Validación de las definiciones de los diagnósticos enfermeros para personas con Sida

Souza Neto, Vinicius Lino de; Costa, Rayanne Teresa da Silva; Santos, Wenysson Noleto dos; Fernandes, Sâmara Fontes; Lima, Dhyanine Morais de; Silva, Richardson Augusto Rosendo da

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Revista Brasileira de Enfermagem

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Sumário

ORIGINAL ARTICLE • Rev. Bras. Enferm. 73 (4) • 2020 • https://doi.org/10.1590/0034-7167-2018-0915 copiar

Validación de las definiciones de los diagnósticos enfermeros para personas con Sida

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivos:

elaborar y validar el contenido de las definiciones conceptuales y operativas de los Diagnósticos Enfermeros de la Clasificación Internacional para la Práctica de Enfermería para personas que viven con el Sida.

Métodos:

estudio metodológico con 100 personas viviendo con Sida, en un Hospital Escuela. Además, 19 enfermeros seleccionados por medio de la plataforma Lattes actuaron como jueces en el proceso de validación. La investigación se realizó, siguiendo tres momentos: identificación y validación de los diagnósticos enfermeros; construcción de las definiciones conceptuales y operacionales de los diagnósticos y validación de contenido, utilizando el índice de validez de contenido.

Resultados:

se identificaron 35 diagnósticos, validando solo 18 para los cuales fueron construidas y validadas definiciones conceptuales y operacionales con índice de validez de contenido ≥ 0.8.

Conclusiones:

la construcción de las definiciones conceptuales y operativas permite que el enfermero pueda analizar las inferencias clínicas y así reafirmar el diagnóstico enfermero, contribuyendo a su capacidad predictora.

Descriptores:
Enfermería; Diagnóstico de Enfermería; Terminología Normalizada de Enfermería; Estudios de Validación; Síndrome de Inmunodeficiencia Adquirida

PsychobiologicalBHN	Nursing diagnoses
Oxygenation	Dyspnea
Nutrition	Impaired swallowing
Elimination	Urinary incontinence
Elimination	Bowel incontinence
Sleep and Rest	Insomnia
Body Care	Impaired hygiene of the scalp
Neurological regulation	Impaired Consciousness
Immune regulation	Risk for Infection
Therapy	Impaired adherence to the therapeutic regimen

PsychosocialBHN	Nursing diagnoses
Emotional safety	Fear about death
Learning	Knowledge of deficient health
Gregarious	Loneliness
Gregarious	Lack family support
Acceptance	Impaired acceptance of health status
Self-image	Marked body changes
Psychosocial care	Alcohol abuse
Psychosocial care	Tobacco abuse
Psycho-spiritual BHN	Nursing diagnoses
Religious/ Spirituality	Impaired religious belief

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: Richardson Augusto Rosendo da Silva. E-mail: rirosendo@hotmail.com

