Coping strategies of chronically ill adolescents and their parents

The marginalization of chronically ill adolescents

Chronic illness during adolescence adds a dimension to a developmental stage that already has the potential to be tumultuous. Consequences of marginalization that predispose well adolescents to risk behaviors such as low self-worth and feelings of isolation are compounded in the chronically ill. In the author's proposed model, it is essential that nurses promote strategies that empower chronically ill adolescents. Care should be community-based and have an integrated multidisciplinary approach involving nursing, medicine, allied health care providers, and, (very importantly) the social networks of the adolescent [38,39]. For optimal health outcomes, we must begin to empower the chronically ill to meet their developmental need both within their social and medical contexts.

A theoretical model of compliance in young diabetics

The purpose of this paper is to present a theoretical model of compliance in young diabetics. According to the model, compliance is an active, intentional and responsible process in which young diabetics work to maintain their health in collaboration with the physician. Factors which improved compliance were motivation, the results of care, a sense of normality and adequate energy and will-power for care. Motivation was improved by support and encouragement given by parents and was found to influence energy and will-power for care. Energy and will-power for care were increased through the support of parents, encouragement and the results of care. Furthermore it was found that when young diabetics were not afraid of complications, their energy and will-power for care were better. Fear may, however, improve compliance, which is connected with the control of diabetes. The results of the study can be used to plan and implement care in young diabetics. In addition to this, the model is a good starting-point for further development and for developing an instrument to measure compliance and the factors related to it.

Adolescents' perceptions of physicians, nurses, parents and friends: help or hindrance in compliance with diabetes self-care?

Although compliance with self-care amongst adolescents with diabetes is known to be problematic, this issue has rarely been examined from the perspective of young diabetics themselves. The purpose of the study was to explore how adolescents with diabetes perceived the actions of physicians, nurses, parents and friends in relation to compliance with self-care. Fifty-one young diabetics aged from 13 to 17 responded to a questionnaire concerning compliance and were interviewed on the topic of compliance. Interview data were analysed by content analysis. The categories obtained were quantified and the relationship between compliance and the actions of physicians, nurses, parents and friends analysed by cross-tabulation. Interviews with 51 adolescents showed that the actions of physicians, nurses and parents described as motivating were associated with better compliance. Good compliance was also more evident when parental actions were perceived as accepting. Young diabetics whose friends offered silent support, or who viewed friends as irrelevant, were more likely to report good compliance. In contrast, physicians' actions described as routine/negligent, disciplined control by parents, and domination by friends were linked with poor compliance.

Development of a tool to measure the life situation of parents of children with cancer

The aim of this study was to test the validity and reliability of the recently developed Life Situation Scale for Parents (LSS-P) among parents of children with cancer. One hundred and ten parents of seventy-four children and adolescents who visited three paediatric wards in Sweden filled out three instruments: The LSS-P, the Quality of Life Scale and the Family Support Scale. The reliability coefficient, Cronbach's alpha, was found to be 0.82 for the LSS-P. A factor analysis with orthogonal varimax rotation of 37 items of the LSS-P gave twelve factors. A higher order factor analysis reduced the factors to four (Care, Well-being, Social life and Preparedness), explaining the underlying dimensions to 57.9%. The total LSS-P correlated significantly with the Quality of Life Scale, and the higher order factor Care with the Family Support Scale. The LSS-P discriminated, in some aspects, between two-parent visiting the ward for treatment or check-up. The conclusion is that this first version of the LSS-P was valid and reliable (internal consistency) to a certain extent, but that the instrument should be tested on larger samples and during different phases of the disease.

Symptom distress and life situation in adolescents with cancer

Having a life-threatening disease like cancer during adolescence poses a number of problems. The purpose of this study was to identify the adolescent's own experience of areas of the life situation affected by the disease and problems related to it. Ten adolescents with varying diagnoses and treatment were interviewed. They also completed a quantitative measurement of problems. The result shows eight domains and 24 subdomains influencing the experience of life situation. Those were disease and treatment (side effects, isolation, medical procedures), identification (others are ill, appearance), feelings and reactions (mood, self-image, meaning, hope), coping (positive thinking, distraction, positive effects), togetherness (family, friends, school), support (family and friends, the youth association, professional support), reactions of the families (parents, siblings), and quality of care (professionalism, information, organization, equipment). The problems mentioned in the interviews are also compared with the quantitative measurement used. The adolescents mentioned 77 problems in the interviews, of which 17 were not on the list of problems. Of those 17, seven dealt with physical problems, and six were problems concerning the quality of care. They ranked wanting and depending on parents as the worst problems for themselves from the list of problems.