APLIKASI MODEL ROY –

ASUHAN KEPERAWATAN
NURSING PHYLOSOPHY
Nursing Phylosophy

HUMANISM HOLISM CARE

“PERSON” “CARING”
CENTER AS BASIC
OF NURSING OF NURSING

PARADIGMA KEPERAWATAN

MAN HEALTH

ENV

NURSING
Nursalam (2006)
 Patobiologi:
Perub Biologis (imbalance)
Cont’ Fisiobiologis:
Perub Biologis (balance)
NURSING

ART SCIENCE PROFESSION

I. KEDOKTERAN
I. PSIKOLOGI
THE HEALTH SCIENCE
OF CARING

HEALTH SCIENCE NURSING SCIENCE /

CARING SCIENCE

BASIC NURSING SCIENCES

BEHAVIORAL SCIENCES
CLINICAL NURSING SCIENCES
SOCIAL SCIENCES
COMMUNITY NURSING
BIOMEDICAL SCIENCES SCIENCES

PUBLIC HEALTH SCIENCES

Τhe meta-paradigm of Nursing

Health

Person Environment

Nursing
Health Environment

Balance Harmony

Individual Need

Person Care
 The Human Being as Personality

Τhe human being as a

The human being as a
receiver of the nursing an individual and as a
care. whole entity receiver
In that sense receivers of the offered care.
of the nursing care can
be specific persons,
families, the community
or other groups.
 Τhe Individual

Integrity

Individual

Wholeness uniqueness
 The harmonic Environment

The term “Environment”

Τhe important
concerns: people as
 All the important people
that have bonds with
receivers of the
each other, nursing care in
 the objective experiences
of a person during his life.
an agreement and
 The approximate harmonic
environment in which the environment.
nursing care takes place.
 Health as Balance

 The sense of
“health” has a
multiple dimension
which starts from
the complete well-
being to a chronic
illness.
 Care as a Need
Care functions as a
Care concerns the actions
and the needs of a need and as a
person, the presupposition in
satisfaction of which the balance
is dealt according to
between people and
the case, by the
professional nursing their harmonic
staff. environment.
 Care

Love

Care

Professionalism Consciousness
The outcome of the combination of the above four
senses of the “nursing science”, is “the
preoccupation of the wholeness and the well-
being of a person, who in a continuing struggle of
balance with his harmonic environment”.
 S.C ROY
ADAPTATION MODEL
 Adaptation Model
Input Control Effectors Output
processes

Coping Physiological
Stimuli mechanisms Adaptive
Adaptation function and
Regulator Self-concept
Level: focal, Cognator ineffective
contextual, Role function response
Residual Interdependence

Feedback

Person as adaptive system. (From Roy, C. [1984]. Introduction to nursing: An adaptation

model [2nd ed., p. 30]. Englewood Cliffs, NJ: Prentice Hall.)
 COGNATOR
Internal
stimuli

C Processes for
Intact pathways
and apparatus for
Perceptual/ information Selective attention, coding,
processing and memory

A
Perception
Imitation,
Learning reinforcement, insight
R

Problem Solving & Psychomotor choice Effectors Response

Judgement Decision Making of response
I
ADAPTIF
N Emotion Defenses to seek
relief , affective
appraisal &
G attachement

External
stimuli

PAKAR
 REGULATOR
Neural
Internal Spinal Effectors Automatic
cord;brainstem and reflex
stimuli
autonomic reflexes response
Chemical

Intac Intact Responsiveness Hormonal Responsiveness Body

of endocrine output of target organs
Pathways response
Circulation glands or tissues
to & from
CNS

Chemical

External
stimuli
Neural Perception Short term Psychomotor Effectors
memory choice of
response

Long term
memory
 IMMUNE RESPONSE

RECOGNATION
RESPONSE
Immune recognation
Immune response is able to
remarkable for its specificity.
discriminate between foreign
The immune system is able
molecules and the body’s own
to recognized subtle chemical
cell and protein.
differences that distinguish one
foreign pathogen from another.
Nursing also utilizes non-nursing
theories
 PNI
Psycho Neuro Immunology HEALTH

Lived Experience

Potential Psychosocial
Co- Moderators Psychosocial
Factors Functioning

Person Neuro-
Immunological Quality of Life
Factors Perceived Coping Endocrine
Mediators
Stress Patterns Mediators
Physical
Health
Pre tx:
Critical
Factors
 PNI

(Thorton & Andersen, 20

FRAMEWORK (p.403– ADAPTATION & PNI)
Counseling for patient
with Stress – pre op
Learning process
(cognator)
Perception
Coping (+)
(+)
Cognition -
Emotion

Stress A
D
A
Hypotalamus
P
H (CRF)
Adrenal medulla T
(Catecolamines
Pituitary A
P (ACTH) T
I
A Adrenal Cortex Vital signs O
(Cortisol ) (T, P, R, PB)
AXIS N

IMMUNE RESPONSE MODULATION

(CD4; cytokin; IgG)
nursalam-MASALAH
 Immunogen

T helper cell
central to T helper
adaptive
Immune
response
 STRESSOR

MOLECULAR
STRESS
CHAPRONES
CHAPRONINES
CELL
CHANGES
GENE
proteins

Alarm
Adaptation Exhaustion

taat
 ADAPTATION NURSING MODEL
APPROACH PATIENT WITH HIV
INPUT
Coping Strategy Social Support

HIV
COGNITIVE /
COGNATOR LEARNING
RESPONSE PROCESS PROCESS
Cerebral Cortex LIMBIG SYSTEM
(Cognition: (Emotion: .Amigdala) Emotion (+)
Perception (+)
Astrocyte)

Learning (+) Anxiety(-)

Judgment(+) Social Interaction

COPING STYLE (+)
(+)
-Rationalizations
-Utilizing Social Support
Emotion (+)
-Looking for Silver Lining
Nursalam_Holistic_Unair_09
 C O P I N G - ADAPTASI
Kemampuan mengelola stresor

Terkondisi menjadi coping style

Coping Coping Coping
mechanisme model Style
Menentukan kualitas stresor

Menekan respons Meningkatkan

Memodulasi
imun respons
NURSALAM-2004
imun
respons imun
Taat
 CELLULAR ADAPTATIONS
IN GROWTH AND DIFFERENTIATION

stressor

STRESS CELL
Molecular chaprones
changes

In pathobiological
Conditions
chapronines

Exhaustion stage
Diseases In physiobiological
Adaptation stage
taat
conditions
 HPA-
AXIS
Hypothalamus
(CRF )
BIOLOGICAL / PROCESS
COGNATOR
Pituitary
RESPONSE (ACTH) EFFECTOR

Cortex Adrenal:
Fasciculate Zone
(Cortical)
OUTPUT
IMMUNE RESPONSE MODULATION

Th
Th-1 (CD4 ) IL-2, IL-10, Th-2 (CD8 )
IFN-

NKcell &
CTL
Anti-HIV
Nursalam_Holistic_Unair_09
AIDS (-) –QUALITY
A. ASSESSMENT &
PROBLEMS
Nursalam_Holistic_Unair_09
B. DIAGNOSIS
 NURSING PROBLEMS PATIENT WITH
HIV/AIDS (HOLISTIC)
BIOLOGY:
1. The decrease of Psychosocial-Spiritual
immunity (Seluler
& Humoral: CD4,
cytokine, Anti-HIV)
PSYCHOLOGICAL
and RNA 1. Self SOCIAL
Concept (-) 1. Isolated SPIRITUAL
2. Respiration : cough; 2. Discriminati 1. Separation
TBC; Chronic 2. Rejection
3. Frustration on 2. Stress -
Pneumonia 3. Social Spiritual
3. Digestive: diarrhea interaction
(-)
4. Integument: Allergy
(Ig E); Herpes;
Steven Johnson;
Kaposi Sarcoma.
5. Neurology:
Encephalopathy;
Joint pain, etc)
BIOLOGICAL

