Consulta de enfermagem baseada na teoria de orem para pacientes com coinfecção HIV/tuberculose : efetividade na adesão e qualidade de vida

• Ano de defesa: 2011
• Autor(a) principal: Feijão, Alexsandra Rodrigues
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Palavras-chave em Português: HIV; Tuberculose
• Link de acesso: http://www.repositorio.ufc.br/handle/riufc/2052

The clinical severity and social demand of patients co-infected with HIV/tuberculosis demand changes in nursing knowledge and actions for health care, especially health promotion. In this context, this study aimed to: elaborate and validate the contents of a nursing consultation instrument for patients co-infected with HIV/TB based on Orem’s Theory; to assess the efficacy of the nursing consultation for adherence and quality of life of HIV/aids patients during tuberculosis treatment. The research involved two moments. Initially, through a developmental design, a nursing consultation instrument was elaborated based on Orem’s Theory, which was submitted to content validation by experts. The Kappa Coefficient was used to assess the inter-rater agreement level, with a view to achieving an adequate nursing consultation instrument for HIV/TB co-infected patients. Next, a quasi-experimental study was developed, comparing the intervention through the application of the nursing consultation based on Orem’s Theory (exposed group – 1) during six months of follow-up for TB treatment, with another group (non-exposed group – 2) for whose treatment the nursing consultation was used without theories. For inter-group comparisons, quality of life assessment (HAT-QoL) and the Moriski and Green Test were applied, as well as adherence difficulty assessment (TMG and ADA). Study participants were 96 HIV/TB co-infected patients, constituting two groups (48=exposed group and 48=non-exposed group) monitored at Hospital São José de Doenças Infecciosas (HSJ) between October 2009 and September 2010. For data analysis, appropriate statistical tests were used for inter-group comparisons. As for the findings resulting from the nursing consultation application, self-care deficits were observed, mainly regarding inadequate social support (66.7%); service access difficulty due to lack of transportation (60.4%) and lack of knowledge on the disease and treatment (43.8%). According to the HAT-QoL, at the start of the follow-up, inter-group comparison showed low and homogeneous scores. A difference was found in the domain related to financial concerns (p=0.001). At the end of the follow-up, the exposed group demonstrated improved quality of life in the general function (p=0.002), health concern (p=0.000), acceptance of HIV (p=0.000), satisfaction with life (p=0.000) and trust in the professional (p=0.032) domains. Regarding adherence, no inter-group difference was identified. When assessing adherence difficulty at the end of treatment, however, better scores were found in the exposed group. Despite low HAT-QoL scores, a significant increase in quality of life was perceived among patients from the exposed group. Also, treatment adherence improved and abandonment rates dropped in the group submitted to nursing consultations using Orem’s model.