FORMAT PENGKAJIAN KEPERAWATAN KESEHATAN JIWA KELUARGA/MASYARAKAT



FORMAT PENGKAJIAN KEPERAWATAN KESEHATAN JIWA KELUARGA/MASYARAKAT

Nama Kepala Keluarga      :
Umur                                  :
Suku/Ras                            :
Status Pernikahan               :
Pendidikan                         :
Pekerjaan                            :
Alamat                                            :
Jumlah Anak                                  :
Jumlah Anak Yang Ada Di Rumah :
Jumlah Anak Yang Tidak Ada Di Rumah :
Jumlah Anak Yang Sudah Menikah :
Jumlah Anggota Keluarga Dalam Rumah  :

A. PENGKAJIAN BIOLOGIS
       1. Perumahan              : Permanen/ semi permanen
            ....................................................................................................
       2. Kepemilikan Rumah           : Milik sendiri/ sewa/ kontrakan/ lain-lain
            ....................................................................................................
       3. Kebersihan Rumah  : Bersih/ Cukup Bersih/ Kurang Bersih
              ....................................................................................................
         ....................................................................................................
         ....................................................................................................


4. Jarak Rumah dengan Rumah Tetangga Terdekat:
....................................................................................................
            5. Kebiasaan Perilaku Keluarga yang Menguntungkan (Positif): ....................................................................................................
            ....................................................................................................
       ....................................................................................................
            6. Kebiasaan perilaku kelurga yang merugikan (Negatif) : .....................................................................................................
            ....................................................................................................
7. Pelayanan kesehatan yang tersedia :
       ....................................................................................................
       ....................................................................................................
            ....................................................................................................
8. Mutu pelayanan kesehatan yang tersedia :
       ....................................................................................................
             ....................................................................................................
9. Jarak pelayanan kesehatan yang tersedia dengan rumah : ......................................................................................................
 ....................................................................................................
10. Jenis obat yang dikonsumsi keluarga :
       ....................................................................................................
            ....................................................................................................
11. Karakteristik lingkungan tempat tinggal  keluarga :
        ....................................................................................................
       ....................................................................................................
12. Tradisi yang sering dilakukan keluarga : .....................................................................................................
       ....................................................................................................
13. Sikap keluarga terhadap tradisi tersebut :
             ....................................................................................................
             ....................................................................................................
14. Apakah keluarga mau menerima perubahan :
             ....................................................................................................
             ....................................................................................................
15. Siapa yang diuntungkan dalam perubahan tersebut :
             ....................................................................................................
             ....................................................................................................
B. PENGKAJIAN PSIKOSOSIAL
      
            1. Siapa yang mengambil keputusan dalam keluarga: ....................................................................................................
            ....................................................................................................
       ....................................................................................................
            2. Anggota keluarga yang sakit dan penyakitnya : .....................................................................................................
            ....................................................................................................
3. Anggota keluarga (anak) usia < 5 tahun  :
       ....................................................................................................
       ....................................................................................................
            ....................................................................................................
4. Anggota keluarga (usila) usia > 65 tahun  :
       ....................................................................................................
             ....................................................................................................
5. Kasus perceraian dalam keluarga inti : ......................................................................................................
 ....................................................................................................
6.  Anggota keluarga yang abnormal:
       ....................................................................................................
            ....................................................................................................
7. Anggota keluarga yang lari dari rumah :
        ....................................................................................................
       ....................................................................................................
8 . Kejadian yang dapat menimbulkan masalah : .....................................................................................................
       ....................................................................................................
9. Masalah yang terjadi sampai 2 tahun belakangan ini :
             ....................................................................................................
             ....................................................................................................
10. Masalah yang mungkin terjadi 2 tahun ke depan :
             ....................................................................................................
             ....................................................................................................
11. Hubungan antar anggota keluarga :
             ....................................................................................................
             ....................................................................................................
12.  Kemampuan dan jenis koping keluarga:
       ....................................................................................................
            ....................................................................................................
13. Pola hubungan/ interaksi dlam keluarga :
        ....................................................................................................
       ....................................................................................................
14 . Keterlibatan keluarga dalam kegiatan masyarakat : .....................................................................................................
       ....................................................................................................
15. Apakah ada orang lain yang sering membantu memecahkan masalah dalam keluarga :
             ....................................................................................................
             ....................................................................................................
16. Pemahaman keluarga tentang sehat sakit :
             ....................................................................................................
             ....................................................................................................
17. Apakah anggota keluarga pernah dirawat/ berobat karena gangguan jiwa :
             ....................................................................................................
             ....................................................................................................
18. Penerimaan lingkungan terhadap anggota keluarga yang pernah dirawat/ berobat karena gangguan jiwa :
        ....................................................................................................
       ....................................................................................................
19 . Bentuk penerimaan atau penolakan yang tampak: .....................................................................................................
       ....................................................................................................
20. Pengalaman kejadian/ krisis yang merupakan stressor bagi keluarga :
             ....................................................................................................
             ....................................................................................................
21. Harapan keluarga terhadap masa yang akan datang :
             ....................................................................................................
             ....................................................................................................





C. MASALAH KEPERAWATAN
             ....................................................................................................
             ....................................................................................................
             ....................................................................................................
             ....................................................................................................
             ....................................................................................................
             ....................................................................................................
             ....................................................................................................
             ....................................................................................................
             ....................................................................................................
             ....................................................................................................


D. DIAGNOSA KEPERAWATAN
             ....................................................................................................
             ....................................................................................................
             ....................................................................................................
             ....................................................................................................
             ....................................................................................................
             ....................................................................................................
             ....................................................................................................
             ....................................................................................................
             ....................................................................................................
             ....................................................................................................


Tidak ada komentar: