ASUHAN KEPERAWATAN PADA

GANGGUAN PSIKOSOSIAL
Ns. Muhamad Zulfatul A’la, M.Kep
Tujuan Pembelajaran
 Mahasiswa Mampu memahami tentang konsep ansietas,
kehilangan dan distress spiritual
 Mahasiswa mampu memahami asuhan keperawatan pada
pasien dengan ansietas, kehilangan dan distress spiritual
ANXIETY
ANXIETY
 Anxiety is a part of everyday life
 Anxiety disorders are the most common psychiatric
disorders in the United States, affecting between 15% and
25% of the population.
 people are high users of health care services because they
seek treatment for the various symptoms caused by
anxiety
 Anxiety is an emotion and a subjective individual
experience. It is energy and cannot be observed
directly.
 Anxiety is an emotion without a specific object.
 Fear produces anxiety
 Anxiety is communicated interpersonally
 Culture is related to anxiety, because culture can
influence the values one considers most important
(Gwynn et al, 2008; Westermeyer et al, 2010).
RENTANG RESPON
 Mild anxiety can motivate learning and produce
growth and creativity
 Moderate anxiety the person focuses only on
immediate concerns, involves narrowing of the perceptual
field
 Severe anxiety The person tends to focus on a specific
detail
 Panic associated with dread and terror, as the person
experiencing panic is unable to do things even with
direction
ASSESSMENT
 parasympathetic reaction
 Behavioral responses
 Cognitive responses
 affective responses
Predisposing Factors
BIOLOGICAL
 GABA (gamma-aminobutyric Acid) system Patients
with anxiety disorders may have a decreased antianxiety
capacity of the GABA receptors in areas of the limbic
system, making them more sensitive to anxiety and panic
 Norepinephrine system  the activity of the locus
ceruleus  Fight or Flight
 Serotonin system  A dysregulation of serotonin (5-HT)
neurotransmission  anxiety
FAMILIAL people with one anxiety disorder are more
likely to develop another or to experience a major
depression within their lifetime
PSYCHOLOGICAL A person’s level of self-esteem is an
important factor related to anxiety.
Resilience is associated with a number of protective
psychosocial factors, including active coping style, positive
outlook, interpersonal relatedness, moral compass, social
support, role models, and cognitive flexibility
BEHAVIORAL Anxiety can be a product of frustration
caused by anything that interferes with attaining a desired
goal.
Nursing Diagnosis
 Anxiety (p 323)
 Ineffective coping (p 326)
 Readiness for enhanced coping (p 327)
 Fear (p 336)
NOC
ANXIETY SELF-CONTROL (p 94)
 Monitors intensity of anxiety
 Eliminates precursors of anxiety
 Decreases environmental stimuli when anxious
 Seeks information to reduce anxiety
 Plans coping strategies for stressful situations
 Uses effective coping strategies
 Uses relaxation techniques to reduce anxiety
 Monitors duration of episodes
 Monitors length of time between episodes
 Maintains role performance
 Maintains social relationships
 Maintains concentration
 Monitors sensory perceptual distortions
 Maintains adequate sleep
 Monitors physical manifestations of anxiety
 Monitors behavioral manifestations of anxiety
 Controls anxiety response
Intervention
ANXIETY REDUCTION (p 83)
 Establishing a Trusting Relationship.
 Nurses’ Self-Awareness.
 Protecting the Patient
 Modifying the Environment
 Encouraging Activity.
 Medication

BEHAVIOUR MANAGEMENT (p 92)

Phisycal activity
Establish routines
Self-control
GRIEF, MOURNING AND BEREAVEMENT
Discussion
 Pengetahuan tentang kematian
INTRODUCTION
 Death is situation that is frequently encountered by nurses in
the course of their work
 Loss is any situation (either actual, potential, or perceived) in
which a valued object is changed or is no longer accessible to
the individual.
Type of loss
Actual loss: Death of a loved one, theft of one’s property
Perceived loss: Occurs when a sense of loss is felt by an individual
but is not tangible to others
Physical loss: Loss of an extremity in an accident, scarring from
burns, permanent injury
Psychological loss: Such as a woman feeling inadequate after
menopause and resultant infertility
 Grief is an natural human response to separation,
bereavement or loss
 Grief  individual personal response to loss and has
emotional, phyisical, behavioral, cognitive, social and
spiritual dimention
 Mourning outward and active expression of that grief
 Bereavement period after loss during which grief and
mourning occur
 Bereaved person may experience anxiety, insomia, inertia,
hyeperactivity or a feeling of helplesness
 Grief, mourning and bereavement may be affected by
personality, culture, and religion
THEORIES AND FRAMEWORKS
 Many Theories or models of grief have common themes or stages
Kubler-Ross (1969)
- Denial
- Anger
- Bargaining
- Depression
- Acceptance

