Sentimento de impotência em portadores de acidente vascular encefálico: análise de conceito.

Abstract

The study aims to review the nursing diagnosis of powerlessness (DESI) in patients with cerebrovascular accident. In this study the first stage of diagnostic validation proposed by Walker and Avant was performed. For the implementation of the first stage we used an integrative review of the literature from three databases (PubMed, CINAHL and LILACS) with the following combinations of descriptors and equivalent in English and Spanish: Depression and Stroke and Powerlessness and Stroke. After applying the inclusion and exclusion criteria, 35 studies remained that supported the conceptual analysis. The process of concept analysis led to the following results: a modification of the definition of DESI, naming some clinical indicators and adding others. Forward the definition of DESI we constructed a new label for the DESI as emotional response against perceived the process of coping with the disease or disability, with weakness, helplessness, lack of control and power to achieve the proposed results during functional recovery from the descriptor-controlled depression present association with the feeling of helplessness. The final proposal is recommended reformulation of three factors have not been evidenced in the literature and the addition of 11 factors: severity of injury, unpredictable course, lack of support from the injury, type of injury, location of injury, lack of social participation, offering unsatisfactory care, limitation of physical mobility, low self-esteem, lack of motivation and lack of interest. With respect to the defining characteristics of the resulting 14 DESI were evidenced: dependence on others, depression by physical deterioration, report of doubt regarding the performance of the role, reporting frustration at the inability to perform basic activities of daily living, reports of frustration at the inability to perform instrumental activities of daily living, reports of frustration at the inability to perform advanced activities of daily living, fatigue, cognitive impairment and progressive in time, while physical rehabilitation and motor, level of participation in rehabilitation, difficulty verbally expressing thoughts and decide on your health, suicide attempts, life purpose and reporting of shame. Thus, it is considered that the review process has subsidized a direction to the diagnostic efficiency of clinical indicators of DESI, contributing to the improvement and refinement of this diagnosis and its components.