Cystic fibrosis-related diabetes in older adolescents: parental support and self-management.

PURPOSE: The purpose of this study was to describe the experience of cystic fibrosis-related diabetes (CFRD), parental support of adolescent self-management, and the relationship of parental autonomy support with disease self-management. DESIGN AND METHODS: Semi-structured interviews and questionnaires were employed in a study conducted with 10 adolescents and their parents. RESULTS: Parents and adolescents lacked confidence to manage CFRD. Mothers' autonomy support was associated with adolescents' CFRD competence and cystic fibrosis self-care. Fathers' autonomy support was associated with mothers' reports of adolescent cystic fibrosis self-care. PRACTICE IMPLICATIONS: Education about CFRD management and support of adolescent autonomy in disease management is needed.

Parental separation anxiety and diabetes self-management of older adolescents: a pilot study.

Parents of high school seniors with type 1 diabetes mellitus are faced with many concerns and fears as their adolescent prepares to assume primary disease management responsibility and leave the parental residence. The purpose of this study was to explore the relationship between parental separation anxiety and adolescent self-management and glycemic control. A second aim was to assess the relationship between adolescent self-management and glycemic control. Twenty-three families who had adolescents 16 to 18 years of age in or entering in their senior year of high school were recruited. Adolescents from higher income families reported better self-management skills than those from poorer families (r = 0.410, p = 0.05). Length of time since diabetes diagnosis was inversely related to glycemic control (r = 0.448, p = 0.02), indicating that adolescents who had the disease longer had poorer control. Parental separation anxiety was not related to adolescent self-management. Adolescent self-management was negatively related to glycemic control (r = -0.370, p = 0.08), suggesting that adolescents who demonstrated better self-management skills had improved glycemic control in comparison to adolescents who did not demonstrate effective self-management skills. Paternal, not maternal, separation anxiety demonstrated a significant relationship with glycemic control (r = 0.639, p < 0.001).

Parents' experiences supporting self-management of middle adolescents with type 1 diabetes mellitus.

The purpose of this article is to describe the experiences of parents regarding the fostering of self-management of diabetes mellitus with their middle adolescents with type 1 diabetes mellitus (T1DM). A purposive sample of parents of 16- to 18-year-old adolescents with T1DM from 23 families who attended the endocrinology clinic of a children's hospital were interviewed about their experience with their adolescent's diabetes management and how they supported or inhibited their adolescent's diabetes self-management. Qualitative description was used to analyze the transcripts of audio-recorded interviews. Parents often described having negative experiences involving struggle, frustration, and worry about adolescent self-management. Parents supported their adolescent's self-management primarily by reminding, recognizing positive aspects of the adolescent's diabetes management, and granting more freedom. Conversely, parents inhibited their adolescents' diabetes management by scolding and judging, checking and nagging, and becoming emotional. Clinicians can help parents share their experiences, cope with their emotions, and practice effective strategies to motivate adolescent diabetes self-management in the transition to later adolescence.

Poverty and adolescent mental health.

PROBLEM: Poverty and accelerations of inequality, manifested by the increasing difference between the richest and poorest populations, have significant effects on the mental health of vulnerable groups. Adolescents are vulnerable to the effects of poverty. As a time of change and transition for youth and their families, adolescence creates both challenges and opportunities to intervene in the effects of poverty. PURPOSE: The purpose of this article is to discuss the significance of poverty and its impact on adolescent mental health and mental health services. SOURCES: An interdisciplinary literature search was conducted on the topic of poverty and adolescent mental health. CONCLUSIONS: Results indicated that nurses need to remain active participants in the provision of mental health services to adolescents in poverty and increase their advocacy for the creation of policy changes that address mental health needs of this population.

Finding the balance: adolescents with type 1 diabetes and their parents.

INTRODUCTION: The purpose of this study was to describe the ways that parents and 11- to 15-year-old teens communicate and the recurrent themes and patterns of behavior that were revealed during brief interactions about issues related to diabetes management. METHOD: A secondary qualitative analysis of data, based on a template for analysis developed from the literature, was completed on audiotaped interactions of 28 adolescents and their parents. RESULTS: Themes identified were frustration, fear, normalizing, trusting, and discounting. Trusting the adolescent to manage diabetes was difficult for the parents and was associated with frustration, fear, and discounting communication. DISCUSSION: Results support the need for clinicians to work with families to facilitate trust and positive parent-adolescent communication about diabetes management.

Development and testing of a scale to measure separation anxiety of parents of adolescents.