Nursing Diagnosis	Conceptual definitions	Operational definitions
Dyspnea	Forced air movement into and out of the lungs, shortness of breath, associated with circulating oxygen deficiency, feeling of discomfort and anxiety⁽¹⁰10 Tsiligianni IG, Alma HJ, Jong C, Jelusic D, Wittmann M, Schuler M, et al. Investigating sensitivity, specificity, and area under the curve of the Clinical COPD Questionnaire, COPD Assessment Test, and Modified Medical Research Council scale according to GOLD using St George’s Respiratory Questionnaire cutoff 25 (and 20) as reference. Int J Chron Obstruct Pulmon Dis [Internet]. 2016 [cited 2018 Aug 08];18;11:1045-52. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27274226 https://www.ncbi.nlm.nih.gov/pubmed/2727... ⁾. (CVI = 1,0)	To evaluate the dyspnea by means of the identification of the signs of fatigue, with the use of the accessory musculature. Measure the degree of dyspnea using the Medical Research Council scale⁽¹⁰10 Tsiligianni IG, Alma HJ, Jong C, Jelusic D, Wittmann M, Schuler M, et al. Investigating sensitivity, specificity, and area under the curve of the Clinical COPD Questionnaire, COPD Assessment Test, and Modified Medical Research Council scale according to GOLD using St George’s Respiratory Questionnaire cutoff 25 (and 20) as reference. Int J Chron Obstruct Pulmon Dis [Internet]. 2016 [cited 2018 Aug 08];18;11:1045-52. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27274226 https://www.ncbi.nlm.nih.gov/pubmed/2727... ⁾. Measures ventilation and perfusion by means of pulse oximeter and arterial blood gas. (CVI = 0,98)
Impaired swallowing	Difficulty swallowing that arises from a variety of disorders affecting the neural, motor, and/or sensory systems underlying the swallowing function. There is difficulty of oral control of the food bolus and greater time of oral transit. Based on the presence of coughing and/or gagging during feeding, regurgitation, low diet acceptance and consequent weight loss⁽¹¹11 Lopes M, Freitas E, Oliveira M, Dantas E, Azevedo N, Rodrigues P, et al. Impact of the systematic use of the Gagging Swallowing Screen in patients with acute ischaemic stroke. Eur J Neurol[Internet]. 2019 [cited 2018 Aug 08]; May;26(5):722-726.Available from: https://www.ncbi.nlm.nih.gov/pubmed/30298612 https://www.ncbi.nlm.nih.gov/pubmed/3029... ⁾. (CVI = 0,92)	Measure the commitment of swallowing as well as categorize it according to severity grades using the Gugging Swallowing Screen (GUSS) scale⁽¹¹11 Lopes M, Freitas E, Oliveira M, Dantas E, Azevedo N, Rodrigues P, et al. Impact of the systematic use of the Gagging Swallowing Screen in patients with acute ischaemic stroke. Eur J Neurol[Internet]. 2019 [cited 2018 Aug 08]; May;26(5):722-726.Available from: https://www.ncbi.nlm.nih.gov/pubmed/30298612 https://www.ncbi.nlm.nih.gov/pubmed/3029... ⁾. ( CVI = 0,91)
Urinary incontinence	Involuntary loss of urine. Based on altered urinalysis for density, piocytes, proteins and glucose⁽¹²12 Hikita K, Honda M, Kawamoto B, Tsounapi P, Muraoka K, Sejima T, et al. Evaluation of Incontinence after Robot-Assisted Laparoscopic Radical Prostatectomy: Using the International Consultation on Incontinence Modular Questionnaire Short Form and Noting the Number of Safety Pads Needed by Japanese Patients. YonagoActa Med [Internet]. 2017 [cited 2018 Aug 08]; 60(1):52-5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28331422 https://www.ncbi.nlm.nih.gov/pubmed/2833... ⁾. (CVI = 0,98)	Identify increased urinary frequency, nocturia, urgency, increase or reduction or absence of bladder sensitivity, hesitancy, short urinary blast, intermittence, urge force, scattered urination, and incomplete emptying sensation. Evaluate through the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF)⁽¹²12 Hikita K, Honda M, Kawamoto B, Tsounapi P, Muraoka K, Sejima T, et al. Evaluation of Incontinence after Robot-Assisted Laparoscopic Radical Prostatectomy: Using the International Consultation on Incontinence Modular Questionnaire Short Form and Noting the Number of Safety Pads Needed by Japanese Patients. YonagoActa Med [Internet]. 2017 [cited 2018 Aug 08]; 60(1):52-5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28331422 https://www.ncbi.nlm.nih.gov/pubmed/2833... ⁾. (CVI = 0,94)
