Nursing diagnoses for elderly women vulnerable to HIV/AIDS

Classify the diagnoses in the conceptual framework of vulnerability of Ayres and in the Orem's self-care theory; Elaborate operational definitions of nursing diagnoses for elderly women vulnerable to HIV/AIDS.

Method:

A descriptive exploratory study, developed from March to December 2016 in the stages: 1. Classification of diagnoses in the conceptual framework of vulnerability of Ayres and in the Orem's self-care theory; 2. Operational definition of nursing diagnoses.

Results:

70 nursing diagnoses were classified in the conceptual framework of vulnerability of Ayres and Orem's self-care theory, and their operational definitions were constructed, where 75.7% of these were validated.

Final consideration:

Diagnoses represent conditions that make older women vulnerable to HIV/AIDS and are linked to their self-care practices. Operational definitions contribute to a systematic approach to care and greater clarity in its implementation.

Descriptors:
Aging; Women Health; HIV; Nursing Processes; Nursing Diagnosis

Individual vulnerability
Self-care requirements	Nursing diagnoses/results
Health diversion requirement	1. Alcohol abuse (or alcoholism) - Excess consumption of alcoholic beverages, characterized by behaviors suggestive of drunkenness or abstinence, and/or reports of use by the patient or family members.
	2. Non-adherence to the drug regimen - Behavior of elderly person that does not agree with the therapeutic plan agreed between the patient and the health professional, characterized by totally or partially non-adherent behavior that leads to ineffective or partially effective clinical results.
	3. Non-adherence to the diagnostic test - Behavior of the individual that does not coincide with the health promotion plan agreed between him and the health professional, characterized by totally or partially non-adherent behavior that leads to ineffective or partially effective clinical results.
Health diversion requirement	4. Attitude towards conflicting treatment - Attitude of opposition in relation to the adopted therapy, characterized by the demonstration of negative intention in relation to the accomplishment of the treatment through gesture or posture.
	5. Attitude regarding the negative health condition - Attitude of denial or difficulty of facing the health condition, characterized by the demonstration of feelings of guilt due to the health condition and/or refusal of the clinical picture.
	6. Violent behavior - Aggressive behavior, where inappropriate and unjustified acts of force and power, or culturally prohibited, are taken for the purpose of injuring or harming, mistreating or attacking, characterized by violent, abusive and illegal attack on another, in a manner psychological, physical or financial, with an antisocial and violent behavior pattern, including indirectly.
	7. Self-care deficit for treatment - Impaired ability to remain operative to perform treatment activities, characterized by the need for therapeutic activities to be performed by health professionals or a trained caregiver.
	8. Self-care deficit for prevention - Impaired ability to carry out prevention activities, which may be characterized by a lack of concern about prevention or the lack of knowledge about this need, making the health professional the role of providing information.
	9. Side effect of the present medication - Event/physiological phenomenon of corporal response to the medication, which results from the intentional use of the pharmaceutical preparations, characterized by the observation/detection of accompanying symptomatology to that desired primary.
	10. Ineffective sexual process - Absence or decrease in the ability to participate in sexual intercourse, characterized by a report of abstention, an expression of concern about one's own sexuality and reports of difficulty in sexual activity.
	11. Interrupted medication regimen - Prescribed medication regimen interrupted, characterized by non-cooperation of the patient in the duration, dosage and/or frequency of medicines use, and by ineffectiveness of the therapeutic regimen initiated.
	12. Response to negative treatment - Physical reaction not corresponding to what was expected when using medication and adopting specific therapeutic measures, characterized by no cessation of symptoms and/or no return to the original, previous clinical condition.
	13. Symptom of infection - Subjective evidence and/or physiological alteration, revealed by the patient, suggesting the existence of infection, characterized by clinical observation and/or complaint of changes in sensations, functions or body appearance, indicating the existence of an infectious process.
	14. Negative self-esteem - Negative self-esteem, negative self-esteem and negative feelings about themselves and their values and abilities, characterized by negative beliefs about themselves, lack of self-confidence and negative images, with difficulty of accepting compliments, encouragement and constructive criticism.
	15. Ineffective coping - Inability to manage stress, inadequate choices of responses and/or inability to use available resources, characterized by self-destructive behavior, inadequate problem-solving skills, and inability to cope.
Development requirement	16. Impaired health learning - Absence or ineffectiveness in the acquisition of health-related knowledge or skills, characterized by the failure to achieve positive health outcomes due to lack of education, guidance, practice and experience, so that there are no changes in behavior of health.
	17. Learning about impaired prevention - Absence or ineffectiveness in the acquisition of knowledge or skill related to disease prevention, characterized by the non-adoption of preventive measures due to lack of knowledge, instruction, guidance and/or experience.
