ABSTRACT
A grounded theory approach was used to explore the influence of peer relationships on adjustment to cystic fibrosis (CF) in 15 adolescents. Discovering the course was the core category that captured the influence of peers on adjustment to CF. Four subcategories were identified: (1) losing ground, (2) being out of the loop, (3) finding a new company of friends, (4) fighting a never-ending battle. The downward progression of CF and increasing social interactions with peers with CF during hospitalization helped them learn CF was a lifelong disease with relentless demands. Interventions should focus on strategies for promoting peer support, a positive attitude, and hope to create a sense of belonging, social competence, and well-being.
Subject(s)
Adaptation, Psychological , Cystic Fibrosis/psychology , Interpersonal Relations , Peer Group , Adolescent , Adult , Cystic Fibrosis/nursing , Disease Progression , Female , Humans , Male , Models, Psychological , Southeastern United StatesABSTRACT
A single-case study approach was used to provide an in-depth examination of the special events surrounding the decision of a 21-year-old adolescent to undergo lung transplantation for end-stage cystic fibrosis. The central theme "playing for time" characterized the interplay between the disease progression and adolescent development as illustrated by 3 subthemes: (a) a strange balance; (b) playing chicken; and (c) being listed. The adolescent's developmental needs provided the context for the struggle with the competing demands of physiologic and psychologic readiness for the transplant, quality-of-life issues, and a renewed hope for the future. Developmental needs were more important to the adolescent than the opportunity for increased length of survival provided by lung transplantation. Advanced practice nurses are in an excellent position to provide continuity of care for chronic illness management over time and across settings.
Subject(s)
Cystic Fibrosis/psychology , Lung Transplantation/psychology , Psychology, Adolescent , Terminal Care/psychology , Waiting Lists , Adaptation, Psychological , Adolescent , Adult , Cystic Fibrosis/surgery , Decision Making , Disease Progression , Humans , Male , Nurse Practitioners , Pediatric Nursing/organization & administration , Quality of LifeABSTRACT
This exploratory, qualitative pilot study explored the meaning of the chronic illness experience for adolescents with diabetes in relation to taking on responsibility for their own care. Four adolescents aged 15 to 17 years with insulin-dependent diabetes mellitus participated in indepth interviews. Gaining freedom was the central phenomenon that captured the process of gaining self-responsibility in diabetes management during adolescence. Three themes marked the process: (a) making it fit; (b) being ready and willing; and (c) having a safety net of friends. These adolescents described a gradual transition from dependence to independence in learning to manage their diabetes. These findings should cause advanced practice nurses to re-evaluate their frameworks for adolescents with diabetes and develop a collaborative approach. Intervention strategies must be developed that incorporate adolescent developmental needs, determine readiness and motivation to learn, and provide opportunities to practice independence in self-management.
Subject(s)
Diabetes Mellitus, Type 1/nursing , Diabetes Mellitus, Type 1/psychology , Self Care/psychology , Adaptation, Psychological , Adolescent , Adult , Diabetes Mellitus, Type 1/drug therapy , Female , Follow-Up Studies , Health Knowledge, Attitudes, Practice , Humans , Insulin/administration & dosage , Internal-External Control , Interpersonal Relations , Life Style , Male , Pilot Projects , Sampling Studies , Self-Help GroupsABSTRACT
This qualitative study used a grounded theory approach to explore adolescent conceptualizations of their chronic illness experience and related life events. A purposive sample of 20 adolescents (12-18 years of age) with cystic fibrosis were interviewed. Adolescents used three protective strategies for reducing a sense of difference from peers: (1) keeping secrets, (2) hiding visible differences, and (3) discovering a new baseline. "Good friends" were a critical source of support and decreased the importance of differences in their social world. Interventions should focus on strategies for dealing with difficult peer situations and the negative reactions of others.
Subject(s)
Cystic Fibrosis/psychology , Adaptation, Psychological , Adolescent , Child , Chronic Disease , Female , Humans , Male , Peer Group , Psychology, AdolescentABSTRACT
This qualitative study used a grounded theory approach to explore the unfolding of the chronic illness experience for children during middle childhood. A purposive sample of 20 children (6-12 years) with cystic fibrosis (CF) were interviewed. Discovering a sense of difference was found to be the central phenomenon that described the experience of having CF during the middle childhood years. Four central themes emerged in the stories of these children: (a) puzzling out the diagnosis, (b) being teased and picked on, (c) telling others, and (d) keeping up. The study concluded that interventions must focus on the psychosocial demands made on children with CF along their course of development. By designing interventions around meaningful outcomes in their daily lives, we will help children with CF find ways to feel normal while adhering to treatment regimens, thereby helping to improve the quality of their lives.
