Senin, 19 Desember 2011

Format Pengkajian Kesehatan Jiwa Masyarakat Untuk Program Pendidikan Keperawatan

 

FORMAT PENGKAJIAN KEPERAWATAN KESEHATAN JIWA
KELUARGA / MASYARAKAT

Nama Kepala Keluarga                                      :
U m u r                                                             :
Suku / Ras                                                        :
A g a m a                                                          :
Menikah/tidak menikah/janda/duda                     :
Pendidikan                                                       :
Pekerjaan                                                         :
Alamat                                                              :
Jumlah Anak                                                     :
Jumlah Anak yang ada dirumah                          :
Jumlah Anak yang tidak ada dirumah                  :
Jumlah Anak yang sudah menikah                     :
Jumlah Anggota keluarga dalam rumah              :


I. A.     PENGKAJIAN BIOLOGIS
           
1. Perumahan                                        : Permanen/semi permanen.................
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            2. Kepemilikan rumah                            : Milik sendiri/Sewa/Kontrak/ Lain-lain
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            3. Kebersihan rumah                             : Bersih/cukup bersih/kurang bersih....
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            4. Jarak rumah keluarga dengan tetangga terdekat
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            5. Kebiasaan perilaku keluarga yang positif (menguntungkan)
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            6. Kebiasaan perilaku keluarga yang negatif (merugikan)
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7. Pelayanan Kesehatan yang tersedia      ...........................................................
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            8. Mutu Pelayanan Kesehatan yang tersedia
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            9. Jarak Pelayanan Kesehatan yang tersedia dengan rumah keluarga
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          10. Jenis obat yang sering dikonsumsi keluarga
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          11. Karakteristik lingkungan tempat tinggal keluarga
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          12. Tradisi yang sering dilakukan keluarga
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          13. Sikap keluarga terhadap tradisi tersebut
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          14. Apakah keluarga mau menerima perubahan
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          15. Siapa yang diuntungkan dengan perubahan itu
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   B.     PENGKAJIAN PSIKOSOSIAL

           16. Siapa pengambil keputusan dalam keluarga
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           17. Anggota keluarga yang sakit dan sebutkan jenis penyakitnya
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           18. Anggota keluarga (anak) usia  < 5 tahun
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           19. Anggota keluarga (usila) > 65 tahun       ..................................................................
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           20. Kasus perceraian dalam keluarga inti     ..................................................................
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           21. Anggota keluarga yang abnormal           ..................................................................
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           22. Anggota keluarga yang lari dari rumah   ..................................................................
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           23. Kejadian yang dapat menimbulkan masalah
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           24. Masalah yang pernah terjadi sampai 2 tahun kebelakang
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           25. Masalah yang mungkin terjadi pada 2 tahun kedepan
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           26. Hubungan antar anggota keluarga        ..................................................................
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           27. Kemampuan dan jenis koping keluarga  ..................................................................
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           28.Pola hubungan/interaksi dengan tetangga   
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           29. Keterlibatan keluarga didalam kegiatan kemasyarakatan
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30. Apakah ada orang lain yang sering membantu memecahkan masalah dalam keluarga                                        ..................................................................
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31. Pemahaman keluarga tentang sehat – sakit  jiwa
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32. Adakah anggota keluarga yang pernah dirawat / berobat karena mengalami gangguan /sakit jiwa, sudah sembuh atau belum, dan sekarang dirawat / tinggal dimana
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33. Penerimaan lingkungan terhadap anggota keluarga yang pernah dirawat/berobat karena gangguan jiwa                                   ..................................................................
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34. Bentuk penerimaan atau penolakan yang tampak
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35. Pengalaman kejadian krisis yang merupakan stressor bagi keluarga
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36. Harapan keluarga terhadap masa yang akan datang
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II. A.  MASALAH KEPERAWATAN KESEHATAN JIWA KELUARGA
           
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      B.  DIAGNOSA KEPERAWATAN KESEHATAN JIWA KELUARGA
           
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III.   RENCANA TINDAKAN KEPERAWATAN KESEHATAN JIWA KELUARGA
           
           
1.................................................................................................................................
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            2.................................................................................................................................
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            3.................................................................................................................................
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            4.................................................................................................................................
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            5..................................................................................................................................
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IV. IMPLEMENTASI DAN EVALUASI

NO DAN TANGGAL
IMPLEMENTASI KEPERAWATAN KESEHATAN JIWA KEL / MASY
EVALUASI
















































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  1. ASPEK PRESIPITASI DAN PRERDISPOSISI SERTA PENJELASAN TENTANG POIN POINT PENGKAJIAN

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