Nursalam_Holistic_Unair_09
Common symptom (PSYCHOLOGICAL)
symptom PREVALENCIES
– Pain 52%
– Pale 50%
Anxiety 40%
 Sleep disturbance 37%
 Stomatitis 33%
 Sad 32%
 Weight lost 31%
 Anorexia 28%
 Fever 27%
 Cough 27%
 Diarrhea 24%
 Skin problems 24%
 Depression 24%

Source : Larue F, et al (1994) Pain & symptoms during HIV disease. A French national
study. Journal Palliative Care: 10(2):95 – referred from Agung (2005)
Nursalam_Holistic_Unair_09
 STRESS DAN STRESSOR
Stressor
Stimuli yg
ENGINEERING
mengancam /
PSYCHOLOGICAL
merusak
stress
APPROACH
KONSEP STRES MEDICOPHYSIOLOGICAL
MODEL
APPROACH
1. Engineering Approach
2. Psychological Approach
StresLingkungan
Stres
merupakan
merupakan
istilah
system istilah
untuk
untuk
menamakan
menamakan
Stres untuk interaksi
menamakan
Coping lingkungan
dinamis
respons
3. Medicophysiological Approach yang
antaramengancam
individuorang
Organdengan
secara atau
biologis
sakit
mechanism
(variabel dependen)
lingkungannya.
merusak
(proses
(variabel
kognitif
independen).
& emosional)
Cell
orangGen
stres
NURSALAM-2004
STRESSOR TARGETS

CELL COAT,
PLASMA MEMBRANE,
ENDOPLASMIC RETICULUM,
RIBOSOME,
MITOCHONDRIA,
LYSOSOME,
MICROBODIES,
MICROTUBULES,
CYTOPLASMIC MATRIX,
NUCLEUS,
AND Stress
GENES Protective
Injury
proteins
NURSALAM-2004
 STRESSOR
“PERILAKU TIDAK TERAPEUTIK”
Get Oh my Interaksi
up ! God perawat dan klien ini
menghasilkan kondisi
stres tahap ekshausi,
yang menyebabkan
ketahanan tubuh
semakin menurun.
Kondisi ini
menyebabkan proses
penyembuhan
terhambat dan
Stop
bahkan dapat
it !
menimbulkan
NURSALAM-2004 penyakit baru.
 SOCIAL
KETAKUTAN STIGMA

DENIAL DISKRIMINASI

BLAME &
COUNTER-BLAME PERSECUTION

Nursalam_Holistic_Unair_09
DISINTEGRASI SPIRITUAL
 Nyeri spiritual : merasa dihukum Tuhan
 Pengkucilan spritual : merasa dikucilkan
 Kecemasan spiritual : takut berhadapan Tuhan
 Bersalah spiritual : sadar gaya hidup salah
 Marah spiritual : tidak terima takdir
 Kehilangan spiritual : ditinggalkan Tuhan
 Kesedihan spiritual : kehilangan cinta Tuhan
 C. INTERVENSI
ADAPTATION NURSING CARE
MODEL
 ROLE of CD4+ T Helper Cell
ON IMMUNE RESPONS HIV/AIDS
MHC
class I CD-
Cytokines 8 Virus-infected
Cytotoxic T cell
cells
CTL TcR

IL-2

APC TcR T-Helper IL-4, IL-10

CD-4
MHC
class II
B-cell
IFN- Cortisol
Machrophage

Stres Virus –Specific

Antibody: Anti
HIV
INTERVENTION FOR
HIV - AIDS
1. BIOLOGIS
2. PSIKOLOGIS
3. SOSIAL
4. SPIRITUAL
1. BIOLOGICAL
RESPONSE
 BIOLOGICAL SUPPORT
1. ARV & I-O
2. NUTRITION: Carbohydrate;
PROTEIN, MULTIVITAMIN,
ANTIOXYDANT
3. REST AND ACTIVITY
4. UNIVERSAL PRECAUTIONS
Nursalam_Holistic_Unair_09
Nursalam_Holistic_Unair_09
 I-O
INFEKSI
OPORTUNISTIK
& NYERI
TB- Infiltrat interstitial
HERPES SIMPLEK
HERPES SIMPLEK
PPE
CANDIDIASIS
SARKOMA KAPOSI
 NUTRISI
 ANTIOKSIDAN-
TKW & TKTP
 MULTIVITAMIN
AKTIVITAS

