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Jurnal Keperawatan Indonesia
Articles
VIEWS: 807
10.7454/jki.v23i1.598
Submitted: 2023-01-30
Published: 2020-03-30

Changes in The Signs, Symptoms, and Anger Management of Patients with A Risk of Violent Behavior After Receiving Assertive Training and Family Psychoeducation Using Roy’s Theoretical Approach: A Case Report

1. School of Nursing, Faculty of Medicine and Health Science, Universitas Muhammadiyah Yogyakarta, Yogyakarta 55183
Faculty of Nursing, Universitas Indonesia, Depok 16424
Faculty of Nursing, Universitas Indonesia, Depok 16424
assertive training family psychoeducation risk for violence schizophrenia

Abstract

Mental disorders are predicted to increase every year. Patients with severe mental disorders, such as schizophrenia, often engage in violent behavior. The treatment of such patients can use general nursing treatments (anger management with physical therapy, taking medicines regularly, and verbal and spiritual methods) and specialist nursing interventions (assertive training and family psychoeducation). This case report involved 11 patients, with the majority aged between 26 and 60 years, unemployed, high school graduates, unmarried, and with previous inpatient history. Generalist and specialist nursing interventions (assertive training and family psychoeducation) use Roy’s adaptation theory and Stuart’s stress adaptation approach. Nursing interventions were conducted sequentially, starting with generalist nursing interventions, followed by specialist ones. The method used was a pre–posttest in which each patient received generalist and specialist nursing interventions, assertive training, and family psychoeducation, each consisting of five sessions. Results of assertive training therapy and family psychoeducation showed a decrease in the signs and symptoms of violent behavior as well as an improvement in the patient’s ability to overcome the risk of violent behavior. The application of Roy’s adaptation theory and Stuart’s stress adaptation approach is potentially appropriate for the treatment of patients with a risk of violent behavior.

Abstrak

Perubahan Tanda, Gejala, dan Manajemen Marah pada Pasien dengan Risiko Perilaku Kekerasan Setelah Menerima Pelatihan Asertif dan Psikoedukasi Keluarga Menggunakan Pendekatan Teori Roy: Studi Kasus. Gangguan jiwa secara keseluruhan diprediksikan akan semakin meningkat setiap tahunnya. Pasien dengan masalah gangguan jiwa berat seperti skizofrenia seringkali melakukan perilaku kekerasan. Penanganan pasien dengan perilaku kekerasan dapat menggunakan tindakan keperawatan generalis (mengontrol marah dengan cara fisik, minum obat teratur, cara verbal dan cara spiritual) dan tindakan keperawatan spesialis (latihan asertif dan psikoedukasi keluarga). Laporan kasus ini melibatkan 11 pasien dengan karakteristik mayoritas usia 26–60 tahun, tidak bekerja, tingkat pendidikan SMA, belum menikah, dan memiliki riwayat dirawat sebelumnya. Tindakan keperawatan yang diberikan adalah tindakan keperawatan generalis dan ners spesialis latihan asertif dan psikoedukasi keluarga dengan menggunakan pendekatan teori adaptasi Roy dan adaptasi stress Stuart. Tindakan keperawatan dilakukan secara berurutan/ bertahap dimulai dengan tindakan keperawatan generalis kemudian dilanjutkan dengan tindakan keperawatan ners spesialis. Metode yang digunakan adalah pre-posttest dimana setiap pasien mendapatkan tindakan generalis serta tindakan ners spesialis latihan asertif dan psikoedukasi keluarga yang masing-masing terdiri dari 5 sesi. Hasil penerapan terapi latihan asertif dan psikoedukasi keluarga menunjukkan terjadinya penurunan tanda dan gejala risiko perilaku kekerasan serta terjadinya peningkatan kemampuan pasien dalam mengatasi risiko perilaku kekerasan. Penggunaan pendekatan teori adaptasi Roy dan teori adaptasi stress Stuart berpotensi sesuai diterapkan pada penanganan pasien dengan risiko perilaku kekerasan.

 

Kata Kunci: latihan asertif, psikoedukasi keluarga, risiko perilaku kekerasan, skizofrenia

References

  1. Ahmed, S., Reena, M.D., Nuzhat Hussain, M.D., Ahmed, R., Amin, S., & Ahmed, S. (2014). Nicotine addiction in schizophrenia, availability of better treatment options as are in general population, Int J Emergency Ment Health Hum Resilience, 17(1), 156–160.
  2. Aldridge, M.A. (2011). Addressing non-adherence to antipsychotic medication: A harm-reduction approach. Journal of Psychiatric and Mental Health Nursing, 19(1), 85–96.
  3. Alligood, M.R., Hamid, A.Y., & Ibrahim, K. (2017). Pakar teori keperawatan dan karya mereka (Terjemahan, Edisi 8). Singapore: Elsevier.
  4. Association of Southeast Asian Nations. (2016). ASEAN mental health systems. Retrieved from https://asean.org/storage/2017/02/55.-December-2016-ASEAN-Mental-Health-System.pdf
  5. Atri, A., & Sharma, M. (2007). Psychoeducation: Implications for the profession of health education. Californian Journal of Health Promotion, 5(4), 32–39.
  6. Batista, T.A., Baes, C.V.W., & Juruena, M.F. (2011). Efficacy of psychoeducation in bipolar patients: Systematic review of randomized trials. Psychology & neuroscience, 4(3), 409–416.
  7. Bhattacharjee, D., Rai, A.K., Singh, N.K., Kumar, P., Munda, S.K., & Das, B. (2011). Psychoeducation: A measure to strengthen psychiatric treatment. Delhi Psychiatry Journal, 14(1), 33–39.
  8. Bo, S., Abu-Akel, A., Kongerslev, M., Haahr, U. H., & Simonsen, E. (2011). Risk factors for violence among patients with schizophrenia. Clinical Psychology Review, 31, 711–726.
  9. Bowers, L., Stewart, D., Papadopoulos, C., Dack, C., Ross, J., & Khanom, H. (2011). Inpatient violence and aggression: A literature review. London: Section of Mental Health Nursing Health Servi and Population research Institute of Psychiatry Kings College London.
  10. De Leon, J., & Diaz, F.J. (2005). A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors. Schizophrenia research, 76(2–3), 135–157.
  11. Desousa, A., Kurvey, A., & Sonavane, S. (2012). Family Psychoeducation for Schizophrenia: A clinical review. MJP Online Early, 21(2). Retrieved from https://www.mjpsychiatry. org/index.php/mjp/article/view/196.
  12. Delalibera, M., Presa, J., Coelho, A., Barbosa, A., & Franco, M.H.P. (2015). Family dynamics during the grieving process: A systematic literature review. Ciencia & Saude Colectiva, 20(4), 1119–1134.
  13. Douglas, K.S., & Ogloff, J.R. (2003). Violence by psychiatric patients: The impact ofarchival measurement source on violence base rates and risk assessment accuracy. Can J Psychiatry, 48(11), 734–740.
  14. Economou, M.P. (2015). Psychoeducation: A Multifaceted Intervention. International Journal of Mental Health, 44, 259–262.
  15. Fiorillo, A., Sampogna, G., Del Gaudio, L., Luciano, M., & Del Vecchio, V. (2013). Efficacy of supportive family interventions in bipolar disorder: A review of the literature. Journal of Psychopathology, 19, 134–142.
  16. Gajali, G., Mustikasari, M., & Putri, Y.S.E. (2014). Pengaruh family psichoeducation therapy terhadap kemampuan keluarga merawat pasien skizofrenia dengan halusinasi di Kota Samarinda Kalimantan Timur (Master Thesis, Degree in Nursing). Depok: Faculty of Nursing Universitas Indonesia.
  17. Harvey, C., & O’Hanlon, B. (2013). Family psycho-education for people with schizophrenia and other psychotic disorders and their families. Australian & New Zealand Journal of Psychiatry, 47(6), 516–520.
  18. Hassan, G., Kirmayer, L.J., MekkiBerrada A., Quosh, C., el Chammay, R., Deville-Stoetzel, J.B., Youssef, A., Jefee-Bahloul, H., Barkeel-Oteo, A., Coutts, A., Song, S. & Ventevogel, P. (2015). Culture, context and the mental health and psychosocial wellbeing of syrians: A review for mental health and psychosocial support staff working with syrians affected by armed conflict. Geneva: UNHCR.
  19. Howarth. R.A. (2011). Concepts and Controversies in Grief and Loss. Journal of Mental Health Counseling, 33(1), 4–10.
  20. Karimi, S., Mahmoodi, M., & Hashemi, L. (2014). Effectiveness of assertiveness group training on reducing anxiety, aggression and burnout. Journal of Applied Science Research, 10(5), 370–375.
  21. Keliat, B.A., Tololiu, T.A., Daulima, N.H.C., & Erawati, E. (2015). Effectiveness assertive training of bullying prevention among adolescents in West Java Indonesia. International Journal of Nursing, 2(1), 128–134.
  22. Keliat, B.A., Daulima.N.H.C., & Farida, P. (2011). Manajemen keperawatan psikososial & kader kesehatan CMHN (Intermediate Course). Jakarta: EGC.
  23. Keyes, K.M., Pratt, C., Galea, S., McLaughlin, K.A. (2014). The burden of loss: Unexpected death of a loved one and psychiatric disorders across the life course in a national study. Am J Psychiatry, 171(8), 864–871.
  24. Komala, E., Keliat, B.A., Wardani, I.Y. (2016). Efektifitas program edukasi pasien, terapi penerimaan komitmen, psikoedukasi keluarga terhadap insight, tanda, gejala serta kemampuan klien mengontrol perilaku kekerasan (Master Thesis, Degree in Nursing). Depok: Faculty of Nursing Universitas Indonesia.
  25. Koolaee, A.K., Baighi, H.E., & Navidian, A. (2016). Effects of communication skills training on aggressionand quality of life of male patients with chronic mental illnesses. Journal of Client-Centered Nursing Care, 2(1), 3–10.
  26. Kozier, B., Erb, G., Berman, A., & Snyder, S. (2011). Buku ajar fundamental keperawatan konsep proses & praktik (Edisi 7, Volume 1). Jakarta: EGC
  27. Kuruvilla, A., & Jacob, K.S. (2007). Poverty, social stress & mental health. Indian Journal of Med, 126, 273–278.
  28. Mancini, A.D., Moser, L.L., Whitley, R., McHugo, G.J., Bond, G.R., Finnerty, M.T., & Burns, B.J. (2009). Assertive community treatment: Facilitators and barriers to implementation in routine mental health settings. Psychiatric Services, 60(2), 189–195.
  29. Martens, W.H.J. (2010). Schizoid personality disorder linked to unbearable and inescapable loneliness. Eur. J. Psychiat, 24(1), 38–45.
  30. Mehta, R.J., Mehta, R.Y., & Shah, N.D. (2016). A case control study of aggressive behavior in stable patients of schizophrenia who have
  31. improved on treatment and in normal and its effect on quality of life at government medical college surat. International Journal of Medical Science and Clinical Inventions, 3(2), 1565–1574.
  32. Mousa, A.A., Imam, S.A., & Sharaf, A. (2011). The effect of an assertiveness training program on assertiveness skills and social interaction anxiety of individuals with schizophrenia. Journal of American Science. 7(12), 454–466.
  33. National Institute of Health Research and Development, The Ministry of Health Republic of Indonesia. (2013). Hasil riset kesehatan dasar 2013. Jakarta: The Ministry of Health Republic of Indonesia.
  34. Oladepo, O., Yusuf, O.B., & Arulogun, O.S. (2011). Factors influencing gender based violence among men and women in selected states in Nigeria. African Journal of Reproductive Health, 15(4), 78–86.
  35. Pasadas, C., & Manso, F. (2015). Psychoeducation: A strategy for preventing relapse in patients with schizophrenia. International Journal of Nursing, 2(1), 89–102.
  36. Pipas, M.D., & Jaradat, M. (2010). Assertive communication skills. Annales Universitatis Aqulensis Series Oeconomica. 12(2), 649–656.
  37. Queensland Government. (2010). Queensland Mind essentials. Queensland: State of Queensland.
  38. Rahayu, D.A., Hamid, A.Y., Sabri, L. (2011). Pengaruh psikoedukasi keluarga terhadap dukungan psikososial keluarga pada anggota keuarga dengan penyakit kusta di kabupaten Pekalongan (Master Thesis, Degree in Nursing). Depok: Faculty of Nursing Universitas Indonesia.
  39. Royal College of Physicians, Royal College of Psychiatrists. (2013). Smoking and mental health. London: RCP.
  40. Rueve, M.E., & Welton, R.S. (2008). Violence and mental illness. Psychiatry, 5(5), 35–48.
  41. Sadock, B.J., & Sadock, V.A. (2013). Buku ajar psikiatri klinis edisi 2. Jakarta: EGC.
  42. Samy, A.L., Khalaf, Z.F., & Low, W.Y. (2015). Mental health in the asia pacific region: An overview. International Journal of Behavioral Science, 10(2), 9–18.
  43. Sari, H., Keliat., B.A., & Mustikasari, M. (2009). Pengaruh family psychoeducation therapy terhadap beban dan kemampuan keluarga dalam merawat klien pasung di Kabupaten Bireuen Nanggroe Aceh Darussalam (Master Thesis, Degree in Nursing). Depok: Faculty of Nursing Universitas Indonesia.
  44. Sariah, A. (2012). Factors influencing relapse among patients with schizophrenia in muhimbili national hospital: The perspectives of patients and their caregivers (Doctoral Dissertation, Degree of Master of Science Nursing). Tansania: Muhimbili University of Health and Allied Sciences
  45. Shah, A.J., Wadoo, O., & Latoo, J. (2010). Psychological distress in carers of people with mental disorders. British Journal of Medical Practitioners, 3(3), a327. Retrieved from https://www.bjmp.org/content/psycho logical-distress-carers-people-mental-disorders.
  46. Smith, S.S. (2014). Traumatic loss in low-income communities of color. Focus, 31(1), 32–34.
  47. Sodikin, M.A., Wihastuti, T.A., & Supriati, L. (2015). Pengaruh latihan asertif dalam memperpendek fase intensif dan menurunkan gejala perilaku kekerasan di ruang Intensive Psychiatric Care Unit RSJ Dr Radjiman Wediodiningrat. Jurnal Ilmu Keperawatan, 3(2), 168–182.
  48. Stuart, G.W. (2013). Priciples and practice of psyciatric nursing (10th Ed.). St Louis Missouri: Elsivier Mosby.
  49. Udechuku, A.Y., Harrison, B., Mayo-Wilson, E., Young, N., Woodhams, P., Shiers, D., ... & Kendall, T. (2015). Interventions to improve the experience of caring for people with severe mental illness: Systematic review and meta-analysis. The British Journal of Psychiatric, 206(4), 268–274.
  50. Varcarolis, E.M. (2014). Psychiatric mental health nursing: A clinical approach. St. Louis: Elsevier.
  51. Varshney, M., Mahapatra, A., Krishnan, V., Gupta, R., & Deb, K.S. (2016). Violence and mental illness: what is the true story. J Epidemiol Community Health, 70(3), 223–225.
  52. Videbeck, S.L. (2011). Psyciatric mental health nursing (5th Ed.). Lippincott Williams & Wilkiins: Wolter Kluer Health.
  53. Volavka, J. (2013). Violence in schizophrenia and bipolar disorder. Psychiatria Danubina, 25(1), 24–33.
  54. Wardaningsih, S., Keliat, B.A., Daulima, N.H.C. (2007). Pengaruh family psychoeducation terhadap beban dan kemampuan keluarga dalam merawat klien dengan halusinasi di kabupaten Bantul Yogyakarta (Master Thesis, Degree in Nursing). Depok: Faculty of Nursing Universitas Indonesia.
  55. Wahyuningsih, D., Keliat, B.A., & Hastono, S.P. (2011). Penurunan perilaku kekerasan pada klien skizoprenia dengan assertiveness training. Jurnal Keperawatan Indonesia, 14(1), 51–56.
  56. Wiyati, R., Hamid, A.Y., Gayatri, D. (2009). Pengaruh psikoedukasi keluarga terhadap kemampuan keluarga dalam merawat klien isolasi social (Master Thesis, Degree in Nursing). Depok: Faculty of Nursing Universitas Indonesia.
  57. World Health Organization. (2009). Improving Health System and service for mental health: WHO library cataloging in publication. Geneva: World Health Organization. Retrieved from https://apps.who.int/iris/ bitstream/handle/10665/44219/9789241598774_eng.pdf

How to Cite

Fahrizal, Y., Mustikasari, M., & Daulima, N. H. C. (2020). Changes in The Signs, Symptoms, and Anger Management of Patients with A Risk of Violent Behavior After Receiving Assertive Training and Family Psychoeducation Using Roy’s Theoretical Approach: A Case Report. Jurnal Keperawatan Indonesia, 23(1), 1–14. https://doi.org/10.7454/jki.v23i1.598