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The population of older adults with chronic disease is increasing, yet little is known about their perception of chronic disease and self-management. To develop successful and sustainable chronic disease self-management interventions in the older adult population, health care providers must first understand older adults’ attitudes toward health status and behavior change. This pilot study was conducted to determine the feasibility of the study design. The purpose of this pilot study was to assess the appropriateness of using a mixed-methods research design to investigate Appalachian older adult’s attitude toward the chronic disease experience and health behavior change. A convergent, parallel mixed-method design included a quantitative questionnaire and qualitative focus groups in churches in northeast Tennessee. The aim of the study was met, and the methodology of the study was found to be feasible for larger studies. Divergence of data was found when evaluating qualitative and quantitative data. The study instrument was found to be reliable for future use. The implications of the results suggest that the study design is appropriate for the purpose of the study.

Bakgrund: Antal patienter med kroniska sjukdomar ökar. Detta orsakar lidande och förändrad livsvärld hos patienter. Att drabbas av kronisk sjukdom kan innebära ökade antal tillfällen som kräver vård. Sjuksköterskans ansvar är att ge en personcentrerad vård och lindra lidande trots komplexa vårdsituationer. Syfte: Belysa sjuksköterskors upplevelser av att vårda patienter med kroniska sjukdomar. Metod: Studien är en kvalitativ litteraturöversikt. Resultat: Resultatet visar att förståelse för patienten kunde uppnås genom öppenhet och lyssnande. En vårdande relation gynnar den personcentrerade vården och genom att stärka patientens självbestämmande ökade engagemanget. Stöttning för både patienter och sjuksköterskor ansågs vara viktigt, genom reflektion kunde stöttning utvecklas. Bristande följsamhet hos patienten hanterades på olika sätt av sjuksköterskorna. Tiden var en viktig faktor som kunde påverka den vårdande relationen och informationen som framkom genom samtal. Slutsats: Sjuksköterskor upplever att patienter med kroniska sjukdomar är komplexa och kräver långa vårdtillfällen och regelbunden vårdkontakt. Genom att vara öppen och lyssna ökade förståelsen för patienten vilket gynnar vårdrelationen och således den personcentrerade vården. För att göra vården mer patientsäker upplevde sjuksköterskorna tiden, koordinering, interprofessionellt arbete, stöttning och hanteringen av bristande följsamhet som viktiga faktorer. / Background: The number of patients with chronic diseases is increasing and causing suffering and a changed life situation for patients. Suffering from a chronic illness can mean an increased number of occasions that require care. The nurse's responsibility is to provide person-centered care and alleviate suffering despite complex care situations. Aim: To research nurses' experiences of caring for patients with chronic diseases. Method: The study is a qualitative literature review. Results: Understanding could be achieved through openness and listening. A caring relationship benefits the person-centered care and by strengthening the patient's selfdetermination, the commitment increased. Support for both patients and nurses was considered important, through reflection support could be developed. Lack of patient compliance was handled in different ways. Time was an important factor that could affect the caring relationship and the information that could emerge through conversations. Conclusion: Nurses experience that chronically ill patients are complex, require long-care sessions and regular care contact. By being open and listening, the understanding increased, which benefits the care relationship and thus the person-centered care. To make care more patient-safe, the nurses experienced time, coordination, interprofessional work, support and management of lack of compliance as important factors.

Although health care transitions have received some attention in the literature, few researchers have emphasized family relational experiences and communication during major changes while living with a chronic illness. The purpose of this phenomenological study was to understand the lived experience of parents and their adult children while transitioning from pediatric to adult care of a chronic illness. The bio-psychosocial theory, family systems theory, and attachment theory established the context for this study. A criterion-based sampling technique and snowball sampling were used to recruit 7 parents and 6 of their adult children aged 18 to 30 years who were diagnosed with cystic fibrosis or congenital heart disease, and who had either completed or were in the process of completing the transition from pediatric to adult healthcare. Semi-structured interviews were conducted, and content analysis was used to code and analyze themes that emerged from the experiences of participants. The themes that were identified included that parents were instrumental in maintenance of treatments during high risk periods of adolescence, healthy parent and child relations included collaboration that accommodated autonomy, and that early coaching helped reduce parental anxiety about non-adherence while increasing the self-efficacy of the child. This study contributes to positive social change by informing the design of current procedures to transition young adults with chronic illness by recommending flexibility in negotiations, early education, shadowing between facilities, and incorporating evidence-based practice based on feedback from each family member.

