E-Learning Keperawatan: 12/02/08

Tuesday, December 02, 2008

TEORI LEININGER

Author : Luzni Novita Lestari
NPM : 22011180046

DASAR - DASAR KONSEP TEORI LEININGER

Tahun 1940an : caring penting dalam keperawatan dan care adalah etos dominan keperawatan.

Tahun 1950an : cultural shock yaitu adanya recurrent behavioral differences,perbedaan ini punya dasar kultural.

Kurangnya pengetahuan tentang kultural anak sebagai missing link dalam keperawatan untuk memahami variasi dalam perawatan klien.
Tahun 1979 : Transcultural care yaitu suatu sub bidang pelajaran atau cabang keperawatan yang berfokus pada studi komparatif dan analisis kultural mengenai praktek, keyakinan dan nilai - nilai keperawatan dan perawatan sehat sakit.

TUJUAN :
Menyediakan/memberikan pelayanan asuhan perawatan yang bermutu dan efektif kepada orang lain berdasarkan nilai - nilai kultural mereka dan konteks sehat sakit. Dibangun dari pemikiran bahwa manusia dari tiap kebudayaan tidak hanya dapat mengetahui dan mendefinisikan pengalaman dan perasaan dunia keperawatan mereka tetapi juga dapat menghubungkan pengalaman dan perasaan itu ke kepercayaan dan praktek kesehatan umum mereka.

KONSEP TEORI LEININGER
Tahun 1991, definisi yang lebih berorientasi untuk konsep : culture, cultural care diversity, cultural care universality, nursing, worldview,dimensi struktur budaya dan social, konteks lingkungan, ethnohistory, generic ( folk or lay) care system, sistem perawatan profesional, kesehatan,care/caring, culture care preservation, accomodation dan repatterning.

Budaya : keseluruhan nilai, kepercayaan, norma dan cara hidup yang di pelajari, dibagi dan di transmisikan dalam kelompok tertentu yang menuntun mereka dalam berpikir, mengambil keputusan dan bertindak dalam pola tertentu.
Melekat dalam : bahasa, agama, sosial, politik, pendidikan, ekonomi, teknologi lingkungan.
Cultural care : yang membantu, mendukung untuk memelihara kondisi dan meningkatkan kesehatan.
Cultural Care Preservation : maintenance
Cultural Care Accomodation : negotiation
Cultural care Repatterning : restrukturisasi
Health : status keadaan manusia yang secara kultural merefleksikan kemampuan melakukan aktifitasharian dalam cara hidup yang terpola.

Development of the theory

Dikembangkan terutama sekali untuk menemukan jalan dan maksud dalam memberi kepedulian terhadap masyarakat yang mempunyai nilai - nilai berbeda dan jalan hidup masing - masing.
Di desain untuk memandu perawat dalam menyediakan pelayanan keperawatan.
Teori ini tidak hanya bepusat pada interaksi perawat klientetapi berfokus juga meliputi kepedulian keluarga, kelompok , masyarakat , kultur dan institusi.

Teori Leininger dan Paradigma Keperawatan
Leininger mengkritisi empat konsep keperawatan yaitu manusia, kesehatan, lingkungan dan keperawatan.

Definisi konseptual menurut asumsi dan teori dari M.Leininger

Manusia seseorang yang diberi perawatan dan harus diperhatikan kebutuhannya.
Kesehatan : konsep yang penting dalam perawatan transkultural.
Lingkungan tidak didefinisikan secara khusus, namun jika dilihat bahwa telah terwakili dalam kebudayaan, maka lingkungan adalah inti utama dari teori M. Leininger.
Keperawatan. Beliau menyajikan 3 tindakan yang sebangun dengan kebudayaan klien yaitu cultural care preservation, accomodation dan repatterning.