	18. Learning about impaired treatment - Absence or ineffectiveness in the acquisition of knowledge or skills related to the treatment, characterized by the failure to carry out treatment measures due to lack of instruction, guidance, practice and experience, so that there are no significant changes in the state of health.
	19. Autonomy for absentee of decision making (specify) - Absence of the client's right to be independent or self-directed, especially in relation to decision making, characterized by the impossibility of deciding what is good for him or not.
	20. Impaired sexual behavior - Impaired ability to modify sexual behaviors that compromise the state of health, characterized by negative attitude and lack of knowledge to prevent health problems.
	21. Absence of health knowledge - Absence or deficiency of cognitive information related to health, healthy practices, signs and symptoms of diseases and/or health services available, and may be characterized by the presentation of erroneous information, resulting from an insufficient supply of information, with insufficient interest in learning, inappropriate behaviors or inappropriate follow-up of instructions.
	22. Negative Emotion - Conscious or subconscious feelings, painful physically or psychologically, which can increase with or develop from stress or illness, characterized by the expression or perception of negative feelings.
	23. Risk of cross infection - Possibility of a new pathological process by invasion of the body by pathogenic microorganisms that cause diseases associated with primary infections, characterized by clinical symptoms of infection, such as fever and purulent secretions associated with the previous infection.
Development requirement	24. Fear - Negative feelings about the threat perceived and consciously recognized as a danger due to some cause, accompanied sometimes by psychological struggle or escape response, characterized by excessive concern with a certain fact or with a certain possibility, which may disappear with the end of the situation threatening.
	25. Fear of death - Unpleasant feeling of real or imagined threat, of recognition of danger, concern or anguish related to the cessation of life, characterized by increased tension, attack or isolation behaviors, focus always directed towards the source of fear, and may cause biopsychosocial impairment.
	26. Impaired quality of life - A state or condition that reflects an insufficiency in the set of characteristics, habits, customs and behaviors of the individual, in order to present biopsychosocial commitment, characterized by insufficient access to education and information and/or negative social insertion.
	27. Suffering - A negative feeling, characterized by prolongation of sadness and/or distress, associated with martyrdom and the need to tolerate chronic physical symptoms, chronic psychological stress, bad reputation or injustice.
Universal requirement	28. Adherence to the medication regimen - Action initiated by the individual to promote recovery following the guidelines without straying, adhering to a framework of behavior in accordance with the therapeutic regime, characterized by the personal motivation to seek medication on the due date, take them according to orientation and to modify erroneous behaviors, with consequent presentation of signs of improvement.
	29. Adherence to the diagnostic test - Acceptance by the person himself for prevention and promotion of well-being, being devoted to a diagnostic plan, characterized by the demonstration of internalization of the value of health care behaviors and personal motivation in line with good relationship with health professionals.
	30. Conflicting Spiritual Belief - Impersonal personal conviction regarding a power greater than itself, capable of invading, integrating, and transcending the individual's biological and psychosocial nature, characterized by his unwillingness to maintain and/or abandon actions influenced by the spiritual principles of life.
	31. Taking care of (or taking care of) ineffective health - Reducing the ability to provide care for one's own health, including identification, disease prevention, welfare promotion, and health treatment, when necessary, characterized by meeting the on health's needs.
	32. Ineffective Gender Identity - Negative ideas, feelings and attitudes about the internalized personal sense of masculinity or femininity, characterized by confusion about ideological values, self-description for inappropriate ideas, feelings of estrangement, and oscillating feelings about gender .
	33. Need for care (specify) - Demand condition of basic or less priority actions, whose normal performance leads to biopsychosocial satisfaction, characterized by the evidence of impossibility of ceasing to act for the benefit of the individual.
	34. Ineffective prevention role - Lack of adoption of behavioral patterns to avoid disease involvement, so that it does not meet a set of expectations, norms and standards of health prevention, characterized by reporting or identifying non-performance of responsibilities with preventive measures according to norms.
	35. Impaired sexual intercourse - Ineffective process of sexual activity between two people for the purpose of mutual arousal and orgasm, characterized by the report of abstention or impairment in sexual activity.
	36. Risk of infection - Vulnerability to the invasion of the body by pathogenic microorganisms that multiply and may compromise health, characterized by risk factors such as evidence of contact with sources of infection, insufficient knowledge about prevention and presence of chronic disease.