Nursalam_Holistic_Unair_09
UNIVERSAL PRECAUTIONS

CUCI TANGAN
APD (ALAT PELINDUNG DIRI)
DEKONTAMINASI
LIMBAH

Nursalam_Holistic_Unair_09
Nursalam_Holistic_Unair_09
 Indicator of Biological Response
Progress
Psychological response (IMMUN
response)
1. Cortisol (-)

2. CD4
3. Cytokine (IFN gamma, IL-2)
- 4. mRNA
5. Antigen Antibody - HIV
2. PSIKOLOGIS
PENANGANAN STRES

Nursalam_Holistic_Unair_09
Nursalam_Holistic_Unair_09
 Kenyataan Hidup
 Penyakit adalah kejadian besar dalam
hidup yang menyebabkan timbulnya
pertanyaan besar bagi diri, tujuan dan
arti hidup.
 Penyakit dapat mengganggu karir,
kehidupan keluarga dan kemampuan
untuk menikmati hidup

Nursalam_Holistic_Unair_09
 PSYCHOLOGICAL INTERVENTION

 SELF POTENTION EMPOWERMENT

 COGNITION TECHNIQUE (LEARNING

PROCESS)

 BEHAVIOR (ACT – HEALTH CONDITION)

 Indicator adaptive psychological
response (psychology)
Psychological response progress
(Acceptance response)
1. Denial
psychology 2. Anger
- Kubler – Ross 3. Bargaining
(Sign. Anger & 4. Depression
Bargaining) 5. Acceptance

Nursalam_Holistic_Unair_09
3. SOCIAL (16-19)

EMOSIONAL

MATERIAL / FASILITAS

INFORMASI

PENGHARGAAN
SOCIAL SUPPORT

NURSALAM-2004
Nursalam_Holistic_Unair_09
 ASPEK SOSIAL
PENDERITA HIV & AIDS

Nursalam_Holistic_Unair_09
 Indicator adaptive social
response
Social adaptation progress
1. Emotional need
2. Self definition(-)
Social (Emotional)
3. Interpersonal
relationship (+)
4. SPIRITUAL

Pray
Self control
Nursalam_Holistic_Unair_09
 SPIRITUAL INTERVENTION
 Spiritual : values & religiosity

Hope

Reality

 Life value : Meaningful Life

 Religiosity : Improve
 Daya Tahan & Dukungan
Emosional Beribadah
 Mengenali kekuatan diri hasil beribadah,
mengklarifikasikan dan menyempurnakannya
contoh : berdoa kala sedih  tenang
 Menimbulkan tilikan diri yang positif.
contoh : keraguan akan Tuhan pada saat
krisis adalah manusiawi  atasi
 Manejemen stres agar sampai ketahap
BERSERAH DIRI
Nursalam_Holistic_Unair_09
 Indicator of Adaptive spiritual
response

Spiritual Response
1. Realistic expectation
2. Patience
3. Looking for silver
lining (-)
 SPIRITUAL
Principle

ITS
IKHTIAR - IKHLAS,
TAWAKKAL, SABAR
C. EVALUATION
 Kesimpulan

LEARNING COPING
MODEL PROCESS (+)
of PAKAR -Utilizing sos. Support
-Looking for silver Lining
-Acceptance-Rasionalisation
Coping strategy Stress
Soc. support
PERCEPTION
(-)

RESP. BIOLOGICAL

HPA-AXIS (cortisol -)
ADAPTATION
Immune response
Induce Modulation
Immune response (CD4, IFN-, A-HIV)