KASUS
Seorang wanita bersuku jawa, bernama ny. M berumur 61 tahun, pendidikan terakhir S1 dengan gelar Spd, masuk rumah sakit 3 hari yang lalu karena stroke dan sedang dalam masa pemulihan . Sekarang diamenderita kelemahan pada tubuh bagian kiri.Dia dirawat di RS B di kelas 1 dengan 1 orang pasien lainnya. Sebelum dia masuk rumah sakit karena stroke Ny.M memelihara rumahnya sendiri dan cukup mandiri. Dia merupakan wanita yang ulet dan mandiri serta percaya dengan kemampuannya sendiri. Dia mengatakan bahwa dia juga aktif berpolitik. rumahnya berada di linhkungan tempat tinggal yang masih memegang kepercayaan tradisional yaitu tidak boleh merubah bentuk rumah sehingga daerah itu mempunyai nilai historis.

Pembahasan :
Pengkajian : Dikaji berdasar aspek - aspek yang biasanya melekat dalam budaya antara lain :

Kinship dan struktur sisial : janda dengan dua anak, aktif dalam kelompok lansia dan menjadi tenaga sukarela bagian administrasi ditempatnya bekerja 1x seminggu.
Profesional : dokter merupakan kepala tim dan profesi lainnya juga merupakan bagian dari tim.
Keperawatan juga bagian dari tim, mengidentifikasi kebutuhan perawatan makan yaitu kebutuhan ADL.

Diagnosa keperawatan:
Berdasarkan dari area Diversity dan Universality yang belum terpenuhi, termasuk kebutuhan akan kemandirian akan mobilitas, makan, BAB, BAK dan kebutuhan interaksi dengan orang lain dalam kelompok lansia.

Perencanaan:
Pemberian keperawatan berdasarkan kebudayaan (cultural care preservation), pengakomodasian perawatan bwerdasarkan kebudayaan, restrukturisasi perawatan berdasarkan kebudayaan ( cultural care repatterning) atau kombinasi dari ketiga-tiganya.

Implementasi

Pemeliharaan ( preservation ): membantu Ny.M melakukan hubungan dengan anggota kelompok lansia yang lain.
Akomodasi : membantunya dalam belajar menggunakan alat bantu jalan.
Repatterning : menemaninya makan dengan menggunakan tangan kanan.

Evaluasi:

Apakah sudah terpenuhi cultural diversity dan universality?
Apakah ny.M bisa memandang dirinya untuk melanjutkan kemandirian?

Kesimpulan:

Teori Leininger pada intinya menitik beratkan pada kebudayaan seseorang.
Teori Leininger telah di usahakan untuk dapat diaplikasikan kedalam berbagai budaya oleh penemunya yaitu Madeleine M. Leininger.
kekuatan utama dari teori ini adalah pentingnya pengenalan budaya dan pengaruhnya terhadap perawatan perawatan pasien.
Teori Leininger sangat diperlukan dan membantu dalam praktek keperawatan, serta mendukung dalam pelaksanaan asuhan keperawatan.
Dalam pelaksanaan asuhan keperawatan, perawat perlu memahami norma - norma dan cara hidup budaya dari klien sehingga klien dapat mempertahankankesejahteraannya, memperbaiki cara hidupnya atau kondisinya.
Pemberian informasi mengenai penyakit dan prosedur pengobatan kepada klien/keluarga klien akan membantu kelancaran pengobatannya.

saran

Hendaknya ada pemberian informasi yang jelas dari perawat kepada klien, sehingga tidak ada suatu penolakan klien dalam pengobatannya.
Walaupun klien termasuk orang yang berpendidikan , hendaknya klien menerima anjuran yang diberikan dokter yang menanganinya.
Seharusnya perawat lebih memperhatikan kebutuhan klien.

References :
www.madeleine-leininger.com
www.fik.ui.edu
nursingart.blogspot.com/2008/07/nursing-theory

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Blog Contents

Florence Nightingales’s Environmental Theory

by Sudiryo NPM 220111080041

Florence Nightingales’s Environmental Theory

Defined Nursing: “The act of utilizing the environment of the patient to assist him in his recovery.”
Focuses on changing and manipulating the environment in order to put the patient in the best possible conditions for nature to act.
Identified 5 environmental factors: fresh air, pure water, efficient drainage, cleanliness/sanitation and light/direct sunlight.
Considered a clean, well-ventilated, quiet environment essential for recovery.
Deficiencies in these 5 factors produce illness or lack of health, but with a nurturing environment, the body could repair itself.

Virginia Henderson’s Definition of the Unique Function of Nursing

By Sudiryo NPM 220111080041

Virginia Henderson’s Definition of the Unique Function of Nursing

Defined Nursing: “Assisting the individual, sick or well, in the performance of those activities contributing to health or it’s recovery (or to peaceful death) that an individual would perform unaided if he had the necessary strength, will or knowledge”.
Identified 14 basic needs :
1. Breathing normally
2. Eating and drinking adequately
3. Eliminating body wastes
4. Moving and maintaining desirable position
5. Sleeping and resting
6. Selecting suitable clothes
7. Maintaining body temperature within normal range
8. Keeping the body clean and well-groomed
9. Avoiding dangers in the environment
10. Communicating with others
11. Worshipping according to one’s faith
12. Working in such a way that one feels a sense of accomplishment
13. Playing/participating in various forms of recreation
14. Learning, discovering or satisfying the curiosity that leads to normal development and health and using available health facilities.

Calixta Roy’s Adaptation Theory

By Sudiryo NPM 220111080041

Calixta Roy’s Adaptation Theory

Viewed humans as Biopsychosocial beings constantly interacting with a changing environment and who cope with their environment through Biopsychosocial adaptation mechanisms.
Focuses on the ability of Individuals., families, groups, communities, or societies to adapt to change.
The degree of internal or external environmental change and the person’s ability to cope with that change is likely to determine the person’s health status.
Nursing interventions are aimed at promoting physiologic, psychologic, and social functioning or adaptation.

Jean Watson’s The Philosophy and Science of Caring

By Sudiryo NPM 220111080041

Jean Watson’s The Philosophy and Science of Caring

Nursing is concerned with promotion health, preventing illness, caring for the sick, and restoring health.
Nursing is a human science of persons and human health-illness experiences that are mediated by professional, personal, scientific, esthetic and ethical human care transactions
She defined caring as a nurturant way or responding to a valued client towards whom the nurse feels a personal sense of commitment and responsibility. It is only demonstrated interpersonally that results in the satisfaction of certain human needs. Caring accepts the person as what he/she may become in a caring environment
Carative Factors:

1. The promotion of a humanistic-altruistic system of values
2. Instillation of faith-hope
3. The cultivation of sensitivity to one’s self and others
4. The development and acceptance of the expression of positive and negative feelings.
5. The systemic use of the scientific problem-solving method for decision making
6. The promotion of interpersonal teaching-learning
7. The provision for supportive, protective and corrective mental, physical, socio-cultural and spiritual environment
8. Assistance with the gratification of human needs
9. The allowance for existential phenomenological forces

Dorothea Orem’s Self-Care Theory

By Sudiryo, NPM 220111080041

Dorothea Orem’s Self-Care Theory

Defined Nursing: “The act of assisting others in the provision and management of self-care to maintain/improve human functioning at home level of effectiveness.”
Focuses on activities that adult individuals perform on their own behalf to maintain life, health and well-being.
Has a strong health promotion and maintenance focus.
Identified 3 related concepts:
1. Self-care - activities an Individual performs independently throughout life to promote and maintain personal well-being.
2. Self-care deficit - results when self-care agency (Individual’s ability) is not adequate to meet the known self-care needs.
3. Nursing System - nursing interventions needed when Individual is unable to perform the necessary self-care activities:
  1. Wholly compensatory - nurse provides entire self-care for the client.
    - Example: care of a new born, care of client recovering from surgery in a post-anesthesia care unit
  2. Partial compensatory - nurse and client perform care, client can perform selected self-care activities, but also accepts care done by the nurse for needs the client cannot meet independently.
    - Example: Nurse can assist post operative client to ambulate, Nurse can bring a meal tray for client who can feed himself
  3. Supportive-educative - nurse’s actions are to help the client develop/learn their own self-care abilities through knowledge, support and encouragement.
- - - Example: Nurse guides a mother how to breastfeed her baby, Counseling a psychiatric client on more adaptive coping strategies.

