Nursing diagnosis: Powerlessness related to confirmed diagnosis of a potentially terminal disease, incomplete grieving process; social ramifications of AIDS; alteration in body image, desired lifestyle; advancing CNS involvement
Possibly evidenced by
Feelings of loss of control over own life
Depression over physical deterioration that occurs despite client compliance with regimen
Anger, apathy, withdrawal, and passivity
Dependence on others for care and/or decision making, resulting in resentment, anger, guilt
Desired Outcomes/Evaluation Criteria—Client Will
Health Beliefs: Perceived Control
Acknowledge feelings and healthy ways to deal with them.
Verbalize some sense of control over present situation.
Make choices related to care and be involved in self-care.
Nursing intervention with rationale:
1. Identify factors that contribute to client’s feelings of powerlessness—diagnosis of a terminal illness, lack of support systems, and lack of knowledge about present situation.
Rationale: Powerlessness is most prevalent in a client newly diagnosed with HIV and when dying with AIDS. Fear of AIDS (by the general population and the client’s family/SO) is the most profound cause of client’s isolation. Multiple medications and inconvenient dosing regimens can also reduce a person’s sense of control, independence, and general quality of life.
2. Assess degree of feelings of helplessness noting verbal and nonverbal expressions indicating lack of control (“It won’t make any difference”), flat affect, or lack of communication.
Rationale: Determines the status of the individual client and allows for appropriate intervention when client is immobilized by depressed feelings.
3. Encourage active role in planning activities, establishing realistic and attainable goals. Encourage client control and responsibility as much as possible. Assist client to identify things that client can and cannot control.
Rationale: May enhance feelings of control and self-worth and sense of personal responsibility.
4. Encourage advance directives or living will and durable medical power of attorney documents, with specific and precise instructions regarding acceptable and unacceptable procedures to prolong life.
Rationale: Many factors associated with the treatments used in this debilitating and often fatal disease process place client at the mercy of medical personnel and other unknown people who may be making decisions for and about client without regard for client’s wishes, increasing loss of independence.
5. Discuss desires and assist with planning for funeral, as appropriate.
Rationale: The individual can gain a sense of completion and value to his or her life when he or she decides to be involved in planning this final ceremony. This provides an opportunity to include things that are of importance to the client.