Mediation of Self-Management and Treatment Adherence Health-Related Quality of Life for Adolescents With Congenital Heart Disease.

BACKGROUND: Improved autonomy, relatedness, competence, self-management, and treatment adherence have been linked to better health-related quality of life (HRQOL) in adolescents with chronic illnesses. Nonetheless, potential mediating relationships among these concepts have not been investigated. Mediation research is necessary to fully examine ways to improve health and other outcomes for adolescents living with chronic illnesses. OBJECTIVES: The purpose of this study was to examine the relationship among the three innate needs (autonomy, relatedness, and competence) of the self-determination theory (SDT)-self-management and treatment adherence-and its relationship to HRQOL for adolescents with congenital heart disease (CHD). The current study examined the potential mediation effects of self-management and treatment adherence on the relationship between the three SDT variables on HRQOL. METHODS: Ninety-two adolescents with CHD completed self-report surveys (Basic Psychological Needs Autonomy and Relatedness subscales, Generalized Self-Efficacy Scale, UNC TRxANSITION Scale, and Pediatric Quality of Life 4.0 Generic Core Scale). Exploratory multiple regression and the bootstrap method were used to examine the relationship between the SDT variables and HRQOL and test whether these relationships were mediated by self-management and treatment adherence after controlling for covariates. RESULTS: The mediation hypothesis was not supported, indicating that self-management and treatment adherence do not mediate the relationship between the SDT variables and HRQOL for adolescents with CHD. However, multiple regression findings suggest optimizing autonomy and competence contributes to better self-management and treatment adherence and that better autonomy, competence, and relatedness improves HRQOL. DISCUSSION: The findings in this study indicate that studies with larger samples are needed if self-management and treatment adherence mediates the innate needs and HRQOL in adolescents with CHD. Future research focusing on other potential mediators affecting the relationship with HRQOL is warranted to improve the transition into adulthood.

The Self-Determination Theory: Health-Related Quality of Life in Adolescents with Congenital Heart Disease.

The purpose of this paper is to present a conceptual-theoretical-empirical model addressing variables associated with self-management of care and adherence to treatment and its relationship to health-related quality of life for adolescents with congenital heart disease. There is limited research on adolescents with congenital heart disease regarding the relationship between autonomy, relatedness, competence, self-management of care and adherence to treatment, and health-related quality of life. The proposed Health-Related Quality of Life and Transition of Adolescents With Congenital Heart Disease to Self-Manage in Adulthood model, adapted from the Self-Determination Theory, will help to better understand these relationships.

A Nurses' Personal Labor and Postpartum Experience During COVID-19.

This special interest article describes a nurses' labor and postpartum experience during the COVID-19 pandemic.

Applying the Self-determination Theory to Health-related Quality of Life for Adolescents with Congenital Heart Disease.

PURPOSE: The purpose of this study is to examine the relationship among the three innate needs of Self-Determination Theory (SDT), self-management of care and adherence to treatment, and the relationship to health-related quality of life (HRQOL) for adolescents with congenital heart disease (CHD). DESIGN AND METHODS: A non-experimental, cross-sectional, correlational design was conducted in a sample of 92 participants with CHD, ages 13 to 18 years. For data analysis, Pearson's correlations were used to explore associations between variables, and the hypotheses were tested using multiple linear regression. RESULTS: Demographic and clinical data were collected: 15 ±â€¯1.6 yrs; 59% male; 65% White; 43% mild CHD; 25% severe CHD. After controlling for covariates, regression analyses revealed relatedness (ß = 0.64) and competence (ß = 0.79) contributed significant variance to HRQOL, R2 = 0.56, p < .001; however, autonomy and self-management of care and treatment adherence did not contribute significant variance to HRQOL. CONCLUSIONS: This study found that relatedness and competence were significantly associated with HRQOL in adolescents with CHD; however, autonomy and self-management of care and adherence to treatment were not. These findings demonstrate the importance of further examining relatedness and competence in adolescents with CHD. PRACTICE IMPLICATIONS: Nursing care should focus on the improvement of social support systems and interventions to increase self-efficacy for adolescents with CHD.

Nurses' Perceptions of Quality of Life for Adolescents with Congenital Heart Disease.

The purpose of this study was to understand nurses' perceptions and experiences regarding Quality of Life (QOL) of adolescents with complex congenital heart disease (CHD). Interpretive, hermeneutic, phenomenology was used to explore the perceptions and experiences of nurses who care for adolescents with complex CHD. The participants included 6 female registered nurses with experience taking care of adolescents with complex CHD. Data were collected using semi-structured interviews. Data analysis revealed 4 themes: QOL depends on how the psychological and social issues are interwoven with the physical; finding that balance between overprotection and too much freedom; setting goals to envision a future; and not being defined by a CHD. These results indicate that understanding nurses' perspectives and experiences may contribute to effective guidance for adolescents with complex CHD transitioning into adulthood.