Bowel incontinence	Complaint of loss of any amount of feces repeated times. Based on changes in stool appearance and increased bowel frequency⁽¹³13 Hsu LF, Hung CL, Kuo LJ, Tsai PS. An abbreviated Faecal Incontinence Quality of Life Scale for Chinese-speaking population with colorectal cancer after surgery: cultural adaptation and item reduction. Eur J Cancer Care (Engl) [Internet]. 2017 [cited 2018 Nov 24];26(5). Available from: https://www.ncbi.nlm.nih.gov/pubmed/27467830 https://www.ncbi.nlm.nih.gov/pubmed/2746... ⁾. (CVI = 1,0)	Measure the anal incontinence index by means of Fecal incontinence quality of life scale (FIQL), which can be classified as frequency, generating a score of 0 normal continence and 20 complete incontinence⁽¹³13 Hsu LF, Hung CL, Kuo LJ, Tsai PS. An abbreviated Faecal Incontinence Quality of Life Scale for Chinese-speaking population with colorectal cancer after surgery: cultural adaptation and item reduction. Eur J Cancer Care (Engl) [Internet]. 2017 [cited 2018 Nov 24];26(5). Available from: https://www.ncbi.nlm.nih.gov/pubmed/27467830 https://www.ncbi.nlm.nih.gov/pubmed/2746... ⁾. (CVI = 0,97)
Impaired hygiene of the scalp	Scalp cleansing status changed. Grounded by reduced hygiene, scalp with dirt, showing oiliness, peeling, infestations, unpleasant odor, pruritus, hair loss⁽¹⁴14 Cunha GH, Araujo TL, Araujo FET, Cavalcante TF, Galvão MTG. Hygiene practices for patients with HIV/AIDS. Rev Gaúcha Enferm [Internet].2014 [cited 2017 Nov 26];35(3):137-44. Available from: http://www.scielo.br/pdf/rgenf/v35n3/1983-1447-rgenf-35-03-00137.pdf http://www.scielo.br/pdf/rgenf/v35n3/198... ⁾. (CVI = 1,0)	Verify through the inspection the presence of dirt, dandruff, and pediculosis; on palpation to investigate the presence of oily capillary fiber⁽¹⁴14 Cunha GH, Araujo TL, Araujo FET, Cavalcante TF, Galvão MTG. Hygiene practices for patients with HIV/AIDS. Rev Gaúcha Enferm [Internet].2014 [cited 2017 Nov 26];35(3):137-44. Available from: http://www.scielo.br/pdf/rgenf/v35n3/1983-1447-rgenf-35-03-00137.pdf http://www.scielo.br/pdf/rgenf/v35n3/198... ⁾. (CVI = 0,96)
Impaired Consciousness	Qualitative change in the overall pattern of mental functioning which the individual feels to be radically different from his usual mode of functioning. Grounded by decreased awareness, difficulty staying alert, disorientation, confusion and delusions⁽⁸8 Debone MC, Pedruncci ESN, Candido MCP, Marques S, Kusumota L. Nursing diagnosis in older adults with chronic kidney disease on hemodialysis. Rev Bras Enferm [Internet]. 2017 [cited 2018 Nov 23]; 70(4):800-5. Available from :http://www.scielo.br/pdf/reben/v70n4/0034-7167-reben-70-04-0800.pdf http://www.scielo.br/pdf/reben/v70n4/003... ⁾. (CVI = 0,89)	Identify alteration in the overall pattern of mental functioning through neurological physical examination, application of the Glasgow Coma Scale and Mini Mental State Examination (MMSE)⁽⁸8 Debone MC, Pedruncci ESN, Candido MCP, Marques S, Kusumota L. Nursing diagnosis in older adults with chronic kidney disease on hemodialysis. Rev Bras Enferm [Internet]. 2017 [cited 2018 Nov 23]; 70(4):800-5. Available from :http://www.scielo.br/pdf/reben/v70n4/0034-7167-reben-70-04-0800.pdf http://www.scielo.br/pdf/reben/v70n4/003... ⁾. (CVI = 0,87)
Insomnia	Difficulty with initiation, duration, consolidation or quality of sleep that occurs despite the adequate opportunity for sleep, and which results in some form of daytime involvement. Based on stress, difficulty in resting and use of medications for sleep⁽¹⁵15 Morris JL, Rohay J, Chasens ER. Sex Differences in the Psychometric Properties of the Pittsburgh Sleep Quality Index. J Womens Health (Larchmt) [Internet]. 2018 [cited 2019 Apr 20];27(3):278-82. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29154713 https://www.ncbi.nlm.nih.gov/pubmed/2915... ⁾. (CVI = 0,98)	To evaluate the quality of sleep of the patients through the application of instrument called "Pittsburgh Sleep Quality Index (PSQI)"⁽¹⁵15 Morris JL, Rohay J, Chasens ER. Sex Differences in the Psychometric Properties of the Pittsburgh Sleep Quality Index. J Womens Health (Larchmt) [Internet]. 2018 [cited 2019 Apr 20];27(3):278-82. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29154713 https://www.ncbi.nlm.nih.gov/pubmed/2915... ⁾. (CVI = 0,97)
