Jumat, 12 Maret 2010

"Yes, I'am nurse"

BismiLLah…

“Dan mereka, para perawat cuci darah, dimanapun mereka berada, akan selalu menjadi bagian terpenting bagi keberlangsungan hidup pasien cuci darah. Hormatku untuk ketulusan, keikhlasan, senyuman, dan perhatian mereka. Semoga Alloh mengganti setiap kelelahan, kejenuhan, dan kepenatan mereka menghadapi keluhan-keluhan pasien dengan kebaikan bagi kehidupan mereka. Terima kasihku untuk mereka. Semoga Alloh memuliaperhatian mkan mereka…..senantiasa.” (Dikutip dari sebuah buku yg ditulis oleh seorang pasien hemodialisa)

Ketika membaca kalimat tersebut, sungguh hati ini langsung terenyuh sekaligus tersadarkan akan dunia nyata sebagai seorang caLon perawat. SubhanaLLah…….. ternyata para pasien di RS ada yg memberikan doa yg muLia bwt para perawat.
Perawat, sebuah profesi yang di Indonesia sampai saat ini masih dipandang “sebelah mata”, prestisenya rendah. Tapi ternyata….. stLah membaca kutipan kaLimat di atas, diri ini baru tersadarkan bahwa menjadi PERAWAT ADALAH PROFESI YANG BENAR2 MULIA. Bisa dibayangkan, andai saja semua pasien mendoakan perawat seperti kaLimat tersebut dan semua doanya dikabuLkan oleh Alloh, maka para perawat bisa langsung mendapatkan kemuliaan dari Alloh dgn mudah. Melalui profesi sbg seorang perawat juga, ternyata kita bisa mendapatkan tiket syurga Lbh banyak (tentunya asaLkan ikhLas). Selain itu, iLmu yg didapatkan bisa dimanfaatkan minimal untuk merawat diri sendiri & keLuarga.

So, sekarang akan berani ku katakan, “Yes, I’m nurse”

Selasa, 15 Desember 2009

Theories of Mental Disorders
Many theories and models are relevant to practice mental health nursing. One theory is not more “correct” than another, and practitioners choose the theory or model that it most appropriate for the client.
The theories are organized under these heading, with representative theorists for each category: intrapersonal, social-interpersonal, behavioral, cognitive, biogenic.
A. Intrapersonal Theory
Intrapersonal theory focuses on the behaviors, feelings, thoughts, and experiences of each individual person. Mental disorders are viewed as arising from within the individual.
 Sigmund Freud
Freud divided all aspects of consciousness into three categories: conscious, preconscious, unconscious. The first category, conscious, includes thoughts, feelings, and experiences that are easily remembered, such as certain addresses, phone numbers, anniversaries, and birthdays, and recent enjoyable events. The second category, preconscious (sometimes called sub-conscious), includes thoughts, feelings, and experiences that have been forgotten but that can easily be recalled to consciousness. Examples are old phone numbers or addresses, the feeling a woman had during the birth of her first child, the name of first girl friend, and the animosity one felt toward a former boss. The third category, unconscious, encompasses thoughts, feelings, experiences, and dreams that can not be brought to conscious thought or remembered (Freud, 1935).
Freud theorized that there were three components to the personality: the id, ego, and the superego. Each component has individualized functions, but the three are so closely interrelated that it is difficult to separate their individual effects on a person’s behavior.
The biologic and psychologic drives which with a person is born constitute the id. The id holds in reserve all psychic energy, which in turn furnishes the power for the operations of the ego and superego. It has no knowledge of outside reality and functions totally within its own subjective reality.The id is self contered, and its major concern is the instant gratification of needs. The ego is the component of the personality that mediates the drives of the id with objective reality in a way that’s promotes well-being and survival. The ego does not concern itself with moral values or societal taboos. The superego is the component of the personality that is concerned with moral behavior. It is the accumulation of societal rules and personal values as interpreted by individuals. The emphasis of the superego is not reality but the ideal, and its goals are perfection as opposed to the id’s pleasure or the ego’s reality (Freud, 1935).

