No abstract

Although the incidence rate of diabetes in children under the age of 3 years is increasing dramatically, no previous studies provide information about the day-to-day experience of caring for these infants and toddlers. Because a young child with diabetes is dependent on the parent for his/her very existence, the purpose of this phenomenological study was to gain knowledge and understanding of the parents' experiences so that appropriate interventions could be developed and implemented to support parental care for this unique population. Findings revealed three distinct phases in the parents' experiences: the diagnosis and child's hospitalization; adjusting to care at home; and long-term adaptation. Within these phases, parents described inordinate amounts of stress exacerbated by the child's young age and the complex, intrusive nature of diabetes management. On the basis of these findings, implications for practice are discussed.

Theoretical advances in nursing have been complicated by polarization and extreme positions regarding nursing's approach to its main metaparadigm concepts: person, health, environment and nursing. In this paper, the authors deconstruct some of the central arguments that are used to further this polarization. Using a critical interpretive approach, they explain some of the logical implications imposed by various extreme positions for the larger project of nursing's health and social mandate, and consider the effects of such polarization. On the basis of an appreciation of the serious difficulties inherent in certain philosophical and theoretical positions currently evident within nursing's literature, the authors argue for a less extreme and more integrated reference point for nursing's theory and practice.

Nurses were able to work with families in the hospital care of their children in ways that parents perceived as positive. However, in parents' views, their interactions with nurses did not constitute collaborative relationships. A deeper understanding of these interactions may provoke new thinking about how to promote an agency's philosophy, and how nurses enact this philosophy in practice.

Concurrent with the recent enthusiasm for qualitative research in the health fields, an energetic call for methods by which to synthesize the knowledge has been generated on various substantive topics. Although there is an emerging literature on meta-analysis and metasynthesis, many authors overestimate the simplicity of such approaches and erroneously assume that useful knowledge can be synthesized from limited collections of study reports without a thorough analysis of their theoretical, methodological, and contextual foundations and features. In this article, the authors report some of the insights obtained from an extensive and exhaustive metastudy of qualitative studies of chronic illness experience. Their findings reveal the complexities inherent not only in any phenomenon of interest to health researchers but also in the study of how we have come to know what we think we know about it.

Parents of chronically ill or disabled children face a number of common tasks in adapting to their child's condition. These tasks are delineated from the literature on theory, research and clinical issues and are discussed in relation to their documented importance to family adaptation, the difficulties parents have in managing the tasks and effective coping strategies parents can use to accomplish the tasks. The implications of utilizing adaptive tasks as an organizing framework for assessing and intervening with parents of children with chronic conditions are discussed.

The trend toward community-based care, along with advances in medical technology, has resulted in increased numbers of individuals with complex healthcare needs being cared for at home by their families. This shift from hospital to community care places increased demands on family caregivers. Families are now providing long-term care for chronically ill people with a variety of conditions. Caregiver research has, for the most part, explored burden, stress, and depression as outcomes of caregiving. There is little research assessing the quality of life (QOL) of long-term caregivers. In the research on quality of life, the patient is most frequently the focus. With the increased demand on families as caregivers, quality of life needs to be included as a variable in studying family caregivers for chronically ill individuals. The purpose of this paper is to discuss issues in studying quality of life in family caregivers of persons with chronic conditions. Conceptualization of quality of life is explored, measurement of quality of life examined and the research on quality of life reviewed, with a focus on the quality of life of the family caregiver.

Qualitative researchers have long recognized that fatigue is a common concern among those with chronic illness; however, the insights derived from this body of inquiry have not been synthesized into a coherent body of clinical knowledge that could provide direction for nursing practice. Using a synthesis approach of meta-study, the authors identify four predominant assumptions embedded in qualitative studies that have influenced the way researchers have interpreted and made sense of their findings about fatigue in chronic illness over the past two decades. They argue that these assumptions may have inhibited the development of more dynamic, comprehensive understandings of fatigue. They conclude that addressing some of the methodological issues within this body of research might lead to a more accurate portrayal of the complexity, fluidity, and contextual nature of the fatigue experienced in chronic illness.