Madeleine Leininger’s Transcultural Care Theory and Ethno-nursing

Madeleine Leininger’s Transcultural Care Theory and Ethnonursing

Nursing is a learned humanistic and scientific profession and discipline which is focused on human care phenomena and activities in order to assist, support, facilitate, or enable individuals or groups to maintain or regain their well being (or health) in culturally meaningful and beneficial ways, or to help people face handicaps or death.
Transcultural nursing as a learned subfield or branch of nursing which focuses upon the comparative study and analysis of cultures with respect to nursing and health-illness caring practices, beliefs and values with the goal to provide meaningful and efficacious nursing care services to people according to their cultural values and health-illness context.
Focuses on the fact that different cultures have different caring behaviors and different health and illness values, beliefs, and patterns of behaviors.
Awareness of the differences allows the nurse to design culture-specific nursing interventions.

Hildegard Peplau’s Interpersonal Relations Theory

Hildegard Peplau’s Interpersonal Relations Theory

Defined Nursing: “An interpersonal process of therapeutic interactions between an Individual who is sick or in need of health services and a nurse especially educated to recognize, respond to the need for help.
Nursing is a “maturing force and an educative instrument”
Identified 4 phases of the Nurse - Patient relationship:
1. Orientation - individual/family has a “felt need” and seeks professional assistance from a nurse (who is a stranger). This is the problem identification phase.
2. Identification - where the patient begins to have feelings of belongingness and a capacity for dealing with the problem, creating an optimistic attitude from which inner strength ensues. Here happens the selection of appropriate professional assistance.
3. Exploitation - the nurse uses communication tools to offer services to the patient, who is expected to take advantage of all services.
4. Resolution - where patient’s needs have already been met by the collaborative efforts between the patient and the nurse. Therapeutic relationship is terminated and the links are dissolved, as patient drifts away from identifying with the nurse as the helping person.

Faye Glenn Abdellah’s Concept of Twenty One Nursing Problems

by Sudiryo, NPM : 220111080041

Faye Glenn Abdellah’s Concept of Twenty One Nursing Problems

Nursing is broadly grouped into 21 problem areas to guide care and promote the use of nursing judgement.
Nursing is a comprehensive service that is based on the art and science and aims to help people, sick or well, cope with their health needs.

21 Nursing Problems

To maintain good hygiene.
To promote optimal activity; exercise, rest and sleep.
To promote safety.
To maintain good body mechanics
To facilitate the maintenance of a supply of oxygen
To facilitate maintenance of nutrition
To facilitate maintenance of elimination
To facilitate the maintenance of fluid and electrolyte balance
To recognize the physiologic response of the body to disease conditions
To facilitate the maintenance of regulatory mechanisms and functions
To facilitate the maintenance of sensory functions
To identify and accept positive and negative expressions, feelings and reactions
To identify and accept the interrelatedness of emotions and illness.
To facilitate the maintenance of effective verbal and non-verbal communication
To promote the development of productive interpersonal relationship
To facilitate progress toward achievement of personal spiritual goals
To create and maintain a therapeutic environment
To facilitate awareness of self as an individual with varying needs.
To accept the optimum possible goals
To use community resources as an aid in resolving problems arising from illness.
To understand the role of social problems as influencing factors

Rosemarie Rizzo Parse’s Theory of Human Becoming

Martha Roger’s Concept of Science of Unitary Human Beings, and Principles of Homeodynamics

By Sudiryo NPM 220111080041

Martha Roger’s Concept of Science of Unitary Human Beings, and Principles of Homeodynamics

Nursing is an art and science that is humanistic and humanitarian. It is directed toward the unitary human and is concerned with the nature and direction of human development. The goal of nurses is to participate in the process of change..
Nursing interventions seek to promote harmonious interaction between persons and their environment, strengthen the wholeness of the Individual and redirect human and environmental patterns or organization to achieve maximum health.
5 basic assumptions:

1. The human being is a unified whole, possessing individual integrity and manifesting characteristics that are more than and different from the sum of parts.
2. The individual and the environment are continuously exchanging matter and energy with each other
3. The life processes of human beings evolve irreversibly and unidirectionally along a space-time continuum
4. Patterns identify human being and reflect their innovative wholeness
5. The individual is characterized by the capacity for abstraction and imagery, language and thought, sensation and emotion