Bowlby’s (1973)
- Shock
- Yearning and protest
- Despair
- Recovery
 Worden (1991)
- To accept the reality loss
- To work through and experience the pain of grief
- To adjust to an environment without the decreased
person
- To withdraw emotionally from or relocate the decreased
and move on
Bouglass (2010) adopted from Stroebe (1988)
ASSESSMENT
Nursing Diagnosis
 Grieving (p 338)
A normal complex process that includes emotional, physical,
spiritual, social and intelectual responses and behaviours by
which individuals, families and communities incorporate an
actual, anticipated, or perceived loss into their daily lives
 Complicated grieving (p 339)
A disorder that occurs after the death of a significant other,
in which the experience of distress accompanying
bereavement fails to follow normative expectations and
manifest in functional impairment
Nursing Outcome
 Grief Resolution (p 240)
 Personal actions to adjust thoughts, feelings, and
behaviour to actual or impending loss
Nursing Intervention
 Dying care (p 153)
 Promotion of Physical comfort and psychological peace in final
phase of life
 Grief Work Facilitation (p 205)
 Assistance with the resolution of a significant loss
- Identify the loss
- Listen a expression grief
- Assist coping strategies
- Identify sources of community support
- Modification needed in life style
 Reminisience therapy (p 323)
 Using the recall of past events, feeling, and thoughts to facilitate
pleasure, quality of life or adaptation to present circumtances
Spirituality
INTRODUCTION
Spirituality is
 mind, body, and spirit in order to allow the development
of a sense of wholeness
 themes of self-awareness, interconnectedness, and a
relationship to a higher power

Spirituality is subjective
Spirituality is dinamic
Spirituality and religion
 perbedaan agama dan spiritualitas terletak pada fokus
kajian
 Perbedaan definisi spiritualitas dan agama tidak
berdampak besar terhadap pentingnya spiritualitas dalam
peningkatan status kesehatan
Faktor yang mempengaruhi spiritual
 konteks budaya,
 Keluarga
 tingkat perkembangan,
 kondisi status kesehatan
Spiritual distress vs spiritual well-being
Spiritual distress is
 a disruption in one’s beliefs or value system. It affects a
person’s entire being. It shakes the basic beliefs of one’s
life
 “the impaired ability to experience and integrate meaning
and purpose in life through connectedness with self,
others, art, music, literature, nature, and/ or a power
greater than oneself

 Spiritual well-being  indicator of spirituality

Assessment
 Questions the meaning of life
 Afraid to fall asleep at night or other fears
 Anger at God/higher power
 Questions own belief system
 Feels a sense of emptiness; loss of direction
 Talks about feelings of being left by God/higher power
 Seeking spiritual help
 Questions the meaning of suffering
 Pain and other physical symptoms can be expressions of
spiritual distress as well
Nursing diagnosis
 Spiritual distress (p 372)
A state of suffering related to the impaired ability to
experience meaning in life through connection with self,
others, the world, or a superior being
 Impaired religiousity (p 369)
Impaired ability to exercise reliance on beliefs and / or
participate in rituals of a particular faith tradition
 Risk for spiritual distress (p 374)
 Readiness for enhanced spiritual well-being (p 361)
Nursing Outcome
 Spiritual Health (p 519)
 Connectedness with self, others, higher power, all life,
nature and the universe that trascendent and empowers
the self
Nursing Intervention
 Spiritual support (p 353)
 Assissting the patient to feel balance and connection with
greater power
- Terapeutic comm
- Monitor with SWB
- Individual review
- Encourage life review
- Participation
- Facilitating individual prayers
 Spiritual Growth facilitation (p 352)
Facilitation of growth in patient’s capacity to identify
connect with, and call upon the source of meaning, purpose,
comfort, strenght, and hope in their lives
Discussion
 Pengalaman merawat pasien menjelang ajal
 Peran perawat dan caregiver dalam proses kematian
Kesimpulan
 Ansietas, kehilangan dan spiritualitas merupakan aspek yang saling
berkaitan
 Ansietas adalah perasaan ketakutan yang tidak mempunyai objek
tertentu
 Panik adalah respon maladaptif dari ansietas
 Penanganan ansietas terpenting adalah membawa individu kepada
task-oriented
 Grief, mourning dan bereavement mempunyai pengertian yang
berbeda
 Grieving adalah proses normal
 Complicated grieving adalah respon maladaptif dari proses berduka
 Pendampingan adalah intervensi utama utk berduka
 Spiritual merupakan gabungan antara eksistensi diri dan aspek
religiusitas
 Spiritualitas merupakan aspek mandiri keperawatan yang perlu
banyak pengembangan dalam hal diagnosa maupun intervensi
TERIMA KASIH
Referensi
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(NOC). St Lois:Mosby Elsevier
 Paloutzian, R., Bufford, R., & Wildman, A. (2012). Spiritual Well-Being Scale: Mental
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Textbook of Spirituality in Healthcare. New York: Oxford University Press.
 Strada-Russo, E. (2006). Spirituality as a Protective Factor in Complicated Bereavement.
Disertation. San fransisco.
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