Social vulnerability
Self-care requirements	Nursing diagnoses/results
Health diversion requirement	1. Moral distress - Negative feeling defined by conflict of non-physical and material decisions in relation to functions that are foreseen for the individual, characterized by expression of sadness and distress, related to principles and values before established norms.
	2. Risk of violence - Vulnerability to the behavior of others, characterized by the demonstration of the individual's power to be harmful to the other, physically, emotionally or sexually.
	3. Stigma - Belief impaired in relation to the other, due to a distinctive factor among the subjects, being characterized by unequal access to social participation or opportunity, by the practice of associating discredit, shame to another, discrimination by age and by gender, when it presents diverse conditions, such as mental illness, physical incapacity, religious or behavioral positioning divergent.
Development requirement	4. Elderly women abuse (specify) - Aggressive or violent behavior directed at the elderly woman, characterized by mistreatment, exploitation or abandonment of emotional, financial, nutritional, sexual or physical order, usually coming from someone trusted by the elderly, such as family member or institution staff.
Development requirement	5. Access to impaired health knowledge - Reduced access to information by the elderly person, making it difficult to use awareness of common health problems, healthy practices and available health services, characterized by the inability to recognize signs and symptoms of diseases, presenting erroneous information, resulting from an insufficient supply of information.
Universal requirement	6. Absence of family support - Failure of support systems in the family so that the elderly can progress and prevent them from failing in health care and coping with illnesses characterized by the absence or disorganization of the family's biopsychosocial and spiritual help lead to ineffective resolution of problems and to family and individual conflicts.
	7. Ineffective social support - Failure of support systems in society that provide assistance and encouragement for older people to overcome problems, characterized by lack of effective insertion in social activities or lack of access to social support systems.
	8. Impaired ability of the caregiver to perform care - Difficulty of the individual who attends to the needs of a dependent elderly person to perform, follow up and complete the activities necessary to provide care and can be evidenced in the demonstration of frustration, apprehension regarding health conditions of the elderly person receiving care, impatience and emotional oscillation on the part of the caregiver.
	9. Rights of the individual harmed - Non-guarantee of the human rights of the elderly as a member of the society that has health needs, characterized by non-compliance with cultural, social, economic and educational rights by health services, including the disrespect of its rights, including confidentiality, dignity and honor.
	10. Social isolation - A negative state of establishing barriers in the interaction between the elderly and society, perceived as imposed by others or by choice of the elderly, where there is an insufficient quantity or an ineffective quality of social exchange, characterized by the desire of being alone, feeling different from others, insecurity in public, dissatisfaction with social involvement and/or family reporting of change in interaction.
	11. Present cultural diversity - Coexistence of different groups that have their beliefs, values, traditions and behaviors in the same social unit, characterized by differential factors in the acceptance or not of prevention and/or treatment behaviors.
	12. Ineffective Gender Role - Difficulty adopting a pattern of behavior and self-expression of one or the other gender that meets the expectations of individuals and society in relation to what is proper or improper of the role of being a man or being a woman.
	13. Relationship with the negative family - Absence or insufficiency in the establishment of behavioral, psychological and social relations between the elderly person and the other members of the extended and nuclear family, to interact and meet reciprocal needs.
	14. Relationship with the negative community - Absence or insufficiency in establishing relationships between the elderly person and his social unit, with whom he shares a geographical area, conditions or interests, to interact and meet reciprocal needs.

Programmatic vulnerability
Self-care requirements	Nursing diagnoses/results
Health diversion requirement	1. Access to impaired treatment - Impaired potential to use prescription drugs and adopt care behaviors, characterized by geographical, transportation, financial, and availability difficulties in health services.
Universal requirement	2. Impaired patient rights - Non-guarantee of the human rights of the elderly as a patient under health care, characterized by non-compliance with cultural, social, economic and educational rights by the health services, including not providing decent care, disrespect of the same with respect to confidentiality, dignity and honor.
Universal requirement	3. Partial health policy - A documented comprehensive statement outlining insufficient and non-specific guidelines for decision making in the provision of health services, characterized by a lack of attention to the specificities of the target population of the proposed actions.

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] CORRESPONDING AUTHOR: Márcia Cristina de Figueiredo Santos. E-mail: marciacs@hotmail.com