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Objective: Transfer from pediatric care into the adult health care system is known to be a vulnerable phase in the lives of youth with special health care needs (YSHCN). Recommendations from the literature favor assessment of transition readiness rather than simply pass over YSHCN from pediatric to adult-centered care by the age of 18. Nevertheless, no validated and disease neutral assessment instrument in German exists to date. Hence, our aim was to cross-culturally adapt and to pilot-test a German version of the Transition Readiness Assessment Questionnaire (TRAQ 5.0). We wanted to provide a tool that can be applied broadly during the health care transition (HCT) process of YSHCN. Methods: The development included translating and adapting TRAQ 5.0 to German and conducting a pilot-study with 172 YSHCN between the ages of 14 and 23. Results: Cross-cultural adaptation resulted in the TRAQ-GV-15. Exploratory factor analysis led to a 3 factor-structure. Internal consistency for the overall score was good with a Cronbach’s alpha of 0.82. Age, in contrast to sex, had a significant effect on the TRAQ scoring. The administration of the TRAQ-GV-15 was well received and demonstrated good feasibility. Conclusion: The TRAQ-GV-15 is an easily applicable and clinically usable instrument for assessing transition readiness in German speaking YSHCN prior to HCT.

The current study aimed to better understand how parental functioning and parent-child relationships might moderate the effects of chronic illness on psychological problems in emerging adulthood. Three hypotheses were made: (1) the presence and severity of chronic illness would associate positively with emerging adult psychological problems, (2) parental distress would moderate the effects between chronic illness presence/severity and emerging adulthood psychological problems, and (3) parent-child relationship quality would moderate the effects between chronic illness presence/severity and emerging adult psychological problems. Data analysis consisted of testing interaction effects, pairwise parameter comparisons, and multiple group analysis. The three-way interaction between endorsing a health condition, physical quality of life, and maternal psychological distress significantly predicted psychological problems in both emerging adult men and women. Additionally, the three-way interaction between endorsing a health condition, physical quality of life, and maternal parent-child relationship quality significantly predicted psychological problems in both emerging adult men and women.

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Syfte: Att beskriva skolsköterskors sociala stöd till ungdomar med långvariga och kroniska sjukdomar.Bakgrund: Ungdomar med långvariga och kroniska sjukdomar hade behov av socialt stöd för att klara av sin skolgång på ett tillfredsställande sätt. Skolsköterskor ska arbeta förebyggande och främjande och genom hälsofrämjande omvårdnad stötta elever och vårdnadshavare vid sjukdom gentemot skolans miljö och krav. Eleverna värdesatte att skolsköterskorna lyssnade på dem aktivt och ställde motfrågor. Vidare ansåg eleverna att förtroende, uppmärksamhet, respekt, äkthet, tillgänglighet och kontinuitet var betydelsefullt i kontakten med skolsköterskorna.Design: Kvalitativ design med induktiv ansats.Metod: Individuella intervjuer utfördes med en semistrukturerad intervjuguide. Totalt nio skolsköterskor intervjuades och intervjuerna analyserades med kvalitativ innehållsanalys.Resultat: Analysen resulterade i sex kategorier och 16 underkategorier. Studien visade att skolsköterskors sociala stöd till elever med långvariga och kroniska sjukdomar utgjordes av att finnas tillhands, vara lyhörd och stötta föräldrar i kontakten med vården. Skolsköterskorna upplevde det positivt att involvera föräldrarna i elevernas skolsituation. I interaktionen med elever och föräldrar var samtal ett betydelsefullt verktyg för skolsköterskorna. Tidsbrist bidrog till att det sociala stödet påverkades negativt och tillgängligheten för eleverna försämrades.Slutsats: Skolsköterskornas arbete var mångfacetterat, ställde krav på kompetens, flexibilitet och samarbetsförmåga. De hade en betydelsefull roll när det gällde att ge socialt stöd till ungdomar med långvariga och kroniska sjukdomar.Nyckelord: socialt stöd, skolsköterskor, elever, ungdomar, långvarig sjukdom, kronisk sjukdom, omvårdnad / Aim: To describe school nurses social support to adolescents with long-term and chronic illness. Background: Adolescents with long-term and chronic illness needed social support in order to cope with their schooling in a satisfactory manner. School health nurses work with health prevention and health promotion and should support students and their parents during illness towards the school environment and demands. Students appreciated that the school health nurses listened to them actively and asked counter-questions. Furthermore, the students felt that trust, attention, respect, genuineness, availability and continuity of contact with the school nurses were significant. Design: Qualitative design with inductive approach. Method: Individual interviews were conducted using a semi-structured interview guide. Nine nurses were interviewed and the interviews were analyzed using qualitative content analysis. Findings: The analysis resulted in six categories and 16 subcategories. The study showed that school health nurses’ social support to students with long-term and chronic illness were to be available, be responsive and to support parents in their contact with healthcare. The school health nurses experienced it positively to involve parents in students' school situation. In the interaction with students and parents the dialogue was a meaningful tool for the school health nurses. Social support was negatively affected by lack of time, and the availability for the students was deteriorated. Conclusion: School health nurses work was multifaceted, required expertise, flexibility and teamwork skills. They had a meaningful role in providing social support to adolescents with long-term and chronic illness.Keywords: social support, school health nurses, students, adolescents, long-term illness, chronic illness, nursing