Nursing diagnosis: ineffective self Health Management/family Therapeutic Regimen Management related to complexity of healthcare system and access to care, economic difficulties, complexity of therapeutic regimen—confusing or difficult dosing schedule, duration of regimen, mistrust of regimen and/or healthcare personnel—client and provider interactions, health beliefs or cultural influences, perceived seriousness, susceptibility, or benefits of therapy, decisional conflicts, powerlessness, family conflict or crises
Possibly evidenced by
Expressed desire to manage situation more appropriately
Verbalized difficulty with regulation or integration of one or more prescribed regimens for treatment of illness and its effects
Failure to take actions to reduce risk factors for progression of illness and sequelae
Evidence of acceleration of illness symptoms, development of complications
Desired Outcomes/Evaluation Criteria—Client/Family Will
Treatment Behavior: Illness or Injury
Identify individual factors affecting management of regimen.
Accept personal responsibility for own actions and participate in problem-solving activities.
Develop contract for care with mutually agreeable goals for treatment and mechanisms for changing or terminating elements of plan.
Nursing intervention with rationale:
1. Make time to listen to client concerns.
Rationale: Promotes feelings of value and may identify additional factors that affect outcome of therapy. Timing of teaching needs to consider the stage of acceptance.
2. Note client’s stage of acceptance of the diagnosis: Precontemplation stage
Rationale: Client has just learned of the diagnosis, and may not be able to participate in any discussions.
3. Determine client’s and SO’s perception or understanding of regimen.
Rationale: Identifies areas of confusion or conflict or lack of accurate information that may impede cooperation with regimen.
4. Assess perceived and actual barriers to accessing healthcare services and reasons for deviations from prescribed plan.
Rationale: Provides opportunity to clarify actual problems and develop alternative plan acceptable to healthcare provider.
5. Negotiate a therapy plan client can commit to. Include routines of awakening, meals, work schedule, and medication side effects.
Rationale: The more individualized the plan is, the greater probability of adherence. Note: New dosing regimens are addressing the issues of pill load or number of pills in each dose, dosing frequency, dietary restrictions, and adverse events, resulting in greater individualization of the medication regimen.
6. Assist client to develop realistic health goals and incorporate wellness activities and practices—exercise, smoking cessation, nutrition, vitamin supplements—into daily routine.
Rationale: Multiple responsibilities and demands on the client’s time, especially with women, make it appear difficult to include any additional activities of self-care.
7. Review stress management skills.
Rationale: Client must balance self-care needs and needs of other family members, which may be conflicting.
8. Provide anticipatory guidance and possible occurrences and choices, if any, to prevent or delay complications.
Rationale: Reduces crisis events. Provides time for client to prepare for known, usual, or expected changes. Permits earlier initiation of therapies and decreases disruption of schedule.
9. Monitor adherence to prescribed medical regimen. Alter plan of care as needed.
Rationale: Regimen is likely to be complicated and time consuming. Thoughtful changes in plan may help enhance cooperation.
10. Evaluate short-term side effects and their interference with adherence to the medical regimen.
Rationale: In the past, symptoms were considered part of having the disease and were accepted. Perception is that the side effect symptoms are the “main” effect. Improved options for better client care include the role of new HIV-1 PIs.