Powerlessness — AIDS

Nursing Diagnosis: Powerlessness

May be 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 patient compliance with regimen
• Anger, apathy, withdrawal, passivity
• Dependence on others for care/decision making, resulting in resentment, anger, guilt

Desired Outcomes

• 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 Interventions	Rationale
Identify factors that contribute to patient’s feelings of powerlessness, e.g., diagnosis of a terminal illness, lack of support systems, lack of knowledge about present situation.	Patients with AIDS are usually aware of the current literature and prognosis unless newly diagnosed. Powerlessness is most prevalent in a patient newly diagnosed with HIV and when dying with AIDS. Fear of AIDS (by the general population and the patient’s family/SO) is the most profound cause of patient’s isolation. For some homosexual patients, this may be the first time that the family has been made aware that patient lives an alternative lifestyle.
Assess degree of feelings of helplessness, e.g., verbal/nonverbal expressions indicating lack of control (“It won’t make any difference”), flat affect, lack of communication.	Determines the status of the individual patient and allows for appropriate intervention when patient is immobilized by depressed feelings.
Encourage active role in planning activities, establishing realistic/attainable daily goals. Encourage patient control and responsibility as much as possible. Identify things that patient can and cannot control.	May enhance feelings of control and self-worth and sense of personal responsibility.
Encourage Living Will and durable medical power of attorney documents, with specific and precise instructions regarding acceptable and unacceptable procedures to prolong life.	Many factors associated with the treatments used in this debilitating and often fatal disease process place patient at the mercy of medical personnel and other unknown people who may be making decisions for and about patient without regard for patient’s wishes, increasing loss of independence.
Discuss desires/assist with planning for funeral as appropriate.	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 person.