 Erik Erikson
Erik Erikson saw personality as developing throughout the entire life span rather than stopping at adolescence. He differed with Freud in that he believed people could move backward to achieve developmental tasks they were unable, for whatever reason, to achieve earlier. Erikson’s perspective, the developmental theory of personality, offered the hope of achieving a healthy development pattern sometime during a life span.
Although Erikson accepted Freud’s intrapersonal perspective of the importance of basic needs and drives in children, he felt personality was shaped more by conflict between needs and culture than by conflict between the id, ego, and superego.
Erikson believed that the ego is much more important than the id or superego in determining personality. According to Erikson, every person passes through eight developmental stages: sensory, muscular, locomotor, latency, adolescence, young adulthood, adulthood, and maturity. Each stage is characterized by conflicts and a set of tasks that a person must accomplish before moving on to the next developmental stage. Erikson believed people had difficulty developing normally if they were unable to accomplish the tasks of the previous stage. (Erikson,1963).
B. Social-Interpersonal Theory
 Harry Stack Sullivan
Sullivan believed personality was an a abstraction that could not be observed apart from interpersonal relationship. Sullivan acknowledge heredity and maturation as parts of development but placed more emphasis on the organism as a social rather than a biological entity (Sullivan, 1953). Sullivan indentified three principal components of this sphere: dynamisms, personifications, and cognitive processes.
A dynamism is a long standing pattern of behavior. In Sullivan’s theory, dynamisms highlight personality traits. For instance, a child who is mean can be said to have a dynamism of hostility. The important idea is that any habitual reaction of one person to another or to situation constitutes a dynamism. Sullivan viewed most dynamisms as meeting the basic human needs of and individual by reducing anxiety. Sullivan believed that an infant first feels anxiety as the anxiety is transferred from the mother. Sullivan called the dynamism that develops to reduce anxiety the dynamism of the self, or the self system. The self system is protector of one’s security.
A personification is an image people have of them selves and others. Sullivan believed that personifications are formed early in life to help people cope with interpersonal relationships. As a person gets a older, however, very rigid personifications can interfere with interpersonal relationships.
The third component of the interpersonal sphere, cognitive processes are the development of the thinking process from unconnected to causal symbolic. Sullivan believed that cognitive processes, like personifications, are functions of experiences.
 Abraham Maslow
Maslow devised a hierarchy of needs. People unable to meet their growth needs, Maslow postulated, have the potential of becoming psychologically disturbed (Maslow, 1968). Maslow’s theory helps the nurse to identify client needs and set priorities for care.
a) Physiological needs
Include the needs for food, oxygen, water, sleep, and sex.
b) Safety needs
Include the needs for security, dependency, stability, and protection; the need to feel free from fear, anxiety, and chaos; and the need for structure, order, and limits.
c) Love and belonging
Maslow stresses that love is not synonymous with sex, which a physiological need.
d) Esteem and recognition
Is concerned with the concept of the self as a worthwhile person and with an awareness of one’s own individuality and uniqueness. Satisfaction of this need leads to self-confidence, self respect, and feelings of importance and dignity.
e) Self-actualization_aesthetic needs
 Hildegard Peplau
Peplau noted that both nurses’ and clients’ culture, religion, ethnicity, education, past experiences, and preconceived ideas influence their interpersonal relationships. She believed that psychodynamic nursing and gave them permission to focus on their excellent interpersonal skills.
 Feminist Theory
Feminist theory is a model of mental health for both women and men. Feminist theory examines how gender roles limit the psychologic development of all people and inhibit the development of mutually satisfying and noncoercive intimacy. Feminist therapy is gender-sensitive family or relationship therapy and is not restricted to female therapists. Since women value and focus on relationships, feminist therapists are caring, empathetic, and nonauthoritarian. This sense of being cared about and well regarded helps women to achieve greater feelings of self-worth. The concept of selp help encourages women to be assertive and take control of their own lives (Cown, 1996; Rosnblatt, 1995).

C. Behavioral Theory
 B.F.Skinner
The major emphasis of Skinner’s theory is functional analysis of behavior, which suggests looking at behavior pragmatically. Skinner did not attribute much importance to unconscious motivations, instincts, and feelings; he did attribute importance to a person’s immediate actions.
Skinner thought a person’s behavior could be controlled by rewards and punishments, that all behavior has specific consequences. Consequences that lead to an increase in the behavior he called reinforcements, or rewards, and consequences that lead to a decrease in the behavior he called punishments.
One of the major concepts within Skinner’s system is the principle of reinforcement (sometimes referred to as operant reinforcement theory). Skinner believed certain operations would decrease certain behaviors and increase other behaviors. Another way for the instructor to diminish the behavior is by handing out punishments for it; this is called a punishing response (Skinner, 1953).
D. Cognitive Theory
 Jean Piaget
Jean Piaget believed that intelligence grows by exposing children’s experiences and perceptions are challenged by constantly changing stimuli, whereby they recognize discrepancies between their own reality and the environment. Resolving these discrepancies helps children learn new relationships between objects and therefore develop a more mature understanding (Piaget, 1972).
Piaget identified four major stages of cognitive development: the sensorimotor stage, preoperational stage, concrete operasional stage, and formal operational stage.
 Aaron Beck
Two important constructs of Beck’s cognitive theory are schemas and cognitive triad.


PSYCHIATRIC-MENTAL HEALTH NURSING
Psychiatric-mental health nursing is defined as a specialized area of nursing practice employing theories of human behavior as its scientific aspect and the therapeutic use of self as its art. The goal or purpose of nursing practice is health; its achievement requires primary, secondary, and tertiary prevention. Psychiatric-mental health nursing is concerned with promoting optimal mental health for the individual, the family, the community, and society. It is also concerned with early diagnosis, treatment, and rehabilitation. The role of the psychiatric nurse involves independent, interdependent, and wholly dependent functions. Psychiatric-mental health nurses have a cooperative, collaborative relationship with members of other disciplines who are also working closely with the client. Frequent interdisciplinary team meetings are required for planning good-quality care. Nursing care is practiced in a variety of settings using a variety of approaches. It is holistic, treating the client as whole in body and mind and involving other caregivers and health professionals in the process, if needed, to assist the client to achieve optimum health potential

References:
1. JUDITH HABER, ANITA M., SYLVIA M. SCHUDY, BARBARA FLYNN SIDELEAU, Comprehensive Psychiatric Nursing, McgRAW-HILL BOOK COMPANY, New York, 1982.
2. Fontaine, Karen Lee. 1943. Mental Health Nursing 4th edition