Separation anxiety as an experience of parents of adolescents remains underinvestigated. The purpose of this study was to develop an instrument to assess parental separation anxiety of mothers and fathers of adolescent sons and daughters, that is, the Parental Separation Anxiety Scale (PSAS). The Maternal Separation Anxiety Scale was adapted to address this purpose. Three studies were conducted to assess item performance, internal consistency and test-retest reliability, and construct and predictive validity. Internal consistency reliability ranged from 0.91 to 0.93 across samples. Factor analysis indicated four factors with a primary factor (70% of variance) that was consistent with attachment theory. Parental separation anxiety was negatively associated with global relationship quality (r = -0.23, p = .01). Maternal separation anxiety was negatively associated with cognitive autonomy of sons (r = -0.34, p = .05), while paternal separation anxiety was positively associated with cognitive autonomy of daughters (r = 0.20, p = .05). It was concluded that the final 18-item PSAS has good psychometric qualities and is appropriate for use with parents of chronically ill and healthy adolescents.

Parent-adolescent communication and diabetes: an integrative review.

AIM: This paper presents a synthesis of findings from empirical studies about communication and interaction between parents and their adolescents with diabetes. BACKGROUND: Communication between parent and adolescent is essential in transitioning the adolescent to increased responsibility for diabetes self-management. Nurses are in a pivotal position to enhance the type of parent-adolescent communication that facilitates this transition. DATA SOURCES: A search of published studies from 1985 to 2006 featuring communication or interaction between parents and adolescents with type 1 diabetes was implemented through a computerized search. REVIEW METHODS: Papers were organized by type of evidence and were analysed sequentially. Sources were described based on data elements which were extracted. Findings in the areas of productive and problematic parent-adolescent communications were included. Data elements were compared and critiqued, noting consistencies, and findings were summarized and evaluated. RESULTS: Studies across several countries indicate that maternal support, conflict, control, involvement and emotional expression are important communication concepts that are linked to diabetes outcomes in adolescents. The influences of different family structures and cultural and socioeconomic circumstances, as well as developmental status and gender of adolescents on these types of communication, have not been systematically studied. CONCLUSION: Nurses caring for adolescents with type 1 diabetes need to consider family relationships and communication patterns in achieving health outcomes. Studies of communication, including perspectives of mothers and fathers, and the influence of family structure, economics and culture are needed to build a framework of parent-adolescent interaction and health outcomes for adolescents with type 1 diabetes.

Relationships between parenting styles and risk behaviors in adolescent health: an integrative literature review.

Research over the past 20 years suggests that the quality of the parent-adolescent relationship significantly affects the development of risk behaviors in adolescent health. The purpose of this paper is to present a review of studies published between 1996-2007 that address specific relationships between parenting styles and six priority adolescent risk behaviors. The review supports the substantial influence of parenting style on adolescent development. Adolescents raised in authoritative households consistently demonstrate higher protective and fewer risk behaviors than adolescents from non-authoritative families. There is also considerable evidence to show that parenting styles and behaviors related to warmth, communication and disciplinary practices predict important mediators, including academic achievement and psychosocial adjustment. Careful examination of parenting style patterns in diverse populations, particularly with respect to physical activity and unintentional injury, will be a critical next step in the development of efficacious, culturally tailored adolescent health promotion interventions.

Family stress, family adaptation, and psychological well-being of elderly coronary artery bypass grafting patients.

As our population ages, more elderly patients will undergo coronary artery bypass grafting. The psychological well-being of a patient is influenced by many factors, including family support. This descriptive, correlational pilot study was conducted to examine the relationship between family characteristics and psychological well-being in elderly coronary artery bypass grafting patients. The results of this study, which consists of 42 participants, are presented, as well as implications for critical care nursing.

Fathers of children and adolescents with diabetes: what do we know?

Knowing how fathers contribute to child outcomes is critical in the clinical management of children who have type 1 diabetes. The purposes of this review were to synthesize what is known about the role of fathers and to determine directions for future research. Research studies that reported findings that encompassed fathers' perceptions, knowledge, coping and adjustment, and behavior in relation to their children with type 1 diabetes were reviewed. Research suggests that, although fathers are usually not the primary caregiver or manager of the routine day-to-day care, their contribution to the family through perceptions, knowledge, adjustment, and behavior may be associated with important disease management outcomes.

Relationships between parenting styles and risk behaviors in adolescent health: an integrative literature review / Relações entre modelos de pais e comportamentos de risco na saúde do adolescente: uma revisão integrativa da literatura / Relaciones entre los tipos de padres y comportamientos de riesgo en la salud del adolescentes: una revisión bibliográfica integrada

Research over the past 20 years suggests that the quality of the parent-adolescent relationship significantly affects the development of risk behaviors in adolescent health. The purpose of this paper is to present a review of studies published between 1996-2007 that address specific relationships between parenting styles and six priority adolescent risk behaviors. The review supports the substantial influence of parenting style on adolescent development. Adolescents raised in authoritative households consistently demonstrate higher protective and fewer risk behaviors than adolescents from non-authoritative families. There is also considerable evidence to show that parenting styles and behaviors related to warmth, communication and disciplinary practices predict important mediators, including academic achievement and psychosocial adjustment. Careful examination of parenting style patterns in diverse populations, particularly with respect to physical activity and unintentional injury, will be a critical next step in the development of efficacious, culturally tailored adolescent health promotion interventions.