Risk for Infection	It is the probability of a pathological process occurring by invasion of the body by pathogenic microorganisms, or invasion of the environment or environment where the infectious agent circulates. Characterized by the insufficient adoption of preventive measures, which can be determined by the reduction of the immunological capacity of the individual, or by the environment to which he is exposed⁽¹⁶16 Rudd KE, Seymour CW, Aluisio AR, Augustin ME, Bagenda DS, Beane A, et al. Association of the Quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) Score With Excess Hospital Mortality in Adults With Suspected Infection in Low and Middle-Income Countries. JAMA[Internet]. 2018 [cited 2017 Nov 26];319(21):2202-11. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29800114 https://www.ncbi.nlm.nih.gov/pubmed/2980... ⁾. (CVI = 0,96)	Evaluate the devices used in the patient (whether hematogenous, urinary or respiratory), as well as the length of stay, functionality, cleanliness and purpose. Analyze the leukogram, vital signs, as well as antibiogram⁽¹⁶16 Rudd KE, Seymour CW, Aluisio AR, Augustin ME, Bagenda DS, Beane A, et al. Association of the Quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) Score With Excess Hospital Mortality in Adults With Suspected Infection in Low and Middle-Income Countries. JAMA[Internet]. 2018 [cited 2017 Nov 26];319(21):2202-11. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29800114 https://www.ncbi.nlm.nih.gov/pubmed/2980... ⁾. (CVI = 0,95)
Impaired adherence to the therapeutic regimen	Degree of disagreement between a person's behavior and the directions received from the health care professional as the patient attempts to maintain his or her personal identification. Based on difficulty in following the indicated therapy and lack of significant improvement⁽¹⁷17 Abreu RM, da Silva Ferreira C, Ferreira AS, Remor E, Nasser PD, Carrilho FJ, et al. Assessment of Adherence to Prescribed Therapy in Patients with Chronic Hepatitis B. Infect Dis Ther[Internet]. 2016 [cited 2019 Apr 18];5(1):53-64. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26757720 https://www.ncbi.nlm.nih.gov/pubmed/2675... ⁾. (CVI = 0,94)	To assess the degree of adherence through the Assessment of Adherence to Antiretroviral Therapy Questionnaire (CEAT-VIH)⁽¹⁷17 Abreu RM, da Silva Ferreira C, Ferreira AS, Remor E, Nasser PD, Carrilho FJ, et al. Assessment of Adherence to Prescribed Therapy in Patients with Chronic Hepatitis B. Infect Dis Ther[Internet]. 2016 [cited 2019 Apr 18];5(1):53-64. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26757720 https://www.ncbi.nlm.nih.gov/pubmed/2675... ⁾. (CVI = 0,89)
Fear about death	Fear of disease progression and death, based on behavioral changes: anxiety, anguish, introspection, reports of fear of the death process and death, and may be accompanied by isolation⁽¹⁸18 Bužgová R, Janíková E. Adaption of the Collett-Lester Fear of Death Scale in a Sample of Nursing Students. Omega (Westport)[Internet]. 2017 [cited 2019 Apr 18];1:30222817725183.Available from:https://www.ncbi.nlm.nih.gov/pubmed/28792353 https://www.ncbi.nlm.nih.gov/pubmed/2879... ⁾. (CVI = 0,89)	To evaluate the fear of death through the application of the Collett-Lester Death Fear Scale (EMMCL)⁽¹⁸18 Bužgová R, Janíková E. Adaption of the Collett-Lester Fear of Death Scale in a Sample of Nursing Students. Omega (Westport)[Internet]. 2017 [cited 2019 Apr 18];1:30222817725183.Available from:https://www.ncbi.nlm.nih.gov/pubmed/28792353 https://www.ncbi.nlm.nih.gov/pubmed/2879... ⁾, which consists of 28 items, and contains four subscales with seven items each. (CVI = 0,88)
