Aim: validate the contents of NANDA International nursing diagnosis Lack of adherence to antiretroviral treatment in people living with AIDS. Method: this is a methodological study that will use, as a theoretical and methodological reference, the validation model of nursing diagnoses described by Lopes, Silva and Araújo, which proposes the use of the following steps: concept analysis and content analysis by specialists. After the literature review, the interpretation for the diagnosis Lack of adherence will be performed through the transposition for the negation of the components of the diagnosis (definition, defining characteristics and related factors), and an instrument with the components of the diagnosis under study will be elaborated, followed by the analysis by nurses specialized in infectology and NANDA International terminology, which will be selected by the Lattes Platform. The binomial test will be used to evaluate the proportion of judges who classified each item as adequate, considering the level of significance of 5%.
Descriptors: Validation Studies; Nursing Diagnosis; Anti-Retroviral Agents; Medication Adherence; Acquired Immunodeficiency Syndrome.
The main goal of antiretroviral treatment (ART) is to reduce the maximum possible plasma viral load, that is, the amount of virus circulating for the longest period. Adherence is a constant challenge for patients, since current protocols determine the use of at least three medications, ranging from one to three times a day, with a schedule that must be strictly adhered to. Knowledge of obstacles to comply with these guidelines can assist in the individualized choice of treatment and improve outcomes(1).
The study of nursing diagnoses is necessary to maintain and improve the evidence base of NANDA taxonomy, as well as to support the clinical practice of nurses, since these diagnoses support the establishment of nursing interventions and the assessment itself. Diagnoses must be validated and, where necessary, reformulated(2).
The need to increase access to antiretroviral therapy (ART), to control its undesirable effects, and to recognize and manage emerging comorbidities arises from the challenge of avoiding poor adherence to therapy, associated factors being, among others, low educational level, the family and social support deficit, the consumption of alcoholic beverages and illicit drugs and the side effects of the use of ART(3).
General
Validate the content of the NANDA International nursing diagnosis Lack of adherence to ART in people living with AIDS.
Specifics
• Construct the definition of the diagnosis Lack of adherence and operational definitions of clinical indicators, defining characteristics and related factors in people living with AIDS;
• Verify with specialists the adequacy of the constructed components (definition, defining characteristics and related factors) of the nursing diagnosis Lack of adherence to ART in people living with AIDS.
This is a methodological study that will use, as a theoretical and methodological reference, the validation model of nursing diagnoses described by Lopes, Silva and Araújo, which proposes the use of the following steps: concept analysis and content analysis by specialists. Throughout the first phase of the validation process, the baseline developed by Walker and Avant will be used, in conjunction with the development of an integrative literature revision proposed by Whittemore and Knafl. The integrative review will be carried out in the LILACS, CINAHL, PUBMED, SCOPUS, Web of Science and COCHRANE databases, with the following descriptors in Health Sciences: antiretrovirals; adherence to medication; and acquired immunodeficiency syndrome.
The articles selected in the review will be analyzed by means of a thorough reading for the identification of definitive, antecedent and consequent attributes of the nursing diagnosis Lack of adherence to ART in people living with AIDS. Then, the interpretation for the said diagnosis will be performed through the transposition to the negation of the components of the diagnosis (definition, defining characteristics and related factors). Subsequently, an instrument with the components of the diagnosis will be elaborated, continuing for the analysis of nurses specialists in infectology and in the terminology of NANDA International, which will be selected by the Platform Lattes. For the selection of specialists the following criteria will be adopted: be a nurse with clinical experience in infectology and have some scientific production on NANDA International diagnostics. Experts who do not have the Lattes curriculum updated in the last six months will be excluded from the study.
The data obtained will be entered in a database of the Statistical Package for Social Sciences (SPSS) version 20.0 for treatment of the results and will be submitted to descriptive statistical analysis, using absolute frequencies and percentages.
Inferential statistical analysis with logistic regression using the stepwise method will also be used to identify the predictive factors of the characteristics that will influence the validation of the nursing diagnosis Lack of adherence. In addition, the binomial test will be used to evaluate the proportion of specialists that classify each item as adequate, considering the level of significance of 5%. With this study, it is hoped to contribute to the early development of strategies for the promotion of adherence to the use of antiretrovirals in people living with AIDS.
The project was approved by the Committee of Ethics in Research with human beings of the Federal University of Rio Grande do Norte under the opinion No. 1,146,907 and Certificate of Presentation for Ethical Appreciation No. 46206215.3.0000.5537.
All authors participated in the phases of this publication in one or more of the following steps, in according to the recommendations of the International Committee of Medical Journal Editors (ICMJE, 2013): (a) substantial involvement in the planning or preparation of the manuscript or in the collection, analysis or interpretation of data; (b) preparation of the manuscript or conducting critical revision of intellectual content; (c) approval of the version submitted of this manuscript. All authors declare for the appropriate purposes that the responsibilities related to all aspects of the manuscript submitted to OBJN are yours. They ensure that issues related to the accuracy or integrity of any part of the article were properly investigated and resolved. Therefore, they exempt the OBJN of any participation whatsoever in any imbroglios concerning the content under consideration. All authors declare that they have no conflict of interest of financial or personal nature concerning this manuscript which may influence the writing and/or interpretation of the findings. This statement has been digitally signed by all authors as recommended by the ICMJE, whose model is available in http://www.objnursing.uff.br/normas/DUDE_eng_13-06-2013.pdf
Received: 11/17/2017 Revised: 09/20/2018 Approved: 09/20/2018