Resultados de investigaciones realizadas durante los últimos 20 años muestran que la calidad en las relaciones entre padres e hijos ha provocado un impacto significativo en el desarrollo de comportamientos de riesgo para la salud del adolescente. El objetivo de este artículo es mostrar una revisión bibliográfica de estudios publicados entre 1996-2007, analizando relaciones específicas entre los tipos de padres y los seis principales comportamientos de riesgo en adolescentes. Adolescentes criados bajo una disciplina autoritaria muestran comportamientos más seguros y menores comportamientos de riesgo al ser comparados con adolescentes que provienen de familias poco autoritarias. El tipo paternal y comportamientos relacionados con la afectividad, comunicación familiar y disciplina predicen importantes mediadores para la formación del adolescente, incluyendo desarrollo académico y adaptación psico-social. Cuidadosas evaluaciones sobre los tipos de padres estándar en poblaciones diversas será una próxima etapa crítica para el desarrollo de intervenciones eficaces y adaptadas culturalmente para la promoción de la salud del adolescente.

Pesquisas realizadas durante os últimos 20 anos sugerem que a qualidade da relação entre pais e adolescentes tem obtido impacto significante no desenvolvimento de comportamentos de risco a saúde dos adolescentes. A finalidade deste estudo é apresentar uma revisão bibliográfica de estudos publicados entre o ano de 1996 e 2007, que analisam relações especificas entre modelos de pais e seis principais comportamentos de risco em adolescentes. Os adolescentes crescidos sob disciplina autoritária demonstraram consistentemente mais comportamentos seguros e menos comportamentos de risco comparados a adolescentes vindos de famílias não autoritárias. O modelo dos pais e comportamentos relacionados a afetividade, comunicação familiar e práticas disciplinares, predizem importantes mediadores na formação do adolescente, incluindo o desenvolvimento acadêmico e o ajuste psico-social. Avaliações cuidadosas de modelos padrões de pais em diversas populações, será uma próxima etapa crítica no desenvolvimento de intervenções eficazes e culturalmente adaptadas, na promoção de saúde a adolescentes.

Self-care of young adolescents with type 1 diabetes.

The purpose of this study was to describe the universal and health deviation self-care of adolescents with Type 1 diabetes and the associations of basic conditioning factors with universal and health deviation self-care. Subjects for this study were 152 adolescents aged between 11 and 15 years with a diagnosis of Type 1 diabetes. Data were collected in the home setting of each adolescent and his or her family. The mean universal self-care scores ranged from 66.62% to 90%. The overall mean for this sample was 75.37, indicating that these adolescents took care of their self-care needs 75% of the time. Health deviation self-care was a mean of 27.26, indicating more positive self-care behaviors and treatment adherence. Health deviation and universal self-care were significantly and positively related (r = .36, p < .001). Ethnicity and adolescent sex were statistically significant in predicting universal self-care. Adolescent age was statistically significant in predicting health deviation self-care. Health deviation self-care decreases with age, suggesting that early adolescence or late school age is an appropriate time for interventions to strengthen self-care behaviors. Furthermore, the interrelationship of the two types of self-care supports the potential for a synergistic effect of intervention.

Conflicts between young adolescents with type I diabetes and their parents.

ISSUES AND PURPOSE: The purposes were to describe sources of parent-adolescent conflict in families of young adolescents with type I diabetes and to determine if the sources of conflict were similar to those in a comparable nondistressed group from an earlier study. DESIGN AND METHODS: A descriptive study of 161 adolescents with type I diabetes and their parents examined conflict using the Issues Checklist. RESULTS: Adolescents with type I diabetes and their families were similar to a non-distressed population in their ranking of quantity, intensity, and frequency by intensity scores. Issues generating the highest frequency of discussion were comparable to those reported in the nondistressed group, with the exception of topics regarding what time to have meals and to watch television. Intensity of discussion was also comparable, with the exception of topics regarding getting up in the morning and bothering the parents. Adolescent report of conflict with the mother was significantly lower overall for the adolescents with type I diabetes. PRACTICE IMPLICATIONS: Conflict is expected between young adolescents and parents, and having type I diabetes does not heighten conflict with parents with respect to general adolescent issues. Understanding this principle should help healthcare workers recognize usual adolescent-parent conflict and use similar approaches to address these conflicts as are used with nondistressed families.

Autonomy development in adolescents with insulin dependent diabetes mellitus.

This descriptive study investigated autonomy development among young adolescents with insulin-dependent diabetes mellitus (IDDM); assessed relationships among behavioral, cognitive, and emotional autonomy; and determined the relationships between these types of autonomy and metabolic control. Developmental and family theory provided the framework for this study. This investigation suggested that the pattern of autonomy for adolescents with IDDM is congruent with that of adolescents without chronic illness. The three autonomy types are conceptually distinct and one aspect of emotional autonomy was related to poorer metabolic control. Daughters and adolescents in one-parent families scored higher on this component.