms)
◦ Sulit untuk tidur atau tidur tapi dengan gelisah
(Having a difficult time falling or staying asleep).
◦ Mudah / lekas marah atau meledak-ledak
(Feeling more irritable or having outbursts of
anger).
◦ Memiliki kesulitan untuk berkonsentrasi (Having
difficulty concentrating).
◦ Selalu merasa seperti sedang diawasi atau merasa
seakan-akan bahaya mengincar di setiap sudut
"Feeling constantly "on guard" or like danger is
lurking around every corner".
◦ Menjadi gelisah, tidak tenang, atau mudah
"terpicu" / sangat "waspada" (Being "jumpy" or
easily startled).
 Kegiatan di Tempat Pengungsian
 Kegiatan di barak pengungsian
pengganti rumah tempat tinggal
 Kegiatan di rumah atau kembali
ke desa
 DSSJ&KKJ

BARAK
KEMBALI KE
PENGUNGSIAN PENGGANTI
KAMPUNG/DESA
TEMPAT TINGGAL

DSSJ&KKJ
KELOMPOK BESAR (SELURUH PENGUNGSI)

KELOMPOK KECIL

INDIVIDU/KELUARGA
DESA SIAGA SEHAT JIWA

KADER KESEHATAN JIWA

MASYARAKAT SEHAT JIWA

PELAYANAN KESEHATAN JIWA KAB/KOTA

PELAYANAN KESWA PUSKESMAS

DESA SIAGA SEHAT JIWA

KADER KESWA

KELUARGA-INDIVIDU
  PENDEKATAN KELOMPOK BESAR

 PENDEKATAN KELOMPOK KECIL

 PENDEKATAN KELUARGA & INDIVIDU

 FISIK

LINGKUNGAN PIKIRAN

SPIRITUAL SOSIAL
 DEWASA
 LANSIA
 REMAJA
 ANAK
 Bercakap-cakap tentang :
◦ perasaan,
◦ harapan,
◦ keinginan,
◦ hal positif yang masih dapat disyukuri

Kelompok dukungan sosial

membangun harapan masa depan yang realistis.
MEMBANGUN KELUARGA YANG
HARMONIS

 KOMUNIKASI TERBUKA
 SALING MENGHARGAI (VIP)
 SALING MENOLONG
 BERUBAH BUKAN MERUBAH
 BERPIKIR POSITIF
 PEDULI
 SETIA
 Bercakap-cakap :
◦ tentang perasaan,
◦ berikan informasi tentang kegiatan yang dilakukan
di pengungsian,
◦ berbagi pengalaman masa lalu yang sukses,
◦ lakukan pendampingan untuk masalah dan
kebutuhan lansia

Lansia merupakan kelompok yang butuh

perhatian dan rentan
  Olah raga
 Musik, tari, bernyanyi
 Menulis
 Aktivitas sosial
 Latihan membangun percaya diri
dan harga diri.
  Bermain
 Menggambar
 Musik, Bernyanyi, Menari
 Berceritra
 Olah raga
 Pemutarn film kartun atau
film anak-anak.
  Kehilangan
 Penyakit fisik
 Penyakit jiwa