Uncertainty and Spirituality in Women with HIV/AIDS
Gray, Jennifer R., Beard, Margaret T., Journal of Theory Construction and Testing
Abstract: A secondary analysis of an existing data set is conducted to explore alternative theoretical explanation of factors influencing coping in women witth HIV/AIDS. A formula (theorem) from a previous constructed theory was used in the conceptualization of uncertainity, The equation included duration of infection since diagnosis, stage of diseasem and conflict, support, and perceived stree. Subject consisted of 67 women. Significant findings are uncertainity has a negative influence on the experience of health, and there is a positive relationship between spiritual perspective and mastery.
Key Words: uncertainity, spirituality, women, HIV/AIDS
The new antiretroviral medications, protease inhibitors, have changed the lives of persons infected with the human immunodeficiency virus (HIV)(Holzemer et al., 1999). HIV infection progresses more slowly to acquired immunodeficlency syndrome (AIDS) due to the medications and the death rate has dropped dramatically. These improvements are in contrast to the increasing number of women being diagnosed as HIV positive. Of the 5.2 million people newly infected with the virus in 1998, 2.1 million were women (National Institutes of Health [NIH], 1999). Fewer women are dying, at least among those received medications. At the same time, more women are being infected. As a result more women are living with HIV/ AIDS than ever before. Worldwide, 13.8 million women are living with HIV/AIDS (NIH, 1999). Because of the treatment improvements, women with HIV/AIDS in developed countries will live long enough to develop other health conditions and will interact with nurses in a variety of clinical settings.
Nurses recognize that HIV infection is "a human event that requires reformulation of existing knowledge about an individual's development amid personal challenge, change, and transition" (Troesman, 1998, pg. 17). Nurses can facilitate coping by addressing the emotional and psychological needs of HIV-positive women. Coping in women affected by HIV/AIDS was found by Rose and Clark-Alexander (1998) to be a complex phenomenon involving quality of life, caregiving, and self care. To better understand the phenomenon, the researcher conducted a secondary analysis using an existing database. The purpose of the secondary analysis is to explore an alternative theoretical explanation of the factors influencing coping in women with HIV/AIDS.
Review of the Literature
The researcher reviewed studies of women living with HIV/ AIDS and identified spiritual perspective and uncertainty as two factors with potential influence on coping.
Uncertainty changes over the disease trajectory of HIV infection (Brashers, Neidig, Reynolds, & Haas, 1998). The physical and mental effects of the infection are unpredictable. Medical management of the infection has changed rapidly with the availability of new medications. Physicians and other health care providers struggle to keep abreast of the latest developments. Because of the improved prognosis, high uncertainty may persist for persons with HIV infection for longer periods of time. Symptoms are often ambiguous. According to Mishel's theory of uncertainty, all these factors increase uncertainty, hindering @ person's ability to find meaning in an illness (Mishel, 1990,). Nurses will need to develop uncertainty management interventions that are specific to the disease phase. These interventions are needed for both infected persons and their caregivers (Brashers et al. 1998).
Often women with HIV infection live in stressful environments full of uncertainty. Worries are one manifestation of their uncertainty. HIV positive mothers attributed their poor sleep to worries about their children, the progression of their illness, and the potential for increasing pain (Rose, 1993). Deren, Beardsley, Tortu, Davis, and Clatts (1993)found numerous stressors in the lives of women at risk for HIV infection (N =624). …