TUGAS

KEPERAWATAN JIWA I

ISOLASI SOSIAL

Diajukan Sebagai Salah Satu Syarat Untuk Mendapatkan Nilai Mata Kuliah Keperawatan Jiwa I

Oleh :

Najmal Hadi Zain

NIM 083213804

Dosen :

Ns.Novi Herawati,S.Kep

POLITEKNIK KESEHATAN DEPKES RI PADANG

PRODI KEPERAWATAN SOLOK

2009/2010
 KATA PENGANTAR

Puji syukur penulis ucapkan kepada Allah SWT yang senantiasa melimpahkan rahmat dan
karunia-Nya kepada penulis terutama dalam penyusunan makalah ini , sehingga makalah yang
berjudul Isolasi Sosial dapat penulis selesaikan. Makalah ini diajukan untuk memenuhi tugas
mata kuliah Keperawatan Jiwa I tahun ajaran 2009/2010.

Dalam penulisan makalah ini penulis banyak di bantu oleh berbagai pihak terutama dosen
pembimbing Ibu Ns.Novi Herawati S. Kep, teman-teman dan berbagai pihak yang turut
membantu penulis sehingga makalah ini dapat diselesaikan.

Penulis menyadari bahwa makalah ini masih jauh dari sempurna. Oleh karena itu, penulis
mengharapkan kritik dan saran dari pembaca agar dapat menyempurnakan makalah ini. Semoga
makalah ini dapat bermanfaat bagi para pembaca.

Solok, 19 September 2010

Penulis
 BAB II

ASUHAN KEPERAWATAN PADA KLIEN DENGAN

GANGGUAN ISOLASI SOSIAL : MENARIK DIRI

A.KONSEP DASAR

Isolasi adalah keadaan dimana individu atau kelompok mengalami atau merasakan
kebutuhan atau keinginan untuk meningkatkan keterlibatan dengan orang lain tetapi tidak
mampu untuk membuat kontak ( Carpenito, 1998 ) Isolasi sosial adalah suatu keadaan kesepian
yang dialami oleh seseorang karena orang lain menyatakan sikap yang negatif dan mengancam
(Towsend,1998)

Seseorang dengan perilaku menarik diri akan menghindari interaksi dengan orang lain.
Individu merasa bahwa ia kehilangan hubungan akrab dan tidak mempunyai kesempatan untuk
membagi perasaan, pikiran dan prestasi atau kegagalan. Ia mempunyai kesulitan untuk
berhubungan secara spontan dengan orang lain, yang dimanivestasikan dengan sikap
memisahkan diri, tidak ada perhatian dan tidak sanggup membagi pengalaman dengan orang lain
(DepKes, 1998).

B.FAKTOR PREDISPOSISI DAN PRESIPITASI

Faktor predisposisi terjadinya perilaku menarik diri adalah kegagalan perkembangan

yang dapat mengakibatkan individu tidak percaya diri, tidak percaya orang lain, ragu takut salah,
putus asa terhadap hubungan dengan orang lain, menghindar dari orang lain, tidak mampu
merumuskan keinginan dan meresa tertekan.

Sedangkan faktor presipitasi dari faktor sosio-cultural karena menurunnya stabilitas

keluarga dan berpisah karena meninggal dan fakto psikologis seperti berpisah dengan orang yang
terdekat atau kegagalan orang lain untuk bergantung, merasa tidak berarti dalam keluarga
sehingga menyebabkan klien berespons menghindar dengan menarik diri dari lingkungan (Stuart
and sundeen, 1995).
 C. TANDA DAN GEJALA

Observasi yang dilakukan pada klien akan ditemukan (data objektif) :

1. Apatis, ekspresi, afek tumpul.

2. Menghindar dari orang lain (menyendiri) klien tampak memisahkan diri dari orang lain.

3. Komunikasi kurang atau tidak ada. Klien tidak tampak bercakap-cakap dengan klien lain
atau perawat.

4. Tidak ada kontak mata, klien lebih sering menunduk.

5. Berdiam diri di kamar/tempat berpisah – klien kurang mobilitasnya.

6. Menolak hubungan dengan orang lain – klien memutuskan percakapan atau pergi jika
diajak bercakap-cakap.

7. Tidak melakukan kegiatan sehari-hari, artinya perawatan diri dan kegiatan rumah tangga
sehari-hari tidak dilakukan.

8. Posisi janin pada saat tidur.

Data subjektif sukar didapat jika klien menolak berkomunikasi, beberapa data subjektif
adalah menjawab dengan singkat kata-kata “tidak”, “ya”, “tidak tahu”.

D.KAREKTERISTIK PERILAKU

1. Gangguan pola makan : tidak nafsu makan atau makan berlebihan.

2. Berat badan menurun atau meningkat secara drastis.

3. Kemunduran secara fisik.

4. Tidur berlebihan.

5. Tinggal di tempat tidur dalam waktu yang lama.

6. Banyak tidur siang.

 7. Kurang bergairah.

8. Tidak memperdulikan lingkungan.

9. Kegiatan menurun.

10. Immobilisasai.

11. Mondar-mandir (sikap mematung, melakukan gerakan berulang).

12. Keinginan seksual menurun.

BAB III
KONSEP DASAR ASUHAN KEPERAWATAN KESEHATAN JIWA PADA KLIEN
DENGAN GANGGUAN ISOLASI SOSIAL ; MENARIK DIRI.

I. DESKRIPSI
Tanggapan atau deskripsi tentang isolasi yaitu suatu keadaan kesepian yang dialami oleh
seseorang karena orang lain menyatakan sikap yang negatif dan mengancam (towsend,
1998).
Seseorang dengan perilaku menarik diri akan menghindari interaksi dengan orang lain.

II. PENGKAJIAN
Pengelompokan data pada pengkajian kesehatan jiwa berupa faktor presipitasi, penilaian
stressor , suberkoping yang dimiliki klien. Setiap melakukan pengajian ,tulis tempat
klien dirawat da tanggal dirawat isi pengkajian meliputi :

A. IDENTITAS KLIEN

Meliputi nama klien , umur , jenis kelamin , status perkawinan, agama, tangggal MRS ,
informan, tangggal pengkajian, No Rumah klien dan alamat klien.

B.KELUHAN UTAMA

Keluhan biasanya berupa menyediri (menghindar dari orang lain) komunikasi kurang
atau tidak ada , berdiam diri dikamar ,menolak interaksi dengan orang lain , tidak
melakukan kegiatan sehari – hari , dependen.

C. FAKTOR PREDISPOSISI

Kehilangan , perpisahan , penolakan orang tua ,harapan orang tua yang tidak realistis
,kegagalan / frustasi berulang , tekanan dari kelompok sebaya; perubahan struktur sosial.
Terjadi trauma yang tiba tiba misalnya harus dioperasi , kecelakaan dicerai suami , putus
sekolah ,PHK, perasaan malu karena sesuatu yang terjadi ( korban perkosaan , tituduh
kkn, dipenjara tiba – tiba) perlakuan orang lain yang tidak menghargai klien/ perasaan
negatif terhadap diri sendiri yang berlangsung lama.

D.ASPEK FISIK / BIOLOGIS

Hasil pengukuran tada vital (TD, Nadi, suhu, Pernapasan , TB, BB) dan keluhafisik yang
dialami oleh klien.

E.ASPEK PSIKOSOSIAL

1. Genogram yang menggambarkan tiga generasi

2. Konsep diri

a) citra tubuh :

Menolak melihat dan menyentuh bagian tubuh yang berubah atau tidak menerima
perubahan tubuh yang telah terjadi atau yang akan terjadi.Menolak penjelasan
 perubahan tubuh , persepsi negatip tentang tubuh .

Preokupasi dengan bagia tubuh yang hilang , mengungkapkan keputus asaan,

mengungkapkan ketakutan.

b) Identitas diri

Ketidak pastian memandang diri , sukar menetapkan keinginan dan tidak mampu
mengambil keputusan .

c) Peran

Berubah atau berhenti fungsi peran yang disebabkan penyakit , proses menua ,
putus sekolah, PHK.

d) Ideal diri

Mengungkapkan keputus asaan karena penyakitnya : mengungkapkan keinginan

yang terlalu tinggi.

e) Harga diri

Perasaan malu terhadap diri sendiri , rasa bersalah terhadap diri sendiri , gangguan
hubungan sosial , merendahkan martabat , mencederai diri, dan kurang percaya diri.

3. Klien mempunyai gangguan / hambatan dalam melakukan hubunga sosialdengan

orang lain terdekat dalam kehidupan, kelempok yang diikuti dalam masyarakat.
4. kenyakinan klien terhadap tuhan dan kegiatan untuk ibadah ( spritual)

F. STATUS MENTAL

Kontak mata klien kurang /tidak dapat mepertahankan kontak mata , kurang dapat
memulai pembicaraan , klien suka menyendiri dan kurang mampu berhubungan denga
orang lain , Adanya perasaan keputusasaan dan kurang berharga dalam hidup.
G. KEBUTUHAN PERSIAPAN PULANG.

1. Klien mampu menyiapkan dan membersihkan alat makan

2. Klien mampu BAB dan BAK, menggunakan dan membersihkan WC, membersikan
dan merapikan pakaian.

3. Pada observasi mandi dan cara berpakaian klien terlihat rapi

4. Klien dapat melakukan istirahat dan tidur , dapat beraktivitas didalam dan diluar

rumah
H. MEKANISME KOPING

Klien apabila mendapat masalah takut atau tidak mau menceritakan nya pada orang
orang lain( lebih sering menggunakan koping menarik diri)

I. ASFEK MEDIK

Terapi yang diterima klien bisa berupa therapy farmakologi ECT, Psikomotor,therapy
okopasional, TAK , dan rehabilitas.

III. DIAGNOSA KEPERAWATAN

Diagnosa Keperawatan adalah identifikasi atau penilaian pola respons baik aktual
maupun potensial (Stuart and Sundeen, 1995)

Masalah keperawatan yang sering muncul yang dapat disimpulkan dari pengkajian
adalah sebagai berikut :

*. Isolasi sosial : menarik diri

*. Gangguan konsep diri: harga diri rendah

*. Resiko perubahan sensori persepsi

*. Koping individu yang efektif sampai dengan ketergantungan pada orang lain .

*. Gangguan komunikasi verbal, kurang komunikasi verbal.

*. Intoleransi aktifitas.

*. Kekerasan resiko tinggi.

Pohon Masalah

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Diagnosa Keperawatan

1. Resiko perubahan sensori persepsi berhubungan dengan menarik diri.

2. Isolasi sosial : menarik diri berhubungan dengan harga diri rendah
3. Gangguan harga diri : harga diri rendah berhubungan dengan tidak efektifnya koping
individu : koping defensif.

IV. TINDAKAN KEPERAWATAN

Tindakan keperawatan dalam asuhan keperawatan jiwa berbeda dengan tindakan

keperawatan untuk klien dengan penyakit fisik di RSU dalam perawatan kesehatan jiwa.
Perawat melakukan tindakan yang bertujuan untuk mengatasi penyebab dari masalah
dan daftar masalah diatas dapat diambil salah satu. Contoh masalah keperawatan yaitu :
resiko perubahan sensori persepsi berhubungan dengan isolasi sosial : menarik diri.

V. RENCANA INTERVENSI

Rencana tindakan keperawatan terdiri 3 asfek utama yaitu :

a. tujuan umum

berfokus pada penyelesaian permasalahan dari diagnosa. Tujuan umum dapat dicapai
jika serangkaia tujuan khusus dapat dicapai.

b. tujuan khusus
berfokus pada penyelesaian etiologi dari diagnosa. Tujuan khusus merupakan rumusan
kemampuan klien yang perlu dicapai atau dimiliki klien .umumnya kemampuan pada
tujuan khusus dapat dibagi menjadi 3 aspek (stuart & sundeen ,1995) yaitu : kemampuan
kognitif yang diperlukan untuk menyelesaikan etiologi dari diagnosa keperawatan
,kemampuan psikomotor yang diperlukan agar etiologi dapat selesai dan kemampuan
afektif yang perlu dimiliki agar klien percaya akan kemampuan menyelesaiakan
masalah.

c. Rencana tindakan keperawatan

Tindakan keperawatan merupakan serangkaian tindakan yang dapat mencapai tujuan

khusus. tindakan keperawatan menggambarkan tindakan keperawatan mandiri,
kerjasama dengan klien, keluarga, kelompok dan kolaborasi dengan tim kesehatan jiwa
lainnya.
d. Kriteria Evaluasi keperawatan

Kriteria evaluasi dibuat berdasarkan pada tujuan khusus yang terdiri dari beberapa
tujuan , masing tujuan tersebut ada kriteria evaluasinya .
 DAFTAR PUSTAKA

Carpenito, lynda Juall. 1998. Buku saku buku kedokteran EGC : jakarta.

Keliat, B.A. 1999. Proses keperawatan kesehatan jiwa, penerbit buku kedokteran
EGC : diagnosa keperawatan , Edisi 6, penerbit Jakarta.

Short, G.W dan Sandra, J. Sunden. 1998. Buku Saku Keperawatan Jiwa, Edisi 3,
penerbit buku kedokteran EGC: Jakarta.

Towsend, Mary C. 1998. Buku saku Diagnosa keperawatan psikiatri untuk

pembuatan rencana keperawatan, Edisi 3, Penerbit buku kedokteran EGC: Jakarta.

-----------, 1998. Buku Standart keperawatan Kesehatan Jiwa dan penerapan asuhan
keperawatan pada kasus di Rumah Sakit Ketergantungan obat, Direktorat kesehatan
jiwa Direktorat Jenderal Pelayanan medik, Dep-kes RI, Jakarta.

http//google.co.id_askep isolasi social.html.