Nursing diagnosis: risk-prone health Behavior related to life-threatening, stigmatized disease, incomplete or ongoing grieving, assault to self-esteem, altered locus of control, denial, negative attitudes toward health behavior and/or lifestyle changes, inadequate support systems, complex medication regimen and side effects—fatigue and depression
Possibly evidenced by
Verbalization of nonacceptance or denial of diagnosis
Extended period of shock, disbelief, or anger regarding change in health status
Failure to take action to prevent further health problems
Inability to effectively manage medication regimen
Failure to achieve optimal sense of control
Desired Outcomes/Evaluation Criteria—Client Will
Acceptance: Health Status
Verbalize reality and acceptance of condition.
Demonstrate increased trust and participation in development of plan of action.
Initiate lifestyle changes that will permit adaptation to present life situations.
Nursing intervention with rationale:
1. Evaluate client’s ability to understand events and realistically appraise situation.
Rationale: Provides base to develop plan of action.
2. Identify real barriers to adjustment.
Rationale: Promotes opportunity to deal appropriately with real problems in client’s individual situation.
3. Encourage expression of feelings, denial, shock, and fears. Listen without judgment, accepting client’s expressions. Focus on positive outcomes.
Rationale: It is important to convey belief in client’s fears and feelings. By focusing on positive outcomes, client is encouraged to take charge of those areas in which changes can be made, such as managing medical regimen and behavior.
4. Challenge morbid thoughts and reframe into positive statements: “You know why the virus is going to kill me. I deserve to die for what I’ve done.” Response: “The virus may or may not kill you. It’s not smart enough to decide when you may die. The virus is ‘just there.’ It does not have a mind to know what you have or have not done.”
Rationale: Interrupts morbid thoughts and challenges client’s selfdeprecating ideas. As with any potentially terminal disease, this population is likely to experience depression and is at increased risk for suicide, necessitating ongoing evaluation.
5. Determine available resources and programs.
Rationale: Identifies client needs and what comprehensive services might be available and immediately accessible. Services may include education concerning sexual myths, HIV transmission prevention, safer sex practices, and alternate methods of expressing sexuality. Interventions and education may be needed for addictive behaviors, such as the ability of injection drug user to obtain clean “works.”
6. Assess social system as well as presence of support, perception of losses, and stressors.
Rationale: Partners, friends, and families will have individual responses depending on the individual’s lifestyle, knowledge of HIV transmission, and belief systems. Note: Belief systems can include values or myths, which affect how the individual approaches the disease and the outcome.
7. Encourage client to participate in support groups.
Rationale: Long-term support is critical to dealing with and effectively coping with the reality of being HIV positive and with frequent healthcare evaluations, medical treatments, and ongoing lifestyle changes.
8. Educate client about drug interactions, HIV, and emotions.
Rationale: Fatigue and depression can be side effects of some medications and of the infection itself. Knowledge that these effects are usually of short duration can support informed choices and cooperation and promote hope.
9. Encourage continued or renewed use of familiar effective coping strategies.
Rationale: Client is supported and given encouragement for past effective behaviors. Positive reinforcement enhances self-esteem.
10. Refer client to nurse practitioner or clinical nurse specialist, psychologist, or social worker knowledgeable about HIV as well as specific HIV programs and resources or appropriate research programs.
Rationale: May need additional help adjusting to difficult situation.