Knowledge of deficient health	Inadequate follow-up of instructions and verbalization of the problem. Grounded by difficulty in understanding and performing health information⁽¹⁹19 Feleke BE, Wasie B. Challenges of PMTCT Service Utilization in Amhara Region: A Comparative Cross-sectional Study. Ethiop J Health Sci [Internet]. 2018 [cited 2018 Aug 08];28(6):779-86. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30607095 https://www.ncbi.nlm.nih.gov/pubmed/3060... ⁾. (CVI = 0,89)	To identify the level of health knowledge regarding HIV/AIDS, through the application of the HIV/AIDS Attitudes Scale⁽¹⁹19 Feleke BE, Wasie B. Challenges of PMTCT Service Utilization in Amhara Region: A Comparative Cross-sectional Study. Ethiop J Health Sci [Internet]. 2018 [cited 2018 Aug 08];28(6):779-86. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30607095 https://www.ncbi.nlm.nih.gov/pubmed/3060... ⁾, which is composed of religiosity and magical practices, technical and scientific information, illicit drug use, sexuality and prejudice. (CVI = 0,86)
Loneliness	Cognitive perception that the social relationships existing in one's life are insufficient or inadequate, generating an affective reaction of sadness. Grounded by isolation and feeling of emptiness⁽²⁰20 Barroso SM, Andrade VS, Midgett AH, Carvalho RGN. [Evidence of validity of Brazilian UCLA Loneliness Scale]. J Bras Psiquiatr [Internet]. 2016 [cited 2018 Aug 08];65(1):68-75. Available from: http://www.scielo.br/pdf/jbpsiq/v65n1/0047-2085-jbpsiq-65-1-0068.pdf Portuguese http://www.scielo.br/pdf/jbpsiq/v65n1/00... ⁾. (CVI = 0,92)	Identify the presence of the feeling of loneliness through the UCLA Solitude Scale⁽²⁰20 Barroso SM, Andrade VS, Midgett AH, Carvalho RGN. [Evidence of validity of Brazilian UCLA Loneliness Scale]. J Bras Psiquiatr [Internet]. 2016 [cited 2018 Aug 08];65(1):68-75. Available from: http://www.scielo.br/pdf/jbpsiq/v65n1/0047-2085-jbpsiq-65-1-0068.pdf Portuguese http://www.scielo.br/pdf/jbpsiq/v65n1/00... ⁾. (CVI = 0,90)
Lack family support	Impaired ability to adapt the family to new family events. Based on the offer of reduced family support that may interfere with the treatment⁽²¹21 Amiya RM, Poudel KC, Poudel-Tandukar K, Pandey BD, Jimba M. Perceived family support, depression, and suicidal ideation among people living with HIV/AIDS: a cross-sectional study in the Kathmandu Valley, Nepal. PLOS One [Internet]. 2014 [cited 2017 Nov 26];9(3):1-8. Available from: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0090959 http://journals.plos.org/plosone/article... ⁾. (CVI = 0,88)	Identify low family support through the presence of the following characteristics: verbal expressions of lack of family support, easy crying, isolation, and reports of family neglect ⁽²¹21 Amiya RM, Poudel KC, Poudel-Tandukar K, Pandey BD, Jimba M. Perceived family support, depression, and suicidal ideation among people living with HIV/AIDS: a cross-sectional study in the Kathmandu Valley, Nepal. PLOS One [Internet]. 2014 [cited 2017 Nov 26];9(3):1-8. Available from: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0090959 http://journals.plos.org/plosone/article... ⁾. (CVI = 0,85)
Impaired acceptance of health status	Difficulty of acceptance of the diagnosis. Based on feelings and behaviors such as: sadness lack of self-confidence, behavioral changes and reduction of future prospects⁽¹⁹19 Feleke BE, Wasie B. Challenges of PMTCT Service Utilization in Amhara Region: A Comparative Cross-sectional Study. Ethiop J Health Sci [Internet]. 2018 [cited 2018 Aug 08];28(6):779-86. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30607095 https://www.ncbi.nlm.nih.gov/pubmed/3060... ⁾. (CVI = 0,89)	Identify the low acceptance of the state of health through affective blunting, irritability, aggressiveness, high tone of voice, negativity for any therapeutic action⁽¹⁹19 Feleke BE, Wasie B. Challenges of PMTCT Service Utilization in Amhara Region: A Comparative Cross-sectional Study. Ethiop J Health Sci [Internet]. 2018 [cited 2018 Aug 08];28(6):779-86. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30607095 https://www.ncbi.nlm.nih.gov/pubmed/3060... ⁾. (CVI = 0,86)
Marked body changes	Change in body fat distribution. Based on lipoatrophy or lipohypertrophy, weight loss⁽²²22 Sacilotto LB, Pereira PCM, Manechini JPV, Papini SJ. Body Composition and Metabolic Syndrome Components on Lipodystrophy Different Subtypes Associated with HIV. J Nutr Metab [Internet]. 2017 [cited 2017 Nov 25];1(2):1-8. Available from: https://www.hindawi.com/journals/jnme/2017/8260867/DOI:https://doi.org/10.1155/2017/8260867 https://www.hindawi.com/journals/jnme/20... ⁾. (CVI = 0,98)	Evaluate the presence of marked corporal modifications through the Subjective Global Assessment (AGS) instrument. Investigate issues inherent in the patient's ingestion of food; fat accumulation; changes in weight; changes in the tissues around the face, arms, hands, shoulders and legs⁽²²22 Sacilotto LB, Pereira PCM, Manechini JPV, Papini SJ. Body Composition and Metabolic Syndrome Components on Lipodystrophy Different Subtypes Associated with HIV. J Nutr Metab [Internet]. 2017 [cited 2017 Nov 25];1(2):1-8. Available from: https://www.hindawi.com/journals/jnme/2017/8260867/DOI:https://doi.org/10.1155/2017/8260867 https://www.hindawi.com/journals/jnme/20... ⁾. (CVI = 0,97)
Alcohol abuse	Excessive consumption of alcohol linked to frequent adverse consequences. Fulfills criteria for dependency. Based on behavioral changes and reports of use by the patient and/or family members⁽²³23 Silva RAR, Costa RHS, Braz LCSB, Lucena IA, Ferreira KS, Duarte FHS. People living with AIDS: Association between nursing diagnoses and sociodemographic/clinical characteristics. Rev Bras Enferm [Internet].2018[cited 2019 Oct 07];71(5):2535-42. Available from: http://www.scielo.br/pdf/reben/v71n5/0034-7167-reben-71-05-2535.pdf http://www.scielo.br/pdf/reben/v71n5/003... ⁾. (CVI = 0,99)	To assess alcohol abuse through the HIV/AIDS Attitudes Scale, which is composed of religiosity and magical practices, technical and scientific information, illicit drug use, sexuality and prejudice⁽²³23 Silva RAR, Costa RHS, Braz LCSB, Lucena IA, Ferreira KS, Duarte FHS. People living with AIDS: Association between nursing diagnoses and sociodemographic/clinical characteristics. Rev Bras Enferm [Internet].2018[cited 2019 Oct 07];71(5):2535-42. Available from: http://www.scielo.br/pdf/reben/v71n5/0034-7167-reben-71-05-2535.pdf http://www.scielo.br/pdf/reben/v71n5/003... ⁾. (CVI = 0,97)
Tobacco abuse	Excessive smoking /tobacco consumption linked to frequent adverse effects. Fulfills criteria for dependency⁽²⁴24 Souza Neto VL, Silva RAR , Rocha CCT, Costa RTS, Nóbrega MML. ICNP® nursing diagnoses for people with acquired immunodeficiency syndrome. Acta Paul Enferm [Internet]. 2017[cited 2018 Oct 07]; 30(6):573-81. Available from: http://www.scielo.br/pdf/ape/v30n6/en_0103-2100-ape-30-06-0573.pdf http://www.scielo.br/pdf/ape/v30n6/en_01... ⁾. (CVI = 0,91)	Assessing tobacco abuse by means of a Scale of attitudes toward HIV/AIDS, which is composed of religiosity and magical practices, technical and scientific information, legal drug use, sexuality and prejudice⁽¹⁹19 Feleke BE, Wasie B. Challenges of PMTCT Service Utilization in Amhara Region: A Comparative Cross-sectional Study. Ethiop J Health Sci [Internet]. 2018 [cited 2018 Aug 08];28(6):779-86. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30607095 https://www.ncbi.nlm.nih.gov/pubmed/3060... ^,²⁴24 Souza Neto VL, Silva RAR , Rocha CCT, Costa RTS, Nóbrega MML. ICNP® nursing diagnoses for people with acquired immunodeficiency syndrome. Acta Paul Enferm [Internet]. 2017[cited 2018 Oct 07]; 30(6):573-81. Available from: http://www.scielo.br/pdf/ape/v30n6/en_0103-2100-ape-30-06-0573.pdf http://www.scielo.br/pdf/ape/v30n6/en_01... ⁾. (CVI = 0,92)
Impaired religious belief	Decline in spirituality. Grounded by spiritual anguish, anger of a greater being and feeling guilty⁽²⁵25 Sharif Nia H, Pahlevan Sharif S, Boyle C, Yaghoobzadeh A, Tahmasbi B, Rassool GH, et al. The Factor Structure of the Spiritual Well-Being Scale in Veterans Experienced Chemical Weapon Exposure. J Relig Health[Internet]. 2018 [cited 2019 Jan 12]; 57(2):596-608. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28748326 https://www.ncbi.nlm.nih.gov/pubmed/2874... ⁾. (CVI = 0,89)	Identify the presence of impaired religious belief through the application of the Spiritual Well-being Scale (SBS)⁽²⁵25 Sharif Nia H, Pahlevan Sharif S, Boyle C, Yaghoobzadeh A, Tahmasbi B, Rassool GH, et al. The Factor Structure of the Spiritual Well-Being Scale in Veterans Experienced Chemical Weapon Exposure. J Relig Health[Internet]. 2018 [cited 2019 Jan 12]; 57(2):596-608. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28748326 https://www.ncbi.nlm.nih.gov/pubmed/2874... ⁾